Prevalence and interference of neuropathic pain in the quality of life in patients with knee osteoarthritis

Abstract Objective: With the aging of the population, more patients have complained of pain due to knee Osteoarthritis (OA), and the number of arthroplasties has also increased. The objective of this study is to evaluate the prevalence of the neuropathic pain component in candidates for Total Knee Replacement and the effects of this component on their quality of life. Methods: In this cross-sectional study, patients with OA candidates for knee arthroplasty in the present institution were evaluated using the pain detection questionnaire and the Visual Analog Pain (VAS) scale to measure the pain index and the presence of associated neuropathic pain. In addition, evaluation of the quality of life and functionality using the EQ5D and SF12 questionnaires and their relationship with cases of neuropathic pain were performed. Results: One hundred twenty-six patients were evaluated, and 71.4 % were female. The age ranged from 46 to 85 years, and about 70 % of the patients had some associated clinical comorbidity. Neuropathic pain was present in 28.6 % of the patients evaluated. Patients with neuropathic pain presented worse results in the VAS evaluation, in the care, pain, and anxiety domains of the EQ5D, and in the physical and mental scores of the SF12. Conclusion: Neuropathic pain was present in 28.6 % of the patients with knee OA who are candidates for arthro-plasty. Patients with associated neuropathic pain present a higher level of pain and worse quality of life scores. Recognizing this type of pathology is extremely important in fully monitoring gonarthrosis.

Artroscopia de rodilla en pacientes mayores de 64 años con gonartrosis primaria / Knee Arthroscopy In Patients Over 64 Years Of Age With Primary Gonarthrosis

Introducción: La gonartrosis es una entidad frecuente, que afecta especialmente a personas mayores de 60 años de edad. Para su tratamiento se combinan modalidades conservadoras y quirúrgicas y dentro de esta última, las realizadas por la vía artroscópica. Objetivo: Evaluar los resultados de las técnicas quirúrgicas por vía artroscópica en pacientes con gonartrosis primaria mayores de 64 años de edad. Métodos: Se realizó un estudio pre experimental de diseño (preprueba-posprueba) en 40 pacientes mayores de 64 años tratados por vía artroscópica con el diagnóstico de gonartrosis primaria, en el Hospital Universitario Manuel Ascunce Domenech de la ciudad de Camagüey de octubre 2012 a mayo de 2019. La investigación tiene un nivel de evidencia IV y recomendación D. Resultados: El promedio de edad de los pacientes estudiados fue de 69,6 años con predominio del sexo femenino sobre el masculino, y una razón de 3:1. La afección tricompartimental predominó en la mayoría de los enfermos, así como el grado IV según la clasificación de Outerbridge. Predominaron las lesiones de cartílago y meniscos asociadas. Los tratamientos por vía artroscópica más empleados fueron el desbridamiento y la meniscectomía parcial. Se detectó significación estadística entre un antes y un después. Conclusiones: Los resultados de la investigación muestran que los procedimientos realizados a través de la vía artroscópica en pacientes mayores de 64 años de edad con gonartrosis primaria son efectivos en más de la mitad de los enfermos(AU)

Introduction: Gonarthrosis is a common entity that especially affects people over 60 years of age. For its treatment, conservative and surgical modalities are combined, and within the latter, those carried out by the arthroscopic route. Objective: To evaluate the results of arthroscopic surgical techniques in patients with primary gonarthrosis older than 64 years of age. Methods: A pre-experimental design study (pre-test-post-test) was carried out in 40 patients older than 64 years treated arthroscopically due to the diagnosis of primary gonarthrosis, at Manuel Ascunce Domenech University Hospital in Camagüey from October 2012 to May. of 2019. The research has a level of evidence IV and recommendation D. Results: The average age of the patients studied was 69.6 years, with a predominance of females, and a ratio of 3:1. Tricompartmental involvement prevailed in most of the patients, as well as grade IV according to the Outerbridge classification. Associated cartilage and meniscus injuries predominated. The most used arthroscopic treatments were debridement and partial meniscectomy. Statistical significance was detected between before and after. Conclusions: The results of the investigation show that the procedures carried out through the arthroscopic route in patients older than 64 years of age with primary gonarthrosis are effective in more than half of the patients(AU)

Proloterapia en la gonartrosis

RESUMEN La gonartrosis es una entidad muy frecuente y afecta a un grupo numeroso de pacientes en especial a los mayores de 40 años. El tratamiento conservador constituye la primera línea e incluye la proloterapia. El propósito de este estudio es actualizar los conocimientos en relación al uso de la proloterapia en pacientes con gonartrosis. La búsqueda y análisis de la información se realizó en un periodo de 2 meses (primero de febrero de 2020 al 30 de abril de 2020) y se emplearon las siguientes palabras: prolotherapy, regenerative injection therapy and chronic musculoskeletal pain. A partir de la información obtenida se realizó una revisión bibliográfica de un total de 203 artículos publicados en las bases de datos PubMed, Hinari, SciELO y Medline mediante el gestor de búsqueda y administrador de referencias EndNote, de ellos se utilizaron 39 citas seleccionadas para realizar la revisión, de ellas 32 de los últimos cinco años, además se consultó un libro. Se mencionan las concentraciones a emplear tanto intra- como periarticular, indicaciones y mecanismos de acción. Se describen la frecuencia de su aplicación, así como la comparación con otros métodos de tratamiento por vía intraarticular. Se hace referencia a la duración de su efecto y complicaciones. La proloterapia mediante la administración de dextrosa hipertónica intraarticular es un método útil en el tratamiento de pacientes con gonartrosis, su fácil aplicación, disponibilidad y bajo índice de complicaciones lo convierten en un método conservador factible y eficaz.

ABSTRACT Gonarthrosis is a very frequent entity and affects a large group of patients especially above 40 years, conservative treatment is the first line and includes prolotherapy. To update knowledge regarding the use of prolotherapy in patients with gonarthrosis. The information was searched and analyzed over a period of two months (February 1, 2020 to April 30, 2020) and the following words were used: prolotherapy, regenerative injection therapy and chronic musculoskeletal pain. Based on the information obtained, a bibliographic review of a total of 203 articles published in the PubMed, Hinari, SciELO and Medline databases was carried out using the search manager and reference manager EndNote, 39 selected citations were used to make the review, including 32 of the last five years, also consulted a book. The concentrations to be used both intra and periarticular, indications and mechanisms of action are mentioned. The frequency of its application is described, as well as the comparison with other intra-articular treatment methods. Reference is made to the duration of its effect and complications. Prolotherapy by administering intra-articular hypertonic dextrose is a useful method in the treatment of patients with gonarthrosis, its easy application, availability and low complication rate make it a feasible and effective conservative method.

Eficacia de la viscosuplementación con ácido hialurónico de alto y de mediano peso molecular en pacientes con gonartrosis sintomática grados II-III / Efficacy of viscosupplementation with high and medium molecular weight hyaluronic acid in patients with symptomatic gonarthrosis grades II-III

Resumen: Introducción: La osteoartrosis es actualmente la quinta causa de discapacidad en el adulto. Su prevalencia aumenta a partir de los 40 años. La viscosuplementación es un tratamiento para las etapas iniciales de la osteoartrosis de rodilla. Objetivo: Comparar la eficacia y la calidad de vida en pacientes con gonartrosis sintomática tratados con ácido hialurónico de alto y mediano peso molecular. Material y métodos: Estudio analítico, retrospectivo, transversal, observacional de expedientes clínicos de pacientes con diagnóstico de gonartrosis grado II y grado III, de Octubre de 2017 a Junio de 2018, tratados con viscosuplementación con ácido hialurónico de alto o de mediano peso molecular; se analizó la calidad de vida y la escala de WOMAC de manera previa a la primera aplicación y con seguimiento a los dos, cuatro y seis meses. Resultados: 194 pacientes, con edades entre 30 y 87 años (promedio 61.85; DE = 11.3); 134 mujeres (69.1%) y 60 hombres (30.9%). En ambos grupos la evolución fue hacia la mejoría, con disminución en el puntaje WOMAC, sin diferencia significativa entre grupos. El puntaje de WOMAC tuvo un aumento mínimo pasados seis meses de la aplicación en ambos grupos, lo que se interpreta como disminución del efecto terapéutico. Dos pacientes tuvieron reacciones adversas mínimas localizadas, las cuales se resolvieron con medidas generales. Conclusión: El ácido hialurónico en ambas presentaciones, de alto y de bajo peso molecular, es efectivo en el tratamiento de la gonartrosis sintomática sin diferencia con el peso molecular.

Abstract: Introduction: OA is currently the fifth leading cause of adult disability, its prevalence increases from age 40. Viscosupplementation is a treatment for the early stages of knee OA. Objective: To compare efficacy and quality of life in patients with symptomatic gonartrosis, treated with high and low molecular weight hyaluronic acid. Material and methods: Analytical, retrospective, cross-sectional, observational study of clinical records of patients diagnosed with grade II and grade III gonarthrosis, October 2017 to June 2018, treated with viscosupplementation with high molecular weight hyaluronic acid or low molecular weight; WOMAC quality of life and scale were analyzed prior to the first application and tracked at two, four and six months. Results: 194 patients, aged between 30 to 87 years (promedio 61.85; SD = 11.3); 134 women (69.1%), 60 men (30.9%). In both groups the evolution was towards improvement, with a decrease in the WOMAC score, with no significant difference between groups. The WOMAC score had a minimum increase after 6 months of application in both groups, which is interpreted as decreasing the therapeutic effect. Two patients had localized minimal adverse reactions which were resolved with general measures. Conclusion: Hyaluronic acid in both presentations, high and low molecular weight, are effective in the treatment of symptomatic goonarthrosis without difference to molecular weight.

Inheritance and verification research of Professor Tian Cong-huo's clinical experience on degenerative gonarthrosis treatment / 国际中医中药杂志

Objective To find a method to inherit the experiences of famous senior TCM physicians,through verification and inheritance research of Professor Tian Cong-huo's clinical experience on degenerative gonarthrosis treatment.Methods By means of database of famous senior TCM physicians and various data explore methods,we performed multi-group controlled verification on Professor Tian Cong-huo's acupuncture prescription on degenerative gonarthrosis,in order to investigate the experience thoroughly.Results The three groups treated by Professor Tian Cong-huo's acupuncture prescription got similar therapeutic effects,and patients' symptoms have been relieved remarkably.Compared with the baseline,the scores of the knee joint ache in the group of Professor Tian,Successor,Senior and Control were decreased 1.20 (t=9.00,P＜0.05),1.13 (t=15.76,P＜0.01),1.1 (t=15.99,P＜0.05) and 1 (t=10.42,P＜0.05),respectively.Significant improvements of pain relieves had been achieved in all groups.No significant difference was observed among the previous three groups(F=2.64,P＞0.05),which had obvious improvement effect in comparing with the control group(t=3.81,P＜0.01).Conclusion demonstrated that the group of Professor Tian,the successor,and the senior each did better in knee pain-relief than the control group.Conclusion Confirmed by our research,this acupuncture prescription proves to be repeatable,safe,reliable and stable.Perfoming inheritance and verification research of famous and senior TCM physicians could help juniors learn and investigate their predecessors academic thoughts and connotation,proceed to the next step,inherit the precious experience through verification and combination of theory and practice.

<b>Four Patients with Various Symptoms of Non-Gastrointestinal </b><b>Disorder Successfully Treated with Rikkunshito </b> / 日本東洋医学雑誌

Rikkunshito is known as a drug used for recovery from epigastric distress and loss of appetite. However, here we report four patients with symptoms involving non-gastrointestinal disorders successfully treated with rikkunshito. In Case 1 there was a complaint of erythema around the right eye, in Case 2 of hot flushes, in Case 3 of gonarthrosis, and in Case 4 of urticaria. After taking rikkunshito, these symptoms improved. The four cases were instances of <i>hikyo</i>, because in Cases 1, 3, 4 their disorders of the stomach were so severe that they couldn't take shishihakuhito, boiogito, jumihaidokuto and inchingoreisan, and in Case 2 there was poor appetite in summer. Thus we believe it is important to improve gastrointestinal symptoms with rikkunshito when various <i>hikyo </i>disorders arise.

Principales aspectos clínicos y endoscópicos de la enfermedad degenerativa de la rodilla / Main clinical and endoscopical aspects of the degenerative knee disease

Se realizó un estudio descriptivo y transversal de 100 pacientes atendidos en el Servicio de Reumatología del Hospital Provincial Docente Saturnino Lora de Santiago de Cuba con el diagnóstico de artropatía degenerativa de la rodilla, durante el período 2003-2007, a fin de caracterizarles según los principales aspectos clínicos y endoscópicos de esta afección. Entre los principales resultados sobresalieron: los pacientes con más de 60 años y el sexo femenino. La gonartrosis y la condromalacia constituyeron los hallazgos endoscópicos fundamentales y como opciones terapéuticas más empleadas, predominaron el legrado y el lavado articularAU)

A descriptive and cross-sectional study with one-hundred patients having a diagnosis of degenerative knee arthropathy treated at the Rheumatology Service in Saturnino Lora University Hospital from Santiago de Cuba was carried out between 2003 and 2007 in order to characterize them according to the main clinical and endoscopical aspects of this disorder. Among the most important results, 60-year-old and over patients and female gender were relevant. Gonarthrosis and condromalacy constituted the main endoscopical findings while curettage and articular wash-out, being the therapeutical alternatives most used, were predominant.

Effect of "Jingu Tongxiao Wan" on Blood Stasis and Cold Coagulation Type Gonarthrosis(120 Cases) / 中国康复理论与实践

@#Objective To observe the effect of "Jingu Tongxiao Wan" on blood stasis and cold coagulation type gonarthrosis.Methods 160 patients with blood stasis and cold coagulation type gonarthrosis were divided into the "Jingu Tongxiao Wan" group(group A)with 120 cases(treated with "Jingu Tongxiao Wan" 6 g/time,2 times/d)and "Guci Pian" group(group B)with 40 cases(treated with "Guci Pian" 3 tablets/time,3 times/d).Indexes of effect and safe were observed after one month.Results 23 cases were healed,63 cases were excellent,9 cases were utilitied,9 cases were invalid,total effective rate was 93.8% in the group A.While,in the group B,7 cases were healed,21 cases were excellent,9 cases were utilitied,3 cases were invalid,total effective rate was 92.5%.There was no significant difference between two groups(P>0.05).Scores of sings and symptoms before and after treatment were 8.98±2.24 and 2.15±1.71 respectively in the group A,and 8.29±2.35 and 2.25±1.25 respectively in the group B.The scores after treatment were significantly different from that before treatment in each group(P<0.01),and no significant difference between scores of the group A and group B after treatment(P>0.05).Conclusion The treatment of "Jingu Tongxiao Wan" shows an obvious effect and safe on blood stasis and cold coagulation type gonarthrosis.

The Change of Mechanical Angle after High Tibial Osteotomy using Blade Plate / 대한정형외과학회잡지

PURPOSE: To search cause of recurrence of varus deformity and to correlate the mechanical angle of the knee joint at the third postoperative month following high tibial osteotomy to the final mechanical angle and to the clinical results. MATERIALS AND METHODS: Study of thirty knee joints with lateral closed wedge osteotomy and fixation with 90-degree angle blade plate. Plateau-Blade angle was measured to evaluate the loss of correction at the osteotomy site. At the third postoperative month, the knees were divided into two groups according to the mechanical angle. Group I included the patients with valgus angle (16 knees) and group II included the patients with varus angle (14 knees) . The final mechanical angle was measured and the clinical results were evaluated with the knee score and the function score of Knee Society. RESULTS: Plateau-Blade angle decreased 2.5 in group I and 4.8 in group II at postoperative three month. At the final follow-up, the loss of correction angle was 0.8 in group I and 2.3 in Group II (p>0.05) . The final knee score was 86 in group I and 80 in group II (p>0.05) . The final function score was 90 in Group I and 80 in Group II. CONCLUSIONS: Because the final function score of valgus angle group is superior to that of varus angle group and recurrence of varus was mainly occur within postoperative three months, meticulous postoperative management needed to maintain valgus mechanical angle.

Therapeutic Effect of Coix Seed Extract Drug on Hydrathrosis in Patients under Hemodialysis / 日本東洋医学雑誌

Yokuinin, coix seed extract, has been used to regulate gastric functions and to reduce pathological water retention. This paper reports the effect of Yokuinin on controlling hydrarthrosis for patients with arthralgia. Seventeen patients who have had maintenance hemodialisis for an average of 12.7 years and who have suffered hydrarthrosis with arthralgia have been tested. There are 7 male and 10 female patients, with an average of age of 63.4. The hydrarthrosis of the patients resulted from dialysis arthropathy and gonarthrosis. The patients were provided with 3 to 6 tablets of Yokuinin (Yokuinin extract tablet “Kotaro”) a day, and the effect on hydrarthrosis was measured after 3 weeks. The dosage of Yokuinin was 0.33g in 3 tablets. Yokuinin was effective on 14 patients (hydrarthrosis was reduced), relatively effective on 2 patients, and not effective on one patient. This shows an efficacy rate of 82.8%. Arthralgia was reduced for 12 patients, and analgesia was seen in 3 patients. Effective reduction of hydrarthrosis by this medicine was observed: 5 cases out of 6 for patients with dialysis arthropathy (83.3%); 6 cases out of 7 for gonarthrosis (85.7%); and 3 cases of 4 for other diseases (75.0%)—a total of 82.8%. The patient for whom the drug was not effective was suffering from acute hydrarthrosis. Side effects were not observed except for indigestion and cramps. These results suggest that Yokuinin is an effective medicine to control hydrarthrosis with arthralgia for patients under hemodialysis.

Total Knee Arthroplasty using TC IV / 대한정형외과학회잡지

The proper distribution of stress & a low rate of wear has become major concern in recent design consideration of total knee prosthesis. The TC IV knee system has kept the original anatomical design of the total condylar knee and improved and refined it. And it has some characteristics: deep patellar groove of the femoral component, 5 degree posterior tilted tibial UHMWPE articulating surface with increased potential range of motion, and beaded porous coating applied to the bone-component interface. This study reports the consecutive 61 arthroplasties in 42 patients. Follow up period was average three years and six months. There were 29 osteoarthritis, 29 rheumatoid arthritis, and three infection sequelae. In all cases, we used TC IV prosthesis, bone-cement for prosthesis fixation and sacrificed PCL. All patients were assessed using HSS knee score and American knee society clinical rating system, and roentgenographic evaluation and scoring system. 1. The range of motion was significantly increased from average 87.8 degrees preoperatively to average 122.9 degrees postoperatively. 2. The HSS knee score increased from average 47.7 points preoperatively to average 90.9 points postoperatively, and the functional score of AKS was average 85.6 and knee score was 93.4 postoperatively. 3. The flexion contracture was decreased from average 29.3 degrees preoperatively to average 3.9 degrees postoperatively. 4. In radiological review, the tibiofemoral angle changed from average varus 1.5 degrees preoperatively to average valgus 6.3 degrees postoperatively, and the joint line changed average 9.3mm preoperatively to average 13.7mm postoperatively, and nine knees(14%) had a radiolucency with a width of 2mm or more beneath one or two tibial zone. 5. Complications included two superficial infections and each case of transient peroneal palsy and patellar component wear in the metal backing type. 6. In summary, although the follow-up period was short, functional score of TC IV is no less than that of the other prosthesis with PCL retention.

Usefulness of Hachimi-jio-gan and other Kampo Drugs for Gonarthrosis / 日本東洋医学雑誌

We examined the clinical usefulness of Hachimi-jio-gan and other Kampo drugs for the senile patient suffering from gonarthrosis. Kampo drugs were administered referring not only to “Sho”but also roentgenograph of the knee joint. Hachimi-jio-gan was effective for the senile patients with gonarthrosis, while application of the “Seinetu-Risuizai”, drugs which clear away heat-evil and promote diuresis, were required in cases accompanied by excessive pathogenic dampness-heat combination, swelling and deformity of the Knee joint. Kampo drugs for senile patients are extremely useful because they have few side effects and provide high quality healing.

Total Knee Replacement in Gonarthrosis / 대한정형외과학회잡지

We studied the results in forty-three knees in thirty patients-three male and twenty seven femalewho had rheumatoid arthritis, osteoarthritis, traumatic arthritis and osteonecrosis in the knee and were treated by total knee joint replacement. The average age of the patients was 56.7 years. The results were anaysed after follow-ups ranging from one year to three years and seven months, average being 23.6 months. The assessment was made upon the knee rating system of the Hospital for Special Surgery; the results were excellent in 29 knees, good in 12, fair in one and poor in one. The improvement of the flexion contractures was significant (postoperative average 1.7 degrees compared with preoperative average 20.1 degrees). The postoperative active flexion ranged from 70 degrees to 140 degrees (mean 110.2 degrees). One knee had a deep wound infection. The radiological loosening demonstrated in three cases, two of them had incomplete, nonprogressive radiolucent line, being less than one millimeter in width in the tibial component, one who had a deep infection showed three millimeters radiolucent line.