Research Progress in Application of Patient-Reported Outcome Measures in Total Knee Arthroplasty / 中国医学科学院学报

To summarize the clinical application of patient-reported outcome measures (PROM) in total knee arthroplasty (TKA) and provide reference for the application of PROM in perioperative evaluation of the patients receiving TKA,we reviewed the recent studies about the application of PROM in TKA and analyzed the contents and application characteristics of the PROM.The common PROM in TKA,such as the Western Ontario and McMaster Universities Osteoarthritis Index,Oxford Knee Score,and Forgotten Joint Score,principally focus on patients' subjective feelings about pain,function and other aspects of their knees.However,they have diverse ranges of application and each of them has their own advantages and disadvantages.There is a variety of PROM applied in TKA,which makes it challenging to select the proper measurement for evaluation.The PROM in TKA remains to be improved for broader use.

Effect of fire needling on mild to moderate knee osteoarthritis and related serum inflammatory cytokines / 中国针灸

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.

Safety and efficacy of focused low-intensity pulsed ultrasound therapy for the treatment of knee osteoarthritis / 上海交通大学学报（医学版）

Objective • To investigate the safety and efficacy of focused low-intensity pulsed ultrasound (FLIPUS) therapy on the patients with knee osteoarthritis (KOA). Methods • A total of 100 subjects with KOA from August 2018 to August 2019 in the Department of Rehabilitation Medicine at the Second Affiliated Hospital of Chongqing Medical University were sequentially randomized into group A and group B. Among them, FLIPUS was adopted to treat the 50 patients in group A, and the diclofenac sodium was adopted to treat the other 50 patients in group B. Visual analogue scale (VAS), Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) and Lequesne index (LI) were used to evaluate knee joint pain, the structure and function of the affected knee joint, and the severity of the affected knee joint at baseline, on day 3, day 6 and day 10 after treatment respectively. The knee range of motion (KROM) and maximum walking speed (MWS) were used to evaluate the knee joint movement and walking function at baseline and on day 10 after treatment respectively. Results • There were on significant differences between two groups with respect to KOA evaluation indexes (P>0.05). Compared with those in group B, patients in group A showed significant improvements in VAS and WOMAC scores on day 6 and day 10 after treatment (P=0.021, P=0.000; P=0.005, P=0.001). Meanwhile, patients in group A had higher LI scores than those in group B on day 10 after treatment (P=0.000). In addition, patients in group A showed significant improvements in MWS (P=0.006) and non-significant improvements in KROM (P=0.064) on day 10 after treatment. Conclusion • FLIPUS is a safe and effective treatment modality for relieving pain and improving the functions of patients with KOA.

Clinical effect of knee arthroscopy combined with celecoxib in the treatment of elderly patients with knee osteoarthritis / 中国基层医药

Objective@#To investigate the clinical effect of knee arthroscopy combined with celecoxib in the treatment of elderly patients with knee osteoarthritis.@*Methods@#According to the random table method, 62 elderly patients with knee osteoarthritis admitted to the Third People's Hospital of Zhuji from October 2016 to October 2018 were divided into control group (31 cases) and observation group (31 cases) according to the digital table.The control group was treated with knee arthroscopic debridement, while the observation group was orally given celecoxib on the basis of the control group.Both two groups were treated for 12 weeks.The curative effect of the two groups was compared, and the changes of WOMAC scale score, knee joint active flexion and extension and inflammatory factors before and after treatment were compared.@*Results@#The excellent and good rate of the observation group (83.88%) was higher than that of the control group (51.62%) (χ2=7.381, P<0.05). After treatment, the scores of stiffness[(3.56±0.38)points], difficulty in daily activities[(27.38±7.19)points]and pain[(7.94±2.45)points] in the observation group were lower than those in the control group[(5.81±0.76)points, (38.98±5.42)points and (11.36±1.87)points](t=10.182, 14.743, 6.178, all P<0.05). After treatment, the knee joint active flexion and extension in the observation group[(91.24±7.86)°] was higher than that in the control group[(83.42±7.39)°](t=4.036, P<0.05). After treatment, the serum levels of IL-1beta[(16.58±4.25)ng/L], TNF-α[(183.25±24.15)ng/L]and IL-6[(9.98±2.43) ng/L] in the observation group were lower than those in the control group[(26.31±5.47)ng/L, (219.82±29.96)ng/L and (14.52±4.35)ng/L](t=7.821, 5.291, 5.073, all P<0.05).@*Conclusion@#Knee arthroscopy combined with celecoxib has good clinical effect on elderly patients with knee osteoarthritis.It can improve knee function, alleviate inflammation and improve active knee flexion and extension.

Clinical effect of knee arthroscopy combined with celecoxib in the treatment of elderly patients with knee osteoarthritis / 中国基层医药

Objective To investigate the clinical effect of knee arthroscopy combined with celecoxib in the treatment of elderly patients with knee osteoarthritis.Methods According to the random table method,62 elderly patients with knee osteoarthritis admitted to the Third People's Hospital of Zhuji from October 2016 to October 2018 were divided into control group (31 cases) and observation group (31 cases) according to the digital table.The control group was treated with knee arthroscopic debridement ,while the observation group was orally given celecoxib on the basis of the control group.Both two groups were treated for 12 weeks.The curative effect of the two groups was compared,and the changes of WOMAC scale score,knee joint active flexion and extension and inflammatory factors before and after treatment were compared.Results The excellent and good rate of the observation group (83.88％) was higher than that of the control group (51.62％) (χ2 =7.381,P<0.05).After treatment,the scores of stiffness[(3.56 ±0.38)points], difficulty in daily activities[(27.38 ±7.19)points]and pain[(7.94 ±2.45)points] in the observation group were lower than those in the control group [(5.81 ±0.76)points,(38.98 ±5.42)points and (11.36 ±1.87)points](t=10.182,14.743,6.178,all P<0.05).After treatment,the knee joint active flexion and extension in the observation group[(91.24 ±7.86)°] was higher than that in the control group [(83.42 ±7.39)°](t=4.036,P<0.05).After treatment,the serum levels of IL -1beta[(16.58 ±4.25) ng/L],TNF-α[(183.25 ±24.15) ng/L] and IL -6 [(9.98 ±2.43) ng/L] in the observation group were lower than those in the control group [(26.31 ±5.47)ng/L, (219.82 ±29.96)ng/L and (14.52 ±4.35)ng/L](t =7.821,5.291,5.073,all P <0.05).Conclusion Knee arthroscopy combined with celecoxib has good clinical effect on elderly patients with knee osteoarthritis .It can improve knee function,alleviate inflammation and improve active knee flexion and extension .

Comparison of the clinical effect of intra-articular injection of platelet-rich plasma and methylprednisolone in primary osteoarthritis of knee: a randomized controlled trial

Background: Osteoarthritis of knee is one of the commonest musculoskeletal disorder causing mobility impairment affecting 3.3% in urban areas and 5.5% in rural areas. Intra-articular injection of Platelet-Rich Plasma (PRP) delivers activated platelets that may reduce inflammation, provide pain relief, improve function and stimulate possible cartilage regeneration at the site of worn cartilage area of the knee.Methods: Eighty patients with primary osteoarthritis of the knee fulfilling inclusion and exclusion criteria were recruited in the study conducted in the Department of Physical Medicine and Rehabilitation, RIMS, Imphal from October 2014 to September 2017. Six ml of PRP prepared by conventional bench top centrifugation system was injected intra-articularly, two weeks apart in the PRP group. Steroid group received 80mg of methylprednisolone, two weeks apart by the same technique. The outcome variables (VAS and WOMAC score) were measured before starting intervention (baseline) and at 8 and 24-weeks post-intervention follow up.Results: Significant improvement seen in VAS, WOMAC-pain, stiffness and physical function and total scores in both the groups at 8- and 24-weeks follow-ups (p˂0.001). Steroid group showed better result than the PRP group in VAS (2.78±0.76 vs 3.58±1.03) and WOMAC-total (30.42±6.85 vs 36.25±10.87) scores at 8 weeks respectively (p˂0.001). But at 24 weeks follow-up, PRP showed significantly more effective than the steroid group in reducing pain (2.0±.0.87 vs 2.45±0.78) and disability (22.95±3.78 vs 25.25±6.67) respectively (p˂0.001).Conclusions: Intra-articular injection of methylprednisolone was found to be more effective in reducing pain and disability in primary knee osteoarthritis of KL grade 2 and 3 at the end of 8 weeks whereas 2 doses of PRP intra-articular injection 2 weeks apart was significantly more effective than methylprednisolone at the end of 24 weeks. However, the long-term benefit of PRP is to be determined by studies with a larger sample size and longer duration of follow-up.

Comparison of Efficacy and Tolerability of Immediate Release Glucosamine HCL And Glucosamine HCL Sustained Release Formulation in the Treatment of Knee Osteoarthritis; A Randomised Clinical Trial

Background: Osteoarthritis (OA) is the most common form of and a leading cause of chronic disability between fourth and fifth decade of life, with a prevalence ranging between 17-60.6% in India. Objective: To compare the efficacy and safety profile of glucosamine HCl- sustained release (GLU-SR) with that of Glucosamine HCl- immediate release (GLU-IR) in patients with knee osteoarthritis (OA). Methods: This was an open labelled, randomised, controlled trial conducted in a tertiary care hospital at Kanpur. The study involved 60 patients with knee OA, randomised to receive single oral dose of 1,500 mg GLU-SR and GLU-IR for 60 days with 30 patients in each group. The primary efficacy being reduction in pain and improvement in function was assessed using visual analogue scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores. Intention-to-treat principle, repeated measure of ANOVA and mixed model analysis were used for statistical analysis. The history of adverse reactions experienced was collected throughout the study period. Results: There was a significant reduction in algo functional indices as primary outcome measure in both the groups (P < 0.001). A significant difference (P < 0.05) in the number of patients reporting ADR in the GLU-SR arm (38% lesser) was noted as compared to GLU-IR arm, with no difference in the use of rescue medications in both arms. Conclusions: From the observations made in this study it is concluded that GLU-SR is as effective as GLU-IR in the management of knee OA; with an advantage of having a better safety profile.

The heat-reinforcing needling for Kashin-Beck disease with cold-dampness blocking collaterals syndrome / 中国针灸

<p><b>OBJECTIVE</b>To compare the efficacy differences between heat-reinforcing needling and conventional treatment of western medicine on Kashin-Beck disease (KBD) with cold-dampness blocking collaterals syndrome.</p><p><b>METHODS</b>Sixty KBD patients of cold-dampness blocking collaterals syndrome were randomly assigned into a heat-reinforcing needling group and a western medication group, 30 cases in each one. In the heat-reinforcing needling group, the heat-reinforcing needling was applied at local painful sites, combined with the acupoints based on the syndrome differentiation and the distal acupoints on the affected meridians. Acupuncture was given 30 min per time, once a day, the treatment of 5 days made 1 session; there was an interval of 2 days between two sessions. In the western medication group, sodium selenite tablets were prescribed for oral administration after meals, 2 tablets each time, once a day; ibuprofen sustained release capsules were prescribed for oral administration, 1 capsule each time, twice a day; vitamin C tablets were prescribed for oral administration, 2 tablets each time, three times a day. Four-week treatment was given in the two groups. The Western Ontaraio and Mcmaster Universities Osteoarthritis Index (WOMAC) was adopted to assess the involved joints; the safety was assessed in the process of treatment; the efficacy was analyzed, and the follow-up visit was conducted 3 months and 6 months after treatment, respectively.</p><p><b>RESULTS</b>After 4-week treatment, the total effective rate was 96.7%(29/30) in the western medication group, which was superior to 90.0% (27/30) in the heat-reinforcing needling group (<0.05). However, the safety in the heat-reinforcing needling group was superior to that in the western medication group (<0.05). The improvements of joint function in 3-month and 6-month follow-up visits in heat-reinforcing needling group were superior to those in western medication group (both<0.05).</p><p><b>CONCLUSIONS</b>The heat-reinforcing needling for KBD is safe and effective with less adverse reactions. The short-term effect of heat-reinforcing needling isinferior to western medication, but the long-term efficacy is remarkably superior to western medication.</p>

Observations on the Efficacy of Needle-sticking Warm Needling Moxibustion plus Sodium Hyaluronate in Treating Knee Osteoarthritis / 上海针灸杂志

ObjectiveTo seek a convenient method for improving the clinical therapeutic effect on knee osteoarthritis.Method One hundred and eighty-six patients were randomly allocated to three groups, 62 cases each. The observation group received needle-sticking warm needling moxibustion plus articular cavity injection of sodium hyaluronate; control group 1, needle-sticking warm needling moxibustion; control group 2, articular cavity injection of sodium hyaluronate. Needle-sticking warm needling moxibustion was given once daily, five treatments followed by two days of rest, seven days as a course, for a total of five courses. Articular cavity injection of sodium hyaluronate was administered once a week, for a total of five injections. The therapeutic effects were compared after treatment.ResultA large part of the symptoms and signs resolved, and the cure rate, the cure and marked efficacy rate and the efficacy rate were 40.3%, 87.1% and 95.2%, respectively, in the observation group. Part of thesymptoms and signs resolved in control groups 1 and 2. The cure rate, the cure and marked efficacy rate and the efficacy rate were 24.2%,51.6%and 80.6%, respectively, in control groups 1 and 21.0%, 54.8% and 82.3%, respectively, in control groups 2. There were statistically significant differences in the cure rate (P<0.05), the cure and marked efficacy rate (P<0.01) and the efficacy rate (P<0.05) among the three groups. The therapeutic effect was significantly better in the observation group than in control groups 1 and 2.Conclusion Needle-sticking warm needling moxibustion plus articular cavity injection of sodium hyaluronate is clinically a better way to treat knee osteoarthritis.

Evaluation of the effect of D-002, a mixture of beeswax alcohols, on osteoarthritis symptoms

BACKGROUND/AIMS: Nonsteroidal anti-inflammatory drugs relieve osteoarthritis (OA) symptoms but cause adverse effects. D-002, a mixture of beeswax alcohols, is effective against experimental OA. A pilot study found that D-002 (50 mg/day) for 8 weeks improves OA symptoms. The aim of this study was to investigate the effects of D-002 (50 to 100 mg/day) administered for 6 weeks on OA symptoms. METHODS: Patients with OA symptoms were double-blindly randomized to D-002 (50 mg) or placebo for 6 weeks. Symptoms were assessed by the Western Ontario and McMaster Individual Osteoarthritis Index (WOMAC) and the visual analog scale (VAS) scores. Patients without symptom improvement at week 3 were titrated to two daily tablets. The primary outcome was the total WOMAC score. WOMAC pain, joint stiffness and physical function scores, VAS score, and use of rescue medications were secondary outcomes. RESULTS: All randomized patients (n = 60) completed the study, and 23 experienced dose titration (two in the D-002 and 21 in the placebo groups). At study completion, D-002 reduced total WOMAC (65.4%), pain (54.9%), joint stiffness (76.8%), and physical function (66.9%) WOMAC scores, and the VAS score (46.8%) versus placebo. These reductions were significant beginning in the second week, and became enhanced during the trial. The use of rescue medication by the D-002 (6/30) group was lower than that in the placebo (17/30) group. The treatment was well tolerated. Seven patients (two in the D-002 and five in the placebo group) reported adverse events. CONCLUSIONS: These results indicate that D-002 (50 to 100 mg/day) for 6 weeks ameliorated arthritic symptoms and was well tolerated.

The Effect of a Lumbar Spinal Lesion on the Clinical Results of Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: Patients with osteoarthritis of knee joint often concomitantly suffer from degenerative disease of the spine. Furthermore, resulting spinal problems could influence function and pain after total knee arthroplasty (TKA), and hence, cause the results of TKA to be misinterpreted. The purpose of this prospective study was to evaluate the effect of spinal disorders, as assessed by Swiss Spinal Stenosis score (SSS scores), on knee function as assessed by knee scores, the Hospital for Special Surgery scale (HSS scale) and Western Ontario & McMaster Osteoarthritis Index scores (WOMAC scores) in patients that after TKA. MATERIALS AND METHODS: One hundred and forty nine osteoarthritic knees of 87 patients were enrolled in this study. All patients received TKA by single surgeon (W-S Cho) from August 2009 to May 2010. Preoperative and postoperative 1- and 2-years HSS scale, Knee, WOMAC, and SSS scores were recorded and analyzed. RESULTS: Postoperative HSS scale, Knee, and WOMAC scores showed marked improvements versus preoperative scores, and scores at 2 years postoperatively were better than at 1 year postoperatively. No significant correlation was found between postoperative Knee scores and SSS scores. On the other hand, statistically significant correlations were found between HSS and SSS scores and between WOMAC and SSS scores. Interestingly, differences between Knee scores and HSS scores were found to be significantly correlated with SSS scores. CONCLUSION: When evaluating outcome after TKA, spinal problems should be investigated concomitantly. SSS scores appear to provide a suitable means of assessing spinal problems.

A prospective observational study to assess quality of life and prescription pattern in osteoarthritis patients at tertiary health centre in Mumbai.

Background: Osteoarthritis (OA) is a major cause of disability and is focused in "Bone and Joint Decade" declared by WHO which substantially affect different dimensions of quality of life. The aim of present study was to find the disease pattern in OA patients, monitoring prescription pattern to assess prognosis of osteoarthritis by WOMAC index. Materials and Methods: An observational study on prospective data collected for the evaluation of Quality of Life (QOL) in OA was conducted at tertiary health care centre in Mumbai. Patients with a diagnosis of OA were enrolled. The patient's history and clinical examination was based on classification criteria of the American College of Rheumatology; drugs prescribed were noted on case record form. Same procedure was carried out for the first and second follow-ups at 6 th and 12 th weeks respectively. Results: The patients belong to primary OA (84%) as compared to secondary OA (16%). Females (70.56% and 10%) were affected more commonly than males (13.44% and 6%). Knee Joint was worst affected in 76%, followed by hip joint in 16% and shoulder, ankle, wrist, elbow joint each having 2% (n=1) involvement. NSAIDs continued to dominate prescriptions given to 84% of patients followed by antiarthritic drugs and calcium supplements in 54% cases. The WOMAC score was higher in most of patients. After medication hydroxy chloroquine sulfate has shown maximum reduction in average WOMAC sore followed by paracetamol, indomethacin and diclofenac sodium. Conclusion: Osteoarthritis has a significant impact on quality of life, only partly ameliorated by anti-arthritic drugs, as assessed by the WOMAC scale in this study population. Further, a study with larger sample size is needed to further support our findings.

Correlation between Lower Extremity Extensor Muscle Strength and Pain or Physical Function in Knee Osteoarthritis / 中国康复理论与实践

@# ObjectiveTo investigate the relationship of lower extremity muscle strength and the pain or physical function in patients with knee osteoarthritis. Methods25 patients with knee osteoarthritis diagnosed with have radiological and clinical data were assessed with Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and isokinetic muscle strength testing. ResultsThe lower extremity extensor muscle strength correlated with WOMAC pain scores, WOMAC activity of daily life scores, and WOMAC total scores （P<0.05）. ConclusionThe lower extremity extensor muscle strength correlated with the pain and physical function in patients with knee osteoarthritis.

Test-retest Reliability of Western Ontario and McMaster University Osteoarthritis Index / 中国康复理论与实践

@# ObjectiveTo investigate the test-retest reliability of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) in Chinese patients with knee osteoarthritis. Methods24 patients with radiological diagnosis and clinical symptoms of knee osteoarthritis were evaluated with the WOMAC twice by two staff who pass by the WOMAC formal training within 24 h. ResultsThe intraclass correlation coefficients of the 3 dimensions of pain, stiffness, physical function of the WOMAC and the total were 0.937, 0.914, 0.856, 0.921, respectively. ConclusionThe Chinese version of WOMAC can be used in Chinese patients with knee osteoarthritis with high test-retest reliability.

Effect of Lateral Heel and Sole Wedges in Patients with Osteoarthritis of Knees

OBJECTIVE: The purpose of this study was to evaluate the effect of lateral heel and sole wedges on osteoarthritis of knees. METHOD: Sixty patients with knee osteoarthritis were enrolled and divided into the control (n=30) and wedge (n=30) groups. The control group received only conventional therapy for 5 weeks, while the wedge group took lateral wedges with 4 mm height in additional to the same conventional therapy. Intensity of pain and funtional activity were assessed by Western Ontario and Mac-Master Universities Osteoarthritis index (WOMAC index) and Lequesne s index. Scanogram was measured to assess femorotibial anglechange. WOMAC index, Lequesne's index and scanogram were measured before and 6 months after the therapy. RESULTS: For the wedge group, WOMAC index and Lequesne's index were significantly lower at the six month follow up compared to the initial indices (p<0.05). The femorotibial angle showed no significant change in both groups. CONCLUSION: Lateral heel and sole wedges can be used as an effective therapeutic modality for long term management of knee osteoarthritis in combination with conventional therapy.