Uso de bastones contralaterales en artrosis de rodilla / Contralateral canes for knee osteoarthritis

INTRODUCCIÓN La artrosis de rodilla es un problema de salud relevante dada su alta prevalencia y discapacidad asociada. Dentro de las alternativas de manejo no farmacológico se ha planteado el uso de bastones, sin embargo no existe consenso en la literatura respecto a su indicación. MÉTODOS Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metanálisis, preparamos tablas de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES Identificamos tres revisiones sistemáticas que en conjunto incluyeron cuatro estudios primarios, de los cuales, uno es ensayo aleatorizado. Concluimos que el uso de bastón contralateral en pacientes con artrosis de rodilla probablemente disminuye el dolor. Además, podría aumentar levemente la funcionalidad, pero la certeza de la evidencia es baja.

INTRODUCTION Knee osteoarthritis is a relevant health problem given its high prevalence and associated disability. Within the non-pharmacological management alternatives, the use of canes has been proposed, however, there is no consensus in the literature regarding its indication. METHODS We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified three systematic reviews including four studies overall, of which one was randomized trials. We conclude that the use of a contralateral cane in patients with knee osteoarthritis probably reduces pain. In addition, it could slightly increase function, but the certainty of the evidence is low.

Sensory-motor training versus resistance training among patients with knee osteoarthritis: randomized single-blind controlled trial

ABSTRACT BACKGROUND: Osteoarthritis of the knee is defined as a progressive disease of the synovial joints and is characterized by failure of joint damage repair. The objective here was to compare the effectiveness of sensory-motor training versus resistance training among patients with knee osteoarthritis. DESIGN AND SETTING: Randomized, single-blinded controlled trial conducted at the outpatient service of the University of Santo Amaro. METHODS: A total of 64 patients were randomly assigned to sensory-motor training or resistance training. The evaluations were performed at baseline and 16 weeks after the intervention and included pain evaluation on a visual analogue scale, isometric quadriceps femoris force measurement using a dynamometer, Timed Up and Go test, Tinetti balance scale, Western Ontario and McMaster Universities osteoarthritis index, and the SF-36 quality-of-life questionnaire. Data analysis was performed using analysis of variance with repeated measurements and Cohen's effect size. RESULTS: Sensory-motor training may be a plausible alternative and showed a small effect on pain and a medium effect on maximal voluntary isometric contraction. Resistance training showed a small effect on balance and a medium effect on mobility. CONCLUSION: Resistance training and sensory motor training for the lower limbs among patients with knee osteoarthritis seemed to present similar effects on pain and function. However, because there was a considerable risk of type 2 error, further randomized clinical trials are still needed to provide a sound conclusion.

Reemplazo parcial de rodilla mediante el sistema robótico NAVIO: resultados clínicos postquirúrgicos evaluados mediante Knee injury Osteoartritis Outcome Score / Robotic-assisted unicompartmental knee replacement with NAVIO surgical system: outcome evaluation using the Knee Injury Osteoarthritis Outcome Score

INTRODUCCIÓN: La osteoartritis de rodilla es una de las patologías musculo esqueléticas más prevalentes en el mundo, y el tratamiento quirúrgico es hasta hoy, la única terapia definitiva. El sistema NAVIO™ es uno de los dispositivos robóticos más recientemente a disposición para realizar el reemplazo parcial de rodilla. Ofrece gran precisión en el proceso de alineamiento, remodelado óseo y balance de los tejidos blandos, sin exponer al paciente a la radiación ni a los costos de la tomografía computarizada que suele realizarse con los sistemas robóticos actuales antes del procedimiento artroplástico. OBJETIVO: Evaluar los resultados medidos por los pacientes antes y después del procedimiento artroplástico mediante NAVIO™ y la prótesis STRIDE™. MATERIAL Y MÉTODO: Aplicación del cuestionario Knee injury Osteoarthritis Outcome Score (KOOS) en el preoperatorio y a los 12 meses del procedimiento quirúrgico de los primeros 47 pacientes operados usando NAVIO™ en Cornerstone Regional Hospital, Edinburg, Texas. RESULTADOS: Se observó una mejoría de las muestras normalizadas en todas las categorías con un p < 0.05. COMENTARIO: Estudios recientes han sugerido que en Chile la presentación de la osteoartritis se asocia a un grado de severidad menor que en el resto de los países latinoamericanos. Lo cual torna relevante la aplicación de terapias quirúrgicas más conservadoras, que ofrezcan al paciente un alivio sintomático y le permitan reestablecerse a sus actividades cotidianas causando el mínimo impacto posible. Esas ventajas fueron observadas en los pacientes sometidos a ese procedimiento quirúrgico. CONCLUSIONES: La artroplastia unicompartimental de rodilla mediante el sistema quirúrgico NAVIO™ y prótesis STRIDE™ demostró mejorar substancialmente la vida diaria y calidad de vida de los pacientes, disminuyendo el dolor y mejorando su función durante las actividades deportivas y recreacionales.

INTRODUCTION: Knee osteoarthritis is one of the most prevalent musculoskeletal pathologies in the world and the surgical treatment is until today the only definitive therapy. NAVIO™ system is one of the most recently available robotic devices for partial knee arthroplasty. It offers great precision in the process of alignment, bone remodeling and soft tissue balancing without exposing the patient to the radiation or the costs of the CT scan usually performed before the arthroplasty with the current robotic systems. OBJECTIVE: To evaluate the outcomes measured by the patients before and after the arthroplasty using NAVIO™ and the STRIDE™ prosthesis. MATERIALS AND METHODS: Application of the Knee Injury Osteoarthritis Outcome Score (KOOS) questionnaire in the preoperative and 12 months after the surgical procedure of the first 47 patients operated using NAVIO™ at Cornerstone Regional Hospital, Edinburg, Texas. RESULTS: There was an improvement of the normalized samples in all the categories with p < 0.05. COMMENTARY: Recent studies have suggested that in Chile the presentation of osteoarthritis is associated with a lower degree of severity compared with the rest of Latin American countries. This makes relevant the application of more conservative surgical therapies, which could offer the patient symptomatic relief and allow them to reestablish their daily activities causing the minimum impact possible. These advantages were observed in patients undergoing this surgical procedure. CONCLUSIONS: Unicompartmental knee replacement using NAVIO ™ surgical system and STRIDE™ prosthesis demonstrated a substantial improvement in patient's quality of life, reducing pain and improving their function during sports and recreational activities.

Aerobic training modulates T cell activation in elderly women with knee osteoarthritis

Osteoarthritis of the knee (kOA) is a disease that mainly affects the elderly and can lead to major physical and functional limitations. However, the specific effects of walking, particularly on the immune system, are unknown. Therefore, this study aimed to analyze the effect of 12 weeks of walking (3×/week) on the leukocyte profile and quality of life (QL) of elderly women with kOA. Sixteen women (age: 67±4 years, body mass index: 28.07±4.16 kg/m2) participated in a walking program. The variables were assessed before and after 12 weeks of training with a progressively longer duration (30–55 min) and higher intensity (72–82% of HRmax determined using a graded incremental treadmill test). The QL was assessed using the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), and blood samples were collected for analysis with a cell counter and the San Fac flow cytometer. Walking training resulted in a 47% enhancement of the self-reported QL (P<0.05) and a 21% increase in the VO2max (P<0.0001) in elderly women with kOA. Furthermore, there was a reduction in CD4+ cells (pre=46.59±7%, post=44.58±9%, P=0.0189) and a higher fluorescence intensity for CD18+CD4+ (pre=45.30±10, post=64.27±33, P=0.0256) and CD18+CD8+ (pre=64.2±27, post=85.02±35, P=0.0130). In conclusion, the walking program stimulated leukocyte production, which may be related to the immunomodulatory effect of exercise. Walking also led to improvements in the QL and physical performance in elderly women with kOA.

Effects of resistance training in older women with knee osteoarthritis and total knee arthroplasty

OBJECTIVES: This study sought to analyze the effects of resistance training on functional performance, lower-limb loading distribution and balance in older women with total knee arthroplasty (TKA) and osteoarthritis (OA) in the contralateral knee. In addition, this older knee OA and TKA group (OKG) was compared to older (OG) and young women (YG) without musculoskeletal diseases who underwent the same resistance training program. METHODS: Twenty-three women divided into OKG (N = 7), OG (N = 8) and YG (N = 8) had their functional performance, lower-limb loading distribution and balance compared before and after 13 weeks of a twice-weekly progressive resistance training program. RESULTS: At baseline, the OKG showed lower functional performance and unilateral balance, and impaired lower-limb loading distribution compared to the OG and the YG (p<0.05). After resistance training, the OKG showed improvements in functional performance (∼13% in sit-to-stand and rising from the floor, ∼16% in stair-climbing and ∼23% in 6-minute walking (6 MW)), unilateral balance (∼72% and ∼78% in TKA and OA leg, respectively) and lower-limb loading distribution, which were greater than those observed in the OG and the YG. The OKG showed post-training 6 MW performance similar to that of the OG at baseline. Sit-to-stand performance and unilateral stand balance were further restored to post-training levels of the OG and to baseline levels of the YG. CONCLUSIONS: Resistance training partially restored functional, balance and lower-limb loading deficits in older women with TKA and OA in the contralateral knee. These results suggest that resistance training may be an important tool to counteract mobility impairments commonly found in this population. .

Manual for guided home exercises for osteoarthritis of the knee

INTRODUCTION: Physiotherapy is one of the most important components of therapy for osteoarthritis of the knee. The objective of this prospective case series was to assess the efficiency of a guidance manual for patients with osteoarthritis of the knee in relation to pain, range of movement , muscle strength and function, active goniometry, manual strength test and function. METHODS: Thirty-eight adults with osteoarthritis of the knee (> 45 years old) who were referred to the physiotherapy service at the university hospital (Santa Casa de Misericórdia de São Paulo) were studied. Patients received guidance for the practice of specific physical exercises and a manual with instructions on how to perform the exercises at home. They were evaluated for pain, range of movement, muscle strength and function. These evaluations were performed before they received the manual and three months later. Patients were seen monthly regarding improvements in their exercising abilities. RESULTS: The program was effective for improving muscle strength, controlling pain, maintaining range of movement of the knee joint, and reducing functional incapacity. DISCUSSION: A review of the literature showed that there are numerous clinical benefits to the regular practice of physical therapy exercises by patients with osteoarthritis of the knee(s) in a program with appropriate guidance. This study shows that this guidance can be attained at home with the use of a proper manual. CONCLUSIONS: Even when performed at home without constant supervision, the use of the printed manual for orientation makes the exercises for osteoarthritis of the knee beneficial.

Impacto de un protocolo de fisioterapia sobre a qualidade de vida de idosos com osteoartrite de joelhos / Impact of physical therapy protocol over the quality of lifr elderly with knee osteoarthritis

O impacto de um protocolo de fisioterapia sobre a qualidade vida de idosos com osteoartrite (OA) de joelhos na população brasileira não está documentado. Comparamos as mudanças na gravidade da OA e nas medidas de qualidade de vida entre um grupo controle (n=23), que participou de uma sessão educacional, e um grupo experimental (n=24), que participou desta sessão e recebeu um protocolo de exercícios terapêuticas e caminhadas, durante 6 semanas. Contrastamos os resultados do SF-36 da amostra com os da população saudável e de outras patologias. Quarenta e sete sujeitos, com idades entre 65 e 89 anos, completaram o estudo. A gravidade da OA foi medida pelo índice de Lequesne e a qualidade de vida pelo Health Assessment Questíonnaire (HAQ) e pelo Medícal Outcomes Short-form Health Survey (SF-36). A gravidade do exame radiológico dos joelhos foi critério para o pareamento dos sujeitos nos grupos, que foram avaliados, por um observador independente, no início do estudo, após 3 e 6 meses. Nas comparações ao longo do tempo, entre sujeitos do grupo controle, não houve diferenças estatisticamente significantes, exceto no SF-36 para dor e saúde mental. Entre os sujeitos do grupo experimental, houve melhora, exceto no SF-36 para estado geral de saúde, vitalidade, aspectos sociais, aspecto emocional e saúde mental. Nas comparações entre os grupos, houve diferenças estatisticamente significantes após 3 e 6 meses em todos os instrumentos, exceto para os componentes vitalidade (3 meses), aspectos sociais, aspecto emocional e saúde mental. Os resultados deste estudo demonstraram que o protocolo aplicado parece ter um impacto positivo na qualidade de vida de pessoas com OA de joelhos