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Sample records for knee pain map

  1. Knee pain

    MedlinePlus

    ... the front of your knee around the kneecap Torn ligament. An anterior cruciate ligament (ACL) injury, or ... into your knee, swelling, or an unstable knee. Torn cartilage (a meniscus tear ). Pain felt on the ...

  2. Knee pain (image)

    MedlinePlus

    ... front of the knee can be due to bursitis, arthritis, or softening of the patella cartilage as ... knee. Overall knee pain can be due to bursitis, arthritis, tears in the ligaments, osteoarthritis of the ...

  3. Knee Pain

    MedlinePlus

    ... Schueler, MD How it Works Testimonials FAQ for Consumers FAQ for Physicians News Advertising Terms of Use Contact Us Site Map How it Works When people are sick, they must make critical decisions about when and where they should receive healthcare. ...

  4. Anterior Knee Pain (Chondromalacia Patellae).

    ERIC Educational Resources Information Center

    Garrick, James G.

    1989-01-01

    This article presents a pragmatic approach to the definition, diagnosis, and management of anterior knee pain. Symptoms and treatment are described. Emphasis is on active involvement of the patient in the rehabilitation exercise program. (IAH)

  5. Anterior knee pain

    MedlinePlus

    ... places extra stress on the kneecap (such as running, jumping or twisting, skiing, or playing soccer). You ... noticeable with: Deep knee bends Going down stairs Running downhill Standing up after sitting for awhile

  6. The Painful Total Knee Arthroplasty.

    PubMed

    McDowell, Mitchell; Park, Andrew; Gerlinger, Tad L

    2016-04-01

    There are many causes of residual pain after total knee arthroplasty (TKA). Evaluation and management begins with a comprehensive history and physical examination, followed by radiographic evaluation of the replaced and adjacent joints, as well as previous films of the replaced joint. Further workup includes laboratory analysis, along with a synovial fluid aspirate to evaluate the white blood cell count with differential as well as culture. Advanced imaging modalities may be beneficial when the diagnosis remains unclear. Revision surgery is not advisable without a clear diagnosis, as it may be associated with poor results. PMID:26772940

  7. Brain activity for chronic knee osteoarthritis: dissociating evoked pain from spontaneous pain

    PubMed Central

    Parks, Elle L.; Geha, Paul Y.; Baliki, Marwan N.; Katz, Jeffrey; Schnitzer, Thomas J.; Apkarian, A. Vania

    2011-01-01

    Chronic pain is a hallmark of osteoarthritis (OA), yet little is known about its properties and representation in the brain. Here we use fMRI combined with psychophysics to study knee pain in 14 OA patients and 9 healthy controls. Mechanical painful pressure stimuli were applied to the knee in both groups and ratings of evoked pain and related brain activity examined. We observe that psychophysical properties and brain activation patterns of evoked pain are essentially the same between OA patients and healthy subjects, and between worse and better OA knees. In OA patients, stimulus-related brain activity could be distinguished from brain activity associated with spontaneous pain. The former activated brain regions commonly observed for acute painful stimuli in healthy subjects, while the spontaneous pain of OA engaged prefrontal-limbic regions closely corresponding to areas observed for spontaneous pain in other chronic pain conditions, such as chronic back pain and post-herpetic neuralgia. Arthritis-related clinical characteristics of knee OA also mapped to prefrontal-limbic regions. In a subgroup of patients (n = 6) we examined brain activity changes for a 2-week, repeat measure, cyclooxygenase-2 inhibitor (valdecoxib) therapy. Treatment decreased spontaneous pain for the worse knee and clinical characteristics of OA, and increased blood and csf levels of the drug which correlated positively with prefrontal-limbic brain activity. These findings indicate dissociation between mechanically induced and spontaneous OA knee pain, the latter engaging brain regions involved in emotional assessment of the self, and challenge the standard clinical view regarding the nature of OA pain. PMID:21315627

  8. Comparison of hip and knee muscle moments in subjects with and without knee pain.

    PubMed

    Manetta, Jennifer; Franz, Laura Hayden; Moon, Chris; Perell, Karen L; Fang, Meika

    2002-12-01

    Elderly subjects with and without knee pain walked at a comfortable pace during gait analysis. Comparison of peak hip and knee internal extensor generalized muscle moments (GMMs) during loading response was made between groups. Walking velocity, peak hip internal extensor GMM, and knee range of motion (ROM) were significantly less for the group with knee pain than for the group without pain. Peak hip internal extensor GMM was strongly correlated with velocity, but peak knee internal extensor GMM was not. Knee ROM limitations may account for the increased peak knee internal extensor GMM in the knee pain group. PMID:12443949

  9. Anterior knee pain following primary total knee arthroplasty

    PubMed Central

    Shervin, David; Pratt, Katelyn; Healey, Travis; Nguyen, Samantha; Mihalko, William M; El-Othmani, Mouhanad M; Saleh, Khaled J

    2015-01-01

    Despite improvements in technique and technology for total knee arthroplasty (TKA), anterior knee pain impacts patient outcomes and satisfaction. Addressing the prosthetic and surgical technique related causes of pain after TKA, specifically as it relates to anterior knee pain, can aid surgeons in addressing these issues with their patients. Design features of the femoral and patellar components which have been reported as pain generators include: Improper femoral as well as patellar component sizing or designs that result in patellofemoral stuffing; a shortened trochlear groove distance from the flange to the intercondylar box; and then surgical technique related issues resulting in: Lateral patellar facet syndrome; overstuffed patella/flange combination; asymmetric patellar resurfacing, improper transverse plane component rotation resulting in patellar subluxation/tilt. Any design consideration that allows impingement of extensor mechanism anatomical elements has the possibility of impacting outcome by becoming a pain generator. As the number of TKA procedures continues to increase, it is increasingly critical to develop improved, evidence based prostheses that maximize function and patient satisfaction while minimizing pain and other complications. PMID:26601061

  10. Knee Pain in Children: Part I: Evaluation.

    PubMed

    Wolf, Michael

    2016-01-01

    • On the basis of primarily consensus, due to lack of relevant clinical studies, the information obtained from the history and physical examination is the key to establishing a diagnosis and directing initial management of knee pain. • By applying history and physical examination findings to a diagnosis and management algorithm, clinicians can efficiently and effectively determine the potential cause of the knee pain. • On the basis of primarily consensus, due to lack of relevant clinical studies, the most important step of the evaluation of knee pain is to identify emergent conditions, including limb- and life-threatening conditions (eg, septic arthritis, osteomyelitis, and malignancy), hip pathology, or conditions associated with effusions. PMID:26729778

  11. Techniques for assessing knee joint pain in arthritis

    PubMed Central

    Neugebauer, Volker; Han, Jeong S; Adwanikar, Hita; Fu, Yu; Ji, Guangchen

    2007-01-01

    The assessment of pain is of critical importance for mechanistic studies as well as for the validation of drug targets. This review will focus on knee joint pain associated with arthritis. Different animal models have been developed for the study of knee joint arthritis. Behavioral tests in animal models of knee joint arthritis typically measure knee joint pain rather indirectly. In recent years, however, progress has been made in the development of tests that actually evaluate the sensitivity of the knee joint in arthritis models. They include measurements of the knee extension angle struggle threshold, hind limb withdrawal reflex threshold of knee compression force, and vocalizations in response to stimulation of the knee. A discussion of pain assessment in humans with arthritis pain conditions concludes this review. PMID:17391515

  12. Editorial Commentary: Platelet-Rich Plasma Improves Knee Pain and Function in Patients With Knee Osteoarthritis.

    PubMed

    Lubowitz, James H

    2015-11-01

    Systematic review of overlapping meta-analyses shows that platelet-rich plasma improves knee pain and function in patients with knee osteoarthritis. Ultimately, biologics hold promise for chondroprotection in addition to symptomatic relief. PMID:26542203

  13. Pain hypervigilance is associated with greater clinical pain severity and enhanced experimental pain sensitivity among adults with symptomatic knee osteoarthritis

    PubMed Central

    Herbert, Matthew S.; Goodin, Burel R.; Pero, Samuel T.; Schmidt, Jessica K.; Sotolongo, Adriana; Bulls, Hailey W.; Glover, Toni L.; King, Christopher D.; Sibille, Kimberly T.; Cruz-Almeida, Yenisel; Staud, Roland; Fessler, Barri J.; Bradley, Laurence A.; Fillingim, Roger B.

    2014-01-01

    Background Pain hypervigilance is an important aspect of the fear-avoidance model of pain that may help explain individual differences in pain sensitivity among persons with knee osteoarthritis (OA). Purpose The purpose of this study was to examine the contribution of pain hypervigilance to clinical pain severity and experimental pain sensitivity in persons with symptomatic knee OA. Methods We analyzed cross-sectional data from 168 adults with symptomatic knee OA. Quantitative sensory testing was used to measure sensitivity to heat pain, pressure pain, and cold pain, as well as temporal summation of heat pain, a marker of central sensitization. Results Pain hypervigilance was associated with greater clinical pain severity, as well as greater pressure pain. Pain hypervigilance was also a significant predictor of temporal summation of heat pain. Conclusions Pain hypervigilance may be an important contributor to pain reports and experimental pain sensitivity among persons with knee OA. PMID:24352850

  14. How does knee pain affect trunk and knee motion during badminton forehand lunges?

    PubMed

    Huang, Ming-Tung; Lee, Hsing-Hsan; Lin, Cheng-Feng; Tsai, Yi-Ju; Liao, Jen-Chieh

    2014-01-01

    Badminton requires extensive lower extremity movement and a precise coordination of the upper extremity and trunk movements. Accordingly, this study investigated motions of the trunk and the knee, control of dynamic stability and muscle activation patterns of individuals with and without knee pain. Seventeen participants with chronic knee pain and 17 healthy participants participated in the study and performed forehand forward and backward diagonal lunges. This study showed that those with knee pain exhibited smaller knee motions in frontal and horizontal planes during forward lunge but greater knee motions in sagittal plane during backward lunge. By contrast, in both tasks, the injured group showed a smaller value on the activation level of the paraspinal muscles in pre-impact phase, hip-shoulder separation angle, trunk forward inclination range and peak centre of mass (COM) velocity. Badminton players with knee pain adopt a more conservative movement pattern of the knee to minimise recurrence of knee pain. The healthy group exhibit better weight-shifting ability due to a greater control of the trunk and knee muscles. Training programmes for badminton players with knee pain should be designed to improve both the neuromuscular control and muscle strength of the core muscles and the knee extensor with focus on the backward lunge motion. PMID:24404882

  15. Painful knee arthroplasty: definition and overview

    PubMed Central

    Carulli, Christian; Villano, Marco; Bucciarelli, Giovanni; Martini, Caterina; Innocenti, Massimo

    2011-01-01

    Summary Total Knee Arthroplasty (TKA) is one of the most successful procedures in Orthopaedic Surgery, with good clinical results and high survival rate in more than 90% of the cases at long-term follow-up. Since the increase of population’s mean age, worsening of articular degenerative alterations, and articular sequelae related to previous fractures, there is a persistent growing of the number of knee arthroplasties in every country each year, with expected increase of complications rates. Painful TKA is considered an unusual complication, but several reports focus on this challenging clinical issue. Common causes of painful TKA may be divided as early or late, and in referred, periarticular or intra-articular. Among the early, we recall implant instability (related to surgical and technical mistakes) and problems of extensor mechanism (patella not resurfaced, malalignment of femoral, tibial, or patellar component, tendons failure or degeneration). Late causes of painful TKA are almost related to aseptic loosening and infection, but also, even if unusual, reflex sympathetic dystrophy, synovitis, and hypersensitivity to metal implants are represented. Hypersensitivity to metal is a clinical issue with significative increase, but to date without a specific characterization. The Authors report about incidence, clinical features, and diagnostic pathways of hypersensitivity to metal implants, focusing on the prevention of this challenging problem. PMID:22461811

  16. Tibial Tubercle Osteotomy for Anterior Knee Pain

    PubMed Central

    Bonasia, Davide; Rosso, Federica; Cottino, Umberto; Governale, Giorgio; Cherubini, Valeria; Dettoni, Federico; Bruzzone, Matteo; Rossi, Roberto

    2016-01-01

    Objectives: The aim of this study was to evaluate the mid-term radiological and clinical outcomes of tibial tubercle osteotomy in patients affected by anterior knee pain. In addition, prognostic factors correlated with the outcomes were evaluated. Methods: The patients treated with tibial tubercle osteotomy (anteromedialization) for anterior knee pain between 2002 and 2014 were included. Exclusion criteria: 1) previous knee surgeries; 2) different procedures to treat anterior knee pain; 3) history of patellar dislocation, 4) Rheumatic conditions. Different variables were collected, as shown in. The patients were prospectively evaluated using the WOMAC short form and Kujala scores. An objective evaluation was performed looking for different potential risk factors and using part of the International Knee Documentation Committee (IKDC) score. Radiological evaluation was performed, including the congruence angle, the grade of osteoarthritis (Kellegren-Lawrence) and the patellar tilt angle. Three main outcomes were identified. The multiple logistic regression was used to analyze the correlation between the variables and a worse outcome. Results: 72 cases were included in the study (9 bilateral). 72.2% of the cases were female, and the average age was 42,2 years (SD15,9). The average BMI was 24.4 kg/m2 (SD5,2). In 70.8% of patients a lateral release was associated to the tibial tubercle osteotomy. 77.8% of patients were evaluated clinically, the remaining, who were unable to come for the visits, were interviewed and the subjective scores were administered by phone. The average follow-up was 68.4 months (SD35.5).In 62.5% of cases a valgus lower limb alignment was detected, with 25% and 39.3% of patients having respectively an increased femoral antiversion and foot pronation. Post-operatively there was a statistical significant improvement in all the scores. No differences in the pre-operative and post-operative congruence angle or patellar tilt were detected (p>0.05). All

  17. [A man with a painful knee with restricted flexion].

    PubMed

    Valkering, Lucia J J; Zengerink, Maartje; van Kampen, Albert

    2015-01-01

    A 39-year-old man presented with knee pain and limited knee flexion. MRI showed a mucoid degeneration of the anterior cruciate ligament (celery stalk sign). This rare condition can be treated with arthroscopic debridement with volume reduction of the anterior cruciate ligament. In severe cases, anterior cruciate ligament resection could be considered. PMID:26395568

  18. Editorial Commentary: Knee Hyaluronic Acid Viscosupplementation Reduces Osteoarthritis Pain.

    PubMed

    Lubowitz, James H

    2015-10-01

    In contrast to the AAOS knee osteoarthritis guidelines, systematic review of overlapping meta-analyses shows that viscosupplementation with intra-articular hyaluronic acid injection reduces knee osteoarthritis pain and improves function according to the highest level of evidence. PMID:26433240

  19. Preoperative Predictors of Pain Following Total Knee Arthroplasty

    PubMed Central

    Noiseux, Nicolas O.; Callaghan, John J.; Clark, Charles R.; Zimmerman, M. Bridget; Sluka, Kathleen A.; Rakel, Barbara A.

    2014-01-01

    Total knee arthroplasty has provided dramatic improvements in function and pain for the majority of patients with knee arthritis, yet a significant proportion of patients remain dissatisfied with their results. We performed a prospective analysis of 215 patients undergoing TKA who underwent a comprehensive array of evaluations to discover whether any preoperative assessment could predict high pain scores and functional limitations postoperatively. Patients with severe pain with a simple knee range-of-motion test prior to TKA had a 10x higher likelihood of moderate to severe pain at 6 months. A simple test of pain intensity with active flexion and extension preoperatively was a significant predictor of postoperative pain at 6 months after surgery. Strategies to address this particular patient group may improve satisfaction rates of TKA. PMID:24630598

  20. Factors Associated with Pain Experience Outcome in Knee Osteoarthritis

    PubMed Central

    Rayahin, Jamie E.; Chmiel, Joan S.; Hayes, Karen W.; Almagor, Orit; Belisle, Laura; Chang, Alison H.; Moisio, Kirsten; Zhang, Yunhui; Sharma, Leena

    2014-01-01

    Objective Few strategies to improve pain outcome in knee OA exist, in part because how best to evaluate pain over the long-term is unclear. Our objectives were: determine frequency of a good pain experience outcome based on previously formulated OA pain stages; and test the hypothesis that less depression and pain catastrophizing and greater self-efficacy and social support are each associated with greater likelihood of a good outcome. Methods Study participants all with knee OA reported pain stage at baseline and 2 years. Baseline assessments utilized the Geriatric Depression Scale, Pain Catastrophizing Scale, Arthritis Self-Efficacy Scale, and MOS Social Support Survey. Using pain experience stages, good outcome was defined b persistence in or movement to no pain or stage 1 (predictable pain, known trigger) at 2 years. A multivariable logistic regression model was developed to identify independent predictors of a good outcome. Results Of 212, 136 (64%) had a good pain outcome and 76 (36%) a poor outcome. In multivariable analysis, higher self-efficacy was associated with a significantly higher likelihood of good outcome (adjusted OR 1.14, 95% CI: 1.04–1.24); higher pain catastrophizing was associated with a significantly lower likelihood of good outcome (adjusted OR 0.88, 95% CI: 0.83–0.94). Conclusion This stage-based measure provides a meaningful and interpretable means to assess pain outcome in knee OA. The odds of a good 2-year outcome in knee OA were lower in persons with greater pain catastrophizing and higher in persons with greater self-efficacy. Targeting these factors may help to improve pain outcome in knee OA. PMID:25047144

  1. Arthroscopic knee debridement can delay total knee replacement in painful moderate haemophilic arthropathy of the knee in adult patients.

    PubMed

    Rodriguez-Merchan, E Carlos; Gomez-Cardero, Primitivo

    2016-09-01

    The role of arthroscopic debridement of the knee in haemophilia is controversial in the literature. The purpose of this study is to describe the results of arthroscopic knee debridement (AKD), with the aim of determining whether it is possible to delay total knee replacement (TKR) for painful moderate haemophilic arthropathy of the knee in adult patients. In a 14-year period (1998-2011), AKD was performed for moderate haemophilic arthropathy of the knee in 27 patients with haemophilia A. Their average age at operation was 28.6 years (range 26-39 years). Indications for surgery were as follows: more than 90° of knee flexion, flexion deformity less than 30°, good axial alignment of the knee, good patellar alignment, and pain above >60 points in a visual analogue scale [0 (no pain) to 100 points]. Secondary haematological prophylaxis and rehabilitation (physiotherapy) was given for at least 3 months after surgery. Follow-up was for an average of 7.5 years (range 2-14 years). We assessed the clinical outcome before surgery and at the time of latest follow-up using the Knee Society pain and function scores, the range of motion, and the radiological score of the World Federation of Haemophilia. Knee Society pain scores improved from 39 preoperatively to 66 postoperatively, and function scores improved from 36 to 52. Range of motion improved on an average from -15° of extension and 90° of flexion before surgery, to -5° of extension and 110° of flexion at the last follow-up. A radiological deterioration of 2.8 points on average was found. There were two (7.4%) postoperative complications (haemarthroses resolved by joint aspiration). One patient (3.7%) required a TKR 12.5 years later. AKD should be considered in painful moderate haemophilic arthropathy of the knee in adult patients to delay TKR. PMID:26575489

  2. Myofascial pain in patients waitlisted for total knee arthroplasty

    PubMed Central

    Henry, Richard; Cahill, Catherine M; Wood, Gavin; Hroch, Jennifer; Wilson, Rosemary; Cupido, Tracy; VanDenKerkhof, Elizabeth

    2012-01-01

    BACKGROUND: Knee pain is one of the major sources of pain and disability in developed countries, particularly in aging populations, and is the primary indication for total knee arthroplasty (TKA) in patients with osteoarthritis (OA). OBJECTIVES: To determine the presence of myofascial pain in OA patients waitlisted for TKA and to determine whether their knee pain may be alleviated by trigger point injections. METHODS: Following ethics approval, 25 participants were recruited from the wait list for elective unilateral primary TKA at the study centre. After providing informed consent, all participants were examined for the presence of active trigger points in the muscles surrounding the knee and received trigger point injections of bupivacaine. Assessments and trigger point injections were implemented on the first visit and at subsequent visits on weeks 1, 2, 4 and 8. Outcome measures included the Timed Up and Go test, Brief Pain Inventory, Centre for Epidemiologic Studies Depression Scale, State-Trait Anxiety Inventory and Short-Form McGill Pain Questionnaire. RESULTS: Myofascial trigger points were identified in all participants. Trigger point injections significantly reduced pain intensity and pain interference, and improved mobility. All participants had trigger points identified in medial muscles, most commonly in the head of the gastrocnemius muscle. An acute reduction in pain and improved functionality was observed immediately following intervention, and persisted over the eight-week course of the investigation. CONCLUSION: All patients had trigger points in the vastus and gastrocnemius muscles, and 92% of patients experienced significant pain relief with trigger point injections at the first visit, indicating that a significant proportion of the OA knee pain was myofascial in origin. Further investigation is warranted to determine the prevalence of myofascial pain and whether treatment delays or prevents TKA. PMID:23061082

  3. A review of knee pain in adolescent females.

    PubMed

    Lipman, Rachel; John, Rita Marie

    2015-07-15

    Primary care practitioners are in a position to educate patients and parents about the risk factors that may increase the incidence of knee pain in adolescent females. This article highlights patellofemoral pain syndrome, Sinding-Larsen-Johansson syndrome, Osgood-Schlatter disease, and meniscal tears. PMID:26016939

  4. [Chronic knee pain and specific heat phobia. A case report].

    PubMed

    Pepke, W; Neubauer, E; Schiltenwolf, M

    2013-02-01

    This case report presents the medical history of a patient suffering from chronic knee pain with specific heat phobia who had a long history of sick certificates. Using multimodal pain therapy and biofeedback therapy the acquired anxiety disorder could be solved. Long-term working ability could be achieved. PMID:23321701

  5. Pain sensitivity profiles in patients with advanced knee osteoarthritis.

    PubMed

    Frey-Law, Laura A; Bohr, Nicole L; Sluka, Kathleen A; Herr, Keela; Clark, Charles R; Noiseux, Nicolas O; Callaghan, John J; Zimmerman, M Bridget; Rakel, Barbara A

    2016-09-01

    The development of patient profiles to subgroup individuals on a variety of variables has gained attention as a potential means to better inform clinical decision making. Patterns of pain sensitivity response specific to quantitative sensory testing (QST) modality have been demonstrated in healthy subjects. It has not been determined whether these patterns persist in a knee osteoarthritis population. In a sample of 218 participants, 19 QST measures along with pain, psychological factors, self-reported function, and quality of life were assessed before total knee arthroplasty. Component analysis was used to identify commonalities across the 19 QST assessments to produce standardized pain sensitivity factors. Cluster analysis then grouped individuals who exhibited similar patterns of standardized pain sensitivity component scores. The QST resulted in 4 pain sensitivity components: heat, punctate, temporal summation, and pressure. Cluster analysis resulted in 5 pain sensitivity profiles: a "low pressure pain" group, an "average pain" group, and 3 "high pain" sensitivity groups who were sensitive to different modalities (punctate, heat, and temporal summation). Pain and function differed between pain sensitivity profiles, along with sex distribution; however, no differences in osteoarthritis grade, medication use, or psychological traits were found. Residualizing QST data by age and sex resulted in similar components and pain sensitivity profiles. Furthermore, these profiles are surprisingly similar to those reported in healthy populations, which suggests that individual differences in pain sensitivity are a robust finding even in an older population with significant disease. PMID:27152688

  6. A Novel Association between Femoroacetabular Impingement and Anterior Knee Pain

    PubMed Central

    Sanchis-Alfonso, Vicente; Tey, Marc; Monllau, Joan Carles

    2015-01-01

    Background. For a long time it has been accepted that the main problem in the anterior knee pain (AKP) patient is in the patella. Currently, literature supports the link between abnormal hip function and AKP. Objective. Our objective is to investigate if Cam femoroacetabular impingement (FAI) resolution is related to the outcome in pain and disability in patients with chronic AKP recalcitrant to conservative treatment associated with Cam FAI. Material and Methods. A retrospective study on 7 patients with chronic AKP associated with FAI type Cam was performed. Knee and hip pain were measured with the visual analogue scale (VAS), knee disability with the Kujala scale, and hip disability with the Nonarthritic Hip Score (NAHS). Results. The VAS knee pain score and VAS hip pain score had a significant improvement postoperatively. At final follow-up, there was significant improvement in all functional scores (Kujala score and NAHS). Conclusion. Our finding supports the link between Cam FAI and AKP in some young patients. Assessment of Cam FAI should be considered as a part of the physical examination of patients with AKP, mainly in cases with pain recalcitrant to conservative treatment. PMID:26451254

  7. A Novel Association between Femoroacetabular Impingement and Anterior Knee Pain.

    PubMed

    Sanchis-Alfonso, Vicente; Tey, Marc; Monllau, Joan Carles

    2015-01-01

    Background. For a long time it has been accepted that the main problem in the anterior knee pain (AKP) patient is in the patella. Currently, literature supports the link between abnormal hip function and AKP. Objective. Our objective is to investigate if Cam femoroacetabular impingement (FAI) resolution is related to the outcome in pain and disability in patients with chronic AKP recalcitrant to conservative treatment associated with Cam FAI. Material and Methods. A retrospective study on 7 patients with chronic AKP associated with FAI type Cam was performed. Knee and hip pain were measured with the visual analogue scale (VAS), knee disability with the Kujala scale, and hip disability with the Nonarthritic Hip Score (NAHS). Results. The VAS knee pain score and VAS hip pain score had a significant improvement postoperatively. At final follow-up, there was significant improvement in all functional scores (Kujala score and NAHS). Conclusion. Our finding supports the link between Cam FAI and AKP in some young patients. Assessment of Cam FAI should be considered as a part of the physical examination of patients with AKP, mainly in cases with pain recalcitrant to conservative treatment. PMID:26451254

  8. Knee Pain and the Weekend Warriors

    MedlinePlus

    ... care. “OR-Live,” the vision of improving health. Hello, and welcome to Mercy Hospital. We’re in ... knee arthroscopy. Let me introduce first, Dr. Lavernia. Hello there. Dr. Lavernia Is the chief of the ...

  9. Pain relief in knee osteoarthritis reduces the propensity to trip on an obstacle.

    PubMed

    Pandya, Nirav K; Piotrowski, Gary A; Pottenger, Lawrence; Draganich, Louis F

    2007-01-01

    The pain associated with knee osteoarthritis (OA) has been shown to lead to an increased propensity to trip on an obstacle. Pain-relieving intra-articular injections are widely utilized in the treatment of knee OA. This study examined the effects of pain-relieving intra-articular knee injections on the ability to avoid contacting a suddenly appearing obstacle in patients with knee OA. Obstacle avoidance success rates, pain, body mass index, visual acuity, contrast sensitivity, depth perception, and single-leg stance duration were evaluated in nine patients with painful osteoarthritis of the knee and 14 age-matched healthy control subjects. Obstacle avoidance success rates, pain, and single leg stance duration were tested a second time in the patients with knee OA after they received their injections, which contained a fast-acting local anesthetic to provide rapid pain relief. After receiving the pain-relieving knee injections, patients with knee OA had 48% less pain and were 31% more successful in avoiding stepping on the obstacle. However, after receiving the injection, the obstacle avoidance success rates remained 20% less than those of the healthy controls. The results of this study suggest that knee pain-relief can decrease the propensity of people with painful knee OA to trip and fall over an obstacle. However, pain-relief alone did not return the patients with knee OA in this study to a disease-free risk of tripping. PMID:16529934

  10. Repeatability of gait analysis for measuring knee osteoarthritis pain in patients with severe chronic pain.

    PubMed

    Asay, Jessica L; Boyer, Katherine A; Andriacchi, Thomas P

    2013-07-01

    Gait measures are receiving increased attention in the evaluation of patients with knee osteoarthritis (OA). Yet, there remains a need to assess variability of gait analysis in patients with knee osteoarthritis over time and how pain affects variation in these gait parameters. The purpose of this study was to determine if important gait parameters, such as the knee adduction moment, knee flexion moment, peak vertical ground reaction force, and speed, were repeatable in patients with mild-to-moderate knee OA over a trial period of 12 weeks. Six patients were enrolled in this cross-over study design after meeting strict inclusion criteria. Gait tests were conducted three times at 4 week intervals and once after the placebo arm of a randomized treatment sequence; each gait test followed a 2-week period of receiving a placebo for a pain modifying drug. Repeatability for each gait variable was found using intraclass correlation coefficients (ICC) with a two-way random model. This study found that the knee adduction moment was repeatable throughout the four gait tests. However, normalized peak vertical ground reaction force and knee flexion moment were not as repeatable, varying with pain. This suggests that these gait outcomes could offer a more objective way to measure a patient's level of pain. PMID:23508626

  11. Metallosis Presenting as Knee Pain 26 years after Primary Total Knee Arthroplasty

    PubMed Central

    Sharareh, Behnam; Phan, Duy L.; Goreal, Wamda; Schwarzkopf, Ran

    2015-01-01

    Introduction: Metallosis occurs when periprosthetic soft tissues, synovium, and/or bone is infiltrated by metallic debris secondary to metal-on-metal wear. This debris can cause a chronic inflammatory reaction leading to joint instability, pain, and swelling, and may cause osteolysis, implant looseningand ultimately implant failure. Case Report: An 81 year old female, with a history of primary left total knee arthroplasty, presented with a 6 month history of left knee pain, swelling, and limited range of motion following a fall. Radiographs and joint aspiration were performed, with results that showed no evidence of periprosthetic trauma or infection but were suspicious for chronic metallosis. The patient underwent revision total knee replacement of the left knee which revealed extensive necrotic black metal debris throughout the joint space. Histopathology confirmed the diagnosis of a foreign body reaction consistent with metallosis. Conclusion: This case is a rare example of chronic metallosis presenting 26 years following total knee replacement. Treatment with revision total knee replacement is the consensus management choice to avoid further destruction of the bone and joint capsule that can occur with metal-induced inflammation. PMID:27299048

  12. Relationship of Buckling and Knee Injury to Pain Exacerbation in Knee Osteoarthritis: A Web-Based Case-Crossover Study

    PubMed Central

    Zobel, Isabelle; Erfani, Tahereh; Bennell, Kim L; Makovey, Joanna; Metcalf, Ben; March, Lyn; Zhang, Yuqing; Eckstein, Felix

    2016-01-01

    Background Knee osteoarthritis (OA) is one of the most frequent causes of limited mobility and diminished quality of life. Pain is the main symptom that drives individuals with knee OA to seek medical care and a recognized antecedent to disability and eventually joint replacement. Evidence shows that patients with symptomatic OA experience fluctuations in pain severity. Mechanical insults to the knee such as injury and buckling may contribute to pain exacerbation. Objective Our objective was to examine whether knee injury and buckling (giving way) are triggers for exacerbation of pain in persons with symptomatic knee OA. Methods We conducted a case-crossover study, a novel methodology in which participants with symptomatic radiographic knee OA who have had knee pain exacerbations were used as their own control (self-matched design), with all data collected via the Internet. Participants were asked to log-on to the study website and complete an online questionnaire at baseline and then at regular 10-day intervals for 3 months (control periods)—a total of 10 questionnaires. They were also instructed to go to the website and complete pain exacerbation questionnaires when they experienced an isolated incident of knee pain exacerbation (case periods). A pain exacerbation “case” period was defined as an increase of ≥2 compared to baseline. At each contact the pain exacerbation was designated a case period, and at all other regular 10-day contacts (control periods) participants were asked about knee injuries during the previous 7 days and knee buckling during the previous 2 days. The relationship of knee injury and buckling to the risk of pain exacerbation was examined using conditional logistic regression models. Results The analysis included 157 participants (66% women, mean age: 62 years, mean BMI: 29.5 kg/m2). Sustaining a knee injury was associated with experiencing a pain exacerbation (odds ratio [OR] 10.2, 95% CI 5.4, 19.3) compared with no injury. Knee

  13. Ultrasonographic scan in knee pain in athletes.

    PubMed Central

    Maffulli, N; Regine, R; Carrillo, F; Minelli, S; Beaconsfield, T

    1992-01-01

    Fifty-two knees were examined using real-time high-definition ultrasonography with a 7.5 MHz probe. The extra-articular structures were easily visualized and diagnosis of patellar tendon lesions and Baker's cysts formulated. While the meniscal cartilages were shown as a homogeneous triangular structure between the femoral condyle and the tibial plateau, no lesions were detected. Deeper intra-articular structures, such as the cruciate ligaments, were not shown by the scan, thus their evaluation was not possible. Given its low cost, wide availability, non-invasiveness and patients' acceptability of the technique, ultrasonography may play an important role in the diagnosis of soft tissue lesions in and around the knee joint. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 PMID:1623366

  14. Gonyautoxins: First evidence in pain management in total knee arthroplasty.

    PubMed

    Hinzpeter, Jaime; Barrientos, Cristián; Zamorano, Álvaro; Martinez, Álvaro; Palet, Miguel; Wulf, Rodrigo; Barahona, Maximiliano; Sepúlveda, Joaquín M; Guerra, Matias; Bustamante, Tamara; Del Campo, Miguel; Tapia, Eric; Lagos, Nestor

    2016-09-01

    Improvements in pain management techniques in the last decade have had a major impact on the practice of total knee arthroplasty (TKA). Gonyautoxin are phycotoxins, whose molecular mechanism of action is a reversible block of the voltage-gated sodium channels at the axonal level, impeding nerve impulse propagation. This study was designed to evaluate the clinical efficacy of Gonyautoxin infiltration, as a long acting pain blocker in TKA. Fifteen patients received a total dose of 40 μg of Gonyautoxin during the TKA operation. Postoperatively, all patients were given a standard painkiller protocol: 100 mg of intravenous ketoprofen and 1000 mg of oral acetaminophen every 8 hours for 3 days. The Visual Analog Scale (VAS) pain score and range of motion were recorded 12, 36, and 60 hours post-surgery. All patients reported pain of 2 or less on the VAS 12 and 36 hours post-surgery. Moreover, all scored were less than 4 at 60 hours post-surgery. All patients achieved full knee extension at all times. No side effects or adverse reactions to Gonyautoxin were detected in the follow-up period. The median hospital stay was 3 days. For the first time, this study has shown the effect of blocking the neuronal transmission of pain by locally infiltrating Gonyautoxin during TKA. All patients successfully responded to the pain control. The Gonyautoxin infiltration was safe and effective, and patients experienced pain relief without the use of opioids. PMID:27317871

  15. Knee muscle forces during walking and running in patellofemoral pain patients and pain-free controls.

    PubMed

    Besier, Thor F; Fredericson, Michael; Gold, Garry E; Beaupré, Gary S; Delp, Scott L

    2009-05-11

    One proposed mechanism of patellofemoral pain, increased stress in the joint, is dependent on forces generated by the quadriceps muscles. Describing causal relationships between muscle forces, tissue stresses, and pain is difficult due to the inability to directly measure these variables in vivo. The purpose of this study was to estimate quadriceps forces during walking and running in a group of male and female patients with patellofemoral pain (n = 27, 16 female; 11 male) and compare these to pain-free controls (n = 16, 8 female; 8 male). Subjects walked and ran at self-selected speeds in a gait laboratory. Lower limb kinematics and electromyography (EMG) data were input to an EMG-driven musculoskeletal model of the knee, which was scaled and calibrated to each individual to estimate forces in 10 muscles surrounding the joint. Compared to controls, the patellofemoral pain group had greater co-contraction of quadriceps and hamstrings (p = 0.025) and greater normalized muscle forces during walking, even though the net knee moment was similar between groups. Muscle forces during running were similar between groups, but the net knee extension moment was less in the patellofemoral pain group compared to controls. Females displayed 30-50% greater normalized hamstring and gastrocnemius muscle forces during both walking and running compared to males (p<0.05). These results suggest that some patellofemoral pain patients might experience greater joint contact forces and joint stresses than pain-free subjects. The muscle force data are available as supplementary material. PMID:19268945

  16. Pain in the knee associated with osteoporosis of the patella.

    PubMed Central

    Corbett, M; Colston, J R; Tucker, A K

    1977-01-01

    Four patients, all of whom complained of pain in the knee, were found to have radiological evidence of osteoporosis particularly marked in the patella. In 3 a neurological lesion at the appropriate spinal segment was present, and the fourth patient, who was frankly hysterical, had an autonomic disturbance. If radiological porosis is isolated to the patella a distant cause such as nerve irritation should be sought. Images PMID:856068

  17. PAIN FOLLOWING TOTAL KNEE ARTHROPLASTY – A SYSTEMATIC APPROACH

    PubMed Central

    Alves, Wilson Mello; Migon, Eduardo Zaniol; Zabeu, Jose Luis Amim

    2015-01-01

    Total knee arthroplasty (TKA) is known to be a successful procedure. The aging of the population and the growing demand for quality of life have greatly increased the indications for the procedure. Nonetheless, TKA presents some complications that still lack definitive resolution. Pain after TKA is caused by a myriad of reasons that need to be systematically studied in order to reach the correct diagnosis and treatment. History, physical examination, laboratory tests and imaging examinations must all be included in the workup and repeated until a plausible reason has been identified, since if pain is the only indication for TKA revision, the results may be catastrophic. PMID:27022583

  18. Biomechanical analysis of knee and trunk in badminton players with and without knee pain during backhand diagonal lunges.

    PubMed

    Lin, Cheng-Feng; Hua, Shiang-Hua; Huang, Ming-Tung; Lee, Hsing-Hsan; Liao, Jen-Chieh

    2015-01-01

    The contribution of core neuromuscular control to the dynamic stability of badminton players with and without knee pain during backhand lunges has not been investigated. Accordingly, this study compared the kinematics of the lower extremity, the trunk movement, the muscle activation and the balance performance of knee-injured and knee-uninjured badminton players when performing backhand stroke diagonal lunges. Seventeen participants with chronic knee pain (injured group) and 17 healthy participants (control group) randomly performed two diagonal backhand lunges in the forward and backward directions, respectively. This study showed that the injured group had lower frontal and horizontal motions of the knee joint, a smaller hip-shoulder separation angle and a reduced trunk tilt angle. In addition, the injured group exhibited a greater left paraspinal muscle activity, while the control group demonstrated a greater activation of the vastus lateralis, vastus medialis and medial gastrocnemius muscle groups. Finally, the injured group showed a smaller distance between centre of mass (COM) and centre of pressure, and a lower peak COM velocity when performing the backhand backward lunge tasks. In conclusion, the injured group used reduced knee and trunk motions to complete the backhand lunge tasks. Furthermore, the paraspinal muscles contributed to the lunge performance of the individuals with knee pain, whereas the knee extensors and ankle plantar flexor played a greater role for those without knee pain. PMID:25574707

  19. Persistent post-surgical pain and neuropathic pain after total knee replacement

    PubMed Central

    Drosos, Georgios I; Triantafilidou, Triantafilia; Ververidis, Athanasios; Agelopoulou, Cristina; Vogiatzaki, Theodosia; Kazakos, Konstantinos

    2015-01-01

    AIM: To study the prevalence of persistent post-surgical pain (PPSP) and neuropathic pain (NP) after total knee replacement (TKR). METHODS: MEDLINE and Embase databases were searched for articles published until December 2014 in English language. Published articles were included if they referred to pain that lasts at least 3 mo after primary TKR for knee osteoarthritis, and measured pain with pain specific instruments. Studies that referred to pain caused by septic reasons and implant malalignment were excluded. Both prospective and retrospective studies were included and only 14 studies that match the inclusion criteria were selected for this review. RESULTS: The included studies were characterized by the heterogeneity on the scales used to measure pain and pre-operative factors related to PPSP and NP. The reported prevalence of PPSP and NP seems to be relatively high, but it varies among different studies. There is also evidence that the prevalence of post-surgical pain is related to the scale used for pain measurement. The prevalence of PPSP is ranging at 6 mo from 16% to 39% and at 12 mo from 13.1% to 23% and even 38% of the patients. The prevalence of NP at 6 mo post-operatively is ranging from 5.2% to 13%. Pre-operative factors related to the development of PPSP also differ, including emotional functioning, such as depression and pain catastrophizing, number of comorbidities, pain problems elsewhere and operations in knees with early grade of osteoarthritis. CONCLUSION: No firm conclusions can be reached regarding the prevalence of PPSP and NP and the related factors due to the heterogeneity of the studies. PMID:26301182

  20. Elevated corticospinal excitability in patellar tendinopathy compared with other anterior knee pain or no pain.

    PubMed

    Rio, E; Kidgell, D; Moseley, G L; Cook, J

    2016-09-01

    Anterior knee pain (AKP) is a frequent clinical presentation in jumping athletes and may be aggravated by sustained sitting, stair use, and loading of the quadriceps. Corticospinal activation of the quadriceps in athletes with AKP has not yet been investigated, but is important in guiding efficacious treatment. This cross-sectional study assessed corticospinal excitability (CSE) of the quadriceps in jumping athletes using transcranial magnetic stimulation (TMS). Groups consisted of Control (no knee pain); patellar tendinopathy (PT) [localized inferior pole pain on single-leg decline squat (SLDS)]; and other AKP (nonlocalized pain around the patella). SLDS (numerical score of pain 0-10), Victorian Institute of Sport Assessment Patellar tendon (VISA-P), maximal voluntary isometric contraction (MVIC), active motor threshold (AMT), CSE, and Mmax were tested. Twenty nine athletes participated; control n = 8, PT n = 11, AKP n = 10. There were no group differences in age (P = 0.23), body mass index (P = 0.16), MVIC (P = 0.38) or weekly activity (P = 0.22). PT had elevated CSE compared with controls and other AKP (P < 0.001), but no differences were detected between AKP and controls (P = 0.47). CSE appears to be greater in PT than controls and other AKP. An improved understanding of the corticospinal responses in different sources of knee pain may direct better treatment approaches. PMID:26369282

  1. Analysis of stem tip pain in revision total knee arthroplasty.

    PubMed

    Kimpton, Christine I; Crocombe, Andrew David; Bradley, William Neil; Gavin Huw Owen, Brigstocke

    2013-06-01

    Stem tip pain following revision total knee arthroplasty is a significant cause of patient dissatisfaction, which in the presence of an aseptic well-fixed component has no widely accepted surgical solution. A definitive cause of stem tip pain remains elusive, however it has been suggested that high stress concentrations within the region of the stem tip may play a role. This paper reports a finite element study of a novel clinical technique where a plate is attached to the tibia within the region of the stem tip to reduce stem tip pain. The results demonstrate that the plate reduces stress concentrations in the bone at the stem tip of the implant. The magnitude of stress reduction is dependent upon plate location, material and attachment method. PMID:23523204

  2. Are depression, anxiety and poor mental health risk factors for knee pain? A systematic review

    PubMed Central

    2014-01-01

    Background While it is recognized that psychosocial factors are important in the development and progression of musculoskeletal pain and disability, no systematic review has specifically focused on examining the relationship between psychosocial factors and knee pain. We aimed to systematically review the evidence to determine whether psychosocial factors, specifically depression, anxiety and poor mental health, are risk factors for knee pain. Methods Electronic searches of MEDLINE, EMBASE and PsycINFO were performed to identify relevant studies published up to August 2012 using MESH terms and keywords. We included studies that met a set of predefined criteria and two independent reviewers assessed the methodological quality of the selected studies. Due to the heterogeneity of the studies, a best evidence synthesis was performed. Results Sixteen studies were included in the review, of which 9 were considered high quality. The study populations were heterogeneous in terms of diagnosis of knee pain. We found a strong level of evidence for a relationship between depression and knee pain, limited evidence for no relationship between anxiety and knee pain, and minimal evidence for no relationship between poor mental health and knee pain. Conclusions Despite the heterogeneity of the included studies, these data show that depression plays a significant role in knee pain, and that a biopsychosocial approach to the management of this condition is integral to optimising outcomes for knee pain. PMID:24405725

  3. Painful prosthesis: approaching the patient with persistent pain following total hip and knee arthroplasty

    PubMed Central

    Piscitelli, Prisco; Iolascon, Giovanni; Innocenti, Massimo; Civinini, Roberto; Rubinacci, Alessandro; Muratore, Maurizio; D’Arienzo, Michele; Leali, Paolo Tranquilli; Carossino, Anna Maria; Brandi, Maria Luisa

    2013-01-01

    Summary Background Symptomatic severe osteoarthritis and hip osteoporotic fractures are the main conditions requiring total hip arthroplasty (THA), whereas total knee arthroplasty (TKA) is mainly performed for pain, disability or deformity due to osteoarthritis. After surgery, some patients suffer from “painful prosthesis”, which currently represents a clinical problem. Methods A systematic review of scientific literature has been performed. A panel of experts has examined the issue of persistent pain following total hip or knee arthroplasty, in order to characterize etiopathological mechanisms and define how to cope with this condition. Results Four major categories (non infective, septic, other and idiopathic causes) have been identified as possible origin of persistent pain after total joint arthroplasty (TJA). Time to surgery, pain level and function impairment before surgical intervention, mechanical stress following prosthesis implant, osseointegration deficiency, and post-traumatic or allergic inflammatory response are all factors playing an important role in causing persistent pain after joint arthroplasty. Diagnosis of persistent pain should be made in case of post-operative pain (self-reported as VAS ≥3) persisting for at least 4 months after surgery, or new onset of pain (VAS ≥3) after the first 4 months, lasting ≥2 months. Acute pain reported as VAS score ≥7 in patients who underwent TJA should be always immediately investigated. Conclusions The cause of pain needs always to be indentified and removed whenever possible. Implant revision is indicated only when septic or aseptic loosening is diagnosed. Current evidence has shown that peri-and/or post-operative administration of bisphosphonates may have a role in pain management and periprosthetic bone loss prevention. PMID:24133526

  4. Pain after total knee arthroplasty: a narrative review focusing on the stratification of patients at risk for persistent pain.

    PubMed

    Lavand'homme, P; Thienpont, E

    2015-10-01

    The patient with a painful arthritic knee awaiting total knee arthroplasty (TKA) requires a multidisciplinary approach. Optimal control of acute post-operative pain and the prevention of chronic persistent pain remains a challenge. The aim of this paper is to evaluate whether stratification of patients can help identify those who are at particular risk for severe acute or chronic pain. Intense acute post-operative pain, which is itself a risk factor for chronic pain, is more common in younger, obese female patients and those suffering from central pain sensitisation. Pre-operative pain, in the knee or elsewhere in the body, predisposes to central sensitisation. Pain due to osteoarthritis of the knee may also trigger neuropathic pain and may be associated with chronic medication like opioids, leading to a state of nociceptive sensitisation called 'opioid-induced hyperalgesia'. Finally, genetic and personality related risk factors may also put patients at a higher risk for the development of chronic pain. Those identified as at risk for chronic pain would benefit from specific peri-operative management including reduction in opioid intake pre-operatively, the peri-operative use of antihyperalgesic drugs such as ketamine and gabapentinoids, and a close post-operative follow-up in a dedicated chronic pain clinic. PMID:26430086

  5. Q-angle in patellofemoral pain: relationship with dynamic knee valgus, hip abductor torque, pain and function☆

    PubMed Central

    Almeida, Gabriel Peixoto Leão; Silva, Ana Paula de Moura Campos Carvalho e; França, Fábio Jorge Renovato; Magalhães, Maurício Oliveira; Burke, Thomaz Nogueira; Marques, Amélia Pasqual

    2016-01-01

    Objective To investigate the relationship between the q-angle and anterior knee pain severity, functional capacity, dynamic knee valgus and hip abductor torque in women with patellofemoral pain syndrome (PFPS). Methods This study included 22 women with PFPS. The q-angle was assessed using goniometry: the participants were positioned in dorsal decubitus with the knee and hip extended, and the hip and foot in neutral rotation. Anterior knee pain severity was assessed using a visual analog scale, and functional capacity was assessed using the anterior knee pain scale. Dynamic valgus was evaluated using the frontal plane projection angle (FPPA) of the knee, which was recorded using a digital camera during step down, and hip abductor peak torque was recorded using a handheld dynamometer. Results The q-angle did not present any significant correlation with severity of knee pain (r = −0.29; p = 0.19), functional capacity (r = −0.08; p = 0.72), FPPA (r = −0.28; p = 0.19) or isometric peak torque of the abductor muscles (r = −0.21; p = 0.35). Conclusion The q-angle did not present any relationship with pain intensity, functional capacity, FPPA, or hip abductor peak torque in the patients with PFPS. PMID:27069887

  6. Anterolateral Portal Is Less Painful than Superolateral Portal in Knee Intra-Articular Injection

    PubMed Central

    Lee, Sung Yup; GN, Kiran Kumar; Chung, Byung June; Lee, Sang Wook

    2015-01-01

    Purpose Intra-articular knee injections are commonly performed in clinical practice for treating various knee joint disorders such as osteoarthritis and rheumatoid arthritis. When selecting the portal for injection, not only intra-articular needle accuracy but also procedural pain should be taken into consideration. The purpose of this study was to determine whether injection through anterolateral portal provokes less pain and provides better pain relief compared to superolateral portal. Materials and Methods A total of 60 patients with primary osteoarthritis of the knee receiving intra-articular injections were randomized into 2 groups according to the type of portal approach; anterolateral or superolateral. All patients received hyaluronic acid (20 mg) and triamcinolone (40 mg) as the first injection followed by second and third injections of hyaluronic acid on a weekly basis. Underlying knee pain, procedural pain, and knee pain at 4 weeks were evaluated using visual analogue scale (VAS). Results Injection through anterolateral portal provoked less pain (VAS, 1.5±1.3) than the superolateral portal (VAS, 1.5 vs. 2.7; p=0.004). No differences were found in the degree of pain relief at weeks between the two groups (p=0.517). Conclusions We recommend the use of anterolateral portal for intra-articular knee injection as it provokes less pain and comparably short-term pain relief than the superolateral portal. PMID:26676089

  7. Impact of Alprazolam on Comorbid Pain and Knee Functions in Total Knee Arthroplasty Patients Diagnosed with Anxiety and Depression

    PubMed Central

    Yılmaz, Barış; Kömür, Baran; Aktaş, Erdem; Sonnur Yılmaz, Firdes; Çopuroğlu, Cem; Özcan, Mert; Çiftdemir, Mert; Çopuroğlu, Elif

    2015-01-01

    Purpose: Studies report 19-33% postoperative moderate-severe pain and dissatisfaction in uncomplicated total knee arthroplasty (TKA), even after 1 year. High rates of undiagnosed depression and anxiety may have a strong impact on these unfavourable outcomes. Here we aimed to investigate the efficacy of alprazolam on postoperative analgesic use and knee functions. Methods: Seventy-six patients with a mean age of 65 ± 9.3 years (range 46-80) diagnosed with mild-moderate anxiety or depression according to the Hamilton anxiety scale (HAS) and Beck Depression Inventory (BDI) that underwent TKA were evaluated in the study. Group 1 patients were subjected to alprazolam treatment in addition to an analgesic/antiinflammatory drug, whereas Group 2 consisted of patients receiving only the standard postoperative pain management protocol. Visual analog scale (VAS) and postoperative analgesic use (g/day) were calculated to evaluate the magnitude of pain experienced. Preoperative and postoperative knee functions were assessed from the patients’ Knee Society Score and Knee Society Functional Score records. Results: A positive correlation was found between the preoperative HAS, BDI, and total postoperative analgesic use in both groups. Although the decrease in VAS was significant in both groups, postoperative analgesic need (4.25 ± 0.30 g) in Group 1 was less compared to Group 2 (4.81 ± 0.41 g) (p=0.01). The mean change in postoperative (1 month) Knee Society Score and Knee Society Functional Score were also significantly improved in Group1 compared to Group 2. Conclusion: Alprazolam can reduce postoperative analgesic use and improve knee functions by reducing the pain threshold, and enhancing overall mood via its antidepressive and anxiolytic properties in patients undergoing TKA diagnosed with mild-moderate anxiety/depression. PMID:26664498

  8. The effectiveness of hyaluronic acid intra-articular injections in managing osteoarthritic knee pain

    PubMed Central

    Anand, A

    2013-01-01

    Introduction Knee osteoarthritis (OA) is a common and progressive joint disease. Treatment options for knee OA vary from simple analgesia in mild cases to knee replacement for advanced disease. Knee pain due to moderate OA can be targeted with intra-articular injections. Steroid injections have been used widely in managing acute flare-ups of the disease. In recent years, viscosupplementation has been used as a therapeutic modality for the management of knee OA. The principle of viscosupplementation is based on the physiological properties of the hyaluronic acid (HA) in the synovial joint. Despite a sound principle and promising in vitro studies, clinical studies have been less conclusive on the effectiveness of HA in managing osteoarthritic knee pain. The aim of this systematic review was to assess the effectiveness of HA intra-articular injections in the management of osteoarthritic knee pain. Methods A systematic review of the literature was performed using MEDLINE®, Embase™ and CINAHL® (Cumulative Index to Nursing and Allied Health Literature). The databases were searched for randomised controlled trials available on the effectiveness of HA intra-articular injections in managing osteoarthritic knee pain. Results The search yielded 188 studies. Of these, 14 met the eligibility criteria and were reviewed in chronological order. Conclusions HA intra-articular injections have a modest effect on early to moderate knee OA. The effect peaks at around 6–8 weeks following administration, with a doubtful effect at 6 months. PMID:24165334

  9. Low Back Pain and Other Musculoskeletal Pain Comorbidities in Individuals with Symptomatic Osteoarthritis of the Knee: Data from the Osteoarthritis Initiative

    PubMed Central

    Suri, Pradeep; Morgenroth, David C.; Kwoh, C. Kent; Bean, Jonathan F.; Kalichman, Leonid; Hunter, David J.

    2010-01-01

    Objective To examine the association of concurrent low back pain (LBP), and other musculoskeletal pain comorbidity, with knee pain severity in symptomatic knee osteoarthritis (OA). Methods 1389 individuals from the Progression Cohort of the Osteoarthritis Initiative, age 45-79 with symptomatic tibiofemoral knee OA, were studied. Participants identified pain in the low back, neck, shoulder, elbow, wrist, hand, hip, knee, ankle, or foot. The primary outcome was the pain subscale of the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) applied to the more symptomatic knee. We examined WOMAC pain score in persons with and without LBP, before and after adjusting for other musculoskeletal symptoms. Results 57.4% of participants reported LBP. WOMAC pain score (possible range 0-20) was 6.5±4.1 in participants with LBP, and 5.2±3.4 in participants without (p<0.0001). In multivariate analyses, LBP was significantly associated with increased WOMAC knee pain score (β[SE]=1.00[0.21]; p=<.0001). However, pain in all other individual musculoskeletal locations demonstrated similar associations with knee pain score. In models including all pain locations simultaneously, only LBP (β[SE]=0.65[0.21];p=.002), ipsilateral elbow pain (0.98 [0.40]; p=.02), and ipsilateral foot pain (1.03[0.45]; p=.02) were significantly associated with knee pain score. Having more than one pain location was associated with greater WOMAC knee pain; this relationship was strongest for individuals having four (β[SE]= 1.83[0.42]; p<0.0001), or five or more pain locations (1.86[0.36]; p<0.0001). Conclusions LBP, foot pain, and elbow pain are significantly associated with WOMAC knee pain score, as are a higher total number of pain locations. This may have implications for clinical trial planning. PMID:20799265

  10. Knee Pain during Strength Training Shortly following Fast-Track Total Knee Arthroplasty: A Cross-Sectional Study

    PubMed Central

    Bandholm, Thomas; Thorborg, Kristian; Lunn, Troels Haxholdt; Kehlet, Henrik; Jakobsen, Thomas Linding

    2014-01-01

    Background Loading and contraction failure (muscular exhaustion) are strength training variables known to influence neural activation of the exercising muscle in healthy subjects, which may help reduce neural inhibition of the quadriceps muscle following total knee arthroplasty (TKA). It is unknown how these exercise variables influence knee pain after TKA. Objective To investigate the effect of loading and contraction failure on knee pain during strength training, shortly following TKA. Design Cross-sectional study. Setting Consecutive sample of patients from the Copenhagen area, Denmark, receiving a TKA, between November 2012 and April 2013. Participants Seventeen patients, no more than 3 weeks after their TKA. Main outcome measures: In a randomized order, the patients performed 1 set of 4 standardized knee extensions, using relative loads of 8, 14, and 20 repetition maximum (RM), and ended with 1 single set to contraction failure (14 RM load). The individual loadings (kilograms) were determined during a familiarization session >72 hours prior. The patients rated their knee pain during each repetition, using a numerical rating scale (0–10). Results Two patients were lost to follow up. Knee pain increased with increasing load (20 RM: 3.1±2.0 points, 14 RM: 3.5±1.8 points, 8 RM: 4.3±2.5 points, P = 0.006), and repetitions to contraction failure (10% failure: 3.2±1.9 points, 100% failure: 5.4±1.6 points, P<0.001). Resting knee pain 60 seconds after the final repetition (2.7±2.4 points) was not different from that recorded before strength training (2.7±1.8 points, P = 0.88). Conclusion Both loading and repetitions performed to contraction failure during knee- extension strength-training, increased post-operative knee pain during strength training implemented shortly following TKA. However, only the increase in pain during repetitions to contraction failure exceeded that defined as clinically relevant, and was very short-lived. Trial Registration

  11. Ultrasonographic Findings in a Large Series of Patients with Knee Pain

    PubMed Central

    Artul, Suheil; Khazin, Fadi; Hakim, Jeries; Habib, George

    2014-01-01

    Background: Musculoskeletal ultrasound (MSKUS) is becoming more and more popular in the evaluation of different musculoskeletal abnormalities. The aim of this retrospective study was to document the prevalence and spectrum of MSKUS findings at the painful knee. Materials and Methods: All the studies of MSKUS that were performed for the evaluation of knee pain during the previous 2 years at the Department of Radiology in Nazareth hospital were reviewed. Demographic and clinical parameters including age, gender, side, and MSKUS findings were documented. Results: Two hundred and seventy-six patients were included in the review. In 21 of them, both knees were evaluated at the same setting (total number of knees evaluated was 297). One hundred and forty-four knees were of the left side. Thirty-three pathologies were identified. 34% of the studies were negative. The most common MSKUS findings were medial meniscal tear (MMT) (20%), Baker's cyst (BC) (16%), and osteoarthritis (OA) (11%). Only one knee of all the knees evaluated in our study showed synovitis. Fifty-three knees (18% of all the knees evaluated) had more than one imaging finding, mosty two and while some had three findings. The most common combination of findings was MMT and BC (8 knees), MMT with OA (8 knees), and MMT with fluid (6 knee). In 67% of the patients who had simultaneous bilateral knee evaluation, at least one knee had no abnormal findings and in 43%, both knees were negative. Conclusions: MSKUS has the potential for revealing huge spectrum of abnormalities. In nearly 90% of the positive studies, degenerative/mechanical abnormalities were reported, with MMT, BC, and osteoarthritic changes being the most common. PMID:25250194

  12. [The relevance of muscle strength--extensors of the knee on pain relief in elderly people with knee osteoarthritis].

    PubMed

    Slivar, Senka Rendulić; Peri, Dusan; Jukić, Igor

    2011-01-01

    The main aim of this study was to evaluate muscle strength after short-term exercise program by elderly people with knee osteoarthritis that usually non exercising and to estimate if this change have influence on decrease of the pain. This study was longitudinal experiment that involved thirty participants aged 61-80 years with clinical signs and radiographic evidence of knee OA stage Kellgren II and III. They completed individual strengthening program knee muscle stabilisator and hydrotherapy in the pool during two weeks. Muscle strength and pain was estimated pre and post experimental time. The results are analysed by SPSS programme, version 15.0 for Windows. Values demonstrated decreasing degrees of the pain and increasing of muscle strength. The pain decreased 33% in advance, final pain oposite initial estimated 2.4 degrees smaller by VAS. Muscle strength for stronger leg was (initial/final) 93.10/106.33 kg/cm2 (t-test 3.584*, p < 0.001), and for weak leg 71.93/83.37 kg/cm2 (t-test 3.118* p < 0.004). Regression analysis gave small valuables of determination coefficient (R2 of 0.014-0.081) and regression coefficient (B of 0.004-0.015) for stronger and weaker leg. Exercises produced significant increase in muscle strength and decrease in pain in OA of the knee. Hypothesis that increase of muscle quadriceps strength have influence on decrease of the pain in the knee is not confirmed. PMID:21751572

  13. Lower Limbs Function and Pain Relationships after Unilateral Total Knee Arthroplasty

    ERIC Educational Resources Information Center

    Tali, Maie; Maaroos, Jaak

    2010-01-01

    The aim of the study was to evaluate gait characteristics, lower limbs joint function, and pain relationships associated with knee osteoarthritis of female patients before and 3 months after total knee arthroplasty at an outpatient clinic rehabilitation department. Gait parameters were registered, the active range of lower extremity joints was…

  14. Muscle power is an independent determinant of pain and quality of life in knee osteoarthritis

    Technology Transfer Automated Retrieval System (TEKTRAN)

    OBJECTIVE: This study examined the relationships between leg muscle strength, power, and perceived disease severity in subjects with knee osteoarthritis (OA) in order to determine whether dynamic leg extensor muscle power would be associated with pain and quality of life in knee OA. METHODS: Baseli...

  15. Unusual Presentation of Anterior Knee Pain in Elite Female Athletes: Report of Two Cases

    PubMed Central

    Li, Xinning; Williams, Phillip; Curry, Emily J.; Hannafin, Jo A.

    2016-01-01

    Two elite female athletes presented with anterior knee pain with range of motion and reproducible tenderness to palpation. Diagnostic arthroscopy was performed in both cases resulting in excision of a nodular pigmented villonodular synovitis (PVNS) in the first patient and scar tissue in the second patient. Correct diagnosis of anterior knee pain in the elite female athlete can present a challenge to clinicians. Although patellofe-moral pain is the most common diagnosis, other uncommon causes include PVNS and residual scar formation in patients with a history of surgery or trauma. Magnetic resonance imaging (MRI) images are helpful in confirming the diagnosis, however, in a subset of patients, the physician must rely on clinical suspicion and physical exam to make the proper diagnosis. Given the possibility of a false negative MRI images, patients with persistent anterior knee pain with a history of knee surgeries and focal tenderness reproducible on physical exam may benefit from a diagnostic arthroscopy. PMID:27114812

  16. Unusual Presentation of Anterior Knee Pain in Elite Female Athletes: Report of Two Cases.

    PubMed

    Li, Xinning; Williams, Phillip; Curry, Emily J; Hannafin, Jo A

    2016-03-21

    Two elite female athletes presented with anterior knee pain with range of motion and reproducible tenderness to palpation. Diagnostic arthroscopy was performed in both cases resulting in excision of a nodular pigmented villonodular synovitis (PVNS) in the first patient and scar tissue in the second patient. Correct diagnosis of anterior knee pain in the elite female athlete can present a challenge to clinicians. Although patellofe-moral pain is the most common diagnosis, other uncommon causes include PVNS and residual scar formation in patients with a history of surgery or trauma. Magnetic resonance imaging (MRI) images are helpful in confirming the diagnosis, however, in a subset of patients, the physician must rely on clinical suspicion and physical exam to make the proper diagnosis. Given the possibility of a false negative MRI images, patients with persistent anterior knee pain with a history of knee surgeries and focal tenderness reproducible on physical exam may benefit from a diagnostic arthroscopy. PMID:27114812

  17. Care-seeking behaviour of adolescents with knee pain: a population-based study among 504 adolescents

    PubMed Central

    2013-01-01

    Background Knee pain is common during adolescence. Adolescents and their parents may think that knee pain is benign and self-limiting and therefore avoid seeking medical care. However, long-term prognosis of knee pain is not favourable and treatment seems to offer greater reductions in pain compared to a “wait-and-see” approach. The purpose of this study was to describe the determinants of care-seeking behaviour among adolescents with current knee pain and investigate what types of treatment are initiated. Methods An online questionnaire was forwarded to 2,846 adolescents aged 15–19 in four upper secondary schools. The questionnaire contained questions on age, gender, height, weight, currently painful body regions, frequency of knee pain, health-related quality of life measured by the EuroQol 5-dimensions, sports participation and if they had sought medical care. Adolescents who reported current knee pain at least monthly or more frequently were telephoned. The adolescents were asked about pain duration, onset of knee pain (traumatic or insidious) and if they were currently being treated for their knee pain. Results 504 adolescents currently reported at least monthly knee pain. 59% of these had sought medical care and 18% were currently under medical treatment . A longer pain duration and higher pain severity increased the odds of seeking medical care. Females with traumatic onset of knee pain were more likely to have sought medical care than females with insidious onset of knee pain. Females with traumatic onset of knee pain and increased pain severity were more likely to be undergoing medical treatment. The most frequently reported treatments were the combination of exercises and orthotics (68% of those undergoing medical treatment). Conclusion Females with insidious onset of knee pain do not seek medical care as often as those with traumatic onset and adolescents of both genders with insidious onset are less likely to be under medical treatment. These

  18. Comparison of pain perception between open and minimally invasive surgery in total knee arthroplasty

    PubMed Central

    Moretti, Biagio; Vitale, Elsa; Esposito, Antonio; Colella, Antonio; Cassano, Maria; Notarnicola, Angela

    2010-01-01

    Total knee arthroplasty (TKA) was a well-established procedure that had shown excellent long-term results in terms of reduced pain and increased mobility. Pain was one of the most important outcome measures that contributed to patient dissatisfaction after TKA. After a computerized search of the Medline and Embase databases, we considered articles from January 1st, 1997 to October 31st, 2009 that underlined the impact on patient pain perception of either standard open total knee arthroplasty or minimally invasive total knee arthroplasty. We included articles that used the visual analog scale (VAS), Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC), Knee Score, Hospital for Special Surgery Score (HSS), Oxford Knee Score (OKS) as postoperative pain indicators, and we included studies with a minimum follow-up period of two months. We excluded studies that monitored only functional postoperative knee activities. It was shown that TKA with the open technique was a better treatment for knees with a positive effect on pain and function than the minimally invasive technique. PMID:21042568

  19. Knee and hip radiographic osteoarthritis features: differences on pain, function and quality of life.

    PubMed

    Pereira, Duarte; Severo, Milton; Santos, Rui A; Barros, Henrique; Branco, Jaime; Lucas, Raquel; Costa, Lúcia; Ramos, Elisabete

    2016-06-01

    The association between radiographic osteoarthritis (OA) and symptoms is inconsistent and variable according to each joint. The purpose of this study is to understand the relation between radiographic OA features, pain, function and quality of life, in knee and hip joints. A cross-sectional study was performed using information from EPIPorto cohort. Data was obtained by interview using a structured questionnaire on social, demographic, behavioural and clinical data. Pain was assessed using a pain frequency score (regarding ever having knee pain, pain in the last year, in the last 6 months and in the last month). Quality of life was evaluated with Short Form 36 (SF-36) and function disability with the Lequesne knee and hip indexes. Radiographic knees and hips were classified using the Kellgren-Lawrence score (KL 0-4). Linear regression and proportional odds ratios estimated the association between radiographic features, pain, function and quality of life. In our study, symptomatic OA (KL ≥ 2 plus joint pain) was 26.0 % in knee and 7.0 % hip joints. In knee, the increase on radiographic score increased the odds to have a higher pain frequency score [1.58 (95 % CI = 1.27, 1.97)] and was associated [adjusted β (95 % CI)] with worst general health [-3.05 (-5.00, -1.09)], physical function [-4.92 (-7.03, -2.80)], role-physical [-4.10 (-8.08, -0.11)], bodily pain [-2.96 (-5.45, -0.48)] and limitations in activities of daily living [0.48 (0.08, 0.89)]. Regarding hip, no significant associations were found between the severity of radiographic lesions and these measures. Radiographic lesions in knee were associated with higher complaints, as far as pain and functional limitations are concerned, compared with hip. PMID:26445941

  20. Increased joint loads during walking--a consequence of pain relief in knee osteoarthritis.

    PubMed

    Henriksen, Marius; Simonsen, Erik B; Alkjaer, Tine; Lund, Hans; Graven-Nielsen, Thomas; Danneskiold-Samsøe, Bente; Bliddal, Henning

    2006-12-01

    Joint pain is a primary symptom in knee osteoarthritis (OA), but the effect of pain and pain relief on the knee joint mechanics of walking is not clear. In this study, the effects of local knee joint analgesia on knee joint loads during walking were studied in a group of knee osteoarthritis patients. A group of healthy subjects was included as a reference group. The joint loads were calculated from standard gait analysis data obtained with standardised walking speed (4 km/h). The gait analyses were performed before and after pain relief by intra-articular injections of 10 mL lidocaine (1%). Pre-injection measurements revealed lower joint loads in the OA group compared to the reference group. Following injections pain during walking decreased significantly and the joint loads increased in the OA group during the late single support phase to a level comparable to the reference group. Although the patients walked with less compressive knee joint forces compared to the reference group, the effects of pain relief may accelerate the degenerative changes. PMID:17011194

  1. Predictors of pain medication use for arthroplasty pain after revision total knee arthroplasty

    PubMed Central

    Lewallen, David G.

    2014-01-01

    Objective. Our objective was to study the use of pain medications for persistent knee pain and their predictors after revision total knee arthroplasty (TKA). Methods. We examined whether demographic (gender, age) and clinical characteristics [BMI, co-morbidity measured by the Deyo–Charlson index (a 5-point increase), anxiety and depression] predict the use of NSAIDs and narcotic pain medications 2 and 5 years after revision TKA. Multivariable logistic regression adjusted for these predictors as well as operative diagnosis, American Society of Anesthesiologists class and distance from the medical centre. Results. A total of 1533 patients responded to the 2-year questionnaire and 881 responded to the 5-year questionnaire. NSAID use was reported by 13.4% (206/1533) of patients at 2 years and 16.7% (147/881) at 5 years. Narcotic medication use was reported by 5.4% (83/1533) of patients at 2 years and 5.9% (52/881) at 5 years. Significant predictors of the use of NSAIDs for index TKA pain at 2 and 5 years were age >60–70 years [odds ratio (OR) 0.62 (95% CI 0.39, 0.98) and 0.46 (0.25, 0.85)] compared with age ≤60 years and a higher Deyo–Charlson index [OR 0.51 (95% CI 0.28, 0.93)] per 5-point increase at 5-year after revision TKA. Significant predictors of narcotic pain medication use for index TKA pain were age >60–70 years [OR 0.41 (0.21, 0.78)] and >70–80 years [0.40 (95% CI 0.22, 0.73)] at 2 years and depression [OR 4.58 (95% CI 1.58, 13.18)] at 5 years. Conclusion. Younger age and depression were risk factors for the use of NSAIDs and narcotic pain medications for index TKA pain at 2- and 5-years after revision TKA. PMID:24459220

  2. Medial Abrasion Syndrome: A Neglected Cause of Knee Pain in Middle and Old Age

    PubMed Central

    Lyu, Shaw-Ruey; Lee, Ching-Chih; Hsu, Chia-Chen

    2015-01-01

    Abstract Knee pain is a prevailing health problem of middle and old age. Medial plica-related medial abrasion syndrome (MAS), although a well-known cause of knee pain in younger individuals, has rarely been investigated in older individuals. This prospective study was conducted to investigate the prevalence and clinical manifestations of this syndrome as a cause of knee pain in middle and old age. The outcomes of arthroscopic treatment for this syndrome were also evaluated. A total of 232 knees of 169 patients >40 years of age (41–82, median: 63 years old) suffering from chronic knee pain were analyzed. The clinical diagnosis, predisposing factors, presenting symptoms, and physical signs were investigated. The sensitivity and specificity of each parameter of the clinical presentation for the diagnosis of MAS were evaluated after confirmation by arthroscopy. For patients with MAS, the roentgenographic and arthroscopic manifestations were investigated, and arthroscopic medial release (AMR) was performed. The outcomes were evaluated by the changes in the pain domain of the Knee Society scoring system and by patient satisfaction. The prevalence of medial plica was 95%, and osteoarthritis (OA) was the most common clinical diagnosis. Symptoms of pain and crepitus in motion and local tenderness during physical examination were the most sensitive parameters for the diagnosis. A history of a single knee injury combined with local tenderness and a palpable band found during physical examination were the most specific parameters for the diagnosis. The majority of patients suffering from this syndrome were successfully treated using AMR, yielding a satisfaction rate of 85.5% after a minimum of 3 years. MAS is a common cause of knee pain in middle and old age and can be effectively treated by AMR. Its concomitance with OA warrants further investigation. PMID:25906102

  3. Vitamin D, Race, and Experimental Pain Sensitivity in Older Adults with Knee Osteoarthritis

    PubMed Central

    Glover, T.L.; Goodin, B.R.; Horgas, A.L.; Kindler, L.L.; King, C.D.; Sibille, K.T.; Peloquin, C.A.; Riley, J.L.; Staud, R.; Bradley, L.A.; Fillingim, R.B.

    2012-01-01

    Objective Low levels of serum circulating 25-hydroxyvitamin D have been correlated with many health conditions, including chronic pain. Recent clinical practice guidelines define vitamin D levels < 20 ng/mL as deficient and values of 21–29 ng/mL as insufficient. Vitamin D insufficiency, including the most severe levels of deficiency, is more prevalent in black Americans. Ethnic and race group differences have been reported in both clinical and experimental pain, with black Americans reporting increased pain. The purpose of this study was to examine whether variation in vitamin D levels contribute to race differences in knee osteoarthritic pain. Methods The sample consisted of 94 participants (75% female), including 45 blacks and 49 whites with symptomatic knee osteoarthritis. Average age was 55.8 years (range 45–71 years). Participants completed a questionnaire on knee osteoarthritic symptoms and underwent quantitative sensory testing, including measures of heat and mechanical pain sensitivity. Results Blacks had significantly lower levels of vitamin D compared to whites, demonstrated greater clinical pain, and showed greater sensitivity to mechanical and heat pain. Low levels of vitamin D predicted increased experimental pain sensitivity, but did not predict self-reported clinical pain. Group differences in vitamin D significantly predicted group differences in heat pain and pressure pain thresholds on the index knee and ipsilateral forearm. Conclusion These data demonstrate race differences in experimental pain are mediated by differences in vitamin D level. Vitamin D deficiency may be a risk factor for increased knee osteoarthritic pain in black Americans. PMID:23135697

  4. Calcific tendinitis of biceps femoris: an unusual site and cause for lateral knee pain.

    PubMed

    Chan, Warwick; Chase, Helen Emily; Cahir, John G; Walton, Neil Patrick

    2016-01-01

    A 37-year-old man presented to the acute knee and sports medicine clinic with atraumatic lateral knee pain. He had point tenderness over the lateral aspect of his knee which had not settled with anti-inflammatory medications. Imaging revealed a large opaque lesion lateral to the knee and although there was no clear mechanism, injury to the posterolateral corner was considered. An MRI subsequently revealed a rare case of calcific tendinitis to the biceps femoris tendon insertion. This condition was self-limiting and did not require interventions such as steroid injections. This is the first reported case of calcific tendinitis of biceps femoris as a cause of acute knee pain. PMID:27473032

  5. Knee Pain and Low Back Pain Additively Disturb Sleep in the General Population: A Cross-Sectional Analysis of the Nagahama Study

    PubMed Central

    Murase, Kimihiko; Tabara, Yasuharu; Ito, Hiromu; Kobayashi, Masahiko; Takahashi, Yoshimitsu; Setoh, Kazuya; Kawaguchi, Takahisa; Muro, Shigeo; Kadotani, Hiroshi; Kosugi, Shinji; Sekine, Akihiro; Yamada, Ryo; Nakayama, Takeo; Mishima, Michiaki; Matsuda, Shuichi; Matsuda, Fumihiko; Chin, Kazuo

    2015-01-01

    Introduction Association of knee and low back pain with sleep disturbance is poorly understood. We aimed to clarify the independent and combined effects of these orthopedic symptoms on sleep in a large-scale general population. Methods Cross-sectional data about sleep and knee/low back pain were collected for 9,611 community residents (53±14 years old) by a structured questionnaire. Sleep duration less than 6 h/d was defined as short sleep. Sleep quality and the presence of knee and low back pain were evaluated by dichotomous questions. Subjects who complained about knee or low back pains were graded by tertiles of a numerical response scale (NRS) score and a Roland-Morris disability questionnaire (RDQ) score respectively. Multivariate regression analyses were performed to determine the correlates of short sleep duration and poor sleep quality. Results Frequency of participants who complained of the orthopedic symptoms was as follows; knee pain, 29.0%; low back pain, 42.0% and both knee and low back pain 17.6%. Both knee and low back pain were significantly and independently associated with short sleep duration (knee pain: odds ratio (OR) = 1.19, p<0.01; low back pain: OR = 1.13, p = 0.01) and poor sleep quality (knee pain: OR = 1.22, p<0.01; low back pain; OR = 1.57, p<0.01). The group in the highest tertile of the NRS or RDQ score had the highest risk for short sleep duration and poor sleep quality except for the relationship between the highest tertile of the RDQ score and short sleep duration.(the highest tertile of the NRS: OR for short sleep duration = 1.31, p<0.01; OR for poor sleep quality = 1.47, p<0.01; the highest tertile of the RDQ: OR for short sleep duration = 1.11, p = 0.12; OR for poor sleep quality = 1.81, p<0.01) Further, coincident knee and low back pain raised the odds ratios for short sleep duration (either of knee or low back pain: OR = 1.10, p = 0.06; both knee and low back pain: OR = 1.40, p<0.01) and poor sleep quality (either of knee or

  6. Fracture of the Anterior Locking Flange of a Total Knee Arthroplasty Polyethylene Liner Presenting with Pain following Knee Replacement

    PubMed Central

    Jeavons, Richard; Dowen, Daniel; Rushton, Paul; Ryan, Daniel; Gill, Peter

    2014-01-01

    Introduction: Fracture of the modern polyethylene insert of a total knee arthroplasty is rare. We describe the first case of a fractured anterior locking flange of the commonly used Depuy Press-fit Condylar (PFC) Sigma prosthesis. Case Report: The 80 year old Caucasian gentleman presented 8 years following previously uncomplicated and successful primary total knee replacement with pain, swelling and symptoms of instability of the knee. He was able to sublux his knee posteriorly using his hamstrings. Dissociation of the liner was evident on radiographs. He underwent revision of the polyethylene liner. It was evident during the revision that the anterior locking flange of the polyethylene liner had fractured allowing it to dissociate from the tibial tray. At 12 months following this revision he continues to do well and has similar range of movement and function to prior to the episode. This cause of the failure is not clear. Conclusion: Surgeons should be aware of this rare complication when assessing a painful or unstable total knee replacement. PMID:27298962

  7. Effects of transcutaneous electrical nerve stimulation on quadriceps function in individuals with experimental knee pain.

    PubMed

    Son, S J; Kim, H; Seeley, M K; Feland, J B; Hopkins, J T

    2016-09-01

    Knee joint pain (KJP) is a cardinal symptom in knee pathologies, and quadriceps inhibition is commonly observed among KJP patients. Previously, KJP independently reduced quadriceps strength and activation. However, it remains unknown how disinhibitory transcutaneous electrical nerve stimulation (TENS) will affect inhibited quadriceps motor function. This study aimed at examining changes in quadriceps maximum voluntary contraction (MVC) and central activation ratio (CAR) before and after sensory TENS following experimental knee pain. Thirty healthy participants were assigned to either the TENS or placebo groups. All participants underwent three separate data collection sessions consisting of two saline infusions and one no infusion control in a crossover design. TENS or placebo treatment was administered to each group for 20 min. Quadriceps MVC and CAR were measured at baseline, infusion, treatment, and post-treatment. Perceived knee pain intensity was measured on a 100-mm visual analogue scale. Post-hoc analysis revealed that hypertonic saline infusion significantly reduced the quadriceps MVC and CAR compared with control sessions (P < 0.05). Sensory TENS, however, significantly restored inhibited quadriceps motor function compared with placebo treatment (P < 0.05). There was a negative correlation between changes in MVC and knee pain (r = 0.33, P < 0.001), and CAR and knee pain (r = 0.62, P < 0.001), respectively. PMID:26346597

  8. Uncommon causes of anterior knee pain: a case report of infrapatellar contracture syndrome.

    PubMed

    Ellen, M I; Jackson, H B; DiBiase, S J

    1999-01-01

    The uncommon causes of anterior knee pain should always be considered in the differential diagnosis of a painful knee when treatment of common origins become ineffective. A case is presented in which the revised diagnosis of infrapatellar contracture syndrome was made after noting delayed progress in the rehabilitation of an active female patient with a presumed anterior horn medial meniscus tear and a contracted patellar tendon. The patient improved after the treatment program was augmented with closed manipulation under arthroscopy and infrapatellar injection of both corticosteroids and a local anesthetic. Infrapatellar contraction syndrome and other uncommon sources of anterior knee pain, including arthrofibrosis, Hoffa's syndrome, tibial collateral ligament bursitis, saphenous nerve palsy, isolated ganglions of the anterior cruciate ligament, slipped capital femoral epiphysis, and knee tumors, are subsequently discussed. Delayed functional advancement in a rehabilitation program requires full reassessment of the patient's diagnosis and treatment plan. Alternative diagnoses of knee pain are not always of common origins. Ample knowledge of uncommon causes of anterior knee pain is necessary to form a full differential diagnosis in patients with challenging presentations. PMID:10418845

  9. Advantage of Minimal Anterior Knee Pain and Long-term Survivorship of Cemented Single Radius Posterior-Stabilized Total Knee Arthroplasty without Patella Resurfacing

    PubMed Central

    Ji, Hyung-Min; Baek, Ji-Hoon; Ko, Young-Bong

    2015-01-01

    Background The single radius total knee prosthesis was introduced with the advantage of reduced patellar symptoms; however, there is no long-term follow-up study of the same. The purpose of this study was to determine the survival rate of single radius posterior-stabilized total knee arthroplasty and patellofemoral complication rates in a consecutive series. Methods Seventy-one patients (103 knees) who underwent arthroplasty without patellar resurfacing using a single radius posterior-stabilized total knee prosthesis were followed up for a minimum 10 years. Clinical evaluation using Knee Society knee and function scores and radiologic evaluation were performed at regular intervals. Anterior knee pain as well as patellofemoral complications were evaluated with a simple questionnaire. The Kaplan-Meier product-limit method was used to estimate survival. Results Seventeen patients (23 knees) were excluded due to death (12 knees) or lost to follow-up (11 knees). Of the 80 knees enrolled, all femoral components and 78 tibial components were well fixed without loosening at final follow-up. Two revisions were performed because of tibial component loosening and periprosthetic joint infection. One patient with tibial component loosening refused to have revision surgery. No obvious tibial insert polyethylene wear was observed. The survivorships at 132 months were 96.7% using revision or pending revision as end points. Anterior knee pain was present in 6 patients (6 knees, 7.5%) at the latest follow-up. No patellofemoral complication requiring revision was encountered. Conclusions The single radius posterior-stabilized total knee prosthesis demonstrated an excellent minimum 10-year survivorship. The low rates of implant loosening and 7.5% of anterior knee pain as a patellofemoral complication are comparable with those reported for other modern total knee prosthesis. PMID:25729519

  10. Preoperative pain mechanisms assessed by cuff algometry are associated with chronic postoperative pain relief after total knee replacement.

    PubMed

    Petersen, Kristian Kjær; Graven-Nielsen, Thomas; Simonsen, Ole; Laursen, Mogens Berg; Arendt-Nielsen, Lars

    2016-07-01

    Chronic postoperative pain after total knee replacement (TKR) in knee osteoarthritis (KOA) implies clinical challenges. Widespread hyperalgesia, facilitated temporal summation of pain (TSP), and impaired conditioned pain modulation (CPM) have been found in painful KOA. This exploratory study investigated postoperative pain relief 12 months after TKR in 4 subgroups of patients preoperatively profiled by mechanistic quantitative sensory testing. In 103 patients with KOA, pressure pain detection threshold (PDT) and tolerance thresholds (PTT) were assessed at the lower leg using cuff algometry. Temporal summation of pain was measured as an increase in pain intensity scores during 10 repeated (2 seconds intervals) painful cuff stimuli. Conditioned pain modulation was calculated as the relative increase in PDT during painful conditioning stimulation. The grand averages of TSP and CPM were calculated and values below or above were used for subgrouping: facilitated TSP/impaired CPM (group A, N = 16), facilitated TSP/normal CPM (group B, N = 15), normal TSP/impaired CPM (group C, N = 44), and normal TSP/normal CPM (group D, N = 28). Clinical VAS pain intensity scores were collected before and 12 months after TKR surgery and the pain relief calculated. Less pain relief was found in group A (52.0% ± 14.0% pain relief) than in group B (81.1% ± 3.5%, P = 0.023) and group C (79.6% ± 4.4%, P = 0.007), but not group D (69.4% ± 7.9%, P = 0.087). Low preoperative PDT was associated with a less postoperative pain relief (R = -0.222, P = 0.034), whereas TSP or CPM alone showed no associations with postoperative pain relief. This explorative study indicated that patients with osteoarthritis with facilitated TSP together with impaired CPM are more vulnerable to experience less pain relief after TKR. PMID:27331347

  11. Alpine Skiing With total knee ArthroPlasty (ASWAP): physical activity, knee function, pain, exertion, and well-being.

    PubMed

    Würth, S; Finkenzeller, T; Pötzelsberger, B; Müller, E; Amesberger, G

    2015-08-01

    This study focused on the psychological and quality of life aspects of resuming alpine skiing practice after total knee arthroplasty (TKA) in elderly skilled skiers. Two data pools were used in order to analyze psychological states: (a) at the beginning, at the end, and 8 weeks after a 12-week skiing intervention; and (b) concerning diurnal variations of states (i.e., skiing days compared with everyday life during intervention and retention phase). In particular, effects of skiing on amount of physical activity and perceived exertion, perceived pain and knee function, and subjective well-being were analyzed using a control group design. Results reveal that the skiing intervention substantially increases the amount of physical activity by the intervention group (122.30 ± 32.38 min/day), compared with the control group (75.14 ± 21.27 min/day) [F (2, 32) = 8.22, P < 0.01, η(2)  = 0.34)]. Additionally, the analyses of psychological states demonstrated that skiing goes along with enhanced well-being and no significant impact on perceived pain, exertion or knee function. In sum, alpine skiing can be recommended for older persons with TKA with respect to well-being, perceived pain and knee function, and perceived exertion. PMID:26083705

  12. Anterior knee pain following total knee replacement correlates with the OARSI score of the cartilage of the patella

    PubMed Central

    Vorobjov, Sigrid; Lepik, Katrin; Märtson, Aare

    2014-01-01

    Background Attempts to relate patellar cartilage involvement to anterior knee pain (AKP) have yielded conflicting results. We determined whether the condition of the cartilage of the patella at the time of knee replacement, as assessed by the OARSI score, correlates with postsurgical AKP. Patients and methods We prospectively studied 100 patients undergoing knee arthroplasty. At surgery, we photographed and biopsied the articular surface of the patella, leaving the patella unresurfaced. Following determination of the microscopic grade of the patellar cartilage lesion and the stage by analyzing the intraoperative photographs, we calculated the OARSI score. We interviewed the patients 1 year after knee arthroplasty using the HSS patella score for diagnosis of AKP. Results 57 of 95 patients examined had AKP. The average OARSI score of painless patients was 13 (6–20) and that of patients with AKP was 15 (6–20) (p = 0.04). Patients with OARSI scores of 13–24 had 50% higher risk of AKP (prevalence ratio = 1.5, 95% CI: 1.0–2.3) than patients with OARSI scores of 0–12. Interpretation The depth and extent of the cartilage lesion of the knee-cap should be considered when deciding between the various options for treatment of the patella during knee replacement. PMID:24954482

  13. Characterizing Pain Flares from the Perspective of Individuals with Symptomatic Knee Osteoarthritis

    PubMed Central

    Murphy, Susan; Lyden, Angela; Kratz, Anna; Fritz, Heather; Williams, David A.; Clauw, Daniel J.; Gammaitoni, Arnold R.; Phillips, Kristine

    2015-01-01

    Objective Although pain in knee osteoarthritis (OA) commonly affects activity engagement, the daily pain experience has not been fully-characterized. Specifically, the nature and impact of pain flares is not well-understood. This study characterized pain flares, defined by participants with knee OA; pain flare occurrence and experience were measured over 7 days. Methods This was a multiple methods study; qualitative methods were dominant. Data were collected during the baseline portion of a randomized controlled trial. Participants met criteria for knee OA and had moderate to severe pain. They completed questionnaires and a 7-day home monitoring period that captured momentary symptom reports simultaneously with physical activity via accelerometry (N = 45). Participants also provided individual definitions of pain flare which were used throughout the home monitoring period to indicate whether a pain flare occurred. Results Pain flares were described most often by quality (often sharp), followed by timing (seconds-minutes), and by antecedents and consequences. When asked if their definition of a flare agreed with a supplied definition, 49% of the sample reported only “somewhat”, “a little” or “not at all”. Using individual definitions, 78% experienced at least one daily pain flare over the home monitoring period; 24% had a flare on over 50% of the monitored days. Conclusions Pain flares were common, fleeting, and often experienced in the context of activity engagement. Participants’ views on what constitutes a pain flare differ from commonly accepted definitions. Pain flares are an understudied aspect of the knee OA pain experience and require further characterization. PMID:25580697

  14. Auricular Acupuncture for Pain Relief after Ambulatory Knee Arthroscopy—A Pilot Study

    PubMed Central

    2005-01-01

    Auricular acupuncture (AA) is effective in treating various pain conditions, but there have been no analyses of AA for the treatment of pain after ambulatory knee surgery. We assessed the range of analgesic requirements under AA after ambulatory knee arthroscopy. Twenty patients randomly received a true AA procedure (Lung, Shenmen and Knee points) or sham procedure (three non-acupuncture points on the auricular helix) before ambulatory knee arthroscopy. Permanent press AA needles were retained in situ for one day after surgery. Post-operative pain was treated with non-steroidal anti-inflammatory ibuprofen, and weak oral opioid tramadol was used for rescue analgesic medication. The quantity of post-operative analgesics and pain intensity were used to assess the effect of AA. The incidence of analgesia-related side effects, time to discharge from the anesthesia recovery room, heart rate and blood pressure were also recorded. Ibuprofen consumption after surgery in the AA group was lower than in the control group: median 500 versus 800 mg, P = 0.043. Pain intensity on a 100 mm visual analogue scale for pain measurement and other parameters were similar in both groups. Thus AA might be useful in reducing the post-operative analgesic requirement after ambulatory knee arthroscopy. PMID:15937559

  15. Pain Management in the Elderly: Transdermal Fentanyl for the Treatment of Pain Caused by Osteoarthritis of the Knee and Hip

    PubMed Central

    2014-01-01

    This study was designed to evaluate the utility of transdermal fentanyl (transdermal fentanyl, TDF) for the treatment of pain due to osteoarthritis (osteoarthritis, OA) of the knee and hip, which was not adequately controlled by nonopioid analgesics or weak opioids. WOMAC is a reliable, valid, and responsive multidimensional, self-administrated outcome measure designed specifically to evaluate patients with OA of the knee or hip. TDF significantly increased pain control and improved functioning and quality of life. Metoclopramide appeared to be of limited value in preventing nausea and vomiting. PMID:24527441

  16. Knee pain during activities of daily living and its relationship with physical activity in patients with early and severe knee osteoarthritis.

    PubMed

    Fukutani, Naoto; Iijima, Hirotaka; Aoyama, Tomoki; Yamamoto, Yuko; Hiraoka, Masakazu; Miyanobu, Kazuyuki; Jinnouchi, Masashi; Kaneda, Eishi; Tsuboyama, Tadao; Matsuda, Shuichi

    2016-09-01

    This study aimed to investigate whether knee pain during various activities of daily living (ADLs) is associated with physical activity in patients with early and severe knee osteoarthritis (OA). We hypothesized that the painful ADLs associated with decreased physical activity differ according to disease severity. This cross-sectional study enrolled 270 patients with medial knee OA, assigned to either the early (Kellgren Lawrence [K/L] grade 1-2) or the severe group (K/L grade 3-4). Physical activity was assessed using a pedometer. Knee pain during six ADLs (waking up in the morning, walking on a flat surface, ascending stairs, etc.) was evaluated using a questionnaire. We performed multiple regression and quantile regression analysis to investigate whether knee pain during each ADL was associated with physical activity. In the early group, the more knee pain they experienced while ascending stairs, the lower their physical activity was (75th regression coefficient = -1033.70, P = 0.018). In the severe group, the more knee pain they experienced while walking on a flat surface or bending to the floor or standing up, the lower their physical activity was (unstandardized coefficients = -1850.87, P = 0.026; unstandardized coefficients = -2640.35, P = 0.010). Knee pain while ascending stairs and while walking on a flat surface or bending to the floor or standing up was a probable limiting factor for physical activity in early and severe knee OA, respectively. These findings suggested that a reduction in task-specific knee pain according to disease severity could improve physical activity levels. PMID:27041381

  17. Women with knee osteoarthritis have more pain and poorer function than men, but similar physical activity prior to total knee replacement

    PubMed Central

    2011-01-01

    Background Osteoarthritis of the knee is a major clinical problem affecting a greater proportion of women than men. Women generally report higher pain intensity at rest and greater perceived functional deficits than men. Women also perform worse than men on function measures such as the 6-minute walk and timed up and go tests. Differences in pain sensitivity, pain during function, psychosocial variables, and physical activity levels are unclear. Further the ability of various biopsychosocial variables to explain physical activity, function and pain is unknown. Methods This study examined differences in pain, pain sensitivity, function, psychosocial variables, and physical activity between women and men with knee osteoarthritis (N = 208) immediately prior to total knee arthroplasty. We assessed: (1) pain using self-report measures and a numerical rating scale at rest and during functional tasks, (2) pain sensitivity using quantitative sensory measures, (3) function with self-report measures and specific function tasks (timed walk, maximal active flexion and extension), (4) psychosocial measures (depression, anxiety, catastrophizing, and social support), and (5) physical activity using accelerometry. The ability of these mixed variables to explain physical activity, function and pain was assessed using regression analysis. Results Our findings showed significant differences on pain intensity, pain sensitivity, and function tasks, but not on psychosocial measures or physical activity. Women had significantly worse pain and more impaired function than men. Their levels of depression, anxiety, pain catastrophizing, social support, and physical activity, however, did not differ significantly. Factors explaining differences in (1) pain during movement (during gait speed test) were pain at rest, knee extension, state anxiety, and pressure pain threshold; (2) function (gait speed test) were sex, age, knee extension, knee flexion opioid medications, pain duration, pain

  18. The Role of Botulinum Toxin Type A in the Clinical Management of Refractory Anterior Knee Pain

    PubMed Central

    Singer, Barbara J.; Silbert, Benjamin I.; Silbert, Peter L.; Singer, Kevin P.

    2015-01-01

    Anterior knee pain is a highly prevalent condition affecting largely young to middle aged adults. Symptoms can recur in more than two thirds of cases, often resulting in activity limitation and reduced participation in employment and recreational pursuits. Persistent anterior knee pain is difficult to treat and many individuals eventually consider a surgical intervention. Evidence for long term benefit of most conservative treatments or surgical approaches is currently lacking. Injection of Botulinum toxin type A to the distal region of vastus lateralis muscle causes a short term functional “denervation” which moderates the influence of vastus lateralis muscle on the knee extensor mechanism and increases the relative contribution of the vastus medialis muscle. Initial data suggest that, compared with other interventions for anterior knee pain, Botulinum toxin type A injection, in combination with an active exercise programme, can lead to sustained relief of symptoms, reduced health care utilisation and increased activity participation. The procedure is less invasive than surgical intervention, relatively easy to perform, and is time- and cost-effective. Further studies, including larger randomized placebo-controlled trials, are required to confirm the effectiveness of Botulinum toxin type A injection for anterior knee pain and to elaborate the possible mechanisms underpinning pain and symptom relief. PMID:26308056

  19. The comparison of anterior knee pain in severe and non severe arthritis of the lateral facet of the patella following a mobile bearing unicompartmental knee arthroplasty.

    PubMed

    Pongcharoen, Boonchana; Reutiwarangkoon, Chaivet

    2016-01-01

    In the past, medial osteoarthritis (OA) knee with symptomatic patellofemoral (PF) arthritis has not been recommended for a unicompartmental knee arthroplasty (UKA). However, recent studies have reported that UKA has shown good results in patients with medial OA of the knee, including those with PF arthritis. The purpose of this study is to compare the results between patients with medial OA knees; those with severe arthritis of the lateral facet of the patella and patients without severe arthritis of the lateral facet of the patella following mobile bearing UKA. We have prospectively evaluated 104 patients (114 knees) who had undergone an Oxford mobile bearing UKA. The mean follow-up was 19.05 months (range 12.30-29.70 months). The patients were divided into two groups: group I consisted of eighty patients (88 knees) who did not have severe arthritis of the lateral facet (Outerbridge grade 0-2) and group II had twenty-four patients (26 knees) who had severe arthritis of the lateral facet (Outerbridge grade 3, 4). We recorded the incidence of anterior knee pain, knee scores, pain scores, and functional scores in comparison of the two groups. The visual analog scale (VAS) and incidence of post-operative anterior knee pain had not shown any significant differences. The VAS for post-operative anterior knee pain was 0.11 (SD 0.56, range 0-3 point) versus 0.12 (SD 0.59, range 0-3 point) for group I and group II patients, respectively (P = 0.98). The incidence of post-operative anterior knee pain was 4.5 versus 3.8 % for group I and group II patients, respectively (P = 0.88). The pain scores and functional scores had not exhibited any differences. However, the knee scores of patients with severe arthritis of the lateral facet of the patella was worse than those seen in patients without severe arthritis of the lateral facet of the patella with a statistical significance. It was scored as 96.78 (SD 4.56, range 85-100) versus 94.43 (SD 4.50, range 81-100) for group I

  20. Serum Levels of Proinflammatory Cytokines in Painful Knee Osteoarthritis and Sensitization

    PubMed Central

    Imamura, Marta; Ezquerro, Fernando; Marcon Alfieri, Fábio; Vilas Boas, Lucy; Tozetto-Mendoza, Tania Regina; Chen, Janini; Özçakar, Levent; Arendt-Nielsen, Lars

    2015-01-01

    Osteoarthritis (OA) is the most common joint disorder in the world. Among the mechanisms involved in osteoarthritis, biomarkers (cytokines profile) may be related to pain and pain intensity, functional capacity, and pressure pain thresholds (PPT). Thus, the study of these relationships may offer useful information about pathophysiology and associated mechanisms involved in osteoarthritis. Therefore, the objective of this study was to investigate the seric concentration of pro (IL-6, IL-8, and TNF-α) and anti-inflammatory (IL-10) cytokines in patients with painful knee osteoarthritis and to correlate the levels of these biomarkers with the patients' functional capacity and pressure pain threshold (PPT) values. PMID:25821631

  1. Determinants of pain and functioning in knee osteoarthritis: a one-year prospective study

    PubMed Central

    Helminen, Eeva-Eerika; Sinikallio, Sanna H; Valjakka, Anna L; Väisänen-Rouvali, Rauni H; Arokoski, Jari PA

    2016-01-01

    Objective: To identify predictors of pain and disability in knee osteoarthritis. Design: A one-year prospective analysis of determinants of pain and functioning in knee osteoarthritis. Study setting: Primary care providers in a medium-sized city. Patients: A total of 111 patients aged from 35 to 75 with clinical symptoms and radiographic grading (Kellgren-Lawrence 2–4) of knee osteoarthritis who participated in a randomized controlled trial. Main measures: The outcome measures were self-reported pain and function, which were recorded at 0, 3 and 12 months. Disease-specific pain and functioning were assessed using the pain and function subscales of the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index. Generic physical and mental functioning were assessed using the RAND-36 subscales for function, and physical and mental component summary scores. Possible baseline predictors for these outcomes were 1) demographic, socioeconomic and disease-related variables, and 2) psychological measures of resources, distress, fear of movement and catastrophizing. Results: Multivariate linear mixed model analyses revealed that normal mood at baseline measured with the Beck Anxiety Inventory predicted significantly better results in all measures of pain (WOMAC P=0.02) and function (WOMAC P=0.002, RAND-36 P=0.002) during the one-year follow-up. Psychological resource factors (pain self-efficacy P=0.012, satisfaction with life P=0.002) predicted better function (RAND-36). Pain catastrophizing predicted higher WOMAC pain levels (P=0.013), whereas fear of movement (kinesiophobia) predicted poorer functioning (WOMAC P=0.046, RAND-36 P=0.024). Conclusions: Multiple psychological factors in people with knee osteoarthritis pain are associated with the development of disability and longer term worse pain. PMID:27496698

  2. Two cases of chronic knee pain caused by unusual injuries to the popliteus tendon

    PubMed Central

    DAVALOS, ERIC A.; BARANK, DAVID; VARMA, RAJEEV K.

    2016-01-01

    Injuries to the popliteus tendon are less frequent than injuries to the menisci or ligamentous structures of the knee. When they do occur, injuries to the popliteus tendon tend to be the result of trauma and associated with injuries to other components of the knee. The most commonly seen injuries include tears at the musculotendinous junction and avulsion tears at the lateral femoral condyle insertion site. This report presents two unusual injuries of the popliteus tendon in patients with chronic knee pain: an isolated split tear of the tendon and a subluxed tendon residing within the lateral joint space. PMID:27386449

  3. Cam Femoroacetabular Impingement as a Possible Explanation of Recalcitrant Anterior Knee Pain

    PubMed Central

    Sanchis-Alfonso, Vicente; Tey, Marc; Monllau, Joan Carles

    2016-01-01

    We present a case of a patient with chronic anterior knee pain (AKP) recalcitrant to conservative treatment who returned to our office for severe hip pain secondary to Cam femoroacetabular impingement (Cam FAI) at 10 months after the onset of knee pain. This case highlights the fact that the main problem is not in the patella but in the hip in some patients with AKP. We hypothesize that there is an external femoral rotation in order to avoid the impingement and therefore the hip pain in patients with Cam FAI. This functional femoral rotation could provoke a patellofemoral imbalance that may be, in theory, responsible for patellofemoral pain in this particular patient. In our case, Cam FAI resolution was related to the resolution of AKP. PMID:27247817

  4. Giant Cell Tumor of the Patella Tendon Sheath Presenting as a Painful Locked Knee

    PubMed Central

    Panagopoulos, Andreas; Tsoumpos, Pantelis; Tatani, Irini; Iliopoulos, Ilias; Papachristou, Dionysios

    2015-01-01

    Patient: Male, 26 Final Diagnosis: Giant cell tumor of the patella tendon seath Symptoms: Efusion • locking kneepain Medication: None Clinical Procedure: Arthroscopy and open resection of the tumor Specialty: Orthopedics and Traumatology Objective: Rare disease Background: The giant cell tumor of the tendon sheath (GCT-TS) is a benign proliferative synovial tumor manifesting as an intra-articular solitary nodule. When it involves the infrapatellar fat pad it can present acutely as a painful locked knee. Case Report: A 26-year-old white male presented with a 2-week history of painful locking in his right knee. Clinical examination revealed lack of extension by approximately 20°. To help establish the diagnosis, an MRI scan of the right knee was performed, showing a large (5×4×2 cm), oval, well-circumscribed mass with a low-intensity homogenous signal. The size of the mass prohibited the removal by arthroscopy and we therefore proceeded with an open arthrotomy. Histological examination showed a tendosynovial giant cell tumor of the patella tendon sheath. At the latest follow-up, 2 years postoperatively, there was no local tumor recurrence. Conclusions: These rare tumorous lesions should be included in the differential diagnosis of painful locking knee, especially in the absence of definite traumatic history. PMID:26302970

  5. Analysis of Early Postoperative Pain in the First and Second Knee in Staged Bilateral Total Knee Arthroplasty: A Retrospective Controlled Study

    PubMed Central

    Sun, Jiuyi; Li, Lintao; Yuan, Shuai; Zhou, Yiqin

    2015-01-01

    Objective A retrospective analysis of early postoperative pain in the first and second knee in staged bilateral total knee arthroplasty (TKA) to provide a clinical evidence for the change of analgesic strategy. Methods From January 2009 to January 2013, 87 cases which meet the inclusion criterion were retrospectively reviewed. In stage TKA, the postoperative pain in the first and second knee at 24h, 48h, 72h after operation were compared using the visual analogue scale (VAS) score in the rest and maximum knee flexion position. The difference in pain scores (ΔVAS) was also compared between the second and first knee at different time intervals (less than 6 months, 6-12 months, more than 12 months). Results The VAS scores in the second knee were significantly higher than those in the first knee at 24h, 48h after surgery, but with no difference at 72h. The ΔVAS in the group of less than 6 months was significantly higher than of those more than 6 months, and there was no difference in ΔVAS between group of 6-12 months and group of more than 12 months. Conclusions Patient receiving staged bilateral TKA experiences greater postoperative pain within 48h after operation in the second knee than in the first knee, which can provide a clinical evidence to enhance the analgesic strategy in the second operation of the staged bilateral TKA. And for the management of postoperative pain in staged bilateral TKA, it’s better to recommend that the interval between two operations should be more than 6 months, which may reduce the postoperative pain in the second knee, improve patient satisfaction, and speed up patient‘s rehabilitation process. PMID:26068371

  6. The relationship among psychological factors, neglect-like symptoms and postoperative pain after total knee arthroplasty

    PubMed Central

    Hirakawa, Yoshiyuki; Hara, Michiya; Fujiwara, Akira; Hanada, Hirofumi; Morioka, Shu

    2014-01-01

    BACKGROUND: Persistent postoperative pain has a significant relationship with patient health and satisfaction. OBJECTIVES: To investigate the prevalence and association of neglect-like symptoms (NLS) and other psychological factors on postoperative pain in patients following total knee arthroplasty (TKA). NLS are defined as the loss of perception of the limb with pain and excessive effort required to move the limb. The authors hypothesized that NLS were an important contributor to postoperative pain. METHODS: The factors influencing pain were investigated using a longitudinal study with assessments at three and six weeks postsurgery. The relationships among demographic factors (age, body weight, body mass index), psychological factors (State-Trait Anxiety Inventory and Pain Catastrophizing Scale [PCS]) and NLS with postoperative pain were investigated in 90 patients after TKA. The associations among motor functions (muscle strength of knee extension, range of motion), sensory functions (joint position sense and two-point discrimination in the thigh) and NLS were also investigated. RESULTS: At three and six weeks after surgery, 36% and 19% of patients, respectively, experienced NLS. In hierarchical multiple regression analysis, NLS and PCS scores were significantly associated with postoperative pain, while joint position sense and range of motion were significantly associated with NLS. CONCLUSIONS: These results suggest that facilitation of sensory integration is important in rehabilitation after TKA because NLS appears to result from impaired sensory integration. The association of PCS scores with postoperative pain and NLS suggests the need to provide appropriate postoperative education to reduce persistent negative thoughts regarding future pain. PMID:25101335

  7. Modifiable lifestyle factors are associated with lower pain levels in adults with knee osteoarthritis

    PubMed Central

    Connelly, A Erin; Tucker, Amy J; Kott, Laima S; Wright, Amanda J; Duncan, Alison M

    2015-01-01

    BACKGROUND: With no cure or effective treatments for osteoarthritis (OA), the need to identify modifiable factors to decrease pain and increase physical function is well recognized. OBJECTIVE: To examine factors that characterize OA patients at different levels of pain, and to investigate the relationships among these factors and pain. METHODS: Details of OA characteristics and lifestyle factors were collected from interviews with healthy adults with knee OA (n=197). The Western Ontario and McMaster Universities Osteoarthritis Index was used to assess pain. Factors were summarized across three pain score categories, and χ2 and Kruskal-Wallis tests were used to examine differences. Multiple linear regression analysis using a stepwise selection procedure was used to examine associations between lifestyle factors and pain. RESULTS: Multiple linear regression analysis indicated that pain was significantly higher with the use of OA medications and higher body mass index category, and significantly lower with the use of supplements and meeting physical activity guidelines (≥150 min/week). Stiffness and physical function scores, bilateral knee OA, body mass index category and OA medication use were significantly higher with increasing pain, whereas self-reported health, servings of fruit, supplement use and meeting physical activity guidelines significantly lower. No significant differences across pain categories were found for sex, age, number of diseases, duration of OA, ever smoked, alcoholic drinks/week, over-the-counter pain medication use, OA supplement use, physical therapy use, servings of vegetables or minutes walked/week. CONCLUSIONS: Healthy weight maintenance, exercise for at least 150 min/week and appropriate use of medications and supplements represent important modifiable factors related to lower knee OA pain. PMID:26125195

  8. Comparison of the thoracic flexion relaxation ratio and pressure pain threshold after overhead assembly work and below knee assembly work

    PubMed Central

    Yoo, Won-gyu

    2016-01-01

    [Purpose] The purpose of this study was to compare the thoracic flexion relaxation ratio following overhead work and below-knee work. [Subjects and Methods] Ten men (20–30 years) were recruited to this study. The thoracic flexion relaxation ratio and pressure pain threshold was measured after both overhead work and below-knee work. [Results] The pressure-pain thresholds of the thoracic erector spinae muscle decreased significantly from initial, to overhead, to below-knee work. Similarly, the thoracic flexion relaxation ratio decreased significantly from initial, to overhead, to below-knee work. [Conclusion] Below-knee work results in greater thoracic pain than overhead work. Future studies should investigate below-knee work in detail. This study confirmed the thoracic relaxation phenomenon in the mid-position of the thoracic erector spinae. PMID:26957744

  9. Analgesia and Improved Performance in a Patient Treated by Cooled Radiofrequency for Pain and Dysfunction Postbilateral Total Knee Replacement.

    PubMed

    Menzies, Robert D; Hawkins, Jeffery K

    2015-07-01

    Total knee replacement (TKR) is a terminal therapy for osteoarthritis (OA) of the knee. While TKR results are generally satisfactory, a significant proportion of patients experience persistent pain lasting > 3 months following surgery, even after a technically acceptable operation. Knee pain of any kind post-TKR has been reported in up to 53% of patients, while 15% of patients have reported severe pain. Pain post-TKR is worse than preoperative pain in 7%, often resulting in surgical revision. The clinical experience of a patient that originally presented to an orthopedic surgeon with OA of both knees demonstrates an alternative relatively noninvasive pain management strategy: cooled radiofrequency (CRF) ablation of sensory nerves. PMID:25857719

  10. Bipartite patella causing knee pain in young adults: a report of 5 cases.

    PubMed

    Vaishya, Raju; Chopra, Surender; Vijay, Vipul; Vaish, Abhishek

    2015-04-01

    We report on 5 patients who underwent arthroscopic excision or open reduction and internal fixation for bipartite patella. All patients presented with refractory anterior knee pain. The diagnosis of bipartite patella was made using radiography, and confirmed with magnetic resonance imaging or computed tomographic arthrography. All 5 patients achieved complete resolution of symptoms after surgery, and remained pain-free after a mean followup period of 13 months. PMID:25920661

  11. LATERAL PAIN IN AN ATHLETE'S KNEE: A RARE CASE OF DISLOCATION OF THE FEMORAL BICEPS TENDON

    PubMed Central

    Duarte, Aires; Severino, Nilson; da Silva, Ana Paula Simões; de Lima, Marcos Vaz; Resende, Vanessa Ribeiro; Kertzman, Paulo F.

    2015-01-01

    Dislocation of the femoral biceps tendon is rare and is described clinically in the literature as a lateral pain in the knee. It was initially reported as an anomalous insertion of the long head of the femoral biceps. Subsequently, it was found to be caused by abnormal mobility of the tendon over the prominence of the fibular head at certain angles of knee flexion. The objective of the present report was to describe and discuss a condition of lateral knee pain in a swimmer who started to present subluxation of the femoral biceps during sports practice, which incapacitated him from taking part in trials and competitions. The case is discussed in the light of the literature surveyed; the likelihood that the etiology for the trauma leading to this condition was repetition; and the surgical treatment instituted, which led to excellent results and the patient's return to his habitual sports practice. PMID:27047902

  12. Synovial lipomatosis: A rare cause of knee pain in an adolescent female

    PubMed Central

    Miladore, Nicholas; Childs, Mary A; Sabesan, Vani J

    2015-01-01

    Synovial lipomatosis is a benign proliferative disease of the subsynovial adipose which can lead to a variety of presentations. Cases of synovial lipomatosis in children or adolescents are rare. This case report describes an adolescent patient with a rare bilateral presentation of synovial lipomatosis. She had been treated for years prior to her presentation for juvenile idiopathic arthritis. She presented with chronic bilateral knee pain, swelling, and mechanical symptoms. Bilateral MR imaging demonstrated effusions, hypertrophy of the synovium, and polyp-like projections of tissue with the same signal intensity as fat which is pathognomonic for synovial lipomatosis. Arthroscopic synovectomy and extensive debridement of polyp like fat projections of the right knee was performed. Histopathology was consistent with the synovial lipomatosis diagnosis. Postoperatively, the patient was satisfied with her outcome with improved pain relief and function in her right knee. PMID:25893181

  13. Laboratory and sonographic findings in dialyzed patients with bilateral chronic knee pain versus dialyzed asymptomatic patients.

    PubMed

    Barisić, Igor; Ljutić, Dragan; Vlak, Tonko; Bekavac, Josip; Janković, Stipan

    2007-06-01

    The aim of this study is to evaluate connection of plasma level of beta2-microglobulin, C-reactive protein and uric acid as well as sonographic parameters like thickness of synovial membrane, thickness of femoral condylar cartilage and presence of joint effusion and Baker's cysts with bilateral knee pain in dialyzed patients, comparing them with parameters in asymptomatic dialyzed patients. Plasma levels of beta2-microglobulin and C-reactive protein were significantly higher in symptomatic patients while uric acid level showed no difference among the groups. In symptomatic patients synovial membrane was thicker and in those patients there were more knee effusions and Baker's cysts. Thickness of femoral condylar cartilage showed no difference between groups. That suggests that inflammatory mechanisms developing from beta2-microglobulin accumulation could be important factor in bilateral knee pain in dialyzed patients even in shorter duration dialysis. PMID:17847928

  14. Comparison of Indirect MR Arthrography With Conventional MRI in the Diagnosis of Knee Pathologies in Patients With Knee Pain

    PubMed Central

    Babaei Jandaghi, Ali; Mardani-Kivi, Mohsen; Mirbolook, Ahmadreza; Emami-Meybodi, Mohammad Kazem; Mohammadzadeh, Solmaz; Farahmand, Maral

    2016-01-01

    Background Knee pain is a common problem in the general population. In order to determine the extent of the injury and the appropriate treatment, MRI provides the most accurate imaging method. This may be done through conventional MRI techniques or by injecting a contrast material (MR arthrography). Objectives The purpose of this study was to compare the diagnostic value of these two methods. Patients and Methods The study involved the diagnostic evaluation on 60 patients with knee pain who received treatment over the course of a one-year period. Referred patients were randomly divided into two groups: indirect MR arthrography was performed on one group, and conventional MRI was performed on the other group. Both groups then underwent arthroscopy. The results from both groups were compared with the arthroscopic findings. Results In all of the pathologies studied, the sensitivity, specificity, and the positive and negative predictive values were evaluated. A high rate of accuracy was found between MR arthrography and arthroscopy (P < 0.05) for all knee injuries, however a similar rate of accuracy between conventional MRI and arthroscopy was only seen in patients with damage to the posterior cruciate ligament (PCL), the tibio-femoral articular cartilage, and patella chondromalacia (P < 0.05). The highest rate of accuracy was seen in cases where indirect MR arthrography was used for the diagnosis of anterior cruciate ligament (ACL) damage (K = 1). Conclusions Our results have shown that indirect MR arthrography had greater diagnostic accuracy in regards to the sensitivity, specificity, and positive and negative predictive values than conventional MRI in knee pathologies. PMID:27625998

  15. Knee Pain in Children, Part II: Limb- and Life-threatening Conditions, Hip Pathology, and Effusion.

    PubMed

    Wolf, Michael

    2016-02-01

    On the basis of primarily consensus due to lack of relevant clinical studies, the most important evaluative step for knee pain is to identify any emergent conditions, including limb- and life-threatening disorders (septic arthritis, osteomyelitis, and malignancy), hip pathology, or conditions associated with effusions. (2)(3)(6)(8)(11)(13)(14) PMID:26834226

  16. Influence of pain severity on health-related quality of life in Chinese knee osteoarthritis patients

    PubMed Central

    Pang, Jian; Cao, Yue-Long; Zheng, Yu-Xin; Gao, Ning-Yang; Wang, Xue-Zong; Chen, Bo; Gu, Xin-Feng; Yuan, Weian; Zhang, Ming; Liu, Ting; Zhan, Hong-Sheng; Shi, Yin-Yu

    2015-01-01

    Objective: The aim of this cross-sectional study was to examine the relationship among pain and other symptoms intensity, and health-related quality of life (HRQoL) in Chinese patients with knee osteoarthritis (OA). Methods: The study was cross-sectional, descriptive, and correlational. A convenience sample of 466 patients with knee OA was recruited in the study. Age, gender, body mass index (BMI), duration of disease, and Kellgren- Lawrence (KL) scores were recorded. HRQoL and symptoms were assessed using the 36-item Short Form Health Survey (SF-36) and the Western Ontario and McMaster (WOMAC) index in participants. Results: The sample was predominantly female (82%) with mean age 56.56 years and mean BMI 24.53 kg/m2. We found that WOMAC subscale scores significantly negative correlated with the majority of SF-36 subscale scores in knee OA patients (P < 0.05). There were no correlations between BMI, duration of disease, KL score and the vast majority of SF-36 subscale scores in patients (P > 0.05). In addition, there was a significant correlation between age and PCS, gender and MCS in patients (P < 0.05). Regression analysis showed, WOMAC subscale scores significantly negative correlated with the vast majority of SF-36 subscale scores. WOMAC-pain score had the strongest relationship with SF-36 PCS and MCS scores. Conclusions: In summary, pain severity has a greater impact on HRQoL than patient characteristics, other joint symptoms and radiographic severity in Chinese knee OA patients. Relieving of knee symptoms may help to improve patients’ HRQOL. The study provided the evidence that relieving pain should be the first choice of therapy for knee osteoarthritis. PMID:26064371

  17. The effect of patient age, gender, and tibial component fixation on pain relief after cementless total knee arthroplasty.

    PubMed

    Whiteside, L A

    1991-10-01

    Cementless total knee arthroplasties (TKAs) were prospectively evaluated for pain relief in 1110 knees. The effect of screws in the tibial component, the age of the patients, and the gender of the patients were studied to determine the effect of these parameters on pain relief one and two years postsurgery. The group with screws in the tibial component (Ortholoc II) had a significantly higher percentage of pain-free knees at one year than at two years postsurgery, and the older patients had a significantly higher rate of pain-free knees at one- and two years postsurgery than the younger patients. Older female patients with Ortholoc I TKAs had a significantly higher percentage of pain-free knees than did older male patients at one-year postsurgery, but not at two years. The group with screws in the tibial components (Ortholoc II) had a higher percentage of pain-free knees at one-year postsurgery than did the Ortholoc I knees, but there was no difference between Ortholoc I and II at two-years postsurgery. In the Ortholoc II group, there was also no difference in results among sexes or between patients older and younger than 65 years old. The correlation coefficient was calculated to evaluate the relationship between body weight and the degree of pain after TKA. No significant correlation could be found at one and two years after surgery. PMID:1914298

  18. Adductor Canal Block for Postoperative Pain Treatment after Revision Knee Arthroplasty: A Blinded, Randomized, Placebo-Controlled Study

    PubMed Central

    Jæger, Pia; Koscielniak-Nielsen, Zbigniew J.; Schrøder, Henrik M.; Mathiesen, Ole; Henningsen, Maria H.; Lund, Jørgen; Jenstrup, Morten T.; Dahl, Jørgen B.

    2014-01-01

    Background Revision knee arthroplasty is assumed to be even more painful than primary knee arthroplasty and predominantly performed in chronic pain patients, which challenges postoperative pain treatment. We hypothesized that the adductor canal block, effective for pain relief after primary total knee arthroplasty, may reduce pain during knee flexion (primary endpoint: at 4 h) compared with placebo after revision total knee arthroplasty. Secondary endpoints were pain at rest, morphine consumption and morphine-related side effects. Methods We included patients scheduled for revision knee arthroplasty in general anesthesia into this blinded, placebo-controlled, randomized trial. Patients were allocated to an adductor canal block via a catheter with either ropivacaine or placebo; bolus of 0.75% ropivacaine/saline, followed by infusion of 0.2% ropivacaine/saline. Clinicaltrials.gov ID: NCT01191593. Results We enrolled 36 patients, of which 30 were analyzed. Mean pain scores during knee flexion at 4 h (primary endpoint) were: 52±22 versus 71±25 mm (mean difference 19, 95% CI: 1 to 37, P = 0.04), ropivacaine and placebo group respectively. When calculated as area under the curve (1–8 h/7 h) pain scores were 55±21 versus 69±21 mm during knee flexion (P = 0.11) and 39±18 versus 45±23 mm at rest (P = 0.43), ropivacaine and placebo group respectively. Groups were similar regarding morphine consumption and morphine-related side effects (P>0.05). Conclusions The only statistically significant difference found between groups was in the primary endpoint: pain during knee flexion at 4 h. However, due to a larger than anticipated dropout rate and heterogeneous study population, the study was underpowered. Trial Registration Clinicaltrials.gov NCT01191593 PMID:25386752

  19. Association of neuropathic pain with ultrasonographic measurements of femoral cartilage thickness and clinical parameters in patients with knee osteoarthritis

    PubMed Central

    Mesci, Nilgün; Mesci, Erkan; Külcü, Duygu Geler

    2016-01-01

    [Purpose] The aim of this study was to investigate whether neuropathic pain is associated with femoral condylar cartilage thickness, electrical pain threshold, and clinical parameters in patients with knee osteoarthritis. [Subjects and Methods] Sixty patients over the age of 40 diagnosed with knee osteoarthritis were enrolled. The PainDETECT questionnaire, Western Ontario and McMaster Universities Osteoarthritis Index, Hospital Anxiety and Depression Scale, and Short Form-36 questionnaire were completed for all patients. Electrical sensory threshold and electrical pain threshold measurements were obtained. Femoral condylar cartilage thickness was determined by means of ultrasound. [Results] PainDETECT scores of 13 or greater were observed in 28 (46.7%) patients, indicating the presence of neuropathic pain. These patients were found to have greater average pain severity, Western Ontario and McMaster Universities Osteoarthritis Index, and depression and anxiety scores and lower Short Form-36 scores than patients without neuropathic pain. Patients with neuropathic pain showed lower knee electrical sensory threshold and pain threshold values on average than patients without neuropathic pain. Femoral condylar cartilage thickness was not different between the two groups. [Conclusion] Neuropathic pain is associated with increased pain severity and decreased functional capacity and adversely affects quality of life and mood in patients with knee osteoarthritis.

  20. The intra-articular use of ropivacaine for the control of post knee arthroscopy pain

    PubMed Central

    Samoladas, Efthimios P; Chalidis, Byron; Fotiadis, Hlias; Terzidis, Ioanis; Ntobas, Thomas; Koimtzis, Miltos

    2006-01-01

    Aims The purpose of this prospective randomised study is to evaluate the efficacy, safety and the appropriate dose of the ropivacaine in the control of post-knee arthroscopy pain. Methods We randomised 60 patients in two groups to receive 10 ml/7.5 mg/ml ropivacaine (Group B) or 20 ml/7.5 mg/ml (Group A) at the end of a routine knee arthroscopy. We monitored the patient's blood pressure, heart rate, allergic reactions, headache, nausea, we assessed the pain using the visual analogue score at intervals of 1,2,3,4 and 6 hours after the operation. and we recorded the need for extra analgesia. Results The intraarticular use of the ropivacaine provided excellent control of pain after knee arthroscopy. At two hours post-operatively there wasn't any difference between the two groups. Afterwards, the Group A showed increased pain and need for supplementary medication. Conclusion We believe that intraarticular use of ropivacaine is effective to reduce post-operative pain minimising the use of systematic analgesia. PMID:17187686

  1. The relation of MRI-detected structural damage in the medial and lateral patellofemoral joint to knee pain: The Multicenter and Framingham Osteoarthritis Studies

    PubMed Central

    Stefanik, Joshua J.; Gross, K. Douglas; Guermazi, Ali; Felson, David T.; Roemer, Frank W.; Zhang, Yuquing; Niu, Jingbo; Segal, Neil A.; Lewis, Cora E.; Nevitt, Michael; Neogi, Tuhina

    2015-01-01

    Objective To examine the relation of cartilage loss and bone marrow lesions (BMLs) in the medial and lateral patellofemoral joint (PFJ) to knee pain. Methods We categorized the location of full-thickness cartilage loss and BMLs in the PFJ on knee MRIs from the Multicenter Osteoarthritis (MOST) and Framingham Osteoarthritis (FOA) Studies as no damage, isolated medial, isolated lateral, or both medial and lateral (mixed). We determined the relation of MRI lesions in each PFJ region to prevalent knee pain. Differences in knee pain severity were compared among categories of PFJ full-thickness cartilage loss and BMLs using quantile regression. Results In MOST (n=1137 knees), compared with knees without full-thickness cartilage loss, knees with isolated lateral or mixed PFJ full-thickness cartilage loss had 1.9 (1.3, 2.8) and 1.9 (1.2, 2.9) times the odds of knee pain, respectively, while isolated medial cartilage loss had no association with knee pain.. BMLs in both the medial and lateral PFJ had 1.5 (1.1, 2.0) times the odds of knee pain compared with knees without BMLs. Knee pain severity was lowest in knees with isolated medial PFJ cartilage loss or BMLs. In FOA (n=934 knees), neither isolated medial nor lateral cartilage loss was associated with knee pain, whereas isolated BMLs in either region were associated with pain. Conclusions Results were not completely concordant but suggest that knee pain risk and severity is greatest with cartilage loss isolated to (MOST) or inclusive of (MOST and FOA) the lateral PFJ. While BMLs in either the medial or lateral PFJ are related to pain. PMID:25575967

  2. Acupuncture for chronic knee pain: a protocol for an updated systematic review

    PubMed Central

    Zhang, Qinhong; Yue, Jinhuan; Sun, Zhongren; Lu, Ying

    2016-01-01

    Introduction The aim of this study is to evaluate the efficacy and safety of acupuncture for patients with chronic knee pain. Methods and analysis MEDLINE, EMBASE, CENTERAL, CINAHL and four Chinese medical databases will be searched from their inception to present. We will also manually retrieve eligible studies. Randomised controlled trials (RCTs) in which acupuncture is assessed as the sole treatment or as an adjunct treatment for chronic knee pain will be included. The primary outcome of our analysis is pain measured by the visual analogue scale (VAS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale or the 11-point numeric rating scale (NRS). The secondary outcomes will include the quality of life, measured by the 36-item Short-Form Health Survey (SF-36) and adverse events. Two researchers will conduct the study selection, data extraction and quality assessment independently. Any disagreement will be resolved through discussion with a third reviewer. The Cochrane risk-of-bias criteria and the Standards for Reporting Interventions in Controlled Trials of Acupuncture (STRICTA) checklist will be used to assess the methodological quality of the trials. Dissemination This systematic review will assess the current evidence on acupuncture therapy for chronic knee pain. It uses aggregated published data instead of individual patient data and does not require an ethical board review and approval. The findings will be published in a peer-reviewed journal and disseminated in conference presentations. It will provide the latest analysis of the currently available evidence for acupuncture treating chronic knee pain. Trial registration number CRD42014015514. PMID:26911581

  3. [Rotational malalignment of the components may cause chronic pain or early failure in total knee arthroplasty].

    PubMed

    Hofmann, S; Romero, J; Roth-Schiffl, E; Albrecht, T

    2003-06-01

    Rotational alignment of the tibial and femoral component plays an important role in modern total knee replacement surgery. After correct frontal alignment and proper soft tissue balancing, the rotational placement of the components represents the "third dimension" in knee endoprosthetic surgery. Improved surgical techniques with modified instruments and better rotational component positioning will lead to better functional outcomes. Patients with painful total knee arthroplasties (TKA) or early failure without evident classic implantation failures or signs of infection should be evaluated for malrotation of the components. In a prospective study in 26 patients with painful TKA and malrotation of the tibia and/or femur component, revision surgery with exchange of the components was performed. Twenty-five cases showed clinically relevant internal malrotation of the tibial component (ø 8.4 degrees ) and/or femoral component (ø 5.6 degrees ). Only one patient had 10 degrees of external malrotation of the femoral component. Combined malrotations of the tibia and femur were found in ten knees (38%). After revision surgery and correction of malrotations, 20 patients (78%) were scored with excellent and good results. Patients with painful TKA resistant to conservative therapy and evident malrotations of the component should be considered for revision surgery with change of the malrotated components. PMID:12819885

  4. Fabella Syndrome as an Uncommon Cause of Posterolateral Knee Pain after Total Knee Arthroplasty: A Case Report and Review of the Literature

    PubMed Central

    Okano, Eriko; Yanai, Takaji; Kohyama, Sho; Kanamori, Akihiro; Yamazaki, Masashi; Tanaka, Toshikazu

    2016-01-01

    The fabella is a sesamoid bone that is located in the lateral head of the gastrocnemius muscle and has been identified on magnetic resonance imaging in 31% of Japanese people. In the present case, a 65-year-old woman experienced posterolateral knee pain, accompanied by a clicking “sound” during active knee flexion, after undergoing total knee arthroplasty for knee osteoarthritis. Eight months of conservative therapy failed to produce an improvement, with progressive osteoarthritic change of the fabella identified on plain radiography. Based on this evidence, a diagnosis of fabella syndrome was made and the patient underwent a fabellectomy. Fabellectomy provided immediate resolution of posterolateral knee pain and the clicking sound with knee flexion, with the patient remaining symptom-free 18 months after fabellectomy and with no limitations in knee function. Fabellectomy eliminated symptoms in all of five case reports that have been previously published and is regarded as an effective first choice for treating fabella syndrome after total knee arthroplasty. PMID:27418991

  5. Postoperative Pain Control for Total Knee Arthroplasty: Continuous Femoral Nerve Block Versus Intravenous Patient Controlled Analgesia

    PubMed Central

    Lee, Rui Min; Lim Tey, John Boon; Chua, Nicholas Hai Liang

    2012-01-01

    Background: Pain after total knee arthroplasty is severe and impacts functional recovery. Objectives: We performed a retrospective study, comparing conventional patient control analgesia (PCA) modalities versus continuous femoral nerve blockade (CFNB) for 1582 post-TKA (total knee arthroplasty) patients. Patients and Methods: Using our electronic acute pain service (APS) database, we reviewed the data of 579 patients who had received CFNBs compared with 1003 patients with intravenous PCA over 4 years. Results: Our results show that the incidence of a severe pain episode was higher in the PCA compared with the CFNB group. Lower pain scores were observed in the CFNB group compared with the PCA group from postoperative day (POD) 1 to 3, primarily due to lower rest pain scores in the CFNB group. Conclusions: Our study shows that there is improvement in pain scores, at rest and on movement, as well as a reduction in incidence of severe pain, in patients who receive CFNB versus those who receive intravenous PCA. PMID:24904807

  6. Knee osteoarthritis related pain: a narrative review of diagnosis and treatment

    PubMed Central

    Alshami, Ali M.

    2014-01-01

    Background Osteoarthritis is a common progressive joint disease, involving not only the joint lining but also cartilage, ligaments, and bone. For the last ten years, majority of published review articles were not specific to osteoarthritis of the knee, and strength of evidence and clinical guidelines were not appropriately summarized. Objectives To appraise the literature by summarizing the findings of current evidence and clinical guidelines on the diagnosis and treatment of knee osteoarthritis pain. Methodology English journal articles that focused on knee osteoarthritis related pain were searched via PubMed (1 January 2002 – 26 August 2012) and Physiotherapy Evidence Database (PEDro) databases, using the terms ‘knee’, ‘osteoarthritis’ and ‘pain’. In addition, reference lists from identified articles and related book chapters were included as comprehensive overviews. Results For knee osteoarthritis, the highest diagnostic accuracy can be achieved by presence of pain and five or more clinical or laboratory criteria plus osteophytes. Some inconsistencies in the recommendations and findings were found between the clinical guidelines and systematic reviews. Generally, paracetamol, oral and topical non-steroidal anti-inflammatory drugs, opioids, corticosteroid injections and physical therapy techniques, such as therapeutic exercises, joint manual therapy and transcutaneous electrical nerve stimulation, can help reduce pain and improve function. Patient education programs and weight reduction for overweight patients are important to be considered. Conclusions Some inconsistencies in the recommendations and findings were found between the clinical guidelines and systematic reviews. However, it is likely that a combination of pharmacological and non-pharmacological treatments is most effective in treating patients with knee osteoarthritis. PMID:24899883

  7. [Calcified inclusions in a popliteal cyst as a rare cause of persistent knee pain and recurrent effusions].

    PubMed

    Küllmer, K; Letsch, R; Bug, R

    1994-11-01

    Popliteal cysts may occur with diseases of the knee and may cause several complications. We report about a patient with a popliteal cyst, that contained calcified concrements after a femur fracture and a complex knee injury and that we found to be a rare cause of persisting knee pain and effusions. The etiology of the concrements will be discussed, that we think are more likely to be posttraumatic loose joint bodies than traumatically induced chondromatosis. PMID:7825471

  8. Cingulate GABA levels inversely correlate with the intensity of ongoing chronic knee osteoarthritis pain

    PubMed Central

    Reckziegel, Diane; Raschke, Felix; Cottam, William J

    2016-01-01

    Background This study aims to investigate the role of the mid-anterior cingulate cortex γ-aminobutyric acid levels in chronic nociceptive pain. The molecular mechanisms of pain chronification are not well understood. In fibromyalgia, low mid-anterior cingulate cortex γ-aminobutyric acid was associated with high pain suggesting a role of prefrontal disinhibition. We hypothesize that mid-anterior cingulate cortex GABAergic disinhibition may underpin chronic pain independent of the pain etiology and comorbid negative affect. Proton magnetic resonance spectra were acquired at 3T from the mid-anterior cingulate cortex in 20 patients with chronic painful knee osteoarthritis, and 19 healthy pain-free individuals using a point resolved spectroscopy sequence optimized for detection of γ-aminobutyric acid. Participants underwent questionnaires for negative affect (depression and anxiety) and psychophysical pain phenotyping. Results No differences in mid-anterior cingulate cortex γ-aminobutyric acid or other metabolite levels were detected between groups. Ratings of perceived intensity of ongoing osteoarthritis pain were inversely correlated with γ-aminobutyric acid (r = −0.758, p < 0.001), but no correlations were seen for negative affect or pain thresholds. The pain γ-aminobutyric acid interrelation remained strong when controlling for depression (r = −0.820, p < 0.001). Combined levels of glutamine and glutamate were unrelated to psychometric or to pain thresholds. Conclusion Our study supports mid-anterior cingulate cortex γ-aminobutyric acid as a potential marker of pain severity in chronic nociceptive pain states independent of negative affect. The findings suggest that GABAergic disinhibition of the salience network may underlie sensitization to averse stimuli as a mechanism contributing to pain chronification. PMID:27206661

  9. Do the Effects of Transcutaneous Electrical Nerve Stimulation on Knee Osteoarthritis Pain and Function Last?

    PubMed

    Cherian, Jeffrey Jai; Harrison, Paige E; Benjamin, Samantha A; Bhave, Anil; Harwin, Steven F; Mont, Michael A

    2016-08-01

    Transcutaneous electrical nerve stimulation (TENS) has been shown to decrease pain associated with knee osteoarthritis, which potentially leads to better function, improved quality of life, and postpones the need for surgical intervention. The purpose of this study was to perform a 1-year follow-up of a previous prospective group of patients with knee osteoarthritis, randomized to TENS or standard of care, who were asked to rate their changes in: (1) patient pain perception; (2) subjective medication use; (3) subjective functional abilities; (4) quality of life; (5) device use; and (6) conversion to TKA. A population of 70 patients were randomized to receive either a TENS device or a standard conservative therapy regimen. Patients were evaluated based on various subjective outcomes at minimum 1-year (mean, 19 months) follow-up. The TENS cohort had lower visual analog pain scores compared with the matching cohort. Subjective functional outcomes, as well as functional and activity scores, were also greater in the TENS cohort. Patients in TENS cohort showed significant improvements in their subjective and functional outcomes as compared with their initial status, while the control group did not show significant change. A majority of the TENS patients were able to reduce the amount of pain medications. Additionally, a large portion of the patients assigned to the TENS group continue to use the device, after completion of the trial. This study demonstrated the benefit of TENS for improving subjective outcomes in patients with pain due to knee osteoarthritis, compared with standard conservative treatments. The results of the study suggest that TENS is a safe and effective adjunct as part of the spectrum of current nonoperative treatment methods for knee osteoarthritis. PMID:26540652

  10. PAIN AT THE TIP OF THE STEM AFTER REVISION TOTAL KNEE ARTHROPLASTY

    PubMed Central

    Albino, Rômulo Ballarin; Santos, Lívia Souza; Gobbi, Riccardo Gomes; lamaguchi, Maurício; Demange, Marco Kawamura; Tirico, Luis Eduardo; Pécora, José Ricardo

    2015-01-01

    Objective: To correlate parameters of implants with incidence of pain. Methods: 32 knees (31 patients) operated on between 2006 to 2008 in a serie of cases of TKA revision surgery were monitored for evidence of pain at the tip of the stem. In all we used uncemented stem Scorpio TS Total Knee ® Revision System (Stryker ®). Criteria assessed: pain in the leg or thigh without other causes, diameter and length of the nail; position of the rod in the medullary canal, intramedullary canal diameter. Results: Mean age was 66.7 years and mean follow-up was 2.6 years.21,87% of patients reported leg pain, 9.37% thigh pain. The group of pacients with leg pain presented with shaft diameter 14.7 mm, length 80 mm in 71.42% and 155 mm in 28,58%, stem diameter/ intramedullary canal diameter average relation of 0,76, 42.8% had stem malalignment. The group without leg pain presented with shaft diameter 15.2 mm, length 80 mm in 68% and 155 mm in 32%, diameters average relation of 0.80, 20.8% had stem malalignment. The group with thigh pain presented with shaft diameter 18.3 mm, length 80 mm in 66.67% and 155 mm in 33,33%,diameters average relation of 0.75, 0% had stem malalignment The group without thigh pain presented with shaft diameter 16.56 mm, length 80 mm in 70.37% and 155 mm in 29,63%, diameters average relation of 0.79, 14,2% had stem malalignment. Conclusion: There was no association between the assessed criteria and pain in the tip of the stem. PMID:27027084

  11. Patient-level improvements in pain and activities of daily living after total knee arthroplasty

    PubMed Central

    Lewallen, David G.

    2014-01-01

    Objective. To study patient-level improvements in pain and limitations of key activities of daily living (ADLs) after primary or revision total knee arthroplasty (TKA). Methods. We analysed prospectively collected data from the Mayo Clinic Total Joint Registry for improvements in index knee pain severity and limitations in three key ADLs (walking, climbing stairs and rising from a chair) from pre-operative to 2 and 5 years post-TKA. Results. The primary TKA cohort consisted of 7229 responders pre-operatively, 7139 at 2 years and 4234 at 5 years post-operatively. The revision TKA cohort consisted of 1206 responders pre-operatively, 1533 at 2 years and 881 at 5 years post-operatively. In the primary TKA cohort, important pain reduction to mild or no knee pain at 2 years was reported by 92% with moderate pre-operative pain and 93% with severe pre-operative pain; respective proportions were 91% and 91% at 5 years follow-up. For revision TKA, respective proportions were 71% and 66% at 2 years and 68% and 74% at 5 years. Three per cent with no/mild pre-operative overall limitation and 19% with moderate/severe pre-operative overall limitation had moderate/severe overall activity limitation 2 years post-operatively; at 5 years the respective proportions were 4% and 22%. Respective proportions for revision TKA were up to 3% and 32% at 2 years and 4% and 34% at 5 years. Conclusion. Our study provides comprehensive data for patient-level improvements in pain and key ADLs. These data can be used to inform patients pre-operatively of expected outcomes, based on pre-operative status, which may further help patients set realistic goals for improvements after TKA. PMID:24162150

  12. Strengthening of the Hip and Core Versus Knee Muscles for the Treatment of Patellofemoral Pain: A Multicenter Randomized Controlled Trial

    PubMed Central

    Ferber, Reed; Bolgla, Lori; Earl-Boehm, Jennifer E.; Emery, Carolyn; Hamstra-Wright, Karrie

    2015-01-01

    Context: Patellofemoral pain (PFP) is the most common injury in running and jumping athletes. Randomized controlled trials suggest that incorporating hip and core strengthening (HIP) with knee-focused rehabilitation (KNEE) improves PFP outcomes. However, no randomized controlled trials have, to our knowledge, directly compared HIP and KNEE programs. Objective: To compare PFP pain, function, hip- and knee-muscle strength, and core endurance between KNEE and HIP protocols after 6 weeks of rehabilitation. We hypothesized greater improvements in (1) pain and function, (2) hip strength and core endurance for patients with PFP involved in the HIP protocol, and (3) knee strength for patients involved in the KNEE protocol. Design: Randomized controlled clinical trial. Setting: Four clinical research laboratories in Calgary, Alberta; Chicago, Illinois; Milwaukee, Wisconsin; and Augusta, Georgia. Patients or Other Participants: Of 721 patients with PFP screened, 199 (27.6%) met the inclusion criteria (66 men [31.2%], 133 women [66.8%], age = 29.0 ± 7.1 years, height = 170.4 ± 9.4 cm, weight = 67.6 ± 13.5 kg). Intervention(s): Patients with PFP were randomly assigned to a 6-week KNEE or HIP protocol. Main Outcome Measure(s): Primary variables were self-reported visual analog scale and Anterior Knee Pain Scale measures, which were conducted weekly. Secondary variables were muscle strength and core endurance measured at baseline and at 6 weeks. Results: Compared with baseline, both the visual analog scale and the Anterior Knee Pain Scale improved for patients with PFP in both the HIP and KNEE protocols (P < .001), but the visual analog scale scores for those in the HIP protocol were reduced 1 week earlier than in the KNEE group. Both groups increased in strength (P < .001), but those in the HIP protocol gained more in hip-abductor (P = .01) and -extensor (P = .01) strength and posterior core endurance (P = .05) compared with the KNEE group. Conclusions: Both the HIP and KNEE

  13. Individuals with incident accelerated knee osteoarthritis have greater pain than those with common knee osteoarthritis progression: data from the Osteoarthritis Initiative.

    PubMed

    Driban, Jeffrey B; Price, Lori Lyn; Eaton, Charles B; Lu, Bing; Lo, Grace H; Lapane, Kate L; McAlindon, Timothy E

    2016-06-01

    We evaluated whether accelerated knee osteoarthritis (AKOA) was associated with greater pain and other outcomes and if outcomes varied over time differently among those with incident AKOA or common knee osteoarthritis (KOA), which we defined as a gradual onset of disease. We conducted longitudinal analyses among participants in the Osteoarthritis Initiative who had no radiographic KOA at baseline (Kellgren-Lawrence [KL] <2). Participants were considered AKOA if ≥1 knees progressed to KL grade ≥3 and common KOA if ≥1 knees increased in radiographic scoring within 48 months. We defined the index visit as the study visit when they met the AKOA or common KOA criteria. Our observation period included up to 3 years before and after the index visit. Our primary outcome was WOMAC pain converted to an ordinal scale: none (pain score = 0/1 out of 20), mild (pain score = 2/3), and moderate-severe pain (pain score >3). We explored 11 other secondary outcome measures. We performed an ordinal logistic regression or linear models with generalized estimating equations. The predictors were group (AKOA or common KOA), time (seven visits), and a group-by-time interaction. Overall, individuals with AKOA (n = 54) had greater pain, functional disability, and global rating scale as well as slower chair-stand and walking pace compared with those with common KOA (n = 187). There was no significant interaction between group and time for knee pain; however, there was for chair-stand pace and global rating scale. In conclusion, AKOA may be a painful and disabling phenotype that warrants more attention by clinicians and researchers. PMID:26614536

  14. Low-tech rehabilitation of bilateral patellofemoral knee pain in a runner: a case study

    PubMed Central

    Stefanick, Gary F

    2004-01-01

    Patellofemoral pain is a common ailment within both the running and general populations. Many of the structures of the anterior knee that comprise the patellofemoral joint can be the source of chronic pain and inflammation that is associated with this condition. Much of the evidence in the literature points to a delay in activation of the vastus medialis oblique muscle as compared to the vastus lateralis, vastus medialis weakness, and ultimately faulty patellar tracking as the chief causative factors in the development of patellofemoral pain. This is a single case study of a 51-year-old recreational runner with an 18-month history of bilateral patellofemoral knee pain. Treatment included the use of low-tech in office rehabilitation strategies known to affect those causative factors responsible for patellofemoral pain. Evidence based treatment modalities were utilized in combination, which included patellar mobilization, spinal manipulation, proprioceptive and strength training, and semi-rigid orthotic use, to effect vastus medialis oblique vs. vastus lateralis activation, vastus medialis strength, and patellar movement. The patient responded very well to a 12 week course of treatment and resumed recreational running with minimal to no pain at the six month, one and two year follow-ups. PMID:17549103

  15. MRI findings of young male soldiers with atraumatic anterior knee pain.

    PubMed

    Kang, S; Park, J; Kang, S-B; Chang, C B

    2016-05-01

    The purpose of this study is to investigate abnormal magnetic resonance image (MRI) findings of young active males with atraumatic anterior knee pain (AKP). Targeting young male soldiers, we prospectively gathered and analyzed 157 knee MRIs from patients with atraumatic AKP (AKP group) and 53 knee MRIs from patients without knee pain (control group). Abnormalities of the patellofemoral (PF) joint and extensor mechanism on MRI were more common in the AKP group than the control group (48% vs 13%, P < 0.001). The overall prevalence of medial plica (34% vs 13%, P = 0.004) and the prevalence of the thick medial plica (9% vs 0%, P = 0.023) were considerably higher in the AKP group. The cartilaginous sulcus angle in the AKP group without abnormalities on MRI was significantly higher than both the AKP group with abnormalities and the control group (145° vs 141° vs 142°, respectively, P = 0.001). Our results suggest that careful assessment of young, active males with atraumatic AKP is warranted regarding PF joint abnormalities, particularly the presence of medial plica and/or subtle abnormalities of the articular geometry. The results from the present study could be used for the management of patients with AKP. PMID:25996828

  16. Trajectories of Pain and Function after Primary Hip and Knee Arthroplasty: The ADAPT Cohort Study

    PubMed Central

    Lenguerrand, Erik; Wylde, Vikki; Gooberman-Hill, Rachael; Sayers, Adrian; Brunton, Luke; Beswick, Andrew D.; Dieppe, Paul; Blom, Ashley W.

    2016-01-01

    Background and Purpose Pain and function improve dramatically in the first three months after hip and knee arthroplasty but the trajectory after three months is less well described. It is also unclear how pre-operative pain and function influence short- and long-term recovery. We explored the trajectory of change in function and pain until and beyond 3-months post-operatively and the influence of pre-operative self-reported symptoms. Methods The study was a prospective cohort study of 164 patients undergoing primary hip (n = 80) or knee (n = 84) arthroplasty in the United Kingdom. Self-reported measures of pain and function using the Western Ontario and McMaster Universities Osteoarthritis index were collected pre-operatively and at 3 and 12 months post-operatively. Hip and knee arthroplasties were analysed separately, and patients were split into two groups: those with high or low symptoms pre-operatively. Multilevel regression models were used for each outcome (pain and function), and the trajectories of change were charted (0–3 months and 3–12 months). Results Hip: Most improvement occurred within the first 3 months following hip surgery and patients with worse pre-operative scores had greater changes. The mean changes observed between 3 and twelve months were statistically insignificant. One year after surgery, patients with worse pre-operative scores had post-operative outcomes similar to those observed among patients with less severe pre-operative symptoms. Knee: Most improvement occurred in the first 3 months following knee surgery with no significant change thereafter. Despite greater mean change during the first three months, patients with worse pre-operative scores had not ‘caught-up’ with those with less severe pre-operative symptoms 12 months after their surgery. Conclusion Most symptomatic improvement occurred within the first 3 months after surgery with no significant change between 3–12 months. Further investigations are now required to

  17. The fabella syndrome - a rare cause of posterolateral knee pain: a review of the literature and two case reports

    PubMed Central

    2014-01-01

    Background The purpose of this article was to evaluate the risks and benefits of non-operative treatment versus surgical excision of a fabella causing posterolateral knee pain. We performed a systematic review of literature and also present two case reports. Twelve publications were found in a PubMed literature review searching the word “fabella syndrome”. Non-operative treatment and surgical excision of the fabella has been described. Case presentation Two patients presented to our outpatient clinic with persisting posterolateral knee pain. In both cases the presence of a fabella was identified, located in close proximity to the posterolateral femoral condyle. All other common causes of intra- and extra articular pathologies possibly causing the posterolateral knee pain were excluded. Following failure to respond to physiotherapy both patients underwent arthroscopy which excluded other possible causes for posterolateral knee pain. The decision was made to undertake surgical excision of the fabella in both cases without complication. Both patients were examined 6 month and one year after surgery with the Tegner activity score, the Visual Analogue Scale (VAS), and International Knee Documentation Committee Score (IKDC). Conclusion Consistent posterolateral pain during exercise might indicate the presence of a fabella syndrome. Resecting the fabella can be indicated and is a minor surgical procedure with minimal risk. Despite good results in the literature posterolateral knee pain can persist and prevent return to a high level of sports. Level of evidence: IV, case reports and analysis of literature. PMID:24666711

  18. Multivariate Radiological-Based Models for the Prediction of Future Knee Pain: Data from the OAI

    PubMed Central

    Galván-Tejada, Jorge I.; Celaya-Padilla, José M.; Treviño, Victor; Tamez-Peña, José G.

    2015-01-01

    In this work, the potential of X-ray based multivariate prognostic models to predict the onset of chronic knee pain is presented. Using X-rays quantitative image assessments of joint-space-width (JSW) and paired semiquantitative central X-ray scores from the Osteoarthritis Initiative (OAI), a case-control study is presented. The pain assessments of the right knee at the baseline and the 60-month visits were used to screen for case/control subjects. Scores were analyzed at the time of pain incidence (T-0), the year prior incidence (T-1), and two years before pain incidence (T-2). Multivariate models were created by a cross validated elastic-net regularized generalized linear models feature selection tool. Univariate differences between cases and controls were reported by AUC, C-statistics, and ODDs ratios. Univariate analysis indicated that the medial osteophytes were significantly more prevalent in cases than controls: C-stat 0.62, 0.62, and 0.61, at T-0, T-1, and T-2, respectively. The multivariate JSW models significantly predicted pain: AUC = 0.695, 0.623, and 0.620, at T-0, T-1, and T-2, respectively. Semiquantitative multivariate models predicted paint with C-stat = 0.671, 0.648, and 0.645 at T-0, T-1, and T-2, respectively. Multivariate models derived from plain X-ray radiography assessments may be used to predict subjects that are at risk of developing knee pain. PMID:26504490

  19. Does patella resurfacing really matter? Pain and function in 972 patients after primary total knee arthroplasty

    PubMed Central

    Espehaug, Birgitte; Havelin, Leif Ivar; Vollset, Stein Emil; Furnes, Ove

    2010-01-01

    Background and purpose Resurfacing of the patella during primary total knee arthroplasty (TKA) is often recommended based on higher revision rates in non-resurfaced knees. As many of these revisions are insertions of a patella component due to pain, and since only patients with a non-resurfaced patella have the option of secondary resurfacing, we do not really know whether these patients have more pain and poorer function. The main purpose of the present paper was therefore to assess pain and function at least 2 years after surgery for unrevised primary non-resurfaced and resurfaced TKA, and secondary among prosthesis brands. Methods Information needed to calculate subscales from the knee injury and osteoarthritis outcome score (KOOS) was collected in a questionnaire given to 972 osteoarthritis patients with intact primary TKAs that had been reported to the Norwegian Arthroplasty Register. Pain and satisfaction on visual analog scales and improvement in EQ-5D index score ΔEQ-5D) were also used as outcomes. Outcomes were measured on a scale from 0 to 100 units (worst to best). To estimate differences in mean scores, we used multiple linear regression with adjustment for possible confounders. Results We did not observe any differences between resurfacing and non-resurfacing in any outcome, with estimated differences of ≤ 1.4 units and p-values of > 0.4. There was, however, a tendency of better results for the NexGen implant as compared to the reference brand AGC for symptoms (difference = 4.9, p = 0.05), pain (VAS) (difference = 8.3, p = 0.004), and satisfaction (VAS) (difference = 7.9, p = 0.02). However, none of these differences reached the stated level of minimal perceptible clinical difference. Interpretation Resurfacing of the patella has no clinical effect on pain and function after TKA. Differences between the brands investigated were small and they were assumed to be of minor importance. PMID:20158405

  20. Knee Injuries and Disorders

    MedlinePlus

    Your knee joint is made up of bone, cartilage, ligaments and fluid. Muscles and tendons help the knee joint move. When any of these structures is hurt or diseased, you have knee problems. Knee problems can cause pain and difficulty ...

  1. Evidence for a central mode of action for etoricoxib (COX-2 inhibitor) in patients with painful knee osteoarthritis.

    PubMed

    Arendt-Nielsen, Lars; Egsgaard, Line Lindhardt; Petersen, Kristian Kjær

    2016-08-01

    The COX-2 inhibitor etoricoxib modulates the peripheral and central nociceptive mechanisms in animals. This interaction has not been studied in patients with pain. This randomized, double-blind, placebo-controlled, 2-way crossover, 4-week treatment study investigated the pain mechanisms modulated by etoricoxib in patients with painful knee osteoarthritis. Patients were randomized to group A (60 mg/d etoricoxib followed by placebo) or B (placebo followed by 60 mg/d etoricoxib). The quantitative, mechanistic pain biomarkers were pressure pain thresholds, temporal summation (TS), and conditioning pain modulation. Clinical readouts were Brief Pain Inventory, WOMAC, painDETECT questionnaire (PD-Q), and time and pain intensity during walking and stair climbing. Etoricoxib as compared with placebo significantly modulated the pressure pain thresholds (P = 0.012, localized sensitization) at the knee and leg (control site) (P = 0.025, spreading sensitization) and TS assessed from the knee (P = 0.038) and leg (P = 0.045). Conditioning pain modulation was not modulated. The Brief Pain Inventory (pain scores), PD-Q, WOMAC, and walking and stair climbing tests were all significantly improved by etoricoxib. Based on a minimum of 30% or 50% pain alleviation (day 0-day 28), responders and nonresponders were defined. The nonresponders showed a significant association between increased facilitation of TS and increased pain alleviation. None of the other parameters predicted the degree of pain alleviation. Generally, a responder to etoricoxib has the most facilitated TS. In conclusion, etoricoxib (1) modulated central pain modulatory mechanisms and (2) improved pain and function in painful osteoarthritis. Stronger facilitation of TS may indicate a better response to etoricoxib, supporting the central mode-of-action of the drug. PMID:27007068

  2. Web-Based Study of Risk Factors for Pain Exacerbation in Osteoarthritis of the Knee (SPARK-Web): Design and Rationale

    PubMed Central

    Metcalf, Ben; Zhang, Yuqing; Bennell, Kim; March, Lyn; Hunter, David J

    2015-01-01

    Background Knee osteoarthritis (OA) is the most frequent cause of limited mobility and diminished quality of life. Pain is the main symptom that drives individuals with knee OA to seek medical care and a recognized antecedent to disability and eventually joint replacement. Many persons with symptomatic knee OA experience recurrent pain exacerbations. Knowledge and clarification of risk factors for pain exacerbation may allow those affected to minimize reoccurrence of these episodes. Objective The aim of this study is to use a Web-based case-crossover design to identify risk factors for knee pain exacerbations in persons with symptomatic knee OA. Methods Web-based case-crossover design is used to study persons with symptomatic knee OA. Participants with knee pain and radiographic knee OA will be recruited and followed for 90 days. Participants will complete an online questionnaire at the baseline and every 10 days thereafter (totaling up to 10 control-period questionnaires); participants will also be asked to report online when they experience an episode of increased knee pain. Pain exacerbation will be defined as an increase in knee pain severity of two points from baseline on a numeric rating scale (NRS 0-10). Physical activity, footwear, knee injury, medication use, climate, psychological factors, and their possible interactions will be assessed as potential triggers for pain exacerbation using conditional logistic regression models. Results This project has been funded by the National Health and Medical Research Council (NHMRC). The enrollment for the study has started. So far, 343 participants have been enrolled. The study is expected to be finished in October 2015. Conclusions This study will identify risk factors for pain exacerbations in knee OA. The identification and possible modification/elimination of such risk factors will help to prevent the reoccurrence of pain exacerbation episodes and therefore improve knee OA management. PMID:26156210

  3. Knee joint replacement - series (image)

    MedlinePlus

    ... than 3 blocks because of knee pain Loose knee prosthesis Some knee fractures ... an incision over the affected knee. The patella (knee cap) is moved ... helps the prosthesis to adhere better. The two parts of the ...

  4. The impact of including corticosteroid in a periarticular injection for pain control after total knee arthroplasty

    PubMed Central

    Tsukada, S.; Wakui, M.; Hoshino, A.

    2016-01-01

    There is conflicting evidence about the benefit of using corticosteroid in periarticular injections for pain relief after total knee arthroplasty (TKA). We carried out a double-blinded, randomised controlled trial to assess the efficacy of using corticosteroid in a periarticular injection to control pain after TKA. A total of 77 patients, 67 women and ten men, with a mean age of 74 years (47 to 88) who were about to undergo unilateral TKA were randomly assigned to have a periarticular injection with or without corticosteroid. The primary outcome was post-operative pain at rest during the first 24 hours after surgery, measured every two hours using a visual analogue pain scale score. The cumulative pain score was quantified using the area under the curve. The corticosteroid group had a significantly lower cumulative pain score than the no-corticosteroid group during the first 24 hours after surgery (mean area under the curve 139, 0 to 560, and 264, 0 to 1460; p = 0.024). The rate of complications, including surgical site infection, was not significantly different between the two groups up to one year post-operatively. The addition of corticosteroid to the periarticular injection significantly decreased early post-operative pain. Further studies are needed to confirm the safety of corticosteroid in periarticular injection. Take home message: The use of corticosteroid in periarticular injection offered better pain relief during the initial 24 hours after TKA. Cite this article: Bone Joint J 2016;98-B:194–200. PMID:26850424

  5. Reduced Maximal Force during Acute Anterior Knee Pain Is Associated with Deficits in Voluntary Muscle Activation

    PubMed Central

    Salomoni, Sauro; Tucker, Kylie; Hug, François; McPhee, Megan; Hodges, Paul

    2016-01-01

    Although maximal voluntary contraction (MVC) force is reduced during pain, studies using interpolated twitch show no consistent reduction of voluntary muscle drive. The present study aimed to test if the reduction in MVC force during acute experimental pain could be explained by increased activation of antagonist muscles, weak voluntary activation at baseline, or changes in force direction. Twenty-two healthy volunteers performed maximal voluntary isometric knee extensions before, during, and after the effects of hypertonic (pain) and isotonic (control) saline injections into the infrapatellar fat pad. The MVC force, voluntary activation, electromyographic (EMG) activity of agonist, antagonist, and auxiliary (hip) muscles, and pain cognition and anxiety scores were recorded. MVC force was 9.3% lower during pain than baseline (p < 0.001), but there was no systematic change in voluntary activation. Reduced MVC force during pain was variable between participants (SD: 14%), and was correlated with reduced voluntary activation (r = 0.90), baseline voluntary activation (r = − 0.62), and reduced EMG amplitude of agonist and antagonist muscles (all r > 0.52), but not with changes in force direction, pain or anxiety scores. Hence, reduced MVC force during acute pain was mainly explained by deficits in maximal voluntary drive. PMID:27559737

  6. New and Common Perioperative Pain Management Techniques in Total Knee Arthroplasty.

    PubMed

    Elmallah, Randa K; Cherian, Jeffrey J; Pierce, Todd P; Jauregui, Julio J; Harwin, Steven F; Mont, Michael A

    2016-02-01

    Optimal pain control in patients undergoing total knee arthroplasty (TKA) is imperative for good rehabilitation and functional outcomes. However, despite technological advancements, surgeons continue to struggle with adequate pain management in their patients. Current modalities in use, such as patient-controlled analgesia, opioids, and epidural anesthetics, provide good pain relief but can be associated with side effects and serious complications. As a result, newer pain control modalities have been used to try to reduce the use of opioids while providing adequate pain relief. Currently, there are no clear guidelines or evidence for an optimum postoperative TKA analgesic regimen. Our aim was to evaluate the recent literature and provide a summary of the newer perioperative analgesic modalities. Evidence suggests that analgesics, such as newer oral medications, peripheral nerve blocks, and periarticular injections, may improve pain management, rehabilitation, and patient satisfaction, as well as reduce opioid consumption. The literature has also highlighted that a multimodal approach to pain management may provide the best results. However, determining which modalities provide superior pain control is still being extensively studied, and further research is needed. PMID:25892004

  7. Knee pain and osteoarthritis in older adults: a review of community burden and current use of primary health care

    PubMed Central

    Peat, G; McCarney, R; Croft, P

    2001-01-01

    BACKGROUND—Osteoarthritis is the single most common cause of disability in older adults, and most patients with the condition will be managed in the community and primary care.
AIM—To discuss case definition of knee osteoarthritis for primary care and to summarise the burden of the condition in the community and related use of primary health care in the United Kingdom.
DESIGN—Narrative review.
METHOD—A literature search identified studies of incidence and prevalence of knee pain, disability, and radiographic osteoarthritis in the general population, and data related to primary care consultations. Findings from UK studies were summarised with reference to European and international studies.
RESULTS—During a one year period 25% of people over 55 years have a persistent episode of knee pain, of whom about one in six in the UK and the Netherlands consult their general practitioner about it in the same time period. The prevalence of painful disabling knee osteoarthritis in people over 55 years is 10%, of whom one quarter are severely disabled.
CONCLUSION—Knee osteoarthritis sufficiently severe to consider joint replacement represents a minority of all knee pain and disability suffered by older people. Healthcare provision in primary care needs to focus on this broader group to impact on community levels of pain and disability.

 PMID:11156538

  8. Does anterior knee pain severity and function relate to the frontal plane projection angle and trunk and hip strength in women with patellofemoral pain?

    PubMed

    Almeida, Gabriel Peixoto Leão; Carvalho E Silva, Ana Paula de Moura Campos; França, Fábio Jorge Renovato; Magalhães, Maurício Oliveira; Burke, Thomaz Nogueira; Marques, Amélia Pasqual

    2015-07-01

    The aim of the present study was to determine the relationship between knee pain severity and function with the frontal plane projection angle (FPPA) and trunk and hip peak torque (PT) in women with patellofemoral pain (PFPS). Twenty-two women with PFPS were assessed. Knee pain severity (KPS) was assessed with an 11-point visual analog scale and function with an Anterior Knee Pain Scale. The FPPA was recorded with a digital camera. PT of extensors, abductors, and the lateral rotators of hip and lateral core stability were measured with a handheld dynamometer. FPPA was the only predictor for the KPS. Regarding predictors of function, PT of lateral core stability and the extensor and abductor of the hip explained 41.4% of the function. Increase in FPPA was associated with greater KPS, and the lowest PT of lateral core stability, hip abductors, and extensors was associated with lower function in women with PFPS. PMID:26118529

  9. The effect of music on pain and acute confusion in older adults undergoing hip and knee surgery.

    PubMed

    McCaffrey, Ruth; Locsin, Rozzano

    2006-01-01

    The purpose of this study was to examine the effects of music listening in older adults following hip or knee surgery. Acute confusion and pain after surgery can increase length of stay and reduce function. Study results demonstrate a reduction in acute confusion and pain and improved ambulation and higher satisfaction scores in older adults who listened to music. PMID:16974175

  10. Exercise in children with joint hypermobility syndrome and knee pain: a randomised controlled trial comparing exercise into hypermobile versus neutral knee extension

    PubMed Central

    2013-01-01

    Background Knee pain in children with Joint Hypermobility Syndrome (JHS) is traditionally managed with exercise, however the supporting evidence for this is scarce. No trial has previously examined whether exercising to neutral or into the hypermobile range affects outcomes. This study aimed to (i) determine if a physiotherapist-prescribed exercise programme focused on knee joint strength and control is effective in reducing knee pain in children with JHS compared to no treatment, and (ii) whether the range in which these exercises are performed affects outcomes. Methods A prospective, parallel-group, randomised controlled trial conducted in a tertiary hospital in Sydney, Australia compared an 8 week exercise programme performed into either the full hypermobile range or only to neutral knee extension, following a minimum 2 week baseline period without treatment. Randomisation was computer-generated, with allocation concealed by sequentially numbered opaque sealed envelopes. Knee pain was the primary outcome. Quality of life, thigh muscle strength, and function were also measured at (i) initial assessment, (ii) following the baseline period and (iii) post treatment. Assessors were blinded to the participants’ treatment allocation and participants blinded to the difference in the treatments. Results Children with JHS and knee pain (n=26) aged 7-16 years were randomly assigned to the hypermobile (n=12) or neutral (n=14) treatment group. Significant improvements in child-reported maximal knee pain were found following treatment, regardless of group allocation with a mean 14.5 mm reduction on the visual analogue scale (95% CI 5.2 – 23.8 mm, p=0.003). Significant differences between treatment groups were noted for parent-reported overall psychosocial health (p=0.009), specifically self-esteem (p=0.034), mental health (p=0.001) and behaviour (p=0.019), in favour of exercising into the hypermobile range (n=11) compared to neutral only (n=14). Conversely, parent

  11. Inferomedial or Inferolateral Intra-articular Injections of the Knee to Minimize Pain Intensity.

    PubMed

    Pierce, Todd P; Elmallah, Randa K; Jauregui, Julio J; Cherian, Jeffrey J; Harwin, Steven F; Mont, Michael A

    2016-05-01

    Pain levels of 3 knee intra-articular corticosteroid injection sites were assessed to determine if an optimal site exists. Patients were stratified by site, demographic, and disease characteristics. All injections were performed by 1 surgeon using a uniform technique. Pain severity was assessed before, 1 minute after, and 5 minutes after injection using a visual analog scale. Mean visual analog scale scores for the lateral suprapatellar, medial infrapatellar, and lateral infrapatellar injection sites were 7, 4, and 2 points, respectively, but this was not statistically significant. These results suggest intra-articular injections should be administered from an inferomedial or inferolateral site to minimize pain intensity. [Orthopedics. 2016; 39(3):e578-e581.]. PMID:27064778

  12. The Associations between Pain Sensitivity and Knee Muscle Strength in Healthy Volunteers: A Cross-Sectional Study

    PubMed Central

    Graven-Nielsen, Thomas; Bliddal, Henning

    2013-01-01

    Objectives. To investigate associations between muscle strength and pain sensitivity among healthy volunteers and associations between different pain sensitivity measures. Methods. Twenty-eight healthy volunteers (21 females) participated. Pressure pain thresholds (PPTs) were obtained from 1) computer-controlled pressure algometry on the vastus lateralis and deltoid muscles and on the infrapatellar fat pad and 2) computerized cuff pressure algometry applied on the lower leg. Deep-tissue pain sensitivity (intensity and duration) was assessed by hypertonic saline injections into the vastus lateralis, deltoid, and infrapatellar fat pad. Quadriceps and hamstring muscle strength was assessed isometrically at 60-degree knee flexion using a dynamometer. Associations between pain sensitivity and muscle strength were investigated using multiple regressions including age, gender, and body mass index as covariates. Results. Knee extension strength was associated with computer-controlled PPT on the vastus lateralis muscle. Computer-controlled PPTs were significantly correlated between sites (r > 0.72) and with cuff PPT (r > 0.4). Saline induced pain intensity and duration were correlated between sites (r > 0.39) and with all PPTs (r < −0.41). Conclusions. Pressure pain thresholds at the vastus lateralis are positively associated with knee extensor muscle strength. Different pain sensitivity assessment methods are generally correlated. The cuff PPT and evoked infrapatellar pain seem to reflect the general pain sensitivity. This trial is registered with ClinicalTrials.gov: NCT01351558. PMID:24167727

  13. Knee Replacement

    MedlinePlus

    ... doctor may recommend it if you have knee pain and medicine and other treatments are not helping you anymore. When you have a total knee replacement, the surgeon removes damaged cartilage and bone ...

  14. A COMPARISON OF TWO TAPING TECHNIQUES (KINESIO AND MCCONNELL) AND THEIR EFFECT ON ANTERIOR KNEE PAIN DURING FUNCTIONAL ACTIVITIES

    PubMed Central

    Babu, Jenie; Dmochowska, Katarzyna; Scariah, Shiju; Varughese, Jincy

    2013-01-01

    Background: Anterior knee pain is a clinical syndrome characterized by pain experienced perceived over the anterior aspect of the knee that can be aggravated by functional activities such as stair climbing and squatting. Two taping techniques commonly used for anterior knee pain in the clinic include the McConnell Taping Technique (MT) and the Kinesio Taping® Method (KT®). Objective: The purpose of this study was to compare the effectiveness of KT® and the MT versus no tape in subjects with anterior knee pain during a squat lift and stair climbing. Design: Pretest‐ posttest design. Participants: A total of 20 subjects (15 female, 5 male) with unilateral anterior knee pain were recruited. The mean age of the subjects was 24 (+/–3) years, with a mean weight of 160 (+/–28) pounds. Methods: Each participant was tested during two functional activities; a squat lift with a weighted box (10% of his/her body weight, plus the weight [8.5 pounds] of the box) and stair climbing under three conditions: 1) no tape, 2) MT and 3) KT®. Pain levels were assessed (verbally) using the 0‐10 Numeric Pain Intensity Scale. Results: The median (interquartile range [IQR]) pain during squat lift was 2 (2.75) for no tape, 1 (1) for KT®, and 0.5 (2) for McConnell, with no significant differences between the groups. During the stair activity the median (IQR) pain was 1.5 (2.75) for no tape, 1 (1.75) for KT®, and 1 (1.75) for MT with a significant difference (p=0.024) between the groups. Further analysis determined that the only a significant difference was (p=0.034) between the no tape and the KT® conditions. Conclusion: The results of this study found that both the KT® and the MT may be effective in reducing pain during stair climbing activities. Level of Evidence: Level 2, Prospective Cohort study PMID:23593548

  15. EULAR report on the use of ultrasonography in painful knee osteoarthritis. Part 1: Prevalence of inflammation in osteoarthritis

    PubMed Central

    D'Agostino, M; Conaghan, P; Le Bars, M; Baron, G; Grassi, W; Martin-Mola, E; Wakefield, R; Brasseur, J; So, A; Backhaus, M; Malaise, M; Burmester, G; Schmidely, N; Ravaud, P; Dougados, M; Emery, P

    2005-01-01

    Objectives: To assess the prevalence of inflammation in subjects with chronic painful knee osteoarthritis (OA), as determined by the presence of synovitis or joint effusion at ultrasonography (US); and to evaluate the correlation between synovitis, effusion, and clinical parameters. Methods: A cross sectional, multicentre, European study was conducted under the umbrella of EULAR-ESCISIT. Subjects had primary chronic knee OA (ACR criteria) with pain during physical activity ⩾30 mm for at least 48 hours. Clinical parameters were collected by a rheumatologist and an US examination of the painful knee was performed by a radiologist or rheumatologist within 72 hours of the clinical examination. Ultrasonographic synovitis was defined as synovial thickness ⩾4 mm and diffuse or nodular appearance, and a joint effusion was defined as effusion depth ⩾4 mm. Results: 600 patients with painful knee OA were analysed. At US 16 (2.7%) had synovitis alone, 85 (14.2%) had both synovitis and effusion, 177 (29.5%) had joint effusion alone, and 322 (53.7%) had no inflammation according to the definitions employed. Multivariate analysis showed that inflammation seen by US correlated statistically with advanced radiographic disease (Kellgren-Lawrence grade ⩾3; odds ratio (OR) = 2.20 and 1.91 for synovitis and joint effusion, respectively), and with clinical signs and symptoms suggestive of an inflammatory "flare", such as joint effusion on clinical examination (OR = 1.97 and 2.70 for synovitis and joint effusion, respectively) or sudden aggravation of knee pain (OR = 1.77 for joint effusion). Conclusion: US can detect synovial inflammation and effusion in painful knee OA, which correlate significantly with knee synovitis, effusion, and clinical parameters suggestive of an inflammatory "flare". PMID:15878903

  16. De Novo Cerebral Palsy Diagnosis in 9-Year-Old Soccer Player Presenting With Knee Pain.

    PubMed

    Ouellet, Jérôme; Jevremovic, Tatiana

    2016-01-01

    A 9-year-old boy presented to our outpatient specialized sport and exercise medicine clinic complaining of a subacute onset of unilateral knee pain, after an increased level of soccer training. His knee examination was unremarkable. However, he demonstrated significant tenderness on palpation of his ipsilateral hip flexor and adductor tendons. Abnormalities in muscle tone and difficulty in relaxing and resisting the examiner properly were noted and lead to a complete neurological examination. It demonstrated multiple abnormalities such as increased tone and deep tendon reflexes, greater in lower than upper extremities, and abnormal patterning. A mild form of spastic diplegia was suspected and the patient was referred to a pediatric neurologist who confirmed our initial diagnosis. This case draws attention to the importance of maintaining a high level of suspicion for milder forms of diseases that can go unnoticed for years. PMID:25831409

  17. Does pre-surgical central modulation of pain influence outcome after total knee replacement? A systematic review.

    PubMed

    Baert, I A C; Lluch, E; Mulder, T; Nijs, J; Noten, S; Meeus, M

    2016-02-01

    The aim of this study is to systematically review whether the presence of altered central pain modulation pre-surgical influences outcome after total knee replacement (TKR) in patients with knee osteoarthritis (OA), and if so which indices of central pain modulation predict poor outcome after TKR. To identify relevant articles, PubMed and Web of Science were searched. The search strategy was a combination of key words related to "Knee Osteoarthritis and Total Knee Replacement", "Central Pain Modulation" and "Post-Surgical Outcome Measures". Articles fulfilling the inclusion criteria were screened for methodological quality and results were analyzed and summarized. Sixteen prospective cohort studies were included. Strong evidence is available that presence of catastrophic thinking and poor coping strategies predict more pain after TKR and that there is no association between fear of movement and post-surgical pain or function. Evidence on other psychosocial influences is limited or conflicting. Literature on the influence of other signs of altered central pain modulation on post-surgical outcome is scarce. It is plausible that pre-surgical signs of altered central pain modulation, such as joint pain at rest or widespread pain sensitization, predict more post-surgical pain. Surgeons should be attentive for patients with signs of altered central pain modulation before surgery as they might be at risk for unfavorable outcome. A broader therapeutic approach aiming to desensitize the central nervous system can be adapted in these patients. Further research is however needed to identify the influence of central pain modulation pre-surgical in predicting outcome after TKR. PMID:26382109

  18. PAIN MANAGEMENT AFTER TOTAL KNEE ARTHROPLASTY: THE GOOD, THE BAD AND THE UGLY.

    PubMed

    Spinarelli, A; Moretti, L; Marella, G; Solarino, G; Maccagnano, G; Moretti, B

    2015-01-01

    Improvement in pain management after knee replacement surgery has made progress in the last years, improving the results of this type of operation. Among these techniques, multimodal have shown the best results. In this study we try to compare the results of a combination of intravenous analgesia (IA), oral controlled analgesia (OCA) and periarticular injection (PAI) with our traditional protocol consisting in intravenous analgesia and femoral nerve block (IA/FNB). ne-hundred patients, undergoing primary unilateral total knee arthroplasty between June 2014 and June 2015 were randomized into 2 groups. Mean patient age was 69.4. The first group received the intravenous analgesia combined with continuous femoral nerve block, while the second group received the new combined protocol. We used the same technique with standard medial parapatellar approach for all patients and they all received pre-emptive analgesia and postoperative pain protocols. All patients were interviewed daily postoperatively at 3 days, at discharge and at 3 months. The 2 groups had a similar discharge period (traditional group 7.3 days, combined group 6.9 days). In both groups, the results indicated no statistical difference in regards to rest and continuous passive movement. Pain on ambulation was the only category that was statistically lower in the PAI/IA/OCA group compared to traditional group. PMID:26652499

  19. Transcatheter Arterial Embolization as a Treatment for Medial Knee Pain in Patients with Mild to Moderate Osteoarthritis

    SciTech Connect

    Okuno, Yuji; Korchi, Amine Mohamed; Shinjo, Takuma; Kato, Shojiro

    2015-04-15

    PurposeOsteoarthritis is a common cause of pain and disability. Mild to moderate knee osteoarthritis that is resistant to nonsurgical options and not severe enough to warrant joint replacement represents a challenge in its management. On the basis of the hypothesis that neovessels and accompanying nerves are possible sources of pain, previous work demonstrated that transcatheter arterial embolization for chronic painful conditions resulted in excellent pain relief. We hypothesized that transcatheter arterial embolization can relieve pain associated with knee osteoarthritis.MethodsTranscatheter arterial embolization for mild to moderate knee osteoarthritis using imipenem/cilastatin sodium or 75 μm calibrated Embozene microspheres as an embolic agent has been performed in 11 and three patients, respectively. We assessed adverse events and changes in Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scores.ResultsAbnormal neovessels were identified within soft tissue surrounding knee joint in all cases by arteriography. No major adverse events were related to the procedures. Transcatheter arterial embolization rapidly improved WOMAC pain scores from 12.2 ± 1.9 to 3.3 ± 2.1 at 1 month after the procedure, with further improvement at 4 months (1.7 ± 2.2) and WOMAC total scores from 47.3 ± 5.8 to 11.6 ± 5.4 at 1 month, and to 6.3 ± 6.0 at 4 months. These improvements were maintained in most cases at the final follow-up examination at a mean of 12 ± 5 months (range 4–19 months).ConclusionTranscatheter arterial embolization for mild to moderate knee osteoarthritis was feasible, rapidly relieved resistant pain, and restored knee function.

  20. The use of gabapentin in the management of postoperative pain after total knee arthroplasty

    PubMed Central

    Han, Chao; Li, Xiao-dan; Jiang, Hong-qiang; Ma, Jian-xiong; Ma, Xin-long

    2016-01-01

    Abstract Pain management after total knee arthroplasty (TKA) varies and has been widely studied in recent years. Some randomized controlled studies have carried out to evaluate the effects of gabapentin on pain relief after TKA. However, no solid result was made about it. The purpose of this Meta-Analysis of Randomized Controlled Trials (RCTs) was to estimate the overall effect of pain control of gabapentin versus placebo after a TKA. An electronic-based search using the following databases: PubMed, EMBASE, Ovid MEDLINE, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trial from 1966 to June 2015. RCTs involving gabapentin and placebo for total knee arthroplasty were included. The meta-analysis was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Six trials with 859 participants met the inclusion criteria. The primary endpoint was cumulative narcotic consumption and the visual analog scale scores at 12 hours, 24 hours, and 48 hours, postoperatively. The knee flexion degree and treatment side effects were also compiled to evaluate the safety of gabapentin. After testing for the heterogeneity and publication bias among studies, data were aggregated for random-effects modeling when necessary. There was a significant decrease in morphine consumption at 12 hours (MD = –4.69, 95% CI: −7.18 to –2.21, P = 0.0002), 24 hours (MD = –5.30, 95% CI: −9.94 to –0.66, P = 0.03), and 48 hours (MD = –17.80, 95% CI: −31.95 to –3.64, P = 0.01), respectively. Compared with the control group, the rate of pruritus was less in the gabapentin group (RR 0.20, 95% CI 0.10 to 0.38, P = 0.00). In summary, the administration of gabapentin was effective in decreasing postoperative narcotic consumption and the incidence of pruritus. There was a high risk of selection bias and a higher heterogeneity of knee flexion range in this analysis. More high-quality large randomized controlled

  1. The effects of various physical non-operative modalities on the pain in osteoarthritis of the knee.

    PubMed

    Cherian, J J; Jauregui, J J; Leichliter, A K; Elmallah, R K; Bhave, A; Mont, M A

    2016-01-01

    The purpose of this study was to evaluate the effect of various non-operative modalities of treatment (transcutaneous electrical nerve stimulation (TENS); neuromuscular electrical stimulation (NMES); insoles and bracing) on the pain of osteoarthritis (OA) of the knee. We conducted a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify the therapeutic options which are commonly adopted for the management of osteoarthritis (OA) of the knee. The outcome measurement tools used in the different studies were the visual analogue scale and The Western Ontario and McMaster Universities Arthritis Index pain index: all pain scores were converted to a 100-point scale. A total of 30 studies met our inclusion criteria: 13 on insoles, seven on TENS, six on NMES, and four on bracing. The standardised mean difference (SMD) in pain after treatment with TENS was 1.796, which represented a significant reduction in pain. The significant overall effect estimate for NMES on pain was similar to that of TENS, with a SMD of 1.924. The overall effect estimate of insoles on pain was a SMD of 0.992. The overall effect of bracing showed a significant reduction in pain of 1.34. Overall, all four non-operative modalities of treatment were found to have a significant effect on the reduction of pain in OA of the knee. This study shows that non-operative physical modalities of treatment are of benefit when treating OA of the knee. However, much of the literature reviewed evaluates studies with follow-up of less than six months: future work should aim to evaluate patients with longer follow-up. PMID:26733650

  2. Knee pain

    MedlinePlus

    ... in the back of your thigh (hamstrings). Avoid running down hills -- walk down instead. Bicycle, or better ... inserts and arch supports (orthotics). Make sure your running shoes are well made, fit well, and have ...

  3. An 11-year-old girl presenting with chronic knee pain: a case report with diagnostic dilemma.

    PubMed

    Maj, M Kamal; Ar, Abdul Halim; Faisal, Syed A; Ahmad, Johan; Das, Srijit

    2010-01-01

    Discoid meniscus is the commonest anatomical aberration of the knee joint, among rare cases such as bilateral separated lateral meniscus, accessory lateral meniscus, partial deficiency of the lateral meniscus and double-layered lateral meniscus. An 11-year-old girl presented with history of chronic pain in her right knee for the last 6 months. The problem disturbed her involvement in the sport activities at school. Clinical examination revealed a clicking sensation on knee extension with lateral joint line tenderness. Magnetic resonance imaging (MRI) of her right knee showed torn posterior horn of lateral meniscus. Arthroscopy examination revealed a discoid meniscus with absence posterior horn. Posterior horn deficient discoid meniscus is a rare form of a congenital meniscus anomaly. We as clinicians believe that the abnormal shaped meniscus may pose a diagnostic challenge clinically and radiologically. Presentation of this case may be beneficial for orthopaedicians in their daily clinical practice. PMID:21400986

  4. Unexplained Pain Following Total Knee Arthroplasty – Is Rotational Malalignment the Problem?

    PubMed Central

    Young, Simon; Roberts, Catherine; Bauman, Alicia; Sperlak, Cynthia; Spangehl, Mark; Clarke, Henry

    2016-01-01

    Objective: Malrotation of both tibial and femoral components has been suggested as a potential source of pain following total knee arthroplasty (TKA). However previous studies have been small, with variable control groups. The aim of this study was to compare component rotational alignment in TKA patients with unexplained pain to a control group with well-functioning TKA. Method: Seventy-one patients presenting with unexplained pain following primary TKA were included in this retrospective, comparative study. Diagnostic work-up included clinical examination, blood tests, x-rays, long-leg films, and CT scan. Patients with an identifiable diagnosis or with initially well-functioning TKAs were excluded. A control group of 41 patients with well-functioning TKAs also underwent CT scans. Femoral component rotation was measured relative to the surgical epicondylar axis, and tibial component rotation relative to the medial third of the tibial tubercle using a previously validated method involving 3D-image reconstruction. Findings were compared between painful and control TKA groups. Results: We found no difference in femoral component rotation between the painful and control groups (mean 0.6° vs 1.0° external rotation (ER), p=0.4), and no difference in tibial component rotation (mean 11.2° vs 9.5° internal rotation(IR), p=0.3). Fifty-nine percent of patients in the painful group had tibial component rotation >9°IR versus 49% in the control group. 6% of patients in the painful group and 2% in the control group had femoral component rotation >3°IR. There was no difference in overall coronal alignment between groups (mean 1.3° varus vs 0.5° varus, p=0.23). Conclusion: In this the largest study yet reported on component rotation in TKA, we found no difference in the incidence of tibial or femoral component malalignment in painful versus well-functioning TKAs. Tibial component IR in particular appears to be a common finding, and its significance when evaluating the

  5. Low Vitamin D levels are associated with greater pain and slow walking speed in patients with knee osteoarthritis (KOA)

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The clinical status of patients with knee OA is primarily predicated by their level of pain and their muscle function. Recent studies have shown that vitamin D influences both musculoskeletal health and neuromuscular function. Vitamin D deficiency is common among elders and those with comorbidities....

  6. Intensive lifestyle intervention improves physical function among obese adults with knee pain: Findings from the Look AHEAD trial

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Lifestyle interventions causing weight loss or improved physical fitness in obese individuals may lead to improved physical function. This study involved participants in the Action for Health in Diabetes (Look AHEAD) trial who reported knee pain at baseline (n = 2,203). The purposes of this study we...

  7. Intensive lifestyle intervention improves physical function among obese adults with knee pain: Findings from the Look AHEAD Trial

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Lifestyle interventions have resulted in weight loss or improved physical fitness among individuals with obesity, which may lead to improved physical function. This prospective investigation involved participants in the Action for Health in Diabetes (Look AHEAD) trial who reported knee pain at basel...

  8. Acupuncture for postoperative pain following total knee arthroplasty: a systematic review protocol

    PubMed Central

    Jung, Jae-Young; Cho, Jae-Heung; Chung, Seok-hee

    2015-01-01

    Introduction Total knee arthroplasty (TKA) is a common surgical method in orthopaedics; however, pain management after TKA remains a significant challenge. This review provides a comprehensive evaluation of the effects of acupuncture for postoperative pain after TKA. Methods and analysis The following 10 databases will be searched until August 2015: MEDLINE, EMBASE, CENTRAL, AMED, CINAHL, three Chinese databases (the China National Knowledge Infrastructure Database, the Chongqing VIP Chinese Science and Technology Periodical Database, and Wanfang Database) and five Korean databases (the Korean Medical Database, the Korean Studies Information Service System, the National Discovery for Science Leaders, the Database Periodical Information Academic, and the Oriental Medicine Advanced Searching Integrated System). All eligible randomised controlled trials related to the use of acupuncture for postoperative pain after TKA will be included. Assessment of risk of bias will be performed with the Cochrane risk-of-bias method. Mean differences or standardised mean differences will be calculated with 95% CIs for continuous data; the risk ratio will be used with 95% CIs for dichotomous data. Dissemination This systematic review will be presented in a peer-reviewed journal. The result of this review will also be disseminated at a relevant conference presentation. Trial registration number PROSPERO 2015: CRD42015020924. PMID:26582406

  9. Prevalence and Predictive Factors of Chronic Postsurgical Pain and Global Surgical Recovery 1 Year After Outpatient Knee Arthroscopy

    PubMed Central

    Hoofwijk, Daisy M.N.; Fiddelers, Audrey A.A.; Emans, Peter J.; Joosten, Elbert A.; Gramke, Hans-Fritz; Marcus, Marco A.E.; Buhre, Wolfgang F.F.A.

    2015-01-01

    Abstract Outpatient knee arthroscopy is one of the most commonly performed surgical procedures. Previous research has demonstrated that chronic postsurgical pain (CPSP) after outpatient surgery is prevalent. Our objective was to determine the prevalence and predictive factors of CPSP and Global Surgical Recovery (GSR) 1 year after knee arthroscopy. A prospective longitudinal cohort study was performed. Patients were included during an 18-month period. Data were collected by using 3 questionnaires: at 1 week preoperatively, 4 days postoperatively, and 1 year postoperatively. A value of >3 on an 11-point numeric rating scale (NRS) was defined as moderate to severe pain. A score of ≤80% on the Global Surgical Recovery Index was defined as poor GSR. Stepwise logistic regression analysis was performed to determine which variables were predictors for CPSP and poor GSR. The prevalence of moderate to severe preoperative pain in patients undergoing knee arthroscopy (n = 104) was 71.2%, of acute postsurgical pain 37.5%, and of CPSP 32.7%. Risk factors for CPSP were the presence of preoperative pain and preoperative analgesic use, with odds ratios of 6.31 (1.25–31.74) and 4.36 (1.58–12.07), respectively. The prevalence of poor GSR 1 year after outpatient knee arthrosocpy was 50.0%. Poor GSR 4 days after the surgery was a risk factor with an odds ratio of 8.38 (0.92–76.58) and quality of life 4 days after surgery was a protective factor with and odds ratio of 0.10 (0.02–0.64). Both CPSP and poor GSR are common 1 year after knee arthroscopy. Patients at risk for CPSP can be identified during the preoperative phase. Prediction of poor GSR 1 year after surgery is mainly related to early postoperative recovery. PMID:26559300

  10. Associations between Pressure-Pain Threshold, Symptoms, and Radiographic Knee and Hip Osteoarthritis: The Johnston County Osteoarthritis Project

    PubMed Central

    Goode, Adam P.; Shi, Xiaoyan A.; Gracely, Richard H.; Renner, Jordan B.; Jordan, Joanne M.

    2014-01-01

    Objective To determine the association between generalized evoked pressure pain sensitivity with distal pressure-pain threshold (PPT) and the presence, severity, or number of involved knee/hip joints with radiographic osteoarthritis (rOA) or related symptoms. Methods Data for these cross-sectional analyses come from the second follow-up (2008–11) of the Johnston County Osteoarthritis Project (n=1,602). Pressure-pain threshold measurements were averaged over two trials from both the left and right trapezius. Outcomes of radiographic knee and hip OA were both defined by a Kellgren-Lawrence score of 2–4 and site-specific symptoms were ascertained at clinical interview. Associations were determine with multiple logistic regression models, and two-way interactions were tested at p<0.05. Results The sample was 67.2% female and 31.0% African American. Participants’ mean age was 67.9 (SD 9.0); mean body mass index was 31.5 (SD 7.1); mean Center for Epidemiologic Studies Depression Scale score was 6.5 (SD 7.4); and mean total PPT was 3.6kg (SD 0.7). Significant associations were found between PPT and self-reported knee/hip symptoms. No significant associations were found between PPT and presence, severity, or number of joints with knee and hip rOA without accompanying symptoms. No significant interactions were found with demographic or clinical characteristics. Conclusion Pressure-pain threshold was significantly associated with self-reported single and multi-joint symptoms. In contrast, after adjustment, PPT measured at the trapezius was not associated with asymptomatic knee or hip rOA. As such, PPT may prove to be a useful indicator of rOA pain processing and of why individuals respond favorably and others do not to treatments targeting rOA. PMID:24643946

  11. The effects of laparoscopic sleeve gastrectomy on head, neck, shoulder, low back and knee pain of female patients

    PubMed Central

    Çakır, Tuğrul; Oruç, Mehmet Tahir; Aslaner, Arif; Duygun, Fatih; Yardımcı, Erdem Can; Mayir, Burhan; Bülbüller, Nurullah

    2015-01-01

    As the rise on the prevalence of obesity, it is related with physical impairment of joints, especially in the lumbar spine and knee joints. Losing body weight can reduce or eliminate pain of head, neck, shoulder, lumbar spine and knees. By performing a laparoscopic bariatric surgery we demonstrated a significant improvement on the pain by body weight reduction. In this study we aimed to explore the efficacy and safety of Laparoscopic Sleeve Gastrectomy (LSG) on the relief of pain on head and neck, shoulder, low back and knee among the severely morbid obese female patients. A total of 39 morbidly obese female patients who underwent LSG for morbid obesity were included in this study. Body weight, height, body mass index (BMI), head and neck, shoulder, low back and knee pain intensity were measured with Visual Analog Scale (VAS) before and after LSG at the 6th month. 39 morbidly obese female patients were enrolled to this study. The mean age of the patients was 37.69 ± 11.33 years. Preoperative and postoperative body weights were 127.3 kg and 91.21 kg, respectively. Mean height was 165.23 ± 5.78 cm. Preoperative and postoperative BMIs were 46.49 kg/m2 and 32.33 kg/m2, respectively. A significant correlation between preoperative and postoperative parameters was found according to BMI. Our data showed that LSG is an efficient and safe procedure on severely obese patients and showed a predictive remission of head and neck, shoulder, low back and knee pain intensity of female patients by analyzing with VAS during the first 6 months. PMID:25932217

  12. Intraoperative music reduces perceived pain after total knee arthroplasty: a blinded, prospective, randomized, placebo-controlled clinical trial.

    PubMed

    Simcock, Xavier C; Yoon, Richard S; Chalmers, Peter; Geller, Jeffrey A; Kiernan, Howard A; Macaulay, William

    2008-10-01

    Patients undergoing total knee arthroplasty (TKA) often experience a difficult recovery due to severe postoperative pain. Using a multimodal pain management protocol, a blinded, randomized, placebo-controlled study was designed to evaluate the efficacy of patient-selected music on reducing perceived pain. Thirty patients undergoing primary unilateral TKA were enrolled and randomized into the music group (15 patients) or the control group (15 patients). Postoperative pain scores, assessed with the visual analog scale, indicated the music group experienced less pain at 3 and 24 hours postoperatively than did the nonmusic group (at 3 hours: 1.47+/-1.39 versus 3.87+/-3.44, P=.01; at 24 hours: 2.41+/-1.67 versus 4.03+/-2.89, P=.04). Intraoperative music provides an inexpensive nonpharmacological option to further reduce postoperative pain. PMID:18979928

  13. Clinical value of SPECT/CT in the ‘unhappy’ total knee arthroplasty (TKA)- a prospective study in a consecutive series of 100 painful knees after TKA

    PubMed Central

    Rotigliano, Niccolò; Hirschmann, Michael T.

    2016-01-01

    Aims and Objectives: Bone SPECT/CT is considered as beneficial hybrid imaging modality in unhappy patients with pain, stiffness or swelling after total knee arthroplasty (TKA). The purpose of this study was to identify typical pattern of tracer uptake distribution and intensity values in these patients after TKA. The above findings were correlated with the type of TKA, the time from primary TKA, fixation of TKA (cemented or non-cemented) and intraoperative findings at revision surgery (loose vs well fixed TKA components). Materials and Methods: A total of 100 knees (mean age±standard deviation 70±11 years) of 84 consecutive patients who have previously undergone primary TKA and complained about postoperative knee pain or stiffness after TKA were prospectively included. All patients underwent clinical and radiological examination including standardized radiographs and Tc-99m-HDP-SPECT/CT as part of a routine diagnostic algorithm. The diagnosis before and after SPECT/CT imaging, as well as the final treatment were recorded. Femoral and tibial TKA component position (varus-valgus, flexion-extension, internal rotation-external rotation) was determined on 3D reconstructed images using a customized analysis software. Intensity and anatomical distribution of 99mTc-HDP-SPECT/CT bone tracer uptake was determined using a validated localisation scheme. Maximum intensity values were recorded as well as ratios between the respective value and the background tracer activity (proximal mid-shaft of the femur). Level of significance was p<0.05. Univariate analysis (Chi square test, Pearson correlation, t-test for independent samples) was performed to identify any correlations between component position, tracer uptake and diagnosis. For all analysis, p<0.05 was considered statistically significant. Results: SPECT/CT changed the clinical diagnosis and final treatment in 85/100 (85%) knees. 33 knees (33%) were surgically revised, 58 knees (58%) non-surgically treated and 9 knees (9

  14. Reliability and Validity of the Anterior Knee Pain Scale: Applications for Use as an Epidemiologic Screener

    PubMed Central

    2016-01-01

    A screening instrument’s ability to provide clinicians with consistent and reproducible information is crucial to intervention. Despite widespread acceptance and clinical use of the Kujala Anterior Knee Pain Scale (AKPS) in orthopedics and sports medicine, few studies have reported on its reliability and no such studies have concentrated on child or adolescent samples exclusively, segments of the population for which this instrument is often used. The purpose of the current study was to describe and report on the reliability and validity of the AKPS for use with high school female athletes participating in interscholastic athletics. The study was a secondary analysis of prospective epidemiologic data using established scale validation methods. The records of 414 female athletes 11.0 to 18.1 years of age (Mean 13.9 yrs, SD = 1.7 yrs) were used for analysis. Four different approaches to scoring and scale reduction of the AKPS were evaluated, including the original, ordinal 13-item form, a modified, ordinal 6-item form, a modified, dichotomous 13-item form, and a modified, dichotomous 6-item form. Three different types of reliability (internal consistency, equivalence across forms, standard error of measurement) and one type of validity (criterion-related) were estimated for the AKPS in the current sample. The four scoring formats of the AKPS scale were found to have high internal consistency (αcoef = 0.83 to 0.91), equivalence across the short and long forms (r = 0.98), acceptable standard errors of measurement (0.82 to 3.00), and moderate to high criterion related validity—as determined by physican’s diagnosis: 0.92 (13-item form), 0.90 (6-item form). The Kujala AKPS is a valid and reliable measure of anterior knee pain and appropriate for use as an epidemiologic screening tool with adolescent female athletes. PMID:27441381

  15. Reliability and Validity of the Anterior Knee Pain Scale: Applications for Use as an Epidemiologic Screener.

    PubMed

    Ittenbach, Richard F; Huang, Guixia; Barber Foss, Kim D; Hewett, Timothy E; Myer, Gregory D

    2016-01-01

    A screening instrument's ability to provide clinicians with consistent and reproducible information is crucial to intervention. Despite widespread acceptance and clinical use of the Kujala Anterior Knee Pain Scale (AKPS) in orthopedics and sports medicine, few studies have reported on its reliability and no such studies have concentrated on child or adolescent samples exclusively, segments of the population for which this instrument is often used. The purpose of the current study was to describe and report on the reliability and validity of the AKPS for use with high school female athletes participating in interscholastic athletics. The study was a secondary analysis of prospective epidemiologic data using established scale validation methods. The records of 414 female athletes 11.0 to 18.1 years of age (Mean 13.9 yrs, SD = 1.7 yrs) were used for analysis. Four different approaches to scoring and scale reduction of the AKPS were evaluated, including the original, ordinal 13-item form, a modified, ordinal 6-item form, a modified, dichotomous 13-item form, and a modified, dichotomous 6-item form. Three different types of reliability (internal consistency, equivalence across forms, standard error of measurement) and one type of validity (criterion-related) were estimated for the AKPS in the current sample. The four scoring formats of the AKPS scale were found to have high internal consistency (αcoef = 0.83 to 0.91), equivalence across the short and long forms (r = 0.98), acceptable standard errors of measurement (0.82 to 3.00), and moderate to high criterion related validity-as determined by physican's diagnosis: 0.92 (13-item form), 0.90 (6-item form). The Kujala AKPS is a valid and reliable measure of anterior knee pain and appropriate for use as an epidemiologic screening tool with adolescent female athletes. PMID:27441381

  16. Evaluation of bone marrow lesion volume as a knee osteoarthritis biomarker - longitudinal relationships with pain and structural changes: data from the Osteoarthritis Initiative

    PubMed Central

    2013-01-01

    Introduction Bone marrow lesion (BML) size may be an important imaging biomarker for osteoarthritis-related clinical trials and reducing BML size may be an important therapeutic goal. However, data on the interrelationships between BML size, pain, and structural progression are inconsistent and rarely examined in the same cohort. Therefore, we evaluated the cross-sectional and longitudinal associations of BML volume with knee pain and joint space narrowing (JSN). Methods A BML volume assessment was performed on magnetic resonance images of the knee collected at the 24- and 48-month Osteoarthritis Initiative visits from a convenience sample of 404 participants in the progression cohort. During the same visits, knee pain was assessed with WOMAC pain scores and knee radiographs were acquired and scored for JSN. BML volume was summed to generate a total knee volume and an index tibiofemoral compartment volume (compartment with greater baseline JSN). Primary analyses included multiple linear regressions (outcome = pain, predictor = total knee BML volume) and logistic regressions (outcome = JSN, predictor = index tibiofemoral compartment BML volume). Results This sample was 49% female with a mean age of 63 (9.2 standard deviation (SD)) years, and 71% had radiographic osteoarthritis in the study knee. Larger baseline BMLs were associated with greater baseline knee pain (P = 0.01), the presence of JSN at baseline (odds ratio (OR) = 1.50, 95% confidence interval (CI) = 1.23 to 1.83), and JSN progression (OR = 1.27, 95%CI = 1.11 to 1.46). Changes in total knee BML volume had a positive association with changes in knee pain severity (P = 0.004) and this association may be driven by knees that were progressing from no or small baseline BMLs to larger BMLs. In contrast, we found no linear positive relationship between BML volume change and JSN progression. Instead, regression of medial tibiofemoral BML volume was associated with JSN progression compared to knees with no or

  17. EULAR report on the use of ultrasonography in painful knee osteoarthritis. Part 2: Exploring decision rules for clinical utility

    PubMed Central

    Conaghan, P; D'Agostino, M; Ravaud, P; Baron, G; Le Bars, M; Grassi, W; Martin-Mola, E; Wakefield, R; Brasseur, J; So, A; Backhaus, M; Malaise, M; Burmester, G; Schmidely, N; Emery, P; Dougados, M

    2005-01-01

    Background: Synovial inflammation (as defined by hypertrophy and effusion) is common in osteoarthritis (OA) and may be important in both pain and structural progression. Objective: To determine if decision rules can be devised from clinical findings and ultrasonography (US) to allow recognition of synovial inflammation in patients with painful knee OA. Methods: A EULAR-ESCISIT cross sectional, multicentre study enrolled subjects with painful OA knee who had clinical, radiographic, and US evaluations. A classification and regression tree (CART) analysis was performed to find combinations of predictor variables that would provide high sensitivity and specificity for clinically detecting synovitis and effusion in individual subjects. A range of definitions for the two key US variables, synovitis and effusion (using different combinations of synovial thickness, depth, and appearance), were also included in exploratory analyses. Results: 600 patients with knee OA were included in the analysis. For both knee synovitis and joint effusion, the sensitivity and specificity were poor, yielding unsatisfactory likelihood ratios (75% sensitivity, 45% specificity, and positive LR of 1.36 for knee synovitis; 71.6% sensitivity, 43.2% specificity, and positive LR of 1.26 for joint effusion). The exploratory analyses did not improve the sensitivity and specificity (demonstrating positive LRs of between 1.26 and 1.57). Conclusion: Although it is possible to determine clinical and radiological predictors of OA inflammation in populations, CART analysis could not be used to devise useful clinical decision rules for an individual subject. Thus sensitive imaging techniques such as US remain the most useful tool for demonstrating synovial inflammation of the knee at the individual level. PMID:15878902

  18. Pessimistic explanatory style: a psychological risk factor for poor pain and functional outcomes two years after knee replacement.

    PubMed

    Singh, J A; O'Byrne, M M; Colligan, R C; Lewallen, D G

    2010-06-01

    Seligman's theory of causal attribution predicts that patients with a pessimistic explanatory style will have less favourable health outcomes. We identified 702 patients who had undergone 894 primary total knee replacements between 1993 and 2005, who responded to follow-up surveys at two (n = 783 knee replacements) and/or five years (n = 443 knee replacements) and had also completed the Minnesota Multiphasic Personality Inventory long before the joint replacement (median = 16.6 and 14.5 years for two- and five-year cohorts, respectively). Scores from the Minnesota Multiphasic Personality Inventory Optimism-Pessimism scale were used to categorise patients as pessimistic (t-score > 60) or non-pessimistic (t-score < or = 60). Multivariate logistic regression models assessing the effect of pessimistic explanatory style on pain or improvement in knee function were adjusted for gender, age, distance from the place of treatment and depression score. Pessimists reported (a) significantly more moderate or severe pain at two years with odds ratio 2.21 (95% confidence interval (CI) 1.12 to 4.35; p = 0.02), but not at five years when the odds ratio was 1.21 (95% CI 0.51 to 2.83; p = 0.67); and (b) less improvement in knee function at two years when the odds ratio was 0.53 (95% CI 0.30 to 0.96; p = 0.04), but not at five years when the odds ratio was 1.26 (95% CI 0.57 to 2.77; p = 0.57). No significant associations with moderate or severe limitation of activity were seen at two or five years. We conclude that a pessimistic explanatory style is associated with worse pain and functional outcomes two years after total knee replacement. PMID:20513876

  19. DIAGNOSIS AND MANAGEMENT OF ATYPICAL AND PERSISTENT ANTEROLATERAL KNEE PAIN IN A 16-YEAR-OLD TRIATHLETE: AN ITERATIVE PROCESS

    PubMed Central

    2013-01-01

    Introduction and Background: The subject of this case study, a 16‐year‐old female triathlete, presented to physiotherapy reporting a 6 month history of anterior knee pain, with symptoms unchanged upon resuming a graduated triathlon training program, despite 3 months rest from all training. Case Description: The case describes the differential diagnosis and management of patellofemoral pain syndrome (PFPS), iliotibial band syndrome (ITBS), and discoid lateral meniscus (DLM) in an adolescent female triathlete. Clinical reasoning and rehabilitation strategies are presented with respect to literature base. Final outcome was full resolution of symptoms and return to full athletic function, however, symptoms were relatively persistent and atypical. Purpose: This case report discusses the differential diagnosis and management of persistent and atypical anterior knee pain in a sixteen‐year‐old female triathlete. In such cases, the diagnostic process is often iterative, where intervention serves both therapeutic and diagnostic purposes. Discussion: Recent changes in the understanding of the pathophysiology of ITBS and links between the anterior and lateral knee compartments through highly innervated knee synovial tissue assist the therapist's understanding of how these conditions may occur concomitantly, with resulting atypical symptoms. The potential influences of likely changes in the subject's peripheral and central nervous system on symptom perception is also discussed. Level of Evidence: Level 5; Single case report. PMID:24377071

  20. Psychological Health Impact on Two-Year Changes in Pain and Function in Persons with Knee Pain: Data from the Osteoarthritis Initiative

    PubMed Central

    Kong, Xiangrong; Fitzgerald, G. Kelley

    2011-01-01

    Objective We determined whether baseline depressive symptoms, knee-related confidence and general psychological distress influenced changes in pain and function during two years of follow up. Design We included persons in the OAI dataset with baseline pain of 1 or greater on a 0 to 10 scale in at least one knee and no knee or hip surgery during the two-year follow-up (n=3,407). The four outcome variables were repeated chair standing, 20 meter walk and WOMAC Pain and Disability. Linear mixed effects models assessed the association of each mental health variable with the yearly change in each baseline adjusted outcome measure after controlling for covariates. Results Depressive symptoms were significantly predictive of worsening in most outcomes. The magnitude of worsening predicted for each year was small. For example, the dichotomized WOMAC Pain model indicated that depressed persons experience more rapid worsening than non-depressed persons at an average rate of 0.59 WOMAC points per year (95%CI 0.176, 1.013, p=0.005). Similar significant but very small effects of depressive symptoms on other outcomes were observed. Knee confidence was not predictive of change. General psychological distress was predictive of change in 20-meter walk and WOMAC Pain. Conclusions The most consistent psychological predictor of yearly worsening was baseline depressive symptoms. Although a statistically robust predictor of outcome, given that change was very small and highly dependent on baseline status, our results indicate that a considerable degree of persistent depressive symptoms would be required to have a meaningful effect on future self-reported outcome. PMID:21723400

  1. Ipsilateral lower extremity joint involvement increases the risk of poor pain and function outcomes after hip or knee arthroplasty

    PubMed Central

    2013-01-01

    Background Poor pain and function outcomes are undesirable after an elective surgery such as total hip or knee arthroplasty (THA/TKA). Recent studies have indicated that the presence of contralateral joint influences outcomes of THA/TKA, however the impact of ipsilateral knee/hip involvement on THA/TKA outcomes has not been explored. The objective of this study was to assess the association of ipsilateral knee/hip joint involvement on short-term and medium-term pain and function outcomes after THA/TKA. Methods In this retrospective study of prospectively collected data, we used the data from the Mayo Clinic Total Joint Registry to assess the association of ipsilateral knee or hip joint involvement with moderate to severe pain and moderate to severe activity limitation at 2-year and 5-year follow-up after primary and revision THA and TKA using multivariable-adjusted logistic regression analyses. Results At 2 years, 3,823 primary THA, 4,701 primary TKA, 1,218 revision THA and 725 revision TKA procedures were studied. After adjusting for multiple covariates, ipsilateral knee pain was significantly associated with outcomes after primary THA (all P values <0.01): (1) moderate to severe pain: at 2 years, odds ratio (OR), 2.3 (95% confidence interval (CI) 1.5 to 3.6); at 5 years, OR 1.8 (95% CI 1.1 to 2.7); (2) moderate to severe activity limitation: at 2 years, OR 3.1 (95% CI 2.3 to 4.3); at 5 years, OR 3.6 (95% CI 2.6 to 5.0). Ipsilateral hip pain was significantly associated with outcomes after primary TKA (all P values <0.01): (1) moderate to severe pain: at 2 years, OR 3.3 (95% CI 2.3 to 4.7); at 5 years, OR 1.8 (95% CI 1.1 to 2.7); (2) moderate to severe activity limitation: at 2 years, OR 3.6 (95% CI 2.6 to 4.9); at 5 years, OR 2.2 (95% CI 1.6 to 3.2). Similar associations were noted for revision THA and TKA patients. Conclusions To the best of our knowledge, this is the first study showing that the presence of ipsilateral joint involvement after THA or TKA is

  2. Epidemiology of hip and knee pain in a community based sample of Italian persons aged 65 and older1

    PubMed Central

    Cecchi, F.; Mannoni, A.; Molino-Lova, R.; Ceppatelli, S.; Benvenuti, E.; Bandinelli, S.; Lauretani, F.; Macchi, C.; Ferrucci, L.

    2016-01-01

    Summary Objective To describe prevalence, characteristics and correlates of hip pain (HP) and knee pain (KP) in an Italian community based cohort aged 65 and older (65+). Method Baseline survey (1998–2000), population-based study in the Chianti area (Tuscany, Italy); 1299 persons aged 65+ were selected from the city registry of Greve in Chianti and Bagno a Ripoli (multistage sampling method); 1006 participants (564 women and 442 men, age 75.2 ± 7.1) provided information for this analysis. Persons reporting HP/KP in the past 4 weeks were recorded and their Western Ontario and McMaster University Osteoarthritis Index pain score (WPS-range 0–20) calculated. Potential correlates of HP/KP, including clinical, lifestyle and psycho-social features and physical measures, were tested in age- and gender-adjusted regression analyses and then entered a multivariate regression model. Results HP was reported by 11.9% participants, while 22.4% reported KP and 7.2% both conditions. Climbing/descending stairs and walking were the activities eliciting more severe pain in either condition. Average WPSs were 5.6 ± 3.5 for HP and 5.4 ± 10.4 for KP. Both HP and KP were related to back pain, reduced hip abduction, reduced muscle power and increased trunk flexibility. HP was also related to KP and poor self-rated health (SRH), while KP to HP, foot pain, high body mass index, reduced knee passive flexion and knee extension torque, low education. Conclusion In a community sample of an Italian persons aged 65+, the prevalence of KP almost doubled that of HP. While both conditions were related to pain in other joints and specific joint impairment, only HP was related to poor SRH, and only KP to mechanical overload. PMID:18343164

  3. [PAIN MANAGEMENT IN PATIENTS OF RAPID RECOVERY (RR) PROGRAM IN TOTAL KNEE ARTHROPLASTY (TKA)].

    PubMed

    Marina Fernández, Rosa; Ginés Mateos, Gracia; Arco Pérez, Ma Carmen; Nuevo Gayoso, Montse; Faura Vendrell, Teresa

    2015-06-01

    Total knee arthroplasty (TKA) is a surgery consisting on the artificial joint replacement, due to a traumatic injury or a degenerative process or arthrosis. This surgery causes an important pain to patients, and sometimes affects negatively on their recovery. The choice of the prostheses will depend on the anatomical features of the patient and the surgeon criterion. The concept of a "rapid recovery surgery" was introduced in 1997 by Khelet and meant the beginning of the Fast Track model or the Rapid Recovery (RR) linked to an accelerated rehabilitation, an early discharge and the optimization of all the aspects of pre, intra and post-operative patient experience. Fast recovery is a surgical process which aims to achieve maximum autonomy of the patient through education, pain control and early mobilization. The key of the rapid recovery is to get the involvement of the patient thanks to the empowerment, which means a preoperative patient education that will help to reduce anxiety and it will make easier to engage in their own recovery. Furthermore the patient will take part of an effective post-operative physical therapy, using all the necessary tools to increase their ability to manage their own health problems. The empowerment of these patients is part of the Nursing Model in the Hospital Clinic de Barcelona (HCB), adopted by the Nursing Management in December of 2012. In Catalonia, until the start of the RR surgery, 14,132 interventions in 2008 where done by TKA conventional surgery, needing subsequent conventional hospitalization. This article describes the care and outcomes of nurse interventions, defined in the RR of TKA clinical way, which is focused on the pain's minimization and the impact on patients' mobilization. It was performed in a monographic unit from a tertiary-level hospital in Barcelona in 2013. PMID:26591937

  4. Synovial haemangioma of the knee joint: an unusual cause of knee pain in a 14-month old girl.

    PubMed

    Wen, D W; Tan, T J; Rasheed, S

    2016-06-01

    We report a histologically proven case of synovial haemangioma of the knee in a 14-month old girl who presented to the emergency department with an acute 1-day history of refusing to weight-bear on the right leg and a preceding 3-week history of a right knee lump. Physical examination revealed a non-tender, soft lump over the lateral infrapatellar region. Radiographs revealed a poorly defined soft tissue density over the infrapatellar fat pad and a suprapatellar joint effusion. Ultrasound was used to confirm the presence of a vascular soft tissue mass compatible with a synovial haemangioma within the infrapatellar fat pad which showed both intra-articular and extra-articular extension. There was good correlation of the ultrasound findings with magnetic resonance imaging (MRI), highlighting the potential clinical utility of ultrasound as an alternative imaging modality in establishing the pre-operative diagnosis and extent of a synovial haemangioma about the knee joint. PMID:26960422

  5. Efficacy of acupuncture for chronic knee pain: protocol for a randomised controlled trial using a Zelen design

    PubMed Central

    2012-01-01

    Background Chronic knee pain is a common and disabling condition in people over 50 years of age, with knee joint osteoarthritis being a major cause. Acupuncture is a popular form of complementary and alternative medicine for treating pain and dysfunction associated with musculoskeletal conditions. This pragmatic Zelen-design randomised controlled trial is investigating the efficacy and cost-effectiveness of needle and laser acupuncture, administered by medical practitioners, in people with chronic knee pain. Methods/Design Two hundred and eighty two people aged over 50 years with chronic knee pain have been recruited from metropolitan Melbourne and regional Victoria, Australia. Participants originally consented to participate in a longitudinal natural history study but were then covertly randomised into one of four treatment groups. One group continued as originally consented (ie natural history group) and received no acupuncture treatment. The other three were treatment groups: i) laser acupuncture, ii) sham laser or, iii) needle acupuncture. Acupuncture treatments used a combined Western and Traditional Chinese Medicine style, were delivered by general practitioners and comprised 8–12 visits over 12 weeks. Follow-up is currently ongoing. The primary outcomes are pain measured by an 11-point numeric rating scale (NRS) and self-reported physical function measured by the Western Ontario and McMaster (WOMAC) Universities Osteoarthritis Index subscale at the completion of treatment at 12 weeks. Secondary outcomes include quality of life, global rating of change scores and additional measures of pain (other NRS and WOMAC subscale) and physical function (NRS). Additional parameters include a range of psychosocial measures in order to evaluate potential relationships with acupuncture treatment outcomes. Relative cost-effectiveness will be determined from health service usage and outcome data. Follow-up assessments will also occur at 12 months. Discussion The

  6. Glucosamine-containing supplement improves locomotor functions in subjects with knee pain – a pilot study of gait analysis

    PubMed Central

    Kanzaki, Noriyuki; Otsuka, Yuta; Izumo, Takayuki; Shibata, Hiroshi; Nagao, Hideyuki; Ogawara, Keita; Yamada, Hiroshi; Miyazaki, Seiji; Nakamura, Yutaka

    2016-01-01

    Background Previously, we demonstrated that glucosamine-containing supplementation was effective for improving locomotor functions, especially walking speed. However, the biomechanical mechanism of efficacy has not been elucidated. This study aimed to address this challenge in subjects with knee pain, using a motion capture system. Methods An open label study was conducted in 30 Japanese subjects with knee pain. The subjects were administered a daily supplement containing 1,200 mg of glucosamine hydrochloride, 60 mg of chondroitin sulfate, 45 mg of type II collagen peptides, 90 mg of quercetin glycosides, 10 mg of imidazole peptides, 1 mg of proteoglycan, and 5 μg of vitamin D (GCQID). The intervention continued for 16 weeks. Efficacy for locomotor functions involving the knee joint was evaluated mainly using the Japanese Knee Osteoarthritis Measure (JKOM) and the 5-question Geriatric Locomotive Function Scale (GLFS-5). To examine the biomechanical mechanism of efficacy for locomotor functions, motions of subjects in a normal walking state were captured. Gait analysis was conducted and efficacy for gait parameters such as normal walking speed, stride length, cadence, and angle of soles was evaluated. Results GCQID significantly improved total scores on the JKOM and GLFS-5. In gait analysis, normal walking speed, stride length, and angle of soles at the end of the stance phase were all significantly increased, but cadence did not change significantly during the intervention period. There were significant intercorrelations of changes in normal walking speed, stride length, and angle of soles at the end of the stance phase, and between changes in stride length and total JKOM score. Conclusion A GCQID supplement may increase walking speed through increased stride length and angle of kicking from the ground during steps, which might be mainly associated with alleviated knee pain. PMID:27382267

  7. The value of indium 111 leukocyte scanning in the evaluation of painful or infected total knee arthroplasties

    SciTech Connect

    Rand, J.A.; Brown, M.L. )

    1990-10-01

    Evaluation of painful total knee arthroplasties (TKAs) for infection can be difficult. Indium 111 ({sup 111}In) leukocyte bone scanning provides a minimally invasive technique for evaluation of possible infection. Thirty-eight patients with a painful TKA who had surgical exploration after {sup 111}In leukocyte scanning were reviewed. The scan had an accuracy of 84%, a sensitivity of 83%, and a specificity of 85%. The {sup 111}In leukocyte scans must be interpreted in conjunction with the clinical evaluation of the patient because they are less accurate for study of TKAs than of total hip arthroplasties.

  8. Two cases of medial knee pain involving the medial coronary ligament in adolescents treated with conservative rehabilitation therapy

    PubMed Central

    Hudes, Karen

    2011-01-01

    Objective: This case study chronicled the assessment, treatment and management of two adolescent patients presenting with acute knee pain, diagnosed as medial meniscus tear, with or without a medial collateral ligament sprain, with coronary ligament involvement. Cases Patient 1: A 16 year old male football player presented with right medial knee pain of 2 days duration after having been tackled during practice from the left side. Patient 2: A 16 year old female presented with right medial knee pain that began 1 week prior to presentation after a fall down the stairs. Treatment: Treatment was initiated in both cases using inflammatory control techniques of icing and fascial stripping and progressed to rehabilitative exercises including VMO (vastus medialis oblique) exercises and squatting exercises to strengthen the quadriceps femoris musculature and proprioceptive exercise. Rehabilitation occurred over a four week duration in both cases with progression of exercises on an individual basis. Both cases resolved within four weeks and return to normal activities resumed at the three week mark including a return to play in patient 1. Both patients reported complete resolution of symptoms at the four week mark with no recurrence on follow up a number of months later. Summary: Conservative management, including icing, fascial stripping, and rehabilitative exercises may be beneficial in the treatment of medial meniscus tears with coronary ligament involvement in adolescents. PMID:21629464

  9. The effects of kinesiology taping therapy on degenerative knee arthritis patients’ pain, function, and joint range of motion

    PubMed Central

    Lee, Kwansub; Yi, Chae-Woo; Lee, Sangyong

    2016-01-01

    [Purpose] The purpose of the present study was to examine the effects of kinesiology taping therapy on degenerative knee arthritis patients’ pain, function, and joint range of motion. [Subjects] To conduct the experiment in the present study, 30 patients with degenerative knee arthritis were divided into a control group (the conservative treatment group) of 15 patients, who received conservative physical therapy, and an experimental group (the kinesiology taping group) of 15 patients, who received kinesiology taping therapy. [Methods] All patients received treatment three times per week for four weeks. The kinesiology taping group had elastic tapes applied to the hamstring muscles, anterior tibialis, quadriceps femoris, and gastrocnemius. The range of motion was measured using joint goniometers, pain was measured using visual analog scales, and functional evaluation was conducted using the Korean Western Ontario and McMaster Universities Osteoarthritis Index. [Results] In intragroup comparisons of the kinesiology taping group and the conservative treatment group, the visual analog scale and Korean Western Ontario and McMaster Universities Osteoarthritis Index scores significantly decreased, and the range of motion increased more than significantly. In intergroup comparisons, the kinesiology taping group showed significantly lower visual analog scale and Korean Western Ontario and McMaster Universities Osteoarthritis Index scores and significantly larger ranges of motion than the conservative treatment group. [Conclusion] Kinesiology taping therapy is considered to be an effective nonsurgical intervention method for pain relief, daily living activities, and range of motion of degenerative knee arthritis patients. PMID:26957729

  10. Depression and the Overall Burden of Painful Joints: An Examination among Individuals Undergoing Hip and Knee Replacement for Osteoarthritis.

    PubMed

    Gandhi, Rajiv; Zywiel, Michael G; Mahomed, Nizar N; Perruccio, Anthony V

    2015-01-01

    The majority of patients with hip or knee osteoarthritis (OA) report one or more symptomatic joints apart from the one targeted for surgical care. Therefore, the purpose of the present study was to investigate the association between the burden of multiple symptomatic joints and self-reported depression in patients awaiting joint replacement for OA. Four hundred and seventy-five patients at a single centre were evaluated. Patients self-reported joints that were painful and/or symptomatic most days of the previous month on a homunculus, with nearly one-third of the sample reporting 6 or more painful joints. The prevalence of depression was 12.2% (58/475). When adjusted for age, sex, education level, hip or knee OA, body mass index, chronic condition count, and joint-specific WOMAC scores, each additional symptomatic joint was associated with a 19% increased odds (odds ratio: 1.19 (95% CI: 1.08, 1.31, P < 0.01)) of self-reported depression. Individuals reporting 6 or more painful joints had 2.5-fold or greater odds of depression when compared to those patients whose symptoms were limited to the surgical joint. A focus on the surgical joint alone is likely to miss a potentially important determinant of postsurgical patient-reported outcomes in patients undergoing hip or knee replacement. PMID:25861476

  11. Depression and the Overall Burden of Painful Joints: An Examination among Individuals Undergoing Hip and Knee Replacement for Osteoarthritis

    PubMed Central

    Gandhi, Rajiv; Zywiel, Michael G.; Mahomed, Nizar N.; Perruccio, Anthony V.

    2015-01-01

    The majority of patients with hip or knee osteoarthritis (OA) report one or more symptomatic joints apart from the one targeted for surgical care. Therefore, the purpose of the present study was to investigate the association between the burden of multiple symptomatic joints and self-reported depression in patients awaiting joint replacement for OA. Four hundred and seventy-five patients at a single centre were evaluated. Patients self-reported joints that were painful and/or symptomatic most days of the previous month on a homunculus, with nearly one-third of the sample reporting 6 or more painful joints. The prevalence of depression was 12.2% (58/475). When adjusted for age, sex, education level, hip or knee OA, body mass index, chronic condition count, and joint-specific WOMAC scores, each additional symptomatic joint was associated with a 19% increased odds (odds ratio: 1.19 (95% CI: 1.08, 1.31, P < 0.01)) of self-reported depression. Individuals reporting 6 or more painful joints had 2.5-fold or greater odds of depression when compared to those patients whose symptoms were limited to the surgical joint. A focus on the surgical joint alone is likely to miss a potentially important determinant of postsurgical patient-reported outcomes in patients undergoing hip or knee replacement. PMID:25861476

  12. A randomized controlled trial for the effectiveness of intraarticular versus intravenous midazolam on pain after knee arthroscopy

    PubMed Central

    Sajedi, Parvin; Nemati, Mohammad; Mosavi, Seye Hamid; Honarmand, Azim; Safavi, Mohammad Reza

    2014-01-01

    Background: This double-blinded, randomized clinical trial was designed to evaluate the comparison of intravenous versus intraarticular (IA) administration of midazolam on postoperative pain after knee arthroscopy. Materials and Methods: In this study, 75 patients randomized in three groups to receive 75 mc/kg IA injection of midazolam and 10 ml intravenous injection of isotonic saline (Group I), 75 mc/kg intravenous injection of midazolam and 10 cc IA injection of isotonic saline (Group II) or IA and intravenous injection of isotonic saline (Group III) at the end of knee arthroscopy. Pain scores, time until the first request for analgesics, cumulative analgesic consumption, satisfaction, sedation, and complications as studied outcomes were assessed. Patients were observed for 24-h. Results: IA administration of midazolam significantly reduced pain scores in the early postoperative period compared with intravenous injection. Mean of time to first analgesic requirement in Group III (33.6 min) was significantly lower than Group II (288.8 min) and Group I (427.5 min). Cumulative analgesic consumption was increased in Groups II (35.5 mg), and III (70 mg) compared with Group I (16 mg), (P < 0.0001). Complications significantly occurred in 3 of 25 patients in Group I in contrast to 20 of 25 patients in Group III (P < 0.0001). At 2-, 4- and 8-h after arthroscopy pain score significantly decreased in Group I than other groups (P < 0.0001). Patients in Group I were significantly satisfy than other groups (P < 0.0001). Conclusion: Results show the greater analgesic effect after IA administration of midazolam than after intravenous injection and hence, IA administration may be is the method of choice for pain relief after knee arthroscopy. PMID:25097627

  13. A Preclinical Physiological Assay to Test Modulation of Knee Joint Pain in the Spinal Cord: Effects of Oxycodone and Naproxen

    PubMed Central

    Miranda, Jason A.; Stanley, Phil; Gore, Katrina; Turner, Jamie; Dias, Rebecca; Rees, Huw

    2014-01-01

    Sensory processing in the spinal cord during disease states can reveal mechanisms for novel treatments, yet very little is known about pain processing at this level in the most commonly used animal models of articular pain. Here we report a test of the prediction that two clinically effective compounds, naproxen (an NSAID) and oxycodone (an opiate), are efficacious in reducing the response of spinal dorsal horn neurons to noxious knee joint rotation in the monosodium iodoacetate (MIA) sensitized rat. The overall objective for these experiments was to develop a high quality in vivo electrophysiology assay to confidently test novel compounds for efficacy against pain. Given the recent calls for improved preclinical experimental quality we also developed and implemented an Assay Capability Tool to determine the quality of our assay and ensure the quality of our results. Spinal dorsal horn neurons receiving input from the hind limb knee joint were recorded in anesthetized rats 14 days after they were sensitized with 1 mg of MIA. Intravenous administered oxycodone and naproxen were each tested separately for their effects on phasic, tonic, ongoing and afterdischarge action potential counts in response to innocuous and noxious knee joint rotation. Oxycodone reduced tonic spike counts more than the other measures, doing so by up to 85%. Tonic counts were therefore designated the primary endpoint when testing naproxen which reduced counts by up to 81%. Both reductions occurred at doses consistent with clinically effective doses for osteoarthritis. These results demonstrate that clinically effective doses of standard treatments for osteoarthritis reduce pain processing measured at the level of the spinal cord for two different mechanisms. The Assay Capability Tool helped to guide experimental design leading to a high quality and robust preclinical assay to use in discovering novel treatments for pain. PMID:25157947

  14. The hard work of self-management: Living with chronic knee pain

    PubMed Central

    ONG, BIE NIO; JINKS, CLARE; MORDEN, ANDREW

    2011-01-01

    Self-management is a key policy initiative in many western countries, and most approaches are designed for people with long-term conditions based upon giving support and advice in order to manage the impact of the condition(s). Less attention has been paid to what people already do themselves. In this paper we focus on the meaning and enactment of self-management in everyday life and the hard work associated with devising and maintaining routine adaptive strategies. This UK-based qualitative study examined how people live with knee pain. From the interviews (22 at baseline, 15 at 6 months) and monthly diaries, it emerged that self-management could be based on implicit and incremental learning from experience or on explicit evaluation of actions. Either way, embodied and emotional hard work was involved in maintaining a daily life that allowed people to fulfil social roles and relationships. This individual and contextualised work needs to be recognised and drawn upon before specific self-management approaches are promoted. PMID:21760837

  15. RESPONSIVENESS OF THE ACTIVITIES OF DAILY LIVING SCALE OF THE KNEE OUTCOME SURVEY AND NUMERIC PAIN RATING SCALE IN PATIENTS WITH PATELLOFEMORAL PAIN

    PubMed Central

    Piva, Sara R.; Gil, Alexandra B.; Moore, Charity G.; Fitzgerald, G. Kelley

    2016-01-01

    Objective To assess internal and external responsiveness of the Activity of Daily Living Scale of the Knee Outcome Survey and Numeric Pain Rating Scale on patients with patellofemoral pain. Design One group pre-post design. Subjects A total of 60 individuals with patellofemoral pain (33 women; mean age 29.9 (standard deviation 9.6) years). Methods The Activity of Daily Living Scale and the Numeric Pain Rating Scale were assessed before and after 8 weeks of physical therapy program. Patients completed a global rating of change scale at the end of therapy. The standardized effect size, Guyatt responsiveness index, and the minimum clinical important difference were calculated. Results Standardized effect size of the Activity of Daily Living Scale was 0.63, Guyatt responsiveness index was 1.4, area under the curve was 0.83 (95% confidence interval: 0.72, 0.94), and the minimum clinical important difference corresponded to an increase of 7.1 percentile points. Standardized effect size of the Numeric Pain Rating Scale was 0.72, Guyatt responsiveness index was 2.2, area under the curve was 0.80 (95% confidence interval: 0.70, 0.92), and the minimum clinical important difference corresponded to a decrease of 1.16 points. Conclusion Information from this study may be helpful to therapists when evaluating the effectiveness of rehabilitation intervention on physical function and pain, and to power future clinical trials on patients with patellofemoral pain. PMID:19229444

  16. Differences in Health-Related Quality of Life among Subjects with Frequent Bilateral or Unilateral Knee Pain: Data from the Osteoarthritis Initiative Study

    PubMed Central

    Bindawas, Saad; Vennu, Vishal; Snih, Soham Al

    2015-01-01

    STUDY DESIGN Cross-sectional study. OBJECTIVE To examine associations between frequent bilateral knee pain (BKP) and unilateral knee pain (UKP) and health-related quality of life (QoL). We hypothesized that frequent BKP would be associated with poorer health-related QoL than would frequent UKP and no knee pain. BACKGROUND Knee pain is one of the most frequently reported types of joint pain among adults in the United States. It is the most frequent cause of limited physical function, disability, and reduced QoL. METHODS Data were collected from the Osteoarthritis Initiative public-use data sets. Health-related QoL was assessed in 2481 participants (aged 45–79 years at baseline). The Knee Injury and Osteoarthritis Outcome Score QoL subscale (knee-specific measure) and the physical component summary and mental component summary (MCS) scores of the Medical Outcomes Study 12-Item Short-Form Health Survey (SF-12) (generic measure) were used to assess health-related QoL. Multiple regression analyses were used to examine the relationships between frequent knee pain and health-related QoL, adjusted for sociodemographic and health covariates. RESULTS Compared with subjects with no knee pain, subjects with frequent BKP and UKP had significantly lower scores on the Knee injury and Osteoarthritis Outcome Score QoL subscale (mean difference, −35.2; standard error [SE], 0.86; P<.001 and mean difference, −29.2; SE, 0.93; P<.001; respectively) and the SF-12 physical component summary score (mean difference, −6.25; SE, 0.41; P<.001 and mean difference, −4.10, SE, 0.43; P<.00; respectively), after controlling for sociodemographic and health covariates. The SF-12 MCS score was lower among those with BKP (−1.29; SE, 0.42; P<.001). Frequent UKP was not associated with the SF-12 MCS. CONCLUSIONS Subjects with frequent BKP had lower health-related QoL than those with frequent unilateral or no knee pain, as reflected in lower Knee injury and Osteoarthritis Outcome Socre Qo

  17. Continuous Local Infiltration Analgesia for Pain Control After Total Knee Arthroplasty

    PubMed Central

    Sun, Xiao-Lei; Zhao, Zhi-Hu; Ma, Jian-Xiong; Li, Feng-Bo; Li, Yan-Jun; Meng, Xin-Min; Ma, Xin-Long

    2015-01-01

    Abstract A total knee arthroplasty (TKA) has always been associated with moderate to severe pain. As more research is conducted on the use of continuous local infiltration analgesia (CLIA) to manage pain after a TKA, it is necessary to reassess the efficacy and safety of the TKA method. The purpose of this systematic review and meta-analysis of randomized controlled trials was to evaluate the efficacy and safety of pain control of CLIA versus placebo after a TKA. In January 2015, a systematic computer-based search was conducted in the Medline, Embase, PubMed, CENTRAL (Cochrane Controlled Trials Register), Web of Science, Google database, and Chinese Wanfang databases. This systematic review and meta-analysis were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement criteria. The primary endpoint was the visual analog scale score after a TKA with rest or mobilization at 24, 48, and 72 hours, which represents the effect of pain control after TKA. The complications of infection, nausea, and whether it prolonged wound drainage were also compiled to assess the safety of CLIA. RevMan 5.30 software was used for the meta-analysis. After testing for publication bias and heterogeneity across studies, data were aggregated for random-effects modeling when necessary. Ten studies involving 735 patients met the inclusion criteria. The meta-analysis revealed that continuous infusion analgesia provided better pain control with rest at 24 hours (mean difference [MD] −12.54, 95% confidence interval [CI] −16.63 to 8.45), and with mobilization at 24 hours (MD −18.27, 95% CI −27.52 to 9.02) and 48 hours (MD −14.19, 95% CI −21.46 to 6.93). There was no significant difference with respect to the visual analog scale score at 48 hours (MD −6.15, 95% CI −13.51 to 1.22, P = 0.10) and 72 hours (MD −3.63, 95% CI −10.43 to 3.16, P = 0.29) with rest and at 72 hours with mobilization (MD −4.25, 95% CI

  18. TREATMENT OF SUBACUTE POSTERIOR KNEE PAIN IN AN ADOLESCENT BALLET DANCER UTILIZING TRIGGER POINT DRY NEEDLING: A CASE REPORT

    PubMed Central

    Tansey, Kimberly A.; Westrick, Richard B.

    2014-01-01

    Study Design: Case Report. Background and Purpose: Dry needling (DN) is an increasingly popular intervention used by clinicians as a treatment of regional neuromusculoskeletal pain. DN is an invasive procedure that involves insertion of a thin monofilament needle directly into a muscle trigger point (MTP) with the intent of stimulating a local twitch response. Current evidence is somewhat limited, but recent literature supports the use of this intervention in specific neuromusculoskeletal conditions. The purpose of this case report is to present the outcomes of DN as a primary treatment intervention in an adolescent subject with subacute posterior knee pain. Case Description: The subject was a 16‐year‐old female competitive ballet dancer referred to physical therapy with a two month history of right posterior knee pain. Palpation identified MTPs which reproduced the patient’s primary symptoms. In addition to an exercise program promoting lower extremity flexibility and hip stability, the subject was treated with DN to the right gastrocnemius, soleus, and popliteus muscles. Outcomes: The subject reported being pain free on the Numerical Pain Scale and a +7 improvement in perceived change in recovery on the Global Rating of Change at final follow‐up. Physical examination demonstrated no observed impairments or functional limitations, including normal mobility, full strength, and unrestricted execution of dance maneuvers. Discussion: The patient was able to return to high level dance training and competition without physical limitations and resumed pre‐injury dynamic movement activities including dancing, running, jumping, and pivoting without pain. DN can be an effective and efficient intervention to assist patients in decreasing pain and returning to high intensity physical activity. Additional research is needed to determine if DN is effective for other body regions and has long‐term positive outcomes. Level of Evidence: Level 4 PMID:24567862

  19. Factors Related to Postoperative Pain Trajectories following Total Knee Arthroplasty: A Longitudinal Study of Patients Admitted to a Russian Orthopaedic Clinic.

    PubMed

    Kornilov, Nikolai; Lindberg, Maren Falch; Gay, Caryl; Saraev, Alexander; Kuliaba, Taras; Rosseland, Leiv Arne; Muniz, Konstantin; Lerdal, Anners

    2016-01-01

    This study explores sociodemographic, clinical, and surgical factors in relation to pain trajectories during the first 3 days following total knee arthroplasty (TKA). 100 patients (mean age 63.5 ± 7.8 years and 93% female) consecutively admitted for uncomplicated primary TKA were prospectively included. Postoperative pain was assessed using pain diaries. Measures of preoperative pain, symptoms, daily functioning, quality of life, comorbidities, knee function, perioperative characteristics, and physical/biochemical parameters were also evaluated. All pain ratings decreased in the three days following surgery (p < .001) as well as the reported number of daily hours in moderate/severe pain (p < .001). Women reported more pain than men (p = .009). Pain trajectories did not differ by education, employment, cohabitation, or any patient clinical and biochemical characteristics but were significantly related to preoperative anxiety (p = .029). Patients reporting moderate/severe pain prior to surgery also reported more hours in moderate/severe pain on days 0-3 postoperatively (p = .029). Patients with surgeries longer than 90 min reported more hours of moderate/severe pain compared with patients who had shorter surgeries (p = .008), and similar results were observed for ratings of pain with activity (p = .012). In this sample, only female gender, higher levels of preoperative pain and anxiety, and longer surgical duration were associated with increased pain after TKA. PMID:26885390

  20. Factors Related to Postoperative Pain Trajectories following Total Knee Arthroplasty: A Longitudinal Study of Patients Admitted to a Russian Orthopaedic Clinic

    PubMed Central

    Kornilov, Nikolai; Lindberg, Maren Falch; Gay, Caryl; Saraev, Alexander; Kuliaba, Taras; Rosseland, Leiv Arne; Muniz, Konstantin; Lerdal, Anners

    2016-01-01

    This study explores sociodemographic, clinical, and surgical factors in relation to pain trajectories during the first 3 days following total knee arthroplasty (TKA). 100 patients (mean age 63.5 ± 7.8 years and 93% female) consecutively admitted for uncomplicated primary TKA were prospectively included. Postoperative pain was assessed using pain diaries. Measures of preoperative pain, symptoms, daily functioning, quality of life, comorbidities, knee function, perioperative characteristics, and physical/biochemical parameters were also evaluated. All pain ratings decreased in the three days following surgery (p < .001) as well as the reported number of daily hours in moderate/severe pain (p < .001). Women reported more pain than men (p = .009). Pain trajectories did not differ by education, employment, cohabitation, or any patient clinical and biochemical characteristics but were significantly related to preoperative anxiety (p = .029). Patients reporting moderate/severe pain prior to surgery also reported more hours in moderate/severe pain on days 0–3 postoperatively (p = .029). Patients with surgeries longer than 90 min reported more hours of moderate/severe pain compared with patients who had shorter surgeries (p = .008), and similar results were observed for ratings of pain with activity (p = .012). In this sample, only female gender, higher levels of preoperative pain and anxiety, and longer surgical duration were associated with increased pain after TKA. PMID:26885390

  1. Effects of isometric exercise using biofeedback on maximum voluntary isometric contraction, pain, and muscle thickness in patients with knee osteoarthritis

    PubMed Central

    Choi, Yun Lak; Kim, Bo Kyung; Hwang, Yong Pil; Moon, Ok Kon; Choi, Wan Suk

    2015-01-01

    [Purpose] The purpose of our study was to investigate the effects of isometric exercises using electromyographic biofeedback (EMGBF) and ultrasound biofeedback (USBF) on maximum voluntary isometric contraction (MVIC), pain assessed by the Visual Analogue Scale (VAS), and vastus medialis oblique (VMO) thickness in patients with knee osteoarthritis (OA). [Subjects and Methods] Thirty females over 65 years of age who had been diagnosed with knee osteoarthritis were recruited and randomly assigned to three groups, each comprising of 10 subjects. The Subjects in the EMGBF training and USBF training groups were trained with the corresponding physical training exercise program targeting the vastus medialis oblique, whereas the subjects in the control group were treated with conventional physical therapies, such as a hot pack, ultrasound, and transcutaneous electrical nerve stimulation. Subjects in each group were trained or treated for 20 min, 3 times a week for 8 weeks. [Results] The MVIC in the EMGBF and USBF training groups was significantly increased compared with that in the control group, and the VAS score (for measurement of pain) in the EMGBF and USBF training groups was significantly decreased compared with that in the control group. Only the EMGBF training group showed a significantly increased VMO thickness compared with before training. [Conclusion] These results suggest that USBF training is similar to EMGBF training in terms of its effectiveness and is helpful for treating patients with knee OA. PMID:25642061

  2. Acupuncture and other physical treatments for the relief of pain due to osteoarthritis of the knee: network meta-analysis☆

    PubMed Central

    Corbett, M.S.; Rice, S.J.C.; Madurasinghe, V.; Slack, R.; Fayter, D.A.; Harden, M.; Sutton, A.J.; MacPherson, H.; Woolacott, N.F.

    2013-01-01

    Summary Objective To compare the effectiveness of acupuncture with other relevant physical treatments for alleviating pain due to knee osteoarthritis. Design Systematic review with network meta-analysis, to allow comparison of treatments within a coherent framework. Comprehensive searches were undertaken up to January 2013 to identify randomised controlled trials in patients with osteoarthritis of the knee, which reported pain. Results Of 156 eligible studies, 114 trials (covering 22 treatments and 9,709 patients) provided data suitable for analysis. Most trials studied short-term effects and many were classed as being of poor quality with high risk of bias, commonly associated with lack of blinding (which was sometimes impossible to achieve). End of treatment results showed that eight interventions: interferential therapy, acupuncture, TENS, pulsed electrical stimulation, balneotherapy, aerobic exercise, sham acupuncture, and muscle-strengthening exercise produced a statistically significant reduction in pain when compared with standard care. In a sensitivity analysis of satisfactory and good quality studies, most studies were of acupuncture (11 trials) or muscle-strengthening exercise (9 trials); both interventions were statistically significantly better than standard care, with acupuncture being statistically significantly better than muscle-strengthening exercise (standardised mean difference: 0.49, 95% credible interval 0.00–0.98). Conclusions As a summary of the current available research, the network meta-analysis results indicate that acupuncture can be considered as one of the more effective physical treatments for alleviating osteoarthritis knee pain in the short-term. However, much of the evidence in this area of research is of poor quality, meaning there is uncertainty about the efficacy of many physical treatments. PMID:23973143

  3. Preoperative Determinants of Patient-reported Pain and Physical Function Levels Following Total Knee Arthroplasty: A Systematic Review

    PubMed Central

    Lungu, E.; Vendittoli, P-A.; Desmeules, F.

    2016-01-01

    Background: A sound knowledge of the determinants of total knee arthroplasty (TKA) outcomes could help in patient selection, preparation and education. We aimed to assess the current status of the literature evaluating preoperative determinants of early and medium term patient-reported pain and disability following TKA. Method: A search in Medline, Pubmed, Embase and CINAHL until October 2014 was undertaken. Selection criteria included: 1- participants undergoing primary unilateral TKA with a follow-up from 6 months to 2 years, 2- validated disease-specific patient-reported outcome measures assessing pain and/or function used as outcome measure and 3- identification of preoperative determinants obtained via multivariate analyses. Risk of bias was assessed using a modified version of the Methodology checklist for prognostic studies. Results: Thirty-three prognostic explanatory studies were included. Mean total score of the methodological quality was 80.7±12.2 %. Sociodemographic and psychosocial determinants included greater socioeconomic deprivation (both studies), greater levels of depression and/or anxiety (7 out of 10 studies) and greater preoperative pain catastrophizing (all 3 studies). Significant clinical determinants included worse pre-operative knee related pain or disability (20 out of 22 studies), presence or greater levels of comorbidity (12 out of 23 studies), back pain (4 out of 5 studies) and lower general health (all 11 studies). Conclusion: Several significant determinants of short to medium-term pain and functional outcomes following TKA have been summarized by studies with moderate-to-high methodological quality. No conclusions can be reached regarding the strength of the associations between significant determinants and TKA results because of heterogeneity of study methodologies and results. Further high-quality research is required. PMID:27398109

  4. Efficacy of nonsurgical interventions for anterior knee pain: systematic review and meta-analysis of randomized trials.

    PubMed

    Collins, Natalie J; Bisset, Leanne M; Crossley, Kay M; Vicenzino, Bill

    2012-01-01

    Anterior knee pain is a chronic condition that presents frequently to sports medicine clinics, and can have a long-term impact on participation in physical activity. Conceivably, effective early management may prevent chronicity and facilitate physical activity. Although a variety of nonsurgical interventions have been advocated, previous systematic reviews have consistently been unable to reach conclusions to support their use. Considering a decade has lapsed since publication of the most recent data in these reviews, it is timely to provide an updated synthesis of the literature to assist sports medicine practitioners in making informed, evidence-based decisions. A systematic review and meta-analysis was conducted to evaluate the evidence for nonsurgical interventions for anterior knee pain. A comprehensive search strategy was used to search MEDLINE, EMBASE, CINAHL and Pre-CINAHL, PEDro, PubMed, SportDiscus, Web of Science, BIOSIS Previews, and the full Cochrane Library, while reference lists of included papers and previous systematic reviews were hand searched. Studies were eligible for inclusion if they were randomized clinical trials that used a measure of pain to evaluate at least one nonsurgical intervention over at least 2 weeks in participants with anterior knee pain. A modified version of the PEDro scale was used to rate methodological quality and risk of bias. Effect size calculation and meta-analyses were based on random effects models. Of 48 suitable studies, 27 studies with low-to-moderate risk of bias were included. There was minimal opportunity for meta-analysis because of heterogeneity of interventions, comparators and follow-up times. Meta-analysis of high-quality clinical trials supports the use of a 6-week multimodal physiotherapy programme (standardized mean difference [SMD] 1.08, 95% CI 0.73, 1.43), but does not support the addition of electromyography biofeedback to an exercise programme in the short-term (4 weeks: SMD -0.21, 95% CI -0.64, 0

  5. A Multi-Station Proprioceptive Exercise Program in Patients with Bilateral Knee Osteoarthrosis: Functional Capacity, Pain and Sensoriomotor Function. A Randomized Controlled Trial

    PubMed Central

    Gür, Hakan

    2005-01-01

    We investigated the effects of a multi-station proprioceptive exercise program on functional capacity, perceived knee pain, and sensoriomotor function. Twenty-two patients (aged 41-75 years) with grade 2-3 bilateral knee osteoarthrosis were randomly assigned to two groups: treatment (TR; n = 12) and non-treatment (NONTR; n = 10). TR performed 11 different balance/coordination and proprioception exercises, twice a week for 6 weeks. Functional capacity and perceived knee pain during rest and physical activity was measured. Also knee position sense, kinaesthesia, postural control, isometric and isokinetic knee strength (at 60, 120 and 180°·s-1) measures were taken at baseline and after 6 weeks of training. There was no significant difference in any of the tested variables between TR and NONTR before the intervention period. In TR perceived knee pain during daily activities and functional tests was lessened following the exercise program (p < 0.05). Perceived knee pain was also lower in TR vs. NONTR after training (p < 0.05). The time for rising from a chair, stair climbing and descending improved in TR (p < 0.05) and these values were faster compared with NONTR after training (p < 0.05). Joint position sense (degrees) for active and passive tests and for weight bearing tests improved in TR (p < 0.05) and the values were lower compared with NONTR after training (p < 0.05). Postural control (‘eyes closed’) also improved for single leg and tandem tests in TR (p < 0.01) and these values were higher compared with NONTR after training. The isometric quadriceps strength of TR improved (p < 0.05) but the values were not significantly different compared with NONTR after training. There was no change in isokinetic strength for TR and NONTR after the training period. The results suggest that using a multi-station proprioceptive exercise program it is possible to improve postural control, functional capacity and decrease perceived knee pain in patients with bilateral knee

  6. Efficacy of balneotherapy on pain, function and quality of life in patients with osteoarthritis of the knee

    NASA Astrophysics Data System (ADS)

    Fioravanti, Antonella; Giannitti, Chiara; Bellisai, Barbara; Iacoponi, Francesca; Galeazzi, Mauro

    2012-07-01

    The aims of this study were to evaluate whether balneotherapy with mineral sulphate-bicarbonate-calcium water could determine substantial symptomatic improvement, and to detect any changes in the quality of life (QoL) of patients with symptomatic knee osteoarthritis (OA). This was a prospective randomized, single blind controlled trial. Sixty outpatients with primary bilateral knee OA, according to ACR criteria, were included in the study and randomized to one of two groups: group I (30 patients) was treated with a daily sulphate-bicarbonate-calcium mineral water bath; group II (30 patients), the control group, continued their regular outpatient care routine. At baseline, after 15 days and after 12 weeks, patients were evaluated by Visual Analogue Scale (VAS) for spontaneous pain, Lequesne and Womac Index for gonarthrosis, SF-36, Arthritis Impact Measurement Scale (AIMS) and symptomatic drugs consumption. We observed a significant improvement of all parameters at the end of the cycle of balneotherapy which persisted throughout the follow-up period, whereas in the control group no significant differences were noted. This symptomatic effect was confirmed by the significant reduction of symptomatic drugs consumption. The differences between the two groups were significant for all considered parameters already from the 15th day and persisted during follow-up. Tolerability of balneotherapy seemed to be good, with light and transitory side effects. Our results confirm that the beneficial effects of balneotherapy in patients with knee OA last over time, with positive effects on the painful symptomatology, a significant improvement on functional capacities and QoL. Balneotherapy can represent a useful backup to pharmacological treatment of knee OA or a valid alternative for patients who do not tolerate pharmacological treatments.

  7. Effect of Eucalyptus Oil Inhalation on Pain and Inflammatory Responses after Total Knee Replacement: A Randomized Clinical Trial

    PubMed Central

    Jun, Yang Suk; Kang, Purum; Lee, Jeong-Min; Kim, Hyo-Keun; Seol, Geun Hee

    2013-01-01

    Eucalyptus oil has been reported effective in reducing pain, swelling, and inflammation. This study aimed to investigate the effects of eucalyptus oil inhalation on pain and inflammatory responses after total knee replacement (TKR) surgery. Participants were randomized 1 : 1 to intervention group (eucalyptus inhalation group) or control group (almond oil inhalation group). Patients inhaled eucalyptus or almond oil for 30 min of continuous passive motion (CPM) on 3 consecutive days. Pain on a visual analog scale (VAS), blood pressure, heart rate, C-reactive protein (CRP) concentration, and white blood cell (WBC) count were measured before and after inhalation. Pain VAS on all three days (P < .001) and systolic (P < .05) and diastolic (P = .03) blood pressure on the second day were significantly lower in the group inhaling eucalyptus than that inhaling almond oil. Heart rate, CRP, and WBC, however, did not differ significantly in the two groups. In conclusion, inhalation of eucalyptus oil was effective in decreasing patient's pain and blood pressure following TKR, suggesting that eucalyptus oil inhalation may be a nursing intervention for the relief of pain after TKR. PMID:23853660

  8. The Design and Methods of Genetic Studies on Acute and Chronic Postoperative Pain in Patients after Total Knee Replacement

    PubMed Central

    Belfer, Inna; Greco, Carol M.; Lokshin, Anna; Vulakovich, Katie; Landsittel, Douglas; Dai, Feng; Crossett, Lawrence; Chelly, Jacques E.

    2015-01-01

    Objective Total knee replacement (TKR) is the treatment option of choice for the millions of individuals whose osteoarthritis pain can no longer be managed through non-invasive methods. Over 500,000 TKRs are performed annually in the United States. Although most patients report improvement in pain and functioning following TKR, up to 30% report persistent pain that interferes with daily function. However, the reasons for poor outcomes are not clear. To best determine which patients are at risk for pain post TKR, a detailed and comprehensive approach is needed. In this article, we present the methodology of a study designed to identify a set of genetic, proteomic, clinical, demographic, psychosocial, and psychophysical risk factors for severe acute and chronic pain post TKR. Design Prospective longitudinal observational study. Setting University Hospital System. Subjects Patients scheduled for unilateral TKR with a target number of 150. Methods Prior to surgery, we collect demographic, psychosocial, and pain data. Biological data, including blood samples for genetic analyses, and serum, urine, and joint fluid for cytokine assessment are collected intraoperatively. Pain assessments as well as medication use are collected during each of the three days postsurgery. Additionally, pain and psychosocial information is collected 6 and 12 months following surgery. Conclusions This study, for the first time, captures the information on both genetic and “environmental” risk factors for acute and chronic pain post-TKR and has the potential to lead to the next step—multicenter large-scale studies on predictors and biomarkers of poor TKR outcomes as well as on tailored interventions and personalized medicine approaches for those at risk. PMID:25040948

  9. The Effect of Gabapentin on Acute Postoperative Pain in Patients Undergoing Total Knee Arthroplasty

    PubMed Central

    Zhai, Lifeng; Song, Zhoufeng; Liu, Kang

    2016-01-01

    Abstract The purpose of this systematic review and meta-analysis of randomized controlled trials (RCTs) and non-RCTs was to evaluate the efficacy and safety of gabapentin versus placebo for pain control after total knee arthroplasty (TKA). In December 2015, a systematic computer-based search was conducted in the Medline, Embase, PubMed, Cochrane Controlled Trials Register (CENTRAL), Web of Science, Google, and Chinese Wanfang databases. This systematic review and meta-analysis were performed according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement criteria. The primary endpoint was the visual analogue scale (VAS) score after TKA with rest or mobilization at 24 and 48 hours, representing the efficacy of pain control after TKA. Cumulative morphine consumption via patient controlled anesthesia (PCA) was also assessed to determine the morphine-spare effect. Complications such as dizziness, pruritus, vomiting, nausea, and sedation were also compiled to assess the safety of gabapentin. Stata 12.0 software was used for the meta-analysis. After testing for publication bias and heterogeneity across studies, the data were aggregated for random-effects modeling whenever necessary. Six studies involving 769 patients met the inclusion criteria. Our meta-analysis revealed that gabapentin resulted in superior pain relief compared to the control group in terms of VAS score with rest at 24 hours (mean difference [MD] = −3.47; 95% confidence interval [CI] −6.16 to −0.77; P = 0.012) and at 48 hours postoperatively (MD = −2.25; 95% CI −4.21 to −0.30; P = 0.024). There was no statistically significant difference between the groups with respect to the VAS score at 24 hours postoperatively (MD = 1.05; 95% CI −3.31 to 5.42; P = 0.636) or at 48 hours (MD = 1.71; 95% CI −0.74 to 4.15; P = 0.171). These results indicated that the perioperative administration of gabapentin decreases the

  10. Role of preoperative pain, muscle function, and activity level in discharge readiness after fast-track hip and knee arthroplasty

    PubMed Central

    Holm, Bente; Bandholm, Thomas; Lunn, Troels Haxholdt; Husted, Henrik; Aalund, Peter Kloster; Hansen, Torben Bæk

    2014-01-01

    Background and purpose The concept of fast-track surgery has led to a decline in length of stay after total hip arthroplasty (THA) and total knee arthroplasty (TKA) to about 2–4 days. However, it has been questioned whether this is only achievable in selected patients—or in all patients. We therefore investigated the role of preoperative pain and functional characteristics in discharge readiness and actual LOS in fast-track THA and TKA. Methods Before surgery, hip pain (THA) or knee pain (TKA), lower-extremity muscle power, functional performance, and physical activity were assessed in a sample of 150 patients and used as independent variables to predict the outcome (dependent variable)—readiness for hospital discharge —for each type of surgery. Discharge readiness was assessed twice daily by blinded assessors. Results Median discharge readiness and actual length of stay until discharge were both 2 days. Univariate linear regression followed by multiple linear regression revealed that age was the only independent predictor of discharge readiness in THA and TKA, but the standardized coefficients were small (≤ 0.03). Interpretation These results support the idea that fast-track THA and TKA with a length of stay of about 2–4 days can be achieved for most patients independently of preoperative functional characteristics. PMID:24954491

  11. Weight Status and Differences in Mobility Performance, Pain Symptoms, and Physical Activity in Older, Knee Osteoarthritis Patients

    PubMed Central

    Garver, Matthew J.; Focht, Brian C.; Dials, Justin; Lucas, Alexander R.; Devor, Steven T.; Emery, Charles F.; Hackshaw, Kevin V.; Rejeski, W. Jack

    2014-01-01

    Knee osteoarthritis (OA) is a leading cause of functional disability among American adults. Obesity is a strong independent risk factor for OA. While research emphasizes the role of obesity in the OA-physical function relationship, the extent to which weight status impacts salient physical, health, and pain measures in older, knee OA patients is not well delineated. The primary aim of this study was to assess differences in mobility performance (stair climb and 400-meter walk), mobility-related self-efficacy, pain symptoms (WOMAC), and measures of accelerometer-determined physical activity (PA) as a function of weight status. Analysis of covariance was conducted to examine differences on the dependent variables. Obese class III patients were outperformed by their counterparts on nearly every measure of mobility, mobility-related self-efficacy, and the assessment of pain symptoms. These outcomes did not differ among other weight comparisons. Normal weight subjects outperformed classes I, II, and III counterparts on most measures of PA (engagement in moderate or greater PA and total weekly steps). Additionally, overweight participants outperformed obese class II participants and obese class I participants outperformed obese classes II and III participants on total weekly steps. Collectively, these findings underscore the meaningful differences observed in relevant OA outcomes as a function of increasing levels of body weight. PMID:24963401

  12. The use of McConnell taping to correct abnormal biomechanics and muscle activation patterns in subjects with anterior knee pain: a systematic review

    PubMed Central

    Leibbrandt, Dominique C; Louw, Quinette A

    2015-01-01

    [Purpose] The aim of this review was to present the available evidence for the effect of McConnell taping on knee biomechanics in individuals with anterior knee pain. [Methods] The PubMed, Medline, Cinahl, SPORTDiscus, PEDro and ScienceDirect electronic databases were searched from inception until September 2014. Experimental research on knee biomechanical or EMG outcomes of McConnell taping compared with no tape or placebo tape were included. Two reviewers completed the searches, selected the full text articles, and assessed the risk of bias of eligible studies. Authors were contacted for missing data. [Results] Eight heterogeneous studies with a total sample of 220 were included in this review. All of the studies had a moderate to low risk of bias. Pooling of data was possible for three outcomes: average knee extensor moment, average VMO/VL ratio and average VMO-VL onset timing. None of these outcomes revealed significant differences. [Conclusion] The evidence is currently insufficient to justify routine use of the McConnell taping technique in the treatment of anterior knee pain. There is a need for more evidence on the aetiological pathways of anterior knee pain, level one evidence, and studies investigating other potential mechanisms of McConnell taping. PMID:26311990

  13. Knee joint replacement

    MedlinePlus

    The results of a total knee replacement are often excellent. The operation relieves pain for most people. Most people do not need help walking after they fully recover. Most artificial knee joints last 10 ...

  14. Partial knee replacement

    MedlinePlus

    Most people recover quickly and have much less pain than they did before surgery. People who have a partial knee replacement recover faster than those who have a total knee replacement. Many people are able to walk ...

  15. The association between comorbidities and pain, physical function and quality of life following hip and knee arthroplasty.

    PubMed

    Peter, W F; Dekker, J; Tilbury, C; Tordoir, R L; Verdegaal, S H M; Onstenk, R; Bénard, M R; Vehmeijer, S B; Fiocco, M; Vermeulen, H M; van der Linden-van der Zwaag, H M J; Nelissen, R G H H; Vliet Vlieland, T P M

    2015-07-01

    The aim of the study was to examine the relationship between comorbidities and pain, physical function and health-related quality of life (HRQoL) after total hip arthroplasty (THA) and total knee arthroplasty (TKA). A cross-sectional retrospective survey was conducted including 19 specific comorbidities, administered in patients who underwent THA or TKA in the previous 7-22 months in one of 4 hospitals. Outcome measures included pain, physical functioning, and HRQoL. Of the 521 patients (281 THA and 240 TKA) included, 449 (86 %) had ≥1 comorbidities. The most frequently reported comorbidities (>15 %) were severe back pain; neck/shoulder pain; elbow, wrist or hand pain; hypertension; incontinence of urine; hearing impairment; vision impairment; and cancer. Only the prevalence of cancer was significantly different between THA (n = 38; 14 %) and TKA (n = 52; 22 %) (p = 0.01). The associations between a higher number of comorbidities and worse outcomes were stronger in THA than in TKA. In multivariate analyses including all comorbidities with a prevalence of >5 %, in THA dizziness in combination with falling and severe back pain, and in TKA dizziness in combination with falling, vision impairments, and elbow, wrist or hand pain was associated with worse outcomes in most of the analyses. A broad range of specific comorbidities needs to be taken into account with the interpretation of patients' health status after THA and TKA. More research including the ascertainment of comorbidities preoperatively is needed, but it is conceivable that in particular, the presence of dizziness with falling, pain in other joints, and vision impairments should be assessed and treated in order to decrease the chance of an unfavorable outcome. PMID:25586654

  16. Synovial Fluid Macrophage Migration Inhibitory Factor Levels Correlate with Severity of Self-Reported Pain in Knee Osteoarthritis Patients

    PubMed Central

    Zhang, Pei-liang; Liu, Jun; Xu, Li; Sun, Yan; Sun, Xue-cheng

    2016-01-01

    Background Inflammation is considered as one of the main pathogeneses in OA-induced pain. Macrophage migration inhibitory factor (MIF) is a well known pro-inflammatory cytokine. We aimed to determine whether MIF levels in serum and synovial fluid (SF) are associated with severity of OA-induced pain. Material/Methods We recruited 226 patients with knee OA and 106 controls. Self-reported pain severity of OA patients was evaluated using the Western Ontario McMaster University Osteoarthritis (WOMAC) pain scores. MIF levels were detected using enzyme-linked immunosorbent assay (ELISA). Results OA patients had similar serum MIF levels compared to controls (11.93 [5.68–18.10] vs. 10.06 [6.60–14.61] ng/ml, P>0.05). In OA patients, MIF levels in SF were dramatically lower compared to paired serum samples (3.39 [1.87–5.89] vs. 11.93 [5.68–18.10] ng/ml, P<0.01). MIF levels in SF were significantly correlated with WOMAC pain scores (r=0.237, P<0.001), but MIF levels in serum had no significant correlation with WOMAC pain scores (r=0.009, P=0.898). Conclusions MIF levels in SF, but not in serum, were independently associated with the severity of self-reported pain in OA patients. The inhibition of MIF signaling pathways may be a novel therapeutic approach for ameliorating OA-induced pain. PMID:27342658

  17. A translation of the Multidimensional Affect and Pain Survey (MAPS) from English to Japanese.

    PubMed

    Hobara, Mieko; Fujiwara, Hisaya; Clark, W Crawford; Wharton, Ralph N

    2003-05-01

    This paper introduces the Japanese translation of the Multidimensional Affect and Pain Survey (MAPS), a 101 item questionnaire which has been demonstrated to possess a number of advantages over the McGill Pain Questionnaire (MPQ). We also review validation and other studies which used translations of MAPS into Chinese, Czech, Italian and Russian to study cancer related and chronic pain. PMID:12795110

  18. Sports Specialization is Associated with An Increased Risk of Developing Anterior Knee Pain in Adolescent Female Athletes

    PubMed Central

    Hall, Randon; Foss, Kim Barber; Hewett, Timothy E.; Myer, Gregory D.

    2014-01-01

    Objectives This study sought to determine if sport specialization increases the risk of anterior knee pain in adolescent female athletes. Design Retrospective cohort epidemiology study. Methods Female basketball, soccer and volleyball players (N=546) were recruited from a single county public school district in Kentucky consisting of five middle schools and four high schools. A total of 357 multi-sport, and 189 single sport (66 basketball, 57 soccer and 66 volleyball) athlete subjects were included due to their diagnosis of patellofemoral pain on physical exam. Testing consisted of completion of a standardized history and physician-administered physical examination to determine the presence of patellofemoral pain (PFP). This study compared self-reported multi-sport athletes with sport specialized athletes participating in only one sport. The sports participation data was normalized by sport season with each sport accounting for one season of exposure. Incidence rate ratios (IRR) and 95% confidence intervals (CI) were calculated and used to determine significant differences between athletes who specialized in sport in early youth and multi-sport athletes. Results Specialization in a single sport increased the relative risk of PFP incidence by 1.5 fold (95% CI 1.0 to 2.2; p=0.038) for cumulative PFP diagnoses. Specific diagnoses such as Sinding Larsen Johansson/patellar tendinopathy (95% CI 1.5 to 10.1; p=0.005) and Osgood Schlatter Disease (95% CI 1.5 to 10.1; p=0.005) demonstrated a four-fold greater relative risk in single sport compared to multiple sport athletes. Other specific PFP diagnoses such as Fat Pad, Plica, Trauma, Pes Anserine Bursitis and IT Band Tendonitis incidence were not different between single sport and multiple sport participants (p>0.05). Conclusion Early sport specialization in female adolescents is associated with increased risk of anterior knee pain disorders including PFP, Osgood Schlatter, Sinding Larsen-Johansson compared to multi

  19. Intensive Lifestyle Intervention Improves Physical Function Among Obese Adults With Knee Pain: Findings From the Look AHEAD Trial

    PubMed Central

    Foy, Capri G.; Lewis, Cora E.; Hairston, Kristen G.; Miller, Gary D.; Lang, Wei; Jakicic, John M.; Rejeski, W. Jack; Ribisl, Paul M.; Walkup, Michael P.; Wagenknecht, Lynne E.

    2011-01-01

    Lifestyle interventions have resulted in weight loss or improved physical fitness among individuals with obesity, which may lead to improved physical function. This prospective investigation involved participants in the Action for Health in Diabetes (Look AHEAD) trial who reported knee pain at baseline (n = 2,203). The purposes of this investigation were to determine whether an Intensive Lifestyle Intervention (ILI) condition resulted in improvement in self-reported physical function from baseline to 12 months vs. a Diabetes Support and Education (DSE) condition, and whether changes in weight or fitness mediated the effect of the ILI. Outcome measures included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain, stiffness, and physical function subscales, and WOMAC summary score. ILI participants exhibited greater adjusted mean weight loss (s.e.) vs. DSE participants (−9.02 kg (0.48) vs. −0.78 kg (0.49); P < 0.001)). ILI participants also demonstrated more favorable change in WOMAC summary scores vs. DSE participants (β (s.e.) = −1.81 (0.63); P = 0.004). Multiple regression mediation analyses revealed that weight loss was a mediator of the effect of the ILI intervention on change in WOMAC pain, function, and summary scores (P < 0.001). In separate analyses, increased fitness also mediated the effect of the ILI intervention upon WOMAC summary score (P < 0.001). The ILI condition resulted in significant improvement in physical function among overweight and obese adults with diabetes and knee pain. The ILI condition also resulted in significant weight loss and improved fitness, which are possible mechanisms through which the ILI condition improved physical function. PMID:20559303

  20. Effect of Hypovitaminosis D on Postoperative Pain Outcomes and Short-Term Health-Related Quality of Life After Knee Arthroplasty

    PubMed Central

    Lee, Anna; Chan, Simon Kin Cheong; Samy, Winnie; Chiu, Chun Hung; Gin, Tony

    2015-01-01

    Abstract Vitamin D may have an important role in pain perception. Inadequate vitamin D levels are associated with suboptimal recovery after surgery. However, the effects of hypovitaminosis D on postoperative pain-related outcomes and its impact on health-related quality of life after surgery are not well understood. The objective of this study was to determine the effects of hypovitaminosis D on postoperative pain-related outcomes and health-related quality of life at 3 months after knee arthroplasty. This was a longitudinal cohort study of 191 consecutive Hong Kong Chinese patients who were given patient-controlled morphine analgesia for up to 72 hours after 214 knee arthroplasties. Serum total 25-hydroxyvitamin D (25-OHD) concentration was assessed by liquid chromatography-tandem mass spectrometry. The primary outcomes were postoperative pain intensity at rest scores (0–72 h), Western Ontario and McMaster Universities (WOMAC) osteoarthritis index (pain, stiffness and function), and moderate-to-severe persistent pain (transformed WOMAC pain score of 0–75 at 3 months after knee arthroplasty; 0, extreme pain; 100, no pain). Group differences were analyzed using generalized estimating equation models and a logistic regression model. The prevalence of preoperative hypovitaminosis D (25-OHD <50 nmol/L) was 44% (95% confidence interval [CI]: 37%–51%). There were transient higher pain intensity scores in the moderate-to-severe hypovitaminosis D (25-OHD <30 nmol/L) group compared with the sufficient vitamin D group. Vitamin D status had no effect on total WOMAC index (P = 0.22). The incidence of moderate-to-severe persistent pain was 9% (95% CI: 6%–14%). Hypovitaminosis D increased the risk of moderate-to-severe persistent pain (adjusted odds ratio 2.64, 95% CI: 1.03–6.77). Preoperative hypovitaminosis D had subtle effects on pain intensity scores in the early postoperative period and is a risk factor for moderate-to-severe persistent pain after knee

  1. Glucosamine-containing supplement improves locomotor functions in subjects with knee pain: a randomized, double-blind, placebo-controlled study

    PubMed Central

    Kanzaki, Noriyuki; Ono, Yoshiko; Shibata, Hiroshi; Moritani, Toshio

    2015-01-01

    Background The aim of this study was to investigate the ability of a glucosamine-containing supplement to improve locomotor functions in subjects with knee pain. Methods A randomized, double-blind, placebo-controlled, parallel-group comparative study was conducted for 16 weeks in 100 Japanese subjects (age, 51.8±0.8 years) with knee pain. Subjects were randomly assigned to one of the two supplements containing 1) 1,200 mg of glucosamine hydrochloride, 60 mg of chondroitin sulfate, 45 mg of type II collagen peptides, 90 mg of quercetin glycosides, 10 mg of imidazole peptides, and 5 μg of vitamin D per day (GCQID group, n=50) or 2) a placebo (placebo group, n=50). Japanese Knee Osteoarthritis Measure, visual analog scale score, normal walking speed, and knee-extensor strength were measured to evaluate the effects of the supplement on knee-joint functions and locomotor functions. Results In subjects eligible for efficacy assessment, there was no significant group × time interaction, and there were improvements in knee-joint functions and locomotor functions in both groups, but there was no significant difference between the groups. In subjects with mild-to-severe knee pain at baseline, knee-extensor strength at week 8 (104.6±5.0% body weight vs 92.3±5.5% body weight, P=0.030) and the change in normal walking speed at week 16 (0.11±0.03 m/s vs 0.05±0.02 m/s, P=0.038) were significantly greater in the GCQID group than in the placebo group. Further subgroup analysis based on Kellgren–Lawrence (K–L) grade showed that normal walking speed at week 16 (1.36±0.05 m/s vs 1.21±0.02 m/s, P<0.05) was significantly greater in the GCQID group than in the placebo group in subjects with K–L grade I. No adverse effect of treatment was identified in the safety assessment. Conclusion In subjects with knee pain, GCQID supplementation was effective for relieving knee pain and improving locomotor functions. PMID:26604721

  2. Altered Spinal MicroRNA-146a and the MicroRNA-183 Cluster Contribute to Osteoarthritic Pain in Knee Joints

    PubMed Central

    Li, Xin; Kroin, Jeffrey S; Kc, Ranjan; Gibson, Gary; Chen, Di; Corbett, Grant T; Pahan, Kalipada; Fayyaz, Sana; Kim, Jae-Sung; van Wijnen, Andre J.; Suh, Joon; Kim, Su-Gwan; Im, Hee-Jeong

    2015-01-01

    Objective Examine whether altered expression of microRNAs in central nervous system components is pathologically linked to chronic knee joint pain in osteoarthritis. Methods A surgical animal model for knee joint OA was generated by medial meniscus transection in rats followed by behavioral pain tests. Relationships between pathological changes in knee joint and development of chronic joint pain were examined by histology and imaging analyses. Alterations in microRNAs associated with OA-evoked pain sensation were determined in bilateral lumbar dorsal root ganglia (DRG) and the spinal dorsal horn by microRNA array followed by individual microRNA analyses. Gain- and loss-of-function studies of selected microRNAs (miR-146a and miR-183 cluster) were conducted to identify target pain mediators regulated by these selective microRNAs in glial cells. Results The ipsilateral hind leg displayed significantly increased hyperalgesia after 4 weeks of surgery and sensitivity was sustained for the remainder of the 8 week experimental period (F=341, P<0.001). The development of OA-induced chronic pain was correlated with pathological changes in the knee joints as assessed by histological and imaging analyses. MicroRNA analyses showed that miR-146a and the miR-183 cluster were markedly reduced in the sensory neurons in DRG (L4/L5) and spinal cord from animals experiencing knee joint OA pain. The downregulation of miR-146a and/or the miR-183 cluster in the central compartments (DRG and spinal cord) are closely associated with the upregulation of inflammatory pain mediators. The corroboration between decreases in these signature microRNAs and their specific target pain mediators were further confirmed by gain- and loss-of-function analyses in glia, the major cellular component of the central nervous system (CNS). Conclusion MicroRNA therapy using miR-146a and the miR-183 cluster could be powerful therapeutic intervention for OA in alleviating joint pain and concomitantly regenerating

  3. Pain Control after Total Knee Arthroplasty: Comparing Intra-Articular Local Anesthetic Injection with Femoral Nerve Block

    PubMed Central

    Kao, Shengchin; Lee, Hungchen; Cheng, Chihwen; Lin, Chingfeng; Tsai, Hsini

    2015-01-01

    Background. Direct intra-articular injection of low doses of local anesthetic (IALA) after closure of the joint capsule remains controversial for pain control after total knee arthroplasty (TKA). Methods. A retrospective study comparing patients receiving IALA with high doses (0.5% bupivacaine 60 mL) of local anesthetics or FNB in addition to intravenous patient-controlled analgesia with opioids for pain management after TKA was conducted. The primary end point was to compare the analgesic efficacy and early ambulation between the two groups. Results. No significant differences between the two groups in pain intensity, cumulative opioid consumption, incidences of opioid-related side effects, the time interval from the end of operation to the first time the patient could walk assisted with a walker postoperatively, and postoperative hospital stay were identified. Three patients in the IALA group but none in the FNB group walked within 12 hours after the end of operation. Summary. IALA with high doses of local anesthetics provides comparable analgesic efficacy as single-shot FNB after TKA and might be associated with earlier ambulation than FNB postoperatively. PMID:26064937

  4. Prevalence and Predictive Factors of Chronic Postsurgical Pain and Global Surgical Recovery 1 Year After Outpatient Knee Arthroscopy: A Prospective Cohort Study.

    PubMed

    Hoofwijk, Daisy M N; Fiddelers, Audrey A A; Emans, Peter J; Joosten, Elbert A; Gramke, Hans-Fritz; Marcus, Marco A E; Buhre, Wolfgang F F A

    2015-11-01

    Outpatient knee arthroscopy is one of the most commonly performed surgical procedures. Previous research has demonstrated that chronic postsurgical pain (CPSP) after outpatient surgery is prevalent. Our objective was to determine the prevalence and predictive factors of CPSP and Global Surgical Recovery (GSR) 1 year after knee arthroscopy.A prospective longitudinal cohort study was performed. Patients were included during an 18-month period. Data were collected by using 3 questionnaires: at 1 week preoperatively, 4 days postoperatively, and 1 year postoperatively. A value of >3 on an 11-point numeric rating scale (NRS) was defined as moderate to severe pain. A score of ≤80% on the Global Surgical Recovery Index was defined as poor GSR. Stepwise logistic regression analysis was performed to determine which variables were predictors for CPSP and poor GSR.The prevalence of moderate to severe preoperative pain in patients undergoing knee arthroscopy (n = 104) was 71.2%, of acute postsurgical pain 37.5%, and of CPSP 32.7%. Risk factors for CPSP were the presence of preoperative pain and preoperative analgesic use, with odds ratios of 6.31 (1.25-31.74) and 4.36 (1.58-12.07), respectively. The prevalence of poor GSR 1 year after outpatient knee arthrosocpy was 50.0%. Poor GSR 4 days after the surgery was a risk factor with an odds ratio of 8.38 (0.92-76.58) and quality of life 4 days after surgery was a protective factor with and odds ratio of 0.10 (0.02-0.64).Both CPSP and poor GSR are common 1 year after knee arthroscopy. Patients at risk for CPSP can be identified during the preoperative phase. Prediction of poor GSR 1 year after surgery is mainly related to early postoperative recovery. PMID:26559300

  5. How Accurate Are Patients at Diagnosing the Cause of Their Knee Pain With the Help of a Web-based Symptom Checker?

    PubMed Central

    Bisson, Leslie J.; Komm, Jorden T.; Bernas, Geoffrey A.; Fineberg, Marc S.; Marzo, John M.; Rauh, Michael A.; Smolinski, Robert J.; Wind, William M.

    2016-01-01

    Background: Researching medical information is the third most popular activity online, and there are a variety of web-based symptom checker programs available. Purpose: This study evaluated a patient’s ability to self-diagnose their knee pain from a list of possible diagnoses supplied by an accurate symptom checker. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: All patients older than 18 years who presented to the office of 7 different fellowship-trained sports medicine surgeons over an 8-month period with a complaint of knee pain were asked to participate. A web-based symptom checker for knee pain was used; the program has a reported accuracy of 89%. The symptom checker generates a list of potential diagnoses after patients enter symptoms and links each diagnosis to informative content. After exploring the informative content, patients selected all diagnoses they felt could explain their symptoms. Each patient was later examined by a physician who was blinded to the differential generated by the program as well as the patient-selected diagnoses. A blinded third party compared the diagnoses generated by the program with those selected by the patient as well as the diagnoses determined by the physician. The level of matching between the patient-selected diagnoses and the physician’s diagnoses determined the patient’s ability to correctly diagnose their knee pain. Results: There were 163 male and 165 female patients, with a mean age of 48 years (range, 18-76 years). The program generated a mean 6.6 diagnoses (range, 2-15) per patient. Each patient had a mean 1.7 physician diagnoses (range, 1-4). Patients selected a mean 2 diagnoses (range, 1-9). The patient-selected diagnosis matched the physician’s diagnosis 58% of the time. Conclusion: With the aid of an accurate symptom checker, patients were able to correctly identify the cause of their knee pain 58% of the time. PMID:26962542

  6. Intravenous Paracetamol Versus Patient-Controlled Analgesia With Morphine for the Pain Management Following Diagnostic Knee Arthroscopy in Trauma Patients: A Randomized Clinical Trial

    PubMed Central

    Hashemi, Seyed Masoud; Esmaeelijah, Aliakbar; Golzari, Samad; Keyhani, Sohrab; Maserrat, Azita; Mohseni, Gholamreza; Ardehali, Seyed Hosein

    2015-01-01

    Background: Most patients undergoing outpatient surgeries have the unpleasant experience of high level pain after surgery. Compared with open surgeries, arthroscopic procedures are less painful; however, inadequate pain management could be associated with significant concerns. Opioids alone or in combination with local anesthetics are frequently used for diminishing postoperative pain using intravenous or epidural infusion pumps. Despite morphine various disadvantages, it is commonly used for controlling pain after surgery. Objectives: The aim of this study was to compare intravenous paracetamol and patient-controlled analgesia (PCA) with morphine for the pain management following diagnostic knee arthroscopy in trauma patients. Patients and Methods: Sixty trauma patients who were scheduled to undergo knee arthroscopy were randomly divided into two groups. Patients immediately received intravenous infusion of 1 g paracetamol within 15 minutes after surgery and every 6 hours to 24 hours in the paracetamol group. The patient-controlled analgesia group received morphine through PCA infusion pump at 2 mL/h base rate and 1mL bolus every 15 minutes. Pain level, nausea and vomiting, and sedation were measured and recorded during entering the recovery, 15 and 30 minutes after entering the recovery, 2, 6, and 24 hours after starting morphine pump infusion in the morphine and paracetamol in the paracetamol groups. Results: There was no significant difference regarding the pain level at different times after entering the recovery between the two groups. No one from the paracetamol group developed drug complications. However, 22.3% in the PCA morphine suffered from postoperative nausea; there was a statistically significant difference regarding the sedation level, nausea, and vomiting at various times between the two groups. Conclusions: Intravenous administration of paracetamol immediately after knee arthroscopy improved postoperative pain, decreased analgesic administration

  7. “…Keep mobile, I think that’s half the battle.” A qualitative study of prevention of knee pain in symptomless older adults

    PubMed Central

    2012-01-01

    Background The emphasis on prevention in English health policy continues to centre predominantly on major diseases such as coronary heart disease and diabetes. A number of key documents detailing self-management techniques and prevention of osteoarthritis (OA) are currently available, including the NICE guidelines and the Arthritis Foundation’s National Public Health Agenda for Osteoarthritis. However, few investigations have explored preventative knowledge of knee OA amongst the population. In particular, asymptomatic members of the population may use further information in considering how to prevent knee pain. This study considers perceptions around the prevention of knee pain amongst an asymptomatic population; this target population may provide alternative insights by which to stimulate preventative behaviours. Methods A sample of thirteen patients with no current knee pain was selected from responders to a population survey. Each interview was tape recorded and fully transcribed. Qualitative computer software package NVivo8 was used to manage the data. Thematic analysis was conducted using the constant comparative method. Results The definition and causes of knee pain were interpreted in a multitude of ways. The importance of prevention was recognised by a sub-set, while a small proportion of participants negated the role of prevention. A range of social factors, including early adoption of actions, influenced the implementation and continuation of preventative behaviours. Individual responsibility for prevention was a key theme, although the role of society was also considered. Exercise was cited as a principal preventative strategy, although some participants viewed exercise as a destructive activity. A number of participants deemed pharmacotherapy to be harmful and at odds with normal physiology, instead preferring to adopt preventative behaviour over medication usage. Conclusions This asymptomatic population exhibit considerable breadth and variation in

  8. The effect of intraarticular levobupivacaine and bupivacaine injection on the postoperative pain management in total knee artroplastic surgery

    PubMed Central

    Yavuz, Nurcan; Taspinar, Vildan; Karasu, Derya; Tezcan, Aysu; Dikmen, Bayazit; Gogus, Nermin

    2014-01-01

    Objective: Total knee arthroplasty (TKA) is associated with considerable postoperative pain. We compared the effects of intraoperative intraarticular levobupivacaine and bupivacaine on postoperative analgesia and analgesic consumption after total knee arthroplasty. Methods: Sixty ASA (American Society of Anesthesiologists) physical status II-III, 18-75 years old patients scheduled for unilateral TKA were included in this study. For the operative procedure combined spinal epidural anesthesia was given by injecting 15mg levobupivacaine in subarachnoid space at L3-4/L4-5 in sitting position for all patients. In Group L 20ml levobupivacaine(0.5%), in Group B 20ml bupivacaine (0.5%) was injected intraarticularly 10 minutes before opening of the tourniquet at the end of the surgery. For all patients postoperative analgesia was provided with PCEA (levobupivacaine+fentanyl) and oral 1gr paracetamol four times a day. Patients’ intraoperative-postoperative hemodynamical data, postoperative sensorial-motor block characteristics, side effects, PCEA demand ratios and bolus volumes, total analgesic consumption, VAS values, first mobilization time, hospitalization time were recorded. Statistical analysis was performed with SPSS version 13.00 software. Results: There was no intergroup difference in demographic data, hemodynamical data, PCEA demand ratios, total analgesic consumption, first mobilization time, hospitalization time and VAS values at 0,2,72 hour. Postoperative lower VAS values were determined at 4,8,12,24 hours in Group B and at 48th hour in Group L(p<0.05). Conclusions: Intraarticular local anesthetic administration in addition to PCEA for post operative pain relief provides good analgesia after TKA surgery. PMID:25674125

  9. Effects of Group-Based Exercise on Range of Motion, Muscle Strength, Functional Ability, and Pain During the Acute Phase After Total Knee Arthroplasty: A Controlled Clinical Trial.

    PubMed

    Hiyama, Yoshinori; Kamitani, Tsukasa; Wada, Osamu; Mizuno, Kiyonori; Yamada, Minoru

    2016-09-01

    Study Design Prospective observational study including a historical control group. Background The extent to which group-based exercise (G-EXE) improves knee range of motion (ROM), quadriceps strength, and gait ability is similar to that of individualized exercise (I-EXE) at 6 weeks and 8 months after total knee arthroplasty (TKA). However, the benefits of G-EXE for patients during the acute recovery phase after TKA remain unclear. Objective To determine the effects of G-EXE during the acute recovery phase after TKA on knee ROM, quadriceps strength, functional ability, and knee pain. Methods Two hundred thirty-one patients participated in G-EXE in addition to regular ambulation and activities-of-daily-living exercises twice daily during the hospital stay. Outcomes were compared to those of a retrospectively identified, historical control group (I-EXE group [n = 206]) that included patients who performed exercises identical to those performed by the G-EXE group. The outcomes included knee ROM, quadriceps strength, pain intensity, and timed up-and-go test score at 1 month before surgery and at discharge. Analyses were adjusted for age, body mass index, sex, length of hospital stay, and preoperative values. Results Changes in ROM of knee flexion and extension (P<.001) and quadriceps strength (P<.001) were significantly better in the G-EXE group than those in the I-EXE group at discharge. The pain intensity improved more in the G-EXE group than in the I-EXE group at discharge (P<.001). However, the changes in the timed up-and-go scores were not significantly different. Conclusion Patients performing G-EXE in addition to regular ambulation and activities-of-daily-living exercises demonstrated greater changes in knee ROM, quadriceps strength, and knee pain than those performing I-EXE in addition to regular ambulation and activities-of-daily-living exercises. The nonrandomized, asynchronous design decreases certainty of these findings. Level of Evidence Therapy, level 2b

  10. Transcutaneous Electrical Nerve Stimulation (TENS) for the Control of Pain during Rehabilitation Following Total Knee Arthroplasty (TKA): A Randomized, Blinded, Placebo-Controlled Trial

    PubMed Central

    Rakel, Barbara; Zimmerman, M. Bridget; Geasland, Katharine; Embree, Jennie; Clark, Charles R; Noiseux, Nicolas O; Callaghan, John J; Herr, Keela; Walsh, Deirdre; Sluka, Kathleen A

    2014-01-01

    This study evaluated the efficacy of TENS in reducing pain and hyperalgesia and increasing function following total knee arthroplasty (TKA). We hypothesized participants using TENS during rehabilitation exercises would: 1) report significantly lower pain during range-of-motion (ROM) and fast walking but not at rest; 2) have less hyperalgesia; and, 3) have better function than participants receiving Placebo-TENS or Standard Care. We also hypothesized that change in ROM pain would differ based on psychological characteristics (trait anxiety, pain catastrophizing and depression) and treatment group. This prospective, randomized study used intent-to-treat analyses on 317 subjects after primary, unilateral TKA. Assessors, blinded to treatment allocation, measured pain, function (ROM and gait speed), and hyperalgesia (quantitative sensory tests) postoperatively and 6 weeks after surgery. Analgesic intake, anxiety, depression, and pain catastrophizing were also assessed. TENS participants used it 1–2 times/day at 42 mA (on average) and had less pain postoperatively during active knee extension (p=0.019) and fast walking (p=0.006) than Standard Care participants. TENS and Placebo-TENS were not significantly different. TENS participants who scored low on anxiety and pain catastrophizing had a greater reduction in ROM pain at 6 weeks than those scoring high on these factors (p=0.002 and 0.03). Both TENS and Placebo-TENS participants had less postoperative mechanical hyperalgesia (p=0.03 – 0.01) than Standard Care participants. Supplementing pharmacologic analgesia with TENS during rehabilitation exercises reduces movement pain postoperatively but a placebo influence exists and the effect is gone by 6 weeks. Patients with low anxiety and pain catastrophizing may benefit most from TENS. PMID:25270585

  11. Improving patient outcomes through advanced pain management techniques in total hip and knee arthroplasty.

    PubMed

    Barrington, John W; Dalury, David F; Emerson, Roger H; Hawkins, Richard J; Joshi, Girish P; Stulberg, Bernard N

    2013-10-01

    Pain following orthopedic surgery is common and often suboptimally managed, with many patients reporting acute moderate to severe pain following surgery. Opioids are often used to manage this pain, yet this can result in significant side effects and complications, including constipation, nausea, vomiting, respiratory distress, and other central nervous system issues. Multimodal therapy that includes surgical site infiltration with extended release local anesthetic has been seen as a new way to minimize this pain for patients, which can result in improved quality of life and shorter length of hospital stay. This article examines the use of bupivacaine liposome injectable suspension (EXPAREL®; Pacira Pharmaceuticals, Inc., San Diego, California), a non-opioid product for pain management. Liposomal bupivacaine uses DepoFoam® technology that allows for the extended release of injected drugs. When used as the foundation of a multimodal regimen, it is effective in reducing postsurgical pain for up to 72 hours while reducing the need for opioids for pain relief. PMID:24911371

  12. Evaluation of distance maps from fast GRE MRI as a tool to study the knee joint space

    NASA Astrophysics Data System (ADS)

    Tamez-Pena, Jose G.; Lerner, Amy L.; Yao, Jiang; Salo, Arthur D.; Totterman, Saara

    2003-05-01

    A new three-dimensional (3D) method of evaluating the joint space from fast GRE MRI has been developed that allows the reconstruction of the two dimensional (2D) distance map between the femur and the tibia bone plates. This method uses the MRI data, an automated 3D segmentation, and an unsupervised joint space extraction algorithm that identify the medial and lateral compartments of the knee joint. The extracted medial and lateral compartments of the tibia-femur joint space were analyzed by 2D distance maps, where visual as well quantitative information was extracted. This method was applied to study the dynamic behavior of the knee joint space under axial load. Three healthy volunteers' knees were imaged using fast GRE sequences in a clinical scanner under unloaded (normal) conditions and with an axial load that mimics the person's standing load. Furthermore, one volunteer's knee was imaged at four regular time intervals while the load was applied and at four regular intervals without load. The results show that changes of 50 microns in the average distance between bones can be measured and that normal axial loads reduce the joint space width significantly and can be detected by this method.

  13. Serum cartilage oligomeric matrix protein and development of radiographic and painful knee osteoarthritis. A community-based cohort of middle-aged women

    PubMed Central

    Kluzek, Stefan; Bay-Jensen, Anne-Christine; Judge, Andrew; Karsdal, Morten A.; Shorthose, Matthew; Spector, Tim; Hart, Deborah; Newton, Julia L.; Arden, Nigel K.

    2015-01-01

    Abstract Context and objective: We evaluated the predictive value of serum cartilage oligomeric matrix protein (sCOMP) levels over 20 years on the development of radiographic (RKOA) and painful knee osteoarthritis (KOA) in a longitudinal cohort of middle-aged women. Materials and methods: Five hundred and ninety-three women with no baseline KOA underwent 5-year knee radiographs over 20-years and were asked about knee pain a month before each assessment. A repeated measures logistic regression model was used where the outcomes were recorded at 5, 10, 15 and 20-years follow-up. Results: The highest quartile of sCOMP was associated with increased risk of RKOA with overall OR of 1.97 (95% CI: 1.33–2.91) over 20 years when compared with the lowest sCOMP quartile. The association with painful KOA was similar and also independent, but only when the fourth and third sCOMP quartiles were compared. Discussion and conclusion: This study demonstrates that sCOMP levels are predictive of subsequent structural changes and incidence of painful KOA, independently of age and BMI. PMID:26848781

  14. Comparison of the effects of intra-articular sole ropivacaine and combined ketorolac and ropivacaine for pain control after knee arthroscopy surgery

    PubMed Central

    Rokhtabnak, Faranak; Ale Bouyeh, Mahmood Reza; Seyed Siamdust, Alireza; Aghajani, Marjan

    2015-01-01

    Introduction: Effective pain relief is important after arthroscopic knee surgery to permit initiation of daily activities of life. This study is performed in order to investigate the effect of multi-model therapy for pain control after surgery. This clinical, randomized and double-blind trial is conducted on patients who get knee arthroscopy surgery. Methods: Of these patients, 40 were divided into two groups by Block Randomization method: 1 − sole ropivacaine group (150 mg); 2 − combined ketorolac (30 mg); and ropivacain (150 mg) group. These drugs were injected intra-articularly at the end of knee arthroscopic surgery. The first consequence including measurement of pain severity after entrance to recovery room and 2, 4, 8, 12, 18 and 24 hours after surgery were evaluated according to the visual analogue pain score. The second consequence, including nausea, vomiting and sedation, was assessed by expert nurses in the recovery room and surgery part according to nausea and vomiting scale and Ramsay sedation scale, respectively. Results: All groups had excellent analgesia at 0 and 4 hours, postoperatively. Group-combined ketorolac and ropivacaine had significantly lower visual analogue pain score as well as higher sedative scale at 8, 12, 18 and 24 hours after surgery at rest and during movement compared with the other group (p < 0.05). Moreover, there was no statistical difference between groups in regard of nausea and vomiting. Conclusion: Addition of ketolorac to ropivacaine intra-articularly in arthroscopic knee surgery enhances analgesic efficacy of local anaesthetics and cause more sedation after surgery. PMID:26516571

  15. Effectiveness of a long-term use of a minimalist footwear versus habitual shoe on pain, function and mechanical loads in knee osteoarthritis: a randomized controlled trial

    PubMed Central

    2012-01-01

    Background Recent studies have shown an important reduction of joint overload during locomotion in elderly women with knee osteoarthritis (OA) after short-term use of minimalist shoes. Our aim is to investigate the chronic effect of inexpensive and minimalist footwear on the clinical and functional aspects of OA and gait biomechanics of elderly women with knee OA. Methods/Design Fifty-six elderly women with knee OA grade 2 or 3 (Kellgren and Lawrence) are randomized into blocks and allocated to either the intervention group, which will use flexible, non-heeled shoes— Moleca®—for six months for at least six hours daily, or the control group, which could not use these shoes. Neither group is undergoing physical therapy treatment throughout the intervention period. Moleca® is a women’s double canvas, flexible, flat walking shoe without heels, with a 5-mm anti-slip rubber sole and a 3-mm internal wedge of ethylene vinyl acetate. Both groups will be followed for six months and will be assessed at baseline condition, after three months, and after six months (end of intervention). All the assessments will be performed by a physiotherapist that is blind to the group allocation. The primary outcome is the pain Western Ontario and McMaster Universities Osteoarthritis (WOMAC) score. The secondary outcomes are global WOMAC score; joint stiffness and disability WOMAC scores; knee pain with a visual analogue scale; walking distance in the six-minute walk test; Lequesne score; amount and frequency (number of days) of paracetamol (500 mg) intake over six months; knee adduction moment during gait; global medical assessment score; and global patient auto-assessment score. At baseline, all patients receive a diary to record the hours of daily use of the footwear intervention; every two weeks, the same physiotherapist makes phone calls to all patients in order to verify adherence to treatment. The statistical analysis will be based on intention-to-treat analysis, as well as

  16. Medical decision-making among Hispanics and non-Hispanic Whites with chronic back and knee pain: A qualitative study

    PubMed Central

    2011-01-01

    Background Musculoskeletal disorders affect all racial and ethnic groups, including Hispanics. Because these disorders are not life-threatening, decision-making is generally preference-based. Little is known about whether Hispanics in the U.S. differ from non-Hispanic Whites with respect to key decision making preferences. Methods We assembled six focus groups of Hispanic and non-Hispanic White patients with chronic back or knee pain at an urban medical center to discuss management of their conditions and the roles they preferred in medical decision-making. Hispanic groups were further stratified by socioeconomic status, using neighborhood characteristics as proxy measures. Discussions were led by a moderator, taped, transcribed and analyzed using a grounded theory approach. Results The analysis revealed ethnic differences in several areas pertinent to medical decision-making. Specifically, Hispanic participants were more likely to permit their physician to take the predominant role in making health decisions. Also, Hispanics of lower socioeconomic status generally preferred to use non-internet sources of health information to make medical decisions and to rely on advice obtained by word of mouth. Hispanics emphasized the role of faith and religion in coping with musculoskeletal disability. The analysis also revealed broad areas of concordance across ethnic strata including the primary role that pain and achieving pain relief play in patients' experiences and decisions. Conclusions These findings suggest differences between Hispanics and non-Hispanic Whites in preferred information sources and decision-making roles. These findings are hypothesis-generating. If confirmed in further research, they may inform the development of interventions to enhance preference-based decision-making among Hispanics. PMID:21510880

  17. Metabolic syndrome and components exacerbate osteoarthritis symptoms of pain, depression and reduced knee function

    PubMed Central

    Li, Hongxing; George, Daniel M.; Jaarsma, Ruurd L.

    2016-01-01

    Background The purpose of this study was to investigate the prevalence of metabolic syndrome and its co-morbidities in patients with primary knee osteoarthritis and to assess if the severity of metabolic syndrome, and components, correlates with the severity of osteoarthritis symptoms. Methods A case controlled analysis of 70 patients with osteoarthritis compared to a control group of 81 patients. Each patient underwent clinical review including history, examination, and pathology tests. The case-group all had stage IV osteoarthritis as determined by radiographs and intra-operative assessment. In addition a visual analogue scale (VAS), Hospital for Special Surgery knee score (HSS), and Hamilton Depression scores were completed. Results The prevalence of hypertension, obesity, dyslipidemia and metabolic syndrome was significantly higher in the patients with osteoarthritis compared to the control group. There is a significant correlation between the degree of hypertension, the presence of dyslipidemia or hyperglycemia and the severity of osteoarthritis symptoms. Variables hypertension, low HDL-C levels, and the number of co-morbidities were all identified as risk factors for increased osteoarthritis symptoms. Conclusions There is a correlation between the number of metabolic disorders, the severity of hypertension and severity of osteoarthritis symptoms. Hypertension and decreased HDL-cholesterol were positive risk factors for increased osteoarthritis symptomatology. PMID:27162783

  18. Is acupuncture a useful adjunct to physiotherapy for older adults with knee pain?: The "Acupuncture, Physiotherapy and Exercise" (APEX) study [ISRCTN88597683

    PubMed Central

    Hay, Elaine; Barlas, Panos; Foster, Nadine; Hill, Jonathan; Thomas, Elaine; Young, Julie

    2004-01-01

    Background Acupuncture is a popular non-pharmacological modality for treating musculoskeletal pain. Physiotherapists are one of the largest groups of acupuncture providers within the NHS, and they commonly use it alongside advice and exercise. Conclusive evidence of acupuncture's clinical effectiveness and its superiority over sham interventions is lacking. The Arthritis Research Campaign (arc) has funded this randomised sham-controlled trial which addresses three important questions. Firstly, we will determine the additional benefit of true acupuncture when used by physiotherapists alongside advice and exercise for older people presenting to primary care with knee pain. Secondly, we will evaluate sham acupuncture in the same way. Thirdly, we will investigate the treatment preferences and expectations of both the participants and physiotherapists participating in the study, and explore the effect of these on clinical outcome. We will thus investigate whether acupuncture is a useful adjunct to advice and exercise for treating knee pain and gain insight into whether this effect is due to specific needling properties. Methods/Design This randomised clinical trial will recruit 350 participants with knee pain to three intervention arms. It is based in 43 community physiotherapy departments in 21 NHS Trusts in the West Midlands and Cheshire regions in England. Patients aged 50 years and over with knee pain will be recruited. Outcome data will be collected by self-complete questionnaires before randomisation, and 6 weeks, 6 months and 12 months after randomisation and by telephone interview 2 weeks after treatment commences. The questionnaires collect demographic details as well as information on knee-related pain, movement and function, pain intensity and affect, main functional problem, illness perceptions, self-efficacy, treatment preference and expectations, general health and quality of life. Participants are randomised to receive a package of advice and exercise; or

  19. Community-acquired methicillin-resistant Staphylococcus aureus: a potential diagnosis for a 16-year-old athlete with knee pain

    PubMed Central

    Larkin-Thier, Susan M.; Barber, Virginia A.; Harvey, Phyllis; Livdans-Forret, Anna B.

    2010-01-01

    Objective This case report aims to raise awareness in chiropractic physicians of the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in adolescents who participate in sports activities and to alert the chiropractic physician of the necessity to consider potential diagnoses that are not within their typical clinical heuristic. Clinical Features A 16-year-old adolescent girl entered the clinic with a complaint of left knee pain that had an insidious onset during her involvement in sports activities. Later that same day, her knee became enlarged, red, and had pustular formations with a discharge. She was taken to an urgent care facility and subsequently diagnosed with MRSA. Her history included treatment of a left knee musculoskeletal condition 6 weeks prior to which she had responded favorably. Interventions and Outcomes She was treated medically with an aggressive course of antibiotic therapy and excision of the furuncle. The chiropractic physician played a role in patient education and notifying local school authorities of the case. Conclusion Doctors of chiropractic must prepare themselves for the unexpected and remain open to diagnostic possibilities outside of the normal scope of practice. Knee pain or cellulitis of any type may require additional diagnostic and patient care protocols to make the correct diagnosis. With the incidence of community-acquired MRSA increasing at an alarming rate, it is certainly a diagnosis doctors of chiropractic should be aware of when treating patients, especially those involved in sports activities. PMID:21629397

  20. Effect of the Herbal Drug Guilu Erxian Jiao on Muscle Strength, Articular Pain, and Disability in Elderly Men with Knee Osteoarthritis

    PubMed Central

    Tsai, Chen-Chen; Chou, Yin-Yi; Chen, Yi-Ming; Tang, Yih-Jing; Ho, Hui-Ching; Chen, Der-Yuan

    2014-01-01

    Background. Guilu Erxian Jiao (GEJ) is a widely used Chinese herbal remedy for knee osteoarthritis, but its clinical efficacy is unknown. Methods. We enrolled 42 elderly male patients with knee OA, including 21 patients who received the herbal drug GEJ as the case group and 21 patients who did not receive GEJ as the control group. The effects of 12 weeks of GEJ treatment on muscle strength of lower limbs were measured by a Biodex dynamometer, with disability evaluated on the Lequesne index and articular pain measured on the visual analog scale (VAS) between the two groups on the baseline and after treatment. Results. There were significant increases in the levels of muscle strength of TQ/BW-ext-dominant and TQ/BW-flex-dominant between the two groups after treatment (P < 0.05). There were also significant increases in muscle strength of knee extensor muscles in the GEJ-treated group (n = 21) self-controlled before and after 12 weeks of treatment (all P < 0.01). There were significant decreases in articular pain (P < 0.01) and Lequesne index scores (P < 0.01) in the GEJ-treated group when compared to the non-GEJ-treated group. Conclusions. Our results showed that GEJ is effective and is tolerated well in elderly men with knee OA. PMID:25309612

  1. Lateral Knee Pain after Outside-in Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction Using the TightRope RT

    PubMed Central

    Kuribayashi, So; Nakayama, Shuichi; Nakazato, Keisuke; Fukubayashi, Toru; Okinaga, Shuji

    2016-01-01

    The anterior cruciate ligament (ACL) TightRope RT (TR) was recently introduced as a novel cortical suspension device for ACL reconstruction. It has an adjustable graft loop that gives the surgeon some advantages during ACL reconstruction. We report three patients who required removal of the TR after an outside-in anatomical ACL reconstruction because of lateral knee pain. We assumed that the knee pain was associated with friction between the TR button of the posterolateral bundle and iliotibial band (ITB). Placing the TR button close to the lateral epicondyle and tissue interposition between the TR button and lateral femoral cortex may be potential risk factors for ITB irritation. Therefore, we recommend not placing the TR button close to the top of the lateral epicondyle and reducing the tissue interposition between the TR button and lateral femoral cortex as much as possible. PMID:26955618

  2. Pain charts (body maps or manikins) in assessment of the location of pediatric pain

    PubMed Central

    von Baeyer, Carl L; Lin, Vivian; Seidman, Laura C; Tsao, Jennie CI; Zeltzer, Lonnie K

    2011-01-01

    SUMMARY This article surveys the use of pain charts or pain drawings in eliciting information about the location of pain symptoms from children and adolescents. While pain charts are widely used and have been incorporated in multidimensional pediatric pain questionnaires and diaries, they present a number of issues requiring further study. These include, in particular, the number and size of different locations or areas of pain that need to be differentiated; the age at which children are able to complete pain charts unassisted; and whether the intensity and other qualities of pain can be accurately recorded on pain charts by children and adolescents. Based on data currently available, it is suggested that the unassisted use of pain charts be restricted to children aged 8 years or over, while for clinical purposes many younger children can complete pain charts with adult support. Where the investigator’s interest is restricted to a few areas of the body, checklists of body parts may have greater utility than pain charts. A new pain chart adapted for use in studies of pediatric recurrent and chronic pain is presented. PMID:21572558

  3. Comparative Effects of Periarticular Multimodal Drug Injection and Single-Shot Femoral Nerve Block on Pain Following Total Knee Arthroplasty and Factors Influencing Their Effectiveness

    PubMed Central

    Nakagawa, Shuji; Inoue, Hiroaki; Kan, Hiroyuki; Hino, Manabu; Ichimaru, Shohei; Ikoma, Kazuya; Fujiwara, Hiroyoshi; Amaya, Fumimasa; Sawa, Teiji; Kubo, Toshikazu

    2016-01-01

    Purpose This study compared the analgesic effects of local infiltration analgesia (LIA) and femoral nerve block (FNB) after total knee arthroplasty (TKA) and assessed factors associated with analgesia obtained by these two methods. Materials and Methods Study subjects included 66 patients (72 knees) who underwent TKA for osteoarthritis of the knee. Pain visual analogue scale (VAS), the amount of analgesics used, number of days to achieve 90° of flexion of the knee joint, date of initiating parallel-bar walking, range of motion of the knee joint at discharge, and adverse events were investigated. Results The VAS scores did not differ significantly between two groups, whereas the amount of analgesics used was significantly lower in the LIA group. Preoperative flexion contracture was significantly more severe in the LIA group with high VAS compared with low VAS. No serious adverse event occurred in the LIA or FNB group. Conclusions The lower analgesic usage in the LIA group than the FNB group indicates that the analgesic effect of LIA was greater than that of singleshot FNB after TKA. There were no serious complications in either group. The postoperative analgesic effect of LIA was smaller in patients with severe than less severe preoperative flexion contracture. PMID:27595078

  4. Intra-Articular Corticosteroids in Addition to Exercise for Reducing Pain Sensitivity in Knee Osteoarthritis: Exploratory Outcome from a Randomized Controlled Trial

    PubMed Central

    Soriano-Maldonado, Alberto; Klokker, Louise; Bartholdy, Cecilie; Bandak, Elisabeth; Ellegaard, Karen; Bliddal, Henning; Henriksen, Marius

    2016-01-01

    Objective To assess the effects of one intra-articular corticosteroid injection two weeks prior to an exercise-based intervention program for reducing pain sensitivity in patients with knee osteoarthritis (OA). Design Randomized, masked, parallel, placebo-controlled trial involving 100 participants with clinical and radiographic knee OA that were randomized to one intra-articular injection on the knee with either 1 ml of 40 mg/ml methylprednisolone (corticosteroid) dissolved in 4 ml lidocaine (10 mg/ml) or 1 ml isotonic saline (placebo) mixed with 4 ml lidocaine (10 mg/ml). Two weeks after the injections all participants undertook a 12-week supervised exercise program. Main outcomes were changes from baseline in pressure-pain sensitivity (pressure-pain threshold [PPT] and temporal summation [TS]) assessed using cuff pressure algometry on the calf. These were exploratory outcomes from a randomized controlled trial. Results A total of 100 patients were randomized to receive either corticosteroid (n = 50) or placebo (n = 50); 45 and 44, respectively, completed the trial. Four participants had missing values for PPT and one for TS at baseline; thus modified intention-to-treat populations were analyzed. The mean group difference in changes from baseline at week 14 was 0.6 kPa (95% CI: -1.7 to 2.8; P = 0.626) for PPT and 384 mm×sec (95% CI: -2980 to 3750; P = 0.821) for TS. Conclusions These results suggest that adding intra-articular corticosteroid injection 2 weeks prior to an exercise program does not provide additional benefits compared to placebo in reducing pain sensitivity in patients with knee OA. Trial Registration EU clinical trials (EudraCT): 2012-002607-18 PMID:26871954

  5. Correlation of changes in pain intensity with synovial fluid adenosine triphosphate levels after treatment of patients with osteoarthritis of the knee with high-molecular-weight hyaluronic acid.

    PubMed

    Kumahashi, Nobuyuki; Naitou, Kohei; Nishi, Hideyuki; Oae, Kazunori; Watanabe, Yohei; Kuwata, Suguru; Ochi, Mitsuo; Ikeda, Mitsugu; Uchio, Yuji

    2011-06-01

    We sought to determine whether a clinical association exists between osteoarthritis (OA)-associated knee pain and adenosine triphosphate (ATP) levels in synovial fluid (SF). A total of 28 patients with 28 primary OA knees were included. They routinely received intra-articular injection of high-molecular-weight hyaluronic acid (HA) once weekly for 5 weeks (treated group). Eight patients without knee pain who had undergone an operation for anterior or posterior cruciate ligament reconstruction 2 years ago were also examined (control group). SF and blood ATP concentrations, total amount of ATP, total SF volume, and Visual Analogue Scale (VAS) scores in all patients were measured and we compared pre-treatment values with those 1 week after the final treatment. We evaluated the correlation of change in total ATP (ΔATP) and change in VAS score (ΔVAS), ΔVAS and change in SF volume (ΔSF), and ATP concentration in SF and blood. In the treated group, SF ATP concentration, total amount of ATP, SF volume, and VAS score were all significantly lower post-treatment than pre-treatment (p = 0.0005, 0.0003, 0.0022, and < 0.0001, respectively). In treated group, ΔVAS was significantly associated with ΔATP (r = 0.56, p = 0.0032), ΔSF was significantly associated with ΔVAS (r = 0.78, p < 0.0001), and total amount of SF ATP and SF volume at pre-treatment were significantly higher than the control group (p < 0.0001, p < 0.0001) We demonstrated an association between SF ATP level changes and OA knee pain, which should facilitate a further understanding of OA pain mechanisms. PMID:20627733

  6. Spironolactone for People Age 70 Years and Older With Osteoarthritic Knee Pain: A Proof‐of‐Concept Trial

    PubMed Central

    Sumukadas, Deepa; Donnan, Peter T.; Cvoro, Vera; Rauchhaus, Petra; Argo, Ishbel; Waldie, Helen; Littleford, Roberta; Struthers, Allan D.; Witham, Miles D.

    2016-01-01

    Objective To determine whether spironolactone could benefit older people with osteoarthritis (OA), based on a previous study showing that spironolactone improved quality of life. Methods This parallel‐group, randomized, placebo‐controlled, double‐blind trial randomized community‐dwelling people ages ≥70 years with symptomatic knee OA to 12 weeks of 25 mg daily oral spironolactone or matching placebo. The primary outcome was between‐group difference in change in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale scores. Secondary outcomes included WOMAC stiffness and physical function subscores, EuroQol 5‐domain (EQ‐5D) 3L score, and mechanistic markers. Analysis was by intent to treat, using mixed‐model regression, adjusting for baseline values of test variables. Results A total of 421 people had eligibility assessed, and 86 were randomized. Mean ± SD age was 77 ± 5 years and 53 of 86 (62%) were women. Adherence to study medication was 99%, and all participants completed the 12‐week assessment. No significant improvement was seen in the WOMAC pain score (adjusted treatment effect 0.5 points [95% confidence interval (95% CI) − 0.3, 1.3]; P = 0.19). No improvement was seen in WOMAC stiffness score (0.2 points [95% CI −0.6, 1.1]; P = 0.58), WOMAC physical function score (0.0 points [95% CI −0.7, 0.8]; P = 0.98), or EQ‐5D 3L score (0.04 points [95% CI −0.04, 0.12]; P = 0.34). Cortisol, matrix metalloproteinase 3, and urinary C‐telopeptide of type II collagen were not significantly different between groups. More minor adverse events were noted in the spironolactone group (47 versus 32), but no increase in death or hospitalization was evident. Conclusion Spironolactone did not improve symptoms, physical function, or health‐related quality of life in older people with knee OA. PMID:26413749

  7. Road map for pain management in pancreatic cancer: A review.

    PubMed

    Lahoud, Marie José; Kourie, Hampig Raphael; Antoun, Joelle; El Osta, Lana; Ghosn, Marwan

    2016-08-15

    Beside its poor prognosis and its late diagnosis, pancreatic cancer remains one of the most painful malignancies. Optimal management of pain in this cancer represents a real challenge for the oncologist whose objective is to ensure a better quality of life to his patients. We aimed in this paper to review all the treatment modalities incriminated in the management of pain in pancreatic cancer going from painkillers, chemotherapy, radiation therapy and interventional techniques to agents under investigation and alternative medicine. Although specific guidelines and recommendations for pain management in pancreatic cancer are still absent, we present all the possible pain treatments, with a progression from medical multimodal treatment to radiotherapy and chemotherapy then interventional techniques in case of resistance. In addition, alternative methods such as acupuncture and hypnosis can be added at any stage and seems to contribute to pain relief. PMID:27574552

  8. Road map for pain management in pancreatic cancer: A review

    PubMed Central

    Lahoud, Marie José; Kourie, Hampig Raphael; Antoun, Joelle; El Osta, Lana; Ghosn, Marwan

    2016-01-01

    Beside its poor prognosis and its late diagnosis, pancreatic cancer remains one of the most painful malignancies. Optimal management of pain in this cancer represents a real challenge for the oncologist whose objective is to ensure a better quality of life to his patients. We aimed in this paper to review all the treatment modalities incriminated in the management of pain in pancreatic cancer going from painkillers, chemotherapy, radiation therapy and interventional techniques to agents under investigation and alternative medicine. Although specific guidelines and recommendations for pain management in pancreatic cancer are still absent, we present all the possible pain treatments, with a progression from medical multimodal treatment to radiotherapy and chemotherapy then interventional techniques in case of resistance. In addition, alternative methods such as acupuncture and hypnosis can be added at any stage and seems to contribute to pain relief. PMID:27574552

  9. Continuous Local Infiltration Analgesia for Pain Control After Total Knee Arthroplasty: A Meta-analysis of Randomized Controlled Trials.

    PubMed

    Sun, Xiao-Lei; Zhao, Zhi-Hu; Ma, Jian-Xiong; Li, Feng-Bo; Li, Yan-Jun; Meng, Xin-Min; Ma, Xin-Long

    2015-11-01

    A total knee arthroplasty (TKA) has always been associated with moderate to severe pain. As more research is conducted on the use of continuous local infiltration analgesia (CLIA) to manage pain after a TKA, it is necessary to reassess the efficacy and safety of the TKA method. The purpose of this systematic review and meta-analysis of randomized controlled trials was to evaluate the efficacy and safety of pain control of CLIA versus placebo after a TKA. In January 2015, a systematic computer-based search was conducted in the Medline, Embase, PubMed, CENTRAL (Cochrane Controlled Trials Register), Web of Science, Google database, and Chinese Wanfang databases. This systematic review and meta-analysis were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement criteria. The primary endpoint was the visual analog scale score after a TKA with rest or mobilization at 24, 48, and 72 hours, which represents the effect of pain control after TKA. The complications of infection, nausea, and whether it prolonged wound drainage were also compiled to assess the safety of CLIA. RevMan 5.30 software was used for the meta-analysis. After testing for publication bias and heterogeneity across studies, data were aggregated for random-effects modeling when necessary. Ten studies involving 735 patients met the inclusion criteria. The meta-analysis revealed that continuous infusion analgesia provided better pain control with rest at 24 hours (mean difference [MD] -12.54, 95% confidence interval [CI] -16.63 to 8.45), and with mobilization at 24 hours (MD -18.27, 95% CI -27.52 to 9.02) and 48 hours (MD -14.19, 95% CI -21.46 to 6.93). There was no significant difference with respect to the visual analog scale score at 48 hours (MD -6.15, 95% CI -13.51 to 1.22, P = 0.10) and 72 hours (MD -3.63, 95% CI -10.43 to 3.16, P = 0.29) with rest and at 72 hours with mobilization (MD -4.25, 95% CI -16.27 to 7.77, P = 0

  10. Cross-cultural adaptation and validation of the Persian version of the Intermittent and Constant Osteoarthritis Pain Measure for the knee

    PubMed Central

    Panah, Sara Hojat; Baharlouie, Hamze; Rezaeian, Zahra Sadat; Hawker, Gilian

    2016-01-01

    Objective: The present study aimed to translate and evaluate the reliability and validity of the Persian version of the 11-item Intermittent and Constant Osteoarthritis Pain (ICOAP) measure in Iranian subjects with Knee Osteoarthritis (KOA). Materials and Methods: The ICOAP questionnaire was translated according to the Manufacturers Alliance for Productivity and Innovation (MAPI) protocol. The procedure consisted of forward and backward translation, as well as the assessment of the psychometric properties of the Persian version of the questionnaire. A sample of 230 subjects with KOA was asked to complete the Persian versions of ICOAP and Knee injury and Osteoarthritis Outcome Score (KOOS). The ICOAP was readministered to forty subjects five days after the first visit. Test–retest reliability was assessed using Intraclass Correlation Coefficient (ICC), and internal consistency was assessed by Cronbach's alpha and item-total correlation. The correlation between ICOAP and KOOS was determined using Spearman's correlation coefficient. Result: Subjects found the Persian-version of the ICOAP to be clear, simple, and unambiguous, confirming its face validity. Spearman correlations between ICOAP total and subscale scores with KOOS scores were between 0.5 and 0.7, confirming construct validity. Cronbach's alpha, used to assess internal consistency, was 0.89, 0.93, and 0.92 for constant pain, intermittent pain, and total pain scores, respectively. The ICC was 0.90 for constant pain and 0.91 for the intermittent pain and total pain score. Conclusion: The Persian version of the ICOAP is a reliable and valid outcome measure that can be used in Iranian subjects with KOA. PMID:27563327

  11. Efficacy of Myofascial Trigger Point Dry Needling in the Prevention of Pain after Total Knee Arthroplasty: A Randomized, Double-Blinded, Placebo-Controlled Trial

    PubMed Central

    Mayoral, Orlando; Salvat, Isabel; Martín, María Teresa; Martín, Stella; Santiago, Jesús; Cotarelo, José; Rodríguez, Constantino

    2013-01-01

    The aim of this study was to determine whether the dry needling of myofascial trigger points (MTrPs) is superior to placebo in the prevention of pain after total knee arthroplasty. Forty subjects were randomised to a true dry needling group (T) or to a sham group (S). All were examined for MTrPs by an experienced physical therapist 4–5 hours before surgery. Immediately following anesthesiology and before surgery started, subjects in the T group were dry needled in all previously diagnosed MTrPs, while the S group received no treatment in their MTrPs. Subjects were blinded to group allocation as well as the examiner in presurgical and follow-up examinations performed 1, 3, and 6 months after arthroplasty. Subjects in the T group had less pain after intervention, with statistically significant differences in the variation rate of the visual analogue scale (VAS) measurements 1 month after intervention and in the need for immediate postsurgery analgesics. Differences were not significant at 3- and 6-month follow-up examinations. In conclusion, a single dry needling treatment of MTrP under anaesthesia reduced pain in the first month after knee arthroplasty, when pain was the most severe. Results show a superiority of dry needling versus placebo. An interesting novel placebo methodology for dry needling, with a real blinding procedure, is presented. PMID:23606888

  12. Isolated iliotibial band rupture after corticosteroid injection as a cause of subjective instability and knee pain in a military special warfare trainee.

    PubMed

    Pandit, Sandeep R; Solomon, Daniel J; Gross, Daniel J; Golijanin, Petar; Provencher, Matthew T

    2014-04-01

    Iliotibial band friction syndrome (ITBFS) of the knee is a common overuse injury in athletes, especially in runners. The syndrome occurs when the ITB, a lateral thickening of the fascia lata of the thigh moves repetitively over the lateral femoral condyle. A variety of nonoperative measures are used for ITBFS treatment, including stretching, core strengthening, and therapeutic injection. Isolated distal ITB rupture is a rare entity and has never yet to be reported in the orthopedic literature. We present a case of isolated ITB rupture as a cause of varus instability and knee pain in a Naval Special Warfare candidate diagnosed with ITBFS and previously treated with several local corticosteroid injections before ITB rupture. Because of continued knee pain and a sense of instability, along with an inability to return to his military special warfare duties, the ITB was surgically repaired. This case highlights the presentation and management of isolated distal ITB rupture and discusses some of the potential risk factors for rupture, including prior local corticosteroid injection. PMID:24690976

  13. Patient directed self management of pain (PaDSMaP) compared to treatment as usual following total knee replacement: study protocol for a randomized controlled trial

    PubMed Central

    2012-01-01

    Background In 2009, 665 patients underwent total knee replacements (TKRs) at the Norfolk and Norwich University Hospitals NHS Foundation Trust (NNUH), representing nearly 1% of the national total. Pain control following the operation can be poor, and this can cause poor mobilization and potential long-term adverse events. Although high levels of pain are not associated with patient dissatisfaction, brief periods of pain may lead to neuronal remodeling and sensitization. Patient controlled oral analgesia (PCOA) may improve pain relief; however, the evidence to date has been inconclusive. Patient directed self management of pain (PaDSMaP) is a single center randomized controlled trial, which aims to establish if patient self-medication improves, or is equivalent to, treatment as usual and to create an educational package to allow implementation elsewhere. Methods/design Patients eligible for a TKR will be recruited and randomized in the outpatient clinic. All patients will undergo their operations according to normal clinical practice but will be randomized into two groups. Once oral medication has commenced, one group will have pain relief administered by nursing staff in the usual way (treatment as usual; TAU), whilst the second group will self manage their pain medication (patient directed self management of pain; PaDSMaP). Those recruited for self-medication will undergo a training program to teach the use of oral analgesics according to the World Health Organization (WHO) pain cascade and how to complete the study documentation. The primary endpoint of the trial is the visual analogue scale (VAS) pain score at 3 days or discharge, whichever is sooner. The follow-up time is 6 weeks with a planned trial period of 3 years. The secondary objectives are satisfaction with the management of patient pain post-operatively whilst an inpatient after primary TKR; overall pain levels and pain on mobilization; satisfaction with pain management information provided; global

  14. Comparison of kinematic analysis by mapping tibiofemoral contact with movement of the femoral condylar centres in healthy and anterior cruciate ligament injured knees.

    PubMed

    Scarvell, Jennifer M; Smith, Paul N; Refshauge, Kathryn M; Galloway, Howard R; Woods, Kevin R

    2004-09-01

    Two methods of analysis of knee kinematics from magnetic resonance images (MRI) in vivo have been developed independently: mapping the tibiofemoral contact, and tracking the femoral condylar centre. These two methods are compared for the assessment of kinematics in the healthy and the anterior cruciate ligament injured knee. Sagittal images of both knees of 20 subjects with unilateral anterior cruciate ligament injury were analysed. The subjects had performed a supine leg press against a 150 N load. Images were generated at 15 degrees intervals from 0 degrees to 90 degrees knee flexion. The tibiofemoral contact, and the centre of the femoral condyle (defined by the flexion facet centre (FFC)), were measured from the posterior tibial cortex. The pattern of contact in the healthy knee showed the femoral roll back from 0 degrees to 30 degrees, then from 30 degrees to 90 degrees the medial condyle rolled back little, while the lateral condyle continued to roll back on the tibial plateau. The contact pattern was more posterior in the injured knee (p=0.012), particularly in the lateral compartment. The medial FFC moved back very little during knee flexion, while the lateral FFC moved back throughout the flexion arc. The FFC was not significantly different in the injured knee (p=0.17). The contact and movement of the FFC both demonstrated kinematic events at the knee, such as longitudinal rotation. Both methods are relevant to design of total knee arthroplasty: movement of the FFC for consideration of axis alignment, and contact pattern for issues of interface wear and arthritic change in ligament injury. PMID:15304265

  15. The Patella Pro study — effect of a knee brace on patellofemoral pain syndrome: design of a randomized clinical trial (DRKS-ID:DRKS00003291)

    PubMed Central

    2014-01-01

    Background Patellofemoral pain syndrome (PFPS) is a frequent cause of anterior knee pain predominantly affecting young female patients who do not have significant chondral damage. Development of PFPS is probably multifactorial, involving various knee, hip, and foot kinematic factors. Biomechanical studies have described patellar maltracking and dynamic valgus (functional malalignment) in patients with patellofemoral pain syndrome. The literature provides evidence for short-term use of nonsteroidal anti-inflammatory drugs; short-term medially directed taping; and exercise programs focusing on the lower extremity, hip, and trunk muscles. Evidence supporting the use of patellar braces is limited because previous studies have been low quality. The aim of this article is to publish the design of a prospective randomized trial that examines the outcomes of patients with PFPS after treatment with a new patellar brace (Patella Pro) that applies medially directed force on the patella. Methods/Design For this multicenter trial, 156 patients (adolescents and young adults) with PFPS were recruited from orthopedic practices and orthopedic hospitals and randomly allocated to 3 months of supervised physiotherapy in combination with the Patella Pro brace or supervised physiotherapy alone. The primary outcome measures are pain (numerical analog scale); knee function (Kujala score and Knee Injury and Osteoarthritis Outcome Score); and self-reported perception of recovery at baseline, 6 weeks, 3 months, and 1 year. Discussion Only limited evidence for the use of a patellar brace for the treatment of PFPS exists in the literature. Disputable evidence for the use of orthoses for PFPS patients has been presented in one meta-analysis, in which only one of three studies found the effect of a medially directed patellar brace to be significant. Because of these low-quality studies, the authors concluded that this evidence should be regarded as limited, and we feel there is a need for

  16. Combined chondroitin sulfate and glucosamine for painful knee osteoarthritis: a multicentre, randomised, double-blind, non-inferiority trial versus celecoxib

    PubMed Central

    Hochberg, Marc C; Martel-Pelletier, Johanne; Monfort, Jordi; Möller, Ingrid; Castillo, Juan Ramón; Arden, Nigel; Berenbaum, Francis; Blanco, Francisco J; Conaghan, Philip G; Doménech, Gema; Henrotin, Yves; Pap, Thomas; Richette, Pascal; Sawitzke, Allen; du Souich, Patrick; Pelletier, Jean-Pierre

    2016-01-01

    Objectives To compare the efficacy and safety of chondroitin sulfate plus glucosamine hydrochloride (CS+GH) versus celecoxib in patients with knee osteoarthritis and severe pain. Methods Double-blind Multicentre Osteoarthritis interVEntion trial with SYSADOA (MOVES) conducted in France, Germany, Poland and Spain evaluating treatment with CS+GH versus celecoxib in 606 patients with Kellgren and Lawrence grades 2–3 knee osteoarthritis and moderate-to-severe pain (Western Ontario and McMaster osteoarthritis index (WOMAC) score ≥301; 0–500 scale). Patients were randomised to receive 400 mg CS plus 500 mg GH three times a day or 200 mg celecoxib every day for 6 months. The primary outcome was the mean decrease in WOMAC pain from baseline to 6 months. Secondary outcomes included WOMAC function and stiffness, visual analogue scale for pain, presence of joint swelling/effusion, rescue medication consumption, Outcome Measures in Rheumatology Clinical Trials and Osteoarthritis Research Society International (OMERACT-OARSI) criteria and EuroQoL-5D. Results The adjusted mean change (95% CI) in WOMAC pain was −185.7 (−200.3 to −171.1) (50.1% decrease) with CS+GH and −186.8 (−201.7 to −171.9) (50.2% decrease) with celecoxib, meeting the non-inferiority margin of −40: −1.11 (−22.0 to 19.8; p=0.92). All sensitivity analyses were consistent with that result. At 6 months, 79.7% of patients in the combination group and 79.2% in the celecoxib group fulfilled OMERACT-OARSI criteria. Both groups elicited a reduction >50% in the presence of joint swelling; a similar reduction was seen for effusion. No differences were observed for the other secondary outcomes. Adverse events were low and similarly distributed between groups. Conclusions CS+GH has comparable efficacy to celecoxib in reducing pain, stiffness, functional limitation and joint swelling/effusion after 6 months in patients with painful knee osteoarthritis, with a good safety profile. Trial

  17. The Effect of Gabapentin on Acute Postoperative Pain in Patients Undergoing Total Knee Arthroplasty: A Meta-Analysis.

    PubMed

    Zhai, Lifeng; Song, Zhoufeng; Liu, Kang

    2016-05-01

    The purpose of this systematic review and meta-analysis of randomized controlled trials (RCTs) and non-RCTs was to evaluate the efficacy and safety of gabapentin versus placebo for pain control after total knee arthroplasty (TKA).In December 2015, a systematic computer-based search was conducted in the Medline, Embase, PubMed, Cochrane Controlled Trials Register (CENTRAL), Web of Science, Google, and Chinese Wanfang databases. This systematic review and meta-analysis were performed according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement criteria. The primary endpoint was the visual analogue scale (VAS) score after TKA with rest or mobilization at 24 and 48 hours, representing the efficacy of pain control after TKA. Cumulative morphine consumption via patient controlled anesthesia (PCA) was also assessed to determine the morphine-spare effect. Complications such as dizziness, pruritus, vomiting, nausea, and sedation were also compiled to assess the safety of gabapentin. Stata 12.0 software was used for the meta-analysis. After testing for publication bias and heterogeneity across studies, the data were aggregated for random-effects modeling whenever necessary.Six studies involving 769 patients met the inclusion criteria. Our meta-analysis revealed that gabapentin resulted in superior pain relief compared to the control group in terms of VAS score with rest at 24 hours (mean difference [MD] = -3.47; 95% confidence interval [CI] -6.16 to -0.77; P = 0.012) and at 48 hours postoperatively (MD = -2.25; 95% CI -4.21 to -0.30; P = 0.024). There was no statistically significant difference between the groups with respect to the VAS score at 24 hours postoperatively (MD = 1.05; 95% CI -3.31 to 5.42; P = 0.636) or at 48 hours (MD = 1.71; 95% CI -0.74 to 4.15; P = 0.171). These results indicated that the perioperative administration of gabapentin decreases the cumulative morphine

  18. The Safety and Efficacy of an Enzyme Combination in Managing Knee Osteoarthritis Pain in Adults: A Randomized, Double-Blind, Placebo-Controlled Trial

    PubMed Central

    Bolten, Wolfgang W.; Glade, Michael J.; Raum, Sonja; Ritz, Barry W.

    2015-01-01

    This randomized, double-blind, placebo-controlled, and comparator-controlled trial evaluated the safety and efficacy of an enzyme combination, as Wobenzym, in adults with moderate-to-severe osteoarthritis (OA) of the knee. Adults (n = 150) received Wobenzym, diclofenac (a nonsteroidal anti-inflammatory drug, NSAID), or placebo for 12 weeks. Improvement in pain scores (Lequesne Functional Index) did not differ between subjects treated with Wobenzym or diclofenac, and both treatment groups improved compared to placebo (P < 0.05). Reduction in total WOMAC scores (secondary outcome measure) did not differ between Wobenzym and diclofenac, although only diclofenac emerged as different from placebo (P < 0.05). The median number of rescue medication (paracetamol) tablets consumed was less in the Wobenzym group compared to placebo (P < 0.05), while there was no difference between diclofenac and placebo. Adverse events were similar in frequency in Wobenzym and placebo groups (7.2% and 9.1% of subjects, resp.) and higher in diclofenac group (15.6%). Wobenzym is comparable to the NSAID diclofenac in relieving pain and increasing function in adults with moderate-to-severe painful knee OA and reduces reliance on analgesic medication. Wobenzym is associated with fewer adverse events and, therefore, may be appropriate for long-term use. PMID:25802756

  19. Pain

    MedlinePlus

    ... realize you have a medical problem that needs treatment. Once you take care of the problem, pain ... Fortunately, there are many ways to treat pain. Treatment varies depending on the cause of pain. Pain ...

  20. Mapping multidimensional pain experience onto electrophysiological responses to noxious laser heat stimuli.

    PubMed

    Stancak, Andrej; Cook, Stephanie; Wright, Hazel; Fallon, Nicholas

    2016-01-15

    The origin of the conscious experience of pain in the brain is a continuing enigma in neuroscience. To shed light on the brain representation of a multifaceted pain experience in humans, we combined multivariate analysis of subjective aspects of pain sensations with detailed, single-trial analysis of electrophysiological brain responses. Participants were asked to fully focus on any painful or non-painful sensations occurring in their left hand during an interval surrounding the onset of noxious laser heat stimuli, and to rate their sensations using a set of visual analogue scales. Statistical parametric mapping was used to compute a multivariate regression analysis of subjective responses and single-trial laser evoked potentials (LEPs) at subject and group levels. Standardized Low Resolution Electromagnetic Tomography method was used to reconstruct sources of LEPs. Factor analysis of subjective responses yielded five factors. Factor 1, representing pain, mapped firstly as a negative potential at the vertex and a positive potential at the fronto-temporal region during the 208-260ms interval, and secondly as a strong negative potential in the right lateral frontal and prefrontal scalp regions during the 1292-1340ms interval. Three other factors, labelled "anticipated pain", "stimulus onset time", and "body sensations", represented non-specific aspects of the pain experience, and explained portions of LEPs in the latency range from 200ms to 700ms. The subjective space of pain during noxious laser stimulation is represented by one large factor featuring pain intensity, and by other factors accounting for non-specific parts of the sensory experience. Pain is encoded in two separate latency components with different scalp and brain representations. PMID:26477652

  1. Effect of Intraoperative Platelet-Rich-Plasma Treatment on Post Operative Donor Site Knee Pain in Patellar Tendon Autograft ACL Reconstruction

    PubMed Central

    Walters, Brian L.; Hobart, Sarah; Porter, David; Hogan, Daniel E.; McHugh, Malachy P.; Bedford, Benjamin B.; Nicholas, Stephen J.; Klein, Devon; Harousseau, Kendall

    2016-01-01

    Objectives: Donor site morbidity in the form of anterior knee pain is a frequent complication after bone-patellar tendon-bone (BPTB) autograft ACL reconstruction. The purpose of this Level I study was to examine the effect of the intraoperative administration of platelet-rich plasma on post operative knee pain and patellar defect healing. Methods: Fifty-nine patients (29±12 y/o) undergoing BPTB ACL reconstruction and eligible to enter the study, were randomized to the treatment (PRP; n=31) or non treatment (sham n=28) arms of the study just prior to surgery. In either case, 10 cc of venous blood was drawn prior to the induction of anesthesia and either discarded (sham) or processed (PRP) for preparation of a PRP gel to be later mixed with donor site bone chips and inserted into the patellar defect. At 12 weeks and 6 months after surgery, patients completed IKDC forms and VAS pain scores for ADLs and kneeling (0-10 scale). Healing indices at the donor site were assessed by MRI at 6 months and included the following measurements taken from axial sequences: AP tendon dimensions at the level of the superior tibial cortex, roof of the intercondylar notch and width at the largest patella graft deficit. Mixed model ANOVA was used to assess the effect of PRP on patient symptoms and MRI indices of donor site healing. The primary dependent variable was VAS kneeling pain. It was estimated that with 25 patients per group there would be 80% power to detect a 1.5-point difference in kneeling pain between treatments at P<0.05. A between group difference of 1.5-points in VAS for kneeling pain was deemed to represent a clinically relevant difference. Results: VAS Kneeling Pain at 12 weeks tended to be lower in the PRP versus placebo group (4.5±3.6 vs. 6.2±2.4, P=0.051) but no difference was apparent at 6 months (3.7±3.2 vs. 4.4±2.9, P=0.41). Kneeling pain decreased from 12 weeks to 6 months (P<0.001) with a trend for a greater decrease in the placebo group (Time by Treatment P

  2. Relationship between frequent knee pain, obesity, and gait speed in older adults: data from the Osteoarthritis Initiative

    PubMed Central

    Bindawas, Saad M

    2016-01-01

    Background Knee pain (KP) causes gait difficulties in older adults and is associated with slow gait speed (GS). Obesity has negative effects on health. GS is an important indicator of health, well-being, and mean life span in older adults and is a strong predictor of future disability and mortality. The relationship between frequent KP, obesity, and GS in older adults remains unclear. Therefore, the present study aimed at examining the relationship between baseline frequent KP and obesity status on GS over time. We hypothesized that frequent KP, obesity, or both would be associated with decreased GS over time. Methods The data from the Osteoarthritis Initiative were used for this 6-year longitudinal cohort study. We studied 3,118 adults aged between 45 years and 79 years. We grouped the participants into the following four categories according to KP frequency and obesity status at baseline: 1) no KP and nonobese, 2) frequent KP and nonobese, 3) no KP and obese, and 4) frequent KP and obese. GS measurements were based on a 20 m walking test timed using a stopwatch; testing was performed at baseline and over a 6-year follow-up period. Walk pace (m/sec) was calculated as the average pace over two trials conducted at clinic visits. General linear mixed models were used to examine the relationships between frequent KP, obesity, and GS. Results After adjusting for all covariates, at baseline, all the nonobese group with frequent KP (β=−0.06, 95% confidence interval [CI]: −0.07 to −0.04), the obese group with no KP (β=−0.07, 95% CI: −0.1 to −0.04), and the obese group with frequent KP (β=−0.08, 95% CI: −0.1 to −0.05) exhibited decreased GS compared with the nonobese and no KP group. However, the associations between frequent KP, obesity, and GS over time were not statistically significant. Conclusion Frequent KP alone, obesity alone, and the combination of frequent KP and obesity were all associated with decreased GS in older adults. These

  3. The use of gabapentin in the management of postoperative pain after total knee arthroplasty: A PRISMA-compliant meta-analysis of randomized controlled trials.

    PubMed

    Han, Chao; Li, Xiao-Dan; Jiang, Hong-Qiang; Ma, Jian-Xiong; Ma, Xin-Long

    2016-06-01

    Pain management after total knee arthroplasty (TKA) varies and has been widely studied in recent years. Some randomized controlled studies have carried out to evaluate the effects of gabapentin on pain relief after TKA. However, no solid result was made about it. The purpose of this Meta-Analysis of Randomized Controlled Trials (RCTs) was to estimate the overall effect of pain control of gabapentin versus placebo after a TKA. An electronic-based search using the following databases: PubMed, EMBASE, Ovid MEDLINE, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trial from 1966 to June 2015. RCTs involving gabapentin and placebo for total knee arthroplasty were included. The meta-analysis was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Six trials with 859 participants met the inclusion criteria. The primary endpoint was cumulative narcotic consumption and the visual analog scale scores at 12 hours, 24 hours, and 48 hours, postoperatively. The knee flexion degree and treatment side effects were also compiled to evaluate the safety of gabapentin. After testing for the heterogeneity and publication bias among studies, data were aggregated for random-effects modeling when necessary. There was a significant decrease in morphine consumption at 12 hours (MD = -4.69, 95% CI: -7.18 to -2.21, P = 0.0002), 24 hours (MD = -5.30, 95% CI: -9.94 to -0.66, P = 0.03), and 48 hours (MD = -17.80, 95% CI: -31.95 to -3.64, P = 0.01), respectively. Compared with the control group, the rate of pruritus was less in the gabapentin group (RR 0.20, 95% CI 0.10 to 0.38, P = 0.00). In summary, the administration of gabapentin was effective in decreasing postoperative narcotic consumption and the incidence of pruritus. There was a high risk of selection bias and a higher heterogeneity of knee flexion range in this analysis. More high-quality large randomized controlled trials with long follow

  4. Patients with knee osteoarthritis demonstrate improved gait pattern and reduced pain following a non-invasive biomechanical therapy: a prospective multi-centre study on Singaporean population

    PubMed Central

    2014-01-01

    Background Previous studies have shown the effect of a unique therapy with a non-invasive biomechanical foot-worn device (AposTherapy) on Caucasian western population suffering from knee osteoarthritis. The purpose of the current study was to evaluate the effect of this therapy on the level of symptoms and gait patterns in a multi-ethnic Singaporean population suffering from knee osteoarthritis. Methods Fifty-eight patients with bilateral medial compartment knee osteoarthritis participated in the study. All patients underwent a computerized gait test and completed two self-assessment questionnaires (WOMAC and SF-36). The biomechanical device was calibrated to each patient, and therapy commenced. Changes in gait patterns and self-assessment questionnaires were reassessed after 3 and 6 months of therapy. Results A significant improvement was seen in all of the gait parameters following 6 months of therapy. Specifically, gait velocity increased by 15.9%, step length increased by 10.3%, stance phase decreased by 5.9% and single limb support phase increased by 2.7%. In addition, pain, stiffness and functional limitation significantly decreased by 68.3%, 66.7% and 75.6%, respectively. SF-36 physical score and mental score also increased significantly following 6 months of therapy (46.1% and 22.4%, respectively) (P < 0.05 for all parameters). Conclusions Singaporean population with medial compartment knee osteoarthritis demonstrated improved gait patterns, reported alleviation in symptoms and improved function and quality of life following 6 months of therapy with a unique biomechanical device. Trial registration Registration number NCT01562652. PMID:24383821

  5. Hip or knee replacement - after - what to ask your doctor

    MedlinePlus

    ... PA: Elsevier Mosby; 2012:chap 7. Read More Hip joint replacement Hip pain Knee joint replacement Knee pain ... joint replacement - discharge Taking care of your new hip joint Update Date 3/5/2015 Updated by: C. ...

  6. Hip or knee replacement - before - what to ask your doctor

    MedlinePlus

    ... PA: Elsevier Mosby; 2012:chap 7. Read More Hip joint replacement Hip pain Knee joint replacement Knee pain ... joint replacement - discharge Taking care of your new hip joint Update Date 3/5/2015 Updated by: C. ...

  7. Will 'Unloading' Shoes Help Your Arthritic Knees?

    MedlinePlus

    ... 160406.html Will 'Unloading' Shoes Help Your Arthritic Knees? Study puts specially designed footwear to the test ... 2016 (HealthDay News) -- For reducing pain from arthritic knees, "unloading" shoes don't offer a leg up ...

  8. Statistical mapping of the effect of knee extension on thigh muscle viscoelastic properties using magnetic resonance elastography.

    PubMed

    Barnhill, Eric; Kennedy, Paul; Hammer, Steven; van Beek, Edwin J R; Brown, Colin; Roberts, Neil

    2013-12-01

    Skeletal muscle viscoelastic properties reflect muscle microstructure and neuromuscular activation. Elastographic methods, including magnetic resonance elastography, have been used to characterize muscle viscoelastic properties in terms of region of interest (ROI) measurements. The present study extended this approach to create thresholded pixel-by-pixel maps of viscoelastic properties of skeletal muscle during rest and knee extension in eleven subjects. ROI measurements were taken for individual quadricep muscles and the quadriceps region as a whole, and the viscoelastic parameter map pixels were statistically tested at positive false discovery rate q ≤ 0.25. ROI measurements showed significant (p ≤ 0.05) increase in storage modulus (G') and loss modulus (G″), with G″ increasing more than G', in agreement with previous findings. The q-value maps further identified the vastus intermedius as the primary driver of this change, with greater G″/G' increase than surrounding regions. Additionally, a cluster of significant decrease in G″/G' was found in the region of vastus lateralis below the fulcrum point of the lift. Viscoelastic parameter mapping of contracted muscle allows new insight into the relationship between physiology, neuromuscular activation, and human performance. PMID:24254405

  9. Duloxetine in OsteoArthritis (DOA) study: study protocol of a pragmatic open-label randomised controlled trial assessing the effect of preoperative pain treatment on postoperative outcome after total hip or knee arthroplasty

    PubMed Central

    Blikman, T; Rienstra, W; van Raaij, T M; ten Hagen, A J; Dijkstra, B; Zijlstra, W P; Bulstra, S K; van den Akker-Scheek, I; Stevens, M

    2016-01-01

    Introduction Residual pain is a major factor in patient dissatisfaction following total hip arthroplasty or total knee arthroplasty (THA/TKA). The proportion of patients with unfavourable long-term residual pain is high, ranging from 7% to 34%. There are studies indicating that a preoperative degree of central sensitisation (CS) is associated with poorer postoperative outcomes and residual pain. It is thus hypothesised that preoperative treatment of CS could enhance postoperative outcomes. Duloxetine has been shown to be effective for several chronic pain syndromes, including knee osteoarthritis (OA), in which CS is most likely one of the underlying pain mechanisms. This study aims to evaluate the postoperative effects of preoperative screening and targeted duloxetine treatment of CS on residual pain compared with care-as-usual. Methods and analysis This multicentre, pragmatic, prospective, open-label, randomised controlled trial includes patients with idiopathic hip/knee OA who are on a waiting list for primary THA/TKA. Patients at risk for CS will be randomly allocated to the preoperative duloxetine treatment programme group or the care-as-usual control group. The primary end point is the degree of postoperative pain 6 months after THA/TKA. Secondary end points at multiple time points up to 12 months postoperatively are: pain, neuropathic pain-like symptoms, (pain) sensitisation, pain catastrophising, joint-associated problems, physical activity, health-related quality of life, depressive and anxiety symptoms, and perceived improvement. Data will be analysed on an intention-to-treat basis. Ethics and dissemination The study is approved by the local Medical Ethics Committee (METc 2014/087) and will be conducted according to the principles of the Declaration of Helsinki (64th, 2013) and the Good Clinical Practice standard (GCP), and in compliance with the Medical Research Involving Human Subjects Act (WMO). Trial registration number 2013-004313-41; Pre

  10. Within-Day Variability of Fatigue and Pain Among African Americans and Non-Hispanic Whites With Osteoarthritis of the Knee

    PubMed Central

    SMITH, DYLAN M.; PARMELEE, PATRICIA A.

    2016-01-01

    Objective Fatigue is common among persons with osteoarthritis (OA), but little is known about racial/ethnic differences in the prevalence, correlates, or dynamics of fatigue in OA. This research therefore used experience sampling methodology (ESM) to examine fatigue and pain at global and momentary levels among African Americans and non-Hispanic whites with OA. Methods Thirty-nine African Americans and 81 non-Hispanic whites with physician-diagnosed knee OA completed a baseline interview and an ESM protocol assessing fatigue, pain, and mood 4 times daily for 7 days. In addition to analyzing basic group differences, multilevel modeling examined within- versus between-subject patterns and correlates of variability in momentary fatigue, controlling for demographics and other potential confounders. Results Both racial groups experienced moderate levels of fatigue; however, there were clear individual differences in both mean fatigue level and variability across momentary assessments. Mean fatigue levels were associated with global pain and depression. Increase in fatigue over the course of the day was much stronger among non-Hispanic whites than African Americans. Momentary fatigue and pain were closely correlated. Mean fatigue predicted variability in mood; at the momentary level, both fatigue and pain were independently associated with mood. Conclusion Fatigue is a significant factor for both African Americans and non-Hispanic whites with OA, and is negatively related to quality of life. Pain symptoms, at both the momentary level and across individuals, were robust predictors of fatigue. Although overall levels of reported symptoms were similar across these 2 groups, the pattern of fatigue symptoms across the day differed. PMID:26315851

  11. Anterior knee pain

    MedlinePlus

    ... do a single leg squat to look at muscle imbalance and your core stability. X-rays are very often normal. However, ... both strengthen and stretch the quadriceps and hamstring muscles. ... your core. Lose weight (if you are overweight). Use special ...

  12. From Recollisions to the Knee: A Road Map for Double Ionization in Intense Laser Fields

    SciTech Connect

    Mauger, F.; Chandre, C.; Uzer, T.

    2010-01-29

    We examine the nature and statistical properties of electron-electron collisions in the recollision process in a strong laser field. The separation of the double ionization yield into sequential and nonsequential components leads to a bell-shaped curve for the nonsequential probability and a monotonically rising one for the sequential process. We identify key features of the nonsequential process and connect our findings in a simplified model which reproduces the knee shape for the probability of double ionization with laser intensity and associated trends.

  13. Local anaesthetic infiltration for peri-operative pain control in total hip and knee replacement: systematic review and meta-analyses of short- and long-term effectiveness

    PubMed Central

    2014-01-01

    Background Surgical pain is managed with multi-modal anaesthesia in total hip replacement (THR) and total knee replacement (TKR). It is unclear whether including local anaesthetic infiltration before wound closure provides additional pain control. Methods We performed a systematic review of randomised controlled trials of local anaesthetic infiltration in patients receiving THR or TKR. We searched MEDLINE, Embase and Cochrane CENTRAL to December 2012. Two reviewers screened abstracts, extracted data, and contacted authors for unpublished outcomes and data. Outcomes collected were post-operative pain at rest and during activity after 24 and 48 hours, opioid requirement, mobilisation, hospital stay and complications. When feasible, we estimated pooled treatment effects using random effects meta-analyses. Results In 13 studies including 909 patients undergoing THR, patients receiving local anaesthetic infiltration experienced a greater reduction in pain at 24 hours at rest by standardised mean difference (SMD) -0.61 (95% CI -1.05, -0.16; p = 0.008) and by SMD -0.43 (95% CI -0.78 -0.09; p = 0.014) at 48 hours during activity. In TKR, diverse multi-modal regimens were reported. In 23 studies including 1439 patients undergoing TKR, local anaesthetic infiltration reduced pain on average by SMD -0.40 (95% CI -0.58, -0.22; p < 0.001) at 24 hours at rest and by SMD -0.27 (95% CI -0.50, -0.05; p = 0.018) at 48 hours during activity, compared with patients receiving no infiltration or placebo. There was evidence of a larger reduction in studies delivering additional local anaesthetic after wound closure. There was no evidence of pain control additional to that provided by femoral nerve block. Patients receiving local anaesthetic infiltration spent on average an estimated 0.83 (95% CI 1.54, 0.12; p = 0.022) and 0.87 (95% CI 1.62, 0.11; p = 0.025) fewer days in hospital after THR and TKR respectively, had reduced opioid consumption, earlier

  14. Intra-Articular Injections of Platelet-Rich Plasma versus Hyaluronic Acid in the Treatment of Osteoarthritic Knee Pain: A Randomized Clinical Trial in the Context of the Spanish National Health Care System.

    PubMed

    Montañez-Heredia, Elvira; Irízar, Sofia; Huertas, Pedro J; Otero, Esperanza; Del Valle, Marta; Prat, Isidro; Díaz-Gallardo, Macarena S; Perán, Macarena; Marchal, Juan A; Hernandez-Lamas, María Del Carmen

    2016-01-01

    Intra-articular injection of platelet-rich plasma (PRP) has been established as a suitable treatment for knee osteoarthritis. Here, we present a double-blind randomized controlled clinical trial, conducted in a public Hospital of the Spanish National Health Care System, to evaluate the efficacy of injecting autologous PRP versus hyaluronic acid (HA) in knee osteoarthritis. PRP was manufactured in Malaga's Regional Blood Center (Spain). Patients that met the eligibility criteria were randomized into a PRP group or a HA group. Pain and functional improvements were assessed pre- and post-treatment (three and six months follow-up) using the Visual Analogue Scale (VAS); the Knee and Osteoarthritis Outcome System (KOOS) scale and the European Quality of Life scale (EUROQOL). Both groups presented pain reduction at six months. The VAS scores for the PRP group improved by at least 50% from their initial value, particularly at three months following the final infiltration, with results resembling those of the HA group at six months. PRP was more effective in patients with lower osteoarthritis grades. Both treatments improved pain in knee osteoarthritis patients without statistically significant differences between them. However, PRP injection was proved to improve pain three months after the final infiltration and to be more effective in lower osteoarthritis grades. PMID:27384560

  15. Intra-Articular Injections of Platelet-Rich Plasma versus Hyaluronic Acid in the Treatment of Osteoarthritic Knee Pain: A Randomized Clinical Trial in the Context of the Spanish National Health Care System

    PubMed Central

    Montañez-Heredia, Elvira; Irízar, Sofia; Huertas, Pedro J.; Otero, Esperanza; del Valle, Marta; Prat, Isidro; Díaz-Gallardo, Macarena S.; Perán, Macarena; Marchal, Juan A.; Hernandez-Lamas, María del Carmen

    2016-01-01

    Intra-articular injection of platelet-rich plasma (PRP) has been established as a suitable treatment for knee osteoarthritis. Here, we present a double-blind randomized controlled clinical trial, conducted in a public Hospital of the Spanish National Health Care System, to evaluate the efficacy of injecting autologous PRP versus hyaluronic acid (HA) in knee osteoarthritis. PRP was manufactured in Malaga’s Regional Blood Center (Spain). Patients that met the eligibility criteria were randomized into a PRP group or a HA group. Pain and functional improvements were assessed pre- and post-treatment (three and six months follow-up) using the Visual Analogue Scale (VAS); the Knee and Osteoarthritis Outcome System (KOOS) scale and the European Quality of Life scale (EUROQOL). Both groups presented pain reduction at six months. The VAS scores for the PRP group improved by at least 50% from their initial value, particularly at three months following the final infiltration, with results resembling those of the HA group at six months. PRP was more effective in patients with lower osteoarthritis grades. Both treatments improved pain in knee osteoarthritis patients without statistically significant differences between them. However, PRP injection was proved to improve pain three months after the final infiltration and to be more effective in lower osteoarthritis grades. PMID:27384560

  16. Effect of integrated yoga therapy on pain, morning stiffness and anxiety in osteoarthritis of the knee joint: A randomized control study

    PubMed Central

    Ebnezar, John; Nagarathna, Raghuram; Yogitha, Bali; Nagendra, Hongasandra Ramarao

    2012-01-01

    Aim: To study the effect of integrated yoga on pain, morning stiffness and anxiety in osteoarthritis of knees. Materials and Methods: Two hundred and fifty participants with OA knees (35–80 years) were randomly assigned to yoga or control group. Both groups had transcutaneous electrical stimulation and ultrasound treatment followed by intervention (40 min) for two weeks with follow up for three months. The integrated yoga consisted of yogic loosening and strengthening practices, asanas, relaxation, pranayama and meditation. The control group had physiotherapy exercises. Assessments were done on 15th (post 1) and 90th day (post 2). Results: Resting pain (numerical rating scale) reduced better (P<0.001, Mann–Whitney U test) in yoga group (post 1=33.6% and post 2=71.8%) than control group (post 1=13.4% and post 2=37.5%). Morning stiffness decreased more (P<0.001) in yoga (post 1=68.6% and post 2=98.1%) than control group (post 1=38.6% and post 2=71.6%). State anxiety (STAI-1) reduced (P<0.001) by 35.5% (post 1) and 58.4% (post 2) in the yoga group and 15.6% (post 1) and 38.8% (post 2) in the control group; trait anxiety (STAI 2) reduced (P<0.001) better (post 1=34.6% and post 2=57.10%) in yoga than control group (post 1=14.12% and post 2=34.73%). Systolic blood pressure reduced (P<0.001) better in yoga group (post 1=−7.93% and post 2=−15.7%) than the control group (post 1=−1.8% and post 2=−3.8%). Diastolic blood pressure reduced (P<0.001) better in yoga group (post 1=−7.6% and post 2=−16.4%) than the control group (post 1=−2.1% and post 2=−5.0%). Pulse rate reduced (P<0.001) better in yoga group (post 1=−8.41% and post 2=−12.4%) than the control group (post 1=−5.1% and post 2=−7.1%). Conclusion: Integrated approach of yoga therapy is better than physiotherapy exercises as an adjunct to transcutaneous electrical stimulation and ultrasound treatment in reducing pain, morning stiffness, state and trait anxiety, blood pressure and pulse rate in

  17. Rapid In Vivo Multicomponent T2 Mapping of Human Knee Menisci

    PubMed Central

    Liu, Fang; Samsonov, Alexey; Wilson, John J.; Blankenbaker, Donna G.; Block, Walter F.; Kijowski, Richard

    2016-01-01

    Purpose To compare multicomponent T2 parameters of menisci measured using Multicomponent Driven Equilibrium Single Pulse Observation of T1 and T2 (mcDESPOT) in asymptomatic volunteers and osteoarthritis (OA) patients with intact and torn menisci. Materials and Methods The prospective study was performed with Institutional Review Board approval and with all subjects signing written informed consent. mcDESPOT was performed on the knee joint of 12 asymptomatic volunteers and 14 patients with knee OA. Single-component T2 relaxation time (T2Single), T2 relaxation time of the fast relaxing water component (T2F), and the slow relaxing water component (T2S), and fraction of the fast relaxing water component (FF) of the medial and lateral menisci were measured. Multivariate linear regression models were used to compare mcDESPOT parameters between normal menisci in asymptomatic volunteers, intact menisci in OA patients, and torn menisci in OA patients with adjustment for differences in age between subjects. Results The mean mcDESPOT parameters for normal menisci in asymptomatic volunteers, intact menisci in OA patients, and torn menisci in OA patients were respectively 16.1 msec, 18.8 msec, and 22.7 msec for T2Single; 9.0 msec, 10.0 msec, and 11.1 msec for T2F; 24.4 msec, 27.7 msec, and 31.4 msec for T2S; and 34%, 32%, 27% for FF. There were significant differences (P<0.05) in T2Single, T2F, T2S, and FF between the three groups of menisci. Conclusion The menisci of OA patients had significantly higher T2Single, T2F, and T2S and significantly lower FF than normal menisci in asymptomatic volunteers with greater changes in multicomponent T2 parameters noted in torn than intact menisci in OA patients. PMID:25847733

  18. Patellofemoral Pain.

    PubMed

    Dutton, Rebecca A; Khadavi, Michael J; Fredericson, Michael

    2016-02-01

    Patellofemoral pain is characterized by insidious onset anterior knee pain that is exaggerated under conditions of increased patellofemoral joint stress. A variety of risk factors may contribute to the development of patellofemoral pain. It is critical that the history and physical examination elucidate those risk factors specific to an individual in order to prescribe an appropriate and customized treatment plan. This article aims to review the epidemiology, risk factors, diagnosis, and management of patellofemoral pain. PMID:26616176

  19. Short-term efficacy of physical interventions in osteoarthritic knee pain. A systematic review and meta-analysis of randomised placebo-controlled trials

    PubMed Central

    Bjordal, Jan M; Johnson, Mark I; Lopes-Martins, Rodrigo AB; Bogen, Bård; Chow, Roberta; Ljunggren, Anne E

    2007-01-01

    Background Treatment efficacy of physical agents in osteoarthritis of the knee (OAK) pain has been largely unknown, and this systematic review was aimed at assessing their short-term efficacies for pain relief. Methods Systematic review with meta-analysis of efficacy within 1–4 weeks and at follow up at 1–12 weeks after the end of treament. Results 36 randomised placebo-controlled trials (RCTs) were identified with 2434 patients where 1391 patients received active treatment. 33 trials satisfied three or more out of five methodological criteria (Jadad scale). The patient sample had a mean age of 65.1 years and mean baseline pain of 62.9 mm on a 100 mm visual analogue scale (VAS). Within 4 weeks of the commencement of treatment manual acupuncture, static magnets and ultrasound therapies did not offer statistically significant short-term pain relief over placebo. Pulsed electromagnetic fields offered a small reduction in pain of 6.9 mm [95% CI: 2.2 to 11.6] (n = 487). Transcutaneous electrical nerve stimulation (TENS, including interferential currents), electro-acupuncture (EA) and low level laser therapy (LLLT) offered clinically relevant pain relieving effects of 18.8 mm [95% CI: 9.6 to 28.1] (n = 414), 21.9 mm [95% CI: 17.3 to 26.5] (n = 73) and 17.7 mm [95% CI: 8.1 to 27.3] (n = 343) on VAS respectively versus placebo control. In a subgroup analysis of trials with assumed optimal doses, short-term efficacy increased to 22.2 mm [95% CI: 18.1 to 26.3] for TENS, and 24.2 mm [95% CI: 17.3 to 31.3] for LLLT on VAS. Follow-up data up to 12 weeks were sparse, but positive effects seemed to persist for at least 4 weeks after the course of LLLT, EA and TENS treatment was stopped. Conclusion TENS, EA and LLLT administered with optimal doses in an intensive 2–4 week treatment regimen, seem to offer clinically relevant short-term pain relief for OAK. PMID:17587446

  20. New perspectives in EEG/MEG brain mapping and PET/fMRI neuroimaging of human pain.

    PubMed

    Chen, A C

    2001-10-01

    With the maturation of EEG/MEG brain mapping and PET/fMRI neuroimaging in the 1990s, greater understanding of pain processing in the brain now elucidates and may even challenge the classical theory of pain mechanisms. This review scans across the cultural diversity of pain expression and modulation in man. It outlines the difficulties in defining and studying human pain. It then focuses on methods of studying the brain in experimental and clinical pain, the cohesive results of brain mapping and neuroimaging of noxious perception, the implication of pain research in understanding human consciousness and the relevance to clinical care as well as to the basic science of human psychophysiology. Non-invasive brain studies in man start to unveil the age-old puzzles of pain-illusion, hypnosis and placebo in pain modulation. The neurophysiological and neurohemodynamic brain measures of experimental pain can now largely satisfy the psychophysiologist's dream, unimaginable only a few years ago, of modelling the body-brain, brain-mind, mind-matter duality in an inter-linking 3-P triad: physics (stimulus energy); physiology (brain activities); and psyche (perception). For neuropsychophysiology greater challenges lie ahead: (a) how to integrate a cohesive theory of human pain in the brain; (b) what levels of analyses are necessary and sufficient; (c) what constitutes the structural organisation of the pain matrix; (d) what are the modes of processing among and across the sites of these structures; and (e) how can neural computation of these processes in the brain be carried out? We may envision that modular identification and delineation of the arousal-attention, emotion-motivation and perception-cognition neural networks of pain processing in the brain will also lead to deeper understanding of the human mind. Two foreseeable impacts on clinical sciences and basic theories from brain mapping/neuroimaging are the plausible central origin in persistent pain and integration of

  1. Microglial Signaling in Chronic Pain with a Special Focus on Caspase 6, p38 MAP Kinase, and Sex Dependence.

    PubMed

    Berta, T; Qadri, Y J; Chen, G; Ji, R R

    2016-09-01

    Microglia are the resident immune cells in the spinal cord and brain. Mounting evidence suggests that activation of microglia plays an important role in the pathogenesis of chronic pain, including chronic orofacial pain. In particular, microglia contribute to the transition from acute pain to chronic pain, as inhibition of microglial signaling reduces pathologic pain after inflammation, nerve injury, and cancer but not baseline pain. As compared with inflammation, nerve injury induces much more robust morphologic activation of microglia, termed microgliosis, as shown by increased expression of microglial markers, such as CD11b and IBA1. However, microglial signaling inhibitors effectively reduce inflammatory pain and neuropathic pain, arguing against the importance of morphologic activation of microglia in chronic pain sensitization. Importantly, microglia enhance pain states via secretion of proinflammatory and pronociceptive mediators, such as tumor necrosis factor α, interleukins 1β and 18, and brain-derived growth factor. Mechanistically, these mediators have been shown to enhance excitatory synaptic transmission and suppress inhibitory synaptic transmission in the pain circuits. While early studies suggested a predominant role of microglia in the induction of chronic pain, further studies have supported a role of microglia in the maintenance of chronic pain. Intriguingly, recent studies show male-dominant microglial signaling in some neuropathic pain and inflammatory pain states, although both sexes show identical morphologic activation of microglia after nerve injury. In this critical review, we provide evidence to show that caspase 6-a secreted protease that is expressed in primary afferent axonal terminals surrounding microglia-is a robust activator of microglia and induces profound release of tumor necrosis factor α from microglia via activation of p38 MAP kinase. The authors also show that microglial caspase 6/p38 signaling is male dominant in some

  2. Neck Pain

    MedlinePlus

    ... get better. No 7. Did you have a whiplash-type injury in the past, or do you have pain and/or stiffness every day in your neck, hands, knees, hips or other joints? Yes Your pain may be from DEGENERATIVE CERVICAL ARTHRITIS, a disorder that affects the bones and ...

  3. How do people with knee osteoarthritis use osteoarthritis pain medications and does this change over time? Data from the Osteoarthritis Initiative

    PubMed Central

    2013-01-01

    Introduction The aim of this analysis was to describe comprehensively the cross-sectional and longitudinal patterns of analgesic and nutraceutical medication use for knee osteoarthritis (OA) in a contemporary US cohort and to investigate associated demographic and clinical factors. Methods Baseline, 12, 24 and 36 month data were obtained retrospectively from the National Institutes of Health Osteoarthritis Initiative. Participants had symptomatic radiographic knee OA. Multiple binary logistic regression models identified characteristics independently associated with the use of analgesics or nutraceuticals. Results We included 987 subjects (55.9% female, mean age 61.5 years, 71.0% white). At baseline, 68.2% reported frequent use of a conventional analgesic or nutraceutical for joint pain (for more than half of the previous month). Non-prescription non-steroidal anti-inflammatory drugs (NSAIDs) were the most frequently reported medications (26.8%), even in those more than 75-years old. Multiple conventional analgesics were used by 11.9%. Frequent analgesic use was more likely in women (odds ratio (OR) 1.8 (95% confidence interval (CI) 1.3 to 2.3)) and people with more pain (moderate 1.7 (1.2 to 2.4); severe 3.1 (2.1 to 4.7)); nutraceutical use was less likely in non-whites (0.4 (0.3 to 0.6)), those more than 74-years old (0.6 (0.3 to 0.9)) and those with comorbidities (0.6 (0.5 to 0.9)) and more likely in people with Kellgren-Lawrence (KL) grade 4 (2.2 (1.5 to 3.3)). Overall there was no change in the proportion of participants frequently using prescription or over the counter (OTC) analgesics at 36 months, although most people had changed medication type; of those using a traditional analgesic at baseline approximately one third were still using the same type at 36 months (ranging from 26.2% of baseline prescription NSAID users to 40.6% of baseline acetaminophen users). All participants reporting baseline analgesic use also reported 36 month analgesic use. Female

  4. Application of Infrared Thermography as a Diagnostic Tool of Knee Osteoarthritis

    NASA Astrophysics Data System (ADS)

    Arfaoui, Ahlem; Bouzid, Mohamed Amine; Pron, Hervé; Taiar, Redha; Polidori, Guillaume

    This paper aimed to study the feasibility of application of infrared thermography to detect osteoarthritis of the knee and to compare the distribution of skin temperature between participants with osteoarthritis and those without pathology. All tests were conducted at LACM (Laboratory of Mechanical Stresses Analysis) and the gymnasium of the University of Reims Champagne Ardennes. IR thermography was performed using an IR camera. Ten participants with knee osteoarthritis and 12 reference healthy participants without OA participated in this study. Questionnaires were also used. The participants with osteoarthritis of the knee were selected on clinical examination and a series of radiographs. The level of pain was recorded by using a simple verbal scale (0-4). Infrared thermography reveals relevant disease by highlighting asymmetrical behavior in thermal color maps of both knees. Moreover, a linear evolution of skin temperature in the knee area versus time has been found whatever the participant group is in the first stage following a given effort. Results clearly show that the temperature can be regarded as a key parameter for evaluating pain. Thermal images of the knee were taken with an infrared camera. The study shows that with the advantage of being noninvasive and easily repeatable, IRT appears to be a useful tool to detect quantifiable patterns of surface temperatures and predict the singular thermal behavior of this pathology. It also seems that this non-intrusive technique enables to detect the early clinical manifestations of knee OA.

  5. A Predictive Model to Estimate Knee-Abduction Moment: Implications for Development of a Clinically Applicable Patellofemoral Pain Screening Tool in Female Athletes

    PubMed Central

    Myer, Gregory D.; Ford, Kevin R.; Foss, Kim D. Barber; Rauh, Mitchell J.; Paterno, Mark V.; Hewett, Timothy E.

    2014-01-01

    Context: Prospective measures of high external knee-abduction moment (KAM) during landing identify female athletes at increased risk of patellofemoral pain (PFP). A clinically applicable screening protocol is needed. Objective: To identify biomechanical laboratory measures that would accurately quantify KAM loads during landing that predict increased risk of PFP in female athletes and clinical correlates to laboratory-based measures of increased KAM status for use in a clinical PFP injury-risk prediction algorithm. We hypothesized that we could identify clinical correlates that combine to accurately determine increased KAM associated with an increased risk of developing PFP. Design: Descriptive laboratory study. Setting: Biomechanical laboratory. Patients or Other Participants: Adolescent female basketball and soccer players (n = 698) from a single-county public school district. Main Outcome Measure(s): We conducted tests of anthropometrics, maturation, laxity, flexibility, strength, and landing biomechanics before each competitive season. Pearson correlation and linear and logistic regression modeling were used to examine high KAM (>15.4 Nm) compared with normal KAM as a surrogate for PFP injury risk. Results: The multivariable logistic regression model that used the variables peak knee-abduction angle, center-of-mass height, and hip rotational moment excursion predicted KAM associated with PFP risk (>15.4 NM of KAM) with 92% sensitivity and 74% specificity and a C statistic of 0.93. The multivariate linear regression model that included the same predictors accounted for 70% of the variance in KAM. We identified clinical correlates to laboratory measures that combined to predict high KAM with 92% sensitivity and 47% specificity. The clinical prediction algorithm, including knee-valgus motion (odds ratio [OR] = 1.46, 95% confidence interval [CI] = 1.31, 1.63), center-of-mass height (OR = 1.21, 95% CI = 1.15, 1.26), and hamstrings strength/body fat percentage (OR

  6. Knee Bracing: What Works?

    MedlinePlus

    MENU Return to Web version Knee Bracing: What Works? Knee Bracing: What Works? What are knee braces? Knee braces are supports ... have arthritis in their knees. Do knee braces work? Maybe. Companies that make knee braces claim that ...

  7. Investigation the efficacy of intra-articular prolotherapy with erythropoietin and dextrose and intra-articular pulsed radiofrequency on pain level reduction and range of motion improvement in primary osteoarthritis of knee

    PubMed Central

    Rahimzadeh, Poupak; Imani, Farnad; Faiz, Seyed Hamid Reza; Entezary, Saeed Reza; Nasiri, Ali Akbar; Ziaeefard, Mohsen

    2014-01-01

    Background: Osteoarthritis is one of the most common diseases and the knee is the most commonly affected joint. Intra-articular prolotherapy is being utilized in acute and chronic pain management setting. This study was designed to compare the efficacy of three methods of intra-articular knee joint therapies with erythropoietin, dextrose, and pulsed radiofrequency. Materials and Methods: After approval by the Ethics Committee and explaining the therapeutic method to volunteers, 70 patients who were suffering from primary knee osteoarthrosis went through one of the treatment methods (erythropoietin, dextrose, and pulsed radiofrequency). The study was double-blind randomized clinical trial performed from December 2012 to July 2013. Patients’ pain level was assessed through the visual analog pain scale (VAS), and range of motion (ROM) was measured by goniometric method. Furthermore, patients’ satisfaction was assessed before and after different treatment methods in weeks 2, 4, and 12. For analysis, Chi-square, one-way ANOVA, and repeated measured ANOVA were utilized. Results: The demographic results among the three groups did not indicate any statistical difference. The mean VAS in erythropoietin group in the 2nd, 4th, and 12th weeks was 3.15 ± 1.08, 3.15 ± 1.08, and 3.5 ± 1.23, respectively (P ≤ 0.005). Knee joint ROM in the erythropoietin group in the 2nd, 4th, and 12th weeks was 124 ± 1.50, 124 ± 1.4, and 123 ± 1.53 respectively (P ≤ 0.005). Satisfaction score in the 12th week in erythropoietin group was extremely satisfied 15%, satisfied 55%, and moderately satisfied 30%, (P = 0.005). No specific side-effects were observed. Conclusion: Intra-articular prolotherapy with erythropoietin was more effective in terms of pain level reduction and ROM improvement compared with dextrose and pulsed radiofrequency. PMID:25422652

  8. Pressure pain mapping of the wrist extensors after repeated eccentric exercise at high intensity.

    PubMed

    Delfa de la Morena, José M; Samani, Afshin; Fernández-Carnero, Josué; Hansen, Ernst A; Madeleine, Pascal

    2013-11-01

    The purpose of this study was to investigate adaptation mechanisms after 2 test rounds consisting of eccentric exercise using pressure pain imaging of the wrist extensors. Pressure pain thresholds (PPTs) were assessed over 12 points forming a 3 × 4 matrix over the dominant elbow in 12 participants. From the PPT assessments, pressure pain maps were computed. Delayed onset muscle soreness was induced in an initial test round of high-intensity eccentric exercise. The second test round performed 7 days later aimed at resulting in adaptation. The PPTs were assessed before, immediately after, and 24 hours after the 2 test rounds of eccentric exercise. For the first test round, the mean PPT was significantly lower 24 hours after exercise compared with before exercise (389.5 ± 64.1 vs. 500.5 ± 66.4 kPa, respectively; p = 0.02). For the second test round, the PPT was similar before and 24 hours after (447.7 ± 51.3 vs. 458.0 ± 73.1 kPa, respectively; p = 1.0). This study demonstrated adaptive effects of the wrist extensors monitored by pain imaging technique in healthy untrained humans. A lack of hyperalgesia, i.e., no decrease in PPT underlined adaptation after the second test round of eccentric exercise performed 7 days after the initial test round. The present findings showed for the first time that repeated eccentric exercise performed twice over 2 weeks protects the wrist extensor muscles from developing exacerbated pressure pain sensitivity. Thus, the addition of eccentric components to training regimens should be considered to induce protective adaptation. PMID:23442281

  9. Automated techniques for visualization and mapping of articular cartilage in MR images of the osteoarthritic knee: a base technique for the assessment of microdamage and submicro damage.

    PubMed

    Cashman, Peter M M; Kitney, Richard I; Gariba, Munir A; Carter, Mary E

    2002-03-01

    The purpose of this paper is to describe automated techniques for the visualization and mapping of articular cartilage in magnetic resonance (MR) images of the osteoarthritic knee. The MR sequences and analysis software which will be described allow the assessment of cartilage damage using a range of standard scanners. With high field strength systems it would be possible, using these techniques, to assess micro-damage. The specific aim of the paper is to develop and validate software for automated segmentation and thickness mapping of articular cartilage from three-dimensional (3-D) gradient-echo MR images of the knee. The method can also be used for MR-based assessment of tissue engineered grafts. Typical values of cartilage thickness over seven defined regions can be obtained in patients with osteoarthritis (OA) and control subjects without OA. Three groups of patients were studied. The first group comprised patients with moderate OA in the age range 45-73 years. The second group comprised asymptomatic volunteers of 50-65 years; the third group, younger volunteers selected by clinical interview, history and X-ray. In this paper, sagittal 3-D spoiled-gradient steady-state acquisition images were obtained using a 1.5-T GE whole-body scanner with a specialist knee coil. For validation bovine and porcine cadaveric knees were given artificial cartilage lesions and then imaged. The animal validations showed close agreement between direct lesion measurements and those obtained from the MR images. The feasibility of semi-automated segmentation is demonstrated. Regional cartilage thickness values are seen as having practical application for fully automated detection of OA lesions even down to the submicrometer level. PMID:16689221

  10. The Effectiveness of Thai Exercise with Traditional Massage on the Pain, Walking Ability and QOL of Older People with Knee Osteoarthritis: A Randomized Controlled Trial in the Community.

    PubMed

    Peungsuwan, Punnee; Sermcheep, Phawinee; Harnmontree, Papatsara; Eungpinichpong, Wichai; Puntumetakul, Rungthip; Chatchawan, Uraiwan; Yamauchi, Junichiro

    2014-01-01

    [Purpose] This study investigated the effectiveness of a class- and home-based exercise with massage between Thai traditional and standardized physical therapy (TPT and SPT) in older people with knee osteoarthritis (KOA). [Subjects and Methods] Thirty-one subjects with KOA (aged 50-85 years) in two selected villages were randomly assigned into the TPT or SPT programs. Seventeen TPT subjects received Thai exercise with traditional massage, and 14 SPT individuals performed strengthening exercise with Swedish massage. Both programs consisted of a class with supervision plus home self-care for 8 weeks; the subjects then managed home self-care for 1 year. [Results] After 2 months, the six-minute walk test (6MWT), Western Ontario and McMaster Universities Arthritis Index (WOMAC), and SF-36 testing showed significant improvement in both groups, but the improvement of the TPT group was greater. After 1year, only the score for the 6MWT was greater in the TPT group than in the SPT group. [Conclusion] The TPT program yielded better results for the 6MWT, but, both programs had beneficial effects on the pain, function, and QOL of middle-aged and older patients with KOA in the community setting. PMID:24567694

  11. The Effectiveness of Thai Exercise with Traditional Massage on the Pain, Walking Ability and QOL of Older People with Knee Osteoarthritis: A Randomized Controlled Trial in the Community

    PubMed Central

    Peungsuwan, Punnee; Sermcheep, Phawinee; Harnmontree, Papatsara; Eungpinichpong, Wichai; Puntumetakul, Rungthip; Chatchawan, Uraiwan; Yamauchi, Junichiro

    2014-01-01

    [Purpose] This study investigated the effectiveness of a class- and home-based exercise with massage between Thai traditional and standardized physical therapy (TPT and SPT) in older people with knee osteoarthritis (KOA). [Subjects and Methods] Thirty-one subjects with KOA (aged 50–85 years) in two selected villages were randomly assigned into the TPT or SPT programs. Seventeen TPT subjects received Thai exercise with traditional massage, and 14 SPT individuals performed strengthening exercise with Swedish massage. Both programs consisted of a class with supervision plus home self-care for 8 weeks; the subjects then managed home self-care for 1 year. [Results] After 2 months, the six-minute walk test (6MWT), Western Ontario and McMaster Universities Arthritis Index (WOMAC), and SF-36 testing showed significant improvement in both groups, but the improvement of the TPT group was greater. After 1year, only the score for the 6MWT was greater in the TPT group than in the SPT group. [Conclusion] The TPT program yielded better results for the 6MWT, but, both programs had beneficial effects on the pain, function, and QOL of middle-aged and older patients with KOA in the community setting. PMID:24567694

  12. Alpine Skiing With total knee ArthroPlasty (ASWAP): physical self-concept, pain, and life satisfaction.

    PubMed

    Amesberger, G; Müller, E; Würth, S

    2015-08-01

    Physical self-concept in the elderly is assumed to be structured in terms of different domains and to contribute substantially to life satisfaction. However, little is known about the role of the physical self-concept in older persons that are engaged in physical activity while suffering from typical age-related impairments or chronic diseases. The present study aimed to investigate the structure of physical self-concept in a group of older persons with total knee arthroplasty (TKA), its development throughout a 12-week skiing intervention, and its importance to life satisfaction. Factor analyses of the present data reveal that the physical self-concept consists of four dimensions addressing strength, flexibility/coordination, endurance, and sportiness. One higher order factor extracted by hierarchical factor analyses reflects a global physical self-concept. The 12-week skiing intervention had no substantial impact in terms of an improvement of self-concept. Life satisfaction is best predicted by positive changes in the subjective ratings between pre- and post-test (i.e., global physical self-concept, flexibility and coordination, and perceived sportiness) and not by objective physical performance (isokinetic strength, endurance, or coordination). Results support the assumption that physical self-concept of older people with TKA is only marginally sensitive to a 12-week skiing intervention. PMID:26083706

  13. Radiosynovectomy of Painful Synovitis of Knee Joints Due to Rheumatoid Arthritis by Intra-Articular Administration of (177)Lu-Labeled Hydroxyapatite Particulates: First Human Study and Initial Indian Experience.

    PubMed

    Shinto, Ajit S; Kamaleshwaran, K K; Chakraborty, Sudipta; Vyshakh, K; Thirumalaisamy, S G; Karthik, S; Nagaprabhu, V N; Vimalnath, K V; Das, Tapas; Banerjee, Sharmila

    2015-01-01

    The aim of this study is to assess the effectiveness of Radiosynovectomy (RSV) using (177)Lu-labeled hydroxyapatite ((177)Lu-HA) in the treatment of painful synovitis and recurrent joint effusion of knee joints in rheumatoid arthritis (RA). Ten patients, diagnosed with RA and suffering from chronic painful resistant synovitis of the knee joints were referred for RSV. The joints were treated with 333 ± 46 MBq of (177)Lu-HA particles administered intra-articularly. Monitoring of activity distribution was performed by static imaging of knee joint and whole-body gamma imaging. The patients were evaluated clinically before RSV and at 6 months after the treatment by considering the pain improvement from baseline values in terms of a 100-point visual analog scale (VAS), the improvement of knee flexibility and the pain remission during the night. RSV response was classified as poor (VAS < 25), fair (VAS ≥ 25-50), good (VAS ≥ 50-75) and excellent (VAS ≥ 75), with excellent and good results considered to be success, while fair and poor as failure and also by range of motion. Three phase bone scan (BS) was repeated after 6 months and changes in the second phase of BS3 were assessed visually, using a four-degree scale and in the third phase, semiquantitatively with J/B ratio to see the response. Biochemical analysis of C-reactive protein (CRP) and fibrinogen was repeated after 48 h, 4 and 24 weeks. In all 10 patients, no leakage of administered activity to nontarget organs was visible in the whole-body scan. Static scans of the joint at 1 month revealed complete retention of (177)Lu-HA in the joints. All patients showed decreased joint swelling and pains, resulting in increased joint motion after 6 months. The percentage of VAS improvement from baseline values was 79.5 ± 20.0% 6 months after RS and found to be significantly related to patients' age (P = 0.01) and duration of the disease (P = 0.03). Knees with Steinbrocker's Grades 0 and I responded better than those

  14. Radiosynovectomy of Painful Synovitis of Knee Joints Due to Rheumatoid Arthritis by Intra-Articular Administration of 177Lu-Labeled Hydroxyapatite Particulates: First Human Study and Initial Indian Experience

    PubMed Central

    Shinto, Ajit S.; Kamaleshwaran, K. K.; Chakraborty, Sudipta; Vyshakh, K.; Thirumalaisamy, S. G.; Karthik, S.; Nagaprabhu, V. N.; Vimalnath, K. V.; Das, Tapas; Banerjee, Sharmila

    2015-01-01

    The aim of this study is to assess the effectiveness of Radiosynovectomy (RSV) using 177Lu-labeled hydroxyapatite (177Lu-HA) in the treatment of painful synovitis and recurrent joint effusion of knee joints in rheumatoid arthritis (RA). Ten patients, diagnosed with RA and suffering from chronic painful resistant synovitis of the knee joints were referred for RSV. The joints were treated with 333 ± 46 MBq of 177Lu-HA particles administered intra-articularly. Monitoring of activity distribution was performed by static imaging of knee joint and whole-body gamma imaging. The patients were evaluated clinically before RSV and at 6 months after the treatment by considering the pain improvement from baseline values in terms of a 100-point visual analog scale (VAS), the improvement of knee flexibility and the pain remission during the night. RSV response was classified as poor (VAS < 25), fair (VAS ≥ 25-50), good (VAS ≥ 50-75) and excellent (VAS ≥ 75), with excellent and good results considered to be success, while fair and poor as failure and also by range of motion. Three phase bone scan (BS) was repeated after 6 months and changes in the second phase of BS3 were assessed visually, using a four-degree scale and in the third phase, semiquantitatively with J/B ratio to see the response. Biochemical analysis of C-reactive protein (CRP) and fibrinogen was repeated after 48 h, 4 and 24 weeks. In all 10 patients, no leakage of administered activity to nontarget organs was visible in the whole-body scan. Static scans of the joint at 1 month revealed complete retention of 177Lu-HA in the joints. All patients showed decreased joint swelling and pains, resulting in increased joint motion after 6 months. The percentage of VAS improvement from baseline values was 79.5 ± 20.0% 6 months after RS and found to be significantly related to patients' age (P = 0.01) and duration of the disease (P = 0.03). Knees with Steinbrocker's Grades 0 and I responded better than those with more

  15. Revision of the Gunston polycentric knee arthroplasty with total knee arthroplasty.

    PubMed

    Memişoğlu, Kaya; Müezzinoğlu, U Sefa; Kesemenli, Cumhur Cevdet

    2010-01-01

    The Gunston polycentric knee arthroplasty, first designed and performed by Frank Gunston in 1971, is the first prosthesis considering the natural knee biomechanics. Although the polycentric knee arthroplasty showed encouraging results to relieve pain and to preserve the preoperative range of motion and joint instability, the improvements in prosthesis design and arthroplasty technology rapidly made the polycentric knee prosthesis obsolete. Herein, we report a 58-year old male patient who had revision of the Gunston polycentric knee arthroplasty with total knee arthroplasty performed 32 years after the initial operation. PMID:21343693

  16. Knee Problems

    MedlinePlus

    ... cartilage, a tough, elastic material that helps absorb shock and allows the knee joint to move smoothly. ... The two menisci in each knee act as shock absorbers, cushioning the lower part of the leg ...

  17. Knee Injuries

    MedlinePlus

    ... Sprains A sprain means you've stretched or torn a ligament. Common knee sprains usually involve damage ... A strain means you've partly or completely torn a muscle or tendon. With knee strains, you ...

  18. Intraarticular osteochondroma of the knee

    PubMed Central

    Morey, Vivek Morey; Jalan, Divesh; Mittal, Ravi; Gamangatti, Shivanand

    2014-01-01

    Osteochondromas are usually extra articular and grow away from the joint towards the diaphysis. Intraarticular osteochondromas are very rare and often misdiagnosed. We report a case of 16-year-old boy who presented with pain and clicking sound in the right knee for last 6 months. On examination, click was felt at the terminal flexion of the knee. The lateral radiograph of the right knee showed a radio opaque shadow at the posterior aspect of the distal end of femur, which was further evaluated with an MRI. Arthroscopy showed a hard lesion arising from the roof of the intercondylar notch of femur. It was excised arthroscopically. Histopathology revealed it to be an osteochondroma. Thus, intraarticular osteochondroma of the knee can be considered as a rare cause of pain in young patients. PMID:24932044

  19. An experimental evaluation of auricular diagnosis: the somatotopic mapping or musculoskeletal pain at ear acupuncture points.

    PubMed

    Oleson, T D; Kroening, R J; Bresler, D E

    1980-04-01

    The present study was designed to experimentally evaluate the claims by French and Chinese acupuncturists that a somatotopic mapping of the body is represented upon the external ear. According to this system of diagnosis, areas of the auricle where there is increased electrical conductivity and heightened tenderness to touch correspond to specific areas of the body where there is some pathological condition. The hypothetical map of different bodily regions appears on the external ear as an inverted fetus, with the head represented towards the lower lobule, the hands and feet represented at the uppermost portion of the auricle, and the body in between. Forty patients were medically examined to determine areas of their body where there was musculoskeletal pain. Each patient was then draped with a sheet to conceal any visible physical problems. The physician conducting the auricular diagnosis had no prior knowledge of the patient's medical condition, but simply examined the patient's ear for areas of elevated skin conductivity or tenderness. The concordance between the established medical diagnosis and the auricular diagnoses was 75.2%. Both quantified readings of electrical current flow and subjective ratings of dermal tenderness were statistically significant in arriving at accurate diagnoses. These results thus support the hypothesis that there is a somatotopoic organization of the body represented upon the human auricle. PMID:7402685

  20. MRI T1ρ and T2 mapping for the assessment of articular cartilage changes in patients with medial knee osteoarthritis after hemicallotasis osteotomy

    PubMed Central

    Nakamura, E.; Hirose, J.; Okamoto, N.; Yamabe, S.; Mizuta, H.

    2016-01-01

    Objectives The purpose of this study was to clarify the appearance of the reparative tissue on the articular surface and to analyse the properties of the reparative tissue after hemicallotasis osteotomy (HCO) using MRI T1ρ and T2 mapping. Methods Coronal T1ρ and T2 mapping and three-dimensional gradient-echo images were obtained from 20 subjects with medial knee osteoarthritis. We set the regions of interest (ROIs) on the full-thickness cartilage of the medial femoral condyle (MFC) and medial tibial plateau (MTP) of the knee and measured the cartilage thickness (mm) and T1ρ and T2 relaxation times (ms). Statistical analysis of time-dependent changes in the cartilage thickness and the T1ρ and T2 relaxation times was performed using one-way analysis of variance, and Scheffe’s test was employed for post hoc multiple comparison. Results The cartilage-like repair tissue appeared on the cartilage surface of the medial compartment post-operatively, and the cartilage thickness showed a significant increase between the pre-operative and one-year post-operative time points (MFC; p = 0.003, MTP; p < 0.001). The T1ρ values of the cartilage-like repair tissue showed no difference over time, however, the T2 values showed a significant decrease between the pre-operative and one-year post-operative time points (MFC; p = 0.004, MTP; p = 0.040). Conclusion This study clarified that the fibrocartilage-like repair tissue appeared on the articular surface of the medial compartment after HCO as evidenced by MRI T1ρ and T2 mapping. Cite this article: H. Nishioka, E. Nakamura, J. Hirose, N. Okamoto, S. Yamabe, H. Mizuta. MRI T1ρ and T2 mapping for the assessment of articular cartilage changes in patients with medial knee osteoarthritis after hemicallotasis osteotomy. Bone Joint Res 2016;5:294–300. DOI: 10.1302/2046-3758.57.BJR-2016-0057.R1. PMID:27421285

  1. Effectiveness and safety of tapentadol prolonged release with tapentadol immediate release on-demand for the management of severe, chronic osteoarthritis-related knee pain: results of an open-label, phase 3b study

    PubMed Central

    Steigerwald, Ilona; Müller, Matthias; Kujawa, Jolanta; Balblanc, Jean-Charles; Calvo-Alén, Jaime

    2012-01-01

    This open-label, phase 3b study (ClinicalTrials.gov Identifier: NCT00983073) evaluated the effectiveness, and tolerability of tapentadol for severe, chronic osteoarthritis knee pain that was inadequately managed with World Health Organization (WHO) Step I or II analgesics or co-analgesics, or that was not treated with regular analgesics. Prior to starting study treatment, patients discontinued any WHO Step II analgesics, while Step I analgesics and/or co-analgesics were continued at the same dose. Patients received tapentadol prolonged release (50–250 mg bid) during a 5-week titration period and a 7-week maintenance period. Doses of tapentadol immediate release 50 mg (≤twice/day; ≥4 hours apart) were permitted throughout the study (total daily dose of tapentadol prolonged and immediate release, ≤250 mg bid). The primary endpoint was the change in pain intensity on an 11-point numerical rating scale-3 (NRS-3; recalled average pain intensity [11-point NRS] during the last 3 days) from baseline to Week 6, using the last observation carried forward (LOCF) to impute missing pain intensity scores. The mean (standard deviation) change from baseline to Week 6 (LOCF) in pain intensity was −3.4 (2.10; P < 0.0001) for all patients evaluated for effectiveness (n = 195). Significant decreases in pain intensity were also observed at Weeks 6, 8, and 12 (all P < 0.0001) using observed-case analysis. Corresponding significant improvements from baseline to Weeks 6 and 12 were observed in the Western Ontario and McMaster Universities osteoarthritis index, the EuroQol-5 Dimension health status questionnaire, the Short Form-36 health survey, and the Hospital Anxiety and Depression Scale (all P ≤ 0.0103). Treatment-emergent adverse events were in line with those observed in previous studies of tapentadol prolonged release. Overall, the results of this study indicate that tapentadol treatment results in significant improvements in pain intensity, health-related quality of

  2. New Generation Lockable Knee Brace

    NASA Technical Reports Server (NTRS)

    1996-01-01

    A knee brace that uses Space Shuttle propulsion technology has moved a step closer to being available to help knee injury and stroke patients and may possibly benefit patients with birth defects, spinal cord injuries, and post-polio conditions. After years of hard work, inventors at NASA's Marshall Space Flight Center (MSFC) in Huntsville, Alabama, have turned over the final design and prototype to industry partners at Horton's Orthotic Lab in Little Rock, Arkansas for further clinical testing. The device, called the Selectively Lockable Knee Brace, may mean faster, less painful rehabilitation for patients by allowing the knee to move when weight is not on the heel. Devices currently on the market lock the knee in a rigid, straight-leg position, or allow continuous free motion. Pictured here is a knee brace prototype being tested and fitted at Horton's Orthotic Lab. The knee brace is just one example of how space technology is being used to improve the lives of people on Earth. NASA's MSFC inventors Michael Shadoan and Neill Myers are space propulsion engineers who use the same mechanisms and materials to build systems for rockets that they used to design and develop the knee brace.

  3. MR imaging of extrasynovial inflammation and impingement about the knee.

    PubMed

    Grando, Higor; Chang, Eric Y; Chen, Karen C; Chung, Christine B

    2014-11-01

    The knee has unique anatomy regarding the relationship between the synovial and capsular layers, with interposed fat pads at certain locations. The extrasynovial impingement and inflammation syndromes about the knee are underdiagnosed and should be included in the differential diagnosis of anterior knee pain. MR imaging is the best imaging modality for evaluation of the anatomy and disorders of these extrasynovial compartments. PMID:25442030

  4. High knee abduction moments are common risk factors for patellofemoral pain (PFP) and anterior cruciate ligament (ACL) injury in girls: Is PFP itself a predictor for subsequent ACL injury?

    PubMed Central

    Myer, Gregory D; Ford, Kevin R; Di Stasi, Stephanie L; Foss, Kim D Barber; Micheli, Lyle J; Hewett, Timothy E

    2014-01-01

    Background Identifying risk factors for knee pain and anterior cruciate ligament (ACL) injury can be an important step in the injury prevention cycle. Objective We evaluated two unique prospective cohorts with similar populations and methodologies to compare the incidence rates and risk factors associated with patellofemoral pain (PFP) and ACL injury. Methods The ‘PFP cohort’ consisted of 240 middle and high school female athletes. They were evaluated by a physician and underwent anthropometric assessment, strength testing and three-dimensional landing biomechanical analyses prior to their basketball season. 145 of these athletes met inclusion for surveillance of incident (new) PFP by certified athletic trainers during their competitive season. The ‘ACL cohort’ included 205 high school female volleyball, soccer and basketball athletes who underwent the same anthropometric, strength and biomechanical assessment prior to their competitive season and were subsequently followed up for incidence of ACL injury. A one-way analysis of variance was used to evaluate potential group (incident PFP vs ACL injured) differences in anthropometrics, strength and landing biomechanics. Knee abduction moment (KAM) cut-scores that provided the maximal sensitivity and specificity for prediction of PFP or ACL injury risk were also compared between the cohorts. Results KAM during landing above 15.4 Nm was associated with a 6.8% risk to develop PFP compared to a 2.9% risk if below the PFP risk threshold in our sample. Likewise, a KAM above 25.3 Nm was associated with a 6.8% risk for subsequent ACL injury compared to a 0.4% risk if below the established ACL risk threshold. The ACL-injured athletes initiated landing with a greater knee abduction angle and a reduced hamstrings-to-quadriceps strength ratio relative to the incident PFP group. Also, when comparing across cohorts, the athletes who suffered ACL injury also had lower hamstring/quadriceps ratio than the players in the PFP

  5. Knee arthroscopy - series (image)

    MedlinePlus

    ... knee problems such as: a torn knee disc (meniscus) a damaged knee bone (patella) a damaged ligament ... surgeon can see the ligaments, the knee disc (meniscus), the knee bone (patella), the lining of the ...

  6. Total knee replacement with and without patellar resurfacing: a prospective, randomised trial using the profix total knee system.

    PubMed

    Smith, A J; Wood, D J; Li, M-G

    2008-01-01

    We have examined the differences in clinical outcome of total knee replacement (TKR) with and without patellar resurfacing in a prospective, randomised study of 181 osteoarthritic knees in 142 patients using the Profix total knee system which has a femoral component with features considered to be anatomical and a domed patellar implant. The procedures were carried out between February 1998 and November 2002. A total of 159 TKRs in 142 patients were available for review at a mean of four years (3 to 7). The patients and the clinical evaluator were blinded in this prospective study. Evaluation was undertaken annually by an independent observer using the knee pain scale and the Knee Society clinical rating system. Specific evaluation of anterior knee pain, stair-climbing and rising from a seated to a standing position was also undertaken. No benefit was shown of TKR with patellar resurfacing over that without resurfacing with respect to any of the measured outcomes. In 22 of 73 knees (30.1%) with and 18 of 86 knees (20.9%) without patellar resurfacing there was some degree of anterior knee pain (p = 0.183). No revisions related to the patellofemoral joint were performed in either group. Only one TKR in each group underwent a re-operation related to the patellofemoral joint. A significant association between knee flexion contracture and anterior knee pain was observed in those knees with patellar resurfacing (p = 0.006). PMID:18160498

  7. Single-blinded, randomised preliminary study evaluating the effects of 2 Hz electroacupuncture for postoperative pain in patients with total knee arthroplasty

    PubMed Central

    Tzeng, Chung-Yuh; Chang, Shih-Liang; Wu, Chih-Cheng; Chang, Chu-Ling; Chen, Wen-Gii; Tong, Kwok-Man; Huang, Kui-Chou; Hsieh, Ching-Liang

    2015-01-01

    Objective To explore the point-specific clinical effect of 2 Hz electroacupuncture (EA) in treating postoperative pain in patients undergoing total knee arthroplasty (TKA), Methods In a randomised, partially single-blinded preliminary study, 47patients with TKA were randomly divided into three groups: control group (CG, n=17) using only patient-controlled analgesia (PCA); EA group (EAG, n=16) with 2 Hz EA applied at ST36 (Zusanli) and GB34 (Yanglingquan) contralateral to the operated leg for 30 min on the first two postoperative days, also receiving PCA; and non-point group (NPG, n=14), with EA identical to the EAG except given 1 cm lateral to both ST36 and GB34. The Mann–Whitney test was used to show the difference between two groups and the Kruskal–Wallis test to show the difference between the three groups. Results The time until patients first required PCA in the CG was 34.1±22.0 min, which was significantly shorter than the 92.0±82.7 min in the EAG (p<0.001) and 90.7±94.8 min in the NPG (p<0.001); there was no difference between the EAG and NPG groups (p>0.05). The total dosage of PCA solution given was 4.6±0.9 mL/kg body weight in the CG, 4.2±1.0 mL/kg in the EAG and 4.5±1.0 mL/kg in the NPG; there were no significant differences (p>0.05) among the three groups. Conclusions In this small preliminary study, EA retarded the first demand for PCA in comparison with no EA. No effect was seen on the total dosage of PCA required and no point-specific effect was seen. PMID:25910930

  8. Acute gouty arthritis in a patient after total knee arthroplasty.

    PubMed

    Fokter, Samo K; Repse-Fokter, Alenka

    2010-06-01

    Symptomatic gout in an artificial joint is exceptionally rare. We present a 68-year-old male patient who developed progressive knee pain and swelling one year after the cemented total arthroplasty of his left knee. The diagnosis was confirmed by crystal identification in the synovial fluid. Beside thorough workout to rule out infection in a painful and inflamed prosthetic knee, specific history of gout should be sought and fluid aspirate examined cytologically and under polarised light for crystal arthropathy. PMID:20552289

  9. Knee Pain (Beyond the Basics)

    MedlinePlus

    ... UpToDate, Inc. ("UpToDate"), in consideration of the subscription fee and acceptance of this Agreement, grants you a ... or your Institution have agreed to pay subscription fees. At the end of this period, your license ...

  10. Osteonecrosis of the knee: review

    PubMed Central

    Karim, Ammar R.; Cherian, Jeffrey J.; Jauregui, Julio J.; Pierce, Todd

    2015-01-01

    Osteonecrosis is a devastating disease that can lead to end-stage arthritis of various joint including the knee. There are three categories of osteonecrosis that affect the knee: spontaneous osteonecrosis of the knee (SONK), secondary, and post-arthroscopic. Regardless of osteonecrosis categories, the treatment of this disease aims to halt further progression or delay the onset of end-stage arthritis of the knee. However, once substantial joint surface collapse has occurred or there are sign of degenerative arthritis, joint arthroplasty is the most appropriate treatment option. Currently, the non-operative treatment options consist of observation, non-steroidal anti-inflammatory drugs (NSAIDs), protected weight bearing, and analgesia as needed. Operative interventions include joint preserving surgery, unilateral knee arthroplasty (UKA), or total knee arthroplasty (TKA) depending on the extent and type of disease. Joint preserving procedures (i.e., arthroscopy, core decompression, osteochondral autograft, and bone grafting) are usually attempted in pre-collapse and some post-collapse lesions, when the articular cartilage is generally intact with only the underlying subchondral bone being affected. Conversely, after severe subchondral collapse has occurred, procedures that attempt to salvage the joint are rarely successful and joint arthroplasty are necessary to relieve pain. The purpose of this article is to highlight the recent evidence concerning the treatment options across the spectrum of management of osteonecrosis of the knee including lesion observation, medications, joint preserving techniques, and total joint arthroplasties. PMID:25705638

  11. New Generation Lockable Knee Brace

    NASA Technical Reports Server (NTRS)

    2000-01-01

    A knee brace that uses Space Shuttle propulsion technology has moved a step closer to being available to help knee injury and stroke patients and may possibly benefit patients with birth defects, spinal cord injuries, and post-polio conditions. After years of hard work, inventors at NASA's Marshall Space Flight Center (MSFC) in Huntsville, Alabama, have turned over the final design and prototype to industry partners at Horton's Orthotic Lab in Little Rock, Arkansas for further clinical testing. The device, called the Selectively Lockable Knee Brace, may mean faster, less painful rehabilitation for patients by allowing the knee to move when weight is not on the heel. Devices currently on the market lock the knee in a rigid, straight-leg position, or allow continuous free motion. The knee brace is just one example of how space technology is being used to improve the lives of people on Earth. NASA's MSFC inventors Michael Shadoan and Neill Myers are space propulsion engineers who use the same mechanisms and materials to build systems for rockets that they used to design and develop the knee brace.

  12. MRI based knee cartilage assessment

    NASA Astrophysics Data System (ADS)

    Kroon, Dirk-Jan; Kowalski, Przemyslaw; Tekieli, Wojciech; Reeuwijk, Els; Saris, Daniel; Slump, Cornelis H.

    2012-03-01

    Osteoarthritis is one of the leading causes of pain and disability worldwide and a major health problem in developed countries due to the gradually aging population. Though the symptoms are easily recognized and described by a patient, it is difficult to assess the level of damage or loss of articular cartilage quantitatively. We present a novel method for fully automated knee cartilage thickness measurement and subsequent assessment of the knee joint. First, the point correspondence between a pre-segmented training bone model is obtained with use of Shape Context based non-rigid surface registration. Then, a single Active Shape Model (ASM) is used to segment both Femur and Tibia bone. The surfaces obtained are processed to extract the Bone-Cartilage Interface (BCI) points, where the proper segmentation of cartilage begins. For this purpose, the cartilage ASM is trained with cartilage edge positions expressed in 1D coordinates at the normals in the BCI points. The whole cartilage model is then constructed from the segmentations obtained in the previous step. An absolute thickness of the segmented cartilage is measured and compared to the mean of all training datasets, giving as a result the relative thickness value. The resulting cartilage structure is visualized and related to the segmented bone. In this way the condition of the cartilage is assessed over the surface. The quality of bone and cartilage segmentation is validated and the Dice's coefficients 0.92 and 0.86 for Femur and Tibia bones and 0.45 and 0.34 for respective cartilages are obtained. The clinical diagnostic relevance of the obtained thickness mapping is being evaluated retrospectively. We hope to validate it prospectively for prediction of clinical outcome the methods require improvements in accuracy and robustness.

  13. Knee bone tumors: findings on conventional radiology*

    PubMed Central

    Andrade Neto, Francisco; Teixeira, Manuel Joaquim Diógenes; Araújo, Leonardo Heráclio do Carmo; Ponte, Carlos Eduardo Barbosa

    2016-01-01

    The knee is a common site for bone tumors, whether clinically painful or not. Conventional radiology has been established as the first line of investigation in patients with knee pain and can reveal lesions that often generate questions not only for the generalist physician but also for the radiologist or general orthopedist. History, image examination, and histopathological analysis compose the essential tripod of the diagnosis of bone tumors, and conventional radiology is an essential diagnostic tool in patients with knee pain. This pictorial essay proposes to depict the main conventional radiography findings of the most common bone tumors around the knee, including benign and malignant tumors, as well as pseudo-tumors. PMID:27403019

  14. Knee bone tumors: findings on conventional radiology.

    PubMed

    Andrade Neto, Francisco; Teixeira, Manuel Joaquim Diógenes; Araújo, Leonardo Heráclio do Carmo; Ponte, Carlos Eduardo Barbosa

    2016-01-01

    The knee is a common site for bone tumors, whether clinically painful or not. Conventional radiology has been established as the first line of investigation in patients with knee pain and can reveal lesions that often generate questions not only for the generalist physician but also for the radiologist or general orthopedist. History, image examination, and histopathological analysis compose the essential tripod of the diagnosis of bone tumors, and conventional radiology is an essential diagnostic tool in patients with knee pain. This pictorial essay proposes to depict the main conventional radiography findings of the most common bone tumors around the knee, including benign and malignant tumors, as well as pseudo-tumors. PMID:27403019

  15. Effect of vitamin D supplementation on progression of knee pain and cartilage volume loss in patients with symptomatic osteoarthritis: a randomized controlled trial

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Knee osteoarthritis (OA), a disorder of cartilage and periarticular bone, is a public health problem without effective medical treatments. Some studies have suggested that vitamin D may protect against structural progression. A 2-year randomized, placebo-controlled, double-blind, clinical trial invo...

  16. Effect of femoral component design on unresurfaced patellas in knee arthroplasty.

    PubMed

    Whiteside, Leo A; Nakamura, Takashi

    2003-05-01

    Three total knee designs were evaluated to test the hypothesis that femoral component design affects the clinical and mechanical functions of the unresurfaced patella after total knee arthroplasty. Patients with the Ortholoc II, Advantim, and Profix femoral components were followed up for as many as 14 years and revision rate, anterior knee pain, and generalized knee pain were compared. A laboratory protocol was devised to evaluate pressure in the patellofemoral joint of knees from cadavers with a pressure-sensitive transducer using the same three designs at various degrees of knee flexion. Thirty Ortholoc II knee components were followed up for 14 years. Nineteen patients (63%) had severe anterior knee pain and 15 patients (50%) had reoperation to resurface the patella within 2 years. Two hundred one patients (222 knees) with Advantim components were followed up for 10 years and 305 patients (330 knees) with Profix components were followed up for 5 years. No patients with these two knee designs had severe anterior knee pain or reoperation for patellar resurfacing. A significantly higher rate of mild anterior knee pain was seen in the patients with Advantim components than in the patients with Profix components. No apparent relationship was seen between the severity of patellar wear found at the time of surgery and the incidence of anterior knee pain. Patients with rheumatoid arthritis receiving either the Advantim or Profix knee component performed as well as patients with osteoarthritis when the patella was not resurfaced. Pressure was significantly higher in the patellofemoral joints of the laboratory knee specimens with Ortholoc II components than in the specimens with either the Advantim or Profix components. The specimens with Advantim components had significantly higher pressure than did the specimens with normal knees, and the specimens with Profix components differed little from those with normal knees. PMID:12771830

  17. Osteoarthritis of the knees in the COPCORD world.

    PubMed

    Haq, Syed A; Davatchi, Fereydoun

    2011-05-01

    This paper examines and summarizes data on knee osteoarthritis (AO) in Community Oriented Program For Control Of Rheumatic Disorders (COPCORD) publications. A literature search was made through PubMed, Google, Proceedings of Asia-Pacific League of Associations for Rheumatology (APLAR) congresses, and Abstracts from APLAR congresses. Data were compiled to examine the prevalence of knee OA and knee pain, sex ratio, urban/rural differences and other risk factors. Data on knee pain and OA were available in a total of 36 COPCORD publications. The pooled prevalence of knee OA was 7.9% in adults above the age of 15 years. It was more common in women. Overweight, squatting and cycling appeared to be modifiable risk factors for knee OA. OA of the knee is the commonest rheumatic disease in studied communities. Further research is needed for identification of its modifiable risk factors and development of strategies for reduction of the community burden of this malady. PMID:21518310

  18. Runner's Knee

    MedlinePlus

    ... Over the summer he bought a pair of running shoes and took up jogging. He started with ... bending the knee — when walking, kneeling, squatting, or running, for example. Walking or running downhill or even ...

  19. Knee arthroscopy

    MedlinePlus

    ... is cartilage that cushions the space between the bones in the knee. Surgery is done to repair or remove it. Torn or damaged anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) Torn or damaged collateral ligament Swollen (inflamed) or ...

  20. Knee Dislocations

    PubMed Central

    Schenck, Robert C.; Richter, Dustin L.; Wascher, Daniel C.

    2014-01-01

    Background: Traumatic knee dislocation is becoming more prevalent because of improved recognition and increased exposure to high-energy trauma, but long-term results are lacking. Purpose: To present 2 cases with minimum 20-year follow-up and a review of the literature to illustrate some of the fundamental principles in the management of the dislocated knee. Study Design: Review and case reports. Methods: Two patients with knee dislocations who underwent multiligamentous knee reconstruction were reviewed, with a minimum 20-year follow-up. These patients were brought back for a clinical evaluation using both subjective and objective measures. Subjective measures include the following scales: Lysholm, Tegner activity, visual analog scale (VAS), Short Form–36 (SF-36), International Knee Documentation Committee (IKDC), and a psychosocial questionnaire. Objective measures included ligamentous examination, radiographic evaluation (including Telos stress radiographs), and physical therapy assessment of function and stability. Results: The mean follow-up was 22 years. One patient had a vascular injury requiring repair prior to ligament reconstruction. The average assessment scores were as follows: SF-36 physical health, 52; SF-36 mental health, 59; Lysholm, 92; IKDC, 86.5; VAS involved, 10.5 mm; and VAS uninvolved, 2.5 mm. Both patients had excellent stability and were functioning at high levels of activity for their age (eg, hiking, skydiving). Both patients had radiographic signs of arthritis, which lowered 1 subject’s IKDC score to “C.” Conclusion: Knee dislocations have rare long-term excellent results, and most intermediate-term studies show fair to good functional results. By following fundamental principles in the management of a dislocated knee, patients can be given the opportunity to function at high levels. Hopefully, continued advances in the evaluation and treatment of knee dislocations will improve the long-term outcomes for these patients in the

  1. Snapping knee caused by symptomatic fabella in a native knee.

    PubMed

    Hire, Justin M; Oliver, David L; Hubbard, Ryan C; Fontaine, Michelle L; Bojescul, John A

    2014-08-01

    We report a case of a 31-year-old man with a 5-year history of snapping knee syndrome secondary to a single, large symptomatic fabella of the knee. On physical examination, the patient was able to reproduce an audible and palpable snapping with active range of motion. His condition was refractory to physical therapy. He had undergone a prior iliotibial band release at an outside facility. After excision of the fabella, measuring 15 × 8 × 9 mm, the patient's snapping and pain with activity were resolved. PMID:25136872

  2. Periarticular regional analgesia in total knee arthroplasty: a review of the neuroanatomy and injection technique.

    PubMed

    Guild, George N; Galindo, Rubin P; Marino, Joseph; Cushner, Fred D; Scuderi, Giles R

    2015-01-01

    Postoperative pain control after total knee arthroplasty may be insufficient, resulting in insomnia, antalgic ambulation, and difficulty with rehabilitation. Current strategies, including the use of femoral nerve catheters, may control pain but have been associated with falls, motor blockade, and quadriceps inhibition. Periarticular infiltration using the appropriate technique and knowledge of intraarticular knee anatomy may increase pain control and maximize rehabilitation. PMID:25435030

  3. Pain relief and improved physical function in knee osteoarthritis patients receiving ongoing hylan G-F 20, a high-molecular-weight hyaluronan, versus other treatment options: data from a large real-world longitudinal cohort in Canada.

    PubMed

    Petrella, Robert J; Wakeford, Craig

    2015-01-01

    From the Southwestern Ontario database, one of the largest primary-care datasets in Canada, 1,263 patients with osteoarthritis (OA) of one or both knees were identified who received two consecutive series of intra-articular (IA) injections of hylan G-F 20 preparation and no other prescribed OA medications, and were evaluated fully between 2006 and 2012. A cohort of 3,318 demographically matched OA patients who had not been treated with IA injection therapy was identified from the same database for comparison. Responses to therapy were assessed by means of a 10-point visual analog scale (VAS) for pain at rest and after completion of a 6-minute walk test (6 MWT), while physical capacity was measured by performance in the 6 MWT itself. After two cycles of hylan G-F 20 therapy, the average VAS score for pain at rest declined from 7.82 ± 1.27 at baseline to 4.16 ± 1.51 (average change 3.66 ± 1.78, significantly more than the reduction of 3.12 ± 2.03 seen in the reference group [P < 0.012]) and the average VAS score for pain after the 6 MWT decreased by 5.56 ± 1.74 points (from 9.58 ± 0.4 at baseline to 4.02 ± 1.67 at the final assessment), a significantly larger change than that seen in the reference group (Δ2.99 ± 1.85; P<0.001 for intergroup comparison). Distance walked in the 6 MWT increased on average by 115 m, significantly more than that seen in the reference group (Δ91 m; P < 0.001 for intergroup comparison). These findings from a primary-care database suggest sustained benefits in terms of pain and physical function from repeat cycles of IA injections of hylan G-F 20 and no other prescribed OA medications in adults with OA of the knee. PMID:26508838

  4. Pain relief and improved physical function in knee osteoarthritis patients receiving ongoing hylan G-F 20, a high-molecular-weight hyaluronan, versus other treatment options: data from a large real-world longitudinal cohort in Canada

    PubMed Central

    Petrella, Robert J; Wakeford, Craig

    2015-01-01

    From the Southwestern Ontario database, one of the largest primary-care datasets in Canada, 1,263 patients with osteoarthritis (OA) of one or both knees were identified who received two consecutive series of intra-articular (IA) injections of hylan G-F 20 preparation and no other prescribed OA medications, and were evaluated fully between 2006 and 2012. A cohort of 3,318 demographically matched OA patients who had not been treated with IA injection therapy was identified from the same database for comparison. Responses to therapy were assessed by means of a 10-point visual analog scale (VAS) for pain at rest and after completion of a 6-minute walk test (6MWT), while physical capacity was measured by performance in the 6MWT itself. After two cycles of hylan G-F 20 therapy, the average VAS score for pain at rest declined from 7.82±1.27 at baseline to 4.16±1.51 (average change 3.66±1.78, significantly more than the reduction of 3.12±2.03 seen in the reference group [P<0.012]) and the average VAS score for pain after the 6MWT decreased by 5.56±1.74 points (from 9.58±0.4 at baseline to 4.02±1.67 at the final assessment), a significantly larger change than that seen in the reference group (Δ2.99±1.85; P<0.001 for intergroup comparison). Distance walked in the 6MWT increased on average by 115 m, significantly more than that seen in the reference group (Δ91 m; P<0.001 for intergroup comparison). These findings from a primary-care database suggest sustained benefits in terms of pain and physical function from repeat cycles of IA injections of hylan G-F 20 and no other prescribed OA medications in adults with OA of the knee. PMID:26508838

  5. Arthroscopic surgery of the knee.

    PubMed Central

    Dandy, D J; O'Carroll, P F

    1982-01-01

    In the first 1000 arthroscopic operations performed by one surgeon 136 patients had two or more procedures, making a total of 1168 during the 1000 operations. The indications for operation were internal mechanical derangements in 565 patients, anterior knee pain in 246, disorders of the synovium in 77, ligament injuries in 63, and degenerative joint disease in 49. Complications included fracture of instruments in the knee in five patients, haemarthrosis in 10, deep vein thrombosis in three, and synovial fistula in one. In no patient was the wound infected. A total of 26 different operations was performed. PMID:6812832

  6. Unsupervised definition of the tibia-femoral joint regions of the human knee and its applications to cartilage analysis

    NASA Astrophysics Data System (ADS)

    Tamez-Peña, José G.; Barbu-McInnis, Monica; Totterman, Saara

    2006-03-01

    Abnormal MR findings including cartilage defects, cartilage denuded areas, osteophytes, and bone marrow edema (BME) are used in staging and evaluating the degree of osteoarthritis (OA) in the knee. The locations of the abnormal findings have been correlated to the degree of pain and stiffness of the joint in the same location. The definition of the anatomic region in MR images is not always an objective task, due to the lack of clear anatomical features. This uncertainty causes variance in the location of the abnormality between readers and time points. Therefore, it is important to have a reproducible system to define the anatomic regions. This works present a computerized approach to define the different anatomic knee regions. The approach is based on an algorithm that uses unique features of the femur and its spatial relation in the extended knee. The femur features are found from three dimensional segmentation maps of the knee. From the segmentation maps, the algorithm automatically divides the femur cartilage into five anatomic regions: trochlea, medial weight bearing area, lateral weight bearing area, posterior medial femoral condyle, and posterior lateral femoral condyle. Furthermore, the algorithm automatically labels the medial and lateral tibia cartilage. The unsupervised definition of the knee regions allows a reproducible way to evaluate regional OA changes. This works will present the application of this automated algorithm for the regional analysis of the cartilage tissue.

  7. "Feeling better" or "feeling well" in usual care of hip and knee osteoarthritis pain: determination of cutoff points for patient acceptable symptom state (PASS) and minimal clinically important improvement (MCII) at rest and on movement in a national multicenter cohort study of 2414 patients with painful osteoarthritis.

    PubMed

    Perrot, Serge; Bertin, Philippe

    2013-02-01

    Patient-reported outcome measures are being developed for more relevant assessments of pain management. The patient acceptable symptom state (PASS) ("feeling well") and the minimal clinically important improvement (MCII) ("feeling better") have been determined in clinical trials, but not in daily pain management. We carried out a national multicenter cohort study of patients over the age of 50years with painful knee osteoarthritis (KOA) or hip osteoarthritis (HOA) who had visited their general practitioner and required treatment for more than 7days. Overall, 2414 patients (50.2% men, mean age 67.3years, body mass index 27.9kg/m(2), 33.5% with HOA) were enrolled by 1116 general practitioners. After 7days of treatment, PASS was estimated on a numerical rating scale as 4 at rest and 5 on movement, for both HOA and KOA, above the PASS threshold in clinical trials. In KOA, PASS was more frequently reached in men and younger people with less pain at rest and on movement, and in patients specifically seeking an improvement during sport activities. In HOA, PASS was most frequently reached in patients with low levels of pain at risk and in nonobese patients. MCII was -1 numerical rating scale point after 7days of usual treatment. This improvement is smaller than that recorded in randomized controlled trials, and was the same for both sites, both at rest and on movement. In conclusion, patient-reported outcome values in daily practice differ from those in clinical trials, and their determinant factors may depend on the site of osteoarthritis. Assessments of the treatment of painful osteoarthritis should be adapted to the characteristics and daily life of the patient, to personalize patient management. PMID:23265687

  8. Brain Mapping-Based Model of Δ(9)-Tetrahydrocannabinol Effects on Connectivity in the Pain Matrix.

    PubMed

    Walter, Carmen; Oertel, Bruno G; Felden, Lisa; Kell, Christian A; Nöth, Ulrike; Vermehren, Johannes; Kaiser, Jochen; Deichmann, Ralf; Lötsch, Jörn

    2016-05-01

    Cannabinoids receive increasing interest as analgesic treatments. However, the clinical use of Δ(9)-tetrahydrocannabinol (Δ(9)-THC) has progressed with justified caution, which also owes to the incomplete mechanistic understanding of its analgesic effects, in particular its interference with the processing of sensory or affective components of pain. The present placebo-controlled crossover study therefore focused on the effects of 20 mg oral THC on the connectivity between brain areas of the pain matrix following experimental stimulation of trigeminal nocisensors in 15 non-addicted healthy volunteers. A general linear model (GLM) analysis identified reduced activations in the hippocampus and the anterior insula following THC administration. However, assessment of psychophysiological interaction (PPI) revealed that the effects of THC first consisted in a weakening of the interaction between the thalamus and the secondary somatosensory cortex (S2). From there, dynamic causal modeling (DCM) was employed to infer that THC attenuated the connections to the hippocampus and to the anterior insula, suggesting that the reduced activations in these regions are secondary to a reduction of the connectivity from somatosensory regions by THC. These findings may have consequences for the way THC effects are currently interpreted: as cannabinoids are increasingly considered in pain treatment, present results provide relevant information about how THC interferes with the affective component of pain. Specifically, the present experiment suggests that THC does not selectively affect limbic regions, but rather interferes with sensory processing which in turn reduces sensory-limbic connectivity, leading to deactivation of affective regions. PMID:26514581

  9. Changes in knee kinematics following total knee arthroplasty.

    PubMed

    Akbari Shandiz, Mohsen; Boulos, Paul; Saevarsson, Stefan Karl; Yoo, Sam; Miller, Stephen; Anglin, Carolyn

    2016-04-01

    Total knee arthroplasty (TKA) changes the knee joint in both intentional and unintentional, known and unknown, ways. Patellofemoral and tibiofemoral kinematics play an important role in postoperative pain, function, satisfaction and revision, yet are largely unknown. Preoperative kinematics, postoperative kinematics or changes in kinematics may help identify causes of poor clinical outcome. Patellofemoral kinematics are challenging to record since the patella is obscured by the metal femoral component in X-ray and moves under the skin. The purpose of this study was to determine the kinematic degrees of freedom having significant changes and to evaluate the variability in individual changes to allow future study of patients with poor clinical outcomes. We prospectively studied the 6 degrees of freedom patellofemoral and tibiofemoral weightbearing kinematics, tibiofemoral contact points and helical axes of rotation of nine subjects before and at least 1 year after total knee arthroplasty using clinically available computed tomography and radiographic imaging systems. Normal kinematics for healthy individuals were identified from the literature. Significant differences existed between pre-TKA and post-TKA kinematics, with the post-TKA kinematics being closer to normal. While on average the pre-total knee arthroplasty knees in this group displayed no pivoting (only translation), individually only five knees displayed this behaviour (of these, two showed lateral pivoting, one showed medial pivoting and one showed central pivoting). There was considerable variability postoperatively as well (five central, two lateral and two medial pivoting). Both preop and postop, flexion behaviour was more hinge-like medially and more rolling laterally. Helical axes were more consistent postop for this group. An inclusive understanding of the pre-TKA and post-TKA kinematics and changes in kinematics due to total knee arthroplasty could improve implant design, patient diagnosis and

  10. Sensitivity and specificity of simultaneously acquired (dual channel) radiogallium and Tc-99m-HDP in painful hip and knee prosthetic joints

    SciTech Connect

    Skarzynski, J.J.; Sziklas, J.J.; Rosenberg, R.J.; Rich, D.A.; Spencer, R.P.

    1985-05-01

    Differentiation of prosthetic loosening from infection, by use of sequential bone and radiogallium imaging, has been discussed in the literature. The authors investigated simultaneous (2 channel) imaging of Ga-67 and Tc-99m-HDP in multiviews, in order to assess the parameter of Tc-99m-Ga-67 incongruity. Acquisition of data was carried out 2 days after 5 mCi of Ga-67 citrate IV and 2 hours after 8 mCi of Tc-99m-HDP. Dual data channels were used to insure perfect superimposition of the images and to reduce total imaging time. Normalized bone images were taken, then subtracted from those of Ga-67, by means of progressive weighting factors. A total of 68 studies were carried out on 43 patients. Exams involved both knee and hip prostheses, in population with 63% of the patients over age 60 years. Time from placement of the prosthesis to the dual radionuclide exam was within 2 years in 48% and within 5 years in 78%. Sensitivity was 0.88 and specificity 0.89. Using information on the follow-up dual channel studies, 40/43 cases were correctly identified (93%). Dual channel radionuclide imaging offers a readily available and accurate means of differentiating infection from loosening of hip or knee prostheses.

  11. Total knee arthroplasty in patients with a previous patellectomy.

    PubMed

    Maslow, Jed; Zuckerman, Joseph D; Immerman, Igor

    2013-01-01

    Post-patellectomy patients represent a specific subgroup of patients that may develop arthritis and persistent knee pain and potentially require treatment with total knee arthroplasty. This article reviews the treatment and functional outcomes following total knee arthroplasty in patients with prior patellectomy. A case report is presented as an example of the clinical management of a post-patellectomy patient with significant knee pain and disability treated with total knee arthroplasty. Emphasis will be placed in decision- making, specifically with the use of a posterior stabilized implant. In addition, postoperative strengthening of the quadriceps is essential to compensate for the lack of the patella and increase the success of total knee arthroplasty in this subgroup of patients. PMID:24151951

  12. [Jumper's knee].

    PubMed

    Hagner, W; Sosnowski, S; Kaziński, W; Frankowski, S

    1993-01-01

    A series of 30 athletes aged about 16 years on an average, exposed to activities putting a strain on the patellar tendon during training has been examined. They were involved in competitive sports for 3 years on an average. In 27 per cent of them jumpers knee symptoms have been found. PMID:7671664

  13. Total Knee Replacement as a Knee Osteoarthritis Outcome

    PubMed Central

    Raynauld, Jean-Pierre; Martel-Pelletier, Johanne; Dorais, Marc; Haraoui, Boulos; Choquette, Denis; Abram, François; Beaulieu, André; Bessette, Louis; Morin, Frédéric; Wildi, Lukas M.

    2013-01-01

    Objective. To predict, using clinical and qMRI data, the incidence of total knee replacement (TKR) during the long-term follow-up of knee osteoarthritis (OA) patients who formerly received chondroitin sulfate (CS) or placebo treatment. Design. A post hoc intention-to-treat analysis to evaluate the incidence of TKR was done on knee OA patients who had participated in a 12-month trial evaluating the impact of CS (800 mg/d) versus placebo for 6 months, followed by a 6-month open-phase in which all patients received CS. Additionally, the clinical and qMRI predictors of TKR were determined. Results. Thirteen TKRs were performed in the population after a 4-year follow-up. More TKRs were performed in the placebo group than in the CS group (69% vs. 31%, P = 0.150, logistic regression). The statistically significant predictors of TKRs were, at baseline, higher WOMAC pain and function scores, presence of bone marrow lesions (BMLs), and higher C-reactive protein levels. Loss of medial cartilage volume and increase in WOMAC pain and function at one-year were also predictors of TKR. Multivariate analyses revealed that baseline presence of BML and higher WOMAC pain score were independent predictors. Time to occurrence of the TKR also favored the CS group versus placebo (log-rank, P = 0.094). Conclusion. Symptoms such as knee pain and function, presence of BML, and cartilage volume loss predict the long-term occurrence of a “hard” outcome such as TKR. PMID:26069668

  14. Pain catastrophizing and cortical responses in amputees with varying levels of phantom limb pain: a high-density EEG brain-mapping study.

    PubMed

    Vase, Lene; Egsgaard, Line Lindhardt; Nikolajsen, Lone; Svensson, Peter; Jensen, Troels Staehelin; Arendt-Nielsen, Lars

    2012-05-01

    Pain catastrophizing has been associated with phantom limb pain, but so far the cortical processes and the brain regions involved in this relationship have not been investigated. It was therefore tested whether catastrophizing was related to (1) spontaneous pain, (2) somatosensory activity and (3) cortical responses in phantom limb pain patients. The cortical responses were investigated via electroencephalography (EEG) as it has a high temporal resolution which may be ideal for investigating especially the attentional and hypervigilance aspect of catastrophizing to standardized acute stimuli. Eighteen upper limb amputees completed the pain catastrophizing scale. Patients' spontaneous pain levels (worst and average pain, numerical rating scales) and thresholds to electrical stimulation (sensory detection and VRS2: intense but not painful) were determined. Non-painful electrical stimuli were applied to both the affected and non-affected arm, while high-resolution (128 channels) EEG signals were recorded. Catastrophizing accounted for significant amounts of the variance in relation to spontaneous pain, especially worst pain (64.1%), and it was significantly associated with thresholds. At the affected side, catastrophizing was significantly related to the power RMS of the N/P135 dipole located in the area around the secondary somatosensory cortex which has been shown to be associated with arousal and expectations. These findings corroborate the attentional model of pain catastrophizing by indicating that even non-painful stimuli are related to enhanced attention to and negative expectations of stimuli, and they suggest that memory processes may be central to understanding the link between catastrophizing and pain. PMID:22349560

  15. A Dutch Survey on Circumpatellar Electrocautery in Total Knee Arthroplasty

    PubMed Central

    van Jonbergen, Hans-Peter W.; Barnaart, Alexander F.W.; Verheyen, Cees C.P.M.

    2010-01-01

    Introduction: Anterior knee pain following total knee arthroplasty is estimated to occur in 4-49% of patients. Some orthopedic surgeons use circumpatellar electrocautery (diathermy) to reduce the prevalence of postsurgical anterior knee pain; however, the extent of its use is unknown. Materials and Methodology: In April 2009, a postal questionnaire was sent to all 98 departments of orthopedic surgery in The Netherlands. The questions focused on the frequency of total knee arthroplasties, patellar resurfacing, and the use of circumpatellar electrocautery. Results: The response rate was 92%. A total of 18,876 TKAs, 2,096 unicompartmental knee arthroplasties, and 215 patellofemoral arthroplasties are performed yearly in The Netherlands by the responding orthopedic surgeons. Of the orthopedic surgeons performing TKA, 13% always use patellar resurfacing in total knee arthroplasty for osteoarthritis, 49% use selective patellar resurfacing, and 38% never use it. Fifty-six percent of orthopedic surgeons use circumpatellar electrocautery when not resurfacing the patella, and 32% use electrocautery when resurfacing the patella. Conclusion: There is no consensus among Dutch orthopedic surgeons on the use of patellar resurfacing or circumpatellar electrocautery in total knee replacement performed for osteoarthritis. A prospective clinical trial is currently underway to fully evaluate the effect of circumpatellar electrocautery on the prevalence of anterior knee pain following total knee arthroplasty. PMID:21228917

  16. Mid-term outcomes of primary constrained condylar knee arthroplasty for severe knee deformity.

    PubMed

    Feng, Xiao-Bo; Yang, Cao; Fu, De-Hao; Ye, Shu-Nan; Liu, Xian-Zhe; Chen, Zhe; Rai, Saroj; Yang, Shu-Hua

    2016-04-01

    This study aimed to examine the clinical and radiographic outcomes of primary total knee arthroplasy (TKA) with use of NexGen® Legacy® Constrained Condylar Knee (CCK) prosthesis for severe knee deformity. Clinical data of 46 patients (48 knees in total, aged 61 years on average) with severe knee deformity who underwent TKA with NexGen® Legacy® CCK prosthesis between December 2007 and February 2012 were retrospectively analyzed. There were 34 knees with severe valgus with incompetent medial collateral ligament, 11 knees with severe flexion contracture with inability to achieve knee balancing in flexion and extension by posterior soft tissue release, 2 knees with Charcot arthritis with severe varus and bone loss, and 1 with traumatic osteoarthritis with severe varus and ligamentous instability. The mean duration of follow-up was 71 months (range 40-90 months). The New Knee Society scoring (NKSS) system and the Hospital for Special Surgery (HSS) score were used to evaluate the functional and clinical outcomes. Visual Analogue Scale (VAS) was used for pain measurement and Knee Society criteria for evaluation of radiological images. The results showed that, in the total 48 knees, 1 case of loosening due to short-stem tibial component at 3 months post-operatively underwent revision. The 6-year prosthesis survival rate in this cohort was 97.9%. There was no component infection occurring within 6 years. Significant post-operative improvements were found in NKSS and HSS scores. Patient satisfaction was significantly increased. Pain score was decreased significantly. Total functional score was improved from 31.46±11.43 to 86.42±8.87, range of motion (ROM) from 42.42°±23.57° to 95.31°±23.45° and the flexion contracture from 5.31°±7.87° to 0.92°±1.80°. Preoperative radiographic study showed excessive valgus (≥7°) in 37 knees, and varus deformity in 3 knees. Post-operative femorotibial alignment was valgus 3.88°±1.76° in 48 knees. Antero/posterior (A

  17. Knee microfracture surgery

    MedlinePlus

    Cartilage regeneration - knee ... Three types of anesthesia may be used for knee arthroscopy surgery: Medicine to relax you, and shots of painkillers to numb the knee Spinal (regional) anesthesia General anesthesia (you will be ...

  18. Knee CT scan

    MedlinePlus

    CAT scan - knee; Computed axial tomography scan - knee; Computed tomography scan - knee ... Saunders; 2015:chap 93. Shaw AS, Prokop M. Computed tomography. In: Adam A, Dixon AK, Gillard JH, Schaefer- ...

  19. Knee joint replacement

    MedlinePlus

    ... page: //medlineplus.gov/ency/article/002974.htm Knee joint replacement To use the sharing features on this page, please enable JavaScript. Knee joint replacement is a surgery to replace a knee ...

  20. Hip or knee replacement - in the hospital after

    MedlinePlus

    ... It may help speed your recovery and reduce pain, bleeding, and risk of infection. You will learn the proper positions for your legs and knees. Make sure you follow these guidelines. Improper positioning ...

  1. Designing a workplace return-to-work program for occupational low back pain: an intervention mapping approach

    PubMed Central

    Ammendolia, Carlo; Cassidy, David; Steensta, Ivan; Soklaridis, Sophie; Boyle, Eleanor; Eng, Stephanie; Howard, Hamer; Bhupinder, Bains; Côté, Pierre

    2009-01-01

    Background Despite over 2 decades of research, the ability to prevent work-related low back pain (LBP) and disability remains elusive. Recent research suggests that interventions that are focused at the workplace and incorporate the principals of participatory ergonomics and return-to-work (RTW) coordination can improve RTW and reduce disability following a work-related back injury. Workplace interventions or programs to improve RTW are difficult to design and implement given the various individuals and environments involved, each with their own unique circumstances. Intervention mapping provides a framework for designing and implementing complex interventions or programs. The objective of this study is to design a best evidence RTW program for occupational LBP tailored to the Ontario setting using an intervention mapping approach. Methods We used a qualitative synthesis based on the intervention mapping methodology. Best evidence from systematic reviews, practice guidelines and key articles on the prognosis and management of LBP and improving RTW was combined with theoretical models for managing LBP and changing behaviour. This was then systematically operationalized into a RTW program using consensus among experts and stakeholders. The RTW Program was further refined following feedback from nine focus groups with various stakeholders. Results A detailed five step RTW program was developed. The key features of the program include; having trained personnel coordinate the RTW process, identifying and ranking barriers and solutions to RTW from the perspective of all important stakeholders, mediating practical solutions at the workplace and, empowering the injured worker in RTW decision-making. Conclusion Intervention mapping provided a useful framework to develop a comprehensive RTW program tailored to the Ontario setting. PMID:19508728

  2. Developing a Web-Based Version of An Exercise-Based Rehabilitation Program for People With Chronic Knee and Hip Pain: A Mixed Methods Study

    PubMed Central

    2016-01-01

    Background Osteoarthritis is highly prevalent and has enormous personal and socioeconomic impact. Enabling Self-management and Coping with Arthritic Pain through Exercise (ESCAPE-pain) is an integrated rehabilitation program that helps people understand how exercise can improve physical and psychosocial well-being. Unfortunately, its availability is limited. A Web-based version of the program could increase access for more people. Many Web-based resources are developed without end-user input and result in over-complex, unwanted, ineffective products with limited uptake. Objective The objective of this study was to codesign a Web-based version of ESCAPE-pain that people with chronic joint pain find engaging, informative, and useful. Methods To establish older persons' Internet use we conducted a postal survey of 200 people. To establish their opinions, likes or dislikes, and requirements for a Web-based version of the ESCAPE-pain program, we conducted two focus groups with 11 people who had participated in a program based on ESCAPE-pain and two with 13 people who had not. Information from the postal survey and focus groups was used to develop an online prototype website. People's opinions of the prototype website were gauged from thematic analysis of eight semistructured “think aloud” interviews. Results The survey response rate was 42% (83/200), of whom 67% (56/83) were female and mean age was 67 years. Eighty-three percent of the people had used the Internet, 69% described themselves as either very confident or confident Internet users, and 77% had looked online for health information. With regard to participating online, 34% had read a commentary or watched a video of someone else’s experience of a health problem and 23% had tracked a health issue. Key qualitative themes emerged that included engagement, acceptability and usability, and structure and content of the program. Conclusions Older people use the Internet as a source of health information but have

  3. Knee arthroscopy

    MedlinePlus

    ... This is also called regional anesthesia. The pain medicine is injected into a space in your spine. You will be awake but will not be able to feel anything below your waist. General ... The pain medicine is injected around the nerve in your groin. ...

  4. Continuous spinal analgesia with levobupivacaine for postoperative pain management: Comparison of 0.125% versus 0.0625% in elective total knee and hip replacement: A double-blind randomized study

    PubMed Central

    D’Ambrosio, Alessandro; Spadaro, Savino; Natale, Chiara; Cotoia, Antonella; Dambrosio, Michele; Cinnella, Gilda

    2015-01-01

    Background and Aims: Continuous spinal anesthesia (CSA) has not been widely used for postoperative analgesia, mainly to avoid complications from the subarachnoid injection. Recently, the introduction of low caliber CSA catheters (Spinocath®), has allowed to decrease anesthetics doses and volumes with good analgesia and reduced complications. The aim of this present study was to compare two concentrations of levobupivacaine administered through CSA for postoperative pain management after major orthopedic surgery. Secondary outcomes were adverse events associated with CSA. Material and Methods: Thirty-two patients were randomized to receive sufentanil 1 mcg/h plus levobupivacaine 0.125%-1 ml/h (Group A0.125) or 0.0625%-2 ml/h (Group B0.0625) for postoperative analgesia through CSA catheter, connected to the elastomeric pump over 48 h. The quality of analgesia was assessed based on pain intensity by Visual Analogic Scale (VAS). Sensory and motor function, hemodynamic, and respiratory parameters were recorded for 96 h after surgery, after which the catheter was removed. In addition, joint mobility was assessed, and any side effects were noted. Results: VAS score was ≤30 mm in 25 patients. Three patients in Group A0.125 and 4 in Group B0.0625 (NS), received a rescue dose of levobupivacaine. Median VAS in Group A0.125 was lower than in Group B0.0625 on T1h (8 ± 11 vs 16 ± 11; P < 0.05), and on T4h (11 ± 8 vs 18 ± 1; P < 0.05). All patients remained hemodynamically stable. There were no significant differences between groups for postoperative joints mobility. Conclusion: Levobupivacaine at a dose of 1.25 mg/h administered by CSA provides good quality analgesia independent of concentration and solution volume in patients undergoing total knee and hip replacement. PMID:26702204

  5. TOTAL KNEE REPLACEMENT IN PATIENTS WITH BELOW-KNEE AMPUTATION

    PubMed Central

    Karam, Matthew D; Willey, Michael; Shurr, Donald G

    2010-01-01

    Total knee replacement (TKR) is reserved for patients with severe and disabling arthritis that is non-responsive to conservative measures. Based on existing data, total knee replacement is a safe and cost-effective treatment for alleviating pain and improving physical function in patients who do not respond to conservative therapy. Despite the large variation in health status of patients and types of prosthesis implanted, total knee replacement has proven to be a relatively low risk and successful operation. Each year in the United States surgeons perform approximately 300,000 TKR.1 Likewise, lower extremity amputation is commonly performed in the United States with an annual incidence of 110,000 per year.2 Nearly 70% of all lower extremity amputations are performed as the result of chronic vascular disease, followed by trauma (22%), congenital etiology and tumor (4% each).3 Approximately 50% of all lower extremity amputations are performed secondary to complications from Diabetes Mellitus. Norvell et al. demonstrated that patients who have previously undergone transtibial amputation and ambulate with a prosthesis are more likely to develop degenerative joint disease in the con-tralateral extremity than the ipsilateral extremity.4 Further, radiographic changes consistent with osteoporosis have been demonstrated in up to 88% of limbs that have undergone transtibial amputation.8 To our knowledge, there have been only three reported cases of total knee replacement in patients with ipsilateral transtibial amputation.5,7 The purpose of the present study is to review the existing data on total knee replacement in patients who have undergone transtibial amputation. Further we present a patient with a transtibial amputation who underwent contralateral total knee replacement. PMID:21045987

  6. Lateral dislocation of the knee joint after total knee arthroplasty: a case report

    PubMed Central

    Ugutmen, Ender; Ozkan, Korhan; Unay, Koray; Mahirogullari, Mahir; Eceviz, Engin; Taser, Omer

    2008-01-01

    Background Total knee arthroplasty (TKA) is a successful therapy for functional improvement and pain relief in advanced symptomatic degeneration of the knee joint. But it can be associated with many complications, one of which is instability. Case presentation A 70-year-old woman was referred to our hospital because of right knee dislocation after TKA was performed on her right knee due to severe varus deformity and flexion contracture. This instability was caused by persistent MCL tightness and iatrogenic lateral collateral, arcuate ligament, and popliteus tendon injury. The torn lateral collateral ligament and arcuate ligament were sutured with no. 2 non-absorbable (Ethibond) sutures with plication of the posterolateral knee capsule. A deep-dish liner was inserted to optimize soft tissue tension. Conclusion This is a very severe complication, and surgeons must be cautious about ligament balancing and soft tissue resection during TKA for severe varus and valgus deformities. PMID:18687153

  7. Soft tissue releases, bone preservation and patient outcome following revision of the oldest total knee replacement.

    PubMed

    Marson, Ben Arthur; Gleeson, Robert; Majkowski, Richard; Atrey, Amit

    2015-01-01

    The patient had a total knee replacement for arthritis secondary to Stills disease performed 35 years earlier, with 20 years of good function followed by 15 years of progressively worsening knee pain. A revision was completed, which improved the patient's quality of life and objective knee scores, with an increase in Oxford Knee Score from 22 to 42 and American Knee Society Score from 76 to 170. We discuss the technical aspects in revising this knee replacement, which is the oldest that we are aware of. The result has been a good recovery, which is the first available in the literature for future comparison. PMID:26055586

  8. [A case of Sinding-Larsen-Johansson and Osgood-Schlatter disease in both knees].

    PubMed

    Hagner, W; Sosnowski, S; Kaziński, W; Frankowski, S

    1993-01-01

    A case of simultaneous occurrence of two types of aseptic bone necrosis in both knees is presented. The knees of 12 years old hurdle runner became markedly painful after 5 months of competing. The pain has disappeared after 3 months of rest and physical therapy. Radiographic assessment carried out 2 years later demonstrated full remodelling of bony tissue. PMID:7671663

  9. Gait Using Pneumatic Brace for End-Stage Knee Osteoarthritis.

    PubMed

    Kapadia, Bhaveen H; Cherian, Jeffrey Jai; Starr, Roland; Chughtai, Morad; Mont, Michael A; Harwin, Steven F; Bhave, Anil

    2016-04-01

    may improve gait, knee pain, and strength in knee OA patients. PMID:26963073

  10. Cartilage Injuries in the Adult Knee

    PubMed Central

    Moyad, Thomas F.

    2011-01-01

    Cartilage injuries are frequently recognized as a source of significant morbidity and pain in patients with previous knee injuries. The majority of patients who undergo routine knee arthroscopy have evidence of a chondral defect. These injuries represent a continuum of pathology from small, asymptomatic lesions to large, disabling defects affecting a major portion of one or more compartments within the knee joint. In comparison to patients with osteoarthritis, individuals with isolated chondral surface damage are often younger, significantly more active, and usually less willing to accept limitations in activities that require higher impact. At the present time, a variety of surgical procedures exist, each with their unique indications. This heterogeneity of treatment options frequently leads to uncertainty regarding which techniques, if any, are most appropriate for patients. The purpose of this review is to describe the workup and discuss the management techniques for cartilage injuries within the adult knee. PMID:26069581

  11. The Meniscus-Deficient Knee

    PubMed Central

    Rao, Allison J.; Erickson, Brandon J.; Cvetanovich, Gregory L.; Yanke, Adam B.; Bach, Bernard R.; Cole, Brian J.

    2015-01-01

    Meniscal tears are the most common knee injury, and partial meniscectomies are the most common orthopaedic surgical procedure. The injured meniscus has an impaired ability to distribute load and resist tibial translation. Partial or complete loss of the meniscus promotes early development of chondromalacia and osteoarthritis. The primary goal of treatment for meniscus-deficient knees is to provide symptomatic relief, ideally to delay advanced joint space narrowing, and ultimately, joint replacement. Surgical treatments, including meniscal allograft transplantation (MAT), high tibial osteotomy (HTO), and distal femoral osteotomy (DFO), are options that attempt to decrease the loads on the articular cartilage of the meniscus-deficient compartment by replacing meniscal tissue or altering joint alignment. Clinical and biomechanical studies have reported promising outcomes for MAT, HTO, and DFO in the postmeniscectomized knee. These procedures can be performed alone or in conjunction with ligament reconstruction or chondral procedures (reparative, restorative, or reconstructive) to optimize stability and longevity of the knee. Complications can include fracture, nonunion, patella baja, compartment syndrome, infection, and deep venous thrombosis. MAT, HTO, and DFO are effective options for young patients suffering from pain and functional limitations secondary to meniscal deficiency. PMID:26779547

  12. Phaeohyphomycosis infection in the knee.

    PubMed

    Sadigursky, David; Nogueira E Ferreira, Luisa; Moreno de Oliveira Corrêa, Liz

    2016-01-01

    Phaeohyphomycosis is caused by cutaneous fungi and rarely affects large joints. This is a case report on phaeohyphomycosis in the left knee of an elderly individual without immunosuppression. It was accompanied by pain and swelling the anterior knee. The case was first suspected to be suprapatellar bursitis, and was treated with nonsteroidal anti-inflammatory drugs, without remission of symptoms. Surgical treatment was performed, with resection of the suprapatellar bursa and anterior region of the quadriceps tendon. The material was sent for anatomopathological examination and culturing. The pathological examination showed phaeohyphomycosis. The treatment instituted consisted of itraconazole, 200 mg/day for six weeks, and complete remission of symptoms was achieved. The physical examination remained normal after one year of follow-up. This is the first published case of phaeohyphomycosis infection in the suprapatellar region of the knee. Although almost all the cases reported have been associated with immunosuppressed patients, this was an exception. It is important to suspect phaeohyphomycosis in cases of knee infection, in the area of the suprapatellar bursa, when the symptoms do not resolve after clinical treatment. PMID:27069894

  13. Total knee arthroplasty using subvastus approach in stiff knee: A retrospective analysis of 110 cases

    PubMed Central

    Shah, Nilen A; Patil, Hitendra Gulabrao; Vaishnav, Vinod O; Savale, Abhijit

    2016-01-01

    Background: Subvastus approach used in total knee arthroplasty (TKA) is known to produce an earlier recovery but is not commonly utilized for TKA when the preoperative range of motion (ROM) of the knee is limited. Subvastus approach is known for its ability to give earlier recovery due to less postoperative pain and early mobilization (due to rapid quadriceps recovery). Subvastus approach is considered as a relative contraindication for TKA in knees with limited ROM due to difficulty in exposure which can increase risk of complications such as patellar tendon avulsion or medial collateral injury. Short stature and obesity are also relative contraindications. Tarabichi successfully used subvastus approach in knees with limited preoperative ROM. However, there are no large series in literature with the experience of the subvatus approach in knees with limited preoperative ROM. We are presenting our experience of the subvastus approach for TKA in knees with limited ROM. Materials and Methods: We conducted retrospective analysis of patients with limited preoperative ROM (flexion ≤90°) of the knee who underwent TKA using subvastus approach and presenting the 2 years results. There were a total 84 patients (110 knees) with mean age 64 (range 49–79 years) years. The mean preoperative flexion was 72° (range 40°–90°) with a total ROM of 64° (range 36°–90°). Results: Postoperatively knee flexion improved by mean 38° (P < 0.05) which was significant as assed by Student's t- test. The mean knee society score improved from 36 (range 20–60) to 80 (range 70–90) postoperatively (P < 0.05). There was one case of partial avulsion of patellar tendon from the tibial tubercle. Conclusions: We concluded that satisfactory results of TKA can be obtained in knees with limited preoperative ROM using subvastus approach maintaining the advantages of early mobilization. PMID:27053806

  14. Rehabilitation of the arthrofibrotic knee.

    PubMed

    Millett, Peter J; Johnson, Burt; Carlson, Jeff; Krishnan, Sumant; Steadman, J Richard

    2003-11-01

    This paper describes the postoperative rehabilitation of the arthrofibrotic knee, with specific emphasis on modern rehabilitation techniques. The significance of prevention and early recognition is discussed. The importance of early motion and patellar mobility is emphasized and specific exercises to prevent and treat stiffness are described. Continuous passive motion, bracing, and exercise--on the stationary bicycle, on the treadmill, and in water--are adjuncts in the program. Strengthening is added when motion is re-established and there is no swelling or pain. Sport-specific activities are added if progress is satisfactory and motion is maintained. If pain, swelling, or stiffness develops, exercises should be discontinued. Modalities such as cryotherapy, ultrasound, electrical stimulation, rest, and manipulation can be used judiciously. Anti-inflammatory and analgesic medications should be used to prevent inflammation, to control pain, and to allow more aggressive rehabilitative exercises. PMID:14653482

  15. Risk of Acute Kidney Injury After Primary and Revision Total Hip Arthroplasty and Total Knee Arthroplasty Using a Multimodal Approach to Perioperative Pain Control Including Ketorolac and Celecoxib.

    PubMed

    Warth, Lucian C; Noiseux, Nicolas O; Hogue, Matthew H; Klaassen, Alison L; Liu, Steve S; Callaghan, John J

    2016-01-01

    Safe and effective perioperative analgesia is instrumental to patient satisfaction and decreasing LOS after TJA. We evaluated rates of acute kidney injury (AKI) in primary and revision TJA using a multimodal pain control regimen including scheduled celecoxib and PRN ketorolac. Postoperative AKI was identified in 43/903 (4.8%) of 903 of patients with adequate preoperative renal function. Those who developed AKI had significantly increased LOS (P < .01), were older, more obese, and more likely to have diabetes (P < .05). With a protocol incorporating NSAIDs in patients without evidence of preoperative renal impairment, there is a 4.8% rate of AKI, which is 2.7 times higher than the reported literature. Acute postoperative kidney injury was significantly correlated with increased LOS and has important patient safety and healthcare-related cost implications. PMID:26377377

  16. Lateral patellar burnishing in total knee arthroplasty following medialization of the patellar button.

    PubMed

    Doerr, T E; Eckhoff, D G

    1995-08-01

    This case report describes a total knee revision necessitated by painful contact between the exposed lateral facet of the patella and the femoral component. Pain was resolved following repositioning and enlarging the patellar component. The clinical significance of this report is that the contemporary practice of medializing the patellar component to improve patellar tracking should be performed in moderation to avoid overexposure of the lateral patella. In the setting of persistent anterior knee pain following total knee arthroplasty, the etiology of the pain may be identified as contact between the patellar and femoral component on the sunrise radiograph. PMID:8523016

  17. Failure of aseptic revision total knee arthroplasties

    PubMed Central

    Leta, Tesfaye H; Lygre, Stein Håkon L; Skredderstuen, Arne; Hallan, Geir; Furnes, Ove

    2015-01-01

    Background and purpose In Norway, the proportion of revision knee arthroplasties increased from 6.9% in 1994 to 8.5% in 2011. However, there is limited information on the epidemiology and causes of subsequent failure of revision knee arthroplasty. We therefore studied survival rate and determined the modes of failure of aseptic revision total knee arthroplasties. Method This study was based on 1,016 aseptic revision total knee arthroplasties reported to the Norwegian Arthroplasty Register between 1994 and 2011. Revisions done for infections were not included. Kaplan-Meier and Cox regression analyses were used to assess the survival rate and the relative risk of re-revision with all causes of re-revision as endpoint. Results 145 knees failed after revision total knee arthroplasty. Deep infection was the most frequent cause of re-revision (28%), followed by instability (26%), loose tibial component (17%), and pain (10%). The cumulative survival rate for revision total knee arthroplasties was 85% at 5 years, 78% at 10 years, and 71% at 15 years. Revision total knee arthroplasties with exchange of the femoral or tibial component exclusively had a higher risk of re-revision (RR = 1.7) than those with exchange of the whole prosthesis. The risk of re-revision was higher for men (RR = 2.0) and for patients aged less than 60 years (RR = 1.6). Interpretation In terms of implant survival, revision of the whole implant was better than revision of 1 component only. Young age and male sex were risk factors for re-revision. Deep infection was the most frequent cause of failure of revision of aseptic total knee arthroplasties. PMID:25267502

  18. Impact of Neuropathic Pain at the Population Level

    PubMed Central

    Vieira, Ana Shirley Maranhao; Baptista, Abrahao Fontes; Mendes, Livia; Silva, Kamilla Soares; Gois, Sharize Cristine de Araujo; Lima, Flavia Manoela de Almeida; Souza, Israel; Sa, Katia Nunes

    2014-01-01

    Background One of the chief complaints of individuals who frequent the Family Health Units is chronic pain which, in Salvador, affects over 40% of the population. However, little is known about the type of pain and its impact on quality of life (QoL) at population level. The aim of the study is to evaluate the impact of neuropathic pain on QoL in a community. Methods A descriptive cross-sectional study was conducted from March to October 2012, in a Family Health Unit, Salvador, Bahia, Brazil. The DN-4 (type of pain), body map (location), VAS (intensity) and SF-36 (QoL) instruments were applied. The Chi-square (univariate analysis) and logistic regression (multivariate) tests were used, with IC 95% and P < 0.05. Results In a sample of 191 individuals with chronic pain, predominantly women (86.4%), single (48.7%), nonwhite (93.2%), low educational (46.6%) and low economic (100%) level. The most affected locations of the body were knees, lumbar region and head. In 60.2% of interviewees, neuropathic pain, of high intensity (VAS = 7.09 ± 3.0) predominated, with duration of 8.53 ± 8.8 years and mean QoL was reduced in 47.13%. Conclusions Intense pain in the dorsal region and type of neuropathy are independent predictors for greater compromise of QoL. PMID:24578752

  19. Magnetic Resonance Imaging of Cartilage Contact and Bound Water in ACL-Deficient and ACL Reconstructed Knees

    PubMed Central

    Baer, Geoffrey Scott; Kaiser, Jarred; Vignos, Michael; Liu, Fang; Smith, Colin Robert; Kijowski, Richard; Thelen, Darryl

    2016-01-01

    Objectives: Osteoarthritis (OA) is common following ACL-reconstructive (ACLR) surgery (6). The cause of early OA is not understood, but theories have focused on osteochondral damage at the time of injury (2) and abnormal joint mechanics following surgical repair (7). In this study, we investigate the inter-relationship of cartilage mechanics and biomarkers of OA in both ACL-deficient (ACLD) and ACLR knees. Our approach employs a novel dynamic MR sequence to measure joint mechanics (3) and the recently developed mcDESPOT to assess regional variations in water bound to proteoglycan (PG) (5). We hypothesize that bound water will be diminished in the cartilage of ACLD knees and, after surgery, will continue to adapt in a manner that reflects altered cartilage loading. This abstract presents initial observations on a cross-section of healthy, ACLD and ACLR knees. Methods: The dominant knees of 8 healthy controls, ACLD knees of 5 patients and ACLR knees of 8 patients were imaged in a 3 T MRI scanner (Table). Controls had no history of pain, injury, or surgery to their knee. Patients had no additional ligament injury and no meniscal damage. ACLD subjects were imaged prior to reconstructive surgery. Femoral and tibial cartilage were segmented from MR images and cartilage thickness was calculated. The mcDESPOT sequence provided a fraction map of water bound to PG (Fpg). Subjects flexed their knee against an inertial load at 0.5 Hz, while a SPGR-VIPR sequence continuously acquired volumetric data. Kinematics were obtained using model tracking of the dynamic images (3). Cartilage was registered to the bone segments for all frames, and contact patterns were characterized by the proximity between surfaces. Spatial representations of tibial cartilage contact, thickness and Fpg were co-registered for each subject. Results: Our initial images suggest lower Fpg values in ACLD knees, primarily on the posterior-lateral tibia. This is also observed in ACLR knees, with additional

  20. Is Knee Magnetic Resonance Imaging Overutilized in Current Practice?

    PubMed Central

    Song, Young Dong; Jain, Nimesh Prakash; Kim, Seok Jin; Kwon, Sae Kwang; Chang, Moon Jong; Chang, Chong Bum

    2015-01-01

    Purpose To determine what proportion of patients visiting a tertiary knee clinic had pre-obtained knee magnetic resonance imaging (MRI) and to assess the impact of pre-obtained knee MRI on the selection of treatment plans. Materials and Methods Six hundred and eighty patients were enrolled from patients who visited our knee clinic during a 6-month period. The proportion of patients with pre-obtained knee MRI was calculated, and associations of sociodemographic factors, disease category, and finally selected treatment options with knee MRI pre-obtainment were investigated. A utility assessment panel of five orthopaedic surgeons was formed and established utility assessment criteria. Two rounds of utility assessment (before and after MRI review) were performed. Results Of the 680 patients, 185 (27%) had pre-obtained knee MRI. In the first round of utility assessment, 39%, 18%, and 43% of the 185 knee MRIs were evaluated as useful, equivocal, and arguably useless, respectively, and almost identical results were obtained in the second round. The proportion of assessed 'useful MRI' was higher in sports related injury (84%) and other conditions (91%) than in degenerative joint disease (18%) and nonspecific knee pain (31%). Utility assessment results among panels varied little for practice patterns and education duration. Conclusions This study suggests clinicians should reconsider and counsel patients the expected utility of knee MRI acquisition. PMID:26060608

  1. Chronic Pain

    MedlinePlus

    ... adults. Common chronic pain complaints include headache, low back pain, cancer pain, arthritis pain, neurogenic pain (pain resulting ... Institute of Neurological Disorders and Stroke (NINDS). Low Back Pain Fact Sheet Back Pain information sheet compiled by ...

  2. Muscle Impairments in Patients With Knee Osteoarthritis

    PubMed Central

    Alnahdi, Ali H.; Zeni, Joseph A.; Snyder-Mackler, Lynn

    2012-01-01

    Context: Muscle impairments associated with knee osteoarthritis (OA) are the primary underlying cause of functional limitations. Understanding the extent of muscle impairments, its relationship with physical function and disease progression, and the evidence behind exercise therapy that targets muscle impairments is crucial. Evidence Acquisition: An electronic search for relevant articles using MEDLINE and CINHAL databases up to September 2011 was performed. In addition to the electronic search, retrieved articles were searched manually for relevant studies. Results: Quadriceps, hamstrings, and hip muscles are significantly impaired in subjects with knee OA compared with age-matched controls. Muscle strength, especially quadriceps, is a major determinant of both performance-based and self-reported physical function. Whether stronger quadriceps is protective against knee OA onset and progression is not clear. Exercise therapy, including global and targeted resistance training, is effective in reducing pain and improving function in subjects with knee OA. Conclusions: Subjects with knee OA have significant muscle impairments. These muscle impairments affect physical function and should be targeted in therapy. Further research is needed to explore the relationship between quadriceps strength and knee OA initiation and progression and to determine the optimal exercise prescription that augments outcomes in this patient population. PMID:23016099

  3. Evidence based knee injections for the management of arthritis

    PubMed Central

    Cheng, Olivia T.; Souzdalnitski, Dmitri; Vrooman, Bruce; Cheng, Jianguo

    2012-01-01

    Objective Arthritis of the knee affects 46 million Americans. We aimed to determine the level of evidence of intraarticular knee injections in the management of arthritic knee pain. Methods We systematically searched PUBMED/MEDLINE and the Cochrane databases for articles published on knee injections and evaluated their level of evidence and recommendations according to established criteria. Results The evidence supports the use of intraarticular corticosteroid injections for rheumatoid arthritis (1A+ level), osteoarthritis (1A+ level), and juvenile idiopathic arthritis (2C+ level). Pain relief and functional improvement are significant for months up to one year after the injection. Triamcinolone hexacetonide offers an advantage over triamcinolone acetonide and should be the intraarticular steroid of choice (2B+ level). Intraarticular injection of hyaluronate may provide longer pain relief than steroid injection in osteoarthritis (2B+ level). It can also be effective for rheumatoid arthritis knee pain (1A+ level). However, it is only recommended for patients with significant surgical risk factors and for patients with mild radiographic disease in whom conservative treatment has failed (2B± level). Botulinum toxin Type A injection is effective in reducing arthritic knee pain (2B+ level) and so is tropisetron (2B+ level) and tanezumab (2B+ level). The new agents, such as rAAV2-TNFR:Fc, SB-210396/CE 9.1, and various radioisotopes have provided various degrees of success, but their long-term safety and efficacy remains to be determined. Conclusions We conclude that strong evidence supports the use of intraarticular knee injection as a valuable intervention in the continuum of management of arthritis between conservative treatment and knee surgeries. PMID:22621287

  4. Snapping Pes Syndrome after Unicompartmental Knee Arthroplasty

    PubMed Central

    Taketomi, Shuji; Yamagami, Ryota; Tahara, Keitaro; Tanaka, Sakae

    2016-01-01

    Snapping pes syndrome is defined as a snapping sensation in the medial knee caused by pes anserinus and rarely occurs. Snapping pes syndrome after unicompartmental knee arthroplasty (UKA) has not been reported yet. We experienced two cases with this syndrome after UKA. Conservative treatment was effective in one case, while surgical excision of the gracilis tendon was necessary to relieve painful snapping in the other case. The main cause of the first case might be posteromedial overhang of the tibial tray that reached up to 5 mm. The probable cause of the second case was posteromedial overhang of the mobile bearing. PMID:27274476

  5. Knee arthroscopy - slideshow

    MedlinePlus

    ... this page: //medlineplus.gov/ency/presentations/100117.htm Knee arthroscopy - series To use the sharing features on ... 5 out of 5 Normal anatomy Overview The knee is a complex joint made up of the ...

  6. Knee braces - unloading

    MedlinePlus

    ... most people talk about the arthritis in their knees, they are referring to a type of arthritis ... is caused by wear and tear inside your knee joints. Cartilage, the firm, rubbery tissue that cushions ...

  7. Partial knee replacement - slideshow

    MedlinePlus

    ... page: //medlineplus.gov/ency/presentations/100225.htm Partial knee replacement - series To use the sharing features on ... A.M. Editorial team. Related MedlinePlus Health Topics Knee Replacement A.D.A.M., Inc. is accredited ...

  8. Osteotomy of the knee

    MedlinePlus

    ... is not affected unless you have had a knee injury in the past. Osteotomy surgery works by shifting ... M. Editorial team. Related MedlinePlus Health Topics Arthritis Knee Injuries and Disorders Browse the Encyclopedia A.D.A. ...

  9. Knee joint replacement - slideshow

    MedlinePlus

    ... page: //medlineplus.gov/ency/presentations/100088.htm Knee joint replacement - series—Normal anatomy To use the sharing ... of 4 Overview The knee is a complex joint. It contains the distal end of the femur ( ...

  10. Perioperative Rehabilitation Using a Knee Extension Device and Arthroscopic Debridement in the Treatment of Arthrofibrosis

    PubMed Central

    Biggs-Kinzer, Angie; Murphy, Brian; Shelbourne, K. Donald; Urch, Scott

    2010-01-01

    Background: Arthrofibrosis is a postoperative complication of intra-articular knee surgery that can be difficult to treat. Evidence suggests that maximizing knee range of motion may improve outcomes in patients with arthrofibrosis who undergo arthroscopic debridement. Hypothesis: Patients who achieve greater knee range of motion will have better subjective scores. Study Design: Retrospective case series analysis. Methods: A review of records was performed for 33 patients with arthrofibrosis who underwent knee arthroscopy and scar resection coupled with perioperative rehabilitation to maximize knee range of motion. Patient demographics and preoperative and postoperative range of motion measurements were extracted from the records. The International Knee Documentation Committee (IKDC) Subjective Knee Form was administered to assess pain, activity, and knee function. Patients performed a preoperative and postoperative rehabilitation program utilizing a knee extension device to maximize knee extension. Results: According to the IKDC range of motion criteria, 27 of 33 patients achieved normal knee extension, and 14 of 33 achieved normal knee flexion at a mean of 8.6 months after surgery. Patients with normal knee motion had a mean IKDC Subjective Knee Form score of 72.6 ± 13.6, which was significantly higher than patients who did not achieve normal motion (P = .04). Overall, mean IKDC Subjective Knee Form scores improved from 45.3 ± 16.7 preoperatively to 67.1 ± 18.0 postoperatively (P < .01) at a mean of 14.7 months after surgery. Conclusions: Perioperative rehabilitation that emphasizes restoration of normal knee range of motion appears to improve outcomes in patients with arthrofibrosis who undergo arthroscopic scar resection. In support of our hypothesis, patients who achieved greater knee range of motion had better subjective knee scores. PMID:23015970

  11. Infection following total knee arthroplasty: prevention and management.

    PubMed

    Garvin, Kevin L; Konigsberg, Beau S

    2012-01-01

    Despite diligent efforts to prevent infection, prosthetic knee infection occurs in up to 2% of patients treated with total knee arthroplasty. Although the risk of infection is relatively low, the effects are considerable. The number of total knee arthroplasties is projected to increase by more than 600% by 2030, resulting in 3.48 million knee replacements, with a possible 70,000 prosthetic knee infections. Infection will be the most common indication for revision total knee arthroplasty. Prophylactic antibiotics and minimizing patient risk factors are critical in preventing infections. Staphylococcus is the most common organism in infected total knee arthroplasties. Prompt diagnosis and treatment are crucial to the long-term outcomes of patients with prosthetic joint infections. The erythrocyte sedimentation rate, C-reactive protein level, and interleukin-6 serum level should be checked in all patients with clinical signs of infection or unexplained pain or stiffness. The surgical management of a prosthetic knee infection depends on several factors, but none is more important than the timing of infection in relationship to the index surgery. With a success rate of 80% to 90%, two-stage component exchange remains the treatment of choice for chronically infected total knee arthroplasties. PMID:22301250

  12. Knee braces - unloading

    MedlinePlus

    ... is caused by wear and tear inside your knee joints. Cartilage, the firm, rubbery tissue that cushions all of your bones and joints, lets the bones glide over one another. If ... the knee become weaker. Over time, your whole knee becomes ...

  13. Imaging following acute knee trauma.

    PubMed

    Kijowski, R; Roemer, F; Englund, M; Tiderius, C J; Swärd, P; Frobell, R B

    2014-10-01

    Joint injury has been recognized as a potent risk factor for the onset of osteoarthritis. The vast majority of studies using imaging technology for longitudinal assessment of patients following joint injury have focused on the injured knee joint, specifically in patients with anterior cruciate ligament injury and meniscus tears where a high risk for rapid onset of post-traumatic osteoarthritis is well known. Although there are many imaging modalities under constant development, magnetic resonance (MR) imaging is the most important instrument for longitudinal monitoring after joint injury. MR imaging is sensitive for detecting early cartilage degeneration and can evaluate other joint structures including the menisci, bone marrow, tendons, and ligaments which can be sources of pain following acute injury. In this review, focusing on imaging following acute knee trauma, several studies were identified with promising short-term results of osseous and soft tissue changes after joint injury. However, studies connecting these promising short-term results to the development of osteoarthritis were limited which is likely due to the long follow-up periods needed to document the radiographic and clinical onset of the disease. Thus, it is recommended that additional high quality longitudinal studies with extended follow-up periods be performed to further investigate the long-term consequences of the early osseous and soft tissue changes identified on MR imaging after acute knee trauma. PMID:25278054

  14. The older worker with osteoarthritis of the knee

    PubMed Central

    Palmer, Keith T

    2012-01-01

    Background Changing demographics mean that many patients with large joint arthritis will work beyond traditional retirement age. This review considers the impact of knee osteoarthritis (OA) on work participation and the relation between work and knee replacement (TKR). Sources Two systematic searches in Embase and Medline, supplemented by three systematic reviews. Areas of agreement Probably, although evidence is limited, knee OA considerably impairs participation in work (labour force participation, work attendance and work productivity). Areas of uncertainty/research need Little is known about effective interventions (treatments, work changes and policies) to improve vocational participation in patients with knee OA; or how type of work affects long-term clinical outcomes (e.g. pain, function, the need for revision surgery) in patients with TKRs. The need for such research is pressing and opportune, as increasing numbers of patients with knee OA or TKR expect to work on. PMID:22544779

  15. Knee Stiffness

    MedlinePlus

    ... Schueler, MD How it Works Testimonials FAQ for Consumers FAQ for Physicians News Advertising Terms of Use Contact Us Site Map How it Works When people are sick, they must make critical decisions about when and where they should receive healthcare. ...

  16. Mapping.

    ERIC Educational Resources Information Center

    Kinney, Douglas M.; McIntosh, Willard L.

    1979-01-01

    The area of geological mapping in the United States in 1978 increased greatly over that reported in 1977; state geological maps were added for California, Idaho, Nevada, and Alaska last year. (Author/BB)

  17. A comparison of the biomechanical effects of valgus knee braces and lateral wedged insoles in patients with knee osteoarthritis.

    PubMed

    Jones, Richard K; Nester, Christopher J; Richards, Jim D; Kim, Winston Y; Johnson, David S; Jari, Sanjiv; Laxton, Philip; Tyson, Sarah F

    2013-03-01

    Increases in the external knee adduction moment (EKAM) have been associated with increased mechanical load at the knee and progression of knee osteoarthritis. Valgus knee braces and lateral wedged insoles are common approaches to reducing this loading; however no study has directly compared the biomechanical and clinical effects of these two treatments in patients with medial tibiofemoral osteoarthritis. A cross-over randomised design was used where each intervention was worn by 28 patients for a two week period. Pre- and post-intervention gait kinematic/kinetic data and clinical outcomes were collected to evaluate the biomechanical and clinical effects on the knee joint. The valgus knee brace and the lateral wedged insole significantly increased walking speed, reduced the early stance EKAM by 7% and 12%, and the knee adduction angular impulse by 8.6 and 16.1% respectively. The lateral wedged insole significantly reduced the early stance EKAM compared to the valgus knee brace (p=0.001). The valgus knee brace significantly reduced the knee varus angle compared to the baseline and lateral wedged insole. Improvements in pain and function subscales were comparable for the valgus knee brace and lateral wedged insole. There were no significant differences between the two treatments in any of the clinical outcomes; however the lateral wedged insoles demonstrated greater levels of acceptance by patients. This is the first study to biomechanically compare these two treatments, and demonstrates that given the potential role of knee loading in osteoarthritis progression, that both treatments reduce this but lateral wedge insoles appear to have a greater effect. PMID:22920242

  18. Subjects with Knee Osteoarthritis Exhibit Widespread Hyperalgesia to Pressure and Cold.

    PubMed

    Moss, Penny; Knight, Emma; Wright, Anthony

    2016-01-01

    Hyperalgesia to mechanical and thermal stimuli are characteristics of a range of disorders such as tennis elbow, whiplash and fibromyalgia. This study evaluated the presence of local and widespread mechanical and thermal hyperalgesia in individuals with knee osteoarthritis, compared to healthy control subjects. Twenty-three subjects with knee osteoarthritis and 23 healthy controls, matched for age, gender and body mass index, were recruited for the study. Volunteers with any additional chronic pain conditions were excluded. Pain thresholds to pressure, cold and heat were tested at the knee, ipsilateral heel and ipsilateral elbow, in randomized order, using standardised methodology. Significant between-groups differences for pressure pain and cold pain thresholds were found with osteoarthritic subjects demonstrating significantly increased sensitivity to both pressure (p = .018) and cold (p = .003) stimuli, compared with controls. A similar pattern of results extended to the pain-free ipsilateral ankle and elbow indicating widespread pressure and cold hyperalgesia. No significant differences were found between groups for heat pain threshold, although correlations showed that subjects with greater sensitivity to pressure pain were also likely to be more sensitive to both cold pain and heat pain. This study found widespread elevated pain thresholds in subjects with painful knee osteoarthritis, suggesting that altered nociceptive system processing may play a role in ongoing arthritic pain for some patients. PMID:26809009

  19. Subjects with Knee Osteoarthritis Exhibit Widespread Hyperalgesia to Pressure and Cold

    PubMed Central

    Moss, Penny; Knight, Emma; Wright, Anthony

    2016-01-01

    Hyperalgesia to mechanical and thermal stimuli are characteristics of a range of disorders such as tennis elbow, whiplash and fibromyalgia. This study evaluated the presence of local and widespread mechanical and thermal hyperalgesia in individuals with knee osteoarthritis, compared to healthy control subjects. Twenty-three subjects with knee osteoarthritis and 23 healthy controls, matched for age, gender and body mass index, were recruited for the study. Volunteers with any additional chronic pain conditions were excluded. Pain thresholds to pressure, cold and heat were tested at the knee, ipsilateral heel and ipsilateral elbow, in randomized order, using standardised methodology. Significant between-groups differences for pressure pain and cold pain thresholds were found with osteoarthritic subjects demonstrating significantly increased sensitivity to both pressure (p = .018) and cold (p = .003) stimuli, compared with controls. A similar pattern of results extended to the pain-free ipsilateral ankle and elbow indicating widespread pressure and cold hyperalgesia. No significant differences were found between groups for heat pain threshold, although correlations showed that subjects with greater sensitivity to pressure pain were also likely to be more sensitive to both cold pain and heat pain. This study found widespread elevated pain thresholds in subjects with painful knee osteoarthritis, suggesting that altered nociceptive system processing may play a role in ongoing arthritic pain for some patients. PMID:26809009

  20. Predicting Knee Osteoarthritis.

    PubMed

    Gardiner, Bruce S; Woodhouse, Francis G; Besier, Thor F; Grodzinsky, Alan J; Lloyd, David G; Zhang, Lihai; Smith, David W

    2016-01-01

    Treatment options for osteoarthritis (OA) beyond pain relief or total knee replacement are very limited. Because of this, attention has shifted to identifying which factors increase the risk of OA in vulnerable populations in order to be able to give recommendations to delay disease onset or to slow disease progression. The gold standard is then to use principles of risk management, first to provide subject-specific estimates of risk and then to find ways of reducing that risk. Population studies of OA risk based on statistical associations do not provide such individually tailored information. Here we argue that mechanistic models of cartilage tissue maintenance and damage coupled to statistical models incorporating model uncertainty, united within the framework of structural reliability analysis, provide an avenue for bridging the disciplines of epidemiology, cell biology, genetics and biomechanics. Such models promise subject-specific OA risk assessment and personalized strategies for mitigating or even avoiding OA. We illustrate the proposed approach with a simple model of cartilage extracellular matrix synthesis and loss regulated by daily physical activity. PMID:26206679

  1. Patients’ decision making in total knee arthroplasty

    PubMed Central

    Barlow, T.; Griffin, D.; Barlow, D.; Realpe, A.

    2015-01-01

    Objectives A patient-centred approach, usually achieved through shared decision making, has the potential to help improve decision making around knee arthroplasty surgery. However, such an approach requires an understanding of the factors involved in patient decision making. This review’s objective is to systematically examine the qualitative literature surrounding patients’ decision making in knee arthroplasty. Methods A systematic literature review using Medline and Embase was conducted to identify qualitative studies that examined patients’ decision making around knee arthroplasty. An aggregated account of what is known about patients’ decision making in knee arthroplasties is provided. Results Seven studies with 234 participants in interviews or focus groups are included. Ten themes are replicated across studies, namely: expectations of surgery; coping mechanisms; relationship with clinician; fear; pain; function; psychological implications; social network; previous experience of surgery; and conflict in opinions. Conclusions This review is helpful in not only directing future research to areas that are not understood, or require confirmation, but also in highlighting areas that future interventions could address. These include those aimed at delivering information, which are likely to affect the satisfaction rate, demand, and use of knee arthroplasties. Cite this article: Bone Joint Res 2015;4;163–169. PMID:26450640

  2. Arthrodiatasis for management of knee osteoarthritis.

    PubMed

    Aly, Tarek A; Hafez, Kamal; Amin, Osama

    2011-08-01

    Osteoarthritic disease is the result of mechanical and biological events that destabilize the normal processes of degradation and synthesis of articular cartilage chondrocytes, extracellular matrix, and subchondral bone. Osteoarthritis of the knee can cause symptoms ranging from mild to disabling. Initial management of most patients should be nonoperative, but because of the progressive nature of the disease, many patients with osteoarthritis of the knee eventually benefit from operative treatment. Various procedures have been described for treatment of the osteoarthritic knee, ranging from arthroscopic lavage and debridement to total knee arthroplasty. The aim of this study was to evaluate the clinical results of distraction arthroplasty combined with arthroscopic lavage and drilling of cartilage defects for treatment of osteoarthritis of the knee. Nineteen patients (15 women and 4 men; age range, 39-65 years) were operated on. Pre- and postoperative findings were compared. A control group comprising 42 patients treated with only arthroscopic procedures was evaluated for comparison. Follow-up ranged from 3 to 5 years. Results were evaluated both clinically and radiologically postoperatively and throughout the follow-up period. Clinically, pain and walking capacity improved in most patients. Radiologically, joint space widening and improvement of the tibiofemoral angle was noted in nearly all patients. PMID:21815573

  3. Vitamin D supplementation in the management of knee osteoarthritis: study protocol for a randomized controlled trial

    PubMed Central

    2012-01-01

    Background Osteoarthritis (OA) is a common health issue worldwide in the aging population who are also commonly deficient in vitamin D. Our previous study suggested that higher serum 25-(OH)D levels were associated with reduced knee cartilage loss, implying that vitamin D supplementation may prevent the progression of knee OA. The aim of the VItamin D Effects on OA (VIDEO) study is to compare, over a 2- year period, the effects of vitamin D supplementation versus placebo on knee structural changes, knee pain, and lower limb muscle strength in patients with symptomatic knee OA. Methods/design Randomised, placebo-controlled, and double-blind clinical trial aiming to recruit 400 subjects (200 from Tasmania and 200 from Victoria) with both symptomatic knee OA and vitamin D deficiency (serum [25-(OH)D] level of >12.5 nmol/liter and <60 nmol/liter). Participants will be randomly allocated to vitamin D supplementation (50,000 IU compounded vitamin D3 capsule monthly) or identical inert placebo group for 2 years. The primary endpoint is loss of knee cartilage volume measured by magnetic resonance imaging (MRI) and Western Ontario and McMaster Universities Index of OA (WOMAC) knee pain score. The secondary endpoints will be other knee structural changes, and lower limb muscle strength. Several other outcome measures including core muscle images and central blood pressure will be recorded. Linear and logistic regression will be used to compare changes between groups using univariable and multivariable modeling analyses. Both intention to treat and per protocol analyses will be utilized. Discussion The trial is designed to test if vitamin D supplementation will reduce loss of knee cartilage volume, prevent the progression of other knee structural abnormalities, reduce knee pain and strengthen lower limb muscle strength, thus modify disease progression in knee OA. Trial registration ClinicalTrials.gov identifier: NCT01176344; Australian New Zealand Clinical Trials

  4. Attitudes to knee osteoarthritis and total knee replacement in Arab women: a qualitative study

    PubMed Central

    2013-01-01

    Background Total Knee Arthroplasty (TKA) is offered to patients with knee osteoarthritis (OA) in the oil-rich countries in the Gulf region without adequate understanding of their perceptions, preferences or pain experiences. This study aimed to explore the pain experience and mobility limitation as well as the patient’s decision making process to undertake TKA among women with knee pain in the waiting list for surgery. Methods Five focus group discussions were conducted comprised of 39 women with severe knee OA from the waiting list for TKA in the only orthopaedic hospital in Kuwait. Discussions were recorded, transcribed and coded for themes to identify the factors considered to be important in decision-making for TKA. Results Experiencing knee pain was central to daily living and affected patients and their families. Mobility limitation was shaped by a strong sense of expected obligation to take care of the family. Two major sources of TKA delay were identified; one was due to late clinical advice to undergo TKA which was the result of receiving several consultations from different clinicians each of whom tried the medical management for OA. The second delay occurred after the clinical advice for TKA and was mainly due to ambivalence of patients because of fear of the operation and the lack of information about TKA that resulted in unclear expectations of the surgery. Conclusions Both verbal and written information about TKA should be provided as part of preoperative rehabilitation. This is critical to improve doctor-patient interactions and facilitate informed decision about the procedure and thus achieve patient-centered healthcare. PMID:24107658

  5. Arthritic Pain Relief through Partial Knee Replacement

    MedlinePlus Videos and Cool Tools

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  6. The evolution of primary hyperalgesia in orthopedic surgery: quantitative sensory testing and clinical evaluation before and after total knee arthroplasty

    PubMed Central

    Martinez, Valéria; Fletcher, Dominique; Bouhassira, Didier; Sessler, Daniel I.; Chauvin, Marcel

    2007-01-01

    Background Quantitative sensory testing (QST), which allows a better characterization of sensory deficits and painful symptoms, may offer additional information on the pathophysiology of postoperative pain. Methodology Twenty patients scheduled for total knee anthroplasty were evaluated clinically and with QST before surgery, at one and four days, and at one and four months after surgery. Clinical evaluation included preoperative pain and inflammation of operative knee, postoperative assessment of pain at rest and during movement (Visual Analog Scale score), cumulative morphine consumption, and circumference and temperature of both knees. QST included thermal and mechanical (pressure) pain threshold measurements and assessment of responses to suprathreshold stimuli. Brush-evoked allodynia was also evaluated. Measurements were taken on the operative knee, contra lateral knee, and on the hand as a control site. Results All patients had prolonged and severe pain before surgery and inflammation of operative knee. Preoperative OST provided evidence of heat hyperalgesia in the inflammatory area on the operative knee, but absence of punctate or brush-evoked allodynia in the adjacent non inflamed area. Patients had intense postoperative pain, mostly induced by movement. Primary heat hyperalgesia was present on the operative knee on the first and fourth days after surgery, and was associated with punctate mechanical allodynia in the inflammatory area, but not in the adjacent non inflamed area. Postoperative morphine consumption was correlated with preoperative heat hyperalgesia (r=0.63; P=0.01). QST was normalyzed at the 4-month evaluation and only 4 patients had moderate knee pain induced by movement at that time. Conclusion Heat hyperalgesia was the predominant OST symptom associated with perioperative pain after total knee arthroplastv and was predictive of postoperative morphine consumption PMID:17717244

  7. Do early life factors affect the development of knee osteoarthritis in later life: a narrative review.

    PubMed

    Antony, Benny; Jones, Graeme; Jin, Xingzhong; Ding, Changhai

    2016-01-01

    Osteoarthritis (OA) mainly affects older populations; however, it is possible that early life factors contribute to the development of OA in later life. The aim of this review is to describe the association between childhood or early adulthood risk factors and knee pain, structural imaging markers and development of knee OA in later life. A narrative overview of the literature synthesising the findings of literature retrieved from searches of computerised databases and manual searches was conducted. We found that only a few studies have explored the long-term effect of childhood or early adulthood risk factors on the markers of joint health that predispose people to OA or joint symptoms. High body mass index (BMI) and/or overweight status from childhood to adulthood were independently related to knee pain and OA in later life. The findings regarding the association between strenuous physical activity and knee structures in young adults are still conflicting. However, a favourable effect of moderate physical activity and fitness on knee structures is reported. Childhood physical activity and performance measures had independent beneficial effects on knee structures including knee cartilage in children and young adults. Anterior knee pain syndrome in adolescence could lead to the development of patellofemoral knee OA in the late 40s. Furthermore, weak evidence suggests that childhood malalignment, socioeconomic status and physical abuse are associated with OA in later life. The available evidence suggests that early life intervention may prevent OA in later life. PMID:27623622

  8. The effect of mechanical massage on early outcome after total knee arthroplasty: a pilot study

    PubMed Central

    Kim, Sun Mi; Kim, Sang-Rim; Lee, Yong Ki; Kim, Bo Ryun; Han, Eun Young

    2015-01-01

    [Purpose] The aim of this study was to evaluate the efficacy of mechanical massage via Endermologie® after total knee arthroplasty in reducing edema and pain and improving knee range of motion, in the early postoperative period. [Subjects and Methods] Eighteen patients with knee edema following total knee arthroplasty were randomly assigned to the intervention group (n=8) or the control group (n=10). The intervention group received mechanical massage therapy using Endermologie® and the control group received conventional physical therapy for 20 minutes a day, 5 times a week from the seventh day postsurgery. Clinical assessments included active knee flexion and extension range of motion, knee pain using a numeric rating scale, the operated limb circumference, the soft tissue cross-sectional area using ultrasonography, the extracelluar fluid volume, and single frequency bioimpedance analysis at 5 kHz using bioelectrical impedance spectroscopy. [Results] Both groups showed significant reduction in edema and pain, and improvement in active knee flexion at the end of treatment. There were no significant inter-group differences before or after treatment. [Conclusion] Mechanical massage could be an alternative way of managing knee edema after total knee arthroplasty in early postoperative recovery. PMID:26696709

  9. Patellofemoral pain syndrome in Iranian female athletes.

    PubMed

    Nejati, Parisa; Forogh, Bijan; Moeineddin, Reza; Baradaran, Hamid Reza; Nejati, Mina

    2011-01-01

    Patellofemoral pain syndrome (PFPS) is the most common overuse syndrome in athletes. It is one of the causes of anterior knee pain in athletic population who come to the sports medicine clinic. Patellofemoral pain is more common among female athletes especially adolescents and young adults. Symptoms include: persistent pain behind the patella or peripatella. Pain increases on ascending and descending stairs and squatting and prolonged sitting. The aim of this study was to evaluate the prevalence of PFPS in Iranian female athletes. 418 female athletes aged 15-35 years were examined in five sports: Soccer (190), volleyball (103), running (42), fencing (45) and rock climbing (38). The athletes who had non- traumatic onset anterior knee pain of at least 3 months that increased in descending and ascending stairs and squatting, had no other causes of anterior knee pain such as ligament instability, bursitis, meniscal injury, tendonitis and arthritis and no history of knee surgery during the one past year were diagnosed as PFPS. 26/190 (13.68 %) soccer players, 21/103(20.38 %) volleyball players, 7/42 (16.66 %) runners, 6/45(13.33 %) fencers and 10/38 (26.31%) rock climbers had patellofemoral pain. Among the 418 female athletes who were evaluated 70 had PFPS. Rock climbers were the most common athletes with PFPS followed by volleyball players and runners. PMID:21681705

  10. Radiolucent lines in low-contact-stress mobile-bearing total knee arthroplasty: a blinded and matched case control study

    PubMed Central

    2011-01-01

    Background Low-contact-stress (LCS) mobile-bearing total knee arthroplasty (TKA) (Johnson & Johnson, New Brunswick, NJ; previously: DePuy, Warsawa, USA) provides excellent functional results and wear rates in long-term follow-up analyses. Radiological analysis shows radiolucent lines (RLL) appearing immediately or two years after primary implantation, indicative of poor seat. Investigations proved RLL to be more frequent in uncemented TKA, resulting in a consensus to cement the tibial plateau, but their association with clinical findings and patients discomfort and knee pain is still unknown. Methods 553 patients with 566 low-contact-stress (LCS) total knee prostheses were screened for continuous moderate knee pain. We compared tibial stress shielding classified by Ewald in patients suffering from pain with a matched, pain-free control group on blinded X-rays. We hypothesized a positive correlation between pain and radiolucency and higher frequency of such radiolucent lines in the most medial and most lateral zones of the tibial plateau. Results Twenty-eight patients suffered from knee pain in total. Radiolucencies were detected in 27 of these cases and in six out of 28 matched controls without knee pain. We could demonstrate a significant correlation of knee pain and radiolucencies, which appeared significantly more frequently in the outermost zones of the tibial plateau. Conclusion Our findings suggest that radiolucent lines, representing poor implant seat, about the tibial plateau are associated with knee pain in LCS patients. Radiolucencies are observed more often in noncemented LCS, and cementing the tibial plateau might improve implant seat and reduce both radiolucent lines and associated knee pain. PMID:21714916

  11. Is symptomatic knee osteoarthritis a risk factor for a fast decline in gait speed? Results from the Osteoarthritis Initiative

    PubMed Central

    White, Daniel K.; Niu, Jingbo; Zhang, Yuqing

    2012-01-01

    Objectives Gait speed is an important marker of health in adults and slows with aging. While knee osteoarthritis (OA) can result in difficulty walking, it is not known if radiographic knee OA (ROA) and/or knee pain are associated with a fast decline trajectory of gait speed over time. Methods Gait speed trajectories were constructed using a multinomial modeling strategy from repeated 20-meter walk tests measured annually over four years among participants from the Osteoarthritis Initiative (OAI), a prospective cohort study of adults with or at high risk of knee OA aged 45 to 79 at baseline. We grouped participants into four knee OA categories (having neither ROA nor knee pain, ROA only, knee pain only, or symptomatic knee OA (ROA and pain)) and examined their association with trajectories of gait speed using a multivariable polytomous regression model adjusting for age and other potential confounders. Results Of the 4179 participants (mean age (sd) = 61.1 (9.1), women =57.6%, mean BMI =28.5 (4.8) kg/m2), 5% (n=205) were in a fast decline trajectory slowing 2.75%/year. People with symptomatic knee OA had almost a 9-fold risk (OR = 8.9, 95% CI [3.1, 25.5]) of being in a fast decline trajectory compared with those with neither pain nor ROA. Participants with knee pain had 4.5 times the odds of fast decline (95% CI [1.4, 14.6]) and those with ROA only had a slight but non-statistically significant increased risk. Conclusions People with symptomatic knee OA have the highest risk of fast decline trajectory of gait speed compared with people with ROA or pain alone. PMID:22899342

  12. Unique Microstructural Changes in the Brain Associated with Urological Chronic Pelvic Pain Syndrome (UCPPS) Revealed by Diffusion Tensor MRI, Super-Resolution Track Density Imaging, and Statistical Parameter Mapping: A MAPP Network Neuroimaging Study

    PubMed Central

    Woodworth, Davis; Mayer, Emeran; Leu, Kevin; Ashe-McNalley, Cody; Naliboff, Bruce D.; Labus, Jennifer S.; Tillisch, Kirsten; Kutch, Jason J.; Farmer, Melissa A.; Apkarian, A. Vania; Johnson, Kevin A.; Mackey, Sean C.; Ness, Timothy J.; Landis, J. Richard; Deutsch, Georg; Harris, Richard E.; Clauw, Daniel J.; Mullins, Chris; Ellingson, Benjamin M.

    2015-01-01

    Studies have suggested chronic pain syndromes are associated with neural reorganization in specific regions associated with perception, processing, and integration of pain. Urological chronic pelvic pain syndrome (UCPPS) represents a collection of pain syndromes characterized by pelvic pain, namely Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) and Interstitial Cystitis/Painful Bladder Syndrome (IC/PBS), that are both poorly understood in their pathophysiology, and treated ineffectively. We hypothesized patients with UCPPS may have microstructural differences in the brain compared with healthy control subjects (HCs), as well as patients with irritable bowel syndrome (IBS), a common gastrointestinal pain disorder. In the current study we performed population-based voxel-wise DTI and super-resolution track density imaging (TDI) in a large, two-center sample of phenotyped patients from the multicenter cohort with UCPPS (N = 45), IBS (N = 39), and HCs (N = 56) as part of the MAPP Research Network. Compared with HCs, UCPPS patients had lower fractional anisotropy (FA), lower generalized anisotropy (GA), lower track density, and higher mean diffusivity (MD) in brain regions commonly associated with perception and integration of pain information. Results also showed significant differences in specific anatomical regions in UCPPS patients when compared with IBS patients, consistent with microstructural alterations specific to UCPPS. While IBS patients showed clear sex related differences in FA, MD, GA, and track density consistent with previous reports, few such differences were observed in UCPPS patients. Heat maps illustrating the correlation between specific regions of interest and various pain and urinary symptom scores showed clustering of significant associations along the cortico-basal ganglia-thalamic-cortical loop associated with pain integration, modulation, and perception. Together, results suggest patients with UCPPS have extensive microstructural

  13. [Symptoms. Localizations: knee, hip, hands, spine, other localizations].

    PubMed

    Pérez Martín, Álvaro

    2014-01-01

    The symptoms of osteoarthritis vary widely from patient to patient, depending especially on the localization on the disease. There is a poor correlation between radiological involvement and pain. In general, symptom onset is gradual and symptoms increase slowly but progressively. The most commonly affected joints are the knees, hips, hands, and spine. The main signs and symptoms are pain, stiffness, joint deformity, and crepitus. Pain is mechanical and its causes are multifactorial; in the initial phases, pain usually manifests in self-limiting episodes but may subsequently be almost constant. The criteria of the American college of Rheumatology for the classification of osteoarthritis of the knee, hip and hands are an aid to classification and standardization but are not useful for diagnosis. Hip osteoarthritis usually produces inguinal pain in the internal and anterior sections of the muscle extending to the knee and, with progression, tends to limit mobility. Knee osteoarthritis is more frequent in women and is usually associated with hand osteoarthritis and obesity. In hand osteoarthritis, the most commonly affected joints are the distal interphalangeal joints, followed by the proximal interphalangeal joints and the trapeziometacarpal joints; the development of Heberden and Bouchard nodes is common; involvement of the trapeziometacarpal joint is called rhizarthrosis and is one of the forms of osteoarthritis that produces the greatest limitation on hand function. Osteoarthritis of the spine affects the facet joints and the vertebral bodies. Other, less frequent, localizations are the foot, elbow and shoulder, which are generally secondary forms of osteoarthritis. PMID:24467955

  14. Outcomes of patellar resurfacing versus nonresurfacing in total knee arthroplasty: a 9-year experience based on a case series of scorpio PS knees.

    PubMed

    Epinette, Jean-Alain; Manley, Michael T

    2008-10-01

    Patellar resurfacing during total knee arthroplasty (TKA) is an actively debated issue. This prospective study addresses fundamental questions regarding whether to resurface the patella. To do this, we compared clinical results of Scorpio PS knees with and without patellar resurfacing to determine whether there was any statistically significant difference in survivorship, function, pain, and radiographic analyses. Our study failed to demonstrate any statistical difference between the 2 groups (resurfaced versus nonresurfaced) according to knee pain, walking abilities, stair climbing, range of motion, and radiologic findings, as well as cross-correlations between patellar pain and age, gender, obesity, or etiology. Our radiologic findings did not reveal any failures of bony structures facing the metallic flange. Some knee designs can thus be seen as "patella friendly." Given the significant cost of patella resurfacing and the resulting well-known complications, we continue to avoid systematic resurfacing of the patella during Scorpio TKA. PMID:18979932

  15. Pilot Study of Massage in Veterans with Knee Osteoarthritis

    PubMed Central

    Juberg, Michael; Allen, Kelli D.; Dmitrieva, Natalia O.; Keever, Teresa

    2015-01-01

    Abstract Objectives: To (1) assess the feasibility and acceptability of Swedish massage among Department of Veterans Affairs (VA) health care users with knee osteoarthritis (OA) and (2) collect preliminary data on efficacy of Swedish massage in this patient group. Design: Experimental pilot study. Setting: Duke Integrative Medicine clinic and VA Medical Center, Durham, North Carolina. Patients: Twenty-five veterans with symptomatic knee OA. Interventions: Eight weekly 1-hour sessions of full-body Swedish massage. Outcome measures: Primary: Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and global pain (Visual Analog Scale [VAS]). Secondary: National Institutes of Health Patient Reported Outcomes Measurement Information System-Pain Interference Questionnaire 6b (PROMIS-PI 6b), 12-Item Short-Form Health Survey (SF-12 v1) and the EuroQol health status index (EQ-5D-5L), knee range of motion (ROM), and time to walk 50 feet. Results: Study feasibility was established by a 92% retention rate with 99% of massage visits and 100% of research visits completed. Results showed significant improvements in self-reported OA-related pain, stiffness and function (30% improvement in Global WOMAC scores; p=0.001) and knee pain over the past 7 days (36% improvement in VAS score; p<0.001). PROMIS-PI, EQ-5D-5L, and physical composite score of the SF-12 also significantly improved (p<0.01 for all), while the mental composite score of the SF-12 and knee ROM showed trends toward significant improvement. Time to walk 50 feet did not significantly improve. Conclusions: Results of this pilot study support the feasibility and acceptability of Swedish massage among VA health care users as well as preliminary data suggesting its efficacy for reducing pain due to knee OA. If results are confirmed in a larger randomized trial, massage could be an important component of regular care for these patients. PMID:25966332

  16. Introduction of total knee arthroplasty in Lithuania

    PubMed Central

    Stucinskas, Justinas; Robertsson, Otto; Wingstrand, Hans

    2009-01-01

    Background and purpose We have previously reported that the first 10 years of hip arthroplasty in Lithuania resulted in a higher cumulative revision rate than that observed in Sweden. We thus compared the corresponding results after introduaction of total knee replacement in Lithuania. Methods The 10-year revision rate for the first 595 primary ScanKnee arthroplasties inserted in Klaipeda, Lithuania, was compared to that for the first 1,280 ScanKnee primary arthroplasties inserted in Sweden. As in the hip replacement study, only patients with osteoarthritis (OA) were included. Primary knee arthroplasties without patellar resurfacing were included, and the endpoint was revision for any reason other than addition of a patellar component. Results We found that the cumulative revision rate was not statistically significantly different between the groups. The revision pattern was different, however, and we observed 24 isolated patellar component additions in Sweden, but none in Klaipeda. Interpretation Contrary to the results of our previous hip arthroplasty study, the cumulative revision rate after total knee arthroplasty was similar in the two groups. This suggests that compared to hip arthroplasty, the outcome of total knee arthroplasty was less dependent on surgical experience. The large difference regarding isolated patellar component additions may be explained by long-term accumulation of severe OA cases in Lithuania. To patients subject to a newly introduced surgical treatment offering great improvement in quality of life, patellofemoral pain may be a minor problem. Furthermore, patellar problems may not have seemed particularly relevant for the surgeons, considering the disability of other patients waiting to be treated. PMID:19297790

  17. Semi-automatic knee cartilage segmentation

    NASA Astrophysics Data System (ADS)

    Dam, Erik B.; Folkesson, Jenny; Pettersen, Paola C.; Christiansen, Claus

    2006-03-01

    Osteo-Arthritis (OA) is a very common age-related cause of pain and reduced range of motion. A central effect of OA is wear-down of the articular cartilage that otherwise ensures smooth joint motion. Quantification of the cartilage breakdown is central in monitoring disease progression and therefore cartilage segmentation is required. Recent advances allow automatic cartilage segmentation with high accuracy in most cases. However, the automatic methods still fail in some problematic cases. For clinical studies, even if a few failing cases will be averaged out in the overall results, this reduces the mean accuracy and precision and thereby necessitates larger/longer studies. Since the severe OA cases are often most problematic for the automatic methods, there is even a risk that the quantification will introduce a bias in the results. Therefore, interactive inspection and correction of these problematic cases is desirable. For diagnosis on individuals, this is even more crucial since the diagnosis will otherwise simply fail. We introduce and evaluate a semi-automatic cartilage segmentation method combining an automatic pre-segmentation with an interactive step that allows inspection and correction. The automatic step consists of voxel classification based on supervised learning. The interactive step combines a watershed transformation of the original scan with the posterior probability map from the classification step at sub-voxel precision. We evaluate the method for the task of segmenting the tibial cartilage sheet from low-field magnetic resonance imaging (MRI) of knees. The evaluation shows that the combined method allows accurate and highly reproducible correction of the segmentation of even the worst cases in approximately ten minutes of interaction.

  18. Bilateral Synovial Knee Chondromatosis in a Patient with Rheumatoid Arthritis: Case-report and Literature Review

    PubMed Central

    Tahmasebi, M.N; Bashti, Kaveh; Sobhan, MR; Ghorbani, GH

    2014-01-01

    We presented a female patient with RA complaining of progressive pain, swelling, and crepitation of the knee joints that was diagnosed with bilateral synovial chondromatosis (SC) of both knees. Radiographies revealed characteristic findings of SC including multiple calcified multifaceted loose bodies within both knees. Removal of cartilaginous segments as well as total synovectomy was performed arthroscopically on the left side and via open surgery on the right side. Short-term postoperative follow-up of our patient revealed improved knee function and resolution of all symptoms. PMID:25692156

  19. The Influence Of Component Alignment On The Life Of Total Knee Prostheses

    NASA Astrophysics Data System (ADS)

    Bugariu, Delia; Bereteu, Liviu

    2012-12-01

    An arthritic knee affects the patient's life by causing pain and limiting movement. If the cartilage and the bone surfaces are severely affected, the natural joint is replaced with an artificial joint. The procedure is called total knee arthroplasty (TKA). Lately, the numbers of implanted total knee prostheses grow steadily. An important factor in TKA is the perfect alignment of the total knee prosthesis (TKP) components. Component misalignment can lead to the prosthesis loss by producing wear particles. The paper proposes a study on mechanical behaviors of a TKP based on numerical analysis, using ANSYS software. The numerical analysis is based on both the normal and the changed angle of the components alignment.

  20. Bilateral Synovial Knee Chondromatosis in a Patient with Rheumatoid Arthritis: Case-report and Literature Review.

    PubMed

    Tahmasebi, M N; Bashti, Kaveh; Sobhan, Mr; Ghorbani, Gh

    2014-10-01

    We presented a female patient with RA complaining of progressive pain, swelling, and crepitation of the knee joints that was diagnosed with bilateral synovial chondromatosis (SC) of both knees. Radiographies revealed characteristic findings of SC including multiple calcified multifaceted loose bodies within both knees. Removal of cartilaginous segments as well as total synovectomy was performed arthroscopically on the left side and via open surgery on the right side. Short-term postoperative follow-up of our patient revealed improved knee function and resolution of all symptoms. PMID:25692156

  1. Preventing Knee Injuries

    MedlinePlus

    ... to tearing. Growth Plate Injuries, Fractures, and Dislocations Knee fractures rarely occur in childhood sports, but with any ... is the bump on the front of the knee where the patellar tendon attaches. Fractures to the growth plate in this area often ...

  2. Groin pain

    MedlinePlus

    Pain - groin; Lower abdominal pain; Genital pain; Perineal pain ... Common causes of groin pain include: Pulled muscle, tendon, or ligaments in the leg: This problem often occurs in people who play sports such as ...

  3. Bicompartmental knee arthroplasty

    PubMed Central

    Giachino, Matteo; Risitano, Salvatore; Atzori, Francesco

    2016-01-01

    Total knee arthroplasty (TKA) is the most worldwide practiced surgery for knee osteoarthritis and its efficacy is mightily described by literature. Concerns about the invasiveness of TKA let the introduction of segmental resurfacing of the joint for younger patients with localized osteoarthritis. Bone stock sparing and ligaments preservation are the essence of both unicompartmental knee arthroplasty (UKA) and bicompartmental knee arthroplasty (BKA). Advantages related to BKA are the respect of knee biomechanics, lower complications rates, shorter hospital stay, faster rehabilitation. Moreover, in case of failure of the first implant the conversion to TKA is undemanding and can be compared to a standard prosthesis. Our experience suggest that BKA is a reliable technique in selected cases and especially younger people with higher functional requests can favourably profit from it. Although those results are encouraging, we still need further prospective, randomized, long-term studies to finally assess BKA indications and outcomes. PMID:26855941

  4. Bicompartmental knee arthroplasty.

    PubMed

    Sabatini, Luigi; Giachino, Matteo; Risitano, Salvatore; Atzori, Francesco

    2016-01-01

    Total knee arthroplasty (TKA) is the most worldwide practiced surgery for knee osteoarthritis and its efficacy is mightily described by literature. Concerns about the invasiveness of TKA let the introduction of segmental resurfacing of the joint for younger patients with localized osteoarthritis. Bone stock sparing and ligaments preservation are the essence of both unicompartmental knee arthroplasty (UKA) and bicompartmental knee arthroplasty (BKA). Advantages related to BKA are the respect of knee biomechanics, lower complications rates, shorter hospital stay, faster rehabilitation. Moreover, in case of failure of the first implant the conversion to TKA is undemanding and can be compared to a standard prosthesis. Our experience suggest that BKA is a reliable technique in selected cases and especially younger people with higher functional requests can favourably profit from it. Although those results are encouraging, we still need further prospective, randomized, long-term studies to finally assess BKA indications and outcomes. PMID:26855941

  5. Vertical Ground Reaction Forces are Associated with Pain and Self-Reported Functional Status in Recreational Athletes with Patellofemoral Pain.

    PubMed

    de Oliveira Silva, Danilo; Briani, Ronaldo; Pazzinatto, Marcella; Ferrari, Deisi; Aragão, Fernando; de Azevedo, Fábio

    2015-12-01

    Individuals with patellofemoral pain (PFP) use different motor strategies during unipodal support in stair climbing activities, which may be assessed by vertical ground reaction force parameters. Thus, the aims of this study were to investigate possible differences in first peak, valley, second peak, and loading rate between recreational female athletes with PFP and pain-free athletes during stair climbing in order to determine the association and prediction capability between these parameters, pain level, and functional status in females with PFP. Thirty-one recreational female athletes with PFP and 31 pain-free recreational female athletes were evaluated with three-dimensional kinetics while performing stair climbing to obtain vertical ground reaction force parameters. A visual analog scale was used to evaluate the usual knee pain. The anterior knee pain scale was used to evaluate knee functional score. First peak and loading rate were associated with pain (r = .46, P = .008; r = .56, P = .001, respectively) and functional limitation (r = .31, P = .049; r = -.36, P = .032, respectively). Forced entry regression revealed the first peak was a significant predictor of pain (36.5%) and functional limitation (28.7%). Our findings suggest that rehabilitation strategies aimed at correcting altered vertical ground reaction force may improve usual knee pain level and self-reported knee function in females with PFP. PMID:26286949

  6. Arthroscopic removal of separated bipartite patella causing snapping knee syndrome.

    PubMed

    Yoo, Jae Ho; Kim, Eung Ha; Ryu, Ho Kwang

    2008-07-01

    The bipartite patella is a developmental osseous variant that is found in approximately 2% to 6% of the population, and is bilateral in 50%. The proposed etiologies include old nonunion, osteochondritis, and congenital growth defect. It is often found incidentally around the inferior pole, lateral margin, or superolateral border of the patella. It is usually asymptomatic, but may be related to anterior knee pain. However, separation of the bipartite patella is rare, with 9 cases reported in the literature. The symptomatic snapping knee syndrome may be caused by multiple intra-articular and extra-articular pathology including discoid meniscus, tumors, iliotibial band, popliteus, gracilis, semitendinosus, or biceps femoris tendon. However, no reports exist on separated bipartite patella as the feasible cause of the snapping knee syndrome in the orthopedic literature. This article presents a case of snapping knee syndrome due to separated bipartite patella. The accessory bone was removed by arthroscopy, which has rarely been described in the literature. PMID:19292364

  7. Early failure with the Journey-Deuce bicompartmental knee arthroplasty.

    PubMed

    Dudhniwala, A G; Rath, N K; Joshy, S; Forster, M C; White, S P

    2016-07-01

    The aim of this study was to evaluate the early functional outcome and survivorship of a bicompartmental knee arthroplasty implant (Journey-Deuce) in a cohort of patients with combined medial and patellofemoral degenerative osteoarthritis. Fifteen patients with a mean age of 57 years were followed up prospectively and evaluated with clinical examination, Oxford knee score and radiology imaging. Poor pain scores, concerns about the tibial fixation, early aseptic loosening of the tibial component and a revision rate of 60 % at a minimum follow-up of 54 months are reported. Implantation of this prosthesis was stopped at our institution well before the first revision due to an unfavourable early clinical response. This was further endorsed by an unacceptable revision rate. The outcome of the Journey-Deuce bicompartmental knee replacement was considerably worse than the published outcome of total knee replacement. PMID:27001223

  8. Posterolateral dislocation of the knee: Recognizing an uncommon entity.

    PubMed

    Woon, Colin Yl; Hutchinson, Mark R

    2016-06-18

    Posterolateral dislocations of the knee are rare injuries. Early recognition and emergent open reduction is crucial. A 48-year-old Caucasian male presented with right knee pain and limb swelling 3 d after sustaining a twisting injury in the bathroom. Examination revealed the pathognomonic anteromedial "pucker" sign. Ankle-brachial indices were greater than 1.0 and symmetrical. Radiographs showed a posterolateral dislocation of the right knee. He underwent emergency open reduction without an attempt at closed reduction. Attempts at closed reduction of posterolateral dislocations of the knee are usually impossible because of incarceration of medial soft tissue in the intercondylar notch and may only to delay surgical management and increase the risk of skin necrosis. Magnetic resonance imaging is not crucial in the preoperative period and can lead to delays of up to 24 h. Instead, open reduction should be performed once vascular compromise is excluded. PMID:27335816

  9. Posterolateral dislocation of the knee: Recognizing an uncommon entity

    PubMed Central

    Woon, Colin YL; Hutchinson, Mark R

    2016-01-01

    Posterolateral dislocations of the knee are rare injuries. Early recognition and emergent open reduction is crucial. A 48-year-old Caucasian male presented with right knee pain and limb swelling 3 d after sustaining a twisting injury in the bathroom. Examination revealed the pathognomonic anteromedial “pucker” sign. Ankle-brachial indices were greater than 1.0 and symmetrical. Radiographs showed a posterolateral dislocation of the right knee. He underwent emergency open reduction without an attempt at closed reduction. Attempts at closed reduction of posterolateral dislocations of the knee are usually impossible because of incarceration of medial soft tissue in the intercondylar notch and may only to delay surgical management and increase the risk of skin necrosis. Magnetic resonance imaging is not crucial in the preoperative period and can lead to delays of up to 24 h. Instead, open reduction should be performed once vascular compromise is excluded. PMID:27335816

  10. External Knee Adduction and Flexion Moments during Gait and Medial Tibiofemoral Disease Progression in Knee Osteoarthritis

    PubMed Central

    Chang, Alison H.; Moisio, Kirsten C.; Chmiel, Joan S.; Eckstein, Felix; Guermazi, Ali; Prasad, Pottumarthi V.; Zhang, Yunhui; Almagor, Orit; Belisle, Laura; Hayes, Karen; Sharma, Leena

    2015-01-01

    Objective Test the hypothesis that greater baseline peak external knee adduction moment (KAM), KAM impulse, and peak external knee flexion moment (KFM) during the stance phase of gait are associated with baseline-to-2-year medial tibiofemoral cartilage damage and bone marrow lesion progression, and cartilage thickness loss. Methods Participants all had knee OA in at least one knee. Baseline peak KAM, KAM impulse, and peak KFM (normalized to body weight and height) were captured and computed using a motion analysis system and 6 force plates. Participants underwent MRI of both knees at baseline and two years later. To assess the association between baseline moments and baseline-to-2-year semiquantitative cartilage damage and bone marrow lesion progression and quantitative cartilage thickness loss, we used logistic regression with generalized estimating equations (GEE), adjusting for gait speed, age, gender, disease severity, knee pain severity, and medication use. Results The sample consisted of 391 knees (204 persons): mean age 64.2 years (SD 10.0); BMI 28.4 kg/m2 (5.7); 156 (76.5%) women. Greater baseline peak KAM and KAM impulse were each associated with worsening of medial bone marrow lesions, but not cartilage damage. Higher baseline KAM impulse was associated with 2-year medial cartilage thickness loss assessed both as % loss and as a threshold of loss, whereas peak KAM was related only to % loss. There was no relationship between baseline peak KFM and any medial disease progression outcome measures. Conclusion Findings support targeting KAM parameters in an effort to delay medial OA disease progression. PMID:25677110

  11. Can combined use of low-level lasers and hyaluronic acid injections prolong the longevity of degenerative knee joints?

    PubMed Central

    Ip, David; Fu, Nga Yue

    2015-01-01

    Background This study evaluated whether half-yearly hyaluronic acid injection together with low-level laser therapy in addition to standard conventional physical therapy can successfully postpone the need for joint replacement surgery in elderly patients with bilateral symptomatic tricompartmental knee arthritis. Methods In this prospective, double-blind, placebo-controlled study, 70 consecutive unselected elderly patients with bilateral tricompartmental knee arthritis were assigned at random to either one of two conservative treatment protocols to either one of the painful knees. Protocol A consisted of conventional physical therapy plus a sham light source plus saline injection, and protocol B consisted of protocol A with addition of half-yearly hyaluronic acid injection as well as low-level laser treatment instead of using saline and a sham light source. Treatment failure was defined as breakthrough pain necessitating joint replacement. Results Among the 140 painful knees treated with either protocol A or protocol B, only one of the 70 painful knees treated by protocol B required joint replacement, whereas 15 of the 70 painful knees treated by protocol A needed joint replacement surgery (P<0.05). Conclusion We conclude that half-yearly hyaluronic acid injections together with low-level laser therapy should be incorporated into the standard conservative treatment protocol for symptomatic knee arthritis, because it may prolong the longevity of the knee joint without the need for joint replacement. PMID:26346122

  12. Treating Osteoarthritis of the Knee

    MedlinePlus

    ... osteotomy may need knee replacement surgery in the future. Arthroplasty is also called joint or knee replacement therapy. A surgeon removes the part of the knee damaged by osteoarthritis and replaces it with an artificial joint made from metals and plastic. All or part of the knee joint may ...

  13. Energy Recovery in Individuals with Knee Osteoarthritis

    PubMed Central

    Sparling, Tawnee L.; Schmitt, Daniel; Miller, Charlotte E.; Guilak, Farshid; Somers, Tamara J.; Keefe, Francis J.; Queen, Robin M.

    2015-01-01

    Objective Pathological gaits have been shown to limit transfer between potential (PE) and kinetic (KE) energy during walking, which can increase locomotor costs. The purpose of this study was to examine whether energy exchange would be limited in people with knee osteoarthritis (OA). Methods Ground reaction forces during walking were collected from 93 subjects with symptomatic knee OA (self-selected and fast speeds) and 13 healthy controls (self-selected speed) and used to calculate their center of mass (COM) movements, PE and KE relationships, and energy recovery during a stride. Correlations and linear regressions examined the impact of energy fluctuation phase and amplitude, walking velocity, body mass, self-reported pain, and radiographic severity on recovery. Paired t-tests were run to compare energy recovery between cohorts. Results Symptomatic knee OA subjects displayed lower energetic recovery during self-selected walking speeds than healthy controls (p=0.0018). PE and KE phase relationships explained the majority (66%) of variance in recovery. Recovery had a complex relationship with velocity and its change across speeds was significantly influenced by the self-selected walking speed of each subject. Neither radiographic OA scores nor subject self-reported measures demonstrated any relationship with energy recovery. Conclusions Knee OA reduces effective exchange of PE and KE, potentially increasing the muscular work required to control movements of the COM. Gait retraining may return subjects to more normal patterns of energy exchange and allow them to reduce fatigue. PMID:24752039

  14. Minimally invasive knee arthroplasty: An overview

    PubMed Central

    Tria, Alfred J; Scuderi, Giles R

    2015-01-01

    Minimally invasive surgery (MIS) for arthroplasty of the knee began with surgery for unicondylar knee arthroplasty (UKA). Partial knee replacements were designed in the 1970s and were amenable to a more limited exposure. In the 1990s Repicci popularized the MIS for UKA. Surgeons began to apply his concepts to total knee arthroplasty. Four MIS surgical techniques were developed: quadriceps sparing, mini-mid vastus, mini-subvastus, and mini-medial parapatellar. The quadriceps sparing technique is the most limited one and is also the most difficult. However, it is the least invasive and allows rapid recovery. The mini-midvastus is the most common technique because it affords slightly better exposure and can be extended. The mini-subvastus technique entirely avoids incising the quadriceps extensor mechanism but is time consuming and difficult in the obese and in the muscular male patient. The mini-parapatellar technique is most familiar to surgeons and represents a good starting point for surgeons who are learning the techniques. The surgeries are easier with smaller instruments but can be performed with standard ones. The techniques are accurate and do lead to a more rapid recovery, with less pain, less blood loss, and greater motion if they are appropriately performed. PMID:26601062

  15. Calcaneal Insufficiency Fracture after Ipsilateral Total Knee Arthroplasty

    PubMed Central

    Jeong, Min; Shin, Sung Jin; Kang, Byoung Youl

    2016-01-01

    Insufficiency fracture of the calcaneus is a rare entity. In the absence of trauma, evaluating a painful ankle in an elderly patient can be difficult and also it might be overlook the insufficiency fracture. We experienced a case of insufficiency calcaneus fracture that occurred after ipsilateral total knee arthroplasty. Here, we report our case with a review of literatures. PMID:26981521

  16. Effect of Mulligan's and Kinesio knee taping on adolescent ballet dancers knee and hip biomechanics during landing.

    PubMed

    Hendry, D; Campbell, A; Ng, L; Grisbrook, T L; Hopper, D M

    2015-12-01

    Taping is often used to manage the high rate of knee injuries in ballet dancers; however, little is known about the effect of taping on lower-limb biomechanics during ballet landings in the turnout position. This study investigated the effects of Kinesiotape (KT), Mulligan's tape (MT) and no tape (NT) on knee and hip kinetics during landing in three turnout positions. The effect of taping on the esthetic execution of ballet jumps was also assessed. Eighteen pain-free 12-15-year-old female ballet dancers performed ballet jumps in three turnout positions, under the three knee taping conditions. A Vicon Motion Analysis system (Vicon Oxford, Oxford, UK) and Advanced Mechanical Technology, Inc. (Watertown, Massa chusetts, USA) force plate collected lower-limb mechanics. The results demonstrated that MT significantly reduced peak posterior knee shear forces (P = 0.025) and peak posterior (P = 0.005), medial (P = 0.022) and lateral (P = 0.014) hip shear forces compared with NT when landing in first position. KT had no effect on knee or hip forces. No significant differences existed between taping conditions in all landing positions for the esthetic measures. MT was able to reduce knee and the hip forces without affecting the esthetic performance of ballet jumps, which may have implications for preventing and managing knee injuries in ballet dancers. PMID:25091570

  17. How Is Pain Managed?

    MedlinePlus

    ... Trials Pain Management Nutrition and Exercise Holistic Care Pathology Intraductal Papillary Mucinous Neoplasms Islet Cell Tumors & Endocrine ... 410-933-7262 Site Map Policies & Credits News Pathology Home Goldman Center © 2016 Johns Hopkins University

  18. [MR imaging for the assessment of osteoarthritic knees].

    PubMed

    Sasho, Takahisa

    2011-06-01

    Currently two types of MR imaging are used for the evaluation of osteoarthritic knees. One is to assess the status of knee joint as a whole such as Whole-Organ Magnetic Resonance Imaging Score (WORMS) ; the other is to assess the status of cartilage using specific sequences such as delayed gadolinium enhanced magnetic resonance imaging for cartilage (dGEMRIC) , T2 mapping, and T1 rho. PMID:21628806

  19. Apparent Skin Discoloration about the Knee Joint: A Rare Sequela of Metallosis after Total Knee Replacement

    PubMed Central

    Jayasekera, Narlaka; Gouk, Conor; Patel, Amit; Eyres, Keith

    2015-01-01

    Introduction. Metallosis is a phenomenon most commonly associated with hip replacement. However it can occur in any metallic implant subject to wear. Wear creates metal debris, which is deposited in the surrounding soft tissue. This leads to many local adverse reactions including, but not limited to, implant loosening/osteolysis, pain, and effusion. In the deeper joints, for example, the hip, metal deposits are mostly only seen intraoperatively. Case Study. A 74-year-old lady represented to orthopaedic outpatient clinic. Her principle complaint was skin discolouration, associated with pain and swelling over the left knee, on the background of a previous total knee replacement with a metal backed patella resurfacing six years. A plain radiograph revealed loosening of the patellar prosthesis. A diagnosis of metallosis was made; the patient underwent debridement of the stained soft tissue and primary revision of the prosthesis. She remained symptom-free five years after revision. Discussion. Metallosis results in metallic debris which causes tissue staining, often hidden within the soft tissue envelope of the hip, but more apparent in the knee. Metallosis may cause pain, effusion, and systemic symptoms because of raised levels of serum-metal ions. Surgical intervention with revision and debridement can have good functional results. PMID:25878914

  20. Symptoms of the knee and hip in individuals with and without limb length inequality

    PubMed Central

    Golightly, Y. M.; Allenz, K. D.; Helmick, C. G.; Renner, J. B.; Jordan, J. M.

    2014-01-01

    Summary Objective This cross-sectional study examined the association of limb length inequality (LLI) with chronic joint symptoms at the hip and knee in a large, community-based sample, adjusting for the presence of radiographic osteoarthritis (OA) and other confounders. Methods The total study group comprised 3012 participants with complete knee symptoms data, 3007 participants with complete hip symptoms data, and 206 with LLI ≥ 2 cm. Presence of chronic knee symptoms was defined as report of pain, aching, or stiffness (symptoms) of the knee on most days. Presence of chronic hip symptoms was defined as hip pain, aching, or stiffness on most days or groin pain. Multiple logistic regression models were used to examine the relationship of LLI with knee and hip symptoms, while adjusting for demographic and clinical factors, radiographic knee or hip OA and history of knee or hip problems (joint injury, fracture, surgery, or congenital anomalies). Results Participants with LLI were more likely than those without LLI to have knee symptoms (56.8% vs 43.0%, P < 0.001), and hip symptoms (49.5% vs 40.0%, P = 0.09). In adjusted models, knee symptoms were significantly associated with presence of LLI (adjusted odds ratio [aOR] = 1.41, 95% confidence interval, [95% CI] 1.02 –1.97), but the relationship between hip symptoms and LLI (aOR = 1.20, 95% CI 0.87–1.67) was not statistically significant. Conclusion LLI was moderately associated with chronic knee symptoms and less strongly associated with hip symptoms. LLI may be a new modifiable risk factor for therapy of people with knee or hip symptoms. PMID:19095470

  1. A comparison of radiographic anatomic axis knee alignment measurements and cross-sectional associations with knee osteoarthritis

    PubMed Central

    Goulston, L.M.; Sanchez-Santos, M.T.; D'Angelo, S.; Leyland, K.M.; Hart, D.J.; Spector, T.D.; Cooper, C.; Dennison, E.M.; Hunter, D.; Arden, N.K.

    2016-01-01

    Summary Objective Malalignment is associated with knee osteoarthritis (KOA), however, the optimal anatomic axis (AA) knee alignment measurement on a standard limb radiograph (SLR) is unknown. This study compares one-point (1P) and two-point (2P) AA methods using three knee joint centre locations and examines cross-sectional associations with symptomatic radiographic knee osteoarthritis (SRKOA), radiographic knee osteoarthritis (RKOA) and knee pain. Methods AA alignment was measured six different ways using the KneeMorf software on 1058 SLRs from 584 women in the Chingford Study. Cross-sectional associations with principal outcome SRKOA combined with greatest reproducibility determined the optimal 1P and 2P AA method. Appropriate varus/neutral/valgus alignment categories were established using logistic regression with generalised estimating equation models fitted with restricted cubic spline function. Results The tibial plateau centre displayed greatest reproducibility and associations with SRKOA. As mean 1P and 2P values differed by >2°, new alignment categories were generated for 1P: varus <178°, neutral 178–182°, valgus >182° and for 2P methods: varus <180°, neutral 180–185°, valgus >185°. Varus vs neutral alignment was associated with a near 2-fold increase in SRKOA and RKOA, and valgus vs neutral for RKOA using 2P method. Nonsignificant associations were seen for 1P method for SRKOA, RKOA and knee pain. Conclusions AA alignment was associated with SRKOA and the tibial plateau centre had the strongest association. Differences in AA alignment when 1P vs 2P methods were compared indicated bespoke alignment categories were necessary. Further replication and validation with mechanical axis alignment comparison is required. PMID:26700504

  2. A pilot randomized, placebo-controlled clinical trial to investigate the efficacy and safety of an extract of Artemisia annua administered over 12 weeks, for managing pain, stiffness, and functional limitation associated with osteoarthritis of the hip and knee.

    PubMed

    Stebbings, Simon; Beattie, Elizabeth; McNamara, Debra; Hunt, Sheena

    2016-07-01

    The objective of this study was to investigate the safety and efficacy of a dietary supplement, Arthrem, containing an extract from the medicinal plant Artemisia annua, on pain, stiffness, and functional limitation in osteoarthritis (OA) of the hip or knee. Forty-two patients were randomized to one of three groups (n = 14 in each group): 150-mg Artemisia annua extract (ART) twice daily (BD) (ART low dose), 300-mg ART BD (ART high dose), or placebo BD administered over 12 weeks. Efficacy was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC®) and visual analog scale (VAS) for pain. Participants treated with ART low dose demonstrated significant improvement in WOMAC total scores from baseline to 12 weeks (mean change, -12.2; standard deviation, [SD] 13.84; p = 0.0159); improvement was not shown in the placebo group (mean change, -7.8; SD, 19.80; p = 0.1029). Statistically significant reductions were seen from baseline in the ART low-dose group for individual WOMAC components stiffness and physical function. VAS pain scores were statistically significantly reduced from baseline to 12 weeks in the ART low-dose group (mean change, -21.4 mm; SD, 23.48 mm; p = 0.0082) but not the placebo group (mean change, -11.5 mm; SD, 28.97 mm, p = 0.1757). No statistically significant changes occurred from baseline in the placebo or ART high-dose groups for any parameter. ART low dose was well tolerated. ART has potential as an anti-inflammatory/analgesic in OA. Treatment with ART 150 mg BD is associated with clinically relevant reductions in pain over 12 weeks. Further studies are warranted. PMID:26631103

  3. Advanced concepts in knee arthrodesis

    PubMed Central

    Wood, Jennifer H; Conway, Janet D

    2015-01-01

    The aim is to describe advanced strategies that can be used to diagnose and treat complications after knee arthrodesis and to describe temporary knee arthrodesis to treat infected knee arthroplasty. Potential difficult complications include nonunited knee arthrodesis, limb length discrepancy after knee arthrodesis, and united but infected knee arthrodesis. If a nonunited knee arthrodesis shows evidence of implant loosening or failure, then bone grafting the nonunion site as well as exchange intramedullary nailing and/or supplemental plate fixation are recommended. If symptomatic limb length discrepancy cannot be satisfactorily treated with a shoe lift, then the patient should undergo tibial lengthening over nail with a monolateral fixator or exchange nailing with a femoral internal lengthening device. If a united knee arthrodesis is infected, the nail must be removed. Then the surgeon has the option of replacing it with a long, antibiotic cement-coated nail. The authors also describe temporary knee arthrodesis for infected knee arthroplasty in patients who have the potential to undergo insertion of a new implant. The procedure has two goals: eradication of infection and stabilization of the knee. A temporary knee fusion can be accomplished by inserting both an antibiotic cement-coated knee fusion nail and a static antibiotic cement-coated spacer. These advanced techniques can be helpful when treating difficult complications after knee arthrodesis and treating cases of infected knee arthroplasty. PMID:25793160

  4. The Cost-Effectiveness of Surgical Treatment of Medial Unicompartmental Knee Osteoarthritis in Younger Patients

    PubMed Central

    Konopka, Joseph F.; Gomoll, Andreas H.; Thornhill, Thomas S.; Katz, Jeffrey N.; Losina, Elena

    2015-01-01

    Background: Surgical options for the management of medial compartment osteoarthritis of the varus knee include high tibial osteotomy, unicompartmental knee arthroplasty, and total knee arthroplasty. We sought to determine the cost-effectiveness of high tibial osteotomy and unicompartmental knee arthroplasty as alternatives to total knee arthroplasty for patients fifty to sixty years of age. Methods: We built a probabilistic state-transition computer model with health states defined by pain, postoperative complications, and subsequent surgical procedures. We estimated transition probabilities from published literature. Costs were determined from Medicare reimbursement schedules. Health outcomes were measured in quality-adjusted life-years (QALYs). We conducted analyses over patients’ lifetimes from the societal perspective, with health and cost outcomes discounted by 3% annually. We used probabilistic sensitivity analyses to account for uncertainty in data inputs. Results: The estimated discounted QALYs were 14.62, 14.63, and 14.64 for high tibial osteotomy, unicompartmental knee arthroplasty, and total knee arthroplasty, respectively. Discounted total direct medical costs were $20,436 for high tibial osteotomy, $24,637 for unicompartmental knee arthroplasty, and $24,761 for total knee arthroplasty (in 2012 U.S. dollars). The incremental cost-effectiveness ratio (ICER) was $231,900 per QALY for total knee arthroplasty and $420,100 per QALY for unicompartmental knee arthroplasty. Probabilistic sensitivity analyses showed that, at a willingness-to-pay (WTP) threshold of $50,000 per QALY, high tibial osteotomy was cost-effective 57% of the time; total knee arthroplasty, 24%; and unicompartmental knee arthroplasty, 19%. At a WTP threshold of $100,000 per QALY, high tibial osteotomy was cost-effective 43% of time; total knee arthroplasty, 31%; and unicompartmental knee arthroplasty, 26%. Conclusions: In fifty to sixty-year-old patients with medial unicompartmental knee

  5. Be aware of wood in the knee

    PubMed Central

    O’Connell, Rachel Louise; Fageir, Mazin M; Addison, Anthony

    2011-01-01

    The authors report a case of a 7-year-old boy who sustained a penetrating injury of a splinter of wood to the knee. Arthroscopic examination, removal of visualised foreign material and washout did not alleviate the symptoms of pain and swelling in its entirety. Microbiology cultures also failed to determine the cause of the on-going symptoms. Five days later, the patient underwent a mini arthrotomy through a lateral incision, which demonstrated synovitis, and removal of the remaining embedded foreign body from the lateral condyle. Although the authors advocate arthroscopy as the surgeon’s first choice for removal of a foreign body from the knee, a mini-arthrotomy should also be considered to facilitate superior visualisation and easier instrumentation to remove embedded foreign bodies. PMID:22669952

  6. Fracture Blisters After Primary Total Knee Arthroplasty.

    PubMed

    Halawi, Mohamad J

    2015-08-01

    Fracture blisters are tense vesicles that arise on markedly swollen skin overlying traumatized soft tissue. While this relatively uncommon complication has been well described in the trauma literature, this article reports for the first time a case of fracture blisters after primary total knee arthroplasty. The fracture blisters developed within 36 hours of surgery and were associated with profound swelling and erythema. There was no evidence of vascular injury, compartment syndrome, iatrogenic fracture, or deep venous thrombosis. The patient was treated with leg elevation, loosely applied nonadhesive dressings, and a short course of oral antibiotics after skin desquamation. Blood-filled blisters required longer time to reepithelialization than fluid-filled blisters. Knee stiffness developed because of pain and fear of participation with physical therapy, but the patient was able to resume intensive rehabilitation after resolution of the blisters. Patient factors, surgical factors, and review of the literature are discussed. PMID:26251947

  7. Osteochondral Allograft Transplantation in the Knee.

    PubMed

    Zouzias, Ioannis C; Bugbee, William D

    2016-06-01

    The technique of osteochondral allograft (OCA) transplantation has been used to treat a wide spectrum of cartilage deficiencies in the knee. Its use has been supported by basic science and clinical studies that show it is a safe and effective treatment option. What sets fresh OCA transplantation apart from other cartilage procedures in the knee, is the ability to treat large defects with mature hyaline cartilage. Studies looking at transplantation of fresh OCAs in the general population have shown reliable pain relief and return to activities of daily living. Reports of cartilage injuries in athletes have risen over the years and more research is needed in evaluating the successfulness of OCA transplantation in the athletic population. PMID:27135291

  8. Controlling joint pain in older people.

    PubMed

    Paisley, Peter; Serpell, Mick

    2016-01-01

    Jont pain in oldder people The prevalence of chronic pain in older people in the community ranges from 25 to 76% and for those in residential care, it is even higher at 83 to 93%. The most common sites affected are the back, hip, or knee, and other joints. There is increased reporting of pain in women (79%) compared with men (53%). Common conditions include osteoarthritis and, to a lesser extent, the inflammatory arthropathies such as rheumatoid arthritis. The differential diagnosis includes non-articular pain such as vascular limb pain and nocturnal cramp, some neuropathic pain conditions (such as compressive neuropathies and postherpetic neuralgia), soft tissue disorders such as fibromyalgia and myofascial pain syndromes. In addition to an assessment of pain intensity, a biopsychosocial model should be adopted to ascertain the effect of the pain on the patient's degree of background pain at rest. The disease is often localised to the large load-bearing joints, predominantly the hips and knees. In contrast to osteoarthritis, the inflammatory arthritides typically present with symmetrical swollen, stiff, and painful small joints of the hands and feet, usually worse in the morning. PMID:27180497

  9. Knee MRI scan

    MedlinePlus

    ... magnetic resonance imaging) scan uses energy from strong magnets to create pictures of the knee joint and ... in your eyes) Because the MRI contains strong magnets, metal objects are not allowed into the room ...

  10. Total Knee Replacement

    MedlinePlus

    ... as anti- inflammatory medications, cortisone injections, lubricating injections, physical therapy, or other surgeries A knee that has become ... your function. Other treatment options — including medications, injections, physical therapy, or other types of surgery — will also be ...

  11. Tourniquetless Total Knee Arthroplasty

    MedlinePlus Videos and Cool Tools

    Tourniquetless Total Knee Arthroplasty You must have Javascript enabled in your web browser. View Program Transcript Click Here to view the OR-Live, Inc. Privacy Policy and Legal Notice © 2010 OR- ...

  12. Knee arthroscopy - discharge

    MedlinePlus

    ... is cartilage that cushions the space between the bones in the knee. Surgery is done to repair or remove it. Torn or damaged anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) Inflamed or damaged lining of the joint. This ...

  13. Knee arthroscopy - discharge

    MedlinePlus

    ... knee arthroscopy). You may have been checked for: Torn meniscus. Meniscus is cartilage that cushions the space ... Surgery is done to repair or remove it. Torn or damaged anterior cruciate ligament (ACL) or posterior ...

  14. Taking care of your new knee joint

    MedlinePlus

    Knee arthroplasty - precautions; Knee replacement - precautions ... After you have knee replacement surgery , you will need to be careful about how you move your knee, especially for the first few months after ...

  15. Ethics of treating postoperative pain.

    PubMed

    Jones, James W; McCullough, Laurence B

    2012-02-01

    You received a call advising that Mr S. H. Irk was in the emergency room having considerable wound pain following an above-knee amputation you performed 6 months ago. You discharged him from your clinic 6 weeks postoperatively to his primary care physician, still complaining of more pain than usual. Your examination, clinical lab tests, and X-rays do not reveal any serious problems, but he is writhing in pain and begging for relief. Mr Irk has been to a number of different physicians in the interlude including a chiropractor, a pain specialist, several primary care physicians, and a psychiatrist without relief. He has braced up with increasing amounts of analgesics, the latest of which was oral Dilaudid. His last source of pain meds on the street has dried up. You admit him with orders for analgesics. What should your treatment plan be? PMID:22264808

  16. Reading Knee-Deep

    ERIC Educational Resources Information Center

    Jewett, Pamela

    2007-01-01

    Freire told his audience at a seminar at the University of Massachusetts, "You need to read knee-deep in texts, for deeper than surface meanings, and you need to know the words to be able to do it" (quoted in Cleary, 2003). In a children's literature class, fifteen teachers and I traveled along a path that moved us toward reading knee-deep as we…

  17. Dashboard (in the) knee.

    PubMed

    Patel, M S; Qureshi, A A; Green, T P

    2015-03-01

    We present the case of a 19-year-old individual presenting to an orthopaedic outpatient clinic several months following a dashboard knee injury during a road traffic accident with intermittent mechanical symptoms. Despite unremarkable examination findings and normal magnetic resonance imaging, the patient was identified subsequently as having an intra-articular plastic foreign body consistent with a piece of dashboard on arthroscopic knee assessment, the retrieval of which resulted in a complete resolution of symptoms. PMID:25723676

  18. [The combination of chondroitin sulfate and glucosamine (artra) for pain relief and to reduce the consumption of NSAIDs in patients with I-II stages of osteoarthritis of the knee].

    PubMed

    Rodionova, S S; Eskin, N A

    2016-01-01

    The analysis of the dynamics of pain and joint function on the background of the 3-month ARTRA.Study was conducted as a multicenter, with the inclusion of 3077 patients, 56.2% of whom received NSAIDs for pain relief. While taking after a month of therapy showed significant compared to the original value of reducing the intensity of pain. The therapeutic effect is increased with duration of dosing. It is shown that the drug reduces the need for arthritis NSAIDs after a month by 6.8%, after 3 months - by 37.3%, ie after the 3-month course of treatment with arthritis, the number of people taking NSAIDs fell by more than 3 times (up 18.9%). A significant reduction in consumption, coupled with the marked dynamics of the pain is regarded by us as a manifestation expressed anesthetic effect of the drug ARTRA. PMID:26977614

  19. Flank pain

    MedlinePlus

    Pain - side; Side pain ... Flank pain can be a sign of a kidney problem. But, since many organs are in this area, other causes are possible. If you have flank pain and fever , chills, blood in the urine, or ...

  20. Chronic Pain

    MedlinePlus

    ... your pain. Medicines used for chronic pain include pain relievers, antidepressants, and anticonvulsants. Different types of medicines help ... If your doctor recommends an over-the-counter pain reliever, read and follow the instructions on the box. ...

  1. Efficacy of strength and aerobic exercise on patient-reported outcomes and structural changes in patients with knee osteoarthritis: study protocol for a randomized controlled trial

    PubMed Central

    2013-01-01

    Background Despite an extensive literature on treatment interventions for patients with knee osteoarthritis, studies comparing the efficacy of different exercise interventions and living the life as usual on quality of life, cartilage quality and cost-effectiveness are lacking. The aim of the present study is to compare the efficacy of two different exercise programs compared to a control group in individuals with established radiographic and symptomatic knee osteoarthritis on self-reported knee-related quality of life, knee pain, physical function, and cartilage quality. Methods/Design A three-armed randomized controlled trial involving two exercise interventions and a control group of individuals doing as they usually do is described. The patients will have mild to moderate radiographic osteoarthritis according to the Kellgren and Lawrence classification (grade 2–3), and fulfill the American College of Rheumatology clinical criteria, be aged between 45 and 65 years, and have no other serious physical or mental illnesses. The patients will be randomly allocated to a strength exercise group; a cycling group, or a control group. The primary outcome is the Knee injury and Osteoarthritis Outcome Score knee-related quality of life subscale. Secondary outcomes include all five Knee Injury and Osteoarthritis Outcome Score subscales, morphological evaluation of cartilage including focal thickness, subchondral bone marrow edema, proteoglycan content and collagen degradation (measured using magnetic resonance imaging clinical sequences, T2 mapping and T1ρ), specific serum biomarkers, isokinetic muscle strength, maximal oxygen uptake, quality of life (EuroQol 5D), and self-efficacy (Arthritis Self-Efficacy Scale). A sample size calculation on the primary outcome showed that 207 individuals, 69 in each group, is needed to detect a clinically relevant difference of 10 points with 80% power and a significance level of 5%. Assessments will be conducted at baseline, 14

  2. Effect of Sodium Hyaluronate on Recovery after Arthroscopic Knee Surgery.

    PubMed

    Anand, Sanjeev; Singisetti, Kiran; Srikanth, Koppa N; Bamforth, Cathy; Asumu, Theophilus; Buch, Keyur

    2016-08-01

    The aim of this study was to evaluate the effect of a single immediate postoperative instillation of 10 mL of sodium hyaluronate (Viscoseal) into the knee following arthroscopy. A single-center, prospective, randomized, controlled study was undertaken. Consenting knee arthroscopy patients were randomized into two groups following surgery: the study group received 10 mL of sodium hyaluronate intra-articularly, while the control group received an intra-articular instillation of 10 mL of Bupivacaine. Pre- and postoperative visual analogue scale scores for pain and Western Ontario and McMaster Universities (WOMAC) scores for knee function were obtained. Overall, 48 patients under the care of a single surgeon were randomized into two groups of 24. There were no statistically significant demographic differences at baseline. Three patients were lost to follow-up. There was a statistically significant difference in pain scores favoring the study group compared with the control group at 3 and 6 weeks postoperatively (p < 0.05), and a statistically significant difference in WOMAC scores favoring the study group compared with the control group at 3 and 6 weeks postoperatively (p = 0.01). Synovial fluid replacement with sodium hyaluronate following arthroscopic knee surgery conferred statistically significant improvements in pain and function scores compared with Bupivacaine in the short term (3-6 weeks). PMID:26551066

  3. Corticospinal and Intracortical Excitability of the Quadriceps in Patients with Knee Osteoarthritis

    PubMed Central

    Kittelson, Andrew J.; Thomas, Abbey C.; Kluger, Benzi M.; Stevens-Lapsley, Jennifer E.

    2015-01-01

    Deficits in voluntary activation of the quadriceps muscle are characteristic of knee osteoarthritis (OA), contributing to the quadriceps weakness that is also a hallmark of the disease. The mechanisms underlying this central activation deficit (CAD) are unknown, although cortical mechanisms may be involved. Here, we utilize transcranial magnetic stimulation (TMS) to assess corticospinal and intracortical excitability in patients with knee osteoarthritis (OA) and in a comparably aged group of healthy older adults, to quantify group differences and to examine associations between TMS measures and pain, quadriceps strength, and CAD. Seventeen patients with knee OA and 20 healthy controls completed testing. Motor evoked potentials (MEPs) were measured at the quadriceps by superficial electromyographic (EMG) recordings. Corticospinal excitability was assessed by measuring resting motor threshold (RMT) to TMS stimulation of the quadriceps representation at primary motor cortex, and intracortical excitability was assessed via paired pulse paradigms for short interval intracortical inhibition (SICI) and intracortical facilitation (ICF). No statistically significant differences between patients with knee OA and healthy controls were found for RMT, SICI or ICF measures (p>0.05). For patients with knee OA, there were significant associations observed between pain and RMT, as well as between pain and ICF. No associations were observed between CAD and measures of corticospinal or intracortical excitability. These data suggest against direct involvement of corticospinal or intracortical pathways within primary motor cortex in the mechanisms of CAD. However, pain is implicated in the neural mechanisms of quadriceps motor control in patients with knee OA. PMID:25183161

  4. Pain threshold correlates with functional scores in osteoarthritis patients

    PubMed Central

    Kuni, Benita; Wang, Haili; Rickert, Markus; Ewerbeck, Volker; Schiltenwolf, Marcus

    2015-01-01

    Background and purpose Pain sensitization may be one of the reasons for persistent pain after technically successful joint replacement. We analyzed how pain sensitization, as measured by quantitative sensory testing, relates preoperatively to joint function in patients with osteoarthritis (OA) scheduled for joint replacement. Patients and methods We included 50 patients with knee OA and 49 with hip OA who were scheduled for joint replacement, and 15 control participants. Hip/knee scores, thermal and pressure detection, and pain thresholds were examined. Results Median pressure pain thresholds were lower in patients than in control subjects: 4.0 (range: 0–10) vs. 7.8 (4–10) (p = 0.003) for the affected knee; 4.5 (2–10) vs. 6.8 (4–10) (p = 0.03) for the affected hip. Lower pressure pain threshold values were found at the affected joint in 26 of the 50 patients with knee OA and in 17 of the 49 patients with hip OA. The American Knee Society score 1 and 2, the Oxford knee score, and functional questionnaire of Hannover for osteoarthritis score correlated with the pressure pain thresholds in patients with knee OA. Also, Harris hip score and the functional questionnaire of Hannover for osteoarthritis score correlated with the cold detection threshold in patients with hip OA. Interpretation Quantitative sensory testing appeared to identify patients with sensory changes indicative of mechanisms of central sensitization. These patients may require additional pain treatment in order to profit fully from surgery. There were correlations between the clinical scores and the level of sensitization. PMID:25323797

  5. Similar outcome for total knee arthroplasty after previous high tibial osteotomy and for total knee arthroplasty as the first measure.

    PubMed

    W-Dahl, Annette; Robertsson, Otto

    2016-08-01

    Background and purpose - Patients having a total knee arthroplasty (TKA) after a previous high tibial osteotomy (HTO) constitute a minor group among those undergoing primary TKA for knee osteoarthritis (OA). There have been few reports on whether such patients differ pre- and postoperatively from those who undergo TKA as the first measure. We evaluated patient characteristics, knee-related pain, function, quality of life, and general health before and 1 year after TKA surgery in these 2 groups of patients. Patients and methods - We included 119 HTOs that were operated on for knee OA in the Skåne region, Sweden, in the period1998-2007 and that had been converted to a TKA during 2009-2013 (the C group). We also included 5,013 primary TKAs performed for knee OA in the same region, during the same period, and in patients of the same age range (42-82 years) (the P group). The patients were evaluated with the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the EQ-VAS preoperatively and 1 year after the TKA surgery, when they were also asked about their satisfaction with the surgery. Case-mix variables available were Charnley category, American Society of Anesthesiologists (ASA) classification, sex, age, and body mass index (BMI). Results - Most of the HTOs were performed using open-wedge osteotomy with external fixation (81 of 119). Compared to the P group, the patients in the C group were more often men, were younger, and were healthier (according to the ASA classification). With respect to pre- and postoperative knee-related pain, function, quality of life, and general health, the 2 groups had similar mean values without any statistically significant differences. A similar proportion of patients in the 2 groups were satisfied with the surgery 1 year postoperatively (82% vs. 80%). Interpretation - Our findings indicate that HTO is a reasonable alternative for delaying TKA surgery in younger and/or physically active OA patients. PMID:27339330

  6. Early Quadriceps Strength Loss After Total Knee Arthroplasty

    PubMed Central

    Mizner, Ryan L; Petterson, Stephanie C; Stevens, Jennifer E; Vandenborne, Krista; Snyder-Mackler, Lynn

    2005-01-01

    Background: While total knee arthroplasty reduces pain and provides a functional range of motion of the knee, quadriceps weakness and reduced functional capacity typically are still present one year after surgery. The purpose of the present investigation was to determine the role of failure of voluntary muscle activation and muscle atrophy in the early loss of quadriceps strength after surgery. Methods: Twenty patients with unilateral knee osteoarthritis were tested an average of ten days before and twenty-seven days after primary total knee arthroplasty. Quadriceps strength and voluntary muscle activation were measured with use of a burst-superimposition technique in which a supramaximal burst of electrical stimulation is superimposed on a maximum voluntary isometric contraction. Maximal quadriceps cross-sectional area was assessed with use of magnetic resonance imaging. Results: Postoperatively, quadriceps strength was decreased by 62%, voluntary activation was decreased by 17%, and maximal cross-sectional area was decreased by 10% in comparison with the preoperative values; these differences were significant (p < 0.01). Collectively, failure of voluntary muscle activation and atrophy explained 85% of the loss of quadriceps strength (p < 0.001). Multiple linear regression analysis revealed that failure of voluntary activation contributed nearly twice as much as atrophy did to the loss of quadriceps strength. The severity of knee pain with muscle contraction did not change significantly compared with the preoperative level (p = 0.31). Changes in knee pain during strength-testing did not account for a significant amount of the change in voluntary activation (p = 0.14). Conclusions: Patients who are managed with total knee arthroplasty have profound impairment of quadriceps strength one month after surgery. This impairment is predominantly due to failure of voluntary muscle activation, and it is also influenced, to a lesser degree, by muscle atrophy. Knee pain with

  7. Rapid prototyping for in vitro knee rig investigations of prosthetized knee biomechanics: comparison with cobalt-chromium alloy implant material.

    PubMed

    Schröder, Christian; Steinbrück, Arnd; Müller, Tatjana; Woiczinski, Matthias; Chevalier, Yan; Weber, Patrick; Müller, Peter E; Jansson, Volkmar

    2015-01-01

    Retropatellar complications after total knee arthroplasty (TKA) such as anterior knee pain and subluxations might be related to altered patellofemoral biomechanics, in particular to trochlear design and femorotibial joint positioning. A method was developed to test femorotibial and patellofemoral joint modifications separately with 3D-rapid prototyped components for in vitro tests, but material differences may further influence results. This pilot study aims at validating the use of prostheses made of photopolymerized rapid prototype material (RPM) by measuring the sliding friction with a ring-on-disc setup as well as knee kinematics and retropatellar pressure on a knee rig. Cobalt-chromium alloy (standard prosthesis material, SPM) prostheses served as validation standard. Friction coefficients between these materials and polytetrafluoroethylene (PTFE) were additionally tested as this latter material is commonly used to protect pressure sensors in experiments. No statistical differences were found between friction coefficients of both materials to PTFE. UHMWPE shows higher friction coefficient at low axial loads for RPM, a difference that disappears at higher load. No measurable statistical differences were found in knee kinematics and retropatellar pressure distribution. This suggests that using polymer prototypes may be a valid alternative to original components for in vitro TKA studies and future investigations on knee biomechanics. PMID:25879019

  8. Rapid Prototyping for In Vitro Knee Rig Investigations of Prosthetized Knee Biomechanics: Comparison with Cobalt-Chromium Alloy Implant Material

    PubMed Central

    Schröder, Christian; Steinbrück, Arnd; Müller, Tatjana; Woiczinski, Matthias; Chevalier, Yan; Müller, Peter E.; Jansson, Volkmar

    2015-01-01

    Retropatellar complications after total knee arthroplasty (TKA) such as anterior knee pain and subluxations might be related to altered patellofemoral biomechanics, in particular to trochlear design and femorotibial joint positioning. A method was developed to test femorotibial and patellofemoral joint modifications separately with 3D-rapid prototyped components for in vitro tests, but material differences may further influence results. This pilot study aims at validating the use of prostheses made of photopolymerized rapid prototype material (RPM) by measuring the sliding friction with a ring-on-disc setup as well as knee kinematics and retropatellar pressure on a knee rig. Cobalt-chromium alloy (standard prosthesis material, SPM) prostheses served as validation standard. Friction coefficients between these materials and polytetrafluoroethylene (PTFE) were additionally tested as this latter material is commonly used to protect pressure sensors in experiments. No statistical differences were found between friction coefficients of both materials to PTFE. UHMWPE shows higher friction coefficient at low axial loads for RPM, a difference that disappears at higher load. No measurable statistical differences were found in knee kinematics and retropatellar pressure distribution. This suggests that using polymer prototypes may be a valid alternative to original components for in vitro TKA studies and future investigations on knee biomechanics. PMID:25879019

  9. Knee osteoarthritis affects the distribution of joint moments during gait.

    PubMed

    Zeni, Joseph A; Higginson, Jill S

    2011-06-01

    Alterations in lower extremity kinetics have been shown to exist in persons with knee osteoarthritis (OA), however few investigations have examined how the intersegmental coordination of the lower extremity kinetic chain varies in the presence of knee joint pathology. The objective of this study was to evaluate how knee OA and walking speed affect total support moment and individual joint contributions to the total support moment. Fifteen healthy subjects and 30 persons with knee OA participated in 3D walking analysis at constrained (1.0 m/s), self-selected and fastest tolerable walking speeds. Individual joint contributions to total support moment were analyzed using separate ANOVAs with one repeated measure (walking speed). Linear regression analysis was used to evaluate the relationship between walking speed and joint contribution. Persons with knee OA reduced the contribution of the knee joint when walking at constrained (p = 0.04) and self-selected walking speeds (p = 0.009). There was a significant increase in the ankle contribution and a significant decrease in the hip contribution when walking speed was increased (p < 0.004), however individual walking speeds were not significantly related to joint contributions. This suggests that the relationship between walking speed and joint contribution is dependent on the individual's control strategy and we cannot estimate the joint contribution solely based on walking speed. The slower gait speed observed in persons with knee OA is not responsible for the reduction in knee joint moments, rather this change is likely due to alterations in the neuromuscular strategy of the lower extremity kinetic chain in response to joint pain or muscle weakness. PMID:20510618

  10. Total knee arthroplasty in valgus knees using minimally invasive medial-subvastus approach

    PubMed Central

    Shah, Nilen Amulak; Jain, Nimesh Prakash

    2016-01-01

    Background: An ideal approach for valgus knees must provide adequate exposure with minimal complications due to approach per se. Median parapatellar approach is most commonly used approach in TKA including valgus knees. A medial subvastus approach is seldom used for valgus knees and has definite advantages of maintaining extensor mechanism integrity and minimal effect on patellar tracking. The present study was conducted to evaluate outcomes of total knee arthroplasty (TKA) and efficacy of subvastus approach in valgus knees in terms of early functional recovery, limb alignment and complications. Materials and Methods: We retrospectively reviewed 112 knees with valgus deformity between January 2006 and December 2011. All patients were assessed postoperatively for pain using Visual Analog Scale (VAS) and quadriceps recovery in form of time to active straight leg raising (SLR) and staircase competency and clinical outcomes using American Knee Society (AKS) score and radiographic evaluation with average followup of 40 months (range 24–84 months). Results: The mean VAS on postoperative day (POD) 1 and POD2 at rest was 2.73 and 2.39, respectively and after mobilization was 3.28 and 3.08, respectively (P < 0.001). The quadriceps recovery was very early and 92 (86.7%) patients were able to do active SLR by POD1 with mean time of 21.98 h while reciprocal gait and staircase competency was possible at 43.05 h. The AKS and function score showed significant improvement from preoperative mean score of 39 and 36 to 91 and 79 (P < 0.001), respectively, and the mean range of motion increased from 102° preoperatively to 119° at recent followup (P < 0.001). The mean tibiofemoral valgus was corrected from preoperative 16° (range 10°–35°) to 5° (range 3°–9°) valgus (P < 0.001). Conclusions: Mini-subvastus quadriceps approach provides adequate exposure and excellent early recovery for TKA in valgus knees, without increase in incidence of complications. PMID:26955174

  11. Stem cell application for osteoarthritis in the knee joint: A minireview.

    PubMed

    Uth, Kristin; Trifonov, Dimitar

    2014-11-26

    Knee osteoarthritis is a chronic, indolent disease that will affect an ever increasing number of patients, especially the elderly and the obese. It is characterized by degeneration of the cartilage substance inside the knee which leads to pain, stiffness and tenderness. By some estimations in 2030, only in the United States, this medical condition will burden 67 million people. While conventional treatments like physiotherapy or drugs offer temporary relief of clinical symptoms, restoration of normal cartilage function has been difficult to achieve. Moreover, in severe cases of knee osteoarthritis total knee replacement may be required. Total knee replacements come together with high effort and costs and are not always successful. The aim of this review is to outline the latest advances in stem cell therapy for knee osteoarthritis as well as highlight some of the advantages of stem cell therapy over traditional approaches aimed at restoration of cartilage function in the knee. In addition to the latest advances in the field, challenges associated with stem cell therapy regarding knee cartilage regeneration and chondrogenesis in vitro and in vivo are also outlined and analyzed. Furthermore, based on their critical assessment of the present academic literature the authors of this review share their vision about the future of stem cell applications in the treatment of knee osteoarthritis. PMID:25426260

  12. Press-fit condylar total knee arthroplasty. 5- to 9-year follow-up evaluation.

    PubMed

    Martin, S D; McManus, J L; Scott, R D; Thornhill, T S

    1997-09-01

    Between November 1984 and December 1987, 378 consecutive Press-Fit Condylar (PFC, Johnson & Johnson Professional, Raynham, MA) total knee arthroplasties were performed in 290 patients. The average age at surgery was 67 years (range, 22-91 years). The average follow-up period was 6.5 years (range, 5-9 years). Scoring was carried out according to the Knee Society scoring system. The average preoperative knee score was 28, and the average postoperative knee score was 88. The average preoperative functional knee score was 49, and the average postoperative functional knee score was 72. Ninety-five percent of the patients had no pain on level walking and were satisfied with their functional result. The average postoperative knee flexion was 110 degrees. No implant showed any evidence of radiographic loosening. There were 17 complications, all requiring reoperation. Complications included excessive wear of a metal-backed patella in 8 knees. If complications resulting from the earlier use of a metal-backed patella are eliminated, the overall complication rate is 2.9%, which is comparable to or lower than the rates for other total knee systems with similar follow-up periods. PMID:9306210

  13. Musculoskeletal pain in overweight and obese children

    PubMed Central

    Smith, S M; Sumar, B; Dixon, K A

    2014-01-01

    This review seeks to provide a current overview of musculoskeletal pain in overweight and obese children. Databases searched were Academic Search Complete, CINAHL, Medline, Proquest Health and Medical Complete, Scopus, Google Scholar, SPORTDiscuss and Trove for studies published between 1 January 2000 and 30 December 2012. We used a broad definition of children within a 3- to 18-year age range. The search strategy included the following terms: obesity, morbid obesity, overweight, pain, musculoskeletal pain, child, adolescent, chronic pain, back pain, lower back pain, knee pain, hip pain, foot pain and pelvic pain. Two authors independently assessed each record, and any disagreement was resolved by the third author. Data were analysed using a narrative thematic approach owing to the heterogeneity of reported outcome measures. Ninety-seven records were initially identified using a variety of terms associated with children, obesity and musculoskeletal pain. Ten studies were included for thematic analysis when predetermined inclusion criteria were applied. Bone deformity and dysfunction, pain reporting and the impact of children being overweight or obese on physical activity, exercise and quality of life were the three themes identified from the literature. Chronic pain, obesity and a reduction in physical functioning and activity may contribute to a cycle of weight gain that affects a child's quality of life. Future studies are required to examine the sequela of overweight and obese children experiencing chronic musculoskeletal pain. PMID:24077005

  14. Musculoskeletal pain in overweight and obese children.

    PubMed

    Smith, S M; Sumar, B; Dixon, K A

    2014-01-01

    This review seeks to provide a current overview of musculoskeletal pain in overweight and obese children. Databases searched were Academic Search Complete, CINAHL, Medline, Proquest Health and Medical Complete, Scopus, Google Scholar, SPORTDiscuss and Trove for studies published between 1 January 2000 and 30 December 2012. We used a broad definition of children within a 3- to 18-year age range. The search strategy included the following terms: obesity, morbid obesity, overweight, pain, musculoskeletal pain, child, adolescent, chronic pain, back pain, lower back pain, knee pain, hip pain, foot pain and pelvic pain. Two authors independently assessed each record, and any disagreement was resolved by the third author. Data were analysed using a narrative thematic approach owing to the heterogeneity of reported outcome measures. Ninety-seven records were initially identified using a variety of terms associated with children, obesity and musculoskeletal pain. Ten studies were included for thematic analysis when predetermined inclusion criteria were applied. Bone deformity and dysfunction, pain reporting and the impact of children being overweight or obese on physical activity, exercise and quality of life were the three themes identified from the literature. Chronic pain, obesity and a reduction in physical functioning and activity may contribute to a cycle of weight gain that affects a child's quality of life. Future studies are required to examine the sequela of overweight and obese children experiencing chronic musculoskeletal pain. PMID:24077005

  15. [Musculoskeletal disorders of the knee of workers].

    PubMed

    Caubet, Alain

    2009-11-20

    50% of workers have been or will be affected by knee pains and complaints will be more frequent as the population ages and careers will be longer. The increase in prevalence depends on mechanical or morphological causes as well as psychosocial state and work organization. Lesions of the meniscus, well known for a long time, seem to be stable in the statistics of Social Security as well as the hygroma; the use of knee-pads (overalls with built-in cushions) is strongly recommended while working in kneeling or squatting position, even DIY activities. Are particularly dangerous: the squatting or kneeling position extended for longer than one hour a day, often recovering from these two positions (more than 30 times a day), lifting or carrying heavy loads, often climbing (around 30 times per day) stairs or ladders. These gestures and postures are unavoidable in some jobs; in those cases, advices given by the specialist of occupational medicine and the ergonomist may improve or alter the habits of the worker or of his entire team. The prevention of overweight and the habit of carrying heavy loads must be amplified, for all the usual positions of work. Consulting to decide about the return to work after surgery for knee replacement will be more frequent. Then, as each time work can interfere with health, it is logical that the family doctor have (via the patient) links with the specialist of occupational medicine, which holds valuable information for quality of life of employees. PMID:19961084

  16. Glanzmann's Thrombasthenia Diagnosed following Knee Arthroscopy

    PubMed Central

    Zvijac, John E.; Ammus, Sharhabil S.; Aran, Fernando; Kiebzak, Gary M.

    2015-01-01

    A 41-year-old man with an unremarkable medical history presented with a painful knee after a sports injury. He was diagnosed with a medial meniscal tear. Symptoms did not abate after 6 months of physical therapy, and he underwent arthroscopic partial medial meniscectomy. A week after beginning physical therapy he experienced a knee effusion, decreased ROM, and inability to flex his quadriceps. His knee was aspirated. Blood tests were ordered and his complete blood count, liver functions tests, and INR/PTT were normal. The patient had recurrent effusions requiring three additional joint aspirations. Ten weeks after the initial surgery, the patient underwent a second arthroscopy, during which a hematoma was removed and a synovectomy performed. The patient continued bleeding from the incisions after portals were sutured, and he was admitted to the hospital. A hematologist was consulted and comprehensive platelet aggregation testing revealed previously undiagnosed Glanzmann's thrombasthenia. The patient began treatment with platelet infusions and desmopressin and progressed to a full recovery. Clinical suspicion for surgical patients with unusual repetitive postoperative bleeding should include previously undetected rare bleeding disorders even in adults. PMID:26000186

  17. Management of knee osteoarthritis with cupping therapy.

    PubMed

    Khan, Asim Ali; Jahangir, Umar; Urooj, Shaista

    2013-10-01

    The study aimed to evaluate the effect of cupping therapy at a clinical setting for knee osteoarthritis. A randomized, controlled clinical trial was conducted. Cupping was performed on 0-6(th) day; 9-11(th) day and 14(th) day, i.e., 11 sittings follow-up to determine longer term carryover of treatment effects utilizing both objective and subjective assessment. The assessment was performed before and after treatment spreading over a period of 15 days. The results of this study shows significant and better results in the overall management of knee osteoarthritis, particularly in relieving pain, edema, stiffness and disability. The efficacy of treatment with cupping therapy in relieving signs and symptoms of knee osteoarthritis is comparable to that of acetaminophen 650 mg thrice a day orally, in terms of analgesia, anti-inflammatory and resolution of edema with minimal and temporary side-effects like echymosis and blister formation while as control drug has greater side-effects particularly on upper gastrointestinal tract. It is recommended that further studies are conducted with a larger study samples and of longer duration. PMID:24350053

  18. It’s not just a knee, but a whole life: A qualitative descriptive study on patients’ experiences of living with knee osteoarthritis and their expectations for knee arthroplasty

    PubMed Central

    Nyvang, Josefina; Hedström, Margareta; Gleissman, Sissel Andreassen

    2016-01-01

    Aim Knee arthroplasties are an increasingly common treatment for osteoarthritis (OA) and the main indication is pain. Previous research states, however, that 15–20% of the operated patients are dissatisfied and 20–30% have persistent pain after surgery. This study is aimed at describing patients’ experiences of living with knee OA when scheduled for surgery and further their expectations for future life after surgery. Methods We interviewed 12 patients with knee OA scheduled for arthroplasty, using semi-structured qualitative interviews. The interviews were recorded and transcribed verbatim and analyzed using qualitative thematic analysis. Findings Three categories were formulated with an overriding theme: “It's not just a knee, but a whole life.” The three categories were “Change from their earlier lives,” “Coping with knee problems,” and “Ultimate decision to undergo surgery.” The main finding was that knee OA affects the whole body and self, ultimately affecting the patients’ lives on many levels. Further findings were that knee OA was considered to be the central focus in the participants’ lives, which limited their level of activity, their ability to function as desired, their quality of life, and their mental well-being. Although surgery was considered to be the only solution, the expectations regarding the outcome differed. Conclusions The participants were forced to change how they previously had lived their lives resulting in a feeling of loss. Thus, the experienced loss and expectations for future life must be put into the context of the individual's own personality and be taken into account when treating individuals with knee OA. The experience of living with knee OA largely varies between individuals. This mandates that patients’ assessment should be considered on individual basis with regard to each patient. PMID:27036130

  19. Case report: Eumycetoma and mycotic arthritis of the knee caused by Arthrographis kalrae.

    PubMed

    Ong, David Chen-Guan; Khan, Riaz; Golledge, Clay; Carey Smith, Richard

    2015-10-01

    A 33-year-old male presents following a penetrating injury to his right knee. Clinically he demonstrated pain, an effusion and fevers. At diagnostic arthroscopy, no microbiological growth was cultured. Delayed growth yielded the fungus Arthrographis kalrae. He was treated with a three-stage total knee arthroplasty. The first stage consisted of soft tissue debridement. The second stage involved femoral and tibial osteotomies and insertion of antifungal-impregnated cement spacers. Definitive total knee joint prosthesis were implanted during stage three. At 2 years follow up, he demonstrated a pain free range of motion and has returned to competitive tennis. To the authors' knowledge this is the first report implicating A. kalrae as an invasive pathogen of the knee in an immunocompetent host. PMID:26719609

  20. Cementless total knee arthroplasty

    PubMed Central

    Risitano, Salvatore; Sabatini, Luigi; Giachino, Matteo; Agati, Gabriele; Massè, Alessandro

    2016-01-01

    Interest for uncemented total knee arthroplasty (TKA) has greatly increased in recent years. This technique, less used than cemented knee replacement in the last decades, sees a revival thanks an advance in prosthetic design, instrumentation and operative technique. The related literature in some cases shows conflicting data on survival and on the revision’s rate, but in most cases a success rate comparable to cemented TKA is reported. The optimal fixation in TKA is a subject of debate with the majority of surgeons favouring cemented fixation. PMID:27162779

  1. Primary rotating-hinge total knee arthroplasty: good outcomes at mid-term follow-up.

    PubMed

    Kowalczewski, Jacek; Marczak, Dariusz; Synder, Marek; Sibiński, Marcin

    2014-06-01

    We evaluated the clinical and radiologic outcomes of primary knee replacements using a rotating-hinge knee prosthesis in 12 knees with a minimum follow-up of 10 years. Indications for the operation included gross joint destruction, significant axial deformities and contracture with a dysfunctional medial collateral ligament in all cases. The patients' WOMAC and Knee Society scores improved, and the use of mobility aids decreased. No loosening of implants was observed. Nonprogressive radiolucent lines were identified around three tibial components. Three patients required marginal wound excision with resuturing and thereafter healed uneventfully. With significant improvement in function, pain and range of motion, the rotating-hinge knee prosthesis can be used as a salvage device in patients with medial collateral ligament deficiency, contracture, and gross joint destruction. PMID:24418767

  2. Back Pain

    MedlinePlus

    ... Back Pain Find a Clinical Trial Journal Articles Back Pain March 2015 Handout on Health: Back Pain This publication is for people who have back ... to discuss them with your doctor. What Is Back Pain? Back pain is an all-too-familiar problem ...

  3. Cancer pain

    SciTech Connect

    Swerdlow, M.; Ventafridda, V.

    1987-01-01

    This book contains 13 chapters. Some of the chapter titles are: Importance of the Problem; Neurophysiology and Biochemistry of Pain; Assessment of Pain in Patients with Cancer; Drug Therapy; Chemotherapy and Radiotherapy for Cancer Pain; Sympton Control as it Relates to Pain Control; and Palliative Surgery in Cancer Pain Treatment.

  4. Current Controversies of Alignment in Total Knee Replacements

    PubMed Central

    Donaldson, James; Joyner, James; Tudor, Francois

    2015-01-01

    Total knee replacement is an increasingly popular operation for end stage knee arthritis. In the majority it alleviates pain and improves function. However up to 20% of patients remain dissatisfied, even with well-aligned and secure implants. Restoration of a neutral mechanical axis has traditionally been strived for, to improve both function and implant survival and there is historical data to support this. More recently this view has been questioned and some surgeons are trying to improve the function and outcomes by moving away from standard alignment principles in an attempt to reproduce the kinematics of the pre-arthritic knee of that individual. Others are using computers, robots and patient specific guides to improve accuracy. This article aims to review the traditional alignment concept and the newer techniques, along with the evidence behind it. PMID:26587067

  5. Strategies for the prevention of knee osteoarthritis.

    PubMed

    Roos, Ewa M; Arden, Nigel K

    2016-02-01

    Osteoarthritis (OA) has been thought of as a disease of cartilage that can be effectively treated surgically at severe stages with joint arthroplasty. Today, OA is considered a whole-organ disease that is amenable to prevention and treatment at early stages. OA develops slowly over 10-15 years, interfering with activities of daily living and the ability to work. Many patients tolerate pain, and many health-care providers accept pain and disability as inevitable corollaries of OA and ageing. Too often, health-care providers passively await final 'joint death', necessitating knee and hip replacements. Instead, OA should be viewed as a chronic condition, where prevention and early comprehensive-care models are the accepted norm, as is the case with other chronic diseases. Joint injury, obesity and impaired muscle function are modifiable risk factors amenable to primary and secondary prevention strategies. The strategies that are most appropriate for each patient should be identified, by selecting interventions to correct--or at least attenuate--OA risk factors. We must also choose the interventions that are most likely to be acceptable to patients, to maximize adherence to--and persistence with--the regimes. Now is the time to begin the era of personalized prevention for knee OA. PMID:26439406

  6. Conversion of unicompartmental knee arthroplasty to total knee arthroplasty: the challenges and need for augments.

    PubMed

    Khan, Zeeshan; Nawaz, Syed Z; Kahane, Steven; Esler, Colin; Chatterji, Urjit

    2013-12-01

    The potential advantages of unicompartmental knee arthroplasty (UKA) include lower morbidity and mortality, quicker recovery, good range of motion, good medium and long-term survival results, potential bone conservation and perceived easier revision. Converting a UKA to a total knee arthroplasty (TKA) may be challenging due to issues of bone loss, need for augmentation, restoring joint line and rotation. We present the intraoperative findings of 201 cases of failed UKA's from the Trent Wales arthroplasty audit group (TWAAG) register. The objectives of the study were to determine the modes of failure, number of cases requiring augments and bone grafting, types of augments and implants used in revision surgery. This study does not include the clinical outcomes after revision knee surgery. The average age of the cohort at revision surgery was 67 years. There were 111 females and 90 males. The commonest modes of failure in young patients were unexplained pain/instability and aseptic loosening and in older patients they were aseptic loosening and progression of the disease. The survivorship of the implant was higher in the less than 55 years age group in comparison to the older patients. A total of 49 patients (25.9%) required bone grafting commonest in the 60 years and above age group (79.6%). Fifty patients (26.4%) required some form of augmentation, with the commonest site being tibia and commonest augment being tibial stem (35 cases). Only 8% of the cohort required revision knee implants whereas 78% of the cases received a cruciate retaining primary knee implant. To the author's knowledge, this is one of the largest studies in the literature which signifies the technical difficulties that might be experienced in revising the UKA's which will require appropriate pre-operative planning. PMID:24563977

  7. Minimally Invasive Total Knee Arthroplasty Improves Early Knee Strength but Not Functional Performance: A Randomized Controlled Trial

    PubMed Central

    Stevens-Lapsley, Jennifer E.; Bade, Michael J.; Shulman, Benjamin C.; Kohrt, Wendy M.; Dayton, Michael R.

    2012-01-01

    A prospective, randomized investigation compared early clinical outcomes of total knee arthroplasty (TKA) using conventional (CONTROL) or minimally invasive surgical (MIS) approaches (n=44). Outcome measures included isometric quadriceps and hamstrings strength, quadriceps activation, functional performance, knee pain, active knee range of motion (AROM), muscle mass, the SF-36, and WOMAC, assessed preoperatively and 4 and 12 weeks after TKA. Four weeks after TKA, the MIS group had greater hamstring strength (p=0.02) and quadriceps strength (p=0.07), which did not translate to differences in other outcomes. At 12 weeks, there were no clinically meaningful differences between groups on any measure. Although MIS may lead to faster recovery of strength in patients undergoing TKA, there was no benefit on longer-term recovery of strength or functional performance. PMID:22459124

  8. Lower extremity thrust and non-thrust joint mobilization for patellofemoral pain syndrome: a case report

    PubMed Central

    Simpson, Brad G; Simon, Corey B

    2014-01-01

    A 40-year old female presented to physical therapy with a one-year history of insidious right anteromedial and anterolateral knee pain. Additionally, the patient had a history of multiple lateral ankle sprains bilaterally, the last sprain occurring on the right ankle 1 year prior to the onset of knee pain. The patient was evaluated and given a physical therapy diagnosis of patellofemoral pain syndrome (PFPS), with associated talocrural and tibiofemoral joint hypomobility limiting ankle dorsiflexion and knee extension, respectively. Treatment included a high-velocity low amplitude thrust manipulation to the talocrural joint, which helped restore normal ankle dorsiflexion range of motion. The patient also received tibiofemoral joint non-thrust manual therapy to regain normal knee extension mobility prior to implementing further functional progression exercises to her home program (HEP). This case report highlights the importance of a detailed evaluation of knee and ankle joint mobility in patients presenting with anterior knee pain. Further, manual physical therapy to the lower extremity was found to be successful in restoring normal movement patterns and pain-free function in a patient with chronic anterior knee pain. PMID:24976753

  9. When it hurts, a positive attitude may help: The association of positive affect with daily walking in knee OA: the MOST Study

    PubMed Central

    White, Daniel K; Keysor, Julie J; Neogi, Tuhina; Felson, David T; LaValley, Michael; Gross, K Doug; Niu, Jingbo; Nevitt, Michael; Lewis, Cora E; Torner, Jim; Fredman, Lisa

    2012-01-01

    OBJECTIVE While depressive symptoms and knee pain are independently known to impede daily walking in older adults, it is unknown whether positive affect promotes daily walking. This study investigated this association among adults with knee osteoarthritis (OA) and examined whether knee pain modified this association. DESIGN Cross-sectional analysis of the Multicenter Osteoarthritis Study. We included 1018 participants (mean age 63.1 ± 7.8 years, 60% female) who had radiographic knee OA and had worn a StepWatch monitor to record steps/day. High- and low- positive affect, and depressive symptoms were based on the Center for Epidemiologic Studies-Depression Scale. Knee pain was categorized as present in respondents who reported pain on most days at both a clinic visit and a telephone screen. RESULTS Compared to respondents with low positive affect (27% of respondents), those with high positive affect (63%) walked similar steps/day while those with depressive symptoms (10%) walked less (adjusted beta coefficients = −32.6 [−458.9, 393.8] and −579.1 [−1274.9, 116.7], respectively). There was a statistically significant interaction of positive affect by knee pain (p= 0.0045). Among respondents with knee pain (39%), those with high positive affect walked significantly more steps/day (711.0 [55.1, 1366.9]) than those with low positive affect. CONCLUSION High positive affect was associated with more daily walking among adults with painful knee OA. Positive affect may be an important psychological factor to consider to promote physical activity among people with painful knee OA. PMID:22504854

  10. Novel Highly Porous Metal Technology in Artificial Hip and Knee Replacement: Processing Methodologies and Clinical Applications

    NASA Astrophysics Data System (ADS)

    Muth, John; Poggie, Matthew; Kulesha, Gene; Michael Meneghini, R.

    2013-02-01

    Hip and knee replacement can dramatically improve a patient's quality of life through pain relief and restored function. Fixation of hip and knee replacement implants to bone is critical to the success of the procedure. A variety of roughened surfaces and three-dimensional porous surfaces have been used to enhance biological fixation on orthopedic implants. Recently, highly porous metals have emerged as versatile biomaterials that may enhance fixation to bone and are suitable to a number of applications in hip and knee replacement surgery. This article provides an overview of several processes used to create these implant surfaces.

  11. Back Pain

    MedlinePlus

    ... BACK PAIN? There are many possible causes of low back pain, including stretched (strained) muscles, torn or stretched (sprained) ... appear to be at an increased risk for low back pain in comparison to the general population (estimates range ...

  12. Neck pain

    MedlinePlus

    ... Alternative Names Pain - neck; Neck stiffness; Cervicalgia; Whiplash Images Neck pain Whiplash Location of whiplash pain References ... pubmed/19272509 . Read More Diskectomy Foraminotomy Laminectomy Spinal fusion Patient Instructions Spine surgery - discharge Update Date 3/ ...

  13. Pain Relievers

    MedlinePlus

    Pain relievers are medicines that reduce or relieve headaches, sore muscles, arthritis, or other aches and pains. There ... also have a slightly different response to a pain reliever. Over-the-counter (OTC) medicines are good for ...

  14. Elbow pain

    MedlinePlus

    Pain - elbow ... Elbow pain can be caused by many problems. A common cause in adults is tendinitis . This is inflammation and ... a partial dislocation ). Other common causes of elbow pain are: Bursitis -- inflammation of a fluid-filled cushion ...

  15. Eye pain

    MedlinePlus

    Ophthalmalgia; Pain - eye ... Pain in the eye can be an important symptom of a health problem. Make sure you tell your health care provider if you have eye pain that does not go away. Tired eyes or ...

  16. Heel pain

    MedlinePlus

    Pain - heel ... Heel pain is most often the result of overuse. Rarely, it may be caused by an injury. Your heel ... on the heel Conditions that may cause heel pain include: When the tendon that connects the back ...

  17. Wrist pain

    MedlinePlus

    Pain - wrist; Pain - carpal tunnel; Injury - wrist; Arthritis - wrist; Gout - wrist; Pseudogout - wrist ... Carpal tunnel syndrome: A common cause of wrist pain is carpal tunnel syndrome . You may feel aching, ...

  18. Hyaluronic Acid (HA) Viscosupplementation on Synovial Fluid Inflammation in Knee Osteoarthritis: A Pilot Study

    PubMed Central

    Vincent, Heather K; Percival, Susan S; Conrad, Bryan P; Seay, Amanda N; Montero, Cindy; Vincent, Kevin R

    2013-01-01

    Objective: This study examined the changes in synovial fluid levels of cytokines, oxidative stress and viscosity six months after intraarticular hyaluronic acid (HA) treatment in adults and elderly adults with knee osteoarthritis (OA). Design: This was a prospective, repeated-measures study design in which patients with knee OA were administered 1% sodium hyaluronate. Patients (N=28) were stratified by age (adults, 50-64 years and elderly adults, ≥65 years). Ambulatory knee pain values and self-reported physical activity were collected at baseline and month six. Materials and Methods: Knee synovial fluid aspirates were collected at baseline and at six months. Fluid samples were analyzed for pro-inflammatory cytokines (interleukins 1β, 6,8,12, tumor necrosis factor-α, monocyte chemotactic protein), anti-inflammatory cytokines (interleukins 4, 10 13), oxidative stress (4-hydroxynonenal) and viscosity at two different physiological shear speeds 2.5Hz and 5Hz. Results: HA improved ambulatory knee pain in adults and elderly groups by month six, but adults reported less knee pain-related interference with participation in exercise than elderly adults. A greater reduction in TNF-α occurred in adults compared to elderly adults (-95.8% ± 7.1% vs 19.2% ± 83.8%, respectively; p=.044). Fluid tended to improve at both shear speeds in adults compared to the elderly adults. The reduction in pain severity correlated with the change in IL-1β levels by month six (r= -.566; p=.044). Conclusion: Reduction of knee pain might be due to improvements in synovial fluid viscosity and inflammation. Cartilage preservation may be dependent on how cytokine, oxidative stress profiles and viscosity change over time. PMID:24093052

  19. Moxibustion Treatment for Knee Osteoarthritis

    PubMed Central

    Li, Ang; Wei, Zhi-Jian; Liu, Yi; Li, Bo; Guo, Xing; Feng, Shi-Qing

    2016-01-01

    Abstract To determine whether the administration of moxibustion is an effective treatment for knee osteoarthritis (KOA). We conducted a search of relevant articles using Medline, EMBASE, the Web of Science, and the Cochrane Library published before October 2015. The Western Ontario and McMaster Universities’ Osteoarthritis Index (WOMAC scale) and the short form 36 questionnaire (SF-36 scale) were assessed. Evidence grading was evaluated according to the Grading of Recommendations, Assessment, Development and Evaluation system. Four studies containing 746 participants fulfilled the inclusion criteria in the final analysis. In terms of quality of life (QOL), the meta-analysis of 2 randomized clinical trials (RCTs) showed significantly effects of moxibustion only in bodily pain (BP) compared with those in the control group (n = 348; weighted mean difference [WMD], 4.36; 95% confidence intervals [CIs], 2.27–6.44; P < 0.0001; heterogeneity: χ2 = 1.53, P = 0.22, I2 = 34%) in all of the subcategories of the SF-36 scale, with moderate quality. The meta-analysis of the 2 included trials showed that there was not a statistically significant difference in the pain or function subscale for the WOMAC scale when the 2 groups were compared (n = 322; WMD, 17.63; 95% CI, −23.15–58.41; P = 0.40; heterogeneity: χ2 = 19.42, P < 0.0001, I2 = 95%), with low or moderate quality separately. The administration of moxibustion can to some extent alleviate the symptoms of KOA. More rigorous, randomized controlled trials are required in the future. PMID:27057863

  20. Depression, Pain, and Pain Behavior.

    ERIC Educational Resources Information Center

    Keefe, Francis J.; And Others

    1986-01-01

    Examined the degree to which depression predicted pain and pain behavior. The Beck Depression Inventory was administered to 207 low back pain patients. Depression and physical findings were the most important predictors of pain and pain behavior. Depression proved significant even after controlling for important demographic and medical status…

  1. Effect of Pedal Deformity on Gait in a Patient With Total Knee Arthroplasty.

    PubMed

    Wynes, Jacob; Lamm, Bradley M; Bhave, Anil; Elmallah, Randa K; Mont, Michael A

    2016-01-01

    The authors present the case of an 81-year-old man who, despite an anatomically aligned total knee arthroplasty, continued to have knee pain. The patient's ipsilateral rigid flatfoot caused by an earlier partial pedal amputation resulted in a valgus moment during gait, thus creating clinical symptoms in the total knee arthroplasty. Because of the deformity and scarring within the flatfoot, this valgus deformity was corrected through a varus distal femoral osteotomy. The result was normalization of the mechanical axis of the lower limb and a pain-free total knee arthroplasty with an excellent clinical outcome. This case shows the importance of comprehensive lower-extremity clinical and radiographic examination as well as gait analysis to understand the biomechanical effect on total knee arthroplasty. Recognition of pedal deformities and lower limb malalignment is paramount for achieving optimal outcomes and long-term success of total knee arthroplasty. The authors show that a rigid or nonflexible pedal deformity can have negative biomechanical effects on total knee arthroplasty. PMID:26709556

  2. The Pathophysiology of Osteoarthritis: A Mechanical Perspective on the Knee Joint

    PubMed Central

    Vincent, Kevin R.; Conrad, Bryan P.; Fregly, Benjamin J.; Vincent, Heather K.

    2013-01-01

    Osteoarthritis (OA) is the most frequent cause of disability in the United States, with the medial compartment of the knee being the most commonly affected.1 The initiation and progression of knee OA is influenced by many factors including kinematics. In response to loading during weight bearing, cartilage in healthy knees demonstrates spatial adaptations in morphology and mechanical properties. These adaptations allow certain regions of the cartilage to respond to loading while other regions are less well suited to accommodate loading. Alterations in normal knee kinematics shift loading from those cartilage regions adapted for loading to regions less well suited. This leads to the initiation and progression of degenerative processes consistent with knee OA. Kinematic variables associated with the development, progression and severity of knee OA are the adduction moment (Madd) and tibiofemoral rotation. Due to its strong correlation with disease progression and pain, the peak Madd during gait has been identified as a target for treatment design. Gait modification offers a non-invasive option for seeking significant reductions. Gait modification has the potential to reduce pain and slow the progression of medial compartment knee OA. PMID:22632700

  3. Effect of Sri Lankan traditional medicine and Ayurveda on Sandhigata Vata (osteoarthritis of knee joint).

    PubMed

    Perera, Pathirage Kamal; Perera, Manaram; Kumarasinghe, Nishantha

    2014-01-01

    Reported case was a 63-year-old female with end-stage osteoarthritis (OA) (Sandhigata Vata) of the left knee joint accompanied by exostoses. Radiology (X-ray) report confirmed it as a Kellgren-Lawrence grade III or less with exostoses. At the beginning, the Knee Society Rating System scores of pain, movement and stability were poor, and function score was fair. Srilankan traditional and Ayurveda medicine treatment was given in three regimens for 70 days. After 70 days, external treatment of oleation and 2 capsules of Shallaki (Boswellia serrata Triana and Planch) and two tablets of Jeewya (comprised of Emblica officinalis Gaertn., Tinospora cordifolia [Willd.] Millers. and Terminalia chebula Retz.), twice daily were continued over 5 months. Visual analogue scale for pain, knee scores in the Knee Society online rating system and a Ayurveda clinical assessment criteria was used to evaluate the effects of treatments in weekly basis. After treatment for 70 days, the Knee Society Rating System scores of pain, movement and stability were also improved up to good level and function score was improved up to excellent level. During the follow-up period, joint symptoms and signs and the knee scores were unchanged. In conclusion, this OA patient's quality of life was improved by the combined treatment of Sri Lankan traditional medicine and Ayurveda. PMID:26195904

  4. Hypermobility and Knee Injuries.

    ERIC Educational Resources Information Center

    Steiner, Mark E.

    1987-01-01

    A review of research on the effect of hypermobility on knee injury indicates that greater than normal joint flexibility may be necessary for some athletic endeavors and that it may be possible to change one's underlying flexibility through training. However, for most athletes, inherited flexibility probably plays only a small role, if any, in…

  5. Benefits of antioxidant supplements for knee osteoarthritis: rationale and reality.

    PubMed

    Grover, Ashok Kumar; Samson, Sue E

    2016-01-01

    Arthritis causes disability due to pain and inflammation in joints. There are many forms of arthritis, one of which is osteoarthritis whose prevalence increases with age. It occurs in various joints including hip, knee and hand with knee osteoarthritis being more prevalent. There is no cure for it. The management strategies include exercise, glucosamine plus chondroitin sulfate and NSAIDs. In vitro and animal studies provide a rationale for the use of antioxidant supplements for its management. This review assesses the reality of the benefits of antioxidant supplements in the management of knee osteoarthritis. Several difficulties were encountered in examining this issue: poorly conducted studies, a lack of uniformity in disease definition and diagnosis, and muddling of conclusions from attempts to isolate the efficacious molecules. The antioxidant supplements with most evidence for benefit for pain relief and function in knee osteoarthritis were based on curcumin and avocado-soya bean unsaponifiables. Boswellia and some herbs used in Ayurvedic and Chinese medicine may also be useful. The benefits of cuisines with the appropriate antioxidants should be assessed because they may be more economical and easier to incorporate into the lifestyle. PMID:26728196

  6. Lipoma Arborescens of both Knees - Case report and Literature Review

    PubMed Central

    Liddle, A; Spicer, DDM; Somashekar, N; Chirag, Thonse

    2012-01-01

    Introduction: Lipoma arborescens (LA) is a rare, benign intra-articular lesion most commonly found in the knee, characterised by villous proliferation of the synovium. It generally presents as a longstanding, slowly progressive swelling of one or more joints associated which may or may not be associated with pain. MRI is the investigation of choice, with images clearest on fat-supressed or STIR sequences. Case Report: We present a 35 year old male patient, who presented with a three year history of bilateral knee pain and swelling. Magnetic resonance imaging (MRI) scans of his knee showed the characteristic features of lipoma arborescens. A 99technetium bone scan revealed increased uptake in both knees. The patient underwent bilateral arthroscopic synovectomies and made an uneventful recovery. The samples sent for histology were reported as being characteristic of lipoma arborescens. Conclusions: Lipoma arborescens is a rare, benign intra-articular tumour which may mimic a number of other diagnoses. MRI should be considered to exclude this pathology as well as other uncommon intra-articular pathology. Treatment with synovectomy is frequently curative.

  7. [Recovery from total knee arthroplasty through continuous passive motion].

    PubMed

    Sánchez Mayo, B; Rodríguez-Mansilla, J; González Sánchez, B

    2015-01-01

    The purpose of this study was to know the effects of continuous passive mobilization in patients who underwent total knee arthroplasty. A search strategy was developed to retrieve all clinical trials, written in English and/or Spanish, published in the electronic search databases PubMed, Cochrane Library Plus, Dialnet, CSIC and PEDro. The inclusion criteria were: clinical trials published from January 2000 until November 2014 in English or Spanish. Out of 537 clinical trials that were potentially relevant, a total of 12 were included in this review. The evaluation of 1,153 patients shows that there is no significant difference in improving the range of the joint, pain, balance, motion, healing and hospital stay using continuous passive mobilization against the regular physiotherapy treatment for total knee arthroplasty. The application of continuous passive mobilization in the long-term does not provide any benefit in terms of the breadth of the range of the joint, pain and improvement of standing and motion in comparison with conventional postoperative physiotherapy treatment in total knee arthroplasty. In the short term an improvement is obtained in the range of joint motion in knee flexion. PMID:26486536

  8. Total Knee Arthroplasty Failure Induced by Metal Hypersensitivity

    PubMed Central

    Gupta, Ryan; Phan, Duy; Schwarzkopf, Ran

    2015-01-01

    Patient: Female, 70 Final Diagnosis: Metal hypersensitivity Symptoms: Joint pain • swelling • instability Medication: — Clinical Procedure: Revision total knee arthroplasty Specialty: Orthopedics and Traumatology Objective: Unusual clinical course Background: Metal hypersensitivity is an uncommon complication after total knee arthroplasty (TKA) that can lead to significant functional impairment and aseptic prosthesis failure. Case Report: We describe a 70-year-old patient who presented with persistent pain, swelling, and instability 2 years after a primary TKA. The patient had a history of metal hypersensitivity following bilateral metal-on-metal total hip arthroplasty (THA) that was revised to ceramic-on-polyethylene implants. Knee radiographs showed severe osteolysis with implant loosening. Serum cobalt was elevated and serum chromium was significantly elevated, while joint aspiration and inflammatory marker levels ruled out a periprosthetic infection. Revision TKA was performed, with intraoperative tissue pathology and postoperative leukocyte transformation testing confirming metal hypersensitivity as the cause for aseptic implant failure. Conclusions: This case report demonstrates the clinical and laboratory signs that suggest metal hypersensitivity in total knee arthroplasty and the potential for joint function restoration with revision surgery. PMID:26278890

  9. 21 CFR 888.3590 - Knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Knee joint tibial (hemi-knee) metallic resurfacing... Knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis. (a) Identification. A knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis is a device intended to be...

  10. 49 CFR 572.136 - Knees and knee impact test procedure.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 7 2014-10-01 2014-10-01 false Knees and knee impact test procedure. 572.136... Hybrid III 5th Percentile Female Test Dummy, Alpha Version § 572.136 Knees and knee impact test procedure. (a) Knee assembly. The knee assembly (refer to §§ 572.130(a)(1)(v) and (vi)) for the purpose of...

  11. 21 CFR 888.3590 - Knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Knee joint tibial (hemi-knee) metallic resurfacing... Knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis. (a) Identification. A knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis is a device intended to be...

  12. 49 CFR 572.126 - Knees and knee impact test procedure.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 7 2012-10-01 2012-10-01 false Knees and knee impact test procedure. 572.126...-year-old Child Test Dummy, Beta Version § 572.126 Knees and knee impact test procedure. (a) Knee assembly. The knee assembly is part of the leg assembly (drawing 127-4000-1 and -2). (b) When the...

  13. 21 CFR 888.3580 - Knee joint patellar (hemi-knee) metallic resurfacing uncemented prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Knee joint patellar (hemi-knee) metallic... § 888.3580 Knee joint patellar (hemi-knee) metallic resurfacing uncemented prosthesis. (a) Identification. A knee joint patellar (hemi-knee) metallic resurfacing uncemented prosthesis is a device made...

  14. 49 CFR 572.136 - Knees and knee impact test procedure.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 7 2010-10-01 2010-10-01 false Knees and knee impact test procedure. 572.136... Hybrid III 5th Percentile Female Test Dummy, Alpha Version § 572.136 Knees and knee impact test procedure. (a) Knee assembly. The knee assembly (refer to §§ 572.130(a)(1)(v) and (vi)) for the purpose of...

  15. 21 CFR 888.3580 - Knee joint patellar (hemi-knee) metallic resurfacing uncemented prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Knee joint patellar (hemi-knee) metallic... § 888.3580 Knee joint patellar (hemi-knee) metallic resurfacing uncemented prosthesis. (a) Identification. A knee joint patellar (hemi-knee) metallic resurfacing uncemented prosthesis is a device made...

  16. 49 CFR 572.126 - Knees and knee impact test procedure.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 7 2013-10-01 2013-10-01 false Knees and knee impact test procedure. 572.126...-year-old Child Test Dummy, Beta Version § 572.126 Knees and knee impact test procedure. (a) Knee assembly. The knee assembly is part of the leg assembly (drawing 127-4000-1 and -2). (b) When the...

  17. 21 CFR 888.3590 - Knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Knee joint tibial (hemi-knee) metallic resurfacing... Knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis. (a) Identification. A knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis is a device intended to be...

  18. 49 CFR 572.126 - Knees and knee impact test procedure.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 7 2011-10-01 2011-10-01 false Knees and knee impact test procedure. 572.126...-year-old Child Test Dummy, Beta Version § 572.126 Knees and knee impact test procedure. (a) Knee assembly. The knee assembly is part of the leg assembly (drawing 127-4000-1 and -2). (b) When the...

  19. 49 CFR 572.136 - Knees and knee impact test procedure.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 7 2013-10-01 2013-10-01 false Knees and knee impact test procedure. 572.136... Hybrid III 5th Percentile Female Test Dummy, Alpha Version § 572.136 Knees and knee impact test procedure. (a) Knee assembly. The knee assembly (refer to §§ 572.130(a)(1)(v) and (vi)) for the purpose of...

  20. 49 CFR 572.126 - Knees and knee impact test procedure.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 7 2010-10-01 2010-10-01 false Knees and knee impact test procedure. 572.126...-year-old Child Test Dummy, Beta Version § 572.126 Knees and knee impact test procedure. (a) Knee assembly. The knee assembly is part of the leg assembly (drawing 127-4000-1 and -2). (b) When the...