symptomatic knee
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2022 ◽  
Vol 23 (1) ◽  
Author(s):  
Indiana Cooper ◽  
Peter Brukner ◽  
Brooke L. Devlin ◽  
Anjana J. Reddy ◽  
Melanie Fulton ◽  
...  

Abstract Background Knee osteoarthritis has an inflammatory component that is linked to pain and joint pathology, yet common non-surgical and non-pharmacological interventions (e.g., exercise, calorie restricting diets) do not typically target inflammation. We aimed to evaluate the feasibility of a telehealth delivered anti-inflammatory diet intervention for knee osteoarthritis. Methods This 9-week single-arm feasibility study recruited participants aged 40–85 years with symptomatic knee osteoarthritis (inclusion criteria: average pain ≥4/10 or maximal pain ≥5/10 during past week). All participants received a telehealth-delivered anti-inflammatory dietary education intervention involving 1:1 consultations at baseline, 3- and 6-week follow-up. The diet emphasised nutrient-dense wholefoods and minimally processed anti-inflammatory foods and discouraged processed foods considered to be pro-inflammatory. The primary outcome of feasibility was assessed via: i) eligibility, recruitment and retention rates; ii) self-reported dietary adherence; iii) adverse events; and iv) treatment satisfaction. Post-intervention interviews evaluated the acceptability of the dietary intervention delivered via telehealth. Secondary outcomes included changes in self-reported body mass, Knee injury and Osteoarthritis Outcome Score (KOOS), health-related quality of life (EuroQoL-5D), analgesic use and global rating of change. Worthwhile effects were determined by the minimal detectable change (MDC) for all five KOOS-subscales (pain, symptoms, activities of daily living, sport/recreation, quality of life) being contained within the 95% confidence interval. Results Forty-eight of seventy-three (66%) individuals screened were eligible and 28 enrolled over 2 months (82% female, mean age 66 ± 8 years, body mass index 30.7 ± 4.8 kg.m−2). Six participants withdrew prior to final follow-up (21% drop-out). Of those with final follow-up data, attendance at scheduled telehealth consultations was 99%. Self-reported adherence to diet during the 9-week intervention period: everyday = 27%, most of time = 68% and some of time = 5%. Two minor adverse events were reported. Change scores contained the MDC within the 95% confidence interval for all five KOOS subscales. Suggestions to improve study design and limit drop-out included an initial face-to-face consultation and more comprehensive habitual dietary intake data collection. Conclusion This study supports the feasibility of a full-scale randomised controlled trial to determine the efficacy of a primarily telehealth-delivered anti-inflammatory dietary education intervention in adults with symptomatic knee osteoarthritis. Trial registration ACTRN12620000229976 prospectively on 25/2/2020.


2022 ◽  
Vol 23 (1) ◽  
Author(s):  
Abed El-Hakim El-Kadiry ◽  
Carlos Lumbao ◽  
Natasha Salame ◽  
Moutih Rafei ◽  
Riam Shammaa

Abstract Background Knee osteoarthritis (OA) is a debilitating condition affecting human body biomechanics and quality of life. Current standard care for knee OA leads to trivial improvement and entails multiple adverse effects or complications. Recently, investigational cell therapies injected intra-articularly, such as bone marrow aspirate concentrate (BMAC) and platelet-rich plasma (PRP), have shown safety and therapeutic potency providing patients with pain relief. In the current retrospective comparative study, we investigated the differences in pain and functional improvements in patients with symptomatic knee OA receiving intra-articular injections of BMAC vs PRP. Methods Pain and functionality scores were measured at baseline and at different time points post-injection over 12 months, using 3 self-administered, clinically validated questionnaires: the visual analogue scale (VAS) for assessing pain intensity, the knee injury and osteoarthritis outcome score (KOOS) for evaluating functionality and knee-related quality of life, and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) for evaluating physical function. The repeated-measures general linear model with Sidak test for pairwise comparisons was used to investigate the influence of the treatment on the score evolution within groups (between baseline and each time point) and between groups (overall). Results The BMAC group (n = 26 knees) significantly improved in VAS, KOOS, and WOMAC scores between baseline and 12 months (57.4, 75.88, and 73.95% mean score improvement, respectively). In contrast, the PRP group (n = 13 knees) witnessed nonsignificant improvement in all scores. BMAC, in comparison to PRP, induced significant improvement in outcomes by 29.38% on the VAS scale, 53.89% on the KOOS scale, and 51.71% on the WOMAC scale (P < .002, P < .01, P < .011, respectively). Conclusions Intra-articular autologous BMAC injections are safe, effective in treating pain, and ameliorate functionality in patients with symptomatic knee OA to a greater extent than PRP injections. Graphical abstract Intra-articular autologous BMAC therapy is safe and provides more relief to patients with symptomatic knee osteoarthritis compared to PRP therapy.


2021 ◽  
Vol 12 (1) ◽  
pp. 164
Author(s):  
Liisa Kuhi ◽  
Ann E. Tamm ◽  
Jaanika Kumm ◽  
Kristel Järv ◽  
Aare Märtson ◽  
...  

The objective of this study was to investigate the dynamics of the urinary collagen type II C-terminal cleavage neoepitope (uC2C) before and after total knee replacement (TKR) in rapid knee OA progressors. C2C in the urine was measured by IBEX-uC2C assay in 86 patients (mean age: 59.9 years) with symptomatic knee OA (kOA) undergoing TKR, assessed before surgery and 3 and 12 months after. The patients’ condition was determined by self-assessment questionnaires, by lower limb performance tests, and by radiography. In the preoperative period, the uC2C level was significantly higher in females than in males, and was associated with the radiographic severity of kOA. A weak correlation between the C2C and knee pain was observed in the whole group and in males, but not in females. The individual dynamics of uC2C after TKR were heterogenic. In general, uC2C increased three months after TKR, but fell to the preoperative level after 12 months. A higher preoperative uC2C implied the tendency to diminish as a result of TKR, and vice versa. TKR did not stop the degradation of Coll2 in the tissues in the majority of cases. The pre-TKR uC2C predicts the postoperative uC2C level. The uC2C dynamic seems to be sex-specific, so it could be considered a prospective pre- and post-TKR biomarker for progressive kOA.


2021 ◽  
Vol 12 ◽  
Author(s):  
Nicola Veronese ◽  
Sinisa Stefanac ◽  
Ai Koyanagi ◽  
Nasser M. Al-Daghri ◽  
Shaun Sabico ◽  
...  

Recent literature suggests that sarcopenia, often represented by low lower limbs muscle mass and strength, can be considered a potential risk factor for knee osteoarthritis (OA), but the available literature is still limited. We therefore aimed to investigate whether sarcopenia is associated with a higher risk of radiographic (ROA) and symptomatic knee OA (SxOA) in a large cohort of North American people in the context of the OA initiative. Sarcopenia at baseline was diagnosed in case of low skeletal muscle mass (i.e., lower skeletal mass index) and poor performance in the chair stands test. The outcomes of interest for this study included ROA (radiographical osteoarthritis) if a knee developed a Kellgren and Lawrence (KL) grade ≥2 at follow-up, and SxOA (symptomatic osteoarthritis) defined as new onset of a combination of painful knee OA. Altogether, 2,492 older participants (mean age: 68.4 years, 61.4% females) were included. At baseline, sarcopenia was present in 6.1% of the population. No significant difference in ROA prevalence was observed between those with and without sarcopenia (p=0.76), whilst people with sarcopenia reported a significant higher prevalence of SxOA (p&lt;0.0001). Using a logistic regression analysis, adjusting for potential confounders at baseline and the diagnosis of sarcopenia during follow-up, sarcopenia was associated with a higher incidence of knee SxOA (odds ratio, OR=2.29; 95%CI [confidence interval]: 1.42-3.71; p=0.001), but not knee ROA (OR=1.48; 95%CI: 0.53-4.10; p=0.45). In conclusion, sarcopenia could be associated with a higher risk of negative knee OA outcomes, in particular symptomatic forms.


BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e049541
Author(s):  
Dorte T Grønne ◽  
Ewa M Roos ◽  
Rikke Ibsen ◽  
Jakob Kjellberg ◽  
Søren T Skou

ObjectivesTo evaluate 1-year cost-effectiveness of an 8-week supervised education and exercise programme delivered in primary care to patients with symptomatic knee or hip osteoarthritis (OA).DesignA registry-based pre–post study linking patient-level data from the Good Life with osteoArthritis in Denmark (GLA:D) registry to national registries in Denmark.Setting and participants16 255 patients with symptomatic knee or hip OA attending GLA:D.InterventionGLA:D is a structured supervised patient education and exercise programme delivered by certified physiotherapists and implemented in Denmark.Outcome measuresAdjusted healthcare costs per Quality-Adjusted Life Year (QALY) gained from baseline to 1 year (ratio of change in healthcare costs to change in EuroQoL 5-Dimensions 5-Level questionnaire (EQ-5D)). All adjusted measures were estimated using a generalised estimating equation gamma regression model for repeated measures. Missing data on EQ-5D were imputed with Multiple Imputations (3 months: 23%; 1 year: 39 %).ResultsAdjusted change in healthcare cost was 298€ (95% CI: 206 to 419) and 640€ (95% CI: 400 to 1009) and change in EQ-5D was 0.035 (95% CI: 0.033 to 0.037) and 0.028 (95% CI: 0.025 to 0.032) for knee and hip patients, respectively. Hence estimated adjusted healthcare costs per QALY gained was 8497€ (95% CI: 6242 to 11 324) for knee and 22 568€ (95% CI: 16 000 to 31 531) for hip patients. In patients with high compliance, the adjusted healthcare costs per QALY gained was 5438€ (95% CI: 2758 to 9231) for knee and 17 330€ (95% CI: 10 041 to 29 364) for hip patients. Healthcare costs per QALY were below conventional thresholds for willingness-to-pay at 22 804€ (20 000£) and 43 979€ (US$50 000), except the upper limit of the 95% CI for hip patients which was in between the two thresholds.ConclusionsA structured 8-week supervised education and exercise programme delivered in primary care was cost-effective at 1 year in patients with knee or hip OA supporting large-scale implementation in clinical practice.


2021 ◽  
Vol 56 ◽  
pp. 102454
Author(s):  
Gabriel Peixoto Leão Almeida ◽  
Isabel Oliveira Monteiro ◽  
Raíssa Grazielle de Oliveira Dantas ◽  
Maria Larissa Azevedo Tavares ◽  
Pedro Olavo de Paula Lima

2021 ◽  
Vol 38 (05) ◽  
pp. 511-514
Author(s):  
Abin Sajan ◽  
Sandeep Bagla ◽  
Ari Isaacson

AbstractSymptomatic knee pain is one of the most common joint diseases that affects millions of people worldwide. The treatment for knee pain secondary to osteoarthritis (OA) begins with conservative therapy and progresses to surgical intervention when conservative therapy fails. Genicular artery embolization (GAE) offers an alternative option for patients who are poor surgical candidates. Multiple studies have been conducted worldwide demonstrating the safety and efficacy of GAE in patients with mild to moderate OA. The purpose of this article is to describe the current literature on GAE and highlight the latest findings from a randomized controlled trial comparing GAE versus sham embolization.


QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ahmed Emad Mahdy Mohamed ◽  
Mohamed Sobhy Hassan ◽  
Mohamed Gamal Eldin AbdelMotelib

Abstract Background Multiple promising researches were done regarding using platelet rich plasma (PRP) injection aiming at establishing new minimally invasive treatment option for knee OA and avoiding surgical procedures hazards which could be an option in advanced cases. Thus, our study will be directed towards ultrasound guided injecting of PRP trying to confirm the efficacy of the procedure as a therapeutic option. Objective The study aims to assess of the role of ultrasound guided PRP injection in cases of knee osteoarthritis and follow up of the symptoms outcome. Methods and material Twenty patients with different knee osteoarthritis grades were injected with PRP under ultrasound guidance and the symptoms outcome were followed up by using visual analogue scale (VAS), WOMAC osteoarthritis index, OXFORD knee score, LYSHOLM knee scoring scale at periods of , and weeks post procedure. Results A total of patients were included with the age ranging from - years old, the mean was . years old (SD ± . ). Among them patients ( ) were females and patients ( ) were males. There was statistically significant difference between the different knee pain scoring scales , and weeks after the procedure compared to before injection, where according to VAS score the mean score was . . pre procedure and became . . , . . and . . after , and weeks respectively with mean reduction ratio of . % after months. The extent of the difference over the periods through WOMAC in knee osteoarthritis patients was . . ,. . and . . after , and weeks respectively, compared to . . before the procedure with a mean reduction ratio of . % after months. While according to OXFORD knee score, the patient’s scores were . . before the procedure Vs . . , . . and . . at , and weeks after injection with symptoms mean reduction ratio of . %. According to LYSHOLM knee scoring scale, the mean score was . . pre procedure and became . . , . . and . . after , and weeks respectively with months mean reduction ratio of . %. Conclusion PRP injection in symptomatic knee osteoarthritis patients cause statistically significant improvement of the symptoms.


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