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The Korean Journal of Pain Jul 2024Radiofrequency ablation is an effective treatment modality in the symptomatic treatment of knee osteoarthritis. Our aim was to compare the efficacy of radiofrequency...
Is conventional radiofrequency ablation of the superolateral branch, one of the three genicular nerves targeted as standard, necessary or not? A non-inferiority randomized controlled trial.
BACKGROUND
Radiofrequency ablation is an effective treatment modality in the symptomatic treatment of knee osteoarthritis. Our aim was to compare the efficacy of radiofrequency ablation of the superomedial and inferomedial genicular nerves (2 branches) with the superolateral, superomedial, and inferomedial genicular nerves (3 branches) and to show whether the 2-branch procedure is inferior to the 3-branch procedure.
METHODS
This study is a prospective, randomized, single-blind clinical study. Eligible participants were randomized into 2 groups: group A, which applied the procedure to the superomedial and inferomedial genicular nerves, and group B, which applied it to the superomedial, superolateral and inferomedial genicular nerves. Pain was evaluated with the numerical rating scale, quality of life with the Short Form-36 (SF-36), and disability with the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index before, and at 1 and 3 months after the procedure.
RESULTS
A total of 41 patients were included. There were no differences between the groups except for the SF-36 physical health sub-score at baseline. A significant improvement was seen in the numeric rating scale (NRS) score, SF-36 sub-scores, WOMAC Index total, as well as pain and physical function scores in both groups, though no significant difference was detected between the groups during follow-up.
CONCLUSIONS
Although we were unable to establish the noninferiority of conventional radiofrequency ablation (CRFA) applied to 2 branches to CRFA applied to 3 branches, in this trial, significant and similar improvement was observed in NRS, WOMAC total, pain, and physical function and SF-36 scores in both groups.
PubMed: 38946697
DOI: 10.3344/kjp.24098 -
Autoimmunity Dec 2024Chondrocyte viability, apoptosis, and migration are closely related to cartilage injury in osteoarthritis (OA) joints. Exosomes are identified as potential therapeutic...
BACKGROUND
Chondrocyte viability, apoptosis, and migration are closely related to cartilage injury in osteoarthritis (OA) joints. Exosomes are identified as potential therapeutic agents for OA.
OBJECTIVE
This study aimed to investigate the role of exosomes derived from osteocytes in OA, particularly focusing on their effects on cartilage repair and molecular mechanisms.
METHODS
An injury cell model was established by treating chondrocytes with IL-1β. Cartilage repair was evaluated using cell counting kit-8, flow cytometry, scratch test, and Western Blot. Molecular mechanisms were analyzed using quantitative real-time PCR, bioinformatic analysis, and Western Blot. An OA mouse model was established to explore the role of exosomal DLX2 .
RESULTS
Osteocyte-released exosomes promoted cell viability and migration, and inhibited apoptosis and extracellular matrix (ECM) deposition. Moreover, exosomes upregulated DLX2 expression, and knockdown of DLX2 activated the Wnt pathway. Additionally, exosomes attenuated OA in mice by transmitting DLX2.
CONCLUSION
Osteocyte-derived exosomal DLX2 alleviated IL-1β-induced cartilage repair and inactivated the Wnt pathway, thereby alleviating OA progression. The findings suggested that osteocyte-derived exosomes may hold promise as a treatment for OA.
Topics: Exosomes; Animals; Osteoarthritis; Mice; Transcription Factors; Homeodomain Proteins; Osteocytes; Wnt Signaling Pathway; Chondrocytes; Disease Models, Animal; Humans; Interleukin-1beta; Cartilage, Articular; Apoptosis; Cartilage; Male; Cell Movement; Cell Survival
PubMed: 38946534
DOI: 10.1080/08916934.2024.2364686 -
Physiotherapy Theory and Practice Jul 2024The relationship between psychosocial factors and bodily pain in people with knee osteoarthritis (KOA) is unclear.
INTRODUCTION
The relationship between psychosocial factors and bodily pain in people with knee osteoarthritis (KOA) is unclear.
PURPOSE
To examine whether widespread pain was associated with poorer self-efficacy, more anxiety, depression, and kinesiophobia in people with KOA.
METHODS
This was a cross-sectional study based on data from Good Life with osteoArthritis in Denmark (GLA:D®). The association between widespread pain (multiple pain sites) and self-efficacy (Arthritis Self-Efficacy Scale), anxiety and depression (item from the EQ-5D-5 L), and kinesiophobia (yes/no) was examined using multiple linear tobit or logistic regression models.
RESULTS
Among 19,323 participants, 10% had no widespread pain, 37% had 2 pain sites, 26% had 3-4 pain sites, and 27% had ≥5 pain sites. Widespread pain was associated with poorer self-efficacy (-0.9 to -8.3 points), and the association was stronger with increasing number of pain sites (p-value <.001). Significant increasing odds ratios (ORs) were observed for having anxiety or depression with 3-4 pain sites (OR 1.29, 95% CI 1.12; 1.49) and ≥5 pain sites (OR 1.80, 95% CI 1.56; 2.07). Having 2 and 3-4 pain sites were associated with lower odds of kinesiophobia compared to having no widespread pain.
CONCLUSION
Widespread pain was associated with lower self-efficacy and more anxiety and depression but also lower kinesiophobia in people with KOA.
PubMed: 38946473
DOI: 10.1080/09593985.2024.2372381 -
Nihon Yakurigaku Zasshi. Folia... 2024
Topics: Humans; Osteoarthritis; Animals; NAV1.7 Voltage-Gated Sodium Channel; Molecular Targeted Therapy
PubMed: 38945912
DOI: 10.1254/fpj.24010 -
The Bone & Joint Journal Jul 2024This study aims to identify the top unanswered research priorities in the field of knee surgery using consensus-based methodology.
AIMS
This study aims to identify the top unanswered research priorities in the field of knee surgery using consensus-based methodology.
METHODS
Initial research questions were generated using an online survey sent to all 680 members of the British Association for Surgery of the Knee (BASK). Duplicates were removed and a longlist was generated from this scoping exercise by a panel of 13 experts from across the UK who provided oversight of the process. A modified Delphi process was used to refine the questions and determine a final list. To rank the final list of questions, each question was scored between one (low importance) and ten (high importance) in order to produce the final list.
RESULTS
This consensus exercise took place between December 2020 and April 2022. A total of 286 clinicians from the BASK membership provided input for the initial scoping exercise, which generated a list of 105 distinct research questions. Following review and prioritization, a longlist of 51 questions was sent out for two rounds of the Delphi process. A total of 42 clinicians responded to the first round and 24 responded to the second round. A final list of 24 research questions was then ranked by 36 clinicians. The topics included arthroplasty, infection, meniscus, osteotomy, patellofemoral, cartilage, and ligament pathologies. The management of early osteoarthritis was the highest-ranking question.
CONCLUSION
A Delphi exercise involving the BASK membership has identified the future research priorities in knee surgery. This list of questions will allow clinicians, researchers, and funders to collaborate in order to deliver high-quality research in knee surgery and further advance the care provided to patients with knee pathology.
Topics: Humans; Delphi Technique; United Kingdom; Societies, Medical; Biomedical Research; Knee Joint; Consensus; Surveys and Questionnaires; Research; Orthopedic Procedures
PubMed: 38945547
DOI: 10.1302/0301-620X.106B7.BJJ-2023-0691.R1 -
The Bone & Joint Journal Jul 2024Robotic arm-assisted surgery offers accurate and reproducible guidance in component positioning and assessment of soft-tissue tensioning during knee arthroplasty, but... (Comparative Study)
Comparative Study
AIMS
Robotic arm-assisted surgery offers accurate and reproducible guidance in component positioning and assessment of soft-tissue tensioning during knee arthroplasty, but the feasibility and early outcomes when using this technology for revision surgery remain unknown. The objective of this study was to compare the outcomes of robotic arm-assisted revision of unicompartmental knee arthroplasty (UKA) to total knee arthroplasty (TKA) versus primary robotic arm-assisted TKA at short-term follow-up.
METHODS
This prospective study included 16 patients undergoing robotic arm-assisted revision of UKA to TKA versus 35 matched patients receiving robotic arm-assisted primary TKA. In all study patients, the following data were recorded: operating time, polyethylene liner size, change in haemoglobin concentration (g/dl), length of inpatient stay, postoperative complications, and hip-knee-ankle (HKA) alignment. All procedures were performed using the principles of functional alignment. At most recent follow-up, range of motion (ROM), Forgotten Joint Score (FJS), and Oxford Knee Score (OKS) were collected. Mean follow-up time was 21 months (6 to 36).
RESULTS
There were no differences between the two treatment groups with regard to mean change in haemoglobin concentration (p = 0.477), length of stay (LOS, p = 0.172), mean polyethylene thickness (p = 0.065), or postoperative complication rates (p = 0.295). At the most recent follow-up, the primary robotic arm-assisted TKA group had a statistically significantly improved OKS compared with the revision UKA to TKA group (44.6 (SD 2.7) vs 42.3 (SD 2.5); p = 0.004) but there was no difference in the overall ROM (p = 0.056) or FJS between the two treatment groups (86.1 (SD 9.6) vs 84.1 (4.9); p = 0.439).
CONCLUSION
Robotic arm-assisted revision of UKA to TKA was associated with comparable intraoperative blood loss, early postoperative rehabilitation, functional outcomes, and complications to primary robotic TKA at short-term follow-up. Robotic arm-assisted surgery offers a safe and reproducible technique for revising failed UKA to TKA.
Topics: Humans; Arthroplasty, Replacement, Knee; Male; Female; Prospective Studies; Robotic Surgical Procedures; Aged; Middle Aged; Reoperation; Treatment Outcome; Range of Motion, Articular; Follow-Up Studies; Length of Stay; Postoperative Complications; Knee Prosthesis; Aged, 80 and over; Osteoarthritis, Knee
PubMed: 38945538
DOI: 10.1302/0301-620X.106B7.BJJ-2023-0943.R2 -
Archives of Physical Medicine and... Jun 2024This review aimed to investigate the effectiveness of mHealth-supported active exercise interventions to reduce pain intensity and disability level in persons with hip... (Review)
Review
Effectiveness of mHealth interventions to improve pain intensity and functional disability in patients with hip or knee osteoarthritis: a systematic review and meta-analysis.
OBJECTIVE
This review aimed to investigate the effectiveness of mHealth-supported active exercise interventions to reduce pain intensity and disability level in persons with hip or knee OA.
DATA SOURCES
Three databases (PubMed, Cochrane Library, and Web of science) were systematically searched for randomized-controlled trials (RCTs) published between 01-01-2012 and 31-07-2023. PROSPERO registration number of this review was CRD42023394119.
STUDY SELECTION
We included only RCTs that were identified and screened by two independent reviewers (JM and GN). In addition, the reference lists of the identified studies were manually checked for further inclusion. Included studies had to provide a mHealth-supported active exercises for persons with hip or knee OA, and evaluate pain intensity and disability using both questionnaires and performance tests.
DATA EXTRACTION
From the included studies, the two independent authors extracted data using a predetermined Excel form. Characteristics of the interventions were described and a meta-analysis was performed.
DATA SYNTHESIS
Twelve RCTs were included, representing 1,541 patients with a mean age of 58.7±5 years, and a BMI of 28.8±3.1; females being more predominant than males with a total ratio female/male of 2.2. The methodological quality of the included studies was of moderate quality in 75% of the studies. There was no statistically significant difference between mHealth-supported active exercises compared to the interventions without mHealth in terms of pain reduction (SMD= -0.42 [95%CI -0.91; 0.07], p = 0.08) and disability mitigation (SMD = -0.36 [95%CI -0.81; 0.09], p = 0.10). However, a statistically significant difference was found between patient education combined with mHealth-supported active exercises compared to patient education alone in terms of pain (SMD= -0.42 [95%CI -0.61; -0.22], p<0.01) and disability (SMD= -0.27 [95%CI -0.46; -0.08], p < 0.01) reduction.
CONCLUSION
mHealth-supported exercises were found to be effective, especially when combined with patient education, in reducing pain and mitigating disability in patients with hip or knee OA.
PubMed: 38945508
DOI: 10.1016/j.apmr.2024.06.008 -
International Journal of Pharmaceutics Jun 2024Rhein, a natural anthraquinone compound derived from traditional Chinese medicine, exhibits potent anti-inflammatory properties via modulating the level of Reactive...
Rhein, a natural anthraquinone compound derived from traditional Chinese medicine, exhibits potent anti-inflammatory properties via modulating the level of Reactive oxygen or nitrogen species (RONS). Nevertheless, its limited solubility in water, brief duration of plasma presence, as well as its significant systemic toxicity, pose obstacles to its in vivo usage, necessitating the creation of a reliable drug delivery platform to circumvent these difficulties. In this study, an esterase-responsive and mitochondria-targeted nano-prodrug was synthesized by conjugating Rhein with the polyethylene glycol (PEG)-modified triphenyl phosphonium (TPP) molecule, forming TPP-PEG-RH, which could spontaneously self-assemble into RPT NPs when dispersed in aqueous media. The TPP outer layer of these nanoparticles enhances their pharmacokinetic profile, facilitates efficient delivery to mitochondria, and promotes cellular uptake, thereby enabling enhanced accumulation in mitochondria and improved therapeutic effects in vitro. The decline in RONS was observed in IL-1β-stimulated chondrocyte after RPT NPs treating. RPT NPs also exert excellent anti-inflammatory (IL-1β, TNF-α, IL-6 and MMP-13) and antioxidative effects (Cat and Sod) via the Nrf2 signalling pathway, upregulation of cartilage related genes (Col2a1 and Acan). Moreover, RPT NPs shows protection of mitochondrial membrane potential and inhibition of chondrocyte apoptosis. Moreover, These findings suggest that the mitochondria-targeted polymer-Rhein conjugate may offer a therapeutic solution for patients suffering from chronic joint disorders, by attenuating the progression of osteoarthritis (OA).
PubMed: 38945463
DOI: 10.1016/j.ijpharm.2024.124397 -
Osteoarthritis and Cartilage Jun 2024Although, during the past decades, substantial advances emerged in identifying major local and systemic factors contributing to initiation and progression of... (Review)
Review
Although, during the past decades, substantial advances emerged in identifying major local and systemic factors contributing to initiation and progression of osteoarthritis (OA), some neuroendocrine mechanisms are still not understood or even neglected when thinking about novel therapeutic options. One of which is the sympathetic nervous system that exhibits various OA-promoting effects in different tissues of the joint. Interestingly, the β2-adrenoceptor (AR) mediates the majority of these effects as demonstrated by several in vitro, in vivo as well as in clinical studies. This review article does not only summarize studies of the past two decades demonstrating that the β2-AR plays an OA-promoting role in different tissues of the joint but also aims to encourage the reader to think about next-level research to discover novel and innovative preventive and/or therapeutic strategies targeting the β2-AR in OA.
PubMed: 38945292
DOI: 10.1016/j.joca.2024.06.012 -
Clinical Biomechanics (Bristol, Avon) Jun 2024The purpose was to explore quadriceps electromechanical function (quadriceps latency) during gait after anterior cruciate ligament injury as a predictor for radiographic...
Prolonged quadriceps latency during gait early after anterior cruciate ligament injury predicts radiographic knee osteoarthritis 6-years after anterior cruciate ligament reconstruction.
BACKGROUND
The purpose was to explore quadriceps electromechanical function (quadriceps latency) during gait after anterior cruciate ligament injury as a predictor for radiographic knee osteoarthritis 6-years after anterior cruciate ligament reconstruction. Change in latency after preoperative physical therapy was also examined.
METHODS
Quadriceps latency (time between peak knee moment and quadriceps electromyography) was calculated before preoperative physical therapy (2.4 [0.5-7.5] months after anterior cruciate ligament injury) and after preoperative physical therapy in 24 athletes. Participants were dichotomized into osteoarthritis (Kellgren and Lawrence grade ≥ 2) and non-osteoarthritis groups at 6-years. Forward selection logistic regression was performed using z-score normalized quadriceps latency and demographics. A 2 × 2 repeated measure ANOVA was performed for quadriceps latency between groups before and after preoperative physical therapy.
FINDINGS
Quadriceps latency before preoperative physical therapy was the only predictor of 6-year radiographic osteoarthritis (p = 0.014, odds ratio [95% confidence interval] = 5.859 [1.435-23.924]). Time by group interaction was observed for quadriceps latency (p = 0.039, ηp = 0.179). In the osteoarthritis group, latency may reduce after training (before preoperative physical therapy = 115.7 ± 20.6 ms, after preoperative physical therapy = 99.5 ± 24.0 ms, p = 0.082).
INTERPRETATION
Prolonged latency after anterior cruciate ligament injury may predict post-traumatic knee osteoarthritis 6-years after anterior cruciate ligament reconstruction. Latency may shorten with preoperative physical therapy, yet athletes still moved on to develop osteoarthritis. Quadriceps function may need intervention immediately following anterior cruciate ligament injury for prevention of post-traumatic knee osteoarthritis.
PubMed: 38945068
DOI: 10.1016/j.clinbiomech.2024.106301