The Effectiveness of Single Injection of Platelet-Rich Plasma for Knee Osteoarthritis Combined with Meniscus Injury: A Randomized Trial

Objectives : To explore the effectiveness of single injection of platelet-rich plasma with rehabilitation therapy for knee osteoarthritis combined with meniscus injury. Methods : Forty patients who met the inclusion criteria were randomly assigned to a rehabilitation group (REH group, 20 cases) receiving rehabilitation training, and a platelet-rich plasma group (PRP group, 20 cases) receiving an ultrasound-guided single injection of PRP in combination with rehabilitation training. Rehabilitation training in the two groups lasted for 2 weeks, and the patients were evaluated using the short-form McGill pain questionnaire (SF-MPQ), Western Ontario McMaster Universities index (WOMAC score), and infrared thermography (knee-joint mean temperature) before treatment, at 1 week, 1 month and 6 months after treatment. Results : Two patients were lost to follow-up in both the PRP group and the REH group. Significant reductions in pain scores, WOMAC scores and knee temperature were observed at 1 week and 1 month after treatment in both groups (p < 0.05). Significant lower SF-MPQ scores were observed in the PRP group than in the REH group at 6 months followup (p < 0.01). Similarly, the mean knee temperature was significantly lower in the PRP group than in the REH group at 6 months follow-up (p < 0.01). No severe complications occurred in either group. Conclusions: Compared to rehabilitation therapy alone, single injection of platelet-rich plasma in combination with rehabilitation therapy has beneficial effect on pain, knee function and mean knee temperature in patients with KOA combined with meniscus injury. Single injection of platelet-rich plasma combined with rehabilitation therapy has a good short-term effectiveness.

Genicular Nerve Radiofrequency Ablation and Dual Subsartorial Block for Chronic Knee Pain Post Total Knee Replacement: A Case Report

Introduction. Chronic pain defines as pain persisting for three months or longer, chronic post-surgical pain can affect all dimensions of health-related quality of life, and is associated with functional limitations. treatment of chronic pain after total knee replacement is challenging, and evaluation of combined treatments and individually targeted treatments matched to patient characteristic. Genicular nerve block radiofrequency ablation is a safe and effective therapeutic procedure for pain associated with chronic pain due to knee osteoarthritis, and the evolution of newer regional analgesia techniques aids in reducing postoperative pain Dual Subsartorial Block (DSB) as a procedure specific, post total knee replacemet. historically there has been a reliance on using a pain-spesific assessment tools Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Case Presentation. A 55-year old woman admitted she had pain on bilateral knee, the knee pain had affected her daily living, she was diagnosed with chronic knee pain post TKR because of osteoarthritis genu bilateral, the patient was planning genicular nerve radiofrequency ablation and dual subsartorial block, from the examination we found that numeric rating scale was 6 (moderate pain) with WOMAC score 76, before the procedure the patients are examined through radiology for any deformity in the knee. The genicular nerve radiofrequency ablation under ultrasound guidance on bonylandmark, resulting anesthesia of the anterior compartment of the knee, and dual subsartorial block that cover almost all the innervations of pain generating component of the anterior and posterior knee joint involved in TKR surgery. After the procedure we reevaluated the pain score using NRS was 2 (mild pain), and with WOMAC Score 19. Conclusion. Treatment of chronic pain post total knee replacemet was challenging, targeted treatment may ameliorate the pain and prevent long term disability.

A study to compare the effectiveness of maitland mobilization protocol on pain and functional mobility of patients with knee osteoarthritis

Osteoarthritis is a common degenerative condition among the elderly. It is characterized With the damage to the articular cartilage and persists with the symptoms of pain and stiffness in the joint. This study was conducted with 30 patients with Osteoarthritis of knee joint. The subjects were divided into three groups: Group A comprised of 15 subjects. Patients in this group received conventional physiotherapy comprising of Strengthening exercises, Stretching exercises, Range of motion exercises and cryotherapy.Group B (Experimental Group 1) comprised of 15 subjects. Patients in this group received Maitland’s Mobilization and Conventional physiotherapy exercises.All the subjects were assessed pre and post intervention program for VAS scale and WOMAC scale test. After analyzing the data following conclusions were drawn;Results showed that there was significant improvement in the VAS score and WOMAC score of all the two groups for the pre and the post test measurement. The inter group comparison of all the two groups showed that there was highly significant difference between the Maitland’s group and the control group (p&#60;0.001).

Comparison of Outcomes in Obese Patients After Total Knee Arthroplasty With Neutral or Mild Varus: a Retrospective Study With 8-year Follow-up

Background Residual varus after total knee arthroplasty (TKA) can affect functional outcomes and prosthetic survival, which may worsen in the presence of obesity. However, no studies were found to compare the outcomes of obese patients involving postoperative residual mild varus or neutral. The aim of this study was to compare outcomes for knees of obese patients with neutral or mild varus after TKA. Methods We retrospectively reviewed 188 consecutive obese patients (body mass index ≥ 30 kg/m2) at our hospital who underwent TKA due to varus knee osteoarthritis from January 2010 to December 2015. The mechanical hip-knee-ankle axis angle was measured in all patients pre- and postoperatively. Prosthesis survival and knee function were retrospectively assessed based on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, Knee Society Knee Score (KS-KS), Knee Society Function Score (KS-FS), Forgotten Joint Score (FJS), and range of motion (ROM). Results Of the 156 knees in 132 obese patients who completed follow-up for a mean of 8.32 ± 1.47 years, 97 knees were corrected from varus to neutral and 54 knees were kept in mild residual varus. Knees with mild varus showed significantly better WOMAC and FJS scores. The two types of knees did not differ significantly in KS-KS, KS-FS or ROM. Although one patient with a neutral knee had to undergo revision surgery, there was no significant difference between two groups.Conclusions For obese patients with osteoarthritis, preservation of residual varus alignment after TKA can improve functional outcomes without compromising prosthesis survival.

Short-term results of a novel management of supracondylar fracture with coexisting osteoarthritis with bifold fixation and total knee arthroplasty

Purpose Presence of supracondylar and periarticular femoral fracture with associated arthritis of knee poses a challenging situation to the orthopaedic surgeon. The results of fixation of fracture in osteoporosis are not very satisfactory and have complications. With fixation alone, they still cannot bear weight on affected leg due to severe disability of osteoarthritis. To make patient walk, conventionally three surgeries in the form of fracture fixation, removal of implant and total knee arthroplasty (TKA) needs to be done in staged manner. We propose a novel management in form of bifold fixation and simultaneous TKA. Methods Eight cases (6 females, 2 males) of supracondylar femoral fractures with severe osteoarthritis of the knee and osteoporosis were primarily fixed with bifold fixation using SIGN nail (www.signfracturecare.org) and locking plate together with simultaneous total knee arthroplasty. There were five cases (2 males and 3 females) of grade 4 (Kellgren-Lawrence grading) osteoarthritis (OA) and three cases (all females) of severe rheumatoid arthritis (RA). Results The mean age was 68 years and average time for full weight bearing was 6 days. Radiographic evidence of fracture union was achieved in 16.25 weeks. The mean Knee Society Score (KSS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score at 26 months was 83.13 and 22.13 respectively. Conclusions Single stage combined bifold osteosynthesis with interlocking nail and locking plate together with total knee arthroplasty helps in one time management of these difficult injuries. It is a cost-effective and economically sound option and gives excellent results with good patient satisfaction.

A Comparative Study to Evaluate the Effect of Blood Flow Restriction Therapy and Retro Walking on Pain, Strength of Muscles and WOMAC Score in Patients of Osteoarthritis of Knee

Aim: To assess the impact of blood flow restriction and retro walking in knee osteoarthritis subjects. Study Design: It was a comparative study. All the participants who meet inclusion criteria gave a written consent and were allocated to Group A or Group B randomly by chit method and the pre and post test scores were derived. The scores obtained in the two groups were compared and the results were derived. Place and Duration of the Study: This study was conducted in musculoskeletal sciences division, RNPC Sawangi, Wardha, for 12 months Methodology: A total of 150 samples were chosen. Using the chit method, they were divided into two groups at random, Group A and Group B. Blood Flow Restriction Training was given to Group A, while retro walking training was given to Group B. The training lasted 15 days. After 15 days, the pain, strength, and WOMAC score were tested again. Result: Out of 150 patients 75 were placed in each group, where p=.0001. Significant increase was seen in mean of group I and II in pre ad post-test NPRS score, Quadricep and hamstrings muscle strength and WOMAC score. Analysis showed significant improvement in both the groups. Conclusion: Both the interventions included in this study, have been shown to help individuals with osteoarthritis reduce pain, enhance strength, and improve their WOMAC score. Both the interventions are easy to practice and can be easily performed by the older population. When these two interventions were compared blood flow restriction therapy was proved to be better than retro walking.

Comparison of NSAIDS Versus NSAIDS Plus Duloxetine in Knee Osteoarthritis Patients

Objective: To compare the efficacy of Duloxetine with NSAIDS versus NSAIDS alone for the treatment of knee pain secondary to osteoarthritis. Study Design: Randomized clinical trial study. Setting and Duration: Department of Rheumatology, PIMS Hospital, Islamabad, from April to August 2021. Methodology: One hundred and twenty eight patients with knee osteoarthritis were included in the study and were divided in two equal groups; one group was subjected to Duloxetine plus NSAIDs and other to just NSAIDs. The response was assessed at end of 3 months. Reduction in pain more than or equal to 50% from the baseline was considered as efficacy. Results: The mean VAS score was 3.56±1.15 in group A (Duloexetine plus NSAIDS) A while in group B (NSAID alone), 4.45±1.22 and significantly (p-value > 0.05). Similarly, the comparison of WOMAC score for pain showed that the mean WOMAC score was significantly (P-value > 0.05) less 5.68±1.56 in group A in contrast to 6.39 ± 1.69 in group B. Comparison of efficacy between two groups showed that the rate of efficacy was significantly (P-value >0.05) higher in group A 48.4% as compared to 31.3% in group B. Conclusion: Addition of Duloxetine to NSAIDs resulted in more reduction of pain in terms of VAS and WOMAC score with acceptable adverse effects. Keywords: Chronic pain, Duloxetine, Knee pain, NSAIDs, Osteoarthritis

Comparison of short-time functional outcomes after TKA between Multigen Plus CR and Physica KR prostheses

Background Aim of this study was to compare functional results within 36 months following primary total knee arthroplasty (TKA) using a conventional prosthesis Multigen Plus CR and a new Physica KR implant. Our hypothesis was that the use of the Kinematics-Retaining design of an TKA implant leads to a significantly greater improvement in the active range of motion and better functional results (KSS 1, KSS 2 and WOMAC score) than the conventional CR implant at short-term follow-up. Materials and methods We retrospectively analysed data of 234 patients who underwent primary TKA at our hospital from April 2010 to August 2015 with the CR type of implant and from July 2014 to August 2015 with the KR implant due to advanced knee arthrosis of IIIrd and IVth grade of Kellgren-Lawrence classification, with no major ligamentous instability. Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) questionnaire, Knee Society Scores 1 (KSS 1) and 2 (KSS 2) and flexion (AROM) were recorded preoperatively and at 6, 12 and 36 months after surgery. Results Our study showed a statistically significant difference in functional results at three years with better KSS 1 score, a tendency to higher values in the KSS 2 score, as well as a statistically significant overall improvement in AROM in favour of the new KR design over the conventional CR implant with a post-hoc power analysis of 83.8%. We found that there was no statistically significant difference between groups when comparing WOMAC score and complications at short-term follow-up. Conclusions Our study provided more favourable clinical results for using Kinematics-Retaining implant in primary TKA. Further studies should focus on radiological and functional outcomes from mid- to long-term follow-up.

Effectiveness of intra-articular autologous-conditioned serum injection in knee osteoarthritis: a meta-analysis study

Aim: Knee osteoarthritis is a common disabling disorder, with no curative treatment. This study aims to assess autologous conditioned serum effectiveness in its treatment. Materials & methods: Following a systematic search (2000–2020) on major databases and screening and filtering processes, eight articles were included in the final analyses. The pooled effect of visual analog scale (VAS) and the Western Ontario and McMaster Universities (WOMAC) variables was evaluated before and after the intervention. Results: The combined standardized mean difference for the global WOMAC score was -2.44 and the combined weighted mean difference was -22.92. The combined standardized mean difference for the VAS score was -3.77 and the combined weighted mean difference was -32.37 (p < 0.000). Conclusion: This meta-analysis reported that the autologous conditioned serum can reduce pain and improve function (VAS and WOMAC outcome measures) in patients with knee osteoarthritis.

Double-high insert presents with worse mid-term outcomes in cruciate-retaining medial-pivotal total knee arthroplasty – a propensity score matched analysis with averaged 8-year follow-up

Background The aim of this study was to compare the mid-term clinical and radiographic outcomes between medial-pivotal (MP) insert and double-high (DH) insert used under cruciate-retaining condition in ADVANCE® total knee arthroplasty (TKA). Methods The follow-up was conducted for 158 consecutive patients underwent unilateral ADVANCE® TKA from January 2011 to April 2014. 84 MP inserts and 74 DH inserts were used under cruciate-retaining condition. A 1:1 propensity score matching (PSM) analysis was performed between MP insert and DH insert to compare the clinical and radiographic outcomes. Results After a 1:1 PSM, 120 patients (60 pairs) were matched between MP insert and DH insert. The baseline demographic parameters and clinical scores were comparable between the two groups. The postoperative clinical outcomes at an averaged 8-year follow-up of both groups were significantly improved. The range of motion (ROM) of DH group was better than that of MP group and equivalent Knee Society Function Score (KSFS) between the two groups was found. However, the Knee Society Score (KSS), Western Ontario and McMaster Universities Arthritis Index (WOMAC) score and Forgotten Joint Score (FJS) of MP group were found to be significantly superior than those of DH group. Comparable complication rate and revision rate were observed between the two groups. The radiographic results were also equally good between MP and DH group. Conclusions Although the mid-term clinical and radiographic outcomes of DH insert are fairly good, the clinical scores of DH group were worse than those of MP group.