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OBJECTIVE@#To compare the clinical effect of fire needling and filiform needling for mild to moderate knee osteoarthritis (KOA) and observe the influence on related serum inflammatory sytokines.@*METHODS@#A total of 60 patients with mild to moderate KOA were randomly divided into an observation group (30 cases, 4 cases dropped off) and a control group (30 cases, 4 cases dropped off). Both groups were given basic health management, and the acupoints of the two groups were Liangqiu (ST 34), Xuehai (SP 10), Neixiyan (EX-LE 4), Dubi (ST 35), Yanglingquan (GB 34) and @*RESULTS@#At each time point of treatment and follow-up, the pain, stiffness, difficulty of daily activities scores and WOMAC total scores of the two groups were lower than those before treatment (@*CONCLUSION@#Fire needling can improve the pain, stiffness and joint dysfunction of patients with mild to moderate KOA, and increase serum MMP-3 and IL-1α levels. Its short and long term clinical effects are better than filiform needling.
Subject(s)
Humans , Acupuncture Points , Acupuncture Therapy , Cytokines , Osteoarthritis, Knee/therapy , Treatment OutcomeABSTRACT
Abstract Background: Intra-articular injections of platelet-rich plasma to treat symptoms of knee osteoarthritis have been successfully used in young patients. However in most of these studies the control and test knees were present in different patients thus incorporating a large amount of bias in the results. Therefore, the present study was designed in which patients with bilateral osteoarthritis knee were included and platelet-rich plasma was administered in one knee and normal saline in another knee of same patient. Methods: 20 patients aged 30-65 years with bilateral osteoarthritis knees (ASA class I and II) of either gender were included in the study. Patients were randomized to receive platelet-rich plasma and normal saline in one of the two knees. The primary outcome was VAS and WOMAC score at 6 months after procedure. The secondary outcome included changes in joint stiffness, physical function, any adverse effects noted during the course of study. Results: The baseline VAS score in platelet-rich plasma knee was 8.4 ± 0.88 which improved significantly to 4.85 ± 2.48 (p < 0.001) at 6 months as compared to normal saline knee (p = 0.017). The WOMAC pain score also improved from baseline (14.5 ± 1.3) to over 6 month 7.00 ± 4.24 (p < 0.001) in platelet-rich plasma knee while in the normal saline knee, no significant change occurred from baseline to six months (10.2 ± 1.2 to 10.05 ± 1.23). There was also significant decrease in stiffness and improvement of physical activity in the platelet-rich plasma knee as compared to normal saline knee. Conclusion: The present study showed significant decrease in pain and stiffness and improvement of physical functions of knee joint with intra-articular platelet-rich plasma injection as compared to normal saline.
Resumo Justificativa e objetivos: Injeções intra-articulares de plasma rico em plaquetas têm sido usadas com sucesso para tratar os sintomas da osteoartrite de joelho em pacientes jovens. Porém, na maioria desses estudos, os joelhos de controle e teste estavam presentes em diferentes pacientes, o que incorporou uma grande quantidade de viés aos resultados. Portanto, o projeto do presente estudo incluiu pacientes com osteoartrite em ambos os joelhos, com a administração de plasma rico em plaquetas em um dos joelhos e de solução salina normal no outro joelho do mesmo paciente. Métodos: 20 pacientes, de ambos os sexos, com idades entre 30-65 anos e portadores de osteoartrite bilateral de joelho (classificação ASA I e II) foram incluídos no estudo. Os pacientes foram randomizados para receber plasma rico em plaquetas e solução salina normal em um dos dois joelhos. O desfecho primário foram os escores VAS e WOMAC seis meses após o procedimento. O desfecho secundário incluiu alterações na rigidez articular, função física e qualquere feito adverso observado durante o curso do estudo. Resultados: O escore VAS basal para o joelho que recebeu plasma rico em plaquetas foi 8,4 ± 0,88 e melhorou significativamente para 4,85 ± 2,48 (p < 0,001) após seis meses, comparado ao joelho que recebeu solução salina normal (p = 0,017). A intensidade da dor avaliada com o WOMAC também melhorou de 14,5 ± 1,3 na fase basal para 7,00 ± 4,24 após seis meses (p < 0,001) nos joelhos que receberam plasma rico em plaquetas, enquanto nenhuma mudança significativa ocorreu nos joelhos que receberam solução salina normal entre a fase basal e após seis meses (10,2 ± 1,2 a 10,05 ± 1,23). Além disso, houve uma diminuição significativa da rigidez e melhora da atividade física nos joelhos que receberam plasma rico em plaquetas, comparados aos joelhos que receberam salina normal. Conclusão: O presente estudo identificou uma diminuição significativa da dor e da rigidez e uma melhora das funções físicas da articulação do joelho com a injeção intra-articular de plasma rico em plaquetas, comparada à solução salina normal.
Subject(s)
Humans , Male , Female , Adult , Aged , Arthralgia , Arthralgia/etiology , Osteoarthritis, Knee/complications , Platelet-Rich Plasma , Pain Management/methods , Knee Joint , Double-Blind Method , Treatment Outcome , Injections, Intra-Articular , Middle AgedABSTRACT
Background: Osteoarthritis (OA) is a joint failure and OA is the most frequent chronic joint disease causing pain and disability. Where all the structures of joints have undergone pathological changes and they are hyaline articular cartilage loss which may be focal or non-uniform, initially it will be focal then spread all over non-uniformly. Non-Steroidal Anti Inflammatory Drugs (NSAID) are the mainstay of medical management of OA. Increased in reports suggests that GIT adverse effect with old NSAID’s and cardiovascular effects with selective cyclooxygenase-2 (COX2) inhibitors had precipitated to chase for better NSAID’s with minimal adverse effects. The current study compares the clinical effectiveness and safety of newer NSAID’s, etoricoxib, lornoxicam, to diclofenac which has been standard therapy in patients of OA of the knee joint.Methods: The current study is randomized, prospective, open-label, parallel group study conducted in 120 patients with OA of the knee joint diagnosed using American College of Rheumatology criteria. After getting the informed consent, they were randomized in three groups of 40 patients each who received tablet etoricoxib 120mg BID, tablet Lornoxicam 16mg BID, tablet diclofenac 50mg TID respectively. The duration of the study is 12 weeks. Data are calculated, tabulated and analyzed using analysis of variance (ANOVA) test, and level of significance was determined by its P value.Results: After 12weeks of treatment, the severity of pain and functional indices using visual analog scale and Western Ontario and McMaster Universities Osteoarthritis score were significantly better (P <0.05) in etoricoxib group as compared to lornoxicam or diclofenac group along with a lesser rate of adverse effects.Conclusions: It is concluded that etoricoxib is more effective and tolerated NSAID than lornoxicam and diclofenac in the treatment of knee joint OA.
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Objective To investigate the effect of acupuncture and moxibustion plus Zushima on serum vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (b FGF) in patients with knee osteoarthritis.Method Two hundred and thirty-six patients with knee osteoarthritis were allocated, using a random number table, to two groups, 118 cases each. The control group was treated with Celecoxib and the observation group, with acupuncture and moxibustion plus Zushima. The therapeutic effects, and pre-treatment and post-treatment VAS scores and WOMAC scores and serum VEGF and bFGF levels were compared between the two groups of patients. The adverse reaction incidences were compared between the two groups of patients. Result The total efficacy rate was 87.3％ in the control group and 94.9％ in the observation group and was significantly higher in the observation group than in the control group (P<0.05). There were no statistically significant pre-treatment differences in the VAS score and WOMAC score between the two groups (P>0.05). The VAS score and WOMAC score decreased significantly in both groups after treatment (P<0.05). After treatment, there was no statistically significant difference in the VAS score between the two groups (P>0.05) but the WOMAC score was significantly lower in the observation group than in the control group (P<0.05). There were no statistically significant pre-treatment differences in VEGF and bFGF between the two groups (P>0.05). After treatment, VEGF and bFGF decreased significantly in both groups (P<0.05) and were significantly lower in the observation group than in the control group (P<0.05). The adverse reaction incidence was3.4％ in the control group and 1.7％ in the observation group with no statistically significant difference between the two groups (P> 0.05). Conclusion Acupuncture and moxibustion plus Zushima can reduce inflammatory reactions, inhibit synovial angiogenesis, and effectively relive the pain, and improve articular functions in the treatment of knee osteoarthritis.
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Objective To study the correlation between knee biomechanics and clinical manifestation in adults with Kaschin-Beck disease(KBD). Methods Three hundred and eighty-nine digital radiographic X-ray (DR)anteroposterior keen films of adult KBD patients diagnosed at the Center for Disease Control and Prevention of Gansu Province from Sep 2012 to Sep 2016 were taken as subjects of observation and were retrospectively reviewed. Every patient must undergo a WOMAC function evaluation for knee joint and biomechanic angle measure for the lower limbs on the DR film which included femur angle, tibial angle, femur-tibial angle and joint space angle, Insall-Salvati index (LT/LP), and LT/HI index. Then, the regression equation was built and the correlation analysis was made with multiple linear regression test. Results Three hundred and eighty-nine patients' average scores of femur angle(X1),tibial angle(X2),joint space angle(X3),femur-tibial angle(X4),LT/LP index(X5),LT/HI index (X6) and WOMAC evaluation were (76.32 ± 2.05)°, (110.65 ± 4.68)°, (4.73 ± 0.91)°, (137.56 ± 2.29)°, 0.98 ± 0.12, 1.73 ± 0.11, and (61.35 ± 7.68) scores. By multiple linear regression test, femur angle, tibial angle, femur-tibial angle,LT/LP index, and LT/HI index were selected to enter into the equation; while, joint space angle was rejected. The multiple linear regression equation was as follows: Y = - 77.307 - 6.327X6+ 1.360X1+ 1.310X5+ 0.331X4-0.147X2.The adjusted determination coefficient (R2) of the equation was 0.958. Through variance analysis, the fitted equation had statistical significance (F = 1 790.391, P < 0.05). Through two- tailed significance test, the above-mentioned 5 indexes that were adopted to enter this question were in significant correlation with WOMAC scores(P<0.05).Conclusion There is a significant correlation between knee biomechanic angle and WOMAC scoring in adults with KBD,which is reflected with the following parameters from big to small in turn:femur angle,tibial angle, LT/LP index,femur-tibial angle,LT/HI index,.
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Objective To investigate the clinical efficacy of thumb-tack needle therapy for the early and middle stages of senile knee osteoarthritis.Method Sixty patients were allocated, using a random number table, to observation and control groups, 30 cases each.Thecontrol group took meloxicam tablets7.5 mg once daily and the observation group received thumb-tack needle therapy8 hrs once daily inaddition.Liangqiu(ST34), Xiyangguan(GB33), Neixiyan(Ex-LE4), Dubi(ST35), Yinlingquan(SP9),Yanglingquan(GB34)and Ashipoint were selected forthumb-tack needle therapy.Both groups were treated five times a week for two consecutive weeks.The WOMAC score and the Lysholm score were recorded before and after treatment.Theclinical therapeutic effects were evaluated.Result The total efficacy rate was 93.3% inthe observation group and 80.0% in the control group.It was higher inthe observation group thanin the control group and there was a statistically significant difference (P<0.05). The WOMAC score decreased and the Lysholm score increased in both groups after treatment; there were statistically significant pre-/post-treatment differences (P<0.05).after treatment, the WOMAC score and the Lysholm score improved more inthe observation group than in the control group; there were statistically significant differences (P<0.05).Conclusion Thumb-tack needle therapyhas a definite effect on the early and middle stages of senile knee osteoarthritis.It can relieve the pain and improveknee functionin the patients.
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Background: Osteoarthritis, a whole organ disease is diagnosed on clinical and radiological features, but plain radiographs show changes only in moderate to advanced stage of disease. Biochemical marker such as Hyaluronic Acid (HA) is used as a diagnostic tool in early stages. Hyaluronic acid level estimation has limited use in developing world due to cost and availability. Methods: A case-control study was done to correlate role of WOMAC score and serum Hyaluronic acid levels in knee osteoarthritis. All subjects were asked to fill the WOMAC questionnaire and were subjected to knee radiography. Blood samples of all subjects were tested for serum levels of Hyaluronic acid by Enzyme Linked Immuno-Sorbent Assay (ELISA). The assessment of severity was done by K-L grading of the radiographs. Results: The mean age in case group was 51.28 ± 7.93 years and in control group was 46.08 ± 4.81 years (P <0.001). A statistically significant difference in WOMAC score, HA levels and K-L grading of cases and controls was found (P <0.001). The results show a mild association of HA (r=0.421), moderate association of age (r=0.570), and strong association of K-L grade (r=0.910) with WOMAC scores and all these associations were highly significant (p<0.001). Multivariate analysis shows only WOMAC score >60 is independently associated with the outcome. Conclusion: WOMAC scores are significantly associated with knee osteoarthritis and can play a crucial role in identification, gradation and management of patients with knee osteoarthritis and can be used singly along with clinical features in situations where treatment cost and assessment of serum HA levels is of concern.
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PURPOSE: The purpose of this study was to evaluate the results of ceramic-on-ceramic bearing primary total hip arthroplasty (THA) using cemented femoral stems and cementless femoral stems. MATERIALS AND METHODS: We studied 59 cases (52 patients) of THAs using ceramic-on-ceramic bearing cemented femoral stems and 64 cases (58 patients) of THAs using ceramic-on-ceramic bearing cementless femoral stems. All THAs were performed between January 2004 and February 2005 and were followed up for more than 3 years. The clinical results were evaluated using the Harris hip score (HHS), WOMAC score, sense of discomfort, and thigh pain. Radiographic results were assessed with serial radiographs. RESULTS: The mean HHS improved from 62.7 points preoperatively to 92.4 points at the last follow-up in the cemented stem group and improved from 61.5 points to 91.8 points in the cementless stem group (p>0.05). And mean WOMAC score improved from 37.9 points to 7.0 points in the cemented stem group and from 38.5 points to 12 points in the cementless stem group (p<0.05). There were 5 patients with a sense of discomfort and 9 patients with thigh pain in the cementless stem group and no cases in the cemented stem group. There were no instances of acetabular loosening in either group. Subsidence of the cemented femoral stem was less than 1 mm in 57 cases and less than 2 mm in 2 cases. All cementless femoral stems acquired firm bony union. CONCLUSION: Ceramic-on-ceramic bearing THA using a cemented stem showed clinical results superior to those achieved using a cementless stem. Cemented THA is thought to be good for complementing the problems caused by the hardness of ceramic-on-ceramic bearings.