Mesenchymal stem cells for chronic knee pain secondary to osteoarthritis: A systematic review and meta-analysis of randomized trials.

OBJECTIVE: To assess the effectiveness of mesenchymal stem cells (MSCs) for chronic knee pain secondary to osteoarthritis (OA). METHODS: We searched MEDLINE, EMBASE, CINAHL, and Cochrane Central to September 2023 for trials that (1) enrolled patients with chronic pain associated with knee OA, and (2) randomized them to MSC therapy vs. placebo or usual care. We performed random-effects meta-analysis and used Grading of Recommendations, Assessment, Development, and Evaluation to assess the certainty of evidence. RESULTS: We included 16 trials (807 participants). At 3-6 months, MSC therapy probably results in little to no difference in pain relief (weighted mean difference [WMD] -0.74 cm on a 10 cm visual analog scale [VAS], 95% confidence interval [95%CI] -1.16 to -0.33; minimally important difference [MID] 1.5 cm) or physical functioning (WMD 2.23 points on 100-point 36-item Short Form Survey (SF-36) physical functioning subscale, 95%CI -0.97 to 5.43; MID 10-points; both moderate certainty). At 12 months, injection of MSCs probably results in little to no difference in pain (WMD -0.73 cm on a 10 cm VAS, 95%CI -1.69 to 0.24; moderate certainty) and may improve physical functioning (WMD 19.36 points on 100-point SF-36 PF subscale, 95%CI -0.19 to 38.9; low certainty). MSC therapy may increase risk of any adverse events (risk ratio [RR] 2.67, 95%CI 1.19 to 5.99; low certainty) and pain and swelling of the knee joint (RR 1.58, 95%CI 1.04 to 2.38; low certainty). CONCLUSIONS: Intra-articular injection of MSCs for chronic knee pain associated with OA probably provides little to no improvement in pain or physical function.

Can ultrasound-guided medial branch blocks be used to select patients for cervical facet joint radiofrequency neurotomy? - A matched retrospective cohort validation study.

BACKGROUND: Medial branch blocks are used to select patients for cervical facet joint radiofrequency neurotomy (CRFN). Blocks are typically performed under fluoroscopic guidance (FLB). The validity of ultrasound guided blocks (USB) is not well established. No prior research has compared cervical USB versus FLB validity using CRFN outcome as the criterion standard. OBJECTIVE: To evaluate cervical USB versus FLB validity using CRFN outcome as the criterion standard. METHODS: Demographic and outcome data were extracted from the EMRs of two affiliated MSK pain management clinics for all patients between 2015 and 2023 inclusive who had cervical USB leading to CRFN. CRFN outcomes of each USB patient were compared to a matched FLB patient from the RFN outcome database of the same clinics. Matching variables included patient age, sex, pain duration, diagnostics/prognostic block paradigm and CRFN number. Each patient completed a NRS pain score and Pain Disability Quality-of-Life Questionnaire (PDQQ) just before and 3-months post-CRFN. At repeat CRFN, patients provided a retrospective estimate of the duration and average magnitude (%) of relief following the CRFN. RESULTS: USB and FLB groups were comprised of 27 patients (58 RFNs) and 38 patients (58 RFNs) respectively. Post RFN NRS pain severity and PDQQ-S scores demonstrated comparable (p > 0.05) absolute improvements, proportion of patients achieving ≥50% improvement, and attainment of MCID. Retrospective estimates of pain relief magnitude and duration were also comparable. CONCLUSIONS: This study finds cervical USB and FLB to be comparably valid as defined by their ability to predict CRFN outcome. Within the limitations of operator competence, USB can be used to select patients for CRFN.

The Effect of Knee Height Asymmetry on Gait Biomechanics.

BACKGROUND: Though the primary goal for limb length discrepancy (LLD) management is to equalize the leg lengths, symmetry between corresponding long bones is usually not achieved, leading to knee height asymmetry (KHA). To date, there is minimal information on what effect KHA has on gait biomechanics and joint loading. Thus, the purpose of this study is to determine the impact of KHA on gait biomechanics. METHODS: Seventeen subjects with KHA after limb equalizing surgery and 10 healthy controls were enrolled. Subjects participated in 3D gait analysis collected using self-selected speed. Lower extremity kinematics, kinetics, work generated/absorbed, and total work were calculated. Standing lower limb x-rays and scanograms were used to measure LLD and calculate the tibia-to-femur (TF) ratio for each limb. Two sample t tests were used to compare differences in standing LLD, TF ratio, and work between groups. Bivariate correlation using Pearson correlation coefficients was conducted between TF ratio and total mechanical work, as well as between knee height asymmetry indices and total work asymmetry (α=0.05). RESULTS: Among participants, there were no differences between LLD; however, there were differences between TF ratio and knee height asymmetry. We found a nonsignificant relationship between TF ratio and total mechanical work for individual lower extremities. Therefore, the length of individual bones (TF ratio) relative to each other within the individual lower extremity was not associated with the amount of work produced. However, when a difference exists between sides (asymmetry, ie, TF ratio asymmetry), there were associated differences in work (work asymmetry) produced between sides (r=0.54, P =0.003). In other words, greater knee height asymmetry between limbs resulted in more asymmetrical mechanical work during walking. CONCLUSIONS: These findings may have implications for the management of LLD. Asymmetrical total mechanical work could lead to atypical joint loading during gait. Surgeons may want to consider prioritizing achieving knee height symmetry as a postoperative goal when correcting limb length discrepancy. LEVEL OF EVIDENCE: Level III, Case Control Study.

Radiofrequency Ablation of the Infrapatellar Branch of the Saphenous Nerve for the Treatment of Chronic Anterior Inferomedial Knee Pain.

INTRO: Genicular nerve radiofrequency ablation (GNRFA) is an effective treatment for chronic knee pain related to osteoarthritis. It is often utilized when conservative management has failed and patients wish to avoid arthroplasty, are poor surgical candidates due to comorbid medical conditions, or in those suffering from persistent pain after arthroplasty. The classic targets for GNRFA include the superior lateral genicular nerve, superior medial genicular nerve, and inferior medial genicular nerve but multiple anatomic studies have demonstrated additional sensory innervation to the knee. OBJECTIVE: In this research article, we propose an image-guided technique that can safely target the infrapatellar branch of the saphenous nerve which also provides sensory innervation to the anterior capsule. PROPOSAL: The proposed technique includes variations for conventional bipolar radiofrequency ablation, cooled radiofrequency ablation, dual-tined bipolar radiofrequency ablation, and monopolar radiofrequency ablation using a long axis approach. The described technique is based on updated anatomic studies and takes into account safety concerns such as thermal risk to the skin and/or pes anserine tendons and breaching of the synovial cavity. CONCLUSION: Future clinical research should be performed to confirm the safety and effectiveness of this specific approach.

Medication management of chronic pain: A comparison of 2 care delivery models.

BACKGROUND: The prevalence of chronic pain is high and increasing. Medication management is an important component of chronic pain management. There is a shortage of physicians who are available and comfortable providing this service. In Alberta, pharmacists have been granted an advanced scope of practice. Given this empowerment, their availability, training and skill set, pharmacists are well positioned to play an expanded role in the medication management of chronic pain sufferers. OBJECTIVE: To compare the effectiveness and cost of a physician-only vs a pharmacist-physician team model of medication management for chronic nonmalignant pain sufferers. METHOD: Data was analyzed for 89 patients who had received exclusively medication management at a rural Alberta multidisciplinary clinic. 56 were managed by a sole physician. 33 were managed by a team (pharmacist + physician). In the team model, the physician did the medical assessment, diagnosis, and established a treatment plan in consultation with the patient and pharmacist. The pharmacist then provided the ongoing follow-up including education, dose titration and side effect management and consulted with the physician as needed. Change in pain (Numerical Rating Scale) and disability (Pain Interference Questionnaire) over the course of treatment were recorded. The treatment duration and number of visits were used to calculate cost of care. RESULTS: Both models of medication management resulted in significant and comparable improvements in pain, disability and patient perception of medication effectiveness. Patients in the physician-only group were seen more frequently and at a greater cost. The pharmacist-physician team approach was markedly more cost-effective, and patients expressed a high level of satisfaction with their medication management. CONCLUSIONS: The pharmacist-physician team model of medication management results in significant reductions of pain and disability for chronic nonmalignant pain sufferers at a reduced cost and is well accepted by patients.

An evaluation of the effectiveness of platelet rich plasma epidural injections for low back pain suspected to be of disc origin - A pilot study with one-year follow-up.

Summary of background data: Low back pain of disc origin is common yet challenging to treat. Intradiscal platelet rich plasma (PRP) has been advocated, but is associated with risk of discitis. Epidural PRP is less invasive and avoids this risk. Few studies exist evaluating effectiveness and safety of epidural PRP for discogenic low back pain without radiculopathy and the follow-up of the studies tends to be short. Objective: Prospectively evaluate for 12 months the effectiveness of PRP epidural injections for patients with low back pain without radiculopathy, suspected to be of disc origin. Methods: 11 consecutive patients with refractory low back pain suspected to be of disc origin (compatible clinical assessment; negative lumbosacral medial branch blocks (MBBs) and/or magnetic resonance imaging (MRI) with high intensity zone (HIZ), Modic 1 or 2 changes) participated. Each underwent one (n = 5) or two (n = 6) epidural injections (caudal or interlaminar). The PRP was leukocyte/red cell depleted with an average platelet concentration of ∼2X whole blood. Numerical rating scale (NRS), Pain Disability Quality-Of-Life Questionnaire (PDQQ) score, Oswestry Disability Index (ODI) score, effect on analgesic intake, treatment satisfaction and endorsement were recorded prior to and at 3, 6 and 12-months post-treatment. Results: Significant improvements in pain and disability were documented post-treatment. Pre-, 3, 6, and 12-month post mean(sd) NRS scores were 7.8(1.8), 5.8(2.7), 5.1(2.5), 4.9(2.8) respectively (F = 7.2; p = 0.002). At 12 months post PRP epidural, the mean improvement in NRS was 36%, 36% had experienced ≥50% pain relief (95% confidence interval (CI): 2%, 70%), and 73% achieved minimal clinically important differences (MCID) (95% CI: 41%, 100%). Similar magnitude improvements in disability (PDQQ and ODI) were documented. At 1-year post, 50% of analgesic users had reduced intake, 91% were satisfied with the treatment and would recommend the procedure to family and friends. No complications were reported. Discussions/conclusion: This pilot project suggests that PRP epidural injections provide modest yet significant improvements in pain and disability that lasts at least 12 months in patients with low back pain suspected to be of disc origin. Additional research including larger sample size and robust study design is encouraged.

Derivation of a clinical decision rule for a bone marrow aspirate concentrate injection in knee osteoarthritis.

Aim: To develop a simple clinical decision rule (CDR) to identify people with knee osteoarthritis who are likely or unlikely to benefit from bone marrow aspirate concentrate (BMAC) injection. Materials & methods: A total of 92 people with clinical and radiographic evidence of refractory knee osteoarthritis received a single intra-articular (IA) BMAC injection. Multiple logistic regression analysis was used to determine which combination of risk factors predicted BMAC responsiveness. A responder was defined as a person whose knee pain improved more than 15% from baseline 6 months post procedure. Results: The CDR demonstrated that those with lower pain levels, or high pain levels with previous surgery, could be predicted to benefit from a single IA BMAC injection. Conclusion: A simple CDR containing three variables predicted responsiveness to a single IA knee BMAC injection with high accuracy. Further validation of the CDR is required prior to routine use in clinical practice.

People with knee osteoarthritis who do not improve with exercise and medicine lack effective long-term treatment options apart from total knee replacement. Although total knee replacement provides effective outcomes in most people, not all people are candidates and not all people respond. Thus, other safe and effective treatment options are required. Bone marrow aspirate concentrate (BMAC) is a regenerative medicine treatment that has demonstrated success in people with chronic knee osteoarthritis. However, it is unclear which people do or do not respond to BMAC. This study investigated factors that predicted a successful response to a single injection of BMAC 6 months post injection. Those with lower initial pain levels (<7/10), or high pain levels with previous surgery, could be predicted to benefit from a single BMAC injection.

The effectiveness and predictive factors of Sacroiliac Joint Radiofrequency Neurotomy success - A retrospective cohort study.

Background: The Sacroiliac Joint (SIJ) accounts for 10-27% of lower back pain. Radiofrequency neurotomy (RFN) is commonly utilized for refractory pain. Outcomes are variable and may be related to patient selection and procedural technique differences. Objective: To assess the effectiveness and outcome success predictors of SIJ RFN at three months. Design/Methods: Data of patients undergoing SIJ RFN were extracted from the electronic medical record of one physiatrist's interventional pain practice between 2016 and 2021. The extracted data included the following outcome variables: ≥2 decrease in Numerical Rating Scale (NRS) [minimal clinically important difference MCID-2], ≥50% NRS reduction, and ≥17 points decrease in the Pain Disability and Quality of Life Questionnaire - Spine (PDQQ-S) [MCID]. Predictor variables included block type [>79% LBB/LBB, >79% IA/LBB, 50-79% LBB/LBB, 50-79% IA/LBB, >79% LBB, and 50-79% LBB] and cannula type/configuration [16 g/longitudinal, Trident bipolar/perpendicular, and 18 g quadripolar/perpendicular]. Data analysis included descriptive statistics and logistic regression with an odds ratio (OR). Covariates included in the logistic regression models were age, gender, and laterality (right, left, and bilateral). Results: Of the 128 patients analyzed for this study (20.8% males; 60.4 ± 14.4 years of age), 66.9% achieved MCID-2 in NRS, 53.9% experienced ≥50% NRS reduction, and 50% experienced ≥17 points decrease in PDQQ-S. Achieving MCID-2 in NRS for the 18 g quadripolar/perpendicular technique was approximately four times higher than the odds for 16 g/longitudinal technique (OR = 3.91; 95% CI = 1.34-11.43; p = 0.013). Block type was not significantly associated with any outcome variable after adjusting for cannula type and other covariates (p > 0.05). Younger age was significantly associated with achieving MCID-2 in NRS, ≥50% NRS reduction, and ≥17 points decrease in PDQQ (p = 0.034, 0.020, and 0.002, respectively). Conclusion: SIJ RFN effectively reduces pain and improves function in most patients at three months. Quadripolar/perpendicular technique and younger age predict SIJ RFN treatment success, whereas block type does not.

Cervical facet joint platelet-rich plasma in people with chronic whiplash-associated disorders: A prospective case series of longer term 6- and 12- month outcomes.

Objective: To explore the 6- and 12-month effectiveness of a single autologous injection of platelet-rich plasma (PRP) in cervical facet joints of people with chronic WAD and facet-mediated pain. Design: A prospective case series of people with chronic whiplash-associated disorders and cervical facet joint mediated pain in a community setting. Interventions: We investigated 44 consecutive people who underwent cervical facet joint PRP ( â€‹± â€‹adjunct physiotherapy) between 2019 and 2021, selected for PRP based on 80% relief following single diagnostic medial branch blocks or 50% relief and a significant improvement in performing a previously limited activity of daily living. Measures: Measures of pain (numerical pain rating scale - NPRS) and disability (Neck Disability Index - NDI) were collected prior to and 3-, 6- and 12- months following cervical facet joint PRP in an electronic registry database. Success was defined as those exceeding the minimal clinically important difference (MCID) for pain (>15%) and disability (>10%). We also calculated the proportion of people with greater than 50% relief of pain. People not reached for follow-up were considered failures for worst-case analysis. Results: Forty-four people (82% female, mean age â€‹= â€‹45.2 (range: 25-71) years) underwent cervical facet joint PRP. Nine people received repeat PRP interventions. Thirty-five people provided 12-month data. There was a significant improvement in pain and disability following PRP (and possibly adjunct physiotherapy) received during this time period. At 12-months, 53% of people exceeded MCID for pain, reporting a mean improvement of 66% (95%CI: 55-77%) on the NPRS. For NDI scores, 69% of people exceeded MCID, reporting a mean improvement of 48% (95%CI: 38-58%). Thirty-seven percent of people reported greater than 50% relief of pain 12-months post-cervical facet joint PRP. Conclusion: In people with chronic WAD and facet-mediated pain, our long-term data suggests that PRP (and possibly adjunct physiotherapy) is effective. A controlled study is warranted to evaluate the efficacy of PRP.

Assessing Leg Length and Offset in Anterior Total Hip Arthroplasty: Overlay Versus AP Pelvis Intraoperative Radiographic Techniques: A Retrospective Cohort Study.

INTRODUCTION: Two intraoperative radiographic techniques to determine leg length and offset during anterior total hip arthroplasty (THA) are the AP pelvis and overlay techniques. The AP pelvis method measures LLDs and offset using AP fluoroscopic images, whereas the overlay method uses printed images of the native and replaced hips. The purpose of this study was to compare these techniques regarding clinical and radiographic LLD and offset discrepancies. METHODS: Patients of a single surgeon at two hospitals from September 2017 to January 2021 were retrospectively reviewed. Clinically detectable LLD was recorded. Radiographic measurements were obtained from preoperative and postoperative radiographs. LLD was determined based on the vertical distance between the lesser trochanters and the ischial tuberosities. Total offset was measured using a combination of femoral and medial offset. The Student t-test, Fisher exact test, and Wilcoxon rank sum tests were used for statistical analysis. RESULTS: Seventy-one procedures were done using the overlay technique and 61 used for the AP pelvis technique. No significant differences were observed in mean postoperative LLD (2.66 versus 2.88 mm, P = 0.66) and mean postoperative offset discrepancy (5.37 versus 4.21 mm, P = 0.143) between the overlay versus AP pelvis groups. The mean preoperative to postoperative absolute difference in offset was less than 5 mm in both groups. Clinically detectable LLD was noted in six of 71 patients in the overlay group and one of 61 in the AP pelvis group (P = 0.123). CONCLUSION: No notable differences were observed in intraoperative leg length and offset discrepancies during direct anterior THA between the AP pelvis and overlay techniques, suggesting they are equally effective in determining LLD and offset intraoperatively. The choice of technique to use anterior THA should be based primarily on the surgeon's preference, comfort, and available resources.

Outcomes of Total Knee and Hip Arthroplasty in Patients With Perioperative Thrombocytopenia.

BACKGROUND: Thrombocytopenia is an abnormally low level of blood platelets (less than 150,000/mL) resulting in an increased risk for bleeding. Typically, patients with platelet levels below 50,000/mL should delay arthroplasty or be transfused with platelets before surgery. However, existing studies are mixed regarding the effects of more moderate thrombocytopenia in terms of total knee and hip arthroplasty outcomes. METHODS: This level III retrospective chart review examined the effects of different severities of preoperative thrombocytopenia on length of hospitalization, readmission, and transfusion rates in 5,617 primary total knee and hip arthroplasties at one tertiary academic medical center. Preoperative platelet levels were sectioned into clinically relevant groups and compared with clinical outcomes using univariable and multivariable models. RESULTS: On univariate analysis, having platelet levels of <100,000/mL and 100 to 149,000/mL was associated with a longer length of stay. However, after controlling individual demographics, there was no association between platelet levels and length of stay, nor with 30-day readmission. Finally, on univariate analysis, patients with platelet levels of <100,000/mL and 100 to 149,000/mL were more likely to have a blood transfusion, which remained true for those with <100,000/mL after controlling for individual demographics. CONCLUSIONS: Total hip and total knee arthroplasty are safe in patients with varying platelet levels and not associated with increased length of stay or 30-day readmission. However, patients with more severe thrombocytopenia are more likely to receive red blood cell transfusions than patients with milder thrombocytopenia.

Prospective Within Subject Comparison of Fluoroscopically Guided Lumbosacral Facet Joint Radiofrequency Ablation Using a Multi-Tined (Trident) Versus Conventional Monopolar Cannula.

BACKGROUND: Radiofrequency ablation (RFA) for the lumbar facet joints has demonstrated efficacy in the management of chronic low back pain. The traditional technique uses a conventional monopolar (CM) cannula placed parallel to the putative nerve to produce a thermal lesion resulting in pain relief of the facet joints. A new multi-tined (MT) cannula has come onto the market that allows targeting the putative nerve using a perpendicular to the nerve approach. OBJECTIVES: This study describes the technique using the MT cannula and compares its efficacy and procedural characteristics to the CM cannula. STUDY DESIGN: This is a pre-post crossover observational study. METHODS: Fifty-one patients were recruited between June 2015 and March 2020. Each patient underwent 2 fluoroscopic guided lumbosacral RFA procedures on 2 separate occasions at the same facet joints, using the CM and MT cannula consecutively. The primary outcome measure was change in pain on the 11-point numeric rating scale (NRS). Secondary outcome measures included change in Pain Disability Quality of Life Questionnaire (PDQQ) score, duration and magnitude of pain relief, local anesthetic use, adverse events, procedural and fluoroscopy exposure time, and radiation dose. RESULTS: There were no statistically significant difference between CM versus MT canula in terms of absolute (4.0 versus 4.3) and relative (52% versus 57%) change in NRS (P = 0.99) and PDQQ (22 versus 22, P = 0.61) at 3 months, or overall pain magnitude (71% versus 72%, P = 0.96) and duration of relief (8.7 months versus 8.4 months, P = 0.68). The procedures using the MT cannula were completed faster (37.6 minutes versus 31.1 minutes, P < 0.001) and required less local anesthetic (15.8 mL versus 11.0 mL, P < 0.001) and radiation dose (41.5 mGy versus 30.2 mGy, P = 0.05). No adverse events were observed with either cannula. LIMITATIONS: This was an observational study at a single center with the proceduralist not blinded to the intervention. CONCLUSION: This study demonstrated that the outcomes in terms of pain, disability, quality of life, adverse events, and fluoroscopy exposure time were equivalent between the 2 cannulae. However, RFA using the MT cannula was faster to perform and involved less local anesthetic and radiation.

The Association Between Sleep Disturbance and Health Outcomes in Chronic Whiplash-associated Disorders: A Series of Mediation Analyses.

OBJECTIVES: To investigate the association between sleep disturbance and clinical features of chronic whiplash-associated disorders (WAD). We also aimed to use a bootstrapped mediation analysis approach to systematically examine both direct and indirect pathways by which sleep disturbance may affect chronic pain and functional status. MATERIALS AND METHODS: One hundred sixty-five people (63% female) with chronic WAD and not taking medications for sleep disturbance completed questionnaires evaluating sleep disturbance, pain intensity, pain interference, disability, physical and mental health quality of life, stress, anxiety, depression, pain catastrophizing, and posttraumatic stress severity. RESULTS: Greater sleep disturbance was associated with increased duration of symptoms, higher levels of pain and disability, higher levels of emotional distress and pain catastrophizing, and functional impairment (reduced health-related quality of life). Mediation analyses demonstrated that sleep disturbance influenced chronic pain intensity and interference through both direct and indirect associations inclusive of stress, anxiety, and pain catastrophizing. Similarly, sleep disturbance was associated with higher levels of disability and poor health-related quality of life, both directly and also through its negative association with pain intensity and interference. DISCUSSION: Sleep disturbance in chronic WAD was associated with worse health outcomes and demonstrated both direct and indirect effects on both chronic pain and function.

Ultrasound-guided radiofrequency Ablation for SI joint pain:An observational study.

Objective: An ultrasound (US) guided RFA technique for the SIJ, utilizing bipolar RF cannula placements along the lateral sacral crest (LSC), has been proposed in anatomical studies. This study evaluated changes in pain intensity, function and quality of life following this technique. Methods: Patients achieving ≥50% pain relief on two blocks (one FL- and one US-guided) were included. US-guided SIJ RFA was performed with sequential bipolar lesions using two multitined RF cannulae placed along the LSC. The Pain, Disability, Quality of Life Questionnaire-Spine (PDQQ-S), which includes an 11-point (0-10) numeric rating scale (NRS) for pain intensity, was completed pre-RFA, and 2, 6, 9, 12 and 16 months post-RFA. Outcomes at 2 months post-RFA were compared between US-guided and FL-guided SIJ RFA in participants with previous FL-guided SIJ RFA. Results: 31 patients were included. Statistically significant decreases in pain intensity were observed up to 9 months after US-guided SIJ RFA (Baseline NRS: mean â€‹= â€‹6.8 SD â€‹= â€‹1.6, 95%CI [6.169, 7.347]; 9 month: mean â€‹= â€‹4.8, SD â€‹= â€‹2.6, 95%CI [3.891, 5.786]; p â€‹= â€‹0.0005), and up to 12 months for PDQQ-S. A clinically significant ≥2 point reduction in pain intensity on the NRS was seen in 48.4% of participants at 9 months. 11 participants had previous FL-guided SIJ RFA; no statistically significant differences were found in pain intensity or PDQQ-S scores between US- and FL-guided SIJ RFA 2-months post-RFA. Conclusions: Preliminary results suggest that SIJ RFA could be performed using US guidance. Further study is required to establish effectiveness.

Cervical facet joint platelet-rich plasma in people with chronic whiplash-associated disorders: A prospective case series of short-term outcomes.

Objective: To explore the safety and feasibility of a single autologous injection of platelet-rich plasma (PRP) in cervical facet joints of people with chronic WAD and facet-mediated pain, and explore the association between pain relief reported with diagnostic medial branch blocks (MBBs) and 3-months post-PRP. Design: A prospective case series of people with chronic whiplash-associated disorders and cervical facet joint mediated pain in a community setting. Interventions: A single autologous PRP injection was provided to cervical facet joints under ultrasound and fluoroscopic guidance. Measures: Adverse events were recorded one-week, and measures of pain (numerical pain rating scale - NPRS) and disability (Neck Disability Index - NDI) were collected prior to and 3-months following cervical facet joint PRP. People not reached for follow-up were considered failures for worst-case analysis. The correlation between percentage response to diagnostic cervical medial branch blocks (MBBs) and percentage pain relief reported at 3-months was also investigated. Results: Forty-four people (82% female; mean age (SD): 45.2 (10.8) years) underwent cervical facet joint PRP. There was a significant improvement in pain and disability following PRP. Seventy percent of people exceeded MCID for pain. For NDI scores, 80% of people exceeded MCID. Forty-one percent of people reported greater than 50% relief of pain 3-months post-cervical facet joint PRP.There was no significant correlation between percentage relief of pain with cervical MBBs and percentage relief of pain 3-months post-PRP (r â€‹= â€‹0.06, p â€‹= â€‹0.73).There were no adverse events reported. Conclusion: In people with chronic WAD and facet-mediated pain, preliminary data suggests that PRP is safe and it is feasible to move forwards with randomized studies to further investigate efficacy and effectiveness.

An assessment of the validity and responsiveness of the Numerical Rating Scale version of the Pain Disability Quality-Of-Life Questionnaire-Spine.

The Numerical Rating Scale Version of the Pain Disability Quality-Of-Life Questionnaire-Spine (NRS PDQQ-S) is a six question compensate patient reported outcome measure designed for use in the field of minimally invasive interventional spine care. Although acceptable reliability, validity and responsiveness have been confirmed for the Visual Analog Scale version of the PDQQ-S in patients undergoing lumbosacral spine corticosteroid injections and radiofrequency neurotomy, the Numerical Rating Scale version has undergone limited psychometric assessment. The purposes of this study were to define the validity and responsiveness of the NRS PDQQ-S, and to do so in a cohort undergoing an emerging type of spine intervention (platelet rich plasma [PRP] injection). Prospectively gathered pre-and 6months post lumbosacral spine PRP injection(s) NRS PDQQ-S and Oswestry Disability Index (ODI) data were analyzed on 75 patients. NRS PDQQ-S construct validity was evaluated by calculating the correlation with the ODI. Internal responsiveness was estimated for both PDQQ-S and ODI by calculating the effect size (Cohen's d). External responsiveness was estimated by calculating the correlation between the change scores of the NRS PDQQ-S and ODI. Strong statistically significant correlations were documented between the PDQQ-S and ODI questionnaires at pre-PRP injection (r â€‹= â€‹0.67; p<.0001) and 6 months post-PRP injection (r â€‹= â€‹0.82; p<.0001) supporting construct validity. Internal responsiveness was confirmed by large and comparable effect sizes for both the NRS PDQQ-S [1.1 (CI 0.8-1.4)] (1.1) and ODI [0.9 (CI 0.7-1.2)]. External responsiveness was confirmed by the strong correlation between the change scores of the NRS PDQQ-S and ODI [r â€‹= â€‹0.73 (p<.0001)]. This study supports the premise that the NRS PDQQ-S is a valid and responsive instrument that can be used to assess patients with low back pain who are treated with PRP injections.

Artificial intelligence accurately identifies total hip arthroplasty implants: a tool for revision surgery.

BACKGROUND: A critical part in preoperative planning for revision arthroplasty surgery involves the identification of the failed implant. Using a predictive artificial neural network (ANN) model, the objectives of this study were: (1) to develop a machine-learning algorithm using operative big data to identify an implant from a radiograph; and (2) to compare algorithms that optimise accuracy in a timely fashion. METHODS: Using 2116 postoperative anteroposterior (AP) hip radiographs of total hip arthroplasties from 2002 to 2019, 10 artificial neural networks were modeled and trained to classify the radiograph according to the femoral stem implanted. Stem brand and model was confirmed with 1594 operative reports. Model performance was determined by classification accuracy toward a random 706 AP hip radiographs, and again on a consecutive series of 324 radiographs prospectively collected over 2019. RESULTS: The Dense-Net 201 architecture outperformed all others with 100.00% accuracy in training data, 95.15% accuracy on validation data, and 91.16% accuracy in the unique prospective series of patients. This outperformed all other models on the validation (p < 0.0001) and novel series (p < 0.0001). The convolutional neural network also displayed the probability (confidence) of the femoral stem classification for any input radiograph. This neural network averaged a runtime of 0.96 (SD 0.02) seconds for an iPhone 6 to calculate from a given radiograph when converted to an application. CONCLUSIONS: Neural networks offer a useful adjunct to the surgeon in preoperative identification of the prior implant.

Evaluation of an Ultrasound-Assisted Longitudinal Axis Lateral Crest Approach to Radiofrequency Ablation of the Sacroiliac Joint.

OBJECTIVE: The aim of the study was to evaluate the effectiveness and procedural characteristics of a novel, ultrasound/fluoroscopically guided technique (longitudinal axis sacroiliac joint radiofrequency ablation) for sacroiliac joint denervation. DESIGN: A single-arm cohort with historical cohort comparison was used in this study. METHODS: Thirty-seven participants underwent longitudinal axis sacroiliac joint radiofrequency ablation after 50% or more pain reduction after diagnostic dual-block criterion. Outcomes were the proportion of participants with 50% or more pain reduction and mean Pain Disability Quality of Life Questionnaire change. Subanalysis included longitudinal axis sacroiliac joint radiofrequency ablation procedural and fluoroscopy times compared with participants previously treated with palisade radiofrequency ablation technique. RESULTS: Primary outcome worst case analysis demonstrated a responder rate of 64.9% (95% confidence interval = 48.8%-78.2%) and 59.5% (95% confidence interval = 43.5%-73.7%) at 3 and 6 mos. There was significant decrease in mean Pain Disability Quality of Life Questionnaire at 3 (45.6 ± 9.5 to 21.4 ± 16.0, P < 0.001) and 6 mos (45.6 ± 9.5 to 23.0 ± 16.5, P < 0.001). Longitudinal axis sacroiliac joint radiofrequency ablation required more procedure time than the palisade technique (38.2 ± 7.9 vs. 32.1 ± 6.9 mins, P = 0.031) but less fluoroscopy time (35.0 ± 11.8 vs. 57.6 ± 16.8 secs, P < 0.001). CONCLUSIONS: Longitudinal axis sacroiliac joint radiofrequency ablation resulted in improvement in pain, disability, and quality of life at 3 and 6 mos. Compared with the palisade technique, longitudinal axis sacroiliac joint radiofrequency ablation required greater procedure time but less fluoroscopy time.

An assessment of the minimal clinically important difference for the pain disability quality-of-Life Questionnaire-Spine.

Objective: The Pain Disability Quality-Of-Life Questionnaire-Spine (PDQQ-S) is a validated six question patient reported outcome measure designed for usage in minimally invasive spine intervention. The purpose of this study was to determine the Minimal Clinically Important Difference (MCID) for the PDQQ-S. Design: Retrospective single arm cohort study involving 411 patients who had undergone lumbar facet and/or sacroiliac joint RFN and had completed pre-and 3-month post RFN PDQQ-S. Methods: The MCID using both distribution and anchor-based ("Rebook RFN"; "Analgesic Requirements") methods were calculated. Results: The distribution-based approach (using standard error of measurement) estimated the MCID to be -17.3 [PDQQ-S baseline mean (SD): 46.9 (7.9)]. This is supported by the anchor based approach, which calculated the MCID to be: -21.5 for rebook RFN; -11.3, -17.2 and -30.5 for mildly, moderately and dramatically decreased NSAID use respectively; and -11.7, -16.9 and -31.7 for mildly, moderately and dramatically decreased opioid use respectively. A moderate reduction in medication use was deemed to be clinically relevant. Conclusion: The MCID value for the PDQQ-S is a score reduction of 17.