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Cartilage Dec 2021Hip osteoarthritis is a prevalent condition responsible for important pain and disability. Most available guidelines for nonsurgical management of hip osteoarthritis... (Review)
Review
INTRODUCTION
Hip osteoarthritis is a prevalent condition responsible for important pain and disability. Most available guidelines for nonsurgical management of hip osteoarthritis recommend a combination of nonpharmacological and pharmacological treatment modalities. Intraarticular corticosteroid injections have been used for decades, although evidence is quite scarce, and many controversies remain.
METHODS
This article reviews the available literature from Medline and Embase and discusses the evidence for intraarticular corticosteroid injections in hip osteoarthritis, where only 5 randomized controlled trials were found in the literature. These are analyzed in this article, which also aims to explain the main characteristics and features of glucocorticoids, along with their contraindications and potential adverse effects.
RESULTS
Available randomized controlled trials show that intraarticular corticosteroid injections provide pain relief and functional improvement in hip osteoarthritis. This efficacy has not been shown with intraarticular hyaluronic acid injections.
CONCLUSION
This review shows that intraarticular corticosteroid injections are efficacious in hip osteoarthritis and that this benefit can last up to 12 weeks.
Topics: Adrenal Cortex Hormones; Humans; Injections, Intra-Articular; Osteoarthritis, Hip; Pain; Pain Management; Range of Motion, Articular; Treatment Outcome
PubMed: 32815375
DOI: 10.1177/1947603520951634 -
Biomedical Reports Sep 2023Hemophilia is an inherited X-linked bleeding condition with predominant joint involvement due to intra-articular bleeding, hemosiderin deposition and the synovial... (Review)
Review
Hemophilia is an inherited X-linked bleeding condition with predominant joint involvement due to intra-articular bleeding, hemosiderin deposition and the synovial hypertrophy that is responsible for cartilage destruction, joint deformity and malalignment, pain and functional restriction. Management of chronic arthropathy includes conservative and surgical approaches. Conservative therapies consist of pain modulation, oral drugs, physiotherapy and intra-articular agents. For the present review, the literature was searched for intra-articular agents and 20 papers on the use of corticosteroids (CS), hyaluronic acid (HA) and platelet-rich plasma (PRP), with different regimes of administration, were included. CS had a longer record of injection, with statistically significant pain reduction and functional improvement in the short-term and moderate persistence in the long-term. HA was able to improve the clinical and functional status of joints with moderate or severe hemophilia. PRP was relatively recently introduced to joint management and the results remain controversial. Different associations between the above-mentioned agents were proposed by studies including a small number of patients, producing comparable results. It was concluded that there is a need for extensive research on intra-articular agents, with stratification according to the severity of joint involvement. The lack of a blinded or placebo-controlled arm due to ethical aspects makes the task challenging.
PubMed: 37614987
DOI: 10.3892/br.2023.1641 -
International Journal of Molecular... Nov 2022More than 10% of the world's population suffers from osteoarthritis (OA) of the knee, with a lifetime risk of 45%. Current treatments for knee OA pain are as follows:... (Review)
Review
More than 10% of the world's population suffers from osteoarthritis (OA) of the knee, with a lifetime risk of 45%. Current treatments for knee OA pain are as follows: weight control; oral pharmacological treatment (non-steroidal anti-inflammatory drugs, paracetamol, opioids); mechanical aids (crutches, walkers, braces, orthotics); therapeutic physical exercise; and intraarticular injections of corticosteroids, hyaluronic acid, and platelet-rich plasma (PRP). The problem is that such treatments usually relieve joint pain for only a short period of time. With respect to intraarticular injections, corticosteroids relieve pain for several weeks, while hyaluronic acid and PRP relieve pain for several months. When the above treatments fail to control knee pain, total knee arthroplasty (TKA) is usually indicated; however, although a very effective surgical technique, it can be associated with medical and postoperative (surgery-related) complications. Therefore, it seems essential to look for safe and effective alternative treatments to TKA. Recently, there has been much research on intraarticular injections of mesenchymal stem cells (MSCs) for the management of OA of the knee joint. This article reviews the latest information on the molecular mechanisms of action of MSCs and their potential therapeutic benefit in clinical practice in patients with painful knee OA. Although most recent publications claim that intraarticular injections of MSCs relieve joint pain in the short term, their efficacy remains controversial given that the existing scientific information on MSCs is indecisive. Before recommending intraarticular MSCs injections routinely in patients with painful knee OA, more studies comparing MSCs with placebo are needed. Furthermore, a standard protocol for intraarticular injections of MSCs in knee OA is needed.
Topics: Humans; Hyaluronic Acid; Injections, Intra-Articular; Osteoarthritis, Knee; Platelet-Rich Plasma; Mesenchymal Stem Cells; Pain; Adrenal Cortex Hormones; Treatment Outcome; Arthralgia
PubMed: 36499280
DOI: 10.3390/ijms232314953 -
Rheumatology International Nov 2020The expectations from any future disease-modifying treatment for knee osteoarthritis (KOA) are extremely high as it has to impact the joint as a whole leading to... (Review)
Review
The expectations from any future disease-modifying treatment for knee osteoarthritis (KOA) are extremely high as it has to impact the joint as a whole leading to favorable alterations of diverse tissues and functions. In this light, targeting the knee only from the inside may not be biologically justified for the management of a whole joint disease such as KOA. Our hypothesis to test is whether any injectable therapeutic intervention alone can lead to disease modification of KOA which is viewed in the complexity of the modern concept of osteoarthritis (OA) as a whole joint disease. Therefore, we aimed at analyzing the intraarticular route to the KOA patient in an attempt to unveil its "biological" constraints. A comprehensive search through databases was carried out using specific keywords to add objectivity to the main messages. The literature analysis has shown that "cutting-edge" intraarticular therapies may offer a key to non-invasive symptomatic relief. Changing the course of KOA, however, may necessitate a multimodal approach towards the knee joint including a combination of intraarticular injections with interventions on multiple levels. Importantly, our understanding of OA has evolved redefining the concept of the disease, being in interaction with the human body as a whole. Any future conservative disease-modifying treatment of KOA should aim at a multimodal, holistic approach towards the knee joint including but not limited only to intraarticular injections. A combination with other interventions should be further researched.
Topics: Arthroplasty, Replacement, Knee; Genetic Therapy; Humans; Hyaluronic Acid; Injections, Intra-Articular; Mesenchymal Stem Cell Transplantation; Molecular Targeted Therapy; Osteoarthritis, Knee; Platelet-Rich Plasma; Viscosupplements
PubMed: 32803403
DOI: 10.1007/s00296-020-04681-7 -
Toxicon : Official Journal of the... Apr 2024Intraarticular botulinum toxin type A (BTA) has been shown to be effective for painful knee osteoarthritis (KOA), while the efficacy and safety of intraarticular BTA... (Meta-Analysis)
Meta-Analysis Review
Intraarticular botulinum toxin type A versus corticosteroid or hyaluronic acid for painful knee osteoarthritis: A meta-analysis of head-to-head randomized controlled trials.
Intraarticular botulinum toxin type A (BTA) has been shown to be effective for painful knee osteoarthritis (KOA), while the efficacy and safety of intraarticular BTA compared to corticosteroid and hyaluronic acid (HA) remains unknown. A meta-analysis was performed to compare. A search was conducted in Medline (PubMed), CENTER (Cochrane Library), Embase (Ovid), Web of Science, Wanfang, and CNKI to find head-to-head randomized controlled trials (RCTs) directly compare the efficacy and safety between intraarticular BTA and intraarticular corticosteroid or HA for patients with painful KOA. The Cochrane Q test and estimation of I were used to assess heterogeneity among studies. After incorporating heterogeneity, a random-effects model was employed for data pooling. Overall, six RCTs involving 348 adults with KOA were included. Intraarticular BTA showed similar efficacy with corticosteroid as evidenced by the changes of pain visual analog scale (VAS: -0.35 [-0.97, 0.28]), total Western Ontario McMaster Universities Arthritis Index (WOMAC: 0.28 [-4.13, 4.69]), and WOMAC for pain (0.64 [-0.42, 1.70]), stiffness (-0.02 [-0.54, 0.50]), and function (0.00 [-2.99, 3.00]). Intraarticular BTA was shown to be more effective than HA in improving pain VAS (-1.31 [-1.97, -0.64]) and WOMAC for pain (-4.81 [-8.73, -0.89]), while the influence on WOMAC for knee stiffness (-1.01 [-4.43, 2.41]) and knee function (-1.86 [-6.71, 2.99]) were similar between groups. No serious adverse events were reported. Evidence from pilot RCTs suggests that intraarticular BTA may confer similar efficacy to corticosteroid for KOA, while BTA may be superior to HA for improving knee pain.
Topics: Adult; Humans; Osteoarthritis, Knee; Hyaluronic Acid; Botulinum Toxins, Type A; Injections, Intra-Articular; Randomized Controlled Trials as Topic; Pain; Adrenal Cortex Hormones; Treatment Outcome
PubMed: 38401692
DOI: 10.1016/j.toxicon.2024.107656 -
International Journal of Surgery... Mar 2017A meta analysis to compare efficacy and safety of intraarticular hyaluronic acid (HA) and intraarticular corticosteroids (CS) in patients with knee osteoarthritis. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
A meta analysis to compare efficacy and safety of intraarticular hyaluronic acid (HA) and intraarticular corticosteroids (CS) in patients with knee osteoarthritis.
METHOD
Potential studies were searched from the electronic databases included PubMed, Embase, web of science and the Cochrane Library up to August 2016. High quality randomized controlled trials (RCTs) were selected based on inclusion criteria. RevMan 5.3 were used for the meta-analysis.
RESULTS
12 RCTs containing 1794 patients meet the inclusion criteria. Visual analog scale (VAS) score in CS group decrease more than HA group up to 1 month (p = 0.03) and it shows equal efficacy at 3 months (p = 0.29); HA is more effective than CS at 6 months (p = 0.006). To Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, there is no significant difference for two groups at 3 months (p = 0.29); HA shows greater relative effect than CS at 6 months (p = 0.005). No significant difference is found on proportion of rescue medication use after initiation of treatment (p = 0.58) and proportion of withdrawal for knee pain (p = 0.54). HA and CS exhibit equal efficacy on improvement of active range of knee flexion at 3 months (p = 0.73) and 6 months (p = 0.43). More topical adverse effects occurred in intraarticular HA group when compared with intraarticular CS group.
CONCLUSION
Intraarticular CS is more effective on pain relief than intraarticular HA in short term (up to 1 month), while HA is more effective in long term (up to 6 months). Two therapies benefit similarly for knee function improvement. Both two methods are relatively safe, but intraarticular HA causes more topical adverse effects compared with intraarticular CS.
Topics: Adrenal Cortex Hormones; Female; Humans; Hyaluronic Acid; Injections, Intra-Articular; Knee Joint; Musculoskeletal Pain; Osteoarthritis, Knee; Pain Measurement; Randomized Controlled Trials as Topic; Treatment Outcome; Viscosupplements
PubMed: 28137554
DOI: 10.1016/j.ijsu.2017.01.087 -
Blood Coagulation & Fibrinolysis : An... Apr 2020: Arthroscopic knee surgery to perform partial meniscectomy and anterior cruciate ligament (ACL) reconstruction is frequent and effective, although a possible... (Review)
Review
: Arthroscopic knee surgery to perform partial meniscectomy and anterior cruciate ligament (ACL) reconstruction is frequent and effective, although a possible complication is postoperative hemarthrosis. When intraarticular bleeding occurs, in addition to the associated pain, the patient usually requires joint aspiration (arthrocentesis) to avoid loss of range of motion (ROM). Sometimes this complication ends up associated with a poor result of surgery due to a loss of ROM. The aim of this narrative review of the literature is to attempt to clarify whether tranexamic acid (TXA) should be utilized in arthroscopic ACL reconstruction and arthroscopic meniscectomy and by what route (intraarticular or intravenous). A number of studies seem to favor the use of intravenous TXA in patients undergoing ACL reconstruction and arthroscopic synovectomy to diminish articular postoperative bleeding and its consequences (pain, swelling, loss of ROM, and the need for arthrocentesis). Regarding the use of intraarticular TXA, one in-vitro study has indicated that TXA in high concentrations is cytotoxic to chondrocytes. Common sense leads me to conclude that until better designed studies can confirm that intraarticular TXA is not cytotoxic to chondrocytes, its use should not be advised. Currently, for patients undergoing arthroscopic ACL reconstruction and arthroscopic meniscectomy, it seems safer to use intravenous TXA.
Topics: Antifibrinolytic Agents; Arthroplasty, Replacement, Knee; Female; Humans; Male; Postoperative Hemorrhage; Tranexamic Acid
PubMed: 31990755
DOI: 10.1097/MBC.0000000000000895 -
Arkhiv Patologii 2006Intraarticular chondromatosis is subdivided into primary (synovial) and secondary one. Synovial chondromatosis is a benign, focal proliferation of cartilaginous tissue... (Review)
Review
Intraarticular chondromatosis is subdivided into primary (synovial) and secondary one. Synovial chondromatosis is a benign, focal proliferation of cartilaginous tissue within the synovial membrane of a joint, articular bursa and tendons. More often synovial chondromatosis is present in the synovial membrane. Some nodules loose a bond to the synovial membrane and form chondromal intraarticular bodies that are freely located within the joint cavity. Secondary intraarticular chondromatosis develops in the presence of a pre-existing process, such as injury, degenerative joint diseases including osteoarthrosis. In secondary intraarticular chondromatosis, loose intraarticular bodies are most commonly formed on the basis of a small disconnected fragment of hyaline articular cartilage.
Topics: Adult; Arthrography; Chondromatosis, Synovial; Female; Humans; Joints; Male; Middle Aged
PubMed: 17144527
DOI: No ID Found -
Orthopaedics & Traumatology, Surgery &... Apr 2021The lengths of the anteromedial bundle (AMB) and posterolateral bundle (PLB) change during knee motion in double-bundle anterior cruciate ligament (ACL) reconstruction....
BACKGROUND
The lengths of the anteromedial bundle (AMB) and posterolateral bundle (PLB) change during knee motion in double-bundle anterior cruciate ligament (ACL) reconstruction. However, the actual intraarticular graft length would be affected by the bone tunnel position and tunnel creation angle during ACL reconstruction. The aim of this study was to investigate the intraarticular length change of the AMB and PLB in patients who underwent anatomic double-bundle ACL reconstruction.
HYPOTHESIS
We hypothesized that the PLB would show a more dynamic length change pattern than the AMB during knee flexion at ACL reconstruction.
METHODS
Thirty-two patients (16 men and 16 women) who had isolated ACL injuries with intact menisci were investigated. Anatomic double-bundle ACL reconstructions were performed using semitendinosus tendon autografts at a mean age of 30.6 years. The graft and tunnel lengths were measured intraoperatively. Intraarticular graft lengths and length changes were calculated at 0° and 90° of knee flexion during ACL reconstruction. Intraoperative data were collected prospectively, and analyses were performed retrospectively.
RESULTS
The intraarticular length of the AMB at 0° of knee flexion was 28.1±5.5mm. At 90° of knee flexion, the AMB intraarticular length decreased to 25.6±4.8mm. The intraarticular length of the PLB decreased to 17.7±4.6mm at 90° of knee flexion compared to 22.0±4.2mm at 0° of knee flexion. Changes in the intraarticular graft length during knee flexion were detected more in the PLB (4.1mm) than in the AMB (2.0mm, p=0.01).
DISCUSSION
This study demonstrated that the intraarticular length change of the PLB during knee motion was larger than that of the AMB in anatomic double-bundle ACL reconstructions with semitendinosus tendon autografts and suspensory femoral fixation devices.
LEVEL OF EVIDENCE
IV; retrospective cohort study.
Topics: Adult; Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Biomechanical Phenomena; Female; Humans; Knee Joint; Male; Retrospective Studies
PubMed: 33484904
DOI: 10.1016/j.otsr.2021.102816 -
Journal of Orthopaedic Science :... Mar 2022Reduction using ligamentotaxis may not be effective enough to treat impacted intraarticular fragments of distal radius fractures. Articular incongruence resulting from...
BACKGROUND
Reduction using ligamentotaxis may not be effective enough to treat impacted intraarticular fragments of distal radius fractures. Articular incongruence resulting from the loss of reduction is a risk factor for postoperative osteoarthritis and worse clinical outcome. This study aimed to analyze the radiographic characterization of the impacted intraarticular fragments of distal radius fractures using two/three-dimensional computed tomography (CT). Further, we assessed the reliability and diagnostic accuracy in detecting the fragments using plain radiographs.
METHODS
We analyzed 167 three-dimensional CT images of the intraarticular distal radius fractures and selected 12 fractures with impacted intraarticular fragments. We recorded the location, size, and displacement of the fragment using CT images. In addition, six examiners evaluated 25 fractures including those 12 fractures having the fragments using plain radiographs for detecting the fragments and their displacements. Further, we evaluated the reliability and diagnostic accuracy of the plain radiographs in the detection of the fragment.
RESULTS
Fifteen impacted intraarticular fragments were found in 12 wrists. The displacement of the scaphoid facet fragment was significantly larger than that of the lunate facet fragment in CT measurement (7.0 mm and 3.6 mm). Inter and intraobserver reliability of the diagnosis for the fragment in plain radiographs were poor and fair (κ: 0.14 and κ:0.27). Diagnostic accuracy in detecting the fragment in plain radiographs generated mean sensitivity: 0.4, mean specificity: 0.73, and mean accuracy: 0.58. The mean sensitivity in detecting a lunate facet fragment was lower than that of a scaphoid facet fragment in plain radiographs (0.24 and 0.44).
CONCLUSION
Impacted intraarticular fragments were found in 7% of intraarticular distal radius fractures. We observed low reliability and sensitivity in detecting the fragment using plain radiographs. Preoperative recognition of the fragments using plain radiograph were difficult, even though the magnitude of step-off of the scaphoid facet fragment was large.
Topics: Humans; Lunate Bone; Radiography; Radius Fractures; Reproducibility of Results; Tomography, X-Ray Computed
PubMed: 33707041
DOI: 10.1016/j.jos.2020.12.029