FUNCTIONAL OUTCOME IN EARLY OSTEOARTHRITIS OF KNEE WITH TWO DOSES OF PLATELET RICH PLASMA OUR EXPERIENCE.

2021 ◽  
pp. 4-6
Author(s):  
Balaji Rao.R. ◽  
Manikumar. C. J. ◽  
Ashok Kumar. P.
Keyword(s):  
Knee Joint ◽  
Functional Outcome ◽  
Platelet Rich Plasma ◽  
Weight Bearing ◽  
Lower Limbs ◽  
Endocrine Disorders ◽  
Related Phenomenon ◽  
Vas Score ◽  
Age Related ◽  
Study Results

Background: Osteoarthritis (OA) is a degenerative disorder of synovial joints in which there is gradual softening and disintegration of articular cartilage accompanied by the new growth of cartilage and bone at the joint margins(Osteophytes), cyst formation and sclerosis in the subchondral bone, mild synovitis, and capsular brosis. It differs from simple wear and tears in that it is asymmetrically distributed, often localized to only one part of a joint i.e., weight bearing, and often associated with abnormal loading rather than frictional wear. It is a dynamic phenomenon and shows features of both destruction and repair. Cartilage softening and disintegration are accompanied from the very outset by hyperactive new bone formation, osteophyte formation and remodeling. Osteoarthritis is an age-related phenomenon, and it affects more than 80% of people greater than 55 years of age. Body mass index (BMI) plays a vital role in osteoarthritis in weight-bearing joints. People with obese or overweight were approximately 4.6 times more likely to have knee OA than normalweight individuals. In addition people with metabolic and endocrine disorders are also more prone for osteoarthritis at an early age. Methods: Sixty patients suffering from grade1and 2 osteoarthritis knee joint who attended the outpatient department of orthopaedics, King George hospital, Visakhapatnam between November 2018 to October 2020 were included in the study. Informed and written consent was taken from the patients. General physical examination was done. Neurovascular status of both lower limbs was also examined. X-ray of both knee joints in antero-posterior and lateral views were taken in standing position. Routine pre-injection WOMAC and VAS score were recorded. Under aseptic conditions, two platelet-rich plasma (PRP) injections were injected into the knee joint at four weeks interval. Functional status of the knee was evaluated using WOMAC and VAS score at one, three and six week's interval. This study is a anlyticl comparative study. Results: There is a signicant difference in the VAS score and WOMAC score before giving an injection and after giving an injection, in patients with grade 1 and grade 2 osteoarthritis. The visual analogue score showed a mean of 7.16 at pre-injection period, which decreased to 5.95 at 1st week and 4.81 at 3rd week and 4.06 at six weeks follow up. Conclusion: In the present study the effectiveness of two aliquots of PRP injection was evaluated. Although studies including more than 2 PRP injections and more advanced stages of osteoarthritis were compared, the time frame was xed to 6 weeks. The functional outcome of the patient was better after 2nd dose of PRP. The present study concluded that two doses of PRP injection decreases the joint pain, alleviates the symptoms and enhances the activity of daily living and quality of life in short term duration.

scholarly journals Effect of Intraarticular Injection of Platelet-Rich Plasma on Knee Osteoarthritis: A Multicenter Retrospective Clinical Study

2022 ◽  
Vol 2022 ◽  
pp. 1-4
Author(s):  
Bin Zhang ◽  
Jiasheng Yu ◽  
Daobo Fan ◽  
Lei Bao ◽  
Dongqian Feng
Keyword(s):  
Clinical Study ◽  
Knee Joint ◽  
Knee Osteoarthritis ◽  
Platelet Rich Plasma ◽  
Intraarticular Injection ◽  
Control Group ◽  
Womac Index ◽  
Vas Score ◽  
Retrospective Clinical Study ◽  
Pain Symptoms

This study aimed to evaluate the effect of intraarticular injection with platelet-rich plasma on knee osteoarthritis. A total of 250 patients with stages I–III osteoarthritis from December 2018 to June 2020 were included in this study. All the patients had received autologous PRP injection (3 ml) into the affected knee joint every week for totally 3 injections. The VAS score and WOMAC index were used to evaluate knee function before and at 3 days, 1 month, and 3 months after injection. A total of 250 patients were enrolled in this study, including 130 patients in the PRP group and 120 patients in the control group. The content of platelets in PRP of patients in the PRP group was 958.0 ± 283.1 × 109/L. The VAS score and WOMAC index of patients in the PRP group before treatment were not significantly different from those in the control group. At 3 days, 1 month, and 3 months after PRP treatment, the VAS score and WOMAC index of the PRP group were significantly lower than those of the control group. PRP is effective in treatment of knee osteoarthritis. The pain symptoms can be alleviated at 3 days after injection.

scholarly journals Postoperative Functional and Radiological Outcome Comparison of Computer-assisted and Conventional Total Knee Arthroplasty at 6 Months Follow-up: A Cross Sectional Study

2020 ◽  
Vol 1 (1) ◽  
pp. 43-49
Author(s):  
Muhammad Budimansyah ◽  
Ismail Hadisoebroto Dilogo ◽  
Endrotomo Sumargono
Keyword(s):  
Functional Outcome ◽  
Weight Bearing ◽  
Oxford Knee Score ◽  
Lower Limbs ◽  
Coronal Plane ◽  
Computer Assisted ◽  
Mechanical Alignment ◽  
Assisted Navigation ◽  
Significant Difference

Background. Computer-assisted navigation TKA has just been adapted in Indonesia for the last decade. The method is aiming to achieve more precise mechanical alignment in TKA. However, controversies still exist especially in terms of functional outcome and radiological outcome.Method. Fifty elderly patients aged more than 50 years old with severe knee osteoarthritis (Kellgren Lawrence stage III or IV) who scheduled for TKA surgery in the first half of 2019 were consecutively sampled. All patients were measured for objective functional status with Western Ontario Mac Master University Index (WOMAC) and Oxford Knee Score (OKS). Weight-bearing, long-leg follow-up radiographs of both lower limbs were taken, and coronal tibiofemoral angle (CTFA), coronal femoral component angle (CFCA) and coronal tibial component angle (CTCA) were measured.Results. Group of computer-assisted navigation TKA surgery was found to have significantly lower WOMAC score (p0.05) and higher OKS score (p0.05). Although not statistically significant, greater angle of deviation is observed in the conventional TKA surgery group. Proportions with deviation of less than 3º were found more in the group using computer navigation.Discussion. The results of this study indicate the advantage of using a computer assisted  system in TKA procedure, in terms of better functional outcome. However, our study only measures mechanical alignment from coronal plane and short term follow up time. Other parameter measurement, such as mechanical alignment on sagittal plane, rotational alignment, and soft tissue balance are also important to determine the success rate of TKA procedure.Conclusion. Patients who had TKA surgery under computer-assisted navigation would benefit a better functional outcome if compared with conventional TKA surgery, as measured with WOMAC and OKS. However, there is no significant difference in terms of radiographic value of coronal-plane mechanical deviation on both methods.

A COMPARATIVE STUDY TO DETERMINE THE KNEE JOINT FUNCTIONAL OUTCOME IN PATIENTS WITH FEMUR SHAFT FRACTURES MANAGED OPERATIVELY OR CONSEVATELY AT NDOLA HOSPITAL:complete enumeration (Preprint)

2019 ◽  
Author(s):  
Ripedah Nakana
Keyword(s):  
Knee Joint ◽  
Functional Outcome ◽  
Road Traffic ◽  
Femur Fracture ◽  
Conservative Group ◽  
Femur Fractures ◽  
Shaft Fractures ◽  
Significant Difference ◽  
Femur Shaft ◽  
Femur Shaft Fractures

BACKGROUND According to WHO, It has been reported that there has been a rise in road traffic accidents globally due to many factors. Consequently this has contributed to an increase in fracture of the femur in hospitals. The annual incidence of these Fractures has been estimated to be 10 per 100,000 persons and this incidence has been noticed to be higher among the youths decreasing after the age of 40 and then increasing in the elderly. These fractures are either managed conservatively or operatively. OBJECTIVE the aim of this study was to determine if there is a significant difference in knee joint functional outcome in patients with femur shaft fractures managed operatively and conservatively at Ndola Teaching Hospital at the orthopedics clinic and physiotherapy. This in future might help to place emphasis on government to sensitize the right measures needed to improve on the functional outcome of a knee joint in patients with femur fracture who are treated operatively or conservatively METHODS the method used for the study was a complete enumeration of all patients with femur fractures that were admitted at orthopedic ward, visited the orthopedic clinic and physiotherapy sessions at NTH between the period of July 2019 to September 2019. Data collected will be analyzed using a statistical data software called Statistical Package of Social Sciences (SPSS). The independent variable that will be considered in the study are age, DOI, DOA, femur shaft fractures, treatment and others that that will meet the selection Criteria. The dependent variable will be “Knee Joint Functional Outcome”. RESULTS Results did not show statistically significant difference in knee functional outcome for two methods (conservative or operative). In the current study it was noted that there was much reduction in swelling in the operative in comparison to the conservative group. We may therefore conclude that the operative management promises a better outcome especially when done on time. However it seemed the operative procedure was not preferred for any conservative approach however the study has shown an in depth feasibility study to affirm such findings in order to inform on policy or management paradigim shift. CONCLUSIONS There is need for further intervention in the management of femur fracture which complicates to poor knee joint function

scholarly journals OP0083 DORSAL ROOT GANGLIA INFILTRATING MACROPHAGES MAINTAIN OSTEOARTHRITIS PAIN

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 55.2-56
Author(s):  
R. Raoof ◽  
C. Martin ◽  
H. De Visser ◽  
J. Prado ◽  
S. Versteeg ◽  
...  
Keyword(s):  
Knee Joint ◽  
Dorsal Root Ganglia ◽  
Immune Cells ◽  
Dorsal Root ◽  
Weight Bearing ◽  
Joint Damage ◽  
Osteoarthritis Pain ◽  
Knee Pathology ◽  
Femoral Condyles ◽  
Over Time

Background:Pain is a major debilitating symptom of knee osteoarthritis (OA). However, the extent of joint damage in OA does not correlate well with the severity of pain. The mechanisms that govern OA pain are poorly understood. Immune cells infiltrating nervous tissue may contribute to pain maintenance.Objectives:Here we investigated the role of macrophages in the initiation and maintenance of OA pain.Methods:Knee joint damage was induced by an unilateral injection of mono-iodoacetate (MIA) or after application of a groove at the femoral condyles of rats fed on high fat diet. Pain-like behaviors were followed over time using von Frey test and dynamic weight bearing. Joint damage was assessed by histology. Dorsal root ganglia (DRG) infiltrating immune cells were assessed over time using flow cytometry. To deplete monocytes and macrophages, Lysmcrex Csfr1-Stop-DTR were injected intrathecal or systemically with diptheria toxin (DT).Results:Intraarticular monoiodoacetate injection induced OA and signs of persistent pain, such as mechanical hyperalgesia and deficits in weight bearing. The persisting pain-like behaviors were associated with accumulation of F4/80+macrophages with an M1-like phenotype in the lumbar DRG appearing from 1 week after MIA injection, and that persisted till at least 4 weeks after MIA injection. Macrophages infiltrated DRG were also observed in the rat groove model of OA, 12 weeks after application of a groove at the femoral condyles. Systemic or local depletion of DRG macrophages during established MIA-induced OA completely ablated signs of pain, without affecting MIA-induced knee pathology. Intriguingly when monocytes/macrophages were depleted prior to induction of osteoarthritis, pain-like behaviors still developed, however these pain-like behaviors did not persist over time.In vitro,sensory neurons innervating the affected OA joint programmed macrophages into a M1 phenotype. Local repolarization of M1-like DRG macrophages towards M2 by intrathecal injection of M2 macrophages or anti-inflammatory cytokines resolved persistent OA-induced pain.Conclusion:Overall we show that macrophages infiltrate the DRG after knee damage and acquire a M1-like phenotype and maintain pain independent of the lesions in the knee joint. DRG-infiltrating macrophages are not required for induction of OA pain. Reprogramming M1-like DRG-infiltrating macrophages may represent a potential strategy to treat OA pain.Acknowledgments:This project has received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Sklodowska-Curie grant agreements No 814244 and No 642720. Dutch Arthritis SocietyDisclosure of Interests:Ramin Raoof: None declared, Christian Martin: None declared, Huub de Visser: None declared, Judith Prado: None declared, Sabine Versteeg: None declared, Anne Heinemans: None declared, Simon Mastbergen: None declared, Floris Lafeber Shareholder of: Co-founder and shareholder of ArthroSave BV, Niels Eijkelkamp: None declared

scholarly journals Analgesic and Anti-Inflammatory Effects of Aucklandia lappa Root Extracts on Acetic Acid-Induced Writhing in Mice and Monosodium Iodoacetate-Induced Osteoarthritis in Rats

Plants ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. 42
Author(s):  
Hee-Geun Jo ◽  
Geon-Yeong Lee ◽  
Chae Yun Baek ◽  
Ho Sueb Song ◽  
Donghun Lee
Keyword(s):  
Acetic Acid ◽  
Weight Bearing ◽  
Bone Diseases ◽  
Joint Disease ◽  
Root Extracts ◽  
Raw264.7 Macrophages ◽  
Age Related ◽  
Monosodium Iodoacetate ◽  
Anti Inflammatory

Osteoarthritis (OA) is an age-related joint disease and one of the most common degenerative bone diseases among elderly people. The currently used therapeutic strategies relying on nonsteroidal anti-inflammatory drugs (NSAIDs) and steroids for OA are often associated with gastrointestinal, cardiovascular, and kidney disorders, despite being proven effective. Aucklandia lappa is a well-known traditional medicine. The root of A. lappa root has several bioactive compounds and has been in use as a natural remedy for bone diseases and other health conditions. We evaluated the A. lappa root extracts on OA progression as a natural therapeutic agent. A. lappa substantially reduced writhing numbers in mice induced with acetic acid. Monosodium iodoacetate (MIA) was injected into the rats through their knee joints of rats to induce experimental OA, which shows similar pathological characteristics to OA in human. A. lappa substantially reduced the MIA-induced weight-bearing of hind limb and reversed the cartilage erosion in MIA rats. IL-1β, a representative inflammatory mediator in OA, was also markedly decreased by A. lappa in the serum of MIA rats. In vitro, A. lappa lowered the secretion of NO and suppressed the IL-1β, COX-2, IL-6, and iNOS production in RAW264.7 macrophages activated with LPS. Based on its analgesic and anti-inflammatory effects, A. lappa could be a potential remedial agent against OA.

scholarly journals Effects of Dominant and Nondominant Limb Immobilization on Muscle Activation and Physical Demand during Ambulation with Axillary Crutches

2021 ◽  
Vol 6 (1) ◽  
pp. 16
Author(s):  
Kara B. Bellenfant ◽  
Gracie L. Robbins ◽  
Rebecca R. Rogers ◽  
Thomas J. Kopec ◽  
Christopher G. Ballmann
Keyword(s):  
Lower Limb ◽  
Muscle Activation ◽  
Weight Bearing ◽  
Lower Limbs ◽  
Medial Gastrocnemius ◽  
Bipedal Walking ◽  
Lower Limb Muscle ◽  
Limb Muscle ◽  
Physical Demand ◽  
Limb Dominance

The purpose of this study was to investigate the effects of how limb dominance and joint immobilization alter markers of physical demand and muscle activation during ambulation with axillary crutches. In a crossover, counterbalanced study design, physically active females completed ambulation trials with three conditions: (1) bipedal walking (BW), (2) axillary crutch ambulation with their dominant limb (DOM), and (3) axillary crutch ambulation with their nondominant limb (NDOM). During the axillary crutch ambulation conditions, the non-weight-bearing knee joint was immobilized at a 30-degree flexion angle with a postoperative knee stabilizer. For each trial/condition, participants ambulated at 0.6, 0.8, and 1.0 mph for five minutes at each speed. Heart rate (HR) and rate of perceived exertion (RPE) were monitored throughout. Surface electromyography (sEMG) was used to record muscle activation of the medial gastrocnemius (MG), soleus (SOL), and tibialis anterior (TA) unilaterally on the weight-bearing limb. Biceps brachii (BB) and triceps brachii (TB) sEMG were measured bilaterally. sEMG signals for each immobilization condition were normalized to corresponding values for BW.HR (p < 0.001) and RPE (p < 0.001) were significantly higher for both the DOM and NDOM conditions compared to BW but no differences existed between the DOM and NDOM conditions (p > 0.05). No differences in lower limb muscle activation were noted for any muscles between the DOM and NDOM conditions (p > 0.05). Regardless of condition, BB activation ipsilateral to the ambulating limb was significantly lower during 0.6 mph (p = 0.005) and 0.8 mph (p = 0.016) compared to the same speeds for BB on the contralateral side. Contralateral TB activation was significantly higher during 0.6 mph compared to 0.8 mph (p = 0.009) and 1.0 mph (p = 0.029) irrespective of condition. In conclusion, limb dominance appears to not alter lower limb muscle activation and walking intensity while using axillary crutches. However, upper limb muscle activation was asymmetrical during axillary crutch use and largely dependent on speed. These results suggest that functional asymmetry may exist in upper limbs but not lower limbs during assistive device supported ambulation.

scholarly journals Efficacy and safety of butylphthalide for patients who had acute ischaemic stroke receiving intravenous thrombolysis or endovascular treatment (BAST trial): study protocol for a randomised placebo-controlled trial

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e045559
Author(s):  
Xuelei Zhang ◽  
Anxin Wang ◽  
Jing Yu Zhang ◽  
Baixue Jia ◽  
Xiaochuan Huo ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Endovascular Treatment ◽  
Functional Outcome ◽  
Acute Ischaemic Stroke ◽  
Controlled Trial ◽  
Intravenous Thrombolysis ◽  
Serious Adverse Events ◽  
Double Blind ◽  
Ischaemic Injury ◽  
Study Results

IntroductionAs a neuroprotective medication, butylphthalide (NBP) may help protect against cerebral ischaemic injury. However, evidence on whether NBP influences the outcomes of patients who had acute ischaemic stroke who are receiving revascularisation treatment is limited. This study aims to evaluate whether additional NBP therapy can improve the functional outcome of patients who receive intravenous recombinant tissue plasminogen activator and/or endovascular treatment (EVT).Methods and analysisThe study will be a randomised, double-blind, placebo-controlled, multiple-centre, parallel group trial. The sample size is estimated at 1200 patients. Eligible patients will be randomised at a 1:1 ratio to receive either NBP or placebo daily for 90 days, which will include 14 days of injections and 76 days of capsules. The first use of NBP/placebo will be started within 6 hours of onset of ischaemic stroke. The primary outcome is the functional outcome as assessed by the 90-day modified Rankin Scale, adjusted for baseline scores on the National Institutes of Health Stroke Scale. The primary safety outcome is the percentage of serious adverse events during the 90 days of treatment. This trial will determine whether NBP medication benefits patients who had acute ischaemic stroke who receive intravenous thrombolysis or EVT.Ethics and disseminationThe protocol was written according to the general ethical guidelines of the Declaration of Helsinki and approved by the Institutional Review Board/Ethics Committee of Beijing Tiantan Hospital, Capital Medical University with approval number KY 2018-003-02. Ethics committees of all participating sites have approved the study . Results of the study will be published in peer-reviewed scientific journals and shared in scientific presentations.Trial registration numberNCT03539445.

Aging and the Osteogenic Response to Mechanical Loading

2001 ◽  
Vol 11 (s1) ◽  
pp. S137-S142 ◽  
Author(s):  
Wendy M. Kohrt
Keyword(s):  
Growth Factors ◽  
Bone Mass ◽  
Mechanical Loading ◽  
Bone Cells ◽  
Weight Bearing ◽  
Bone Modeling ◽  
Mineral Density ◽  
Increase Bone Mass ◽  
Age Related ◽  
Osteogenic Response

The osteogenic response to mechanical stress is blunted with aging. It has been postulated that this decline in responsiveness is related to (a) a limited ability to engender the strain necessary to reach the bone modeling threshold, due to decreased muscle mass and strength, and/or (b) a decline in certain hormones or growth factors that may interact with mechanical signals to change the sensitivity of bone cells to strain. There is reason to believe that both of these factors contribute to the reduced ability to increase bone mass through exercise with advancing age. Weight-bearing endurance exercise and resistance exercise have both been found to increase bone mass in older women and men. However, exercise training studies involving older individuals have generally resulted in increased bone mineral density only when the exercise is quite vigorous. There is also evidence that the osteogenic response to mechanical loading is enhanced by estrogens. Whether age-related changes in other factors (e.g., other hormones, growth factors, cytokines) also contribute to the reduced responsiveness of the aged skeleton to mechanical loading remains to be investigated.

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