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Objective To understand the current status of surgical treatment for hemophilia osteoarthropathy (HO) in China. Methods Using an online questionnaire, select domestic hospitals that partici-pated in the compilation of the 'Guideline for perioperative management of hemophilia patients undergoing orthopaedic surgery in China ', in addition to members of the National Joint Surgery Group, and the Orthopedic Branch of the Chinese Medical Association for targeted investigation and analysis. Results A total of 17 domestic hospitals were included, all of which were general hospitals. Hospitals that started HO surgery treatment before 2000 accounted for 35.29%. A total of 3057 surgical cases of HO were reported by those hospitals. The most commonly performed surgical procedures were hip and knee joint replacement. The most commonly used coagulation factor replacement regimen was recombinant coagulation factor preparation. Ten hospitals reported finding patients with transfusion-related infectious diseases. Bleeding and hematoma formation were the most frequently reported surgical complications. Excessive length of hospital stay and high economic costs were the most frequently reported problems. Conclusions Surgical treatment for HO in 17 hospitals is mainly carried out in some large comprehensive medical centers in the eastern region. Compared with the patient base, the popularity and number of surgeries are still relatively insufficient. It is necessary to further standardize the treatment system by standardizing factor replacement and strengthening rehabilitation to improve surgical treatment outcomes.
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Objective:To explore the diagnostic value of motion pain induction test for early knee osteoarthritis.Methods:A cross-sectional study was conducted and the data came from The Project of Health Management of Knee osteoarthritis in Community in Hangzhou in 2018, and a total number of 1 816 people were included which were divided into normal group ( n=530), early group ( n=534) and middle-late group ( n=752) by not sick, sick while Kellgren-Lawrence (KL) ≤Ⅱ and sick while KL>Ⅱ starting, squatting, walking up and down stairs and doing housework were included in the test, and the statistical indicators included age, gender and pain scores (visual analogue scale, VAS). Receiver operating characteristic (ROC) curves were mapped after the correlation analysis to obtain the cut-off points and compare their values of area under the curve (AUC). The confounders which included age and gender were corrected by propensity score matching (PSM) and the balance test is consistent with P>0.05 after the PSM. The Kappa analysis was used to verify the consistency of two diagnostic methods. Results:The age of normal, early and medial-late groupwas 67.39±7.43, 67.41±9.52, 71.55±9.87. And the gender distribution of three groups was (238 male, 292 female), (209 male, 325 female), (357 male, 395 female). There was no heterogeneitybetween the normal group and early group in distribution ( P>0.05) while there was heterogeneity between the early and medial-late group ( t=-0.034, P<0.05; χ2=8.80, P<0.05). The VAS scoresof starting pain in three groups was 0.16±0.37,2.70±1.69, 3.68±2.10. The VAS scoresof squatting pain was 0.42±0.49, 2.88±1.44, 4.01±2.08. The VAS scoresof up and down stair pain was 0.47±0.50, 2.87±1.38, 3.82±1.98. The VAS scoresof housework pain was 0.14±0.35, 2.15±1.40, 3.45±2.09. The VAS scoresofmaximum pain was 0.51±0.50, 3.59±1.48, 4.68±2.01. And there was significant difference between normal and early groupin all kinds of pain ( t=-33.81; t=-37.25; t=-37.66; t=-32.07; t=-45.41; P<0.05). The difference between early and medial-late group in all type of pain was significant ( t=-8.93; t=-10.84; t=-9.56; t=-12.52; t=-10.64; P<0.05). The results were similar after adjusting for confounders except for the pain of starting ( P>0.05). The results of ROC curve between normal and early group showed the maximum pain's AUC point was 0.98 and larger than others, and its cut-off point was 1. After adjusted, the results of ROC curve between early and medial-late group showed the maximum pain's AUC point was 0.72 which was larger than others and cut-off point was 4. For the AUC of ROC curve between early and medial-late groupwas lower, Kappa-test was used, and the Kappa point of two diagnostic methods was 0.41 ( P<0.05). Conclusion:The maximum of pain score in pain dimension>1 and ≤ 4 could be preliminarily diagnosed as early KOA. It had high value in separating early KOA from normal people and approximately similar to X-ray, and the value of identifying early and mid-late KOAwas moderateas well as the moderate consistency with KL stage. Comprehensive judgment of imaging examination should be improved when conditions are available.
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Objective To evaluate the clinical effects of intra-articular injection of autologous adipose derived stem cells (ADSCs) or ADSCs combined with hyaluronate acid (HA) for knee osteoarthritis.Methods From May 2013 to May 2015,a total of 108 patients with knee osteoarthritis (Kellgren-Lawrence grades:1-3) were recruited in the present study.The patients were randomly divided into three groups:ADSCs,HA and ADSCs+HA.All patients (36 cases in each group) were injected with the drug in the joint cavity once a week for three weeks.The methods used for evaluating the clinical manifestations and joint damage on MRI included visual analogue scale (VAS),Western Ontario and McMaster University (WOMAC) osteoarthritis index and whole-organ magnetic resonance imaging score (WORMS).Evaluations were conducted before injection and at 3,6,12,24 and 36 months after injection.Results All patients were followed up for 36 months without any dissociation.No adverse reaction was observed during the treatment and at the follow-up duration.The VAS score and WOMAC total score of the ADSCs group and the ADSCs+HA group were better than those in the HA group at each time point after injection (P＜0.05).The average VAS of the ADSCs group decreased from 4.14±1.42 at pre-injection to 2.39±1.74 at 36 months after injection.The WOMAC total score decreased from 42.86± 31.24 to 27.17±27.99.The average VAS in the ADSCs+HA group decreased from 4.25±1.13 to 2.31±1.74,and the WOMAC total score decreased from 34.92±22.62 to 21.33±21.38.However,the average VAS and WOMAC total score of the HA group at 36 months after injection were higher than those before the injection.In terms of the VAS at 3 months after injection,the ADSCs+HA group scored better than that of the ADSCs group (P＜0.05).There was no significant difference in WOMAC scores between the ADSCs and ADSCs+HA groups at each time point after injection (P＞0.05).The WORMS cartilage injury score improved in 10 patients with ADSCs after injection (P＜0.05).The subchondral bone wear score improved as well (P＜0.05).The difference of WORMS cartilage injury scores before and after injection was correlated with the difference of the WOMAC total score (r=0.790,P=0.007) and that of VAS score difference (r=0.800,P=0.005).Conclusion Autologous ADSCs and ADSCs combined with HA intra-articular injections can effectively relieve pain and improve function of patients with knee osteoarthritis for 36 months.In addition,ADSCs combined with HA injections can relieve pain more effectively within a short duration.Cartilage repair is associated with joint function improvement.
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Objective To study the clinical efficacy of platelet-rich plasma (PRP) in the treatment of knee osteoarthritis (KOA) and evaluate whether the age,body mass index and grade of KOA are associated with the treatment outcomes.Methods Using the prospective,randomized,controlled study,100 KOA patients hospitalized between December 2013 and November 2014 were enrolled.Twentyeight patients were men and 72 were women.Mean age was 58 years (range,35-85 years).Degenerative arthritis occurred in 68 patients and traumatic arthritis in 32 patients.Kellgren-Lawrence (K-L) score was grade Ⅱ in 35 patients,grade Ⅱ in 46 and grade Ⅲ in 19.The patients were assigned to receive hyaluronic acid (HA) (HA group,n =50) and PRP (PRP group,n =50) by an intraarticular route once weekly for 3 weeks,according to the random number table.Between-group differences were insignificant in age,gender,body mass index (BMI) and K-L grade.Western Ontario and McMaster Universities Arthritis Index (WOMAC),visual analog scale (VAS) and cartilage lesions score (CaLs) were used for clinical and MRI evaluations.At follow-up evaluation,the effective rate was defined at least 36％ improvement from the baseline WOMAC score.Results All patients were followed up for 6 months.The effective rate in PRP group was 84％ versus 68％ in HA group after the last treatment (P ＞0.05),and was 60％ versus 36％ in HA group at the final follow-up (P ＜ 0.05).WOMAC score in both groups had significant improvement after operation,while VAS improved only in PRP group (P ＜ 0.01).In PRP group patients with K-L grade I had better VAS and WOMAC scores than those with grade Ⅱ (P ＜0.05),and patients with grade Ⅱ had better WOAMC score than those with grade Ⅲ (P ＜ 0.05).MRI findings showed seven patients in PRP group had similar CaLs before and after operation (P ＞ 0.05),and the area of abnormal signal in subchondral bone and the depth of cartilage lesion gradually decreased in one of them.Follow-up study showed the outcomes had negative correlation with age and K-L grade (P ＜0.05),but no certain correlation with BMI in PRP group (P ＞ 0.05).Clinical effects in both groups were decreased over time.Conclusions Intraarticular injection of PRP benefits to pain relief,decreased inflammation and tissue repair,and has much better outcome in patients with younger age and lower K-L grade.However,BMI is not associated with the outcome.