Objective To explore the effect of internet of things-based power bicycle training or quadriceps training alone on pain and quality of life in patients with knee osteoarthritis in a community setting. Methods Patients with knee osteoarthritis who were admitted to West China Hospital of Sichuan University between April and July 2022 were selected. They were randomly divided into a power bicycle training group, a quadriceps muscle training group and a control group by random number table method. The primary outcome was improvement in knee pain, assessed by the Numerical Rating Scale (NRS) score. The secondary outcome was health-related quality of life, assessed by the 36-Item Short Form Health Survey (SF-36) score. Outcomes were assessed at baseline and 4, 8, and 12 weeks after the initial intervention. The statistical analysis was conducted using generalized estimating equations. Results A total of 72 patients were included, with 24 in each group. There was no significant difference in age, gender or other demographic characteristics among the three groups (P>0.05). The results of generalized estimating equations showed that there were interaction effects (group × time) on the NRS score, SF-36 physical functioning score, SF-36 bodily pain score, and SF-36 vitality score (P<0.05), while there was no interaction effect (group × time) on the role physical score, general health score, social functioning score, role emotional score or mental health score of SF-36 (P>0.05). At baseline, there was no statistically significant difference in the NRS score or SF-36 scores among the three groups (P>0.05). After 12 weeks of intervention, the two training groups were better than the control group in the NRS score, SF-36 physical functioning score, and SF-36 bodily pain score, the power bicycle training group was better than the quadriceps training group in the NRS score, the power bicycle training group was better than the control group in the SF-36 social functioning score, and the differences were statistically significant (P<0.05). Conclusions In a community setting, 12 weeks of internet of things-based power bicycle training and quadriceps training can significantly improve joint pain, physiological function and physical pain indicators in patients with knee osteoarthritis, and the power bicycle training is better than the quadriceps training in improving the knee pain of patients.
Objective To investigate the short-term effectiveness of joint distraction by Ilizarov combined with arthroscopic debridement in the treatment of knee osteoarthritis (KOA). Methods Between January 2014 and January 2015, 15 patients (15 knees) with KOA were treated using arthroscopic debridement assisting with the Ilizarov distraction technology. There were 7 males and 8 females, aged from 45 to 64 years (mean, 55 years). The left knee and the right knee were involved in 6 and 9 cases respectively. The disease duration was 2.0-9.5 years (median, 6 years). They all had received conservative treatment for 6 months and got poor clinical improvement. The preoperative visual analogue scale (VAS) score, the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score, the knee injury and osteoarthritis outcome score (KOOS), the range of motion (ROM) for knee, and the radiographic joint space width were 76.2±8.8, 59.3±5.7, 44.3±7.2, (75±21)°, and (2.5±0.4) mm respectively. According to Kellgren-Lawrence grade system, 11 cases were rated as grade III and 4 cases as grade IV. Results There was no poor incision healing, infection, and deep vein thrombosis. All the 15 patients were followed up 12-18 months (mean, 15.5 months). Patients achieved pain relief. The knee activity was obviously improved. The postoperative VAS score, WOMAC score, KOOS score, and ROM at 12 months were 20.9±7.8, 38.2±5.5, 92.1±6.9, and (118±14)° respectively, showing significant difference when compared with preoperative ones (t=18.213, P=0.000; t=10.317, P=0.000; t=18.564, P=0.000; t=6.599, P=0.000). Postoperative X-ray film showed that joint space width at 12 months was (3.8±0.3) mm, showing significant difference when compared with preoperative one (t=10.070, P=0.000). Conclusion Joint distraction by Ilizarov combined with arthroscopic debridement can effectively relieve pain, improve the function and quality of life. It was beneficial to cartilaginous tissue repair and delaying the degenerative process of KOA. The short-term effectiveness is satisfactory.
Objective To compare the mid- and long-term effectiveness of patellar resurfacing versus non-resurfacing in primary total knee arthroplasty (TKA). Methods Twenty-six patients who underwent bilateral TKA between March 2013 and September 2015 were selected as the study subjects. One side was randomly chosen for patellar resurfacing (resurfacing group), and the other side was not (control group). There were 4 males and 22 females, the age ranged from 51 to 65 years, with an average of 59 years. According to Kellgren-Lawrence classification, there were 21 cases of grade Ⅳ and 5 cases of grade Ⅲ in both knees. There was no significant difference in the surgical side, and preoperative clinical and functional scores of the Knee Society Score (KSS), visual analogue scale (VAS) score, and the composition ratio of anterior knee pain localization points between the two groups (P>0.05). The operation time, intraoperative blood loss, postoperative abnormal signs such as patellar clunk, feeling of constraint, patellar tendon weakness, crepitus, or snow-on-glass sensation, and the occurrence of complications were recorded and compared. Patient subjective evaluations included Forgotten Joint Score (FJS) and the degree of difficulty in high-level knee activities (including flexion with load bearing, going upstairs, going downstairs, squatting and standing up, kneeling, knee extension, and crossing legs for 7 items); KSS clinical/functional scores and VAS scores were used to evaluate the recovery of knee joint function, and the location of anterior knee pain was determined by a localization diagram. Results The operation time of the resurfacing group was significantly longer than that of the control group (P<0.05), and there was no significant difference in intraoperative blood loss between the two groups (P>0.05). All patients’ incisions healed by first intention; the hospital stay ranged from 8 to 23 days, with an average of 12.6 days. All patients were followed up 9-11 years, with an average of 9.7 years. Except for 1 case who died of multiple organ failure due to internal diseases at 9 years after operation and 5 cases with incomplete radiological data, the rest 20 patients were assessed radiologically and found that 1 side of the knee joint in the control group had patellar dislocation; the remaining patients had no prosthetic failure (fracture, loosening, displacement, etc.), patellar fracture, patellar necrosis, patellar instability, patellar tendon rupture, prosthetic revision, etc. No patients had reoperations due to patellar-related complications or anterior knee pain in both knee joints. At 2 years postoperatively and at last follow-up, there was no significant difference in the incidence of abnormal signs such as patellar clunk, feeling of constraint, patellar tendon weakness, crepitus, or snow-on-glass sensation, the incidence of high-level knee activity difficulty, and the composition ratio of anterior knee pain localization between the two groups (P>0.05). The KSS clinical scores, functional scores, and VAS scores of both groups significantly improved compared to preoperative ones (P<0.05); there was no significant difference in the comparison between the two groups at the two time points postoperatively (P>0.05). At 2 years postoperatively and at last follow-up, there was no significant difference in FJS scores between the two groups (P>0.05). ConclusionPatellar resurfacing or not has similar mid- and long-term effectiveness in primary TKA.
Knee osteoarthritis (KOA) is a common chronic degenerative osteoarthritic disease with a high incidence especially among middle-aged and elderly people, and patients with KOA usually suffer from joint pain and dyskinesia, which is disabling and seriously affects their quality of life. Acupotomy therapy, as one of the characteristic treatments of traditional Chinese medicine, has been proven to significantly reduce the pain of KOA patients and effectively slow down the rapid deterioration of the disease. Therefore, this article reviews the pathogenic factors of KOA and explores the mechanism of action of acupotomy therapy for KOA from the perspectives of mechanical structure, level of inflammatory factors, cartilage repair, and cellular autophagy and apoptosis, in order to provide a more solid theoretical basis and therapeutic strategy for the application of acupotomy therapy in the clinical practice of KOA.
Objective To explore the effects of intra-articular injection of platelet-rich plasma (PRP) on improving pain, joint function, and muscle strength of knee osteoarthritis (KOA). Methods From March 2017 to August 2019, 100 cases of KOA diagnosed and treated in the First Affiliated Hospital of Harbin Medical University were selected. They were divided into intervention group and control group with 50 cases in each group by random number table method. The patients in the intervention group were given intra-articular injection of PRP (5 mL/time, 1 time/week, 6 times in total) combined with isokinetic strength training (2 times/d, 3 d/week, for 12 consecutive weeks) treatment, and the patients in the control group were given intra-articular injection of sodium hyaluronate (2 mL/time, 1 time/week, for 12 consecutive weeks) combined with isokinetic strength training (2 times/d, 3 d/week, for 12 consecutive weeks). The incidence of adverse reactions during the treatment process and the clinical efficacy at 12 weeks of treatment and 6 months after treatment were recorded, and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scoring system was used to evaluate the knee joint function. When the isokinetic strength training instrument measured an angle of 90°/s, the knee joint flexor and extensor peak torque (PT), total work (TW), and average power (AP) were recorded. Results Forty-nine patients of each group completed the study. The between-group differences in WOMAC pain, stiffness, and joint function scores, and extensor and flexor PT, TW, and AP before treatment were not statistically significant (P>0.05). At 12 weeks of treatment and 6 months after treatment, the WOMAC scores of pain, stiffness, and joint function in the two groups were lower than those before treatment (P<0.05), and the extensor and flexor PT, TW, and AP were higher than those before treatment (P<0.05). Six months after treatment, the WOMAC scores of pain, stiffness, and joint function in the intervention group were lower than those in the control group (P<0.05), and the extensor and flexor PT, TW, and AP in the intervention group were higher than those in the control group (P<0.05). There was no significant difference in the effective rate between the two groups at 12 weeks of treatment (95.9% vs. 89.8%, P>0.05). The effective rate in the intervention group was higher than that in the control group 6 months after treatment (93.9% vs. 79.6%, P<0.05). No serious adverse reaction occurred in the two groups during the treatment. Conclusion Intra-articular injection of PRP can reduce pain, improve muscle strength, and improve joint function in patients with KOA, and the long-term effect is better than that of conventional drugs.
ObjectiveTo systematically review the risk factors for knee osteoarthritis among Chinese population.MethodsCNKI, WanFang Data, PubMed and EMbase databases were electronically searched to collect studies related to risk factors for knee osteoarthritis in Chinese population from January 2005 to November 2020. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies; meta-analysis was then performed using RevMan 5.4 software.ResultsA total of 18 studies involving 46 375 patients were included. The results of meta-analysis showed that body mass index (BMI)≥28 kg/m2 (OR=1.78, 95%CI 1.47 to 2.14, P<0.000 1), females (OR=2.20, 95%CI 1.98 to 2.45, P<0.000 1), family history of osteoarthritis (OR=3.56, 95%CI 1.88 to 6.73, P<0.000 1), age≥60 years old (OR=1.42, 95%CI 1.26 to 1.59, P<0.000 1), history of joint trauma (OR=4.11, 95%CI 2.85 to 5.93, P<0.000 1), manual labor (OR=1.57, 95%CI 1.32 to 1.86, P<0.000 1), heavy housework (OR=1.63, 95%CI 1.20 to 2.22, P<0.000 1), humid environment (OR=4.33, 95%CI 2.99 to 6.29, P<0.000 1), drinking habit (OR=1.69, 95%CI 1.21 to 2.36, P=0.002), non-elevator building (OR=1.78, 95%CI 1.18 to 2.70, P=0.006), joint load (OR=9.14, 95%CI 3.05 to 27.45, P<0.000 1), cold environment (OR=2.13, 95%CI 1.32 to 3.44, P=0.002), and habit of sitting cross-legged (OR=7.56, 95%CI 1.74 to 32.79, P=0.007) were risk factors for knee osteoarthritis among Chinese population.ConclusionsControlling and reducing weight, preventing knee injuries, keeping joints warm, controlling alcohol consumption, improving humid and cold living environment, appropriately reducing heavy physical labor, reducing joint weight, and changing the habit of sitting cross-legged can prevent the occurrence of knee osteoarthritis.
Objective To investigate the correlation of elderly knee osteoarthritis with bone marrow edema and osteoprotegerin, DKK-1 (dickkopf-1), sclerostin. Methods A total of 100 elderly patients with knee osteoarthritis in Sichuan Province Orthopedic Hospital from September 2017 to December 2018 were selected and divided into bone marrow edema group (50 cases) and non-bone marrow edema group (50 cases). The patients’ basic data, Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scores and Visual Analogue Scale scores were collected. The patients’ serum osteoprotegerin, DKK-1, sclerostin, C-reactive protein, and erythrocyte sedimentation rate were tested, and the differences between the two groups were compared. The correlation of the detection indicators and bone marrow edema and its clinical indicators was explored. Results There was no significant difference in age, gender, course of disease, C-reactive protein and erythrocyte sedimentation rate between the two groups (P>0.05). WOMAC scores (76.1±5.4 vs. 67.5±6.6), Visual Analogue Scale scores (8.4±1.1 vs. 5.5±0.9), proportion of synovitis (84.0% vs. 52.0%), osteoprotegerin [(1.3±1.1) vs. (0.6±0.5) μg/L], DKK-1 [(18.4±16.9) vs. (6.9±6.0) μg/L] and sclerostin [(147.3±119.4) vs. (99.7±70.7) pg/mL] in the bone marrow edema group were higher than those in the non-bone marrow edema group (P<0.05). There was no statistically significant correlation of the bone marrow edema volume score and degree score and serum osteoprotegerin of patients in the bone marrow edema group (P>0.05). The bone marrow edema volume score and degree score of patients in the bone marrow edema group were positively correlated with serum DKK-1 (volume score rs=0.464, P=0.001; degree score rs=0.379, P=0.007) and sclerostin (volume score rs=0.316, P=0.025; degree score rs=0.461, P=0.003). Conclusion In elderly patients with knee osteoarthritis and bone marrow edema, the local bone metabolism indicators of osteoprotegerin, DKK-1 and sclerostin are up-regulated, especially DKK-1 and sclerostin are related to the severity of bone marrow edema.
ObjectivesTo systematically review the prevalence and disease burden of knee osteoarthritis (KOA) in China.MethodsPubMed, EMbase, CNKI, WanFang Data and VIP databases were searched to collect cross-sectional studies about the prevalence and disease burden of KOA in China from January 1st 1995 to August 31st 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed by using R statistical software.ResultsA total of thirty-three studies were included. The results of meta-analysis showed the prevalance rate of KOA was 18% (95%CI 14% to 22%), and it was higher in women (19%, 95%CI 16% to 23%) than in men (11%, 95%CI 9% to 13%) (P<0.05). The prevalence rates of KOA in different regions were as follows: 11% (95%CI 8% to 14%) in north, 17% (95%CI 15% to 20%) in north-east, 21% (95%CI 13% to 32%) in east, 21% (95%CI 13% to 33%) in north-west, 22% (95%CI 6% to 57%) in south-west, and 18% (95%CI 13% to 23%) in south-central, respectively.ConclusionsThe prevalence of KOA in China is high, and the disease burden is heavy. Due to the quantity and quality of included studies, more high-quality studies are required to verify the above conclusions in future.
ObjectiveTo investigate the causal association between metabolic syndrome (MetS) components and osteoarthritis of the knee (KOA) by using Mendelian randomization analysis. MethodsThe genome-wide association study database (GWAS) was mined, in which the exposure factors were MetS components, namely waist circumference (WC) level, triglyceride (TG) level, high-density lipoprotein cholesterol (HDL-C) level, hypertension (HBP), and type 2 diabetes (T2DM), and the outcome factor was KOA. Mendelian randomization analysis was performed using regression models of inverse-variance weighted (IVW), MR-Egger, Simple Mode, Weighted Median, and Weighted Mode methods. ResultsIVW showed a causal relationship between WC level and KOA with a positive correlation (OR=3.088, 95%CI 2.574 to 3.704, P<0.01), and HDL-C level had a causal relationship with KOA with a negative correlation (OR=0.877, 95%CI 0.779 to 0.989, P<0.05). IVW did not show a causal relationship between TG levels, HBP, and T2DM with KOA (P>0.05). The results of the ME-Egger intercept test were not multiplicative (P>0.05), indicating that Mendelian randomization was a valid method for causal inference in this study. ConclusionCentral obesity and low HDL-C disorder are independent risk factors for KOA. The causal relationship between TG level, HBP, and T2DM with KOA is still uncertain.
ObjectiveTo explore the clinical efficacy of the ultrasound-guided intra-articular injection of platelet-rich plasma (PRP) in the treatment of patients with different stages of knee osteoarthritis.MethodsWe retrospectively analyzed the clinical characteristics and X-ray data of patients with knee osteoarthritis who received ultrasound-guided intra-articular injection of PRP in the Department of Rehabilitation Medicine at Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University between May 2018 and June 2019. The patients were grouped according to the Kellgren & Lawrence Classification (K&L 0, Ⅰ, Ⅱ, Ⅲ, and Ⅳ). All the patients received four injections with a one-week interval. The Visual Analogue Scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were used to evaluate the clinical efficacy before the injection, and 3 and 6 months after the injection. Adverse reactions were recorded.ResultsA total of 102 patients were included without any grade 0 cases. There were 20 patients in K&L Ⅰ group, 37 in Ⅱ group, 31 in Ⅲ group, and 14 in Ⅳ group. No adverse event was reported. Significant differences of VAS scores and WOMAC index were observed in Ⅰ, Ⅱ and Ⅲ groups at the 3rd and 6th month follow-up (P<0.05). VAS and WOMAC scores of the three groups at the 3rd and 6th month after the treatment were significantly improved compared with those before the treatment (P<0.05). There was no significant difference in VAS score at the 3rd or 6th month after the treatment three groups (P>0.05). For K&L Ⅰ group, there was no statistically significant difference in WOMAC score at the 3rd or 6th month after the treatment (P>0.05). However, the WOMAC scores at the 3rd month after the treatment were better than those at the 6th month in K&L Ⅱ and Ⅲ groups (P<0.05). There was no significant time-depended changes in VAS score or WOMAC score in K&L Ⅳ group (P>0.05).ConclusionThe ultrasound-guided intra-articular PRP injection is safe and effective for pain relief and function improvement in patients with knee osteoarthritis at the early and middle stage.