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Sample records for knee osteoarthritis pain

  1. Knee pain, knee injury, knee osteoarthritis & work.

    PubMed

    Dulay, Gurdeep S; Cooper, C; Dennison, E M

    2015-06-01

    Symptomatic knee osteoarthritis (OA) can be viewed as the end result of a molecular cascade which ensues after certain triggers occur and ultimately results in irreversible damage to the articular cartilage. The clinical phenotype that knee OA can produce is variable and often difficult to accurately predict. This is further complicated by the often poor relationship between radiographic OA and knee pain. As a consequence, it can be difficult to compare studies that use different definitions of OA. However, the literature suggests that while there are multiple causes of knee OA, two have attracted particular attention over recent years; occupation related knee OA and OA subsequent to previous knee injury. The evidence of a relationship, and the strength of this association, is discussed in this chapter.

  2. 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.

  3. Nonsurgical Management of Osteoarthritis Knee Pain in the Older Adult.

    PubMed

    Taylor, Nora

    2017-02-01

    Symptomatic knee osteoarthritis is a common complaint of many elderly patients in primary care offices. For those unable or unwilling to undergo knee replacement, the primary practitioners' understanding of the strengths and weaknesses of the available treatment modalities for pain relief is critical to successful in-office counseling and expectation management. Treatment requires a multimodal approach of nonpharmacologic and pharmacologic therapies to achieve a maximal clinical benefit. The focus of this review is on the nonsurgical options for treatment of knee osteoarthritis in patients aged 65 and older.

  4. Tendonitis: the major cause of pain in osteoarthritis knee joint.

    PubMed

    Bokhari, Syed Zahid Hussain

    2012-01-01

    The conventional concept of osteoarthritis is that it occurs as an aging and degenerative process resulting in reduction of the surface cartilage, narrowing of the joint space and reduction of the synovial fluid. The objective of this study was to introduce the new technique of unmasking and treating the underlying problem confirming lesions outside the knee joint being the cause of pain in osteoarthritic knee joint. Clinical work making the base of this paper was carried out at Pain and Plegia Centre, Dabgari Gardens Peshawar from 2005 to 2012. Patients reporting with knee pain were palpated deep around the knee joint and major tender spots identified upon Adductor tubercle on medial aspect and Gastrocnemius (lateral head) on lateral aspect proximal to the knee. These lesions were injected each with 20 mg of Triamcinolone Acetonide diluted in 2 ml of Xylocaine 2%. The lesions responded favourably to the simple treatment and patients of pain knee joint of various durations were completely pain free. The optimum healing time of the lesions was 10 days. Osteoarthritic changes inside the knee joint may not be the cause of painful knee, rather it can be a referred pain. Two lesions, Adductor tubercle on medical side and lateral head of Gastrocnemius on the lateral side proximal to the knee joint are identified to attribute to this pain.

  5. Brain imaging of pain sensitization in patients with knee osteoarthritis.

    PubMed

    Pujol, Jesus; Martínez-Vilavella, Gerard; Llorente-Onaindia, Jone; Harrison, Ben J; López-Solà, Marina; López-Ruiz, Marina; Blanco-Hinojo, Laura; Benito, Pere; Deus, Joan; Monfort, Jordi

    2017-09-01

    A relevant aspect in osteoarthritic pain is neural sensitization. This phenomenon involves augmented responsiveness to painful stimulation and may entail a clinically worse prognosis. We used functional magnetic resonance imaging (fMRI) to study pain sensitization in patients with knee osteoarthritis. Sixty patients were recruited and pain sensitization was clinically defined on the basis of regional spreading of pain (spreading sensitization) and increased pain response to repeated stimulation (temporal summation). Functional magnetic resonance imaging testing involved assessing brain responses to both pressure and heat stimulation. Thirty-three patients (55%) showed regional pain spreading (simple sensitization) and 19 patients (32%) showed both regional spreading and temporal summation. Sensitized patients were more commonly women. Direct painful pressure stimulation of the joint (articular interline) robustly activated all of the neural elements typically involved in pain perception, but did not differentiate sensitized and nonsensitized patients. Painful pressure stimulation on the anterior tibial surface (sensitized site) evoked greater activation in sensitized patients in regions typically involved in pain and also beyond these regions, extending to the auditory, visual, and ventral sensorimotor cortices. Painful heat stimulation of the volar forearm did not discriminate the sensitization phenomenon. Results confirm the high prevalence of pain sensitization secondary to knee osteoarthritis. Relevantly, the sensitization phenomenon was associated with neural changes extending beyond strict pain-processing regions with enhancement of activity in general sensory, nonnociceptive brain areas. This effect is in contrast to the changes previously identified in primary pain sensitization in fibromyalgia patients presenting with a weakening of the general sensory integration.

  6. 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.

  7. Determinants of pain in patients with symptomatic knee osteoarthritis

    PubMed Central

    Heidari, Behzad; Hajian-Tilaki, Karimollah; Babaei, Mansour

    2016-01-01

    Background: Several factors are associated with the development or exacerbation of pain in knee osteoarthritis (KOA). In this study, we reviewed this context based on relevant studies. Methods: Recent published studies which have addressed the relationship between pain and KOA were summarized. Results: Correlates of the clinical, demographic features, laboratory tests and abnormalities on radiographic as well as magnetic resonance imaging (MRI) with the knee pain have been discussed. The results indicated that many factors such as synovitis, synovial effusion, obesity, as well as structural lesions determined by MRI or radiographic examination, serum cytokines, inflammatory markers are determinants of pain in KOA. Conclusion: This context requires further investigations for identification of additional factors which initiate pain in asymptomatic KOA PMID:27757198

  8. The influence of pain on knee motion in patients with osteoarthritis undergoing total knee arthroplasty.

    PubMed

    Bennett, Damien; Hanratty, Brian; Thompson, Neville; Beverland, David E

    2009-04-01

    Pain is the predominant symptom of degenerative knee arthritis and the main reason patients undergo total knee arthroplasty (TKA). Variation in patient response to pain has proved difficult to quantify. The effect of removing pain by testing TKA patients' range of motion (ROM) before and after the administration of anesthesia has not previously been analyzed. This study objectively quantifies the effect of eliminating pain on knee joint ROM for a typical group of TKA patients with osteoarthritis. We prospectively recruited 141 patients with osteoarthritis admitted for TKA to assess the inhibitory effect of pain on ROM. Passive maximum flexion, extension, and ROM were measured preoperatively before and after administration of anesthesia (spinal anesthetic followed by femoral and sciatic regional nerve blocks). Following pain abolition, passive maximum flexion increased by an average of 13.4 degrees (SD=11.9 degrees), passive maximum extension improved by an average of 3.0 degrees (SD=4.2 degrees), and passive ROM increased by an average of 16.4 degrees (SD=13.1 degrees). The change in each parameter was statistically significant (P<.0001). Improvements in flexion (P=.01) and ROM (P=.005) were significantly greater in women. Measurements taken before anesthesia reflect knee ROM that the patient will tolerate before pain becomes the limiting factor, while measurements taken after anesthesia is achieved suggest the knee ROM possible once pain is eliminated. Abolition of pain led to significant increases in knee flexion, extension, and ROM, suggesting that pain has a significant inhibitory effect on knee motion.

  9. The role of knee joint moments and knee impairments on self-reported knee pain during gait in patients with knee osteoarthritis.

    PubMed

    O'Connell, Megan; Farrokhi, Shawn; Fitzgerald, G Kelley

    2016-01-01

    The association between high mechanical knee joint loading during gait with onset and progression of knee osteoarthritis has been extensively studied. However, less attention has been given to risk factors related to increased pain during gait. The purpose of this study was to evaluate knee joint moments and clinical characteristics that may be associated with gait-related knee pain in patients with knee osteoarthritis. Sixty-seven participants with knee osteoarthritis were stratified into three groups of no pain (n=18), mild pain (n=27), or moderate/severe pain (n=22) based on their self-reported symptoms during gait. All participants underwent three-dimensional gait analysis. Quadriceps strength, knee extension range of motion, radiographic knee alignment and self-reported measures of global pain and function were also quantified. The moderate/severe pain group demonstrated worse global pain (P<0.01) and physical function scores (P<0.01) compared to the no pain and the mild pain groups. The moderate/severe pain group also walked with greater knee flexion moments during the midstance phase of gait compared to the no pain group (P=0.02). Additionally, the moderate/severe pain group demonstrated greater varus knee malalignment (P=0.009), which was associated with higher weight acceptance peak knee adduction moments (P=0.003) and worse global pain (P=0.003) and physical function scores (P=0.006). Greater knee flexion moment is present during the midstance phase of gait in patients with knee osteoarthritis and moderate/severe pain during gait. Additionally, greater varus malalignment may be a sign of increased global knee joint dysfunction that can influence many activities of daily living beyond gait. Copyright © 2015 Elsevier Ltd. All rights reserved.

  10. Effects of proprioceptive circuit exercise on knee joint pain and muscle function in patients with knee osteoarthritis.

    PubMed

    Ju, Sung-Bum; Park, Gi Duck; Kim, Sang-Soo

    2015-08-01

    [Purpose] This study applied proprioceptive circuit exercise to patients with degenerative knee osteoarthritis and examined its effects on knee joint muscle function and the level of pain. [Subjects] In this study, 14 patients with knee osteoarthritis in two groups, a proprioceptive circuit exercise group (n = 7) and control group (n = 7), were examined. [Methods] IsoMed 2000 (D&R Ferstl GmbH, Hemau, Germany) was used to assess knee joint muscle function, and a Visual Analog Scale was used to measure pain level. [Results] In the proprioceptive circuit exercise group, knee joint muscle function and pain levels improved significantly, whereas in the control group, no significant improvement was observed. [Conclusion] A proprioceptive circuit exercise may be an effective way to strengthen knee joint muscle function and reduce pain in patients with knee osteoarthritis.

  11. Association of knee confidence with pain, knee instability, muscle strength, and dynamic varus-valgus joint motion in knee osteoarthritis.

    PubMed

    Skou, Søren T; Wrigley, Tim V; Metcalf, Ben R; Hinman, Rana S; Bennell, Kim L

    2014-05-01

    To investigate associations between self-reported knee confidence and pain, self-reported knee instability, muscle strength, and dynamic varus-valgus joint motion during walking. We performed a cross-sectional analysis of baseline data from 100 participants with symptomatic and radiographic medial tibiofemoral compartment osteoarthritis (OA) and varus malalignment recruited for a randomized controlled trial. The extent of knee confidence, assessed using a 5-point Likert scale item from the Knee Injury and Osteoarthritis Outcome Score, was set as the dependent variable in univariable and multivariable ordinal regression, with pain during walking, self-reported knee instability, quadriceps strength, and dynamic varus-valgus joint motion during walking as independent variables. One percent of the participants were not troubled with lack of knee confidence, 17% were mildly troubled, 50% were moderately troubled, 26% were severely troubled, and 6% were extremely troubled. Significant associations were found between worse knee confidence and higher pain intensity, worse self-reported knee instability, lower quadriceps strength, and greater dynamic varus-valgus joint motion. The multivariable model consisting of the same variables significantly accounted for 24% of the variance in knee confidence (P < 0.001). Worse knee confidence is associated with higher pain, worse self-reported knee instability, lower quadriceps muscle strength, and greater dynamic varus-valgus joint motion during walking. Since previous research has shown that worse knee confidence is predictive of functional decline in knee OA, addressing lack of knee confidence by treating these modifiable impairments could represent a new therapeutic target. Copyright © 2014 by the American College of Rheumatology.

  12. The effect of orthotic devices on knee adduction moment, pain and function in medial compartment knee osteoarthritis: a literature review.

    PubMed

    Baghaei Roodsari, Roshanak; Esteki, Ali; Aminian, Gholamreza; Ebrahimi, Ismaeil; Mousavi, Mohammad Ebramim; Majdoleslami, Basir; Bahramian, Fatemeh

    2016-03-15

    Background Knee braces and foot orthoses are commonly used to improve knee adduction moment, pain and function in subjects with knee osteoarthritis (OA). However, no literature review has been performed to compare the effects of foot orthoses and knee braces in this group of patients. Purpose The aim of this review was to evaluate the effects of foot orthoses and knee braces on knee adduction moment, pain and function in individuals with knee OA. Study design Literature review. Method The search strategy was based on the Population Intervention Comparison Outcome method. A search was performed in PubMed, Science Direct, Google Scholar and ISI web of knowledge databases using the PRISMA method and based on selected keywords. Thirty-one related articles were selected for final evaluation. Results The results of the analysis of these studies demonstrated that orthotic devices reduce knee adduction moment and also improve pain and function in individuals with knee OA. Conclusion Foot orthoses may be more effective in improving pain and function in subjects with knee OA. Both knee braces and foot orthoses reduce the knee adduction moment in knee OA and consequently patients typically do not need to use knee braces for a long period of time. Also, foot orthoses and knee braces may be more effective for medial compartment knee OA patients due to the fact that this treatment helps improve pain and function. Implications for Rehabilitation Knee braces and foot orthoses are commonly used for improving knee adduction moment, pain and function in subjects with knee osteoarthritis (OA). Orthotic devices can reduce knee adduction moment, pain and improve function in knee OA. The combined use of a knee braces and foot orthoses can provide more improvement in knee adduction moment, reduced pain and increased function.

  13. Determination of Pain Phenotypes in Knee Osteoarthritis: A Latent Class Analysis Using Data From the Osteoarthritis Initiative.

    PubMed

    Kittelson, Andrew J; Stevens-Lapsley, Jennifer E; Schmiege, Sarah J

    2016-05-01

    Knee osteoarthritis (OA) is a broadly applied diagnosis that may describe multiple subtypes of pain. The purpose of this study was to identify phenotypes of knee OA, using measures from the following pain-related domains: 1) knee OA pathology, 2) psychological distress, and 3) altered pain neurophysiology. Data were selected from a total of 3,494 participants at visit 6 of the Osteoarthritis Initiative study. Latent class analysis was applied to the following variables: radiographic OA severity, quadriceps strength, body mass index, the Charlson Comorbidity Index (CCI), the Center for Epidemiologic Studies Depression Scale, the Coping Strategies Questionnaire-Catastrophizing subscale, number of bodily pain sites, and knee joint tenderness at 4 sites. The resulting classes were compared on the following demographic and clinical factors: age, sex, pain severity, disability, walking speed, and use of arthritis-related health care. A 4-class model was identified. Class 1 (4% of the study population) had higher CCI scores. Class 2 (24%) had higher knee joint sensitivity. Class 3 (10%) had greater psychological distress. Class 4 (62%) had lesser radiographic OA, little psychological involvement, greater strength, and less pain sensitivity. Additionally, class 1 was the oldest, on average. Class 4 was the youngest, had the lowest disability, and least pain. Class 3 had the worst disability and most pain. Four distinct pain phenotypes of knee OA were identified. Psychological factors, comorbidity status, and joint sensitivity appear to be important in defining phenotypes of knee OA-related pain. © 2016, American College of Rheumatology.

  14. The psychometric properties of an Arabic numeric pain rating scale for measuring osteoarthritis knee pain.

    PubMed

    Alghadir, Ahmad H; Anwer, Shahnawaz; Iqbal, Zaheen Ahmed

    2016-12-01

    The aims of this study were to translate the numeric rating scale (NRS) into Arabic and to evaluate the test-retest reliability and convergent validity of an Arabic Numeric Pain Rating Scale (ANPRS) for measuring pain in osteoarthritis (OA) of the knee. The English version of the NRS was translated into Arabic as per the translation process guidelines for patient-rated outcome scales. One hundred twenty-one consecutive patients with OA of the knee who had experienced pain for more than 6 months were asked to report their pain levels on the ANPRS, visual analogue scale (VAS), and verbal rating scale (VRS). A second assessment was performed 48 h after the first to assess test-retest reliability. The test-retest reliability was calculated using the intraclass correlation coefficient (ICC2,1). The convergent validity was assessed using Spearman rank correlation coefficient. In addition, the minimum detectable change (MDC) and standard error of measurement (SEM) were also assessed. The repeatability of ANPRS was good to excellent (ICC 0.89). The SEM and MDC were 0.71 and 1.96, respectively. Significant correlations were found with the VAS and VRS scores (p <0.01). The Arabic numeric pain rating scale is a valid and reliable scale for measuring pain levels in OA of the knee. Implications for Rehabilitation The Arabic Numeric Pain Rating Scale (ANPRS) is a reliable and valid instrument for measuring pain in osteoarthritis (OA) of the knee, with psychometric properties in agreement with other widely used scales. The ANPRS is well correlated with the VAS and NRS scores in patients with OA of the knee. The ANPRS appears to measure pain intensity similar to the VAS, NRS, and VRS and may provide additional advantages to Arab populations, as Arabic numbers are easily understood by this population.

  15. 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.

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

    USDA-ARS?s Scientific Manuscript database

    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...

  17. Effect of adductor canal block on medial compartment knee pain in patients with knee osteoarthritis

    PubMed Central

    Lee, Doo-Hyung; Lee, Michael Y.; Kwack, Kyu-Sung; Yoon, Seung-Hyun

    2017-01-01

    Abstract Knee osteoarthritis (KOA) is a common disease in middle-aged and elderly people. Pain is the chief complaint of symptomatic KOA and a leading cause of chronic disability, which is most often found in medial knees. The aim of this study is to evaluate the efficacy of pain relief and functional improvement in KOA patients treated with ultrasound-guided adductor canal block (ACB). This is a 3-month retrospective case-controlled comparative study. Two hundred patients with anteromedial knee pain owing to KOA that was unresponsive to 3-month long conservative treatments. Ninety-two patients received ACB with 9 mL of 1% of lidocaine and 1 mL of 10 mg triamcinolone acetonide (ACB group), and 108 continued conservative treatments (control group). The main outcome measure was visual analog scale (VAS) of the average knee pain level for the past one week. Secondary outcomes were the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the timed up and go test, numbers of analgesic ingestion per day, and opioid consumption per day. During the 3-month follow-up, 86 patients in ACB group and 92 in control group were analyzed. There was no significant difference, with the exception of the duration of symptoms, between the 2 groups in age, sex, body mass index, and Kellgren-Lawrence grade. Repeated-measures analysis of variance and post hoc tests showed improvement of VAS (at month 1), WOMAC (at month 1), and opioid consumption per day (at month 1 and 2) in ACB group. No adverse events were reported. To our knowledge, this is the first study to assess the efficacy of ACB for patients with KOA. ACB is an effective and safe treatment and can be an option for patients who are either unresponsive or unable to take analgesics. PMID:28328826

  18. Clinical, Radiological and Ultrasonographic Findings Related to Knee Pain in Osteoarthritis

    PubMed Central

    Chan, Keith K. W.; Sit, Regina W. S.; Wu, Ricky W. K.; Ngai, Allen H. Y.

    2014-01-01

    Background Pain is the predominant symptom of knee osteoarthritis (OA) and the main reason of disability. Ultrasound is now one of the new imaging modality in Musculoskeletal medicine and its role in assessing the pain severity in the knee osteoarthritis is evaluated in this study. Objectives (1) To study the correlation between ultrasonographic (US) findings and pain score and (2) whether ultrasonographic findings show a better association of pain level than conventional X-rays in patients suffering from primary knee osteoarthritis. Methods In this multi-center study, 193 patients with primary knee OA were asked to score their average knee pain using the Western Ontario and McMaster Universities Arthritis (WOMAC) questionnaire;patients would then go for a radiological and an US evaluation of their painful knee. Findings from both imaging modalities will be studied with the associated pain score. Results Ultrasound showed that knee effusion has positive correlation with pain score upon walking (r = 0.217) and stair climbing (r = 0.194). Presence of suprapatellar synovitis had higher pain score on sitting (Spearman's Rank correlation  = 0.355). The medial(r = 0.170) and lateral meniscus protrusion (r = 0.201) were associated with pain score upon stair climbing. Conclusions Our study found that both imaging modalities shown some significant association with the aspect of pain; neither one is clearly better but rather complementary to each other. A trend is found in both modalities: walking pain is related to pathologies of the either the lateral or medial tibiofemoral joint(TFJ)while stair climbing pain is related to both tibiofemoral joint pathologies and also to the patellofemoral joint (PFJ) pathology. This suggested that biomechanical derangement is an important aspect in OA knee pain. PMID:24675807

  19. Estimating the probability of radiographic osteoarthritis in the older patient with knee pain.

    PubMed

    Peat, George; Thomas, Elaine; Duncan, Rachel; Wood, Laurence; Wilkie, Ross; Hill, Jonathan; Hay, Elaine M; Croft, Peter

    2007-06-15

    To determine whether clinical information can practically rule in or rule out the presence of radiographic osteoarthritis in older adults with knee pain. We conducted a cross-sectional diagnostic study involving 695 adults ages >/=50 years reporting knee pain within the last year identified by postal survey and attending a research clinic. Potential indicators of radiographic osteoarthritis were gathered by self-complete questionnaires, clinical interview, and physical examination. Participants underwent plain radiography (posteroanterior, skyline, and lateral views). Radiographic osteoarthritis was defined as the presence of definite osteophytes in at least 1 joint compartment of the index knee. Independent predictors of radiographic osteoarthritis were age, sex, body mass index, absence of whole leg pain, traumatic onset, difficulty descending stairs, palpable effusion, fixed-flexion deformity, restricted-flexion range of motion, and crepitus. Using this model, 245 participants had a predicted probability >/=80% (practical rule in), of whom 231 (94%) actually had radiographic osteoarthritis (specificity 93%). Twenty-one participants had a predicted probability <20% (practical rule out), of whom only 2 (10%) had radiographic osteoarthritis (sensitivity 99.6%). The predicted probability of radiographic osteoarthritis for the remaining 429 participants fell into an intermediate category (20-79%). Simple clinical information can be used to estimate the probability of radiographic osteoarthritis in individual patients. However, for the majority of community-dwelling older adults with knee pain this method enables the presence of radiographic osteoarthritis to be neither confidently ruled in nor ruled out. Prospective validation and updating of these findings in an independent sample is required.

  20. Safety of intra-articular hyaluronates for pain associated with osteoarthritis of the knee.

    PubMed

    Hammesfahr, J F Rick; Knopf, Alan B; Stitik, Todd

    2003-06-01

    Sodium hyaluronate (Hyalgan, and Supartz) and hylan G-F 20 (Synvisc) are hyaluronans (HA) injected intra-articularly for pain relief in osteoarthritis of the knee. Each product has demonstrated a very favorable safety profile in clinical trials and practice. The most common adverse event associated with their use is mild injection site pain and swelling. Rare incidences of pseudogout and anaphylactoid reactions have been reported to be associated with their use. Occasionally, pseudosepsis, also known as a severe acute inflammatory reaction (SAIR) syndrome, has been reported to be associated with these products. Clinical and postmarketing data indicate that HA therapy is a safe treatment for osteoarthritis of the knee.

  1. The influence of continuous versus interval walking exercise on knee joint loading and pain in patients with knee osteoarthritis.

    PubMed

    Farrokhi, Shawn; Jayabalan, Prakash; Gustafson, Jonathan A; Klatt, Brian A; Sowa, Gwendolyn A; Piva, Sara R

    2017-07-01

    To evaluate whether knee contact force and knee pain are different between continuous and interval walking exercise in patients with knee osteoarthritis (OA). Twenty seven patients with unilateral symptomatic knee OA completed two separate walking exercise sessions on a treadmill at 1.3m/s on two different days: 1) a continuous 45min walking exercise session, and 2) three 15min bouts of walking exercise separated by 1h rest periods for a total of 45min of exercise in an interval format. Estimated knee contact forces using the OpenSim software and knee pain were evaluated at baseline (1st minute of walking) and after every 15min between the continuous and interval walking conditions. A significant increase from baseline was observed in peak knee contact force during the weight-acceptance phase of gait after 30 and 45min of walking, irrespective of the walking exercise condition. Additionally, whereas continuous walking resulted in an increase in knee pain, interval walking did not lead to increased knee pain. Walking exercise durations of 30min or greater may lead to undesirable knee joint loading in patients with knee OA, while performing the same volume of exercise in multiple bouts as opposed to one continuous bout may be beneficial for limiting knee pain. Copyright © 2017. Published by Elsevier B.V.

  2. The pain in primary osteoarthritis of the knee. Its causes and treatment by osteotomy.

    PubMed Central

    Helal, B.

    1965-01-01

    1. Some results of a clinical investigation of patients with osteoarthritis of the knee are described. 2. The different varieties of pain which occur in osteoarthritis are detailed. 3. A sub-group of patients with primary osteoarthritis of the knee is described. In this group "venous" pain predominated; the venographic appearances are typical, and in a large proportion of cases the veins outside the bone are manifestly abnormal. 4. It is suggested that venous congestion within the bone results from extra-osseus vein disturbances, and leads to congestive bone pain and to progressive joint degeneration. 5. The mechanism by which osteotomy produces relief of pain is analysed and discussed. 6. A simple procedure which reproduces some of the benefits of osteotomy is described. Images Fig. 1 p174-b p175-a Fig. 2 Fig. 3 Fig. 4A Fig. 4B Fig. 4C Fig. 5 PMID:5293938

  3. Clinical descriptors for the recognition of central sensitization pain in patients with knee osteoarthritis.

    PubMed

    Lluch, Enrique; Nijs, Jo; Courtney, Carol A; Rebbeck, Trudy; Wylde, Vikki; Baert, Isabel; Wideman, Timothy H; Howells, Nick; Skou, Søren T

    2017-08-02

    Despite growing awareness of the contribution of central pain mechanisms to knee osteoarthritis pain in a subgroup of patients, routine evaluation of central sensitization is yet to be incorporated into clinical practice. The objective of this perspective is to design a set of clinical descriptors for the recognition of central sensitization in patients with knee osteoarthritis that can be implemented in clinical practice. A narrative review of original research papers was conducted by nine clinicians and researchers from seven different countries to reach agreement on clinically relevant descriptors. It is proposed that identification of a dominance of central sensitization pain is based on descriptors derived from the subjective assessment and the physical examination. In the former, clinicians are recommended to inquire about intensity and duration of pain and its association with structural joint changes, pain distribution, behavior of knee pain, presence of neuropathic-like or centrally mediated symptoms and responsiveness to previous treatment. The latter includes assessment of response to clinical test, mechanical hyperalgesia and allodynia, thermal hyperalgesia, hypoesthesia and reduced vibration sense. This article describes a set of clinically relevant descriptors that might indicate the presence of central sensitization in patients with knee osteoarthritis in clinical practice. Although based on research data, the descriptors proposed in this review require experimental testing in future studies. Implications for Rehabilitation Laboratory evaluation of central sensitization for people with knee osteoarthritis is yet to be incorporated into clinical practice. A set of clinical indicators for the recognition of central sensitization in patients with knee osteoarthritis is proposed. Although based on research data, the clinical indicators proposed require further experimental testing of psychometric properties.

  4. 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 ...

  5. Osteoarthritis

    MedlinePlus

    ... joints most commonly affected by osteoarthritis. Symptoms of knee osteoarthritis include stiffness, swelling, and pain, which make it ... are also common sites of osteoarthritis. As with knee osteoarthritis, symptoms of hip osteoarthritis include pain and stiffness ...

  6. Validated Measures of Illness Perception and Behavior in People with Knee Pain and Knee Osteoarthritis: A Scoping Review.

    PubMed

    Hamilton, Clayon B; Wong, Ming-Kin; Gignac, Monique A M; Davis, Aileen M; Chesworth, Bert M

    2017-01-01

    To identify validated measures that capture illness perception and behavior and have been used to assess people who have knee pain/osteoarthritis. A scoping review was performed. Nine electronic databases were searched for records from inception through April 19, 2015. Search terms included illness perception, illness behavior, knee, pain, osteoarthritis, and their related terms. This review included English language publications of primary data on people with knee pain/osteoarthritis who were assessed with validated measures capturing any of 4 components of illness perception and behavior: monitor body, define and interpret symptoms, take remedial action, and utilize sources of help. Seventy-one publications included relevant measures. Two reviewers independently coded and analyzed each relevant measure within the 4 components. Sixteen measures were identified that capture components of illness perception and behavior in the target population. These measures were originally developed to capture constructs that include coping strategies/skills/styles, illness belief, illness perception, self-efficacy, and pain behavior. Coding results indicated that 5, 11, 12, and 5 of these measures included the monitor body, define and interpret symptoms, take remedial action, and utilize sources of help components, respectively. Several validated measures were interpreted as capturing some components, and only 1 measure was interpreted as capturing all of the components of illness perception and behavior in the target population. A measure that comprehensively captures illness perception and behavior could be valuable for informing and evaluating therapy for patients along a continuum of symptomatic knee osteoarthritis. © 2016 World Institute of Pain.

  7. Cerebral Cortical Thickness in Chronic Pain Due to Knee Osteoarthritis: The Effect of Pain Duration and Pain Sensitization

    PubMed Central

    2016-01-01

    Objective This study investigates associations between cortical thickness and pain duration, and central sensitization as markers of pain progression in painful knee osteoarthritis. Methods Whole brain cortical thickness and pressure pain thresholds were assessed in 70 participants; 40 patients with chronic painful knee osteoarthritis (age = 66.1± 8.5 years, 21 females, mean duration of pain = 8.5 years), and 30 healthy controls (age = 62.7± 7.4, 17 females). Results Cortical thickness negatively correlated with pain duration mainly in fronto-temporal areas outside of classical pain processing areas (p<0.05, age-controlled, FDR corrected). Pain sensitivity was unrelated to cortical thickness. Patients showed lower cortical thickness in the right anterior insula (p<0.001, uncorrected) with no changes surviving multiple test correction. Conclusion With increasing number of years of suffering from chronic arthritis pain we found increasing cortical thinning in extended cerebral cortical regions beyond recognised pain-processing areas. While the mechanisms of cortical thinning remain to be elucidated, we show that pain progression indexed by central sensitization does not play a major role. PMID:27658292

  8. Future directions in painful knee osteoarthritis: harnessing complexity in a heterogeneous population.

    PubMed

    Kittelson, Andrew J; George, Steven Z; Maluf, Katrina S; Stevens-Lapsley, Jennifer E

    2014-03-01

    This perspective article proposes a conceptual model for the pain experience for individuals diagnosed with knee osteoarthritis (OA). Pain in knee OA is likely a heterogeneous, multifactorial phenomenon that involves not only the OA disease process but also elements specific to patient psychology and pain neurophysiology. The relevant contributions to the pain experience for any individual patient remain difficult, if not impossible, to definitively determine, and the rationale for many clinical treatment decisions arises primarily from a mechanistic understanding of OA pathophysiology. The Osteoarthritis Research Society International (OARSI) recently identified "phenotyping" of OA pain as a research priority to "better target pain therapies to individual patients." This perspective article proposes that contributions from 3 domains--knee pathology, psychological distress, and pain neurophysiology--should be considered equally important in future efforts to understand pain phenotypes in knee OA. Ultimately, characterization of pain phenotypes may aid in the understanding of the pain experience and the development of interventions specific to pain for individual patients.

  9. Hydrotherapy improves pain and function in older women with knee osteoarthritis: a randomized controlled trial.

    PubMed

    Dias, João Marcos; Cisneros, Lígia; Dias, Rosângela; Fritsch, Carolina; Gomes, Wellington; Pereira, Leani; Santos, Mary Luci; Ferreira, Paulo Henrique

    2017-07-05

    Currently, there is poor evidence of the effect of hydrotherapy alone on patients with hip or knee osteoarthritis. The study aimed to assess the impact of hydrotherapy on pain, function, and muscle function in older women with knee osteoarthritis. A randomized controlled trial was conducted to evaluate the efficacy of hydrotherapy in women with knee osteoarthritis. Seventy-three women aged 65 and older were randomized to hydrotherapy (n=36) or a control group (n=37). The hydrotherapy group received the intervention program in a heated pool (twice per week for six weeks) and an educational protocol while the control group received an educational protocol only. Primary outcomes (before and post-treatment) were pain intensity (0-100) and function (0-100), assessed with the WOMAC questionnaire. Secondary outcomes (before and post-treatment) were knee extensor and knee flexor muscle performance (strength, power, and endurance), assessed by an isokinetic dynamometer. The magnitude of change between the groups for the outcomes was calculated using linear regression models adjusted by baseline outcome values. The hydrotherapy group had better outcomes for pain (adjusted mean difference=11 points, 95% CI: 3-18) and function (adjusted mean difference=12 points, 95% CI: 5-18). Patients receiving hydrotherapy had better performance for knee flexor and extensor strength, knee flexor power, and knee extensor endurance. Older women with knee osteoarthritis are likely to have benefits from a course of hydrotherapy exercises. Registry of clinical trials (Trial number RBR-8F57KR) - http://www.ensaiosclinicos.gov.br/rg/RBR-8f57kr/. Copyright © 2017 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.

  10. 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.

  11. Existence of a Neuropathic Pain Component in Patients with Osteoarthritis of the Knee

    PubMed Central

    Orita, Sumihisa; Yamashita, Masaomi; Ishikawa, Tetsuhiro; Ito, Toshinori; Shigemura, Tomonori; Nishiyama, Hideki; Konno, Shin; Ohta, Hideyuki; Takaso, Masashi; Inoue, Gen; Eguchi, Yawara; Ochiai, Nobuyasu; Kishida, Shunji; Kuniyoshi, Kazuki; Aoki, Yasuchika; Arai, Gen; Miyagi, Masayuki; Kamoda, Hiroto; Suzkuki, Miyako; Nakamura, Junichi; Furuya, Takeo; Kubota, Gou; Sakuma, Yoshihiro; Oikawa, Yasuhiro; Suzuki, Masahiko; Sasho, Takahisa; Nakagawa, Koichi; Toyone, Tomoaki; Takahashi, Kazuhisa

    2012-01-01

    Purpose Pain from osteoarthritis (OA) is generally classified as nociceptive (inflammatory). Animal models of knee OA have shown that sensory nerve fibers innervating the knee are significantly damaged with destruction of subchondral bone junction, and induce neuropathic pain (NP). Our objective was to examine NP in the knees of OA patients using painDETECT (an NP questionnaire) and to evaluate the relationship between NP, pain intensity, and stage of OA. Materials and Methods Ninety-two knee OA patients were evaluated in this study. Pain scores using Visual Analogue Scales (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), painDETECT, duration of symptoms, severity of OA using the Kellgren-Lawrence (KL) system, and amount of joint fluid were evaluated and compared using a Spearman's correlation coefficient by rank test. Results Our study identified at least 5.4% of our knee OA patients as likely to have NP and 15.2% as possibly having NP. The painDETECT score was significantly correlated with the VAS and WOMAC pain severity. Compared with the painDETECT score, there was a tendency for positive correlation with the KL grade, and tendency for negative correlation with the existence and amount of joint fluid, but these correlations were not significant. Conclusion PainDETECT scores classified 5.4% of pain from knee OA as NP. NP tended to be seen in patients with less joint fluid and increased KL grade, both of which corresponded to late stages of OA. It is important to consider the existence of NP in the treatment of knee OA pain. PMID:22665349

  12. 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

  13. Ultrasound-Guided Genicular Nerve Pulsed Radiofrequency Treatment For Painful Knee Osteoarthritis: A Preliminary Report.

    PubMed

    Kesikburun, Serdar; Yaşar, Evren; Uran, Ayça; Adigüzel, Emre; Yilmaz, Bilge

    2016-07-01

    Genicular nerve ablation with radiofrequency (RF) has recently emerged as a promising treatment in the management of osteoarthritis related knee pain. To date, genicular nerve injections have been performed under fluoroscopic guidance. To evaluate the effect of ultrasound-guided genicular nerve pulsed RF treatment on chronic knee pain and function in patients with knee osteoarthritis. Single-arm prospective study. University hospital and rehabilitation center in Turkey. A review was made of 29 patients with medial knee osteoarthritis who had undergone genicular nerve block in the previous 6 months. Patients with at least 50% reduction in the visual analog scale (VAS) score after genicular nerve block and with no on-going pain relief were selected for the study. Ultrasound-guided genicular nerve pulsed RF was applied to 15 knees of 9 patients. Pain and knee function were assessed with 100-mm VAS and Western Ontario and McMaster Universities (WOMAC) index throughout 3 months. A significant reduction in VAS scores was detected over time after the pulsed RF procedure (f: 69.24, P < 0.01). There was a significant improvement in the WOMAC scores (f: 539.68 , P < 0.01). The small number of participants, the lack of a control group, and short follow-up period were limitations of the study. Genicular nerve pulsed RF treatment has been found to be safe and beneficial in osteoarthritis related knee pain. Further studies with a larger population and randomized controlled study design are warranted to confirm the positive findings of this preliminary report.

  14. Randomised controlled trial of magnetic bracelets for relieving pain in osteoarthritis of the hip and knee

    PubMed Central

    Harlow, Tim; Greaves, Colin; White, Adrian; Brown, Liz; Hart, Anna; Ernst, Edzard

    2004-01-01

    Objective To determine the effectiveness of commercially available magnetic bracelets for pain control in osteoarthritis of the hip and knee. Design Randomised, placebo controlled trial with three parallel groups. Setting Five rural general practices. Participants 194 men and women aged 45-80 years with osteoarthritis of the hip or knee. Intervention Wearing a standard strength static bipolar magnetic bracelet, a weak magnetic bracelet, or a non-magnetic (dummy) bracelet for 12 weeks. Main outcome measures Change in the Western Ontario and McMaster Universities osteoarthritis lower limb pain scale (WOMAC A) after 12 weeks, with the primary comparison between the standard and dummy groups. Secondary outcomes included changes in WOMAC B and C scales and a visual analogue scale for pain. Results Mean pain scores were reduced more in the standard magnet group than in the dummy group (mean difference 1.3 points, 95% confidence interval 0.05 to 2.55). Self reported blinding status did not affect the results. The scores for secondary outcome measures were consistent with the WOMAC A scores. Conclusion Pain from osteoarthritis of the hip and knee decreases when wearing magnetic bracelets. It is uncertain whether this response is due to specific or non-specific (placebo) effects. PMID:15604181

  15. Acute aquatic treadmill exercise improves gait and pain in people with knee osteoarthritis.

    PubMed

    Roper, Jaimie A; Bressel, Eadric; Tillman, Mark D

    2013-03-01

    To examine the acute effects of aquatic and land treadmill exercise on gait kinematics as well as the level of disease-specific and movement-related pain for individuals with osteoarthritis. Quasi-experimental crossover design. Biomechanics laboratory. Participants (N=14; age, 43-64y) diagnosed with osteoarthritis at the knee (n=12), osteoarthritis at the knee and ankle (n=1), or osteoarthritis at the knee and hip (n=1). Participants performed 3 exercise sessions separated by at least 24 hours in 1 week for each mode of exercise (aquatic treadmill and land treadmill). Gait kinematics and pain were measured before and after each intervention. The angular velocity gain score during stance for left knee extension was improved by 38% after aquatic treadmill exercise (P=.004). Similarly, during swing, the gain scores for angular velocity were also greater for left knee internal rotation and extension by 65% and 20%, respectively (P=.004, P=.008, respectively). During stance, the joint angle gain score for left hip flexion was 7.23% greater after land exercise (P=.007). During swing, the angular velocity gain score for right hip extension was significantly greater for aquatic exercise by 28% (P=.01). Only the joint angle gain score for left ankle abduction during stance was significantly higher after land exercise (4.72%, P=.003). No other joint angle gain scores for either stance or swing were significantly different for either condition (P=.06-.96). Perceived pain was 100% greater after land than aquatic treadmill exercise (P=.02). Step rate and step length were not different between conditions (P=.31-.92). An acute training period on an aquatic treadmill positively influenced joint angular velocity and arthritis-related joint pain. Acute aquatic treadmill exercise may be useful as a conservative treatment to improve angular speed of the lower-extremity joints and pain related to osteoarthritis. Copyright © 2013 American Congress of Rehabilitation Medicine. Published

  16. The effectiveness of acupuncture on pain and mobility in patients with osteoarthritis of the knee: a pilot study.

    PubMed

    Maa, Suh-Hwa; Sun, Mao-Feng; Wu, Chi-Chuan

    2008-06-01

    Acupuncture has been repeatedly reported to relieve pain associated with osteoarthritis of the knee. As the vast majority of information on the effectiveness of acupuncture on this condition is based on data collected in Western countries, little is known about patients with osteoarthritis of the knee in Asian countries. In this pilot clinical study, acupuncture was incorporated into the standard care for adult patients with osteoarthritis of the knee to determine its contribution to pain relief and improved mobility. In a prospective, non-randomized controlled study, patients with osteoarthritis of the knee were separated into two groups. The first (the experimental group; n = 12) was scheduled for up to 8 sessions of acupuncture in addition to standard care, while the second (the control group; n = 12) received standard care only. Measurements using the six-minute walking distance test, pain visual analogue scale, and osteoarthritis of the knee outcome measurement were taken at baseline and after 4 weeks. Both study and control groups showed significant improvement with respect to time effects in terms of six-minute walking distance, pain visual analogue scale, pain domain and mobility domain scores determined by the osteoarthritis of the knee outcome measurement (p < .01), after adjusting for covariables. However, improvements measured in the study group did not differ significantly from those in the control group. Patients with osteoarthritis of the knee seemed to experience clinical improvements in six-minute walking distance, pain relief and mobility when their standard care was supplemented with acupuncture.

  17. Pain management in the elderly: transdermal fentanyl for the treatment of pain caused by osteoarthritis of the knee and hip.

    PubMed

    Mordarski, Sylwester

    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.

  18. 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

  19. Experimental pain phenotyping in community-dwelling individuals with knee osteoarthritis.

    PubMed

    Cardoso, Josue S; Riley, Joseph L; Glover, Toni; Sibille, Kimberly T; Bartley, Emily J; Goodin, Burel R; Bulls, Hailey W; Herbert, Matthew; Addison, Adriana S; Staud, Roland; Redden, David T; Bradley, Laurence A; Fillingim, Roger B; Cruz-Almeida, Yenisel

    2016-09-01

    Pain among individuals with knee osteoarthritis (OA) is associated with significant disability in older adults, and recent evidence demonstrates enhanced experimental pain sensitivity. Although previous research showed considerable heterogeneity in the OA clinical pain presentation, less is known regarding the variability in responses to experimental pain. The present study included individuals with knee OA (n = 292) who participated in the Understanding Pain and Limitations in Osteoarthritic Disease study and completed demographic and psychological questionnaires followed by a multimodal quantitative sensory testing (QST) session. Quantitative sensory testing measures were subjected to variable reduction procedures to derive pain sensitivity index scores, which in turn were entered into a cluster analysis. Five clusters were significantly different across all pain sensitivity index variables (P < 0.001) and were characterized by: (1) low pain sensitivity to pressure pain (N = 39); (2) average pain sensitivity across most modalities (N = 88); (3) high temporal summation of punctate pain (N = 38); (4) high cold pain sensitivity (N = 80); and (5) high sensitivity to heat pain and temporal summation of heat pain (N = 41). Clusters differed significantly by race, gender, somatic reactivity, and catastrophizing (P < 0.05). Our findings support the notion that there are distinct subgroups or phenotypes based on experimental pain sensitivity in community-dwelling older adults with knee OA, expanding previous findings of similar cluster characterizations in healthy adults. Future research is needed to further understand the pathophysiological mechanisms underlying pain within these subgroups, which may be of added value in tailoring effective treatments for people with OA.

  20. The association between knee joint biomechanics and neuromuscular control and moderate knee osteoarthritis radiographic and pain severity.

    PubMed

    Astephen Wilson, J L; Deluzio, K J; Dunbar, M J; Caldwell, G E; Hubley-Kozey, C L

    2011-02-01

    The objective of this study was to determine the association between biomechanical and neuromuscular factors of clinically diagnosed mild to moderate knee osteoarthritis (OA) with radiographic severity and pain severity separately. Three-dimensional gait analysis and electromyography were performed on a group of 40 participants with clinically diagnosed mild to moderate medial knee OA. Associations between radiographic severity, defined using a visual analog radiographic score, and pain severity, defined with the pain subscale of the WOMAC osteoarthritis index, with knee joint kinematics and kinetics, electromyography patterns of periarticular knee muscles, BMI and gait speed were determined with correlation analyses. Multiple linear regression analyses of radiographic and pain severity were also explored. Statistically significant correlations between radiographic severity and the overall magnitude of the knee adduction moment during stance (r²=21.4%, P=0.003) and the magnitude of the knee flexion angle during the gait cycle (r²=11.4%, P=0.03) were found. Significant correlations between pain and gait speed (r²=28.2%, P<0.0001), the activation patterns of the lateral gastrocnemius (r²=16.6%, P=0.009) and the medial hamstring (r²=10.3%, P=0.04) during gait were found. The combination of the magnitude of the knee adduction moment during stance and BMI explained a significant portion of the variability in radiographic severity (R(2)=27.1%, P<0.0001). No multivariate model explained pain severity better than gait speed alone. This study suggests that some knee joint biomechanical variables are associated with structural knee OA severity measured from radiographs in clinically diagnosed mild to moderate levels of disease, but that pain severity is only reflected in gait speed and neuromuscular activation patterns. A combination of the knee adduction moment and BMI better explained structural knee OA severity than any individual factor alone. Copyright © 2010

  1. Can multivariate models based on MOAKS predict OA knee pain? Data from the Osteoarthritis Initiative

    NASA Astrophysics Data System (ADS)

    Luna-Gómez, Carlos D.; Zanella-Calzada, Laura A.; Galván-Tejada, Jorge I.; Galván-Tejada, Carlos E.; Celaya-Padilla, José M.

    2017-03-01

    Osteoarthritis is the most common rheumatic disease in the world. Knee pain is the most disabling symptom in the disease, the prediction of pain is one of the targets in preventive medicine, this can be applied to new therapies or treatments. Using the magnetic resonance imaging and the grading scales, a multivariate model based on genetic algorithms is presented. Using a predictive model can be useful to associate minor structure changes in the joint with the future knee pain. Results suggest that multivariate models can be predictive with future knee chronic pain. All models; T0, T1 and T2, were statistically significant, all p values were < 0.05 and all AUC > 0.60.

  2. The Association of Obesity with Walking Independent of Knee Pain: The Multicenter Osteoarthritis Study

    PubMed Central

    White, Daniel K.; Neogi, Tuhina; Zhang, Yuqing; Felson, David; LaValley, Michael; Niu, Jingbo; Nevitt, Michael; Lewis, Cora E.; Torner, James; Douglas Gross, K.

    2012-01-01

    Practice guidelines recommend addressing obesity for people with knee OA, however, the association of obesity with walking independent of pain is not known. We investigated this association within the Multicenter Osteoarthritis Study, a cohort of older adults who have or are at high risk of knee OA. Subjects wore a StepWatch to record steps taken over 7 days. We measured knee pain from a visual analogue scale and obesity by BMI. We examined the association of obesity with walking using linear regression adjusting for pain and covariates. Of 1788 subjects, the mean steps/day taken was 8872.9 ± 3543.4. Subjects with a BMI ≥35 took 3355 fewer steps per day independent of knee pain compared with those with a BMI ≤25 (95% CI −3899, −2811). BMI accounted for 9.7% of the variability of walking while knee pain accounted for 2.9%. BMI was associated with walking independent of knee pain. PMID:22645666

  3. Radiofrequency treatment relieves chronic knee osteoarthritis pain: a double-blind randomized controlled trial.

    PubMed

    Choi, Woo-Jong; Hwang, Seung-Jun; Song, Jun-Gol; Leem, Jeong-Gil; Kang, Yong-Up; Park, Pyong-Hwan; Shin, Jin-Woo

    2011-03-01

    Chronic osteoarthritis (OA) pain of the knee is often not effectively managed with current non-pharmacological or pharmacological treatments. Radiofrequency (RF) neurotomy is a therapeutic alternative for chronic pain. We investigated whether RF neurotomy applied to articular nerve branches (genicular nerves) was effective in relieving chronic OA knee joint pain. The study involved 38 elderly patients with (a) severe knee OA pain lasting more than 3 months, (b) positive response to a diagnostic genicular nerve block and (c) no response to conservative treatments. Patients were randomly assigned to receive percutaneous RF genicular neurotomy under fluoroscopic guidance (RF group; n=19) or the same procedure without effective neurotomy (control group; n=19). Visual analogue scale (VAS), Oxford knee scores, and global perceived effect on a 7-point scale were measured at baseline and at 1, 4, and 12weeks post-procedure. VAS scores showed that the RF group had less knee joint pain at 4 (p<0.001) and 12 (p<0.001) weeks compared with the control group. Oxford knee scores showed similar findings (p<0.001). In the RF group, 10/17 (59%), 11/17 (65%) and 10/17 (59%) achieved at least 50% knee pain relief at 1, 4, and 12 weeks, respectively. No patient reported a post-procedure adverse event during the follow-up period. RF neurotomy of genicular nerves leads to significant pain reduction and functional improvement in a subset of elderly chronic knee OA pain, and thus may be an effective treatment in such cases. Further trials with larger sample size and longer follow-up are warranted. Copyright © 2010 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  4. 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.

  5. The association of body-mass index and depressed mood with knee pain and activity limitations in knee osteoarthritis: results from the Amsterdam osteoarthritis cohort

    PubMed Central

    2013-01-01

    Background Body-mass index (BMI) and depressed mood are both positively associated with pain and activity limitations in knee osteoarthritis (OA), and are interrelated. The aims of the present study were: 1) to assess whether BMI and depressed mood are independently associated with knee pain and activity limitations; and 2) to compare the relative contributions of BMI and depressed mood to knee pain and activity limitations. Methods A cross-sectional study in 294 patients with clinical knee OA. Regression analyses were performed with knee pain or activity limitations (self-reported and performance-based) as dependent variables, and BMI and depressed mood as independent variables. All analyses were adjusted for age, gender, marital status, education level, radiographic OA and comorbidity. Dominance analyses were performed to examine the relative contributions of BMI and depressed mood to knee pain and activity limitations. Results BMI and depressed mood were positively and independently associated with knee pain and activity limitations. BMI and depressed mood explained small parts (3.0% and 2.3%, respectively) of variance in knee pain. BMI explained a substantial part of variance in both self-reported (9.8%) and performance-based (20.4%) activity limitations, while depressed mood explained a small part of variance (3.1% in self-reported and 2.6% in performance-based activity limitations). Conclusions In patients with knee OA both BMI and depressed mood seem to be independently associated with knee pain and activity limitations. The contribution of BMI to activity limitations is most substantial, thereby offering a relevant target for interventions. PMID:24131757

  6. 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.

  7. 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

  8. High Prevalence of Neuropathic Pain Features in Patients with Knee Osteoarthritis: A Cross-Sectional Study.

    PubMed

    Oteo-Álvaro, Ángel; Ruiz-Ibán, Miguel A; Miguens, Xoan; Stern, Andrés; Villoria, Jesús; Sánchez-Magro, Isabel

    2015-09-01

    The present epidemiological research evaluated the prevalence of neuropathic pain characteristics in patients with painful knee osteoarthritis (OA) and the plausibility that such neuropathic features were specific of OA. Outpatients with chronic pain associated with knee OA who attended orthopedic surgery or rehabilitation clinics were systematically screened for neuropathic pain with the Douleur Neuropathique in 4 questions (DN4) questionnaire. Data from medical files and those obtained during a single structured clinical interview were correlated with the DN4 scores. Information on potential confounders of neuropathic-like qualities of knee pain was collected to evaluate as much as possible only the symptoms attributable to OA. Of 2,776 patients recruited, 2,167 patients provided valid data from 2,992 knees. The DN4 was scored positively (≥ 4) in 1,125 patients (51.9%) and 1,459 knees (48.8%). When patients with potential confounders were excluded, the respective prevalences were 33.3% and 29.4%. Patients who scored positively in the DN4 had more severe pain, greater structural damage, and more potential confounders of neuropathic pain. Three potential confounders conveyed much of the variability explained by regression analyses. However, latent class analyses revealed that the concourse of other factors is required to explain the neuropathic pain qualities. A relevant proportion of patients with chronic pain associated with knee OA featured neuropathic pain qualities that were not explained by other conditions. The present research has provided reasonable epidemiological grounds to attempt their definite diagnosis and classification. © 2014 World Institute of Pain.

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

    PubMed Central

    Reid, Kieran F.; Price, Lori Lyn; Harvey, William F.; Driban, Jeffrey B.; Hau, Cynthia; Fielding, Roger A.; Wang, Chenchen

    2015-01-01

    Objectives We examined the relationships between lower extremity muscle strength, power and perceived disease severity in participants with knee osteoarthritis (OA). We hypothesized that dynamic leg extensor muscle power would be associated with pain and quality of life in knee OA. Methods We used baseline data from a randomized controlled trial in 190 participants with knee OA (age: 60.2 ± 10.4 yrs; BMI: 32.7 ± 7.2 kg/m2). Knee pain was measured using the Western Ontario and McMaster Osteoarthritis Index and health-related quality of life using the Short Form 36 (SF-36). One-repetition maximum (1RM) strength was assessed using the bilateral leg press and peak muscle power was measured during 5 maximum voluntary velocity repetitions at 40% and 70% of 1RM. Results In univariate analysis, greater muscle power was significantly associated with pain (r = -0.17, P < 0.02). It was also significantly and positively associated with SF-36 physical component scores (PCS) (r = 0.16, P < 0.05). After adjusting for multiple covariates, muscle power was a significant independent predictor of pain (P ≤ 0.05) and PCS (P ≤ 0.04). However, strength was not an independent determinant of pain or quality of life (P ≥ 0.06). Conclusions Muscle power is an independent determinant of pain and quality of life in knee OA. Compared to strength, muscle power may be a more clinically important measure of muscle function within this population. New trials to systematically examine the impact of muscle power training interventions on disease severity in knee OA are particularly warranted. PMID:26315282

  10. Muscle Power Is an Independent Determinant of Pain and Quality of Life in Knee Osteoarthritis.

    PubMed

    Reid, Kieran F; Price, Lori Lyn; Harvey, William F; Driban, Jeffrey B; Hau, Cynthia; Fielding, Roger A; Wang, Chenchen

    2015-12-01

    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. Baseline data on 190 subjects with knee OA (mean ± SD age 60.2 ± 10.4 years, body mass index 32.7 ± 7.2 kg/m(2) ) were obtained from a randomized controlled trial. Knee pain was measured using the Western Ontario and McMaster Universities Osteoarthritis Index, and health-related quality of life was assessed using the Short Form 36 (SF-36). One-repetition maximum (1RM) strength was assessed using the bilateral leg press, and peak muscle power was measured during 5 maximum voluntary velocity repetitions at 40% and 70% of 1RM. In univariate analysis, greater muscle power was significantly associated with pain (r = -0.17, P < 0.02) and also significantly and positively associated with SF-36 physical component summary (PCS) scores (r = 0.16, P < 0.05). After adjustment for multiple covariates, muscle power was a significant independent predictor of pain (P ≤ 0.05) and PCS scores (P ≤ 0.04). However, muscle strength was not an independent determinant of pain or quality of life (P ≥ 0.06). Muscle power is an independent determinant of pain and quality of life in knee OA. Compared to strength, muscle power may be a more clinically important measure of muscle function within this population. New trials to systematically examine the impact of muscle power training interventions on disease severity in knee OA are particularly warranted. © 2015, American College of Rheumatology.

  11. Efficacy and safety of hyaluronan treatment in combination therapy with home exercise for knee osteoarthritis pain.

    PubMed

    Stitik, Todd P; Blacksin, Marcia F; Stiskal, Doreen M; Kim, Jong H; Foye, Patrick M; Schoenherr, Lisa; Choi, Eun-Seok; Chen, Boqing; Saunders, Howard J; Nadler, Scott F

    2007-02-01

    To assess the efficacy and safety of intra-articular injections of sodium hyaluronate combined with a home exercise program (HEP) in the management of pain associated with osteoarthritis (OA) of the knee. Single-blinded, parallel-design, 1-year clinical study with sequential enrollment. University-based outpatient physiatric practice. Sixty patients (18 men, 42 women; age, > or =50 y) with moderate-to-severe pain associated with OA of the knee. (1) Five weekly intra-articular hyaluronate injections (5-HYL); (2) 3 weekly intra-articular hyaluronate injections (3-HYL); or (3) a combination of an HEP with 3 weekly intra-articular hyaluronate injections (3-HYL+HEP). The primary outcome measure was a 100-mm visual analog scale for pain after a 50-foot walk (15.24 m). Secondary measures included the Western Ontario and McMaster Universities Osteoarthritis Index subscales. The 3-HYL+HEP group had significantly faster onset of pain relief compared with the 3-HYL (P<.01) and 5-HYL groups (P=.01). All groups showed a mean symptomatic improvement from baseline (reduction in baseline pain at 3 mo was 59%, 49%, and 48% for the 3-HYL+HEP, 3-HYL, and 5-HYL groups, respectively) that was clinically and statistically significant. There were no between-group differences in the incidence or nature of adverse events. The combined use of hyaluronate injections with HEP should be considered for management of moderate-to-severe pain in patients with knee OA.

  12. Efficacy of Direct Injection of Etanercept into Knee Joints for Pain in Moderate and Severe Knee Osteoarthritis

    PubMed Central

    Orita, Sumihisa; Yamauchi, Kazuyo; Eguchi, Yawara; Ochiai, Nobuyasu; Kishida, Shunji; Kuniyoshi, Kazuki; Aoki, Yasuchika; Nakamura, Junichi; Ishikawa, Tetsuhiro; Miyagi, Masayuki; Kamoda, Hiroto; Suzuki, Miyako; Kubota, Gou; Sakuma, Yoshihiro; Oikawa, Yasuhiro; Inage, Kazuhide; Sainoh, Takeshi; Sato, Jun; Shiga, Yasuhiro; Abe, Koki; Fujimoto, Kazuki; Kanamoto, Hiroto; Toyone, Tomoaki; Inoue, Gen; Takahashi, Kazuhisa

    2015-01-01

    Purpose Osteoarthritic (OA) pain is largely considered to be inflammatory pain. However, during the last stage of knee OA, sensory nerve fibers in the knee are shown to be significantly damaged when the subchondral bone junction is destroyed, and this can induce neuropathic pain. Several authors have reported that tumor necrosis factor-α (TNFα) in a knee joint plays a crucial role in pain modulation. The purpose of the current study was to evaluate the efficacy of etanercept, a TNFα inhibitor, for pain in knee OA. Materials and Methods Thirty-nine patients with knee OA and a 2-4 Kellgren-Lawrence grading were evaluated in this prospective study. Patients were divided into two groups; hyaluronic acid (HA) and etanercept injection. All patients received a single injection into the knee. Pain scores were evaluated before and 4 weeks after injection using a visual analogue scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and they were compared between the groups. Results Before injection, VAS and WOMAC scores were not significantly different between the groups (p>0.05). Significant pain relief was found in the etanercept group at 1 and 2 weeks by VAS, and at 4 weeks by WOMAC score, compared with the HA group (p<0.05). No adverse events were observed in either group. Conclusion Direct injection of etanercept into OA knee joints was an effective treatment for pain in moderate and severe OA patients. Furthermore, this finding suggests that TNFα is one factor that induces OA pain. PMID:26256983

  13. Disrupted Sleep is Associated with Altered Pain Processing by Sex and Ethnicity in Knee Osteoarthritis

    PubMed Central

    Petrov, Megan E.; Goodin, Burel R.; Cruz-Almeida, Yenisel; King, Chris; Glover, Toni L.; Bulls, Hailey W.; Herbert, Matthew; Sibille, Kimberly T.; Bartley, Emily J.; Fessler, Barri J.; Sotolongo, Adriana; Staud, Roland; Redden, David; Fillingim, Roger B.; Bradley, Laurence A.

    2015-01-01

    Studies indicate that improving sleep decreases reported pain in patients with knee osteoarthritis (OA), but it is unclear if this association extends to experimentally-induced pain responses. A community-based sample of 88 African-American and 52 non-Hispanic white adults (45-76y) with knee OA completed the Insomnia Severity Index and the arousal subscale of the Sleep Hygiene and Practices Scale. Participants underwent quantitative sensory testing including measures of pain sensitivity and facilitation at the knee, and pain inhibition. Outcomes were analyzed with multiple Tobit, hierarchical regression models, with adjustment for relevant covariates. Ethnicity and sex by sleep interactions were also entered into the models. After covariate adjustment, main associations were not observed. However, sex interacted with insomnia severity to predict greater temporal summation of heat and punctate pressure pain among women and lower heat temporal summation among men. Men and women who engaged in frequent arousal-associated sleep behaviors demonstrated higher and lower heat temporal summation, respectively. Non-Hispanic whites with greater insomnia severity displayed lower pressure pain thresholds and pain inhibition. Our findings are the first to demonstrate that disrupted sleep is associated with altered pain processing differentially by sex and ethnicity/race among people with knee OA. PMID:25725172

  14. IS PAIN IN ONE KNEE ASSOCIATED WITH ISOMETRIC MUSCLE STRENGTH IN THE CONTRALATERAL LIMB? - DATA FROM THE OSTEOARTHRITIS INITIATIVE (OAI)

    PubMed Central

    Steidle, E.; Wirth, W.; Glass, N.; Ruhdorfer, A.; Cotofana, S.; Eckstein, F.; Segal, N. A.

    2014-01-01

    Objective Knee pain and muscle weakness confer risk for knee osteoarthritis incidence and progression. The purpose of this study was to determine whether unilateral knee pain influences contralateral thigh muscle strength. Design Of 4796 Osteoarthritis Initiative participants, 224 (mean±SD age 63.9±8.9 years) cases could be matched to a control. Cases were defined as having unilateral knee pain (numerical rating scale (NRS)≥4/10; ≥infrequent pain) and one pain-free knee (NRS 0–1; ≤infrequent pain; WOMAC≤1). Controls were defined as having bilaterally pain-free knees (NRS 0–1; ≤infrequent pain; WOMAC≤1). Maximal isometric muscle strength [N] was compared between limbs in participants with unilateral pain (cases), and between pain-free limbs of cases and controls. Results Knee extensor/flexor strength in pain-free limbs of cases was lower than in bilaterally pain-free controls (−5.5%/–8.4%; p=0.043/p=0.022). Within cases, maximum extensor/flexor strength was significantly lower in the painful than in the pain-free limb (−6.4%/4.1%; p<0.0001/p=0.015). Conclusions These results suggest that strength in limbs without knee pain is associated with the pain status of the contralateral knee. The strength difference between unilateral pain-free cases and matched bilateral pain-free controls was similar to that between limbs in persons with unilateral knee pain. Lower strength due to contralateral knee pain might be centrally mediated. PMID:25768069

  15. The Effects of Acupuncture on Chronic Knee Pain Due to Osteoarthritis: A Meta-Analysis.

    PubMed

    Lin, Xianfeng; Huang, Kangmao; Zhu, Guiqi; Huang, Zhaobo; Qin, An; Fan, Shunwu

    2016-09-21

    Acupuncture reportedly relieves chronic knee pain and improves physical function in patients diagnosed with osteoarthritis, but the duration of these effects is controversial. The aim of this study was to evaluate the temporal effects of acupuncture on chronic knee pain due to knee osteoarthritis by means of a meta-analysis. The PubMed, Embase, and Cochrane Central Register of Controlled Trials databases were searched for studies published through March 2015. Ten randomized controlled trials of acupuncture compared with sham acupuncture, usual care, or no intervention for chronic knee pain in patients with clinically diagnosed or radiographically confirmed knee osteoarthritis were included. All of the studies were available in English. Weighted mean differences (WMDs), 95% confidence intervals (CIs), publication bias, and heterogeneity were calculated. The acupuncture groups showed superior pain improvement (p < 0.001; WMD = -1.24 [95% CI, -1.92 to -0.56]; I(2) > 50%) and physical function (p < 0.001; WMD = 4.61 [95% CI, 2.24 to 6.97]; I(2) > 50%) in the short term (up to 13 weeks). The acupuncture groups showed superior physical function (p = 0.016; WMD = 2.73 [95% CI, 0.51 to 4.94]; I(2) > 50%) but not superior pain improvement (p = 0.199; WMD = -0.55 [95% CI, -1.39 to 0.29]; I(2) > 50%) in the long term (up to 26 weeks). Subgroup analysis revealed that the acupuncture groups tended to have better outcomes compared with the controls. Significant publication bias was not detected (p > 0.05), but the heterogeneity of the studies was substantial. This meta-analysis demonstrates that acupuncture can improve short and long-term physical function, but it appears to provide only short-term pain relief in patients with chronic knee pain due to osteoarthritis. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated.

  16. Does the Q - H index show a stronger relationship than the H:Q ratio in regard to knee pain during daily activities in patients with knee osteoarthritis?

    PubMed

    Fujita, Remi; Matsui, Yasumoto; Harada, Atsushi; Takemura, Marie; Kondo, Izumi; Nemoto, Tetsuya; Sakai, Tadahiro; Hiraiwa, Hideki; Ota, Susumu

    2016-12-01

    [Purpose] The purpose of this study was to elucidate the relationship between knee muscle strength and knee pain in activities of daily living, based on consideration of the difference between extension and flexion strength (Q - H) and the hamstring:quadriceps (H:Q) ratio in patients with knee osteoarthritis. [Subjects and Methods] The participants were 78 females with knee osteoarthritis, and a total of 133 knees that had not been treated surgically were the targets of this research. The legs were divided according to dominance. Isometric knee extension and flexion muscle strength and knee pain during activities of daily living were measured. The H:Q ratio (flexion/extension muscle strength) and the difference between extension and flexion strength, (extension muscle strength/weight) minus (flexion muscle strength/weight), that is, Q - H, were calculated. The correlation between these indices and the knee pain score during activities of daily living was investigated. [Results] Greater knee pain during activities of daily living was related to lower knee extension muscle strength and Q - H in both the dominant and nondominant legs. Knee flexion muscle strength and the H:Q ratio were not significantly correlated with knee pain during any activities of daily living. [Conclusion] Knee extension muscle strength and Q - H were found to be significantly correlated with knee pain during activities of daily living, whereas the H:Q ratio was not.

  17. Prevalence of neuropathic pain in knee or hip osteoarthritis: A systematic review and meta-analysis.

    PubMed

    French, Helen P; Smart, Keith M; Doyle, Frank

    2017-08-01

    Discordance between radiographic and pain severity in osteoarthritis (OA) has led researchers to investigate other pain mechanisms, including neuropathic pain. Accurate identification of any neuropathic pain in hip or knee OA is important for appropriate management, but neuropathic pain prevalence is unknown. We aimed to obtain an overall prevalence estimate by systematically reviewing and meta-analysing the prevalence of neuropathic pain in people with hip or knee OA. Observational studies which measured neuropathic pain in people aged 18 years and older with hip or knee OA were considered for inclusion. Electronic databases were searched up to February 2016. Two reviewers independently identified eligible studies and assessed methodological quality. Prevalence estimates and 95% confidence intervals were calculated using random effects meta-analytic techniques. Nine studies met the inclusion criteria. Study samples were from general population, hospital and community settings and all used self-report questionnaires to determine neuropathic pain. The overall prevalence estimate was 23% (95% CI: 10-39%), with considerable heterogeneity (I(2) = 97.9%, p < 0.001). This estimate was largely unchanged with subgroup analyses based on index joint, questionnaire type, setting and consideration of other potential causes of neuropathic pain. However, the estimate for two studies that excluded other potential causes of neuropathic pain was substantially higher (32%, 95% CI: 29-35%). Neuropathic pain prevalence in people with knee or hip OA is considerable at 23%, and may be higher after other potential causes of neuropathic pain are excluded. Concerns regarding the validity of neuropathic pain questionnaires, selection bias, methodological quality and study heterogeneity suggest caution with interpretation of these findings. Prevalence studies using standardised criteria for neuropathic pain are required. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. 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

  19. 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

  20. Potential role of age, sex, body mass index and pain to identify patients with knee osteoarthritis.

    PubMed

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

    2017-02-01

    To evaluate the potential role of age, sex, body mass index (BMI), radiographic features and pain in knee osteoarthritis (OA) case ascertainment. A cross-sectional study was performed using information from the EPIPorto cohort; social, demographic, behavioral and clinical data was obtained. 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). Knee radiographs were classified using the Kellgren-Lawrence scale (0-4). Path analysis was used to assess the plausibility of the causal assumptions and a classification tree to identify characteristics that could improve the identification of patients with radiographic OA. Higher age and higher BMI were associated with higher radiographic score, but sex had no statistical association. Females, higher age, higher BMI and higher radiographic score were statistically associated with higher pain scores. For both genders, the classification tree estimated age as the first variable to identify individuals with knee radiographic features. In females older than 56 years, pain frequency score is the second discriminator characteristic, followed by age (> 65 years) and (BMI > 30 kg/m(2) ). Higher pain frequency and BMI > 29 kg/m(2) were relevant for identifying OA in men with ages between 43.5 and 55.5 years. Age, BMI and pain frequency are independently associated with radiographic OA and the use of information on these characteristics can improve the identification of patients with knee OA. Beyond age, pain complaints are particularly relevant but the level of pain is different by sex. © 2015 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.

  1. Influence of meteorological elements on balance control and pain in patients with symptomatic knee osteoarthritis

    NASA Astrophysics Data System (ADS)

    Peultier, Laetitia; Lion, Alexis; Chary-Valckenaere, Isabelle; Loeuille, Damien; Zhang, Zheng; Rat, Anne-Christine; Gueguen, René; Paysant, Jean; Perrin, Philippe P.

    2017-05-01

    This study aimed to determine if pain and balance control are related to meteorological modifications in patients with knee osteoarthritis (OA). One hundred and thirteen patients with knee OA (mean age = 65 ± 9 years old, 78 women) participated in this study. Static posturography was performed, sway area covered and sway path traveled by the center of foot pressure being recorded under six standing postural conditions that combine three visual situations (eyes open, eyes closed, vision altered) with two platform situations (firm and foam supports). Knee pain score was assessed using a visual analog scale. Balance control and pain measurements recorded in the morning were correlated with the meteorological data. Morning and daily values for temperature, precipitation, sunshine, height of rain in 1 h, wind speed, humidity, and atmospheric pressure were obtained from the nearest data collecting weather station. The relationship between postural control, pain, and weather variations were assessed for each patient on a given day with multiple linear regressions. A decrease of postural stability was observed when atmospheric pressure and maximum humidity decreased in the morning ( p < 0.05) and when atmospheric pressure decreased within a day ( p < 0.05). Patient's knee pain was more enhanced when it is warmer in the morning ( p < 0.05) and when it is wetter and warmer within a day ( p < 0.05). The relationship between weather, pain, and postural control can help patients and health professionals to better manage daily activities.

  2. [Effectiveness of acupuncture in the treatment of pain from osteoarthritis of the knee].

    PubMed

    Ferrández Infante, A; García Olmos, L; González Gamarra, A; Meis Meis, M J; Sánchez Rodríguez, B M

    2002-12-01

    To determine the effectiveness of acupuncture in controlling pain from arthritis of the knee. Systematic review. MedLine, the Cochrane Library. Of the 9 studies located, only 4 met the inclusion criteria. All were controlled, randomized clinical trials that studied the effect of acupuncture only in the knee joint. Primary outcome variables were intensity of pain, overall measure (general improvement, proportion of patients who recovered, subjective improvement in symptoms) and functional status. As secondary outcome measures we used objective physiological measures (range of knee movement, muscle strength, time needed to walk a certain distance, time needed to climb a certain number of stairs), general health status, and other information such as medication needed and side effects. There was moderately strong evidence that acupuncture was more effective in treating knee joint pain than no treatment. The difference can be explained by its marked placebo effect. There is currently insufficient evidence to recommend acupuncture as a treatment for pain from osteoarthritis of the knee. Additional, better designed studies are needed to determine the actual role of acupuncture in this disease.

  3. Reliability and responsiveness of measures of pain in people with osteoarthritis of the knee: a psychometric evaluation

    PubMed Central

    Turner, Katie V.; Moreton, Bryan M.; Walsh, David A.; Lincoln, Nadina B.

    2017-01-01

    Abstract Purpose: To examine the fit between data from the Short Form McGill Pain Questionnaire (SF-MPQ-2) and the Rasch model, and to explore the reliability and internal responsiveness of measures of pain in people with knee osteoarthritis. Methods: Participants with knee osteoarthritis completed the SF-MPQ-2, Intermittent and Constant Osteoarthritis Pain questionnaire (ICOAP) and painDETECT. Participants were sent the same questionnaires 3 and 6 months later. Results: Fit to the Rasch model was not achieved for the SF-MPQ-2 Total scale. The Continuous subscale yielded adequate fit statistics after splitting item 10 on uniform DIF for gender, and removing item 9. The Intermittent subscale fit the Rasch model after rescoring items. The Neuropathic subscale had relatively good fit to the model. Test–retest reliability was satisfactory for most scales using both original and Rasch scoring ranging from fair to substantial. Effect sizes ranged from 0.13 to 1.79 indicating good internal responsiveness for most scales. Conclusions: These findings support the use of ICOAP subscales as reliable and responsive measure of pain in people with knee osteoarthritis. The MPQ-SF-2 subscales found to be acceptable alternatives. Implications for RehabilitationThe McGill Pain Questionnaire short version 2 is not a unidimensional scale in people with knee osteoarthritis, whereas three of the subscales are unidimensional.The McGill Pain Questionnaire short version 2 Affective subscale does not have good measurement properties for people with knee osteoarthritis.The McGill Pain Questionnaire short version 2 and the Intermittent and Constant Osteoarthritis Pain scales can be used to assess change over time.The painDETECT performs better as a screening measure than as an outcome measure. PMID:27027698

  4. Association of radiographic osteoarthritis, pain on passive movement and knee range of motion: a cross-sectional study.

    PubMed

    Hilfiker, Roger; Jüni, Peter; Nüesch, Eveline; Dieppe, Paul A; Reichenbach, Stephan

    2015-04-01

    Knee pain is associated with radiographic knee osteoarthritis, but the relationships between physical examination, pain and radiographic features are unclear. To examine whether deficits in knee extension or flexion were associated with radiographic severity and pain during clinical examination in persons with knee pain or radiographic features of osteoarthritis. Cross-sectional data of the Somerset and Avon Survey of Health (SASH) cohort study. Participants with knee pain or radiographic features of osteoarthritis were included. We assessed the range of passive knee flexion and extension, pain on movement and Kellgren and Lawrence (K/L) grades. Odds ratios were calculated for the association between range of motion and pain as well as radiographic severity. Of 1117 participants with a clinical assessment, 805 participants and 1530 knees had complete data and were used for this analysis. Pain and radiographic changes were associated with limited range of motion. In knees with pain on passive movement, extension and flexion were reduced per one grade of K/L by -1.4° (95% CI -2.2 to -0.5) and -1.6° (95% CI -2.8 to -0.4), while in knees without pain the reduction was -0.3° (95% CI -0.6 to -0.1) (extension) and -1.1° (-1.8 to -0.3) (flexion). The interaction of pain with K/L was significant (p = 0.021) for extension but not for flexion (p = 0.333). Pain during passive movement, which may be an indicator of reversible soft-tissue changes, e.g., reversible through physical therapy, is independently associated with reduced flexion and extension of the knee. Copyright © 2014 Elsevier Ltd. All rights reserved.

  5. Exercise for knee osteoarthritis.

    PubMed

    Baker, K; McAlindon, T

    2000-09-01

    Adverse outcomes in knee osteoarthritis include pain, loss of function, and disability. These outcomes can have devastating effects on the quality of life of those suffering from the disease. Treatments have generally targeted pain, assuming that disability would improve as a direct result of improvements in pain. However, there is evidence to suggest that determinants of pain and disability differ. In general, treatments have been more successful at decreasing pain rather than disability. Many of the factors that lead to disability can be improved with exercise. Exercise, both aerobic and strength training, have been examined as treatments for knee osteoarthritis, with considerable variability in the results. The variability between studies may be due to differences in study design, exercise protocols, and participants in the studies. Although there is variability among studies, it is notable that a majority of the studies had a positive effect on pain and or disability. The mechanism of exercise remains unclear and merits future studies to better define a concise, clear exercise protocol that may have the potential for a public health intervention.

  6. The effects of high intensity laser therapy on pain and function in patients with knee osteoarthritis.

    PubMed

    Kim, Gook-Joo; Choi, Jioun; Lee, Sangyong; Jeon, Chunbae; Lee, Kwansub

    2016-11-01

    [Purpose] The purpose of this study was to examine the effects of high intensity laser therapy (HILT) on pain and function in patients with knee osteoarthritis. [Subjects and Methods] In this study, an experiment was conducted on 20 subjects who were divided into the control group (n=10), which would receive conservative physical therapy (CPT), and the experimental group (n=10), which would receive effects of high intensity laser therapy after conservative physical therapy. All patients received their respective therapies three times each week over a four-week period. In terms of the intensity of the high intensity laser therapy, it was applied to each patient in the tibia and femoral epicondyle for five minutes while the patient's knee joint was bent at around 30° and the separation distance between the handpiece and the skin was maintained at around 1 cm. The visual analogue scale was used to measure pain, and the Korean Western Ontario and McMaster Universities Osteoarthritis Index was used for functional evaluations. [Results] The comparison of differences in the measurements taken before and after the experiment within each group showed a statistically significant decline in both the VAS and the K-WOMAC. The comparison of the two groups showed that the high intensity laser therapy group had statistically significant lower scores in both the visual analogue scale and the Korean Western Ontario and McMaster Universities Osteoarthritis Index than the conservative physical therapy group. [Conclusion] High intensity laser therapy is considered an effective non-surgical intervention for reducing pain in patients with knee osteoarthritis and helping them to perform daily activities.

  7. The effects of high intensity laser therapy on pain and function in patients with knee osteoarthritis

    PubMed Central

    Kim, Gook-Joo; Choi, Jioun; Lee, Sangyong; Jeon, Chunbae; Lee, Kwansub

    2016-01-01

    [Purpose] The purpose of this study was to examine the effects of high intensity laser therapy (HILT) on pain and function in patients with knee osteoarthritis. [Subjects and Methods] In this study, an experiment was conducted on 20 subjects who were divided into the control group (n=10), which would receive conservative physical therapy (CPT), and the experimental group (n=10), which would receive effects of high intensity laser therapy after conservative physical therapy. All patients received their respective therapies three times each week over a four-week period. In terms of the intensity of the high intensity laser therapy, it was applied to each patient in the tibia and femoral epicondyle for five minutes while the patient’s knee joint was bent at around 30° and the separation distance between the handpiece and the skin was maintained at around 1 cm. The visual analogue scale was used to measure pain, and the Korean Western Ontario and McMaster Universities Osteoarthritis Index was used for functional evaluations. [Results] The comparison of differences in the measurements taken before and after the experiment within each group showed a statistically significant decline in both the VAS and the K-WOMAC. The comparison of the two groups showed that the high intensity laser therapy group had statistically significant lower scores in both the visual analogue scale and the Korean Western Ontario and McMaster Universities Osteoarthritis Index than the conservative physical therapy group. [Conclusion] High intensity laser therapy is considered an effective non-surgical intervention for reducing pain in patients with knee osteoarthritis and helping them to perform daily activities. PMID:27942148

  8. Effect of music on anxiety and pain during joint lavage for knee osteoarthritis.

    PubMed

    Ottaviani, Sébastien; Bernard, Jean-Luc; Jean-Luc, Bernard; Bardin, Thomas; Thomas, Bardin; Richette, Pascal; Pascal, Richette

    2012-03-01

    Joint lavage for knee osteoarthritis is an invasive procedure that can be stressful and painful. We aimed to assess the impact of music therapy on perioperative anxiety, pain and tolerability of the procedure in patients undergoing joint lavage performed with two needles. We randomized all patients diagnosed with knee osteoarthritis and undergoing joint lavage in our department from November 2009 to October 2010 to an experimental group listening to recorded music or a control group receiving no music intervention. Perioperative anxiety and pain related to the procedure were self-reported on a visual analogic scale (0-100 mm visual analog scale [VAS]), and heart rate and blood pressure were measured during the procedure. Tolerability was assessed on a four-grade scale directly after the procedure. We included 62 patients (31 in each group). Mean age was 68.8 ± 12.6 years (72% females). As compared with the control group, the music group had lower levels of perioperative anxiety (40.3 ± 31.1 vs. 58.2 ± 26.3 mm; p = 0.046) and pain related to the procedure (26.6 ± 16.2 vs. 51.2 ± 23.7 mm; p = 0.0005). Moreover, heart rate was lower in the music group (69.5 ± 11.4 vs. 77.2 ± 13.2; p = 0.043) but not diastolic or systolic blood pressure. Tolerability was higher in the music group (p = 0.002). Music is a simple and effective tool to alleviate pain and anxiety in patients undergoing joint lavage for knee osteoarthritis.

  9. A preliminary fMRI study of analgesic treatment in chronic back pain and knee osteoarthritis

    PubMed Central

    Baliki, Marwan N; Geha, Paul Y; Jabakhanji, Rami; Harden, Norm; Schnitzer, Thomas J; Apkarian, A Vania

    2008-01-01

    The effects of an analgesic treatment (lidocaine patches) on brain activity in chronic low back pain (CBP) and in knee osteoarthritis (OA) were investigated using serial fMRI (contrasting fMRI between before and after two weeks of treatment). Prior to treatment brain activity was distinct between the two groups: CBP spontaneous pain was associated mainly with activity in medial prefrontal cortex, while OA painful mechanical knee stimulation was associated with bilateral activity in the thalamus, secondary somatosensory, insular, and cingulate cortices, and unilateral activity in the putamen and amygdala. After 5% lidocaine patches were applied to the painful body part for two weeks, CBP patients exhibited a significant decrease in clinical pain measures, while in OA clinical questionnaire based outcomes showed no treatment effect but stimulus evoked pain showed a borderline decrease. The lidocaine treatment resulted in significantly decreased brain activity in both patient groups with distinct brain regions responding in each group, and sub-regions within these areas were correlated with pain ratings specifically for each group (medial prefrontal cortex in CBP and thalamus in OA). We conclude that the two chronic pain conditions involve distinct brain regions, with OA pain engaging many brain regions commonly observed in acute pain. Moreover, lidocaine patch treatment modulates distinct brain circuitry in each condition, yet in OA we observe divergent results with fMRI and with questionnaire based instruments. PMID:18950528

  10. A preliminary fMRI study of analgesic treatment in chronic back pain and knee osteoarthritis.

    PubMed

    Baliki, Marwan N; Geha, Paul Y; Jabakhanji, Rami; Harden, Norm; Schnitzer, Thomas J; Apkarian, A Vania

    2008-10-25

    The effects of an analgesic treatment (lidocaine patches) on brain activity in chronic low back pain (CBP) and in knee osteoarthritis (OA) were investigated using serial fMRI (contrasting fMRI between before and after two weeks of treatment). Prior to treatment brain activity was distinct between the two groups: CBP spontaneous pain was associated mainly with activity in medial prefrontal cortex, while OA painful mechanical knee stimulation was associated with bilateral activity in the thalamus, secondary somatosensory, insular, and cingulate cortices, and unilateral activity in the putamen and amygdala. After 5% lidocaine patches were applied to the painful body part for two weeks, CBP patients exhibited a significant decrease in clinical pain measures, while in OA clinical questionnaire based outcomes showed no treatment effect but stimulus evoked pain showed a borderline decrease. The lidocaine treatment resulted in significantly decreased brain activity in both patient groups with distinct brain regions responding in each group, and sub-regions within these areas were correlated with pain ratings specifically for each group (medial prefrontal cortex in CBP and thalamus in OA). We conclude that the two chronic pain conditions involve distinct brain regions, with OA pain engaging many brain regions commonly observed in acute pain. Moreover, lidocaine patch treatment modulates distinct brain circuitry in each condition, yet in OA we observe divergent results with fMRI and with questionnaire based instruments.

  11. Effectiveness of High Intensity Laser Therapy for Reduction of Pain in Knee Osteoarthritis

    PubMed Central

    2016-01-01

    Introduction. Osteoarthritis is the most common type of arthritis. It is the main cause of chronic musculoskeletal pain and disability among the elderly population. Aim. This is a pilot, randomized clinical study about the effect of high intensity laser therapy in patients with osteoarthritis of the knee (OA of the knee). Material and Method. 72 patients (aged between 39 and 83 years) with (clinically and radiographically proved) OA of the knee were included in the study. They were randomized in two groups: therapeutic (test) one (n = 37, 65,11 ± 1,40 (mean ± SD) years old; patients were treated with HILT) and control group (n = 35, 64,71 ± 1,98; patients receive sham laser). Both groups had seven sessions of treatment. VAS and dolorimetry were used for assessment of pain before and after the therapy. Pedobarometric analysis (static and dynamic) was used to assess comparatively the contact surface area and maximum pressure under the heel. Results. Pain levels measured by VAS and dolorimetry decreased significantly in the therapeutic group after seven days of treatment (p< 0,001). Conclusion. The results after seven days of treatment show more intensive and cumulative effect after the application of high intensity laser therapy in comparison to sham laser. This is the reason why HILT can be a method of choice in the treatment of gonarthrosis. PMID:28096711

  12. A functional difficulty and functional pain instrument for hip and knee osteoarthritis

    PubMed Central

    Jette, Alan M; McDonough, Christine M; Ni, Pengsheng; Haley, Stephen M; Hambleton, Ronald K; Olarsch, Sippy; Hunter, David J; Kim, Young-jo; Felson, David T

    2009-01-01

    Introduction The objectives of this study were to develop a functional outcome instrument for hip and knee osteoarthritis research (OA-FUNCTION-CAT) using item response theory (IRT) and computer adaptive test (CAT) methods and to assess its psychometric performance compared to the current standard in the field. Methods We conducted an extensive literature review, focus groups, and cognitive testing to guide the construction of an item bank consisting of 125 functional activities commonly affected by hip and knee osteoarthritis. We recruited a convenience sample of 328 adults with confirmed hip and/or knee osteoarthritis. Subjects reported their degree of functional difficulty and functional pain in performing each activity in the item bank and completed the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Confirmatory factor analyses were conducted to assess scale uni-dimensionality, and IRT methods were used to calibrate the items and examine the fit of the data. We assessed the performance of OA-FUNCTION-CATs of different lengths relative to the full item bank and WOMAC using CAT simulation analyses. Results Confirmatory factor analyses revealed distinct functional difficulty and functional pain domains. Descriptive statistics for scores from 5-, 10-, and 15-item CATs were similar to those for the full item bank. The 10-item OA-FUNCTION-CAT scales demonstrated a high degree of accuracy compared with the item bank (r = 0.96 and 0.89, respectively). Compared to the WOMAC, both scales covered a broader score range and demonstrated a higher degree of precision at the ceiling and reliability across the range of scores. Conclusions The OA-FUNCTION-CAT provided superior reliability throughout the score range and improved breadth and precision at the ceiling compared with the WOMAC. Further research is needed to assess whether these improvements carry over into superior ability to measure change. PMID:19589168

  13. 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.

  14. Effect of adductor canal block on medial compartment knee pain in patients with knee osteoarthritis: Retrospective comparative study.

    PubMed

    Lee, Doo-Hyung; Lee, Michael Y; Kwack, Kyu-Sung; Yoon, Seung-Hyun

    2017-03-01

    Knee osteoarthritis (KOA) is a common disease in middle-aged and elderly people. Pain is the chief complaint of symptomatic KOA and a leading cause of chronic disability, which is most often found in medial knees. The aim of this study is to evaluate the efficacy of pain relief and functional improvement in KOA patients treated with ultrasound-guided adductor canal block (ACB).This is a 3-month retrospective case-controlled comparative study. Two hundred patients with anteromedial knee pain owing to KOA that was unresponsive to 3-month long conservative treatments. Ninety-two patients received ACB with 9 mL of 1% of lidocaine and 1 mL of 10 mg triamcinolone acetonide (ACB group), and 108 continued conservative treatments (control group). The main outcome measure was visual analog scale (VAS) of the average knee pain level for the past one week. Secondary outcomes were the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the timed up and go test, numbers of analgesic ingestion per day, and opioid consumption per day.During the 3-month follow-up, 86 patients in ACB group and 92 in control group were analyzed. There was no significant difference, with the exception of the duration of symptoms, between the 2 groups in age, sex, body mass index, and Kellgren-Lawrence grade. Repeated-measures analysis of variance and post hoc tests showed improvement of VAS (at month 1), WOMAC (at month 1), and opioid consumption per day (at month 1 and 2) in ACB group. No adverse events were reported.To our knowledge, this is the first study to assess the efficacy of ACB for patients with KOA. ACB is an effective and safe treatment and can be an option for patients who are either unresponsive or unable to take analgesics.

  15. Managing Knee Osteoarthritis: The Effects of Body Weight Supported Physical Activity on Joint Pain, Function, and Thigh Muscle Strength.

    PubMed

    Peeler, Jason; Christian, Mathew; Cooper, Juliette; Leiter, Jeffrey; MacDonald, Peter

    2015-11-01

    To determine the effect of a 12-week lower body positive pressure (LBPP)-supported low-load treadmill walking program on knee joint pain, function, and thigh muscle strength in overweight patients with knee osteoarthritis (OA). Prospective, observational, repeated measures investigation. Community-based, multidisciplinary sports medicine clinic. Thirty-one patients aged between 55 and 75 years, with a body mass index ≥25 kg/m and mild-to-moderate knee OA. Twelve-week LBPP-supported low-load treadmill walking regimen. Acute knee joint pain (visual analog scale) during full weight bearing treadmill walking, chronic knee pain, and joint function [Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire] during normal activities of daily living, and thigh muscle strength (isokinetic testing). Appropriate methods of statistical analysis were used to compare data from baseline and follow-up evaluation. Participants reported significant improvements in knee joint pain and function and demonstrated significant increases in thigh muscle strength about the degenerative knee. Participants also experienced significant reductions in acute knee pain during full weight bearing treadmill walking and required dramatically less LBPP support to walk pain free on the treadmill. Data suggest that an LBPP-supported low-load exercise regimen can be used to significantly diminish knee pain, enhance joint function, and increase thigh muscle strength, while safely promoting pain-free walking exercise in overweight patients with knee OA. These findings have important implications for the development of nonoperative treatment strategies that can be used in the management of joint symptoms associated with progressive knee OA in at-risk patient populations. This research suggests that LBPP-supported low-load walking is a safe user-friendly mode of exercise that can be successfully used in the management of day-to-day joint symptoms associated with knee OA, helping to improve the

  16. Treatment of knee osteoarthritis.

    PubMed

    Ringdahl, Erika; Pandit, Sandesh

    2011-06-01

    Knee osteoarthritis is a common disabling condition that affects more than one-third of persons older than 65 years. Exercise, weight loss, physical therapy, intra-articular corticosteroid injections, and the use of nonsteroidal anti-inflammatory drugs and braces or heel wedges decrease pain and improve function. Acetaminophen, glucosamine, ginger, S-adenosylmethionine (SAM-e), capsaicin cream, topical nonsteroidal anti-inflammatory drugs, acupuncture, and tai chi may offer some benefit. Tramadol has a poor trade-off between risks and benefits and is not routinely recommended. Opioids are being used more often in patients with moderate to severe pain or diminished quality of life, but patients receiving these drugs must be carefully selected and monitored because of the inherent adverse effects. Intra-articular corticosteroid injections are effective, but evidence for injection of hyaluronic acid is mixed. Arthroscopic surgery has been shown to have no benefit in knee osteoarthritis. Total joint arthroplasty of the knee should be considered when conservative symptomatic management is ineffective.

  17. Effectiveness of a cognitive-behavioral group intervention for knee osteoarthritis pain: protocol of a randomized controlled trial

    PubMed Central

    2013-01-01

    Background Knee osteoarthritis is the most common type of arthritis, with pain being its most common symptom. Little is known about the psychological aspects of knee osteoarthritis pain. There is an emerging consensus among osteoarthritis specialists about the importance of addressing not only biological but also psychosocial factors in the assessment and treatment of osteoarthritis. As few studies have evaluated the effect of psychological interventions on knee osteoarthritis pain, good quality randomized controlled trials are needed to determine their effectiveness. Methods/Design We intend to conduct a 6-week single-blinded randomized controlled trial with a 12-month follow-up. Altogether, 108 patients aged from 35 to 75 years with clinical symptoms and radiographic grading (KL 2–4) of knee osteoarthritis will be included. The clinical inclusion criteria are pain within the last year in or around the knee occurring on most days for at least one month, and knee pain of ≥40 mm on a 100-mm visual analogue scale in the WOMAC pain subscale for one week prior to study entry. Patients with any severe psychiatric disorder, other back or lower limb pain symptoms more aggravating than knee pain, or previous or planned lower extremity joint surgery will be excluded. The patients will be randomly assigned to a combined GP care and cognitive-behavioral intervention group (n = 54) or to a GP care control group (n = 54). The cognitive-behavioral intervention will consist of 6 weekly group sessions supervised by a psychologist and a physiotherapist experienced in the treatment of pain. The main goals of the intervention are to reduce maladaptive pain coping and to increase the self-management of pain and disability. The follow-up-points will be arranged at 3 and 12 months. The primary outcome measure will be the WOMAC pain subscale. Secondary outcome measures will include self-reports of pain and physical function, a health related quality of life questionnaire, and various

  18. Traditional Chinese Medications for Knee Osteoarthritis Pain: A Meta-Analysis of Randomized Controlled Trials.

    PubMed

    Chen, Bo; Zhan, Hongsheng; Marszalek, Jolanta; Chung, Mei; Lin, Xun; Zhang, Min; Pang, Jian; Wang, Chenchen

    2016-01-01

    Traditional Chinese medication (TCM) has analgesic and anti-inflammatory effects in patients with knee osteoarthritis (OA). We conducted the first systematic review of the best quantitative and qualitative evidence currently available in order to evaluate the effectiveness of TCM in relieving pain in knee OA. A comprehensive literature search was conducted using three English and four Chinese biomedical databases from their inception through March 1, 2015. We included randomized controlled trials of TCM for knee OA with intervention durations of at least two weeks. The effects of TCM on pain and other clinical symptoms were measured with the visual analog scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The total effectiveness rate, which was used to assess overall pain, physical performance and wellness, was also measured. Two researchers independently extracted data on study design, population characteristics, duration, intervention, outcomes, risk of bias, and primary results. We performed a random-effects meta-analysis when appropriate. We also explored factors that could explain the heterogeneity by conducting subgroup and meta-regression analyses. Twenty-three studies, totaling 2362 subjects, met the eligibility criteria. Treatments were formulated with an average of 8 Chinese herbs and were prescribed based on the traditional Chinese diagnostic method of syndrome differentiation. The mean treatment duration was seven weeks, with oral administration occurring one to three times a day. Compared with non-steroidal anti-inflammatory drugs and intra-articular hyaluronate injections, 18 of the studies showed significantly improved VAS pain scores (Mean Difference [MD] [Formula: see text] 0.56; 95% confidence interval [CI], 0.18 to 0.94; [Formula: see text]), six of the studies showed significantly improved WOMAC pain subscale scores (MD [Formula: see text] 2.23; 95% CI, 0.56 to 3.91; [Formula: see text]), and 16 of the trials

  19. Bone Marrow Lesions and Joint Effusion are Strongly and Independently Associated with Weight-Bearing Pain in Knee Osteoarthritis: Data from the Osteoarthritis Initiative

    PubMed Central

    Lo, GH; McAlindon, TE; Niu, J; Zhang, Y; Beals, C; Dabrowski, C; Hellio Le Graverand, MP; Hunter, DJ

    2009-01-01

    Objective It is widely believed that there are multiple sources of pain at a tissue level in osteoarthritis (OA). MRIs provide a wealth of anatomic information and may allow identification of specific features associated with pain. We hypothesized that in knees with OA, bone marrow lesions (BMLs), synovitis, and effusion would be associated with weight-bearing and (less so with) non-weight-bearing pain independently. Methods In a cross-sectional study of persons with symptomatic knee OA using univariate and multivariate logistic regressions with maximal BML, effusion, and synovitis defined by Boston Leeds Osteoarthritis Knee Score as predictors, and knee pain using weight-bearing and non-weight-bearing Western Ontario and McMaster University OA Index pain questions as the outcome, we tested the association between MRI findings and knee symptoms Results 160 participants, mean age 61 (±9.9), mean BMI 30.3 (±4.7) and 50% female, stronger associations were seen with weight-bearing compared with non-weight-bearing knee pain with adjusted risk ratios (RRs) of weight-bearing knee pain, for increasing maximal BML scores of 1.0 (referent) (maximal BML = 0), 1.2, 1.9, and 2.0 (p for trend = 0.006). For effusion scores, adjusted ORs of knee pain were 1.0, 1.7, 2.0, and 2.6 (p for trend = 0.0004); and for synovitis scores, adjusted ORs were 1.0, 1.4, 1.5, and 1.9 (p for trend = 0.22). Conclusion Cross-sectionally, maximal BML and effusion scores are independently associated with weight-bearing and less so with non-weight-bearing knee pain, supporting the idea that pain in OA is multifactorial. These MRI features should be considered as possible new treatment targets in knee OA. PMID:19583959

  20. Knee Pain and a Prior Injury Are Associated With Increased Risk of a New Knee Injury: Data from the Osteoarthritis Initiative

    PubMed Central

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

    2015-01-01

    Objectives We explored if knee pain or a history of knee injury was associated with a knee injury in the following 12 months. Methods We conducted longitudinal knee-based analyses among knees in the Osteoarthritis Initiative. We included both knees of all participants who had at least one follow-up visit with complete data. Our first sets of exposures were knee pain (chronic knee symptoms and severity) at baseline, 12-month, 24-month, and 36-month visits. Another exposure was a history of injury, which we defined as a self-reported injury at any time prior to baseline, 12-month, 24-month, or 36-month visits. The outcome was self-reported knee injury during the past year at 12-month, 24-month, 36-month, and 48-month visits. We evaluated the association between ipsilateral and contralateral knee pain or history of injury and a new knee injury within 12 months of the exposure using generalized linear mixed model for repeated binary outcomes. Results A knee with reported chronic knee symptoms or ipsilateral or contralateral history of an injury was more likely to experience a new knee injury in the following 12 months than a knee without chronic knee symptoms (odds ratio [OR]=1.84, 95% confidence interval [CI]=1.57, 2.16) or prior injury (prior ipsilateral knee injury OR=1.81, 95% CI=1.56, 2.09; prior contralateral knee injury OR=1.43, 95% CI=1.23, 1.66). Conclusion Knee pain and a history of injury are associated with new knee injuries. It may be beneficial for individuals with knee pain or a history of injury to participate in injury prevention programs. PMID:26034152

  1. The effect of vitamin D status on pain, lower limb strength and knee function during balance recovery in people with knee osteoarthritis: an exploratory study.

    PubMed

    Levinger, Pazit; Begg, Rezaul; Sanders, Kerrie M; Nagano, Hanatsu; Downie, Calum; Petersen, Aaron; Hayes, Alan; Cicuttini, Flavia

    2017-09-23

    The association between vitamin D and muscle function associated with balance recovery and falls in people with knee osteoarthritis is unclear. Those with vitamin D insufficiency demonstrated poorer knee function during balance recovery, greater pain and locomotor dysfunction. Vitamin D insufficiency may have an adverse effect on muscle power function. Low vitamin D status in people with knee osteoarthritis (OA) is often reported to be associated with increased pain and locomotor dysfunction. However, despite the growing evidence of the effect of vitamin D on the pathogenesis of knee OA, its role remains conflicting. Importantly, muscle function is important for knee joint health; however, the association between vitamin D levels and muscle function associated with balance recovery and falls is unclear. This study investigated the effect of circulating 25-hydroxyvitamin D (25 (OH) D) on pain, quadriceps strength, lower limb muscle mass and knee power function during balance recovery in people with knee OA. Twenty-four participants with clinical symptoms of knee OA (68.6 ± 6.2 years) participated in the study. Serum levels of 25 (OH) D were assessed and participants were classified as follows: vitamin D insufficiency ≤ 50 nmol/L and vitamin D sufficiency > 50 nmol/L. The groups were compared on knee function during balance recovery tasks, lower limb strength and muscle mass as well as perceived pain and function. Seven patients (29.1%) were classified as vitamin D-insufficient. Vitamin D insufficiency was associated with reduced knee muscle function during the balance recovery task, increased pain (Western Ontario and McMasters University Osteoarthritis Index (WOMAC) subscore), dysfunction (WOMAC subscore) and total WOMAC score (p < 0.05). People with knee OA with vitamin D insufficiency demonstrated poorer knee function during balance recovery, greater pain and locomotor dysfunction. Vitamin D insufficiency may have an adverse effect on muscle power

  2. Unique aspects of pain reduction in osteoarthritis of the knee with LMWF-5A.

    PubMed

    McGrath, Brian

    2015-01-01

    Osteoarthritis of the knee (OAK) is a common form of arthritis that can lead to substantial pain and disability. This commentary highlights key aspects of the recently published phase 3 A Efficacy and Safety Study of Two Doses of Intra-Articular Injection of Ampion™ in Adults With Pain Due to Osteoarthritis of the Knee (SPRING) study. SPRING (NCT01839331) was a multicenter, randomized, vehicle-controlled, double-blind trial that evaluated the safety and efficacy of the low-molecular-weight fraction of 5% human serum albumin (LMWF-5A) for treatment of pain, measured by the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) pain scale, in patients with symptomatic OAK (N=329). Patients in this study reflected many characteristics of "real-world" individuals with OAK, with a broad range of disease severity and disability. The most important finding from this study was that treatment with a single intra-articular injection of LMWF-5A led to significant pain reduction in the patients with objective radiographic evidence of severe disease and joint deterioration (Kellgren-Lawrence grade 3; P=0.04 and Kellgren-Lawrence grade 4; P=0.02). The magnitude of pain reduction in the entire cohort treated with LMWF-5A was 42% from baseline and the treatment effect compared with vehicle control (estimated difference in WOMAC pain, -0.25; P=0.004) was also notable, especially relative to a previously reported study of hyaluronic acid, in which only a marginally significant treatment effect was observed (mean difference in WOMAC pain compared with control, -0.15; P=0.047). Significant improvement in physical function observed with LMWF-5A (P=0.04) was also noted and suggests that LMWF-5A may provide therapeutic benefit for those who are limited in the activities of daily living. Intra-articular injection of LMWF-5A was well tolerated, and the adverse event profile was similar to that of control. These results demonstrate significant benefit of LMWF-5A for patients

  3. Impact of exercise on the functional capacity and pain of patients with knee osteoarthritis: a randomized clinical trial.

    PubMed

    Oliveira, Aline Mizusaki Imoto de; Peccin, Maria Stella; Silva, Kelson Nonato Gomes da; Teixeira, Lucas Emmanuel Pedro de Paiva; Trevisani, Virgínia Fernandes Moça

    2012-12-01

    Muscle weakness, especially of the quadriceps muscle, is one of the major musculoskeletal effects of knee osteoarthritis. Exercises are considered one of the main interventions in the conservative treatment of those patients. To assess the effectiveness of quadriceps strengthening exercises on functional capacity and symptoms related of knee osteoarthritis by use of the Timed Up and Go test (TUG), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Lequesne Index. One hundred patients were randomized into two groups: 1) Exercise Group (n = 50), which included stationary bicycle, hamstrings stretching, and quadriceps strengthening; 2) Instruction Group (n = 50), which received a manual with information about knee osteoarthritis and instructions on how to deal with knee symptoms in daily activities. The manual did not include exercise instructions. The Exercise Group showed statistically significant improvement regarding the TUG test, the WOMAC aspects of pain, function, and stiffness, and the Lequesne Index, as compared with the Instruction Group. Quadriceps strengthening exercises for eight weeks are effective to improve pain, function, and stiffness in patients with knee osteoarthritis.

  4. Validity of summing painful joint sites to assess joint-pain comorbidity in hip or knee osteoarthritis.

    PubMed

    Siemons, Liseth; ten Klooster, Peter M; van de Laar, Mart A F J; van den Ende, Cornelia H M; Hoogeboom, Thomas J

    2013-08-09

    Previous studies in patients with hip and knee osteoarthritis (OA) have advocated the relevance of assessing the number of painful joint sites, other than the primary affected joint, in both research and clinical practice. However, it is unclear whether joint-pain comorbidities can simply be summed up. A total of 401 patients with hip or knee OA completed questionnaires on demographic variables and joint-pain comorbidities. Rasch analysis was performed to evaluate whether a sum score of joint-pain comorbidities can be calculated. Self-reported joint-pain comorbidities showed a good fit to the Rasch model and were not biased by gender, age, disease duration, BMI, or patient group. As a group, joint-pain comorbidities covered a reasonable range of severity levels, although the sum score had rather low reliability levels suggesting it cannot discriminate well among patients. Joint-pain comorbidities, in other than the primary affected joints, can be summed into a joint pain comorbidity score. Nevertheless, its use is discouraged for individual decision making purposes since its lacks discriminative power in patients with minimal or extreme joint pain.

  5. A randomised trial of a brace for patellofemoral osteoarthritis targeting knee pain and bone marrow lesions.

    PubMed

    Callaghan, Michael J; Parkes, Matthew J; Hutchinson, Charles E; Gait, Andrew D; Forsythe, Laura M; Marjanovic, Elizabeth J; Lunt, Mark; Felson, David T

    2015-06-01

    Braces used to treat (PF) osteoarthritis (OA) may reduce contact stress across the PF joint. We hypothesised that in PF OA, braces would decrease knee pain and shrink PF bone marrow lesions (BMLs). Eligible subjects had painful PF OA. Subjects were randomly allocated to brace or no brace for 6 weeks. Knee MRIs were acquired at baseline and 6 weeks. We measured BMLs on post-contrast fat suppressed sagittal and proton density weighted axial images. The primary symptom outcome was change in pain at 6 weeks during a preselected painful activity, and the primary structural outcome was BML volume change in the PF joint. Analyses used multiple linear regression. We randomised 126 subjects aged 40-70 years (mean age 55.5  years; 72 females (57.1%)). Mean nominated visual analogue scale (0-10 cm) pain score at baseline was 6.5 cm. 94 knees (75%) had PF BMLs at baseline. Subjects wore the brace for a mean of 7.4 h/day. 6 subjects withdrew during the trial. After accounting for baseline values, the brace group had lower knee pain than the control group at 6 weeks (difference between groups -1.3 cm, 95% CI -2.0 to -0.7; p<0.001) and reduced PF BML volume (difference -490.6 mm(3), 95% CI -929.5 to -51.7; p=0.03) but not tibiofemoral volume (difference -53.9 mm(3), 95% CI -625.9 to 518.2; p=0.85). A PF brace reduces BML volume in the targeted compartment of the knee, and relieves knee pain. UK. ISRCTN50380458. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  6. The influence of weather on the risk of pain exacerbation in patients with knee osteoarthritis - a case-crossover study.

    PubMed

    Ferreira, M L; Zhang, Y; Metcalf, B; Makovey, J; Bennell, K L; March, L; Hunter, D J

    2016-12-01

    To quantify the risk of knee pain exacerbation associated with temperature, relative humidity, air pressure and precipitation in persons with knee osteoarthritis. A web-based case-crossover study was conducted. Participants with a diagnosis of symptomatic, radiographic knee osteoarthritis were measured at baseline and followed for 3 months. Participants were instructed to log on to the study website if they perceived experiencing knee pain exacerbation (hazard period). Pain exacerbation was defined as an increase of ≥2 on a 0-10 numeric rating scale (NRS) from the participant's mildest pain reported at baseline. A time-stratified case-crossover study was conducted to anchor the corresponding hazard date to four control periods within a particular 35-day interval. Data on maximum and minimum temperature (°C), relative humidity (%), barometric pressure (hPa) and precipitation (mm) were obtained for the hazard and control periods from the publicly available meteorological database of the Australian Bureau of Meteorology. The associations were assessed using conditional logistic regression. Of the 345 participants recruited, 171 participants (women: 64%, mean age: 62 years, mean BMI: 30.2 kg/m(2)) experienced at least one episode of pain exacerbation, yielding 1,425 observations included in the analyses. There was no apparent association between temperature, relative humidity, air pressure or precipitation and risk of knee pain exacerbation. Despite anecdotal reports from patients, change in weather factors does not appear to influence the risk of pain exacerbation in persons with knee osteoarthritis. Additional studies should quantify the association of weather and risk of pain exacerbation in regions with more extreme weather conditions. Copyright © 2016 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  7. Comparative Effectiveness of B and E Vitamins with Diclofenac in Reducing Pain Due to Osteoarthritis of the Knee

    PubMed Central

    Dehghan, Morteza

    2015-01-01

    Background: Knee osteoarthritis is one of the most prevalent chronic disorders. Several pharmacological and non pharmacological approaches are used to treat this disease. Today, the effect of B and E vitamins on rheumatology diseases is being discussed. In this study, the efficacy of B and E vitamins accompanied with diclofenac on pain relief in patients with knee osteoarthritis was investigated and compared. Methods: In this double-blinded clinical trial, 120 patients with knee osteoarthritis referring training Rheumatology and Orthopedics Clinic of Shahrekord University of Medical sciences were investigated. Of these patients, 12 were excluded throughout the study. The patients underwent treatment in three groups (oral diclofenac + oral B vitamin, oral diclofenac + oral vitamin E, and oral diclofenac + placebo). Pain relief was assessed by visual analogue scale (VAS) questionnaire and morning stiffness and physical function were assessed by WOMAC standard questionnaire at three times; the first examination, two weeks, and three weeks after referring. Results: The mean score of WOMAC questionnaire at VASs of knee pain, total pain severity, knee joint stiffness, and function of the last 48 hours decreased significantly in all three groups (diclofenac, E and B vitamins) from the first to third examination (P<0.001). Decrease in VAS of knee pain and function of the last 48 hours was higher in B vitamin group than the diclofenac and E vitamin group (P=0.008) and decrease in total pain severity was reported higher in B vitamin group than E vitamin and diclofenac group (P=0.019). Decrease in knee joint stiffness underwent a similar trend in the three groups. Conclusion: In view similar analgesic and anti-inflammatory properties, as well as very few, non prevalent complications of B and E vitamins, use of two or more drugs with a different mechanism of effect seems necessary to enhance their effect on osteoarthritis treatment. PMID:26005259

  8. Physical Therapist-Delivered Pain Coping Skills Training and Exercise for Knee Osteoarthritis: Randomized Controlled Trial.

    PubMed

    Bennell, Kim L; Ahamed, Yasmin; Jull, Gwendolen; Bryant, Christina; Hunt, Michael A; Forbes, Andrew B; Kasza, Jessica; Akram, Muhammed; Metcalf, Ben; Harris, Anthony; Egerton, Thorlene; Kenardy, Justin A; Nicholas, Michael K; Keefe, Francis J

    2016-05-01

    To investigate whether a 12-week physical therapist-delivered combined pain coping skills training (PCST) and exercise (PCST/exercise) is more efficacious and cost effective than either treatment alone for knee osteoarthritis (OA). This was an assessor-blinded, 3-arm randomized controlled trial in 222 people (73 PCST/exercise, 75 exercise, and 74 PCST) ages ≥50 years with knee OA. All participants received 10 treatments over 12 weeks plus a home program. PCST covered pain education and training in cognitive and behavioral pain coping skills, exercise comprised strengthening exercises, and PCST/exercise integrated both. Primary outcomes were self-reported average knee pain (visual analog scale, range 0-100 mm) and physical function (Western Ontario and McMaster Universities Osteoarthritis Index, range 0-68) at week 12. Secondary outcomes included other pain measures, global change, physical performance, psychological health, physical activity, quality of life, and cost effectiveness. Analyses were by intent-to-treat methodology with multiple imputation for missing data. A total of 201 participants (91%), 181 participants (82%), and 186 participants (84%) completed week 12, 32, and 52 measurements, respectively. At week 12, there were no significant between-group differences for reductions in pain comparing PCST/exercise versus exercise (mean difference 5.8 mm [95% confidence interval (95% CI) -1.4, 13.0]) and PCST/exercise versus PCST (6.7 mm [95% CI -0.6, 14.1]). Significantly greater improvements in function were found for PCST/exercise versus exercise (3.7 units [95% CI 0.4, 7.0]) and PCST/exercise versus PCST (7.9 units [95% CI 4.7, 11.2]). These differences persisted at weeks 32 (both) and 52 (PCST). Benefits favoring PCST/exercise were seen on several secondary outcomes. Cost effectiveness of PCST/exercise was not demonstrated. This model of care could improve access to psychological treatment and augment patient outcomes from exercise in knee OA, although

  9. Effect of pain reduction on postural sway, proprioception, and quadriceps strength in subjects with knee osteoarthritis

    PubMed Central

    Hassan, B; Doherty, S; Mockett, S; Doherty, M

    2002-01-01

    Objective: To investigate whether alleviation of knee pain influences quadriceps function, proprioceptive acuity, and postural stability in patients with knee osteoarthritis (OA). Methods: A crossover, within-subject, double blind study design involving 68 subjects with painful knee OA. Each subject received an intra-articular injection into one or both knees (both if symptomatic) of either 5 ml 0.5% bupivacaine or 5 ml 0.9% saline. Two weeks later they received an injection of the alternative agent. Subjects and observer were unaware of the order of injection, which was randomly assigned. Knee pain (100 mm visual analogue scale), static postural sway, knee proprioceptive acuity, maximum voluntary contraction (MVC), and percentage activation of the quadriceps were assessed immediately before and one hour after each injection. Results: Significant pain reduction was achieved one hour post-bupivacaine (mean difference as a percentage change 56.85, 95% CI 31.01 to 73.65; p<0.001) and post-saline (mean difference as a percentage change 41.94, 95% CI 11.57 to 76.66; p< 0.001), with no significant difference between the two. Both MVC and activation increased significantly post-bupivacaine (mean percentage differences 18.83, 95% CI -31.79 to -0.26, and -11.90, 95% CI -39.53 to 2.97, respectively; both p<0.001) and post-saline (mean percentage differences -7.64, 95% CI -21.96 to 4.73, and -10.71, 95% CI -25.19 to 2.60 respectively; both p<0.001). Proprioception worsened after bupivacaine (mean percentage difference -28.15%, 95% CI -83.47 to 19.74; p=0.009), but there was no effect on postural sway; saline injection had no effects. There was no order effect, and comparison of median percentage changes showed no significant differences between injections for change in MVC, activation, proprioception, or sway. Conclusion: Reduction in knee pain through either peripheral (local anaesthetic) or central (placebo) mechanisms resulted in increased MVC. This increase, however, did

  10. Prognosis of Pain and Physical Functioning in Patients With Knee Osteoarthritis: A Systematic Review and Meta-Analysis.

    PubMed

    de Rooij, Mariëtte; van der Leeden, Marike; Heymans, Martijn W; Holla, Jasmijn F M; Häkkinen, Arja; Lems, Willem F; Roorda, Leo D; Veenhof, Cindy; Sanchez-Ramirez, Diana C; de Vet, Henrica C W; Dekker, Joost

    2016-04-01

    To systematically summarize the literature on the course of pain in patients with knee osteoarthritis (OA), prognostic factors that predict deterioration of pain, the course of physical functioning, and prognostic factors that predict deterioration of physical functioning in persons with knee OA. A search was conducted in PubMed, CINAHL, Embase, Psych-INFO, and SPORTDiscus up to January 2014. A meta-analysis and a qualitative data synthesis were performed. Of the 58 studies included, 39 were of high quality. High heterogeneity across studies (I(2)  >90%) and within study populations (reflected by large SDs of change scores) was found. Therefore, the course of pain and physical functioning was interpreted to be indistinct. We found strong evidence for a number of prognostic factors predicting deterioration in pain (e.g., higher knee pain at baseline, bilateral knee symptoms, and depressive symptoms). We also found strong evidence for a number of prognostic factors predicting deterioration in physical functioning (e.g., worsening in radiographic OA, worsening of knee pain, lower knee extension muscle strength, lower walking speed, and higher comorbidity count). Because of high heterogeneity across studies and within study populations, no conclusions can be drawn with regard to the course of pain and physical functioning. These findings support current research efforts to define subgroups or phenotypes within knee OA populations. Strong evidence was found for knee characteristics, clinical factors, and psychosocial factors as prognostics of deterioration of pain and physical functioning. © 2016, American College of Rheumatology.

  11. Sensitivity to Change of Patient‐Preference Measures for Pain in Patients With Knee Osteoarthritis: Data From Two Trials

    PubMed Central

    Callaghan, Michael J.; O'Neill, Terence W.; Forsythe, Laura M.; Lunt, Mark; Felson, David T.

    2016-01-01

    Objective In osteoarthritis (OA) clinical trials, a pain measure that is most sensitive to change is considered optimal. We compared sensitivity to change of patient‐reported pain outcomes, including a patient‐preference measure (where the patient nominates an activity that aggravates their pain). Methods We used data from 2 trials of patients with confirmed (American College of Rheumatology criteria) knee OA: a trial of brace treatment for patellofemoral OA, and a trial of intraarticular steroids in knee OA. Both trials reported an improvement in pain following treatment. Participants rated pain on a 100‐mm visual analog scale (VAS), in the activity that caused them the most knee pain (VASNA), as well as completing questions on overall knee pain and the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were also calculated from the KOOS. Standardized changes in each outcome were generated between treatment and control after 6 weeks intervention in the BRACE trial, and 1–2 weeks following intervention in the steroid trial. Results The VASNA produced standardized changes following treatment that were at least as large as other pain outcomes. In the BRACE trial, the between‐groups standardized change with the VASNA was −0.63, compared with the KOOS pain subscale change of −0.33, and pain in the last week VAS change of −0.56. In the steroid study, within‐group change following treatment in the VASNA was −0.60, compared to the last week VAS change of −0.51, and KOOS pain subscale change of −0.58. Conclusion Pain on nominated activity appears to be at least as, and in some cases more, sensitive to change than the KOOS/WOMAC questionnaire. PMID:26713415

  12. Concurrent foot pain is common in people with knee osteoarthritis and impacts health and functional status: data from the Osteoarthritis Initiative

    PubMed Central

    Paterson, Kade L; Hinman, Rana S; Hunter, David J; Wrigley, Tim V; Bennell, Kim L

    2015-01-01

    Objective To document the prevalence of foot pain and foot pain laterality in people with knee osteoarthritis (OA), and to examine its impact on health and function. Methods Participants from the Progression subcohort (n=1255, aged 45-79 years) of the Osteoarthritis Initiative with symptomatic tibiofemoral knee OA were included. Prevalence of foot pain, defined as pain in the foot/ankle, and foot pain laterality was determined. Health status was evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index, the Short Form-12 and the Centre for Epidemiological Studies Depression Scale. Function was assessed using the 20-meter walk test (20MWT) and a repeated chair stand test. Differences in health and functional measures were compared between groups with and without foot pain using multivariate analysis of covariance. Results One quarter (n=317, 25%) of people with knee OA experienced concurrent foot pain, with the majority (n=174, 55%) reporting pain in both feet. After adjusting for covariates, people with foot pain scored worse on all health measures and on the 20MWT compared to those without (p<0.05). Differences in health and function were found between the bilateral and ispilateral foot pain groups compared to those without foot pain (p<0.05), however no differences were found with the contralateral group. Conclusion Foot pain is common in people with knee OA, and bilateral and ipsilateral foot pain adversely affects health and function suggesting laterality is important. Further research is needed to establish the mechanism and interaction of pathology at these sites, and to evaluate foot pain treatment in this population. PMID:25581254

  13. Modulation of Physical Activity to Optimize Pain Sensation following an Intra-Articular Corticosteroid Injection in Patients with Knee Osteoarthritis

    PubMed Central

    Dessery, Yoann; Belzile, Étienne L.; Turmel, Sylvie; Doré, Jean; Diallo, Binta

    2014-01-01

    Background. Intra-articular corticosteroid injection is often used to relieve pain caused by knee osteoarthritis. This study aims to assess the impact after an intra-articular corticosteroid injection treatment on objective and subjective measurement of physical function in knee osteoarthritis patients. Methods. Fourteen patients with unilateral knee osteoarthritis participated in this open-label uncontrolled trial. The intra-articular corticosteroid injection was given at the end of the second week. Physical activity was objectively measured by an accelerometer worn by the participants for eight weeks. Symptoms, quality of life and spatiotemporal parameters of gait were assessed every two weeks. Results. From the injection until six weeks later, pain and stiffness were reduced by approximately 60%. Patients' daily physical activity time was significantly improved after injection: participation in light and moderate physical activities increased during four and two weeks, respectively. Conclusions. The beneficial effects after the intra-articular corticosteroid injection are visible in the duration and intensity of the knee osteoarthritis patients' daily physical activity. However, these effects declined gradually two weeks after injection. Modulating the intensity and duration of physical activity would allow patients to optimize pain sensation over a longer period following an intra-articular corticosteroid injection. Trial Registration. This trial was registered with ClinicalTrials: NCT02049879. PMID:25478585

  14. Pain Reduction After Laser Acupuncture Treatment in Geriatric Patients with Knee Osteoarthritis: a Randomized Controlled Trial.

    PubMed

    Helianthi, Dwi R; Simadibrata, Christina; Srilestari, Adiningsih; Wahyudi, Edy R; Hidayat, Rudy

    2016-04-01

    to compare the effectiveness of active laser acupuncture with placebo on reducing pain intensity and improving functional outcome in geriatric patients with knee osteoarthritis (OA). a double-blind randomized controlled trial was conducted in geriatrics with knee OA at Medical Acupuncture Outpatient Clinic, Integrated Geriatric Outpatient Clinic, Rheumatology Outpatient Clinic of Cipto Mangunkusumo Hospital, Jakarta, during May to October 2015. Sixty two patients with knee OA were randomly assigned into two groups: active laser acupuncture group or placebo laser acupuncture group. Interventions were carried out using a gallium aluminum arsenide laser device at the ST35 Dubi, ST36 Zusanli, SP9 Yinlingquan, GB34 Yanglingquan and EX - LE - 4 Neixiyan acupuncture points on the affected knee for ten sessions of treatment, i.e. twice a week. Patients were assessed using a visual analogue scale (VAS) and Lequesne index at baseline, after four sessions, after nine sessions and at 2 weeks after the treatment had been stopped. the VAS scores were significantly improved in the active laser acupuncture group compared to the placebo group. The evaluation of VAS scores was carried out after four treatment sessions (mean difference: 0.39; p<0.001), after nine treatment sessions (mean difference: 37.48; p<0.001) and at 2 weeks post intervention (mean difference: 39.15; p<0.001). The evaluation also showed significant improvement of Lequesne index after four treatment sessions (mean difference: 4.68; p<0.001), after nine treatment sessions (mean difference: 5.90; p<0.001) and at 2 weeks post intervention (mean difference: 6.48; p<0.001). active laser acupuncture is effective in reducing pain.

  15. Ultrasound with mineral water or aqua gel to reduce pain and improve the WOMAC of knee osteoarthritis

    PubMed Central

    Abdalbary, Sahar Ahmed

    2016-01-01

    Aims: Osteoarthritis is the most degenerative joint disease. The aim was to investigate the effects of ultrasound using mineral water or aqua sonic gel on severity of knee pain, measured by the visual analog scale and the Western Ontario and McMaster Universities Arthritis Index (WOMAC). Materials and methods: Thirty women with bilateral osteoarthritis of the knee were assigned to two groups: ultrasound with mineral water (group 1, n = 15) or with aqua sonic gel (group 2, n = 15). Both groups underwent 4 weeks intervention, three per week. The participants were assessed using the visual analog scale and the WOMAC. Tests were performed before and after interventions. Results: Both groups had significantly reduced pain and improved WOMAC compared with preintervention values. Discussion: The ultrasound with mineral water group had more pronounced improvement at p-value < 0.001. Conclusion: Ultrasound with mineral water is preferable in treatment of knee OA. PMID:28031953

  16. 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.

  17. Intra-articularly applied pulsed radiofrequency can reduce chronic knee pain in patients with osteoarthritis.

    PubMed

    Karaman, Haktan; Tüfek, Adnan; Kavak, Gönül Ölmez; Yildirim, Zeynep Baysal; Uysal, Ersin; Celik, Feyzi; Kaya, Sedat

    2011-08-01

    Osteoarthritis (OA) is the most widespread chronic joint disease worldwide. Symptomatic knee OA is observed in approximately 12% of individuals more than 60 years of age. Conservative treatments models may not be effective always, and that some of them have serious adverse effects that prompted the researchers to research different treatment methods. In this study, we investigated short- and mid-term effectiveness of intra-articular pulsed radiofrequency (PRF) applied in patients with chronic knee pain due to OA. This study was carried out in the pain management center of a university hospital between January 2009 and June 2009. The patient record files of 31 patients who received intra-articular PRF were retrospectively reviewed. The antero-lateral area of the knee, where the intervention would be applied, was anesthetized with 1% lidocaine. An introducer needle was placed intra-articularly. PRF was started as 42°C at 2 Hz for 15 minutes. The pain of the patients was evaluated by 10 cm Visual Analog Scale (VAS). Furthermore, the ages, the gender, the symptom duration of the patients, the side of the knee on which the intervention was applied, and the complications were collected for statistical evaluation. Although the mean initial VAS scores of the patients were 6.1 ± 0.9 cm, it was found, respectively, to be 3.9 ± 1.9 cm and 4.1 ± 1.9 cm at the first- and sixth-month follow-ups. In general, a decrease of 32.8% in mean in the VAS scores was achieved in the last follow-up; whereas the rate of patients reporting a minimum decrease of 2 points in the VAS scores was 64.5% and the rate of patients reporting a decrease of ≥50% in their pain was calculated as 35.5%. PRF applied to the knee joint appears to be an effective and safe method. Copyright © 2011. Published by Elsevier B.V.

  18. Association of knee osteoarthritis with onset and resolution of pain and physical functional disability: the ROAD study.

    PubMed

    Muraki, Shigeyuki; Akune, Toru; Nagata, Keiji; Ishimoto, Yuyu; Yoshida, Munehito; Tokimura, Fumiaki; Tanaka, Sakae; Oka, Hiroyuki; Kawaguchi, Hiroshi; Nakamura, Kozo; Yoshimura, Noriko

    2014-11-01

    To examine the onset and resolution of pain and physical functional disability using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and their association with knee osteoarthritis (OA) in the longitudinal large-scale population of the nationwide cohort study, Research on Osteoarthritis/osteoporosis Against Disability (ROAD). Subjects from the ROAD study who had been recruited during 2005-2007 were followed up 3 years later. A total of 1,578 subjects completed the WOMAC questionnaire at baseline and follow up, and the onset and resolution rate of pain and physical functional disability were examined. We also examined the association of onset of pain and physical functional disability and their resolution with severity of knee OA as well as age, body-mass index and grip strength. After a 3.3-year follow-up, the onset rate of pain was 35.0% and 35.3% in men and women, respectively, and the onset rate of physical functional disability was 38% and 40%, respectively. Resolution rate of pain was 20.3% and 26.2% in men and women, respectively, and resolution rate of physical functional disability was 16% and 14% in men and women, respectively. Knee OA was significantly associated with onset and resolution of pain and physical functional disability in women, but there was no significant association of knee OA with onset of pain and resolution of physical functional disability in men. The present longitudinal study revealed the onset rate of pain and physical functional disability as well as their resolution, and their association with knee OA.

  19. Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial.

    PubMed

    McAlindon, Timothy E; LaValley, Michael P; Harvey, William F; Price, Lori Lyn; Driban, Jeffrey B; Zhang, Ming; Ward, Robert J

    2017-05-16

    Synovitis is common and is associated with progression of structural characteristics of knee osteoarthritis. Intra-articular corticosteroids could reduce cartilage damage associated with synovitis but might have adverse effects on cartilage and periarticular bone. To determine the effects of intra-articular injection of 40 mg of triamcinolone acetonide every 3 months on progression of cartilage loss and knee pain. Two-year, randomized, placebo-controlled, double-blind trial of intra-articular triamcinolone vs saline for symptomatic knee osteoarthritis with ultrasonic features of synovitis in 140 patients. Mixed-effects regression models with a random intercept were used to analyze the longitudinal repeated outcome measures. Patients fulfilling the American College of Rheumatology criteria for symptomatic knee osteoarthritis, Kellgren-Lawrence grades 2 or 3, were enrolled at Tufts Medical Center beginning February 11, 2013; all patients completed the study by January 1, 2015. Intra-articular triamcinolone (n = 70) or saline (n = 70) every 12 weeks for 2 years. Annual knee magnetic resonance imaging for quantitative evaluation of cartilage volume (minimal clinically important difference not yet defined), and Western Ontario and McMaster Universities Osteoarthritis index collected every 3 months (Likert pain subscale range, 0 [no pain] to 20 [extreme pain]; minimal clinically important improvement, 3.94). Among 140 randomized patients (mean age, 58 [SD, 8] years, 75 women [54%]), 119 (85%) completed the study. Intra-articular triamcinolone resulted in significantly greater cartilage volume loss than did saline for a mean change in index compartment cartilage thickness of -0.21 mm vs -0.10 mm (between-group difference, -0.11 mm; 95% CI, -0.20 to -0.03 mm); and no significant difference in pain (-1.2 vs -1.9; between-group difference, -0.6; 95% CI, -1.6 to 0.3). The saline group had 3 treatment-related adverse events compared with 5 in the triamcinolone group

  20. The Effect of Therapeutic Ultrasound on Pain and Physical Function in Patients with Knee Osteoarthritis.

    PubMed

    Yeğin, Tuğba; Altan, Lale; Kasapoğlu Aksoy, Meliha

    2017-01-01

    Osteoartritis (OA) is one of the most frequent causes of pain, loss of function and disability in adults. The prevalence of OA is expected to increase substantially in the future. Knee OA is the most common subset of OA. Therapeutic ultrasound (US) is one of several physical therapy modalities suggested for the management of pain and loss of function due to OA. The purpose of our study was to investigate the efficacy of US therapy in reducing pain and functional loss and improving the quality of life in patients with knee OA in comparison to sham US therapy. The study involved 62 patients. The patients were randomly divided into two groups. The patients in group 1 (n = 30) were administered 1 W/cm(2), 1 MHz continuous US, and the patients in group 2 (n = 32) were administered sham US. The US treatment was applied for 8 min to each knee, 16 min in total, 5 d a wk, for a total of 10 sessions during 2 wk. The patients were evaluated immediately after treatment and 1 mo after therapy according to the visual analog scale (VAS), night pain, range of motion, morning stiffness, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lequesne and Short Form-36 (SF-36) scales and 6 min walking distance. Improvement in pain and joint functions was observed in both groups according to the evaluation immediately after treatment and at 1 mo after the therapy. According to the evaluation results immediately after treatment, there was significant improvement in all pain scales (VAS, WOMAC, Lequesne, SF-36), morning stiffness and 6 min walking distance in patients receiving real US treatment (p < 0.05), but only in some pain scales (VAS, WOMAC) and functions in the group receiving sham US (p < 0.05). Significantly better improvement was observed in some pain scales (SF-36), functions (WOMAC, SF-36) and 6 min walking distance in the real US group. At 1 mo after therapy, no significant difference was observed between groups except for improvement

  1. Pneumatic osteoarthritis knee brace.

    PubMed

    Stamenović, Dimitrije; Kojić, Milos; Stojanović, Boban; Hunter, David

    2009-04-01

    Knee osteoarthritis is a chronic disease that necessitates long term therapeutic intervention. Biomechanical studies have demonstrated an improvement in the external adduction moment with application of a valgus knee brace. Despite being both efficacious and safe, due to their rigid frame and bulkiness, current designs of knee braces create discomfort and difficulties to patients during prolonged periods of application. Here we propose a novel design of a light osteoarthritis knee brace, which is made of soft conforming materials. Our design relies on a pneumatic leverage system, which, when pressurized, reduces the excessive loads predominantly affecting the medial compartment of the knee and eventually reverses the malalignment. Using a finite-element analysis, we show that with a moderate level of applied pressure, this pneumatic brace can, in theory, counterbalance a greater fraction of external adduction moment than the currently existing braces.

  2. Self-reported knee pain and disability among healthy individuals: reference data and factors associated with the Knee injury and Osteoarthritis Outcome Score (KOOS) and KOOS-Child.

    PubMed

    Baldwin, J N; McKay, M J; Simic, M; Hiller, C E; Moloney, N; Nightingale, E J; Burns, J

    2017-08-01

    To develop normative reference data for the Knee injury and Osteoarthritis Outcome Score (KOOS) and KOOS-Child, as well as investigate socio-demographic, psychological and physical factors associated with knee pain and disability among healthy adults. The KOOS or KOOS-Child (each containing five subscales) was administered to participants aged 8-101 years within the 1000 Norms Project, an observational study of 1000 self-reported healthy individuals. Self-efficacy, physical activity, body mass index (BMI), lower limb alignment, knee frontal plane projection angle (FPPA), knee range of motion (ROM), knee and hip strength, six-minute walk, 30-second chair stand and timed up and down stairs tests were collected. KOOS data were dichotomised using established cut-off scores and logistic regression analyses were conducted for each subscale. Socio-demographic characteristics were similar to the Australian population. Normative reference data were generated for children (8-17 years) and adults (18-101 years). Female adults were up to twice as likely to report knee pain, symptoms and sport/recreation (Sport/Rec) limitations compared to males (P < .05). Older age, lower self-efficacy, greater BMI, varus lower limb alignment, lower knee flexion ROM and lower hip external rotation (ER) strength were independently associated with knee pain and disability among adults. Age- and gender-stratified reference data for the KOOS and KOOS-Child have been developed to guide interpretation of results in practice and research for individuals with knee disorders. Psychological and physical factors are linked with self-reported knee pain/disability among adults, and longitudinal studies to investigate causation are required. Copyright © 2017 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  3. Longitudinal impact of joint pain comorbidity on quality of life and activity levels in knee osteoarthritis: data from the Osteoarthritis Initiative

    PubMed Central

    Hoogeboom, Thomas J.; den Broeder, Alfons A.; de Bie, Rob A.

    2013-01-01

    Objectives. Joint pain comorbidity (JPC) is common in individuals with knee OA. This study investigates the longitudinal association between JPC and health-related quality of life (HRQoL) and physical activity levels in individuals with knee OA. Methods. Data from the progression cohort of the Osteoarthritis Initiative (n = 1233; age 61 years and 58% females) were analysed. JPC was considered present if individuals reported pain in three or more joint groups, including the knee joints. HRQoL was assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS) Quality of Life subscale, and self-reported physical activity was determined using the Physical Activity Scale for the Elderly (PASE). Generalized estimating equation (GEE) analyses were performed, adjusted for age, sex, duration of complaints, medical comorbidity, and physical and mental functioning. Results. Over the 4-year period, 32% of participants never reported JPC, whereas 12% always reported JPC. GEE modelling demonstrated that having JPC was negatively associated with HRQoL [regression coefficient β (95% CI) −3.57 (−4.69, −2.44)] and not associated with physical activity [−1.32 (−6.61, 3.98)]. Conclusion. Considering the impact of JPC on the HRQoL of individuals with knee OA, the assessment of JPC in individuals with knee OA might be a daily routine. PMID:23204552

  4. Longitudinal impact of joint pain comorbidity on quality of life and activity levels in knee osteoarthritis: data from the Osteoarthritis Initiative.

    PubMed

    Hoogeboom, Thomas J; den Broeder, Alfons A; de Bie, Rob A; van den Ende, Cornelia H M

    2013-03-01

    Joint pain comorbidity (JPC) is common in individuals with knee OA. This study investigates the longitudinal association between JPC and health-related quality of life (HRQoL) and physical activity levels in individuals with knee OA. Data from the progression cohort of the Osteoarthritis Initiative (n = 1233; age 61 years and 58% females) were analysed. JPC was considered present if individuals reported pain in three or more joint groups, including the knee joints. HRQoL was assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS) Quality of Life subscale, and self-reported physical activity was determined using the Physical Activity Scale for the Elderly (PASE). Generalized estimating equation (GEE) analyses were performed, adjusted for age, sex, duration of complaints, medical comorbidity, and physical and mental functioning. Over the 4-year period, 32% of participants never reported JPC, whereas 12% always reported JPC. GEE modelling demonstrated that having JPC was negatively associated with HRQoL [regression coefficient β (95% CI) -3.57 (-4.69, -2.44)] and not associated with physical activity [-1.32 (-6.61, 3.98)]. Considering the impact of JPC on the HRQoL of individuals with knee OA, the assessment of JPC in individuals with knee OA might be a daily routine.

  5. Relationship between knee pain and infra-patellar fat pad morphology - A within- and between-person analysis from the Osteoarthritis Initiative.

    PubMed

    Steidle-Kloc, Eva; Culvenor, Adam G; Dörrenberg, Jan; Wirth, Wolfgang; Ruhdorfer, Anja; Eckstein, Felix

    2017-07-13

    Inflammation is known to be strongly associated with knee pain in osteoarthritis. The infra-patellar fat pad represents a potential source of pro-inflammatory cytokines. Yet, the relationship between infra-patellar fat pad morphology and osteoarthritis symptoms is unclear. Here we investigate quantitative imaging parameters of infra-patellar fat pad morphology between: a) painful vs. contralateral pain-free limbs of subjects with unilateral pain; and b) knees of patients with chronic knee pain vs. those of matched pain-free control subjects. 46 subjects with strictly unilateral frequent knee pain and bilateral radiographic osteoarthritis (Kellgren-Lawrence grade [KLG] 2/3) were drawn from the Osteoarthritis Initiative. Further, 43 subjects with chronic knee pain over 4 years and 43 matched pain-free controls without pain over this period were studied. Infra-patellar fat pad morphology (volume, surface area, depth) was determined by manual segmentation of sagittal magnetic resonance images. No significant differences in infra-patellar fat pad morphology were observed between painful vs. painless knees of persons with strictly unilateral knee pain (mean difference -0.7%; 95% confidence interval (CI) -0.6,0.9%; p=0.64) or between chronically painful knees vs. matched painless controls (-2.1%; 95% CI -2.2,1.1%; p=0.51). Independent of the ambiguous role of the IPFP in knee OA (a potential source of pro-inflammatory cytokines or a mechanical shock absorber), the size of the infra-patellar fat pad does not appear to be related to knee pain. This article is protected by copyright. All rights reserved. © 2017, American College of Rheumatology.

  6. Physiotherapy management of knee osteoarthritis.

    PubMed

    Page, Carolyn J; Hinman, Rana S; Bennell, Kim L

    2011-05-01

    Knee osteoarthritis (OA) is a prevalent chronic joint disease causing pain and disability. Physiotherapy, which encompasses a number of modalities, is a non-invasive treatment option in the management of OA. This review summarizes the evidence for commonly used physiotherapy interventions. There is strong evidence to show short-term beneficial effects of exercise on pain and function, although the type of exercise does not seem to influence treatment outcome. Delivery modes, including individual, group or home exercise are all effective, although therapist contact may improve benefits. Attention to improving adherence to exercise is needed to maximize outcomes in the longer-term. Knee taping applied with the aim of realigning the patella and unloading soft tissues can reduce pain. There is also evidence to support the use of knee braces in people with knee OA. Biomechanical studies show that lateral wedge shoe insoles reduce knee load but clinical trials do not support symptomatic benefits. Recent studies suggest individual shoe characteristics also affect knee load and there is current interest in the effect of modified shoe designs. Manual therapy, while not to be used as a stand-alone treatment, may be beneficial. In summary, although the research is not equivocal, there is sufficient evidence to indicate that physiotherapy interventions can reduce pain and improve function in those with knee OA. © 2011 The Authors. International Journal of Rheumatic Diseases © 2011 Asia Pacific League of Associations for Rheumatology and Blackwell Publishing Asia Pty Ltd.

  7. Footwear alterations and bracing as treatments for knee osteoarthritis.

    PubMed

    Krohn, Kelly

    2005-09-01

    The biomechanical aspects of gait and the impact of alignment have been recognized as important in the development and progression of knee osteoarthritis. Improving malalignment and altering the dynamic forces on the involved compartment of the knee during gait have the potential to improve the symptoms of knee osteoarthritis. This review examines the use of foot orthoses and knee braces to change the biomechanical forces on the knee joint and to reduce pain and improve function in patients with existing symptomatic knee osteoarthritis. Malalignment has been shown to have an impact on the development and progression of knee osteoarthritis. Patients with medial compartment knee osteoarthritis who have a visible varus thrust will also progress at a more rapid rate than patients without a varus thrust. Lateral wedge foot orthoses have been shown in biomechanical studies and clinical studies to reduce the load on the medial compartment and improve the symptoms of medial compartment knee osteoarthritis. Knee braces that stabilize the knee joint and provide a valgus stress have been shown to improve pain and function in patients with medial compartment knee osteoarthritis. The development of symptomatic knee osteoarthritis and the progression of joint space loss is in part a biomechanical process. To improve patients' function and possibly reduce disease progression, a biomechanical approach should be included in the treatment plan for patients with knee osteoarthritis. Foot orthoses and knee braces have been shown in selected patients to have a role in the management of unicompartmental knee osteoarthritis.

  8. Impact of knee and low back pain on health-related quality of life in Japanese women: the Research on Osteoarthritis Against Disability (ROAD).

    PubMed

    Muraki, Shigeyuki; Akune, Toru; Oka, Hiroyuki; En-Yo, Yoshio; Yoshida, Munehito; Saika, Akihiko; Suzuki, Takao; Yoshida, Hideyo; Ishibashi, Hideaki; Tokimura, Fumiaki; Yamamoto, Seizo; Nakamura, Kozo; Kawaguchi, Hiroshi; Yoshimura, Noriko

    2010-10-01

    Although knee and low back pain are major public health issues, little information is available on their impact on the quality of life (QOL). We have investigated the impact of knee and low back pain on the QOL in Japanese women by assessing the associations between knee pain and low back pain and various QOL domains using measures such as the Medical Outcomes Study Short Form-8, EuroQOL, and the Western Ontario and McMaster Universities Osteoarthritis Index. From the 3,040 Japanese women participating in the Research on Osteoarthritis Against Disability (ROAD) study, we analyzed data on 1,369 women >40 years old (mean age 68.4 years). We further examined the associations of Kellgren-Lawrence (KL) grade at the knee and lumbar spine and the presence of vertebral fracture (VFx) with the magnitude of QOL loss in women with knee pain and low back pain, respectively. Knee pain and low back pain were found to be significantly associated with lower QOL scores among the women comprising the study cohort. In women with knee pain KL = 4, knee osteoarthritis was strongly associated with the magnitude of QOL loss. For women with low back pain, no significant associations were found between KL grade and magnitude of QOL loss, while there was a moderate association between the latter and VFx.

  9. Individual magnetic resonance imaging and radiographic features of knee osteoarthritis in subjects with unilateral knee pain: the health, aging, and body composition study.

    PubMed

    Javaid, M K; Kiran, A; Guermazi, A; Kwoh, C K; Zaim, S; Carbone, L; Harris, T; McCulloch, C E; Arden, N K; Lane, N E; Felson, D; Nevitt, M

    2012-10-01

    Strong associations between radiographic features of knee osteoarthritis (OA) and pain have been demonstrated in persons with unilateral knee symptoms. This study was undertaken to compare radiographic and magnetic resonance imaging (MRI) features of knee OA and assess their ability to discriminate between painful and nonpainful knees in persons with unilateral symptoms. The study population included 283 individuals ages 70-79 years with unilateral knee pain who were enrolled in the Health, Aging, and Body Composition Study, a study of weight-related diseases and mobility. Radiographs of both knees were read for Kellgren/Lawrence (K/L) grade and individual radiographic features, and 1.5T MRIs were assessed using the Whole-Organ Magnetic Resonance Imaging Score. The association between structural features and pain was assessed using a within-person case-control design and conditional logistic regression. Receiver operating characteristic (ROC) analysis was then used to test the discriminatory performance of structural features. In conditional logistic analyses, knee pain was significantly associated with both radiographic features (any joint space narrowing grade ≥ 1) (odds ratio 3.20 [95% confidence interval 1.79-5.71]) and MRI features (any cartilage defect scored ≥ 2) (odds ratio 3.67 [95% confidence interval 1.49-9.04]). However, in most subjects, MRI revealed osteophytes and cartilage and bone marrow lesions in both knees, and using ROC analysis, no individual structural feature discriminated well between painful and nonpainful knees. The best-performing MRI feature (synovitis/effusion) was not significantly more informative than K/L grade ≥ 2 (P = 0.42). In persons with unilateral knee pain, MRI and radiographic features were associated with knee pain, confirming that structural abnormalities in the knee have an important role in the etiology of pain. However, no single MRI or radiographic finding performed well in discriminating between painful and

  10. Physical performance and movement-evoked pain profiles in community-dwelling individuals at risk for knee osteoarthritis.

    PubMed

    Cruz-Almeida, Yenisel; Cardoso, Josue; Riley, Joseph L; Goodin, Burel; King, Christopher D; Petrov, Megan; Bartley, Emily J; Sibille, Kimberly T; Glover, Toni L; Herbert, Matthew S; Bulls, Hailey W; Addison, Adriana; Staud, Roland; Redden, David; Bradley, Laurence A; Fillingim, Roger B

    2017-08-24

    Knee pain associated with osteoarthritis is a significant contributor to decreased physical function. Recent evidence supports the inter-individual heterogeneity associated with knee pain presentation, but whether there is similar heterogeneity in physical performance among these individuals has not been previously examined. The aim of the present study was to characterize the variability in physical performance profiles and the pain evoked by their performance (i.e., movement-evoked pain). In a secondary analysis of the community-based study Understanding Pain and Limitations in Osteoarthritic Disease (UPLOAD), individuals (n=270) completed functional, pain, psychological, and somatosensory assessments. Hierarchical cluster analysis was used to derive physical function profiles that were subsequently compared across several clinical, psychological and experimental pain measures. Our results support the hypothesis that among persons with knee OA pain, three different physical performance profiles exist with varying degrees of movement-evoked pain. Even as all three groups experienced moderate to severe levels of spontaneous knee pain, those individuals with the most severe movement-evoked pain and lowest physical functional performance also had the least favorable psychological characteristics along with increased mechanical pain sensitivity and temporal summation. Our findings support the need for the assessment and consideration of movement-evoked pain during physical performance tasks as these have the potential to increase the value of functional and pain assessments clinically. The identification of the mechanisms driving pain burden within homogeneous groups of individuals will ultimately allow for targeted implementation of treatments consistent with a biopsychosocial model of pain. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Temporal summation of pain as a prospective predictor of clinical pain severity in adults aged 45 years and above with knee osteoarthritis: ethnic differences

    PubMed Central

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

    2014-01-01

    Objective Enhanced pain facilitation is reportedly an important contributor to the clinical pain experiences of individuals with knee osteoarthritis (OA). Ethnic differences in the prevalence and severity of knee OA in addition to associated pain are also well documented. Temporal summation (TS) of pain is a widely applicable quantitative sensory testing method that invokes neural mechanisms related to pain facilitatory processes. This study tested whether TS of pain, an index of pain facilitation, differentially predicts the clinical pain experiences of African Americans and non-Hispanic Whites with symptomatic knee OA. Methods A total of 225 study participants underwent assessment of TS of mechanical and heat pain stimuli applied to their most symptomatic knee and their ipsilateral hand (mechanical) or forearm (heat). Using telephone-based surveys, participants subsequently reported their average and worst clinical pain severity across four consecutive weeks following assessment of TS. Results In predicting future clinical pain, ethnicity interacted with TS of mechanical pain (but not heat pain), such that TS of mechanical pain at the knee significantly predicted greater clinical ratings of average (b = .02, p = .016) and worst (b = .02, p = .044) clinical pain for non-Hispanic Whites but not African Americans (p’s > .30). Conclusions These results reveal the importance of considering ethnicity when examining pain facilitation and the clinical pain of individuals with symptomatic knee OA. The results of this study are discussed in terms of ethnic differences in the predictors of clinical pain experiences among African Americans and non-Hispanic Whites with knee OA. PMID:24804882

  12. Toward a clinical definition of early osteoarthritis: onset of patient-reported knee pain begins on stairs. Data from the osteoarthritis initiative.

    PubMed

    Hensor, Elizabeth M A; Dube, Bright; Kingsbury, Sarah R; Tennant, Alan; Conaghan, Philip G

    2015-01-01

    Early detection of osteoarthritis (OA) would increase the chances of effective intervention. We aimed to investigate which patient-reported activity is first associated with knee pain. We hypothesized that pain would occur first during activities requiring weight bearing and knee bending. Data were obtained from the Osteoarthritis Initiative (OAI), a multicenter, longitudinal prospective observational cohort of people who have or are at high risk of OA. Participants completed the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC; Likert scale) annually for up to 7 years. Rasch analysis was used to rank the WOMAC pain questions (activities) in order of affirmation as the pain score increased from 0. For each total WOMAC score category (0-20) we selected 25 individuals at random based on their maximum score across all visits. Fit to the Rasch model was assessed in this subset; stability of question ranking over successive visits was confirmed in the full OAI. WOMAC data on 4,673 people were included, with 491 selected for subset analysis. The subset data showed good fit to the Rasch model (χ(2) = 43.31, P = 0.332). In the full OAI, the "using stairs" question was the first to score points as the total pain score increased from 0 (baseline logit score ± 95% confidence interval -4.74 ± 0.07), then "walking" (-2.94 ± 0.07), "standing" (-2.65 ± 0.07), "lying/sitting" (-2.00 ± 0.08), and finally "in bed" (-1.32 ± 0.09). This ordering was consistent over successive visits. Knee pain is most likely to first appear during weight-bearing activities involving bending of the knee, such as using stairs. First appearance of this symptom may identify a group suitable for early intervention strategies. © 2015 The Authors. Arthritis Care & Research is published by Wiley Periodicals, Inc. on behalf of the American College of Rheumatology.

  13. Toward a Clinical Definition of Early Osteoarthritis: Onset of Patient-Reported Knee Pain Begins on Stairs. Data From the Osteoarthritis Initiative

    PubMed Central

    Hensor, Elizabeth M A; Dube, Bright; Kingsbury, Sarah R; Tennant, Alan; Conaghan, Philip G

    2015-01-01

    Objective Early detection of osteoarthritis (OA) would increase the chances of effective intervention. We aimed to investigate which patient-reported activity is first associated with knee pain. We hypothesized that pain would occur first during activities requiring weight bearing and knee bending. Methods Data were obtained from the Osteoarthritis Initiative (OAI), a multicenter, longitudinal prospective observational cohort of people who have or are at high risk of OA. Participants completed the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC; Likert scale) annually for up to 7 years. Rasch analysis was used to rank the WOMAC pain questions (activities) in order of affirmation as the pain score increased from 0. For each total WOMAC score category (0–20) we selected 25 individuals at random based on their maximum score across all visits. Fit to the Rasch model was assessed in this subset; stability of question ranking over successive visits was confirmed in the full OAI. Results WOMAC data on 4,673 people were included, with 491 selected for subset analysis. The subset data showed good fit to the Rasch model (χ2 = 43.31, P = 0.332). In the full OAI, the “using stairs” question was the first to score points as the total pain score increased from 0 (baseline logit score ± 95% confidence interval −4.74 ± 0.07), then “walking” (−2.94 ± 0.07), “standing” (−2.65 ± 0.07), “lying/sitting” (−2.00 ± 0.08), and finally “in bed” (−1.32 ± 0.09). This ordering was consistent over successive visits. Conclusion Knee pain is most likely to first appear during weight-bearing activities involving bending of the knee, such as using stairs. First appearance of this symptom may identify a group suitable for early intervention strategies. PMID:25074673

  14. External validity in randomised controlled trials of acupuncture for osteoarthritis knee pain.

    PubMed

    Purepong, Nithima; Jitvimonrat, Anusorn; Sitthipornvorakul, Ekalak; Eksakulkla, Sukanya; Janwantanakul, Prawit

    2012-09-01

    To assess two aspects of the external validity of acupuncture research for osteoarthritis knee pain and determine the common acupoints and treatment parameters used. The external validity of 16 randomised controlled trials (RCTs) was investigated using a scale consisting of two aspects: reporting and performance. The reporting aspect included acupuncturist's background, study location, treatment detailed, patient characteristics, positive trial results, adverse effects and between-group statistical differences, whereas treatment appropriateness, appropriate controls and outcomes were classified as the performance aspect. Acupuncture treatment in RCTs was compared with common practice according to the literature sources and survey of acupuncturists working in different parts of Thailand. The levels of external validity for the reporting and performance aspects were in the range of 31.3% to 100%. Statistic values such as mean difference and confidence interval were reported by the minority of trials (43.8%). Patient satisfaction and quality of life were seldom used (31.3%). There were minor differences between research and practice in terms of the points used (25.0%), number of treatment sessions (6.3%) and frequency (12.5%). The most frequently used points were ST34, ST35, ST36, SP6, SP9, SP10, GB34, Xiyan and ah shi points, and the commonly used treatment parameters were 20 minutes, 10-15 sessions and two treatments weekly. Reporting of the external validity of acupuncture RCTs for knee pain was notably inadequate in terms of trial setting, treatment provider and statistical reporting. The majority of studies involved appropriate controls and outcomes and applied acupuncture treatments in line with practice.

  15. Assessment of knee joint pain in experimental rodent models of osteoarthritis.

    PubMed

    Piel, Margaret J; Kroin, Jeffrey S; Im, Hee-Jeong

    2015-01-01

    Pain assessment in animal models of osteoarthritis is integral to interpretation of a model's utility in representing the clinical condition, and enabling accurate translational medicine. Here we describe two methods for behavioral pain assessments available for use in animal models of experimental osteoarthritic pain: Von Frey filaments and spontaneous activity monitoring.

  16. 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.

  17. Impact of Pain Reported During Isometric Quadriceps Muscle Strength Testing in People With Knee Pain: Data From the Osteoarthritis Initiative

    PubMed Central

    Stratford, Paul W.

    2011-01-01

    Background Muscle force testing is one of the more common categories of diagnostic tests used in clinical practice. Clinicians have little evidence to guide interpretations of muscle force tests when pain is elicited during testing. Objective The purpose of this study was to examine the construct validity of isometric quadriceps muscle strength tests by determining whether the relationship between maximal isometric quadriceps muscle strength and functional status was influenced by pain during isometric testing. Design A cross-sectional design was used. Methods Data from the Osteoarthritis Initiative were used to identify 1,344 people with unilateral knee pain and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale scores of 1 or higher on the involved side. Measurements of maximal isometric quadriceps strength and ratings of pain during isometric testing were collected. Outcome variables were WOMAC physical function subscale, 20-m walk test, 400-m walk test, and a repeated chair stand test. Multiple regression models were used to determine whether pain during testing modified or confounded the relationship between strength and functional status. Results Pearson r correlations among the isometric quadriceps strength measures and the 4 outcome measures ranged from −.36 (95% confidence interval=−.41, −.31) for repeated chair stands to .36 (95% confidence interval=.31, .41) for the 20-m walk test. In the final analyses, neither effect modification nor confounding was found for the repeated chair stand test, the 20-m walk test, the 400-m walk test, or the WOMAC physical function subscale. Moderate or severe pain during testing was weakly associated with reduced strength, but mild pain was not. Limitations The disease spectrum was skewed toward mild or moderate symptoms, and the pain measurement scale used during muscle force testing was not ideal. Conclusions Given that the spectrum of the sample was skewed toward mild or moderate

  18. Can pain influence the proprioception and the motor behavior in subjects with mild and moderate knee osteoarthritis?

    PubMed

    de Oliveira, Daniela C Silveira; Barboza, Saulo Delfino; da Costa, Franciele Dias; Cabral, Monnique Ponciano; Silva, Vanessa Martins Pereira; Dionisio, Valdeci Carlos

    2014-09-27

    Osteoarthritis (OA) is a chronic disease, usually characterized by pain, which is associated with reduced muscle strength, disability and progressive loss of function. However, the pain influence over proprioception and motor behaviour remains unclear. Thus, the purpose of the study was to identify the levels of pain, the proprioceptive acuity and the pattern of muscle recruitment during stair ascent and descent in elderly patients with mild and moderate osteoarthritis (OA) compared to healthy subjects. The study participants included 11 healthy elderly subjects (7 women and 4 men) and 31 elderly patients with knee OA (19 women and 12 men). The functional capacity was assessed by the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index; the pain was evaluated by Wong-Baker faces pain rating scale (WBS) and pressure pain threshold (PPT); the proprioceptive acuity was based on the joint position sense evaluated by electrogoniometer; and the electromyographic (EMG) activity of the major muscles of the lower limb were evaluated during a task of stair ascent and descent of 15 cm. For statistical analysis it was used Statistic for Windows software (StatSoft Inc., version 5.0). Data from the WOMAC index, WBS, the proprioceptive acuity and IEMG (for each muscle in each phase) were analyzed using the Mann-Whitney U test and data from PPT was used Kruskal-Wallis test. Higher scores were found in the WOMAC index and WBS whereas lower scores were seen in PPT in patients with knee OA compared to healthy subjects. In contrast, there were no significant differences in the proprioceptive acuity and EMG results of most muscles analyzed between the groups. The presence of pain does not influence the proprioception and the motor behavior of the thigh muscles during stair ascent and descent in subjects with mild and moderate knee OA.

  19. Knee osteoarthritis: Therapeutic alternatives in primary care

    PubMed Central

    Evaniew, Allison L; Evaniew, Nathan

    2017-01-01

    AIM To discusses pharmacological and non-pharmacological therapeutic alternatives for managing knee osteoarthritis in primary care by primary health care nurse practitioners. METHODS A case example is presented, the evidence-based guideline recommendations of the Osteoarthritis Research Society International and the American Academy of Orthopaedic Surgeons are reviewed, and a plan of care is developed. RESULTS Osteoarthritis is the most common form of arthritis seen in primary care, and it is a major public health issue because the aging population and widespread obesity have drastically increased incidence. Osteoarthritis is clinically associated with escalating chronic pain, physical disability, and decreased quality of life. Early diagnosis of mild osteoarthritis in relatively young patients presents an opportunity for primary health care providers to manage pain, increase quality of life, and decrease risk of disability. CONCLUSION Primary health care providers can implement these recommendations in their own practices to provide care to patients with knee osteoarthritis based on current best evidence. PMID:28251070

  20. Clinical Validation of Pain Management Manipulative Therapy for Knee Osteoarthritis With the Squeeze-Hold Technique: A Case Series.

    PubMed

    Nakajima, Masaaki

    2017-06-01

    The purpose of this case series was to describe the short-term and long-term clinical effects of a manual technique for treating osteoarthritis (OA) knee pain. This study measured of the immediate effect and long-term effect by using a case series of different groups of subjects. Knee OA and activity restriction in patients were evaluated by using the Kellgren-Lawrence (K/L) Grading Scale and the Japanese Knee Osteoarthritis Measure (JKOM) index. In the intervention, lower limb muscles were squeezed by hand for 20 seconds. Each squeeze was performed for both lower limbs. Passive range-of-motion (ROM) exercise was performed on the knee joint. In one set of cases, immediate effects were measured after a one-time treatment with pretreatment and posttreatment outcome measures. Eleven people with knee OA participated in the study. On a visual analogue scale (VAS) for pain, muscle stiffness, and muscular hemodynamics for estimation of muscle blood flow were recorded before and after the squeeze-hold treatment. In another set of cases, the treatment was given to all patients once a week for 6 months, and long-term effects were measured. Data on 5 subjects with knee OA were collected for 6 months after initial treatment. The VAS for pain and JKOM were recorded every month for 6 months. For immediate effects, the VAS was 69 ± 21 mm before treatment and 26 ± 22 mm after treatment. Muscle stiffness was 8.8 ± 3.6 (absolute number) before treatment and 3.5 ± 2.1 after treatment. Tissue (muscle) oxygen saturation was 60.1 ± 5.7% before treatment and 65.3 ± 4.8% after treatment. Total hemoglobin was 24.3 ± 3.3 (absolute number) before treatment and 25 ± 2.3 after treatment. A tendency for reduction in OA knee pain and muscle stiffness was observed, and a tendency for increase was observed in the blood flow in the muscle. For long-term effects in all 5 participants (any K/L grade, any JKOM score), OA knee pain and JKOM score improved gradually through 6 months. The

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

    PubMed

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

    2013-09-01

    To compare the effectiveness of acupuncture with other relevant physical treatments for alleviating pain due to knee osteoarthritis. 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. 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). 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. Copyright © 2013 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  2. Patella bone density is lower in knee osteoarthritis patients experiencing moderate-to-severe pain at rest.

    PubMed

    Burnett, W; Kontulainen, S; McLennan, C; Hazel, D; Talmo, C; Hunter, D; Wilson, D; Johnston, J

    2016-03-01

    To determine differences in patellar subchondral bone mineral density (BMD) between knee osteoarthritis (OA) patients with differing levels of pain at rest. The preoperative knee of 41 total knee replacement (TKR) patients was scanned using QCT and scored for pain using Western Ontario McMasters Osteoarthritis Index (WOMAC). 'Pain at rest' was defined as average pain while lying//sitting and nocturnal pain. Participants were divided into groups: 'mild-to-no pain at rest' and 'moderate-to-severe pain at rest'. We used a depth-specific CT-based mapping technique to measure patellar subchondral BMD at depths of 0-2.5 mm, 2.5-5 mm, and 5-7.5 mm from the subchondral surface. Mean lateral and medial facet BMD were compared between groups using MANCOVA. Mean adjusted BMD was lower in participants with 'moderate-to-severe pain at rest' over the total lateral facet at depths of 0-2.5 mm (10% lower, p=0.041), 2.5-5 mm (20% lower, p=0.017), and 5-7.5 mm (25% lower, p=0.004), and over the total medial facet at 2.5-5 mm (22% lower, p=0.033) and 5-7.5 mm (28% lower, p=0.016). In OA patients with 'moderate-to-severe pain at rest', depth-specific density measures demonstrated up to 28% lower lateral and medial subchondral BMD. Patients with high levels of pain at rest may have reduced amounts of native bone prior to TKR.

  3. 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.

  4. Exercise and knee osteoarthritis: benefit or hazard?

    PubMed Central

    Bosomworth, Neil J.

    2009-01-01

    ABSTRACT OBJECTIVE To determine whether physical exercise constitutes a benefit or a risk in the development and progression of knee osteoarthritis. QUALITY OF EVIDENCE MEDLINE, EMBASE, DARE, ACP Journal Club, and Cochrane databases were searched from registry inception to January 2009 using MeSH headings or text words, including osteoarthritis, arthritis and knee and exercise, physical training, and run. Reference lists from retrieved articles, citation listings when available, and related articles suggested in PubMed were also evaluated. For individuals without osteoarthritis, strong level II evidence was found (limited by problems with blinding and randomization); for those with pre-existing knee osteoarthritis, robust level I evidence was available. MAIN MESSAGE Knee osteoarthritis is a major contributor to disability in seniors, and patients have expressed concern that continued exercise might lead to knee symptoms in later years. Studies done on subjects self-selected for exercise and followed for substantial periods of time show no evidence of accelerated development of osteoarthritis, provided injury is avoided. Further, there is good evidence for reduced pain and disability with exercise in this cohort compared with controls. Patients with established osteoarthritis are shown to derive uniform benefit to physical functioning, with reduction of pain and disability, using aerobic, muscle strengthening, aquatic, or physiotherapy-based exercise modalities. CONCLUSION Provided trauma is avoided, moderate exercise does not lead to acceleration of knee osteoarthritis, whether or not there is evidence of pre-existing disease. In either case there appears to be improved physical functioning and reduction of pain and disability in those who exercise. It is likely that exercise interventions are underused in the management of established knee osteoarthritis symptoms. PMID:19752252

  5. Does the Q − H index show a stronger relationship than the H:Q ratio in regard to knee pain during daily activities in patients with knee osteoarthritis?

    PubMed Central

    Fujita, Remi; Matsui, Yasumoto; Harada, Atsushi; Takemura, Marie; Kondo, Izumi; Nemoto, Tetsuya; Sakai, Tadahiro; Hiraiwa, Hideki; Ota, Susumu

    2016-01-01

    [Purpose] The purpose of this study was to elucidate the relationship between knee muscle strength and knee pain in activities of daily living, based on consideration of the difference between extension and flexion strength (Q − H) and the hamstring:quadriceps (H:Q) ratio in patients with knee osteoarthritis. [Subjects and Methods] The participants were 78 females with knee osteoarthritis, and a total of 133 knees that had not been treated surgically were the targets of this research. The legs were divided according to dominance. Isometric knee extension and flexion muscle strength and knee pain during activities of daily living were measured. The H:Q ratio (flexion/extension muscle strength) and the difference between extension and flexion strength, (extension muscle strength/weight) minus (flexion muscle strength/weight), that is, Q − H, were calculated. The correlation between these indices and the knee pain score during activities of daily living was investigated. [Results] Greater knee pain during activities of daily living was related to lower knee extension muscle strength and Q − H in both the dominant and nondominant legs. Knee flexion muscle strength and the H:Q ratio were not significantly correlated with knee pain during any activities of daily living. [Conclusion] Knee extension muscle strength and Q − H were found to be significantly correlated with knee pain during activities of daily living, whereas the H:Q ratio was not. PMID:28174444

  6. Walking Exercise Simultaneously Combined With Neuromuscular Electrical Stimulation of Antagonists Resistance Improved Muscle Strength, Physical Function, and Knee Pain in Symptomatic Knee Osteoarthritis: A Single-Arm Study.

    PubMed

    Matsuse, Hiroo; Hashida, Ryuki; Takano, Yoshio; Omoto, Masayuki; Nago, Takeshi; Bekki, Masafumi; Shiba, Naoto

    2017-01-01

    Matsuse, H, Hashida, R, Takano, Y, Omoto, M, Nago, T, Bekki, M, and Shiba, N. Walking exercise simultaneously combined with neuromuscular electrical stimulation of antagonists resistance improved muscle strength, physical function, and knee pain in symptomatic knee osteoarthritis: a single-arm study. J Strength Cond Res 31(1): 171-180, 2017-A hybrid training system (HTS) was developed as a way to combine the application of electrical stimulation and voluntary contraction. Moreover, we developed a novel training method using HTS during walking (HTSW). This study was designed to evaluate the effect of HTSW on muscle strength, physical function, and knee pain in knee osteoarthritis (KOA). Eleven subjects (age: 74.0 ± 8.5 years) participated and performed HTSW for 30 minutes 3 times a week for 12 weeks. Isokinetic knee extension/knee flexion torque, muscle volume, one-leg standing test (OST), functional reach test, 10-m maximum gait speed, timed up and go test, 6-minute walking test, knee pain using Visual Analog Scale (VAS), and Japan Knee Osteoarthritis Measure (JKOM) were assessed. Knee extension torque significantly increased from 1.02 ± 0.29 N·m·kg pretraining to 1.23 ± 0.33 N·m·kg posttraining (P < 0.01, ES = 0.68). Knee flexion torque significantly increased from 0.65 ± 0.18 N·m·kg pretraining to 0.78 ± 0.17 N·m·kg posttraining (p < 0.01). Muscle volume significantly increased from 9.00 ± 2.84 mm pretraining to 10.37 ± 3.16 mm at the end of training (p ≤ 0.05). All the physical functions except OST were significantly improved. The JKOM score improved from 26.7 ± 18.30 pretraining to 17.2 ± 14.02 at the end of training (p < 0.01). The VAS score significantly decreased from 35.4 ± 22.59 pretraining to 16.5 ± 19.73 at the end of training (p ≤ 0.05). Hybrid training system during walking may be an effective training method for the treatment of people with KOA.

  7. Golden plaster for pain therapy in patients with knee osteoarthritis: study protocol for a multicenter randomized, double-blind, placebo-controlled trial.

    PubMed

    Liu, Jin-Tao; Tang, De-Zhi; Li, Xiao-Feng; Zhang, Zhi-Gang; Ji, Wan-Bo; Tao, Shuai; Wang, Yong-Jun; Jiang, Hong

    2013-11-13

    Osteoarthritis is a relatively common musculoskeletal disorder that increases in prevalence with age. Worldwide, knee osteoarthritis is one of the leading causes of disability, particularly in the elderly. In numerous trials of agents for long-term pain therapy, no well-established and replicable results have been achieved. Complementary and alternative medical approaches have been employed for thousands of years to relieve knee osteoarthritis pain. Among herbal medicines, the golden plaster is the preferred and most commonlyused method in China to reduce pain in patients with knee osteoarthritis, as it causes few adverse effects. The purpose of this study will be to evaluate the efficacy and safety of golden plaster on pain in patients with knee osteoarthritis. This study will be a multicenter randomized, double-blind, placebo-controlled trial. A total of 320 participants aged 45 to 79 years with knee osteoarthritis, whose scores on a visual analog scale (VAS) are more than 20 mm,will be randomly allocated into a treatment group and a control group. A golden plaster will be administered externally to participants in the treatment group for 2 weeks, while the control group will receive a placebo plaster externally for 2 weeks. Follow-up will be at regular intervals during a 4-week period with a VAS score for pain, quality of life, and complications. This study will be a methodologically sound randomized controlled trial to assess pain relief after the intervention of golden plaster, compared to a placebo intervention in patients with knee osteoarthritis. ClinicalTrials.gov identifier: ChiCTR-TRC-13003418.

  8. Golden plaster for pain therapy in patients with knee osteoarthritis: study protocol for a multicenter randomized, double-blind, placebo-controlled trial

    PubMed Central

    2013-01-01

    Background Osteoarthritis is a relatively common musculoskeletal disorder that increases in prevalence with age. Worldwide, knee osteoarthritis is one of the leading causes of disability, particularly in the elderly. In numerous trials of agents for long-term pain therapy, no well-established and replicable results have been achieved. Complementary and alternative medical approaches have been employed for thousands of years to relieve knee osteoarthritis pain. Among herbal medicines, the golden plaster is the preferred and most commonlyused method in China to reduce pain in patients with knee osteoarthritis, as it causes few adverse effects. The purpose of this study will be to evaluate the efficacy and safety of golden plaster on pain in patients with knee osteoarthritis. Methods/Design This study will be a multicenter randomized, double-blind, placebo-controlled trial. A total of 320 participants aged 45 to 79 years with knee osteoarthritis, whose scores on a visual analog scale (VAS) are more than 20 mm,will be randomly allocated into a treatment group and a control group. A golden plaster will be administered externally to participants in the treatment group for 2 weeks, while the control group will receive a placebo plaster externally for 2 weeks. Follow-up will be at regular intervals during a 4-week period with a VAS score for pain, quality of life, and complications. Discussion This study will be a methodologically sound randomized controlled trial to assess pain relief after the intervention of golden plaster, compared to a placebo intervention in patients with knee osteoarthritis. Trial registration ClinicalTrials.gov identifier: ChiCTR-TRC-13003418 PMID:24220504

  9. 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

  10. Effects of chondroitin sulfate on brain response to painful stimulation in knee osteoarthritis patients. A randomized, double-blind, placebo-controlled functional magnetic resonance imaging study.

    PubMed

    Monfort, Jordi; Pujol, Jesús; Contreras-Rodríguez, Oren; Llorente-Onaindia, Jone; López-Solà, Marina; Blanco-Hinojo, Laura; Vergés, Josep; Herrero, Marta; Sánchez, Laura; Ortiz, Hector; Montañés, Francisco; Deus, Joan; Benito, Pere

    2017-06-21

    Knee osteoarthritis is causing pain and functional disability. One of the inherent problems with efficacy assessment of pain medication was the lack of objective pain measurements, but functional magnetic resonance imaging (fMRI) has emerged as a useful means to objectify brain response to painful stimulation. We have investigated the effect of chondroitin sulfate (CS) on brain response to knee painful stimulation in patients with knee osteoarthritis using fMRI. Twenty-two patients received CS (800mg/day) and 27 patients placebo, and were assessed at baseline and after 4 months of treatment. Two fMRI tests were conducted in each session by applying painful pressure on the knee interline and on the patella surface. The outcome measurement was attenuation of the response evoked by knee painful stimulation in the brain. fMRI of patella pain showed significantly greater activation reduction under CS compared with placebo in the region of the mesencephalic periaquecductal gray. The CS group, additionally showed pre/post-treatment activation reduction in the cortical representation of the leg. No effects of CS were detected using the interline pressure test. fMRI was sensitive to objectify CS effects on brain response to painful pressure on patellofemoral cartilage, which is consistent with the known CS action on chondrocyte regeneration. The current work yields further support to the utility of fMRI to objectify treatment effects on osteoarthritis pain. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  11. Cooled Radiofrequency Ablation of the Genicular Nerves for Chronic Pain due to Knee Osteoarthritis: Six-Month Outcomes.

    PubMed

    McCormick, Zachary L; Korn, Marc; Reddy, Rajiv; Marcolina, Austin; Dayanim, David; Mattie, Ryan; Cushman, Daniel; Bhave, Meghan; McCarthy, Robert J; Khan, Dost; Nagpal, Geeta; Walega, David R

    2017-04-19

    Determine outcomes of cooled radiofrequency ablation (C-RFA) of the genicular nerves for treatment of chronic knee pain due to osteoarthritis (OA). Cross-sectional survey.  Academic pain medicine center.  Consecutive patients with knee OA and 50% or greater pain relief following genicular nerve blocks who underwent genicular nerve C-RFA.  Survey administration six or more months after C-RFA. Pain numeric rating scale (NRS), Medication Quantification Scale III (MQSIII), Patient Global Impression of Change (PGIC), and total knee arthroplasty (TKA) data were collected. Logistic regression was used to identify factors that predicted treatment success.  Thirty-three patients (52 discrete knees) met inclusion criteria. Thirty-five percent (95% confidence interval [CI] = 22-48) of procedures resulted in the combined outcome of 50% or greater reduction in NRS score, reduction of 3.4 or more points in MQSIII score, and PGIC score consistent with "very much improved/improved." Nineteen percent (95% CI = 10-33) of procedures resulted in complete pain relief. Greater duration of pain and greater than 80% pain relief from diagnostic blocks were identified as predictors of treatment success. The accuracy of the model was 0.88 (95% CI = 0.78-0.97, P  <   0.001).  Genicular C-RFA demonstrated a success rate of 35% based on a robust combination of outcome measures, and 19% of procedures resulted in complete relief of pain at a minimum of six months of follow-up. Report of 80% or greater relief from diagnostic blocks and duration of pain of less than five years are associated with high accuracy in predicting treatment success. Further prospective study is needed to optimize the patient selection protocol and success rate of this procedure.

  12. 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

  13. Knee osteoarthritis pain in the elderly can be reduced by massage therapy, yoga and tai chi: A review.

    PubMed

    Field, Tiffany

    2016-02-01

    This is a review of recently published research, both empirical studies and meta-analyses, on the effects of complementary therapies including massage therapy, yoga and tai chi on pain associated with knee osteoarthritis in the elderly. The massage therapy protocols have been effective in not only reducing pain but also in increasing range of motion, specifically when moderate pressure massage was used and when both the quadriceps and hamstrings were massaged. The yoga studies typically measured pain by the WOMAC. Most of those studies showed a clinically significant reduction in pain, especially the research that focused on poses (e.g. the Iyengar studies) as opposed to those that had integrated protocols (poses, breathing and meditation exercises). The tai chi studies also assessed pain by self-report on the WOMAC and showed significant reductions in pain. The tai chi studies were difficult to compare because of their highly variable protocols in terms of the frequency and duration of treatment. Larger, randomized control trials are needed on each of these therapies using more standardized protocols and more objective variables in addition to the self-reported WOMAC pain scale, for example, range-of-motion and observed range-of-motion pain. In addition, treatment comparison studies should be conducted so, for example, if the lower-cost yoga and tai chi were as effective as massage therapy, they might be used in combination with or as supplemental to massage therapy. Nonetheless, these therapies are at least reducing pain in knee osteoarthritis and they do not seem to have side effects. Copyright © 2016 Elsevier Ltd. All rights reserved.

  14. Periarticular dextrose prolotherapy instead of intra-articular injection for pain and functional improvement in knee osteoarthritis.

    PubMed

    Rezasoltani, Zahra; Taheri, Mehrdad; Mofrad, Morteza Kazempour; Mohajerani, Seyed Amir

    2017-01-01

    Osteoarthritis (OA) is a degenerative disease that can lead to painful and dysfunctional joints. Prolotherapy involves using injections to produce functional restoration of the soft tissues of the joint. Intra-articular injections are controversial because of the introduction of needles into the articular capsule. To compare the effect of periarticular versus intra-articular prolotherapy on pain and disability in patients with knee OA. Randomized double-blind controlled clinical trial. Single center, university hospital (Imam Hossein Hospital, Tehran, Iran). A total of 104 patients with chronic knee OA were enrolled. In the intra-articular group, 8 mL of 10% dextrose and 2 mL of 2% lidocaine were injected. Injections were repeated at 1 and 2 weeks after the first injection. In the periarticular group, 5 mL of 20% dextrose and 5 mL of 1% lidocaine were injected subcutaneously at 4 points in the periarticular area. Pain and disability, as assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), were recorded at each follow-up visit at 1, 2, 3, 4, and 5 months post-injection. The visual analog scale score was significantly lower in the periarticular compared with the intra-articular group at the 2-, 3-, 4-, and 5-month visits but not at 1 month. Morning stiffness and difficulty in rising from sitting were improved in both groups and were not signifi-cantly different in the peri- and intra-articular groups. Pain, joint locking, and limitation scores were all improved in both groups. Difficulty in walking on flat surfaces or climbing stairs, and sitting and standing pain, were all improved in both groups from 1 to 5 months after treatment. WOMAC scores are subjective and could be a limitation of the study. Periarticular prolotherapy has comparable effects on pain and disability due to knee OA to intra-articular injections, while avoiding risks of complications.

  15. A double-blind randomized placebo-controlled feasibility study evaluating individualized homeopathy in managing pain of knee osteoarthritis.

    PubMed

    Koley, Munmun; Saha, Subhranil; Ghosh, Shubhamoy

    2015-07-01

    Few homeopathic complexes seemed to produce significant effects in osteoarthritis; still, individualized homeopathy remained untested. We evaluated the feasibility of conducting an efficacy trial of individualized homeopathy in osteoarthritis. A prospective, parallel-arm, double-blind, randomized, placebo-controlled pilot study was conducted from January to October 2014 involving 60 patients (homeopathy, n = 30; placebo, n = 30) who were suffering from acute painful episodes of knee osteoarthritis and visiting the outpatient clinic of Mahesh Bhattacharyya Homeopathic Medical College and Hospital, West Bengal, India. Statistically significant reduction was achieved in 3 visual analog scales (measuring pain, stiffness, and loss of function) and Osteoarthritis Research Society International scores in both groups over 2 weeks (P < .05); however, group differences were not significant (P > .05). Overall, homeopathy did not appear to be superior to placebo; still, further rigorous evaluation in this design involving a larger sample size seems feasible in future. Clinical Trials Registry, India (CTRI/2014/05/004589). © The Author(s) 2015.

  16. The Modified painDETECT Questionnaire for Patients with Hip or Knee Osteoarthritis: Translation into Dutch, Cross-Cultural Adaptation and Reliability Assessment.

    PubMed

    Rienstra, Wietske; Blikman, Tim; Mensink, Frans B; van Raay, Jos J A M; Dijkstra, Baukje; Bulstra, Sjoerd K; Stevens, Martin; van den Akker-Scheek, Inge

    2015-01-01

    There is a growing amount of evidence that alteration in pain processing by the peripheral and central nervous system play a role in osteoarthritis pain, leading to neuropathic-like symptoms. It is essential to identify knee and hip osteoarthritis patients with a neuropathic pain profile in order to offer such patients education and additional treatment options besides conventional pain treatment. The painDETECT Questionnaire is a self-report questionnaire developed to discriminate between nociceptive and neuropathic pain. This questionnaire was modified to fit patients suffering from knee osteoarthritis. The aim of this study was to translate and cross-culturally adapt the modified painDETECT Questionnaire to the Dutch language and to provide a modified version to fit patients with hip osteoarthritis. Reliability for internal consistency, repeatability and floor and ceiling effects were subsequently assessed. A total of 278 patients were included in the reliability study and 123 patients in the repeatability analysis. The Dutch modified painDETECT Questionnaire shows good internal consistency and small relative measurement errors, represented by a good intraclass correlation coefficient. Absolute measurement error, represented by the Standard Error of Measurement, was acceptable. However, a measurement bias might be present when it comes to repeatability. To our knowledge, this study is the first to provide a Dutch modified painDETECT Questionnaire to fit hip and knee osteoarthritis patients and to assess internal consistency, reliability and agreement. International guidelines were followed in the translation process and this study has ample sample size with an adequate time interval for repeatability. Based on this study, the Dutch modified painDETECT Questionnaire seems to be fit as a discriminative tool to identify knee and hip osteoarthritis patients with a neuropathic pain profile. Whether it is also suitable as an evaluative tool to record changes over time

  17. Effects of hata yoga on knee osteoarthritis.

    PubMed

    Ghasemi, Gholam A; Golkar, Ainaz; Marandi, Sayyd M

    2013-04-01

    The purpose of this research was to study the effects of 8 weeks of Hata yoga exercises on women with knee osteoarthritis. Studies about effects of Yoga on different chronic diseases show that these exercises have positive effects on chronic diseases. As knee osteoarthritis is very common among middle age women we decided to measure effectiveness of these exercises on knee osteoarthritis. Sample included 30 women with knee osteoarthritis who voluntarily participated in this semi-experimental study and were divided into a control group (15) and a yoga group (15). The yoga group received 60 minutes sessions of Hata yoga, 3 times a week and for 8 weeks. Pain, symptoms, daily activities, sports and spare-time activities, and quality of life were respectively measured by Visual Analog Scale (VAS) and Knee injury and Osteoarthritis Outcome Scale (KOOS) questionnaire. The Analysis of Variance (ANOVA) method for repetitive data was used to analyze the results (P = 0.05). Findings showed that pain and symptoms were significantly decreased and scores of daily activities, sports, spare-time activities, and quality of life were significantly increased in the yoga group. It seems that yoga can be used as a conservative treatment besides usual treatments and medications to improve the condition of people with osteoarthritis.

  18. Effects of Hata Yoga on Knee Osteoarthritis

    PubMed Central

    Ghasemi, Gholam A; Golkar, Ainaz; Marandi, Sayyd M

    2013-01-01

    Background: The purpose of this research was to study the effects of 8 weeks of Hata yoga exercises on women with knee osteoarthritis. Studies about effects of Yoga on different chronic diseases show that these exercises have positive effects on chronic diseases. As knee osteoarthritis is very common among middle age women we decided to measure effectiveness of these exercises on knee osteoarthritis. Methods: Sample included 30 women with knee osteoarthritis who voluntarily participated in this semi-experimental study and were divided into a control group (15) and a yoga group (15). The yoga group received 60 minutes sessions of Hata yoga, 3 times a week and for 8 weeks. Pain, symptoms, daily activities, sports and spare-time activities, and quality of life were respectively measured by Visual Analog Scale (VAS) and Knee injury and Osteoarthritis Outcome Scale (KOOS) questionnaire. The Analysis of Variance (ANOVA) method for repetitive data was used to analyze the results (P = 0.05). Results: Findings showed that pain and symptoms were significantly decreased and scores of daily activities, sports, spare-time activities, and quality of life were significantly increased in the yoga group. Conclusions: It seems that yoga can be used as a conservative treatment besides usual treatments and medications to improve the condition of people with osteoarthritis. PMID:23717763

  19. Long-term use of minimal footwear on pain, self-reported function, analgesic intake, and joint loading in elderly women with knee osteoarthritis: A randomized controlled trial.

    PubMed

    Trombini-Souza, Francis; Matias, Alessandra B; Yokota, Mariane; Butugan, Marco K; Goldenstein-Schainberg, Claudia; Fuller, Ricardo; Sacco, Isabel C N

    2015-12-01

    Efforts have been made to retard the progressive debilitating pain and joint dysfunction in patients with knee osteoarthritis. We aimed to evaluate the therapeutic effect of a low-cost minimalist footwear on pain, function, clinical and gait-biomechanical aspects of elderly women with knee osteoarthritis. Throughout a randomized, parallel and controlled clinical trial, fifty-six patients with medial knee osteoarthritis were randomly allocated to an intervention (n=28) or control group (n=28), and assessed at baseline and after three and six months. The intervention involved wearing Moleca(®) footwear for at least 6h/day, 7 days/week, over 6 months. The pain subscale of the Western Ontario and McMaster Universities Osteoarthritis Index was the primary outcome. The secondary outcomes were the other subscales, Lequesne score, distance walked in 6 min, knee oedema and effusion, knee adduction moment and paracetamol intake. Intention-to-treat analysis was performed using two-way casewise ANOVA (< .05) and Cohen's d coefficient. Intervention group showed improvement in pain (effect size: 1.41, p<.001), function (effect size: 1.22, p=.001), stiffness (effect size: 0.76, p=.001), Lequesne score (effect size: 1.07, p<.001), and reduction by 21.8% in the knee adduction moment impulse (p=.017) during gait wearing Moleca(®). The analgesic intake was lower in the intervention group. The long-term use of Moleca(®) footwear relieves pain, improves self-reported function, reduces the knee loading while wearing Moleca(®), refrains the increase of analgesic intake in elderly women with knee osteoarthritis and can be considered as a conservative mechanical treatment option. ClinicalTrials.gov (NCT01342458). Copyright © 2015 Elsevier Ltd. All rights reserved.

  20. A Review of Long-Term Pain Relief after Genicular Nerve Radiofrequency Ablation in Chronic Knee Osteoarthritis.

    PubMed

    Iannaccone, Ferdinand; Dixon, Samuel; Kaufman, Andrew

    2017-03-01

    described pain relief at 3 months, 95% still described pain relief. This group's average percent pain relief was 64% and average day's 0 - 10 pain score 3.3. Our study included a retrospective component in chart review followed by prospective follow-up, only 76% of patients were able to participate in the interview process. Furthermore, some patients suffered from other chronic pain ailments, most commonly chronic back pain, which at times disturbed the patient's ability to focus on solely knee pain. Based on patient interviews and data collection, RFA of genicular nerves can supply on average greater than 60% pain relief in our patient population for as long as 6 months.Key words: Osteoarthritis, knee osteoarthritis, chronic knee pain, radiofrequency ablation, nerve ablation, genicular nerves, long-term pain relief.

  1. Association of knee pain with a reduction in thigh muscle strength - a cross-sectional analysis including 4553 osteoarthritis initiative participants.

    PubMed

    Ruhdorfer, A; Wirth, W; Eckstein, F

    2017-05-01

    To cross-sectionally determine the quantitative relationship of age-adjusted, sex-specific isometric knee extensor and flexor strength to patient-reported knee pain. Difference of thigh muscle strength by age, and that of age-adjusted strength per unit increase on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) knee pain scale, was estimated from linear regression analysis of 4553 Osteoarthritis Initiative (OAI) participants (58% women). Strata encompassing the minimal clinically important difference (MCID) in knee pain were compared to evaluate a potentially non-linear relationship between WOMAC pain levels and muscle strength. In OAI participants without pain, the age-related difference in isometric knee extensor strength was -9.0%/-8.2% (women/men) per decade, and that of flexor strength was -11%/-6.9%. Differences in age-adjusted strength values for each unit of WOMAC pain (1/20) amounted to -1.9%/-1.6% for extensor and -2.5%/-1.7% for flexor strength. Differences in torque/weight for each unit of WOMAC pain ranged from -3.3 to -2.1%. There was no indication of a non-linear relationship between pain and strength across the range of observed WOMAC values, and similar results were observed in women and men. Each increase by 1/20 units in WOMAC pain was associated with a ∼2% lower age-adjusted isometric extensor and flexor strength in either sex. As a reduction in muscle strength is known to prospectively increase symptoms in knee osteoarthritis (KOA) and as pain appears to reduce thigh muscle strength, adequate therapy of pain and muscle strength is required in KOA patients to avoid a vicious circle of self-sustaining clinical deterioration. Copyright © 2016 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  2. The Effects of Yoga on Pain, Mobility, and Quality of Life in Patients with Knee Osteoarthritis: A Systematic Review

    PubMed Central

    Zhang, Jiaqi; Yang, Yonghong

    2016-01-01

    Objective. To systematically assess the effects of yoga on pain, mobility, and quality of life in patients with knee osteoarthritis. Methods. Pubmed, Medline, EMBASE, the Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database (PEDro), and other sources were searched systematically in this study. Two reviewers identified eligible studies and extracted data independently. Downs and Black's Quality Index were used to evaluate the methodological quality of the included studies. Results. A total of 9 articles (6 studies) involving 372 patients with knee osteoarthritis met the inclusion criteria. The most common yoga protocol is 40~90 minutes/session, lasting for at least 8 weeks. The effect of yoga on pain relief and function improvement could be seen after two-week intervention. Conclusion. This systematic review showed that yoga might have positive effects in relieving pain and mobility on patients with KOA, but the effects on quality of life (QOL) are unclear. Besides, more outcome measure related to mental health of yoga effects on people with KOA should be conducted. PMID:27777597

  3. Effect of regenerative injection therapy on function and pain in patients with knee osteoarthritis: a randomized crossover study.

    PubMed

    Dumais, Richard; Benoit, Catherine; Dumais, Alexis; Babin, Lise; Bordage, Rachel; de Arcos, Claire; Allard, Jacques; Bélanger, Mathieu

    2012-08-01

    We assessed the effectiveness of regenerative injection therapy (RIT) to relieve pain and restore function in patients with knee osteoarthritis. Crossover study where participants were randomly assigned to receive exercise therapy for 32 weeks in combination with RIT on weeks 0, 4, 8, and 12 or RIT on weeks 20, 24, 28, and 32. Thirty-six patients with chronic knee osteoarthritis. RIT, which is made up of injections of 1 cc of 15% dextrose 0.6% lidocaine in the collateral ligaments and a 5 cc injection of 20% dextrose 0.5% lidocaine inside the knee joint. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index of severity of osteoarthrosis symptoms (WOMAC) score (range: 0-96). Following 16 weeks of follow-up, the participants assigned to RIT presented a significant reduction of their osteoarthritis symptoms (mean ± standard deviation: -21.8 ± 12.5, P < 0.001). WOMAC scores in this group did not change further during the last 16 weeks of follow-up, when the participants received exercise therapy only (-1.2 ± 10.7, P = 0.65). WOMAC scores in the first 16 weeks did not change significantly among the participants receiving exercise therapy only during this period (-6.1±13.9, P=0.11). There was a significant decrease in this groups' WOMAC scores during the last 16 weeks when the participants received RIT (-9.3±11.4, P=0.006). After 36 weeks, WOMAC scores improved in both groups by 47.3% and 36.2%. The improvement attributable to RIT alone corresponds to a 11.9-point (or 29.5%) decrease in WOMAC scores. The use of RIT is associated with a marked reduction in symptoms, which was sustained for over 24 weeks. Wiley Periodicals, Inc.

  4. Intra-articular hyaluronans: the treatment of knee pain in osteoarthritis

    PubMed Central

    Goldberg, Victor M; Goldberg, Laura

    2010-01-01

    The etiology of pain in osteoarthritis is multifactoral, and includes mechanical and inflammatory processes. Intra-articular injections of hyaluronans (HAs) are indicated when non-pharmacological and simple analgesics have failed to relieve symptoms. The HAs appear to reduce pain by restoring both mechanical and biomechanical homeostasis in the joint. There are five FDA-approved injectable preparations of HAs: Hyalgan®, Synvisc®, Supartz®, Orthovisc® and Euflexxa®. They all appear to relieve pain from 4 to 14 weeks after injection and may have disease-modification properties. Although several randomized controlled trials have established the efficacy of this treatment modality, additional high quality randomized control studies with appropriate comparison are still required to clearly define the role of intra-articular HA injections in the treatment of osteoarthritis. PMID:21197309

  5. Intra-articular hyaluronans: the treatment of knee pain in osteoarthritis.

    PubMed

    Goldberg, Victor M; Goldberg, Laura

    2010-05-10

    The etiology of pain in osteoarthritis is multifactoral, and includes mechanical and inflammatory processes. Intra-articular injections of hyaluronans (HAs) are indicated when non-pharmacological and simple analgesics have failed to relieve symptoms. The HAs appear to reduce pain by restoring both mechanical and biomechanical homeostasis in the joint. There are five FDA-approved injectable preparations of HAs: Hyalgan(®), Synvisc(®), Supartz(®), Orthovisc(®) and Euflexxa(®). They all appear to relieve pain from 4 to 14 weeks after injection and may have disease-modification properties. Although several randomized controlled trials have established the efficacy of this treatment modality, additional high quality randomized control studies with appropriate comparison are still required to clearly define the role of intra-articular HA injections in the treatment of osteoarthritis.

  6. Comparison of intra-articular tenoxicam and oral tenoxicam for pain and physical functioning in osteoarthritis of the knee.

    PubMed

    Unlu, Zeliha; Ay, Kamuran; Tuzun, Cigdem

    2006-02-01

    This study was designed to compare efficacy of local administration of a nonsteroidal anti-inflammatory drug with systemic administration in patients with osteoarthritis (OA) of the knee. For this purpose, intra-articular tenoxicam and oral tenoxicam therapies were applied and the improvement in control of pain and physical functioning were evaluated. A total of 69 patients with OA of the knee were randomized into three groups. Patients in the first group (41 knees of 23 patients) were treated for 1-3 weeks with once weekly intra-articular injection of tenoxicam 20 mg. Patients in the second group (45 knees of 26 patients) received 20 mg/day tenoxicam orally for 3 weeks and only physical exercises were applied to the third group (32 knees of 20 patients). Physical examination of the knee joint, Western Ontario and McMaster Universities Index and the Lequesne Algofunctional Index were used as outcome measurements at baseline, and the 1st, 3rd and 6th months. More significant improvement in pain and disability parameters was observed in groups 1 and 2 than group 3 compared with baseline measures. Among the patients' responses a few of the differences were statistically significant, more in favour of tenoxicam, and tenoxicam seemed to be superior to exercise alone especially at the final evaluation. There was no significant difference between the oral and intra-articular tenoxicam treatment regimens. The results of this study showed that treatment of OA of the knee with intra-articular tenoxicam is as effective as that with oral tenoxicam. It can be thought that intra-articular administration can be preferred to oral therapy due to minimal possibility of systemic side effects.

  7. 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

  8. 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

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

    PubMed

    Makovey, Joanna; Metcalf, Ben; Zhang, Yuqing; Chen, Jian Sheng; Bennell, Kim; March, Lyn; Hunter, David J

    2015-07-08

    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. 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. 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. 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. 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.

  10. Retrowalking as an Adjunct to Conventional Treatment Versus Conventional Treatment Alone on Pain and Disability in Patients with Acute Exacerbation of Chronic Knee Osteoarthritis: A Randomized Clinical Trial

    PubMed Central

    Gondhalekar, Gauri Arun; Deo, Medha Vasant

    2013-01-01

    Background: Increased external knee adduction moment during walking alters the joint biomechanics; which causes symptoms in chronic knee osteoarthritis patients. Aims: To assess additional effects of Retro-walking over conventional treatment on pain and disability in patients with acute exacerbation of chronic knee osteoarthritis. Materials and Methods: Thirty chronic knee osteoarthritis patients were randomly assigned into 2 groups. Group ‘A’ (7 men, 8 women) received conventional treatment. Group ‘B’ (8 men, 7 women) received conventional treatment and Retro-walking. Pain, assessed through visual analogue scale (VAS), and Western Ontario and McMaster Universities Arthritis Index (WOMAC) were the primary outcomes and knee range of motion (ROM), hip abductor and extensor strength were secondary outcomes; measured pre-intervention, after 1 week and after 3 weeks of intervention. Results: Two factors analysis of variance for repeated measures was used for all outcomes. At the end of 3 weeks; WOMAC score showed highly significant difference within (P < 0.0001) and significant difference between groups (P = 0.040) also by Time × group interaction (P = 0.024), VAS showed highly significant difference within groups (P < 0.0001). Knee ROM showed significant difference within groups. Hip abductor and extensor strength showed significant difference by Time × group interaction (P < 0.05). Conclusion: Retrowalking is an effective adjunct to conventional treatment in decreasing disability in patients with knee osteoarthritis. PMID:23641371

  11. Effects of Transcutaneous Electrical Nerve Stimulation on Pain, Pain Sensitivity, and Function in People With Knee Osteoarthritis: A Randomized Controlled Trial

    PubMed Central

    Vance, Carol Grace T.; Rakel, Barbara A.; Blodgett, Nicole P.; DeSantana, Josimari Melo; Amendola, Annunziato; Zimmerman, Miriam Bridget; Walsh, Deirdre M.

    2012-01-01

    Background Transcutaneous electrical nerve stimulation (TENS) is commonly used for the management of pain; however, its effects on several pain and function measures are unclear. Objective The purpose of this study was to determine the effects of high-frequency TENS (HF-TENS) and low-frequency TENS (LF-TENS) on several outcome measures (pain at rest, movement-evoked pain, and pain sensitivity) in people with knee osteoarthritis. Design The study was a double-blind, randomized clinical trial. Setting The setting was a tertiary care center. Participants Seventy-five participants with knee osteoarthritis (29 men and 46 women; 31–94 years of age) were assessed. Intervention Participants were randomly assigned to receive HF-TENS (100 Hz) (n=25), LF-TENS (4 Hz) (n=25), or placebo TENS (n=25) (pulse duration=100 microseconds; intensity=10% below motor threshold). Measurements The following measures were assessed before and after a single TENS treatment: cutaneous mechanical pain threshold, pressure pain threshold (PPT), heat pain threshold, heat temporal summation, Timed “Up & Go” Test (TUG), and pain intensity at rest and during the TUG. A linear mixed-model analysis of variance was used to compare differences before and after TENS and among groups (HF-TENS, LF-TENS, and placebo TENS). Results Compared with placebo TENS, HF-TENS and LF-TENS increased PPT at the knee; HF-TENS also increased PPT over the tibialis anterior muscle. There was no effect on the cutaneous mechanical pain threshold, heat pain threshold, or heat temporal summation. Pain at rest and during the TUG was significantly reduced by HF-TENS, LF-TENS, and placebo TENS. Limitations This study tested only a single TENS treatment. Conclusions Both HF-TENS and LF-TENS increased PPT in people with knee osteoarthritis; placebo TENS had no significant effect on PPT. Cutaneous pain measures were unaffected by TENS. Subjective pain ratings at rest and during movement were similarly reduced by active TENS and

  12. "Functional pain," functional outcomes, and quality of life after hyaluronic acid intra-articular injection for knee osteoarthritis.

    PubMed

    Vincent, Heather K; Montero, Cindy; Conrad, Bryan P; Horodyski, MaryBeth; Connelly, Jacob; Martenson, Matthew; Seay, Amanda N; Vincent, Kevin R

    2013-04-01

    To compare the effect of hyaluronic acid (HA) intra-articular knee injections on pain and functional outcomes in persons with knee osteoarthritis (OA) over 6 months, and to determine whether or not changes in functional pain are related to improvements in quality of life. A prospective cohort study. A research laboratory in an academic medical center. Patients with knee OA (N = 53) who were receiving medical care for OA. Intra-articular knee injections of HA (3 injections, each separated by 1 week) and a comparative noninjection group. Functional pain and outcomes assessments during chair rise, stair climbing, and a 6-minute walking test (by using 0-10 point numerical pain ratings during each test); gait parameters; Medical Outcomes Short Form-36 (SF-36) scores and subscores; the Western Ontario McMaster University Osteoarthritis Index (WOMAC). Six months after HA, the completion times for the chair rise and stair climb tasks, and the distance covered during the 6-minute walk were not different between the groups. However, functional pain ratings during stair climbing decreased in the HA-treated group (P = .05). Six-month changes in gait velocity, cadence, stride length, step length, and the percentage of the gait cycle spent in single support were all higher after HA injection at month 6 (all P < .05). Significant group-by-time interactions existed for total WOMAC scores. SF-36 Vitality subscores improved by 13%, and Role Physical scores were higher in patients treated with HA injection compared with participants in the noninjection group (P < .05). Regression analyses revealed that changes in the functional pain measures did not correspond with SF-36 scores. HA is associated with lower functional pain severity, with minimal impact on functional test scores. We interpreted this finding to represent an increase in the quality of the movement and functional activity. The change in functional pain did not correspond to changes in SF-36 quality-of-life scores

  13. Effect of variable-stiffness walking shoes on knee adduction moment, pain, and function in subjects with medial compartment knee osteoarthritis after 1 year.

    PubMed

    Erhart-Hledik, Jennifer C; Elspas, Barbara; Giori, Nicholas J; Andriacchi, Thomas P

    2012-04-01

    This study investigated the load-modifying and clinical efficacy of variable-stiffness shoes after 12 months in subjects with medial compartment knee osteoarthritis. Subjects who completed a prior 6-month study were asked to wear their assigned constant-stiffness control or variable-stiffness intervention shoes during the remainder of the study. Changes in peak knee adduction moment, total Western Ontario and McMaster Universities (WOMAC), and WOMAC pain scores were assessed. Seventy-nine subjects were enrolled, and 55 completed the trial. Using an intention-to-treat analysis, the variable-stiffness shoes reduced the within-day peak knee adduction moment (-5.5%, p < 0.001) in the intervention subjects, while the constant-stiffness shoes increased the peak knee adduction moment in the control subjects (+3.1%, p = 0.015) at the 12-month visit. WOMAC pain and total scores for the intervention group were significantly reduced from baseline to 12 months (-32%, p = 0.002 and -35%, p = 0.007, respectively). The control group had a reduction of 27% in WOMAC pain score (p = 0.04) and no significant reduction in total WOMAC score. Reductions in WOMAC pain and total scores were similar between groups (p = 0.8 and p = 0.47, respectively). In the intervention group, reductions in adduction moment were related to improvements in pain and function (R(2)  = 0.11, p = 0.04). Analysis by disease severity revealed greater efficacy in adduction moment reduction in the less severe intervention group. While the long-term effects of the intervention shoes on pain and function did not differ from control, the data suggest wearing the intervention shoe reduces the within-day adduction moment after long-term wear, and thus should reduce loading on the affected medial compartment of the knee.

  14. A Cross-Sectional Examination of Vitamin D, Obesity, and Measures of Pain and Function in Middle-Aged and Older Adults with Knee Osteoarthritis

    PubMed Central

    Glover, Toni L.; Goodin, Burel R.; King, Christopher D.; Sibille, Kimberly T.; Herbert, Matthew S.; Sotolongo, Adriana S.; Cruz-Almeida, Yenisel; Bartley, Emily J.; Bulls, Hailey W.; Horgas, Ann L.; Redden, David T.; Riley, Joseph L.; Staud, Roland; Fessler, Barri J.; Bradley, Laurence A.; Fillingim, Roger B.

    2015-01-01

    Objectives The prevalence of knee osteoarthritis is increasing with the aging population and is exacerbated by the growing numbers of obese older adults. Low levels of vitamin D, measured by serum 25-hydroxyvitamin D (25(OH)D), in older adults and obese individuals are correlated with several negative health conditions, including chronic pain. This cross-sectional study sought to examine the interactive influence of 25(OH)D levels and obesity on knee osteoarthritis pain and functional performance measures. Methods The sample consisted of 256 (63% female) racially-diverse (55% Black/African Americans) middle-aged and older adults (mean age 56.8 years). Blood was collected for analysis of 25(OH)D by high performance liquid chromatography. Participants provided self-report regarding knee osteoarthritis pain and underwent a lower extremity functional performance test. Results Results demonstrated that obesity was associated with lower levels of 25(OH)D. Participants with adequate 25(OH)D levels reported significantly less knee osteoarthritis pain compared to participants with deficient or insufficient levels, regardless of obesity status. Furthermore, there was a significant interaction between obesity and 25(OH)D levels for lower extremity functional performance, such that obese individuals with adequate 25(OH)D levels demonstrated better performance than those obese participants with deficient or insufficient 25(OH)D levels. Discussion The mechanisms by which adequate 25(OH)D levels are associated with pain severity and improved function have not been completely elucidated. It may be that the pleiotropic role of biologically active 25(OH)D influences pain and pain processing via peripheral and central mechanisms. Alternatively, higher levels of pain may lead to reduced outdoor activity, which may contribute to both obesity and decreased vitamin D. Thus, investigating vitamin D status in obese and non-obese individuals with knee osteoarthritis warrants further study

  15. 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

  16. 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.

  17. The relationship between psychosocial variables and pain reporting in osteoarthritis of the knee.

    PubMed

    Creamer, P; Hochberg, M C

    1998-02-01

    Psychosocial factors may explain some of the variation in pain reporting among individuals with knee OA. This has important potential implications for management; indeed, several studies (reviewed in ref. 56) have demonstrated that interventions may reduce knee pain without apparent halting or reversing of structural damage. Such interventions have included the simple provision of support by monthly telephone calls (57), self-management programs (58), and cognitive-behavioral approaches designed to teach patients ways of coping with their pain (59). These programs are even more effective if the spouse is involved (60). It should be noted that there may be a large placebo effect in these interventions, and the degree to which patients are responding simply to an interest being taken in them and their problems is unclear; at least one study has shown that formal cognitive-behavioral therapy is no better than didactic education at improving pain and function in knee OA (though both are beneficial) (61). Many studies examining the role of psychosocial factors have suffered from poor design; many, for example, fail to control for radiographic severity. Future studies should define how pain is identified (dichotomous, ever/never/current, severity), differentiate community and hospital subjects, and separate patients by type and location of OA. Studies should also control for other factors potentially associated with pain: obesity, comorbidity, muscle weakness, and aerobic fitness. Prospective studies would allow clarification of the cause and effect relationship between anxiety, depression, and pain, both in the community and in patients who have elected to seek medical help. In this way, we may increase our understanding of the complex interaction between mood, social factors, and pain reporting in knee OA and, thus, improve the effectiveness, already equivalent to many pharmacologic interventions, of treatments designed to address psychosocial factors.

  18. Fatigue in knee and hip osteoarthritis: the role of pain and physical function.

    PubMed

    Snijders, Gijs F; van den Ende, Cornelia H M; Fransen, Jaap; van Riel, Piet L C M; Stukstette, Mirelle J P M; Defoort, Koen C; Arts-Sanders, Marianne A; van den Hoogen, Frank H J; den Broeder, Alfons A

    2011-10-01

    It is suggested that serious levels of fatigue are present in nearly half of patients with OA. However, it is unclear which dimensions of fatigue are involved, if fatigue is related to pain and physical function, and if fatigue is influenced by therapy. The aims of this study were to measure levels of different dimensions of fatigue before and after evidenced-based conservative treatment and to investigate the association between fatigue and pain and physical function in patients with knee or hip OA. In this observational cohort study, levels of different dimensions of fatigue were measured in knee and/or hip OA patients before and after 12 weeks of conservative treatment. Cross-sectional and longitudinal relations between (change in) fatigue dimensions and (change in) pain or physical function were studied using association models, controlling for predefined possible confounders. A total of 231 patients was included, with 47% experiencing severe fatigue. A small decrease in levels of fatigue was seen after standardized treatment. The level of fatigue severity was cross-sectionally and longitudinally associated with physical function, whereas the level of physical fatigue was cross-sectionally and longitudinally associated with pain and physical function. No confounders were identified. Important levels of fatigue are common in knee and hip OA patients. After evidence-based tailored conservative treatment targeted to improve pain and physical function, a small decrease in fatigue levels was found. Reduction in levels of different fatigue dimensions were related to the change in physical function and pain.

  19. Unloader Braces for Medial Compartment Knee Osteoarthritis

    PubMed Central

    Ramsey, Dan K.; Russell, Mary E.

    2009-01-01

    Background: For persons with unicompartment knee osteoarthritis (OA), off-unloader braces are a mechanical intervention designed to reduce pain, improve physical function, and possibly slow disease progression. Pain relief is thought to be mediated by distracting the involved compartment via external varus or valgus forces applied to the knee. In so doing, tibiofemoral alignment is improved, and load is shifted off the degenerative compartment, where exposure to potentially damaging and provocative mechanical stresses are reduced. Objectives: To provide a synopsis of the evidence documented in the scientific literature concerning the efficacy of off-loader knee braces for improving symptomatology associated with painful disabling medial compartment knee OA. Search Strategy: Relevant peer-reviewed publications were retrieved from a MEDLINE search using the terms with the reference terms osteoarthritis, knee, and braces (per Medical Subject Headings), plus a manual search of bibliographies from original and review articles and appropriate Internet resources. Results: For persons with combined unicompartment knee OA and mild to moderate instability, the strength of recommendation reported by the Osteoarthritis Research Society International in the ability of off-loader knee braces to reduce pain, improve stability, and diminish the risk of falling was 76% (95% confidence interval, 69%-83%). The more evidence the treatment is effective, the higher the percentage. Conclusions: Given the encouraging evidence that off-loader braces are effective in mediating pain relief in conjunction with knee OA and malalignment, bracing should be fully used before joint realignment or replacement surgery is considered. With the number of patients with varus deformities and knee pain predicted to increase as the population ages, a reduction of patient morbidity for this widespread chronic condition in combination with this treatment modality could have a positive impact on health care

  20. Immediate effects of electroacupuncture and manual acupuncture on pain, mobility and muscle strength in patients with knee osteoarthritis: a randomised controlled trial.

    PubMed

    Plaster, Ralph; Vieira, Wellington Bueno; Alencar, Flávia Alves Duarte; Nakano, Eduardo Yoshio; Liebano, Richard Eloin

    2014-06-01

    To compare the immediate effects of electroacupuncture and manual acupuncture on pain, mobility and muscle strength in patients with knee osteoarthritis. Sixty patients with knee osteoarthritis, with a pain intensity of ≥2 on the pain Numerical Rating Scale, were included. The patients were randomised into two groups: manual acupuncture and electroacupuncture. Pain intensity, degree of dysfunction (Timed Up and Go (TUG) test), maximal voluntary isometric contraction and pressure pain threshold were assessed before and after a single session of manual acupuncture or electroacupuncture treatments. Both groups showed a significant reduction in pain intensity (p<0.001) and time to run the TUG test after the acupuncture treatment (p=0.005 for the manual acupuncture group and p=0.002 for the electroacupuncture group). There were no differences between the groups regarding pain intensity (p=0.25), TUG test (p=0.70), maximum voluntary isometric contraction (p=0.43) or pressure pain threshold (p=0.27). This study found no difference between the immediate effects of a single session of manual acupuncture and electroacupuncture on pain, muscle strength and mobility in patients with knee osteoarthritis. RBR-9TCN2X. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  1. Using hierarchical linear modeling to explore predictors of pain after total hip and knee arthroplasty as a consequence of osteoarthritis.

    PubMed

    Halket, Ashley; Stratford, Paul W; Kennedy, Deborah M; Woodhouse, Linda J

    2010-02-01

    Hierarchical linear modeling was used to establish differences in, and the average pattern of, recovery of the pain subscale of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and 2 composite performance-specific measures of pain as well as to determine if significant individual variations exist in the growth curves for each measure. Predictors of postoperative pain were also of interest. One hundred forty-seven patients undergoing unilateral primary hip or knee arthroplasty completed 4 performance measures-self-paced 40-m walk, timed up and go, stair test, and 6-minute walk-and the WOMAC prearthroplasty and at multiple points in time between 2 and 27 weeks postarthroplasty. Although patients reported different levels of postoperative pain initially, similar recovery patterns were noted. Predictive variables were found to be site of joint arthroplasty and WOMAC prearthroplasty pain scores for the WOMAC pain subscale, the site of joint arthroplasty and sex for the first composite pain score, and sex for the second composite. 2010 Elsevier Inc. All rights reserved.

  2. Do radiographic disease and pain account for why people with or at high risk of knee osteoarthritis do not meet Physical Activity Guidelines?

    PubMed Central

    White, Daniel K.; Tudor-Locke, Catrine; Felson, David T.; Gross, K. Doug; Niu, Jingbo; Nevitt, Michael; Lewis, Cora E.; Torner, James; Neogi, Tuhina

    2012-01-01

    OBJECTIVE Knee Osteoarthritis (OA) and pain are assumed to be barriers for meeting physical activity guidelines, but this has not been formally evaluated. The purpose of this study was to determine the proportion of people with and without knee OA and knee pain who met recommended physical activity levels through walking. METHODS Cross-sectional analysis of community dwelling adults who have or who are at high risk of knee OA from The Multicenter Osteoarthritis Study. Participants wore a StepWatch activity monitor to record steps/day over 7 days. The proportion that met the recommended physical activity levels was determined as those accumulating ≥150 minutes/week at ≥100 steps/minute in bouts lasting ≥10 minutes. These proportions were also determined for those with and without knee OA, as classified by radiograph, and by severity of knee pain. RESULTS Of the 1788 study participants (age 67 sd 8 yrs, BMI 31 sd 6 kg/m2, 60% female), lower overall percentages of participants with radiographic knee OA and knee pain met recommended physical activity levels. However, these differences were not statistically significant between those with and without knee OA; 7.3% and 10.1% of men (p=0.34), and 6.3% and 7.8% of women (p=0.51), respectively, met recommended physical activity levels. Similarly, for those with moderate/severe pain versus no pain, 12.9% and 10.9% of men (p=0.74) and 6.7% and 11.0% (p=0.40) of women met recommended physical activity levels. CONCLUSIONS Disease and pain have little impact on achieving recommended physical activity levels among people with or at high risk of knee OA. PMID:23124774

  3. Successful nonoperative management of chronic osteoarthritis pain of the knee: safety and efficacy of retreatment with intra-articular hyaluronans.

    PubMed

    Pagnano, Mark; Westrich, Geoffrey

    2005-09-01

    Although there are many nonsurgical therapies available for the treatment of pain associated with osteoarthritis (OA), their long-term use and safety have not been systematically followed. Intra-articular hyaluronan therapy has been used in the treatment of symptoms associated with OA of the knee with a very favorable safety profile. Five intra-articular hyaluronan products are approved in the US. No systematic review of the safety and efficacy of their chronic use has been reported. To evaluate the literature on the efficacy and safety of repeat courses of hyaluronan therapy in patients with OA of the knee. MEDLINE, EMBASE, searched through October 2004. Databases were searched using the terms hyaluronan, sodium hyaluronate, hyaluronic acid, hylan, hylan G-F 20, osteoarthritis, adverse events, repeat treatment, and multiple courses. There are some data that support the benefit and safety of repeat treatment for all products. Data also indicate that one formulation of sodium hyaluronate (molecular weight [MW] 500-730 kDa) is well tolerated and as effective after multiple courses of treatment as it is after a single course. There is also clinical evidence that prolonged use of sodium hyaluronate (MW 500-730 kDa) may significantly decrease the rate of deterioration of joint structure. Localized severe acute inflammatory reactions reported with repeated treatment in some patients are not a class effect but may be linked to physicochemical characteristics of hylan-based treatment. Repeat courses of the hyaluronans are safe and effective in the treatment of pain associated with OA of the knee.

  4. Effects of an exercise therapy protocol on inflammatory markers, perception of pain, and physical performance in individuals with knee osteoarthritis.

    PubMed

    Aguiar, Grazielle Cordeiro; Do Nascimento, Marcela Rêgo; De Miranda, Aline Silva; Rocha, Natalia Pessoa; Teixeira, Antônio Lúcio; Scalzo, Paula Luciana

    2015-03-01

    Establishing prevention and therapeutic strategies for osteoarthritis (OA) is necessary to minimize functional disability and the impact of the disease on society. The aim of this study was to determine the effects of an exercise therapy protocol on inflammatory markers, perception of pain, and physical performance in individuals with OA of the knee. The protocol consisted of flexibility training and muscle strengthening over 12 weeks with three 80-min sessions per week. Peripheral blood was collected to determine serum levels of interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), and soluble forms of the TNF-α receptor (sTNFR1 and sTNFR2). A clinical assessment of the musculoskeletal system and Western Ontario and McMaster Universities (WOMAC) questionnaire were applied to evaluate the specific symptoms of knee OA. Pain intensity was evaluated using a visual analog scale (VAS). All measurements were taken before and after the intervention. Twenty-two individuals (mean age 58.8 ± 6.4 years) completed the protocol. A decrease in the perception of pain was evident on VAS (p < 0.001) and pain subscale of the WOMAC (p < 0.001). In addition, there was a reduction in serum levels of IL-6 (p < 0.001). However, changes in the levels of the TNF-α and its soluble receptors were not statistically significant. Physical function subscale score and the WOMAC global score improved significantly (p < 0.001). The training also promoted an increase in the progression load for all muscles groups analyzed (p < 0.001). Our data suggest that the exercise therapy protocol could be a strategy for reducing IL-6 levels, managing pain, and improving function in individuals with OA of the knee. However, more studies are necessary to investigate the issue.

  5. Longitudinal assessment of cyst-like lesions of the knee and their relation to radiographic osteoarthritis and MRI-detected effusion and synovitis in patients with knee pain

    PubMed Central

    2010-01-01

    Introduction The purpose of the present study was to determine the prevalence of cystic lesions and cyst-like bursitides in subjects with frequent knee pain and to assess their relation to radiographic osteoarthritis (OA) severity; to describe bilaterality and size fluctuation of the lesions over 6 months; and to assess relations between the prevalence of synovium-lined lesions communicating with the joint capsule and severity of magnetic resonance imaging (MRI)-detected effusion and synovitis. Methods One hundred and sixty-three subjects (total 319 knees) aged 35 to 65 with chronic, frequent knee pain were included. Imaging with 3 Tesla MRI was performed at baseline and 6-month follow-up with the same protocols as those used in the Osteoarthritis Initiative. Severity of radiographic OA was assessed using the Kellgren-Lawrence grade (0 to 4). Severity of effusion and synovitis was graded 0 to 3 based on the Whole Organ Magnetic Resonance Imaging Score system. The associations of cysts and cyst-like bursitides and severity of radiographic OA, MRI-detected effusion and synovitis were analyzed using logistic regression controlling for clustering by person. The Wilcoxon signed-rank test was used to determine whether there was a significant change in the size of lesions between baseline and follow-up. Results At least one lesion (any type) was present in 222 (70%) knees. The most prevalent lesions were popliteal cysts (40%, 128/319), followed by subgastrocnemius bursitis (15%, 49/319) and proximal tibiofibular joint cysts (8%, 26/319). Bilateral lesions were seen in 49% of the subjects. Only popliteal cysts and subgastrocnemius bursitis showed a significant change in size (P < 0.001). No trend was observed between prevalence of any of the cyst-like lesions analyzed and the increasing radiographic OA severity. Increasing prevalence of subgastrocnemius bursitis was associated with increasing severity of effusion (P = 0.0072) and synovitis (P = 0.0033). Conclusions None of

  6. Periarticular dextrose prolotherapy instead of intra-articular injection for pain and functional improvement in knee osteoarthritis

    PubMed Central

    Rezasoltani, Zahra; Taheri, Mehrdad; Mofrad, Morteza Kazempour; Mohajerani, Seyed Amir

    2017-01-01

    Background Osteoarthritis (OA) is a degenerative disease that can lead to painful and dysfunctional joints. Prolotherapy involves using injections to produce functional restoration of the soft tissues of the joint. Intra-articular injections are controversial because of the introduction of needles into the articular capsule. Objectives To compare the effect of periarticular versus intra-articular prolotherapy on pain and disability in patients with knee OA. Study design Randomized double-blind controlled clinical trial. Setting Single center, university hospital (Imam Hossein Hospital, Tehran, Iran). Methods A total of 104 patients with chronic knee OA were enrolled. In the intra-articular group, 8 mL of 10% dextrose and 2 mL of 2% lidocaine were injected. Injections were repeated at 1 and 2 weeks after the first injection. In the periarticular group, 5 mL of 20% dextrose and 5 mL of 1% lidocaine were injected subcutaneously at 4 points in the periarticular area. Pain and disability, as assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), were recorded at each follow-up visit at 1, 2, 3, 4, and 5 months post-injection. Results The visual analog scale score was significantly lower in the periarticular compared with the intra-articular group at the 2-, 3-, 4-, and 5-month visits but not at 1 month. Morning stiffness and difficulty in rising from sitting were improved in both groups and were not signifi-cantly different in the peri- and intra-articular groups. Pain, joint locking, and limitation scores were all improved in both groups. Difficulty in walking on flat surfaces or climbing stairs, and sitting and standing pain, were all improved in both groups from 1 to 5 months after treatment. Limitations WOMAC scores are subjective and could be a limitation of the study. Conclusion Periarticular prolotherapy has comparable effects on pain and disability due to knee OA to intra-articular injections, while avoiding risks of

  7. Low-level laser therapy of myofascial pain syndromes of patients with osteoarthritis of knee and hip joints

    NASA Astrophysics Data System (ADS)

    Gasparyan, Levon V.

    2001-04-01

    The purpose of the given research is the comparison of efficiency of conventional treatment of myofascial pain syndromes of patients with osteoarthritis (OA) of hip and knee joints and therapy with additional application of low level laser therapy (LLLT) under dynamic control of clinical picture, rheovasographic, electromyographic examinations, and parameters of peroxide lipid oxidation. The investigation was made on 143 patients with OA of hip and knee joints. Patients were randomized in 2 groups: basic group included 91 patients, receiving conventional therapy with a course of LLLT, control group included 52 patients, receiving conventional treatment only. Transcutaneous ((lambda) equals 890 nm, output peak power 5 W, frequency 80 - 3000 Hz) and intravenous ((lambda) equals 633 nm, output 2 mW in the vein) laser irradiation were used for LLLT. Studied showed, that clinical efficiency of LLLT in the complex with conventional treatment of myofascial pain syndromes at the patients with OA is connected with attenuation of pain syndrome, normalization of parameters of myofascial syndrome, normalization of the vascular tension and parameters of rheographic curves, as well as with activation of antioxidant protection system.

  8. Acupuncture for pain and osteoarthritis of the knee: a pilot study for an open parallel-arm randomised controlled trial.

    PubMed

    Lansdown, Harriet; Howard, Katie; Brealey, Stephen; MacPherson, Hugh

    2009-10-24

    There is some evidence that acupuncture for pain and osteoarthritis (OA) of the knee is more than a placebo, and short term clinical benefits have been observed when acupuncture is compared to usual care. However there is insufficient evidence on whether clinical benefits of acupuncture are sustained over the longer term. In this study our key objectives are to inform the design parameters for a fully powered pragmatic randomised controlled trial. These objectives include establishing potential recruitment rates, appropriate validated outcome measures, attendance levels for acupuncture treatment, loss to follow up and the sample size for a full scale trial. Potential participants aged over 50 with pain and osteoarthritis of the knee were identified from a GP database. Eligible patients were randomised to either 'acupuncture plus usual care' and 'usual care' alone, with allocation appropriately concealed. Acupuncture consisted of up to 10 sessions usually weekly. Outcome measures included Western Ontario and McMaster Universities (WOMAC) index with the sample size for a full scale trial determined from the variance. From the GP database of 15,927 patients, 335 potential trial participants were identified and invited to participate. After screening responses, 78 (23%) were identified as eligible and 30 patients who responded most promptly were randomised to 'acupuncture plus usual care' (15 patients) and 'usual care' alone (15 patients). Attendance for acupuncture appointments was high at 90% of the maximum. Although the trial was not powered to detect significant changes in outcome, the WOMAC pain index showed a statistically significant reduction at 3 months in the acupuncture group compared to usual care. This was not sustained at 12 months. The sample size for a fully powered two-arm trial was estimated to be 350. This pilot study provided the evidence that a fully powered study to explore the longer term impact of acupuncture would be worthwhile, and relevant

  9. Preliminary study of highly cross-linked hyaluronic acid-based combination therapy for management of knee osteoarthritis-related pain

    PubMed Central

    Palmieri, Beniamino; Rottigni, Valentina; Iannitti, Tommaso

    2013-01-01

    Background Hyaluronic acid has been extensively used for treatment of knee osteoarthritis due to its anti-inflammatory properties and its ability to act as a synovial lubricant. Furthermore, it has found application in combination with other drugs in the dermatological field and in pre-clinical studies in animal models of osteoarthritis. Experimental evidence suggests that a combination of this macromolecule with other drugs may act as a slow-release depot. However, to date, to the best of our knowledge, no one has tested local intra-articular delivery of highly cross-linked hyaluronic acid combined with bisphosphonate or nonsteroidal anti-inflammatory drugs for management of knee osteoarthritis pain in the clinical setting. The aim of the present randomized double-blind study was to investigate, for the first time, the effect of a highly cross-linked hyaluronic acid, Variofill®, alone or in combination with diclofenac sodium or sodium clodronate, for management of bilateral knee osteoarthritis-related pain. Methods Sixty-two patients with symptomatic bilateral medial tibiofemoral knee osteoarthritis (Kellgren–Lawrence grade II and III) and pain in both knees corresponding to a daily visual analog scale (VAS) score ≥ 30 in the month before the beginning of the study were included in this investigation. Patients were divided into three groups: group 1, treated with an injection of hyaluronic acid alone (66 mg) into each knee; group 2, treated with an injection of hyaluronic acid (49.5 mg) plus diclofenac sodium (5 mg) into each knee; group 3, treated with an injection of hyaluronic acid (49.5 mg) plus sodium clodronate (5 mg) into each knee. Patients also underwent blood tests for measurement of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) immediately before and at 6-month follow-up. Results Hyaluronic acid alone and in combination with sodium clodronate or diclofenac sodium produced a significant improvement in mean VAS pain score at 3 and

  10. The effect of self-administered superficial local hot and cold application methods on pain, functional status and quality of life in primary knee osteoarthritis patients.

    PubMed

    Aciksoz, Semra; Akyuz, Aygul; Tunay, Servet

    2017-09-07

    To investigate the effect of the self-administered superficial local hot and cold applications on pain, and the functional status and the quality of life in primary knee osteoarthritis patients. Superficial local hot and cold application is used as a non-pharmacological method for the treatment of knee osteoarthritis. However, various guidelines for the management of knee osteoarthritis have conflicting recommendation for hot and cold therapy. A randomized clinical trial design. The sample consisted of patients (n=96) who were diagnosed with primary knee osteoarthritis. During the application stage, patients were designated to the hot and cold application groups and administered hot and cold application twice a day for three weeks together with standard osteoarthritis treatment. The control group only used standard osteoarthritis treatment. The data were collected with a Descriptive Information Form, a Pain Scale, the WOMAC Osteoarthritis Index, the Nottingham Health Profile and a Patient Satisfaction Evaluation Form. Outcome measures included pain intensity, functional status and quality of life. We found decreased primary measurement pain scores, and improved functional status scores and quality of life scores after the application program compared to the pre-application stage in both the hot and cold application groups. Once the application was completed, the pain scores, functional status scores and quality of life scores on the second measurements were found to be still statistically lower than the pre-application scores but higher than the first measurement (p<0.001, χ2=48.000; p<0.001, χ2=34.000), (p<0.001, χ2=22.000; p=0.001 χ2=14.000), (p=0.005, χ2=16.000; p=0.001, χ2=12.500). There was no difference in the perceived pain, functional status, and quality of life between the pre-application, post-application and two weeks post-application periods of the individuals in three groups (p>0.05). It was found that both hot and cold application resulted in a

  11. Pain sensitisation and the risk of poor outcome following physiotherapy for patients with moderate to severe knee osteoarthritis: protocol for a prospective cohort study

    PubMed Central

    O'Leary, Helen; Smart, Keith M; Moloney, Niamh A; Blake, Catherine; Doody, Catherine M

    2015-01-01

    Introduction Pain is the dominant symptom of knee osteoarthritis (OA), and recent evidence suggests factors outside of local joint pathology, such as pain sensitisation, can contribute significantly to the pain experience. It is unknown how pain sensitisation influences outcomes from commonly employed interventions such as physiotherapy. The aims of this study are, first, to provide a comprehensive description of the somatosensory characteristics of people with pain associated with knee OA. Second, we will investigate if indicators of pain sensitisation in patients with knee osteoarthritis are predictive of non-response to physiotherapy. Methods and analysis This is a multicentre prospective cohort study with 140 participants. Eligible patients with moderate to severe symptomatic knee osteoarthritis will be identified at outpatient orthopaedic and rheumatology clinics. A baseline assessment will provide a comprehensive description of the somatosensory characteristics of each participant by means of clinical examination, quantitative sensory testing, and validated questionnaires measuring pain and functional capacity. Participants will then undergo physiotherapy treatment. The primary outcome will be non-response to physiotherapy on completion of the physiotherapy treatment programme as defined by the Osteoarthritis Research Society International treatment responder criteria. A principal component analysis will identify measures related to pain sensitisation to include in the predictive model. Regression analyses will explore the relationship between responder status and pain sensitisation while accounting for confounders. Ethics and dissemination This study has been approved by St James’ Hospital/AMNCH Research Ethics Committee and by the St Vincent's Healthcare Group Ethics and Medical Research Committee. The results will be presented at international conferences and published in a peer review journal. Trial registration number NCT02310945. PMID:26059523

  12. Pain sensitisation and the risk of poor outcome following physiotherapy for patients with moderate to severe knee osteoarthritis: protocol for a prospective cohort study.

    PubMed

    O'Leary, Helen; Smart, Keith M; Moloney, Niamh A; Blake, Catherine; Doody, Catherine M

    2015-06-09

    Pain is the dominant symptom of knee osteoarthritis (OA), and recent evidence suggests factors outside of local joint pathology, such as pain sensitisation, can contribute significantly to the pain experience. It is unknown how pain sensitisation influences outcomes from commonly employed interventions such as physiotherapy. The aims of this study are, first, to provide a comprehensive description of the somatosensory characteristics of people with pain associated with knee OA. Second, we will investigate if indicators of pain sensitisation in patients with knee osteoarthritis are predictive of non-response to physiotherapy. This is a multicentre prospective cohort study with 140 participants. Eligible patients with moderate to severe symptomatic knee osteoarthritis will be identified at outpatient orthopaedic and rheumatology clinics. A baseline assessment will provide a comprehensive description of the somatosensory characteristics of each participant by means of clinical examination, quantitative sensory testing, and validated questionnaires measuring pain and functional capacity. Participants will then undergo physiotherapy treatment. The primary outcome will be non-response to physiotherapy on completion of the physiotherapy treatment programme as defined by the Osteoarthritis Research Society International treatment responder criteria. A principal component analysis will identify measures related to pain sensitisation to include in the predictive model. Regression analyses will explore the relationship between responder status and pain sensitisation while accounting for confounders. This study has been approved by St James' Hospital/AMNCH Research Ethics Committee and by the St Vincent's Healthcare Group Ethics and Medical Research Committee. The results will be presented at international conferences and published in a peer review journal. NCT02310945. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a

  13. Cannabinoid CB2 receptors regulate central sensitization and pain responses associated with osteoarthritis of the knee joint.

    PubMed

    Burston, James J; Sagar, Devi Rani; Shao, Pin; Bai, Mingfeng; King, Emma; Brailsford, Louis; Turner, Jenna M; Hathway, Gareth J; Bennett, Andrew J; Walsh, David A; Kendall, David A; Lichtman, Aron; Chapman, Victoria

    2013-01-01

    Osteoarthritis (OA) of the joint is a prevalent disease accompanied by chronic, debilitating pain. Recent clinical evidence has demonstrated that central sensitization contributes to OA pain. An improved understanding of how OA joint pathology impacts upon the central processing of pain is crucial for the identification of novel analgesic targets/new therapeutic strategies. Inhibitory cannabinoid 2 (CB2) receptors attenuate peripheral immune cell function and modulate central neuro-immune responses in models of neurodegeneration. Systemic administration of the CB2 receptor agonist JWH133 attenuated OA-induced pain behaviour, and the changes in circulating pro- and anti-inflammatory cytokines exhibited in this model. Electrophysiological studies revealed that spinal administration of JWH133 inhibited noxious-evoked responses of spinal neurones in the model of OA pain, but not in control rats, indicating a novel spinal role of this target. We further demonstrate dynamic changes in spinal CB2 receptor mRNA and protein expression in an OA pain model. The expression of CB2 receptor protein by both neurones and microglia in the spinal cord was significantly increased in the model of OA. Hallmarks of central sensitization, significant spinal astrogliosis and increases in activity of metalloproteases MMP-2 and MMP-9 in the spinal cord were evident in the model of OA pain. Systemic administration of JWH133 attenuated these markers of central sensitization, providing a neurobiological basis for analgesic effects of the CB2 receptor in this model of OA pain. Analysis of human spinal cord revealed a negative correlation between spinal cord CB2 receptor mRNA and macroscopic knee chondropathy. These data provide new clinically relevant evidence that joint damage and spinal CB2 receptor expression are correlated combined with converging pre-clinical evidence that activation of CB2 receptors inhibits central sensitization and its contribution to the manifestation of chronic OA

  14. 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.

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

    PubMed

    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.

  16. Transdermal fentanyl for the treatment of pain caused by osteoarthritis of the knee or hip: an open, multicentre study

    PubMed Central

    Le Loët, Xavier; Pavelka, Karel; Richarz, Ute

    2005-01-01

    Background This study was designed to evaluate the utility of transdermal fentanyl (TDF, Durogesic®) for the treatment of pain due to osteoarthritis (OA) of the knee or hip, which was not adequately controlled by non-opioid analgesics or weak opioids. The second part of the trial, investigating TDF in patients with rheumatoid arthritis (RA) is reported separately. Methods Current analgesia was optimised during a 1-week run-in. Patients then received 28 days treatment with TDF starting at 25 μg/hr, with the option to increase the dose until adequate pain control was achieved. Metoclopramide was taken during the first week and then as needed. Results Of the 159 patients recruited, 75 with OA knee and 44 with OA hip completed the treatment phase, 30 knee and 18 hip patients entered the one-week taper-off phase. The most frequently used maximum dose of TDF was 25 μg/hr. The number of patients with adequate pain control increased during the run-in period from 4% to 27%, and further increased during TDF treatment to 88% on day 28. From baseline to endpoint, there were significant reductions in pain (p < 0.001) and improvements in functioning (p < 0.001) and physical (p < 0.001) and mental (p < 0.05) health. Scores for 'pain right now' decreased significantly within 24 hours of starting TDF treatment. TDF was assessed favourably and 84% of patients would recommend it for OA-related pain. Nausea and vomiting were the most common adverse events (reported by 32% and 26% of patients respectively), despite prophylaxis with metoclopramide, which showed limited efficacy in this setting. Conclusion TDF significantly increased pain control, and improved functioning and quality of life. Metoclopramide appeared to be of limited value in preventing nausea and vomiting; more effective anti-emetic treatment may enable more people to benefit from strong opioids such as TDF. This study suggests that four weeks is a reasonable period to test the benefit of adding TDF to improve pain

  17. Treatment of osteoarthritis of the knee (nonarthroplasty).

    PubMed

    Richmond, John; Hunter, David; Irrgang, Jay; Jones, Morgan H; Levy, Bruce; Marx, Robert; Snyder-Mackler, Lynn; Watters, William C; Haralson, Robert H; Turkelson, Charles M; Wies, Janet L; Boyer, Kevin M; Anderson, Sara; St Andre, Justin; Sluka, Patrick; McGowan, Richard

    2009-09-01

    The clinical practice guideline was explicitly developed to include only treatments less invasive than knee replacement (ie, arthroplasty). Patients with symptomatic osteoarthritis of the knee are to be encouraged to participate in self-management educational programs and to engage in self-care, as well as to lose weight and engage in exercise and quadriceps strengthening. The guideline recommends taping for short-term relief of pain as well as analgesics and intra-articular corticosteroids, but not glucosamine and/or chondroitin. Patients need not undergo needle lavage or arthroscopy with débridement or lavage. Patients may consider partial meniscectomy or loose body removal or realignment osteotomy, as conditions warrant. Use of a free-floating interpositional device should not be considered for symptomatic unicompartmental osteoarthritis of the knee. Lateral heel wedges should not be prescribed for patients with symptomatic medial compartmental osteoarthritis of the knee. The work group was unable either to recommend or not recommend the use of braces with either valgus- or varus-directing forces for patients with medial unicompartmental osteoarthritis; the use of acupuncture or of hyaluronic acid; or osteotomy of the tibial tubercle for isolated symptomatic patellofemoral osteoarthritis.

  18. Osteoarthritis

    MedlinePlus

    Osteoarthritis is the most common form of arthritis. It causes pain, swelling, and reduced motion in your ... it affects your hands, knees, hips or spine. Osteoarthritis breaks down the cartilage in your joints. Cartilage ...

  19. The efficacy of non-surgical treatment on pain and sensitization in patients with knee osteoarthritis: a pre-defined ancillary analysis from a randomized controlled trial.

    PubMed

    Skou, S T; Roos, E M; Simonsen, O; Laursen, M B; Rathleff, M S; Arendt-Nielsen, L; Rasmussen, S

    2016-01-01

    To report the efficacy of a 3-month treatment program consisting of neuromuscular exercise, education, diet, insoles and pain medication (MEDIC-treatment) compared to usual care (two leaflets with information and treatment advice) in reducing pain-related measures and sensitization in patients with knee osteoarthritis (OA) not eligible for total knee replacement (TKR). A pre-defined ancillary analysis of the results at 3 months of a randomized controlled trial (RCT) of 100 patients randomized to MEDIC-treatment or usual care. ClinicalTrials.gov (NCT01535001). Outcomes were sensitization assessed at the knee, the lower leg and forearm using a handheld algometer, peak pain intensity in the previous 24 h, pain intensity after 30 min of walking, pain location and pattern, spreading of pain (a region-divided body chart) and the usage of pain medication. The MEDIC group had larger improvements from baseline to 3 months in peak pain intensity (P = 0.02) and pain after 30 min of walking (P < 0.001) and in the number of body sites with pain (P = 0.04). There was no difference in the change in sensitization from baseline to 3 months between groups (P = 0.87), but sensitization decreased in both groups (P < 0.001). A non-surgical treatment program is more efficacious in reducing pain-related measures than usual care, while both are equally efficacious in reducing sensitization, indicating that mechanisms other than pain sensitization contribute to the perceived pain. The patients did not have severe symptomatic knee OA and hence pain sensitization may not yet have developed into a clinically relevant parameter or subgroups with less sensitization may exist. Copyright © 2015 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  20. The effect of balneotherapy on pain relief, stiffness, and physical function in patients with osteoarthritis of the knee: a meta-analysis.

    PubMed

    Matsumoto, Hiromi; Hagino, Hiroshi; Hayashi, Kunihiko; Ideno, Yuki; Wada, Takashi; Ogata, Toru; Akai, Masami; Seichi, Atsushi; Iwaya, Tsutomu

    2017-03-16

    This meta-analysis was performed to determine the effect of balneotherapy on relieving pain and stiffness and improving physical function, compared to controls, among patients with knee osteoarthritis. We searched electronic databases for eligible studies published from 2004 to December 31, 2016, with language restrictions of English or Japanese. We screened publications in Medline, Embase, Cochrane library, and the Japan Medical Abstracts Society Database using two approaches, MeSH terms and free words. Studies that examined the effect of balneotherapy for treating knee osteoarthritis of a ≥2-week duration were included. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were used as the outcome measure. A total of 102 publications were assessed according to the exclusion criteria of the study; eight clinical trial studies, which comprised a total of 359 cases and 375 controls, were included in this meta-analysis. The meta-analysis analyzed improvement in WOMAC score at the final follow-up visit, which varied from 2 to 12 months post-intervention. Our meta-analysis indicates that balneotherapy was clinically effective in relieving pain and stiffness, and improving function, as assessed by WOMAC score, compared to controls. However, there was high heterogeneity (88 to 93%). It is possible that balneotherapy may reduce pain and stiffness, and improve function, in individuals with knee osteoarthritis, although the quality of current publications contributes to the heterogeneity observed in this meta-analysis.

  1. Influence of Centrally Mediated Symptoms on Postoperative Pain in Osteoarthritis Patients Undergoing Total Knee Arthroplasty: A Prospective Observational Evaluation.

    PubMed

    Kim, Shin Hyung; Yoon, Kyung Bong; Yoon, Duck Mi; Yoo, Ji Hyun; Ahn, Ki Ryang

    2015-07-01

    Central sensitization plays an important role in the chronic pain experienced by osteoarthritis (OA) patients. In this prospective observational study, we investigated the influence of the level of preoperative centrally mediated symptoms measured by the Central Sensitization Inventory (CSI) on pain intensity after total knee arthroplasty (TKA) for OA. Ninety-eight female OA patients undergoing TKA were enrolled in this study. We assessed CSI scores, pain-related data, and other clinical data preoperatively. All patients received spinal anesthesia and postoperative epidural analgesia. Pain intensity (at rest and on movement) and rescue meperidine requirements were assessed during postoperative days 1 and 2. Also, pain intensity and patient satisfaction were assessed 1 month and 3 months after surgery. After the completion of all postoperative assessments, we separated the study population into a preoperative CSI score ≥40 and <40 group. We assessed pain-related data between the 2 groups at each assessment time. Ninety-one patients completed the postoperative assessments (a preoperative CSI ≥40 group; n = 44, CSI <40 group; n = 47). Patients with preoperative CSI ≥40 complained of a greater pain intensity (P = 0.001) during postoperative days 1 and 2 and required a higher dose of meperidine rescue (P = 0.003) than those with a preoperative CSI <40. The high CSI score group also showed a less favorable outcome in terms of pain relief on follow-up at 1 month (P = 0.006) and 3 months (P = 0.002) after surgery. In multivariate analysis, a preoperative CSI score ≥40 was the strongest determinant with 5.091 of the highest odds ratio (95% CI 1.324 to 19.523, P = 0.016) for predicting a persistent pain 3 months after surgery among demographic and pain-related variables. OA patients with high levels of comorbid centrally mediated symptoms showed severe pain and increased analgesic requirements after TKA in the early postoperative period. Moreover, these patients

  2. [Effect of Acupuncture plus Different Frequency Shock-wave Interventions on Pain Reactions and Motor Function in Knee Osteoarthritis Patients].

    PubMed

    Li, Jian-wei; Zheng, Shi-jiang; Zhang, Jing-chun; Huang, Jian-jun; Liu, Xiao-gang

    2015-08-01

    To observe the clinical effect of acupuncture plus shock-wave (SW) intervention for osteoarthritis (WA), so as to explore its practicability in clinical practice. A total of 120 cases of knee OA patients were randomly divided into 4 groups, namely acupuncture (acupunct) + LFSW, acupunct + MFSW, acupunct + HFSW and routine acupunct groups, with 30 cases in each group. Xuehai (SP 10) , Liangqiu (ST 34), Yanglingquan (GB 34), Xiyan (ST 35) and Ashi-point were punctured with filiform needles which were manipulated with uniform reinforcing-reducing techniques for 15-20 min, once every other day for 7 times. In addition, these acupoints were also respectively stimulated with shock waves(10 Hz, 14 Hz and 18 Hz, pressure: 1-4 bar) delivered from a DolorClastEMS therapeutic apparatus for 600 times in 3 acupunct+ SW groups. The patients' pain response changes of the knee-joint were assessed by using visual analog scale (VAS) and the motility was evaluated by using a 0-3 grade scale. RESULTS After 7 times of treatment, the patients' VAS scores and motility scores were significantly decreased in the acupunct+ LFSW, acupunct+ MFSW, acupunct+ HFSW and routine acupunct groups compared with their own basic values before treatment (P < 0.01), and the therapeutic effect of the acupunct+ MFSW group was significantly superior to those of the other 3 groups in reducing both VAS and motility scores (P < 0.05). Correspondingly, the Deqi sensation score of the acupunct+ MFSW group was markedly higher than those of the other 3 groups (P < 0.05). Shock wave acu-puncture treatment is effective in relieving OA patients' knee-joint pain and functional activity, and the therapeutic effect of acu- punct + 14 Hz-SW is better, which is closely with Deqi-sensation.

  3. Effect of aqua-cycling on pain and physical functioning compared with usual care in patients with knee osteoarthritis: study protocol of a randomised controlled trial.

    PubMed

    Rewald, Stefanie; Mesters, Ilse; Lenssen, A F; Emans, Pieter J; Wijnen, Wiel; de Bie, Rob A

    2016-02-18

    Over the last decade aquatic exercise has become more and more popular. One of the latest trends is aqua-cycling, where participants sit on a water-resistant stationary bike and, while immersed chest deep in the water, combine continuous cycling with upper body exercises that utilise water resistance. Since stationary cycling and aquatic exercises are frequently recommended to patients with knee osteoarthritis, combining both would seem an obvious step, and an aqua-cycling exercise programme for patients with knee osteoarthritis has indeed been developed. This study protocol gives a detailed description of the exercise programme and the methodology of a study to compare this programme with treatment involving usual care only. The study is a single-blind, parallel-group, randomised controlled trial of Maastricht University Medical Centre+, the Netherlands. knee pain of four to seven on a 10-point pain rating scale; a Kellgren/Lawrence score between one to three; ability to cycle; good mental health; sufficient language skills; indication for physical therapy in conjunction with impairments due to OA. any contra-indication for aquatic exercise; planned total knee replacement; corticosteroid injection <3 months and/or hyaluronic acid injection <6 months; severe joint complaints (other than knee joint); symptomatic and radiological apparent hip OA; inflammatory joint diseases; inability to safely enter and exit the pool; fear of water. Participants will receive two 45-min moderate intense aqua-cycling sessions weekly over a period of 12 weeks in addition to usual care or usual care only. Usual care consists of an individual intervention plan comprising lifestyle recommendations, medication routine and referral to a physical therapist. Participants will be assessed at baseline, and at 12 and 24 weeks after baseline. The primary outcome is self-reported knee pain and physical functioning. Secondary outcomes are lower limb muscle strength, functional capacity, self

  4. [Physical activity for knee osteoarthritis.

    PubMed

    Nagao, Masashi; Ishijima, Muneaki; Kaneko, Haruka; Takazawa, Yuji; Ikeda, Hiroshi; Kaneko, Kazuo

    Elder populations have been increasing in Japan and estimated 24 million people have knee osteoarthritis(OA). Recently, people have diverse sociological background and demand for participating sports has been growing. People may participate sports to prevent some diseases such as locomotive syndrome. According to the recent studies, excessive high impact sports increase the risk of OA, while daily life exercise decrease the risk. Epidemiological approach demonstrated that reduced knee extension muscle strength increases the risk of OA. We reviewed and discussed the recent topics including efficacy of physical therapy for knee OA and how much sports activities could be beneficial after knee surgery.

  5. Adaptive Patterns of Movement during Downward Reach and Pick-up Movements in Knee Osteoarthritis Patients with Mild Low Back Pain

    PubMed Central

    Huang, Hsuan-Ti; Liang, Jing-Min; Hung, Wei-Tso; Guo, Lan-Yuen; Wu, Wen-Lan

    2014-01-01

    [Purpose] Patients with severe bilateral knee osteoarthritis (KOA) often suffer from low back pain (LBP). However, few studies have examined the relationship between LBP and KOA in downward reach and pick-up movements. [Subjects] Eight KOA patients with LBP (LBP group), 8 KOA patients without LBP (NLBP group), and 7 healthy participants (Control group), without osteoarthritis or low back pain, were recruited for this study. [Methods] All subjects were asked to pick up a bottle with one hand, placed at the diagonal on the opposite side of the body. A 3D motion analysis system was used to record trunk and lower limb movements. [Results] The knee flexion angle on the side ipsilateral to the bottle was significantly smaller in both KOA groups than in the controls in the downward reach and pick-up movements. KOA patients showed a significantly lower trunk flexion angle and greater pelvis anterior tilt angle than the controls. In addition, no significant differences were found between the LBP and NLBP group. [Conclusion] We suspect that severe knee pain due to OA determines the priority of movement in strategic planning for the execution of pick-up movements. The knee strategy was abandoned by our severe knee OA patients, even when they had mild LBP. PMID:25364103

  6. Prevention and management of knee osteoarthritis and knee cartilage injury in sports.

    PubMed

    Takeda, Hideki; Nakagawa, Takumi; Nakamura, Kozo; Engebretsen, Lars

    2011-04-01

    Articular cartilage defects in the knee of young or active individuals remain a problem in orthopaedic practice. These defects have limited ability to heal and may progress to osteoarthritis. The prevalence of knee osteoarthritis among athletes is higher than in the non-athletic population. The clinical symptoms of osteoarthritis are joint pain, limitation of range of motion and joint stiffness. The diagnosis of osteoarthritis is confirmed by the symptoms and the radiological findings (narrowing joint space, osteophyte formation and subchondral sclerosis). There is no strong correlation between symptoms and radiographic findings. The aetiology of knee osteoarthritis is multifactorial. Excessive musculoskeletal loading (at work or in sports), high body mass index, previous knee injury, female gender and muscle weakness are well-known risk factors. The high-level athlete with a major knee injury has a high incidence of knee osteoarthritis. Cartilage injuries are frequently observed in young and middle-aged active athletes. Often this injury precedes osteoarthritis. Reducing risk factors can decrease the prevalence of knee osteoarthritis. The prevention of knee injury, especially anterior cruciate ligament and meniscus injury in sports, is important to avoid progression of knee osteoarthritis.

  7. Effect of aromatherapy massage with lavender essential oil on pain in patients with osteoarthritis of the knee: A randomized controlled clinical trial.

    PubMed

    Nasiri, Ahmad; Mahmodi, Mohammad Azim; Nobakht, Zohre

    2016-11-01

    Osteoarthritis of the knee is the most common chronic joint disease that involves middle aged and elderly people. The purpose of this study was to investigate the effect of aromatherapy massage with lavender essential oil on pain in patients with osteoarthritis of the knee. In this single-blinded, randomized clinical trial, 90 patients with osteoarthritis of the knee who referred to the outpatient rheumatology clinics affiliated with Birjand University of Medical Sciences were selected through convenience sampling method. They were randomly assigned to three groups: intervention (aromatherapy massage with lavender essential oil), placebo (massage with almond oil) and control (without massage). The patients were evaluated at baseline, immediately after the intervention, 1 week, and 4 weeks after the intervention in terms of pain via visual analogue scale. The data were analyzed in SPSS (version 16) using the repeated measure ANOVA, one-way ANOVA, and chi-squared test. Pain severity of the patients in the intervention group was significantly different immediately and 1 week after the intervention compared with their initial status (p < 0.001) and that of the control group (p < 0.001 and p = 0.009 respectively). However, at the third phase of follow-up (i.e., 4 weeks after the intervention), there was no significant difference between the groups according to the visual analogue scale (p = 0.67). Aromatherapy massage with lavender essential oil was found effective in relieving pain in patients with knee osteoarthritis. However, further studies are needed to confirm findings of this study. Copyright © 2016 Elsevier Ltd. All rights reserved.

  8. 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

  9. Link Between Positive Clinician-Conveyed Expectations of Treatment Effect and Pain Reduction in Knee Osteoarthritis, Mediated by Patient Self-Efficacy.

    PubMed

    Hsiao-Wei Lo, Grace; Balasubramanyam, Ajay S; Barbo, Andrea; Street, Richard L; Suarez-Almazor, Maria E

    2016-07-01

    A prior knee osteoarthritis (OA) trial found that provider-conveyed expectations for treatment success were associated with pain improvement. We hypothesized this relationship was mediated by patient self-efficacy, since expectations of improvement may enhance one's ability to control health behaviors, and therefore health. Our aim was to examine whether self-efficacy was a mediator of the relationship observed in this trial. A secondary analysis of a 3-arm (traditional acupuncture, sham acupuncture, and wait list) trial for knee OA was conducted. Those in the acupuncture groups were equally randomized to acupuncturists trained to communicate a high or neutral expectation of treatment success (e.g., using language conveying high or unclear likelihood that acupuncture would reduce knee pain). A modified Arthritis Self-Efficacy Questionnaire and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale were administered. Linear regression analyses were used to examine whether patient self-efficacy mediated the relationship between provider communication style and knee pain at 3 months. High-expectation provider communication was associated with patient self-efficacy, β coefficient of 0.14 (95% confidence interval [95% CI] 0.01, 0.28). Self-efficacy was associated with WOMAC pain, β coefficient of -9.29 (95% CI -11.11, -7.47), while controlling for the provider communication style. The indirect effect a × b of -1.36 for high versus neutral expectation (bootstrap 95% CI -2.80, -0.15; does not include 0), supports the conclusion that patient self-efficacy mediates the relationship between provider-communicated expectations of treatment effects and knee pain. Our findings suggest that clinician-conveyed expectations can enhance the benefit of treatments targeting knee OA symptoms, mediated by improved patient self-efficacy. © 2016, American College of Rheumatology.

  10. Correlates of pain intensity in men and women with hip and knee osteoarthritis. Results of a national survey: The French ARTHRIX study.

    PubMed

    Perrot, Serge; Poiraudeau, Serge; Kabir-Ahmadi, Marmar; Rannou, Francois

    2009-01-01

    To examine the clinical and demographic correlates of pain intensity in patients with hip and knee osteoarthritis (OA). In a national cross-sectional survey, 1811 general practitioners recruited and assessed 5324 patients with hip and knee OA. The patients rated the intensity of pain at rest, on movement over the last 24 hours, and during the last 8 days on 11-point numeric rating scales. The patients also completed the Western Ontario and McMaster Universities Osteoarthritis Index. Clinical and demographic correlates of pain intensity and function were investigated by univariate, stepwise multiple logistic regression and odds ratio analyses. Data for 4598 patients were analyzed (86.4% of surveyed patients). The mean pain intensity was 4.1+/-2.2 at rest, 5.9+/-1.8 on movement during the last 24 hours, and 5.1+/-1.7 during the last 8 days. Pain on movement during the last 24 hours and during the last 8 days showed a strong positive correlation (r=0.78; P<0.0001), which suggests that the most of the latter pain was related to movement. Patients with knee or hip OA did not differ in pain intensity, but patients with both joints affected rated pain intensity significantly higher than did those with only 1 affected joint [4.6+/-2.1, 6.3+/-1.8, and 5.5+/-1.6, for the 3 pain assessments, respectively (P>0.01)]. Patients with high pain ratings were more likely to be women, be older than 75 years, and have a body mass index of greater than 40 kg/m. In addition, patients who were retired, unemployed, farmers, or widowed, or had a long duration of OA gave high pain ratings. Patients with regular physical activities reported less intense pain. Pain intensity ratings for patients with lower limb OA differed significantly with respect to sex, age, body mass index, physical activity, professional activity, marital status, and conditions of assessment.

  11. Naringenin regulates production of matrix metalloproteinases in the knee-joint and primary cultured articular chondrocytes and alleviates pain in rat osteoarthritis model.

    PubMed

    Wang, C C; Guo, L; Tian, F D; An, N; Luo, L; Hao, R H; Wang, B; Zhou, Z H

    2017-03-23

    Inflammation of cartilage is a primary symptom for knee-joint osteoarthritis. Matrix metalloproteinases (MMPs) are known to play an important role in the articular cartilage destruction related to osteoarthritis. Naringenin is a plant-derived flavonoid known for its anti-inflammatory properties. We studied the effect of naringenin on the transcriptional expression, secretion and enzymatic activity of MMP-3 in vivo in the murine monosodium iodoacetate (MIA) osteoarthritis model. The assessment of pain behavior was also performed in the MIA rats. The destruction of knee-joint tissues was analyzed microscopically. Moreover, the effect of naringenin was also studied in vitro in IL-1β activated articular chondrocytes. The transcriptional expression of MMP-3, MMP-1, MMP-13, thrombospondin motifs (ADAMTS-4) and ADAMTS-5 was also studied in primary cultured chondrocytes of rats. Naringenin caused significant reduction in pain behavior and showed marked improvement in the tissue morphology of MIA rats. Moreover, a significant inhibition of MMP-3 expression in MIA rats was observed upon treatment with naringenin. In the in vitro tests, naringenin caused a significant reduction in the transcriptional expression, secretion and enzymatic activity of the studied degradative enzymes. The NF-κB pathway was also found to be inhibited upon treatment with naringenin in vitro. Overall, the study suggests that naringenin alleviated pain and regulated the production of matrix-metalloproteinases via regulation of NF-κB pathway. Thus, naringenin could be a potent therapeutic option for the treatment of osteoarthritis.

  12. Longitudinal (4 year) change of thigh muscle and adipose tissue distribution in chronically painful vs. painless knees – data from the Osteoarthritis Initiative

    PubMed Central

    Ruhdorfer, Anja; Wirth, Wolfgang; Dannhauer, Torben; Eckstein, Felix

    2015-01-01

    Objective To evaluate 4-year longitudinal change in thigh muscle and adipose tissue content in chronically painful versus painless knees. Methods Knees from Osteoarthritis Initiative participants with non-acceptable symptom status (numerical rating scale ≥4) and frequent pain (≥6 months at baseline, year 2 and year 4 follow-up) were studied. These were matched with painless controls (bilateral NRS pain intensity≤1 and ≤infrequent pain at all 3 timepoints). 4-year longitudinal changes in thigh muscle anatomical cross-sectional areas (CSAs), isometric muscle strength, and in subcutaneous (SCF) and intermuscular fat (IMF) CSAs were obtained from magnetic resonance images (MRI) and were compared between groups (paired t-tests). Results 43 participants fulfilled the inclusion criteria of chronic pain, had complete thigh muscle MRI acquisitions and strength measurements, and a matched control. Quadriceps CSAs, but not extensor strength, showed a significant longitudinal decrease in chronically painful knees (-3.9%; 95%confidence interval [95 CI] -6.3%,-1.5%) and in painless controls (-2.4%; 95% CI -4.1%, -0.7%); the difference in change was not statistically significant (p=0.33). There was a significant 4-year gain in SCF in painful knees (8.1%; 95% CI 3.1%, 13%) but not in controls (0.0%; 95%CI -4.4%, +4.4%) with the difference in change being significant (p=0.03). The gain in IMF (∼5.2%) was similar between painful and painless knees. Conclusion This is the first paper to show a significant impact of (chronic) knee pain on longitudinal change in local subcutaneous adipose tissue. The effect of pain on subcutaneous fat appeared stronger than that on intermuscular adipose tissue and on muscle status. PMID:25887367

  13. Interventions to increase adherence to therapeutic exercise in older adults with low back pain and/or hip/knee osteoarthritis: a systematic review and meta-analysis.

    PubMed

    Nicolson, Philippa J A; Bennell, Kim L; Dobson, Fiona L; Van Ginckel, Ans; Holden, Melanie A; Hinman, Rana S

    2017-05-01

    To evaluate whether interventions aimed at increasing adherence to therapeutic exercise increase adherence greater than a contextually equivalent control among older adults with chronic low back pain and/or hip/knee osteoarthritis. A systematic review and meta-analysis. Five databases (MEDLINE (PubMed), CINAHL, SportDISCUS (EBSCO), Embase (Ovid) and Cochrane Library) were searched until 1 August 2016. Randomised controlled trials that isolated the effects of interventions aiming to improve adherence to therapeutic exercise among adults ≥45 years of age with chronic low back pain and/or hip/knee osteoarthritis were included. Of 3899 studies identified, nine studies (1045 participants) were eligible. Four studies, evaluating strategies that aimed to increase motivation or using behavioural graded exercise, reported significantly better exercise adherence (d=0.26-1.23). In contrast, behavioural counselling, action coping plans and/or audio/video exercise cues did not improve adherence significantly. Meta-analysis using a random effects model with the two studies evaluating booster sessions with a physiotherapist for people with osteoarthritis revealed a small to medium significant pooled effect in favour of booster sessions (standardised mean difference (SMD) 0.39, 95% CI 0.05 to 0.72, z=2.26, p=0.02, I(2)=35%). Meta-analysis provides moderate-quality evidence that booster sessions with a physiotherapist assisted people with hip/knee osteoarthritis to better adhere to therapeutic exercise. Individual high-quality trials supported the use of motivational strategies in people with chronic low back pain and behavioural graded exercise in people with osteoarthritis to improve adherence to exercise. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  14. Strength training alone, exercise therapy alone, and exercise therapy with passive manual mobilisation each reduce pain and disability in people with knee osteoarthritis: a systematic review.

    PubMed

    Jansen, Mariette J; Viechtbauer, Wolfgang; Lenssen, Antoine F; Hendriks, Erik J M; de Bie, Rob A

    2011-01-01

    What are the effects of strength training alone, exercise therapy alone, and exercise with additional passive manual mobilisation on pain and function in people with knee osteoarthritis compared to control? What are the effects of these interventions relative to each other? A meta-analysis of randomised controlled trials. Adults with osteoarthritis of the knee. INTERVENTION TYPES: Strength training alone, exercise therapy alone (combination of strength training with active range of motion exercises and aerobic activity), or exercise with additional passive manual mobilisation, versus any non-exercise control. Comparisons between the three interventions were also sought. The primary outcome measures were pain and physical function. 12 trials compared one of the interventions against control. The effect size on pain was 0.38 (95% CI 0.23 to 0.54) for strength training, 0.34 (95% CI 0.19 to 0.49) for exercise, and 0.69 (95% CI 0.42 to 0.96) for exercise plus manual mobilisation. Each intervention also improved physical function significantly. No randomised comparisons of the three interventions were identified. However, meta-regression indicated that exercise plus manual mobilisations improved pain significantly more than exercise alone (p = 0.03). The remaining comparisons between the three interventions for pain and physical function were not significant. Exercise therapy plus manual mobilisation showed a moderate effect size on pain compared to the small effect sizes for strength training or exercise therapy alone. To achieve better pain relief in patients with knee osteoarthritis physiotherapists or manual therapists might consider adding manual mobilisation to optimise supervised active exercise programs. Copyright © 2011 Australian Physiotherapy Association. Published by .. All rights reserved.

  15. 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

  16. Acupuncture as an adjunctive therapy to pharmacological treatment in patients with chronic pain due to osteoarthritis of the knee: a 3-armed, randomized, placebo-controlled trial.

    PubMed

    Mavrommatis, Christos I; Argyra, Eriphili; Vadalouka, Athina; Vasilakos, Dimitrios G

    2012-08-01

    The efficacy of acupuncture as an adjunctive therapy to pharmacological treatment of chronic pain due to knee osteoarthritis was studied with a 3-armed, single-blind, randomized, sham-controlled trial; it compared acupuncture combined with pharmacological treatment, sham acupuncture including pharmacological treatment, and pharmacological treatment alone. A total of 120 patients with knee osteoarthritis were randomly allocated to 3 groups: group I was treated with acupuncture and etoricoxib, group II with sham acupuncture and etoricoxib, and group III with etoricoxib. The primary efficacy variable was the Western Ontario and McMaster Universities (WOMAC) index and its subscales at the end of treatment at week 8. Secondary efficacy variables included the WOMAC index at the end of weeks 4 and 12, a visual analogue scale (VAS) at the end of weeks 4, 8, and 12, and the Short Form 36 version 2 (SF-36v2) health survey at the end of week 8. An algometer was used to determine changes in a predetermined unique fixed trigger point for every patient at the end of weeks 4, 8, and 12. Group I exhibited statistically significant improvements in primary and secondary outcome measures, except for Short Form mental component, compared with the other treatment groups. We conclude that acupuncture with etoricoxib is more effective than sham acupuncture with etoricoxib, or etoricoxib alone for the treatment of knee osteoarthritis. Copyright © 2012 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  17. Electro-acupuncture for treatment of knee pain from osteoarthritis and the possible endocrinology changes: a study protocol for a randomized controlled trial.

    PubMed

    Mata, Javier; Cabrera, Sandra; Sanchís, Pilar; Valentí, Pedro; Hernández, Patricia; Fortuny, Regina; Lirola, Serafin; Aguilar, Jose Luis

    2015-06-03

    Osteoarthritis of the knee is a major cause of disability among adults. Electro-acupuncture is considered a potentially useful treatment for osteoarthritis. The purpose of this study is to assess the efficacy of electro-acupuncture on pain control, pain perception, plasma cortisol and beta-endorphin levels, patient-perceived quality of life, and pain medication use in patients with chronic knee pain. This study is a placebo-controlled, randomized, double-blind, parallel design trial. One hundred sixty out-patients who are more than 50 years old and who have osteoarthritis of the knee will be recruited from the island of Mallorca, Spain. Each participant will be randomly placed into one of two groups: (sham) electro-acupuncture non-insertion technique and real electro-acupuncture. Acupuncture treatments will be the Traditional Chinese Medicine type. The patients will be evaluated after a period of 1 month (with two weekly sessions), 3 months (with one monthly session), 6 months (with one session every 45 days), and 1 year later with follow-up sessions at the end of the study (with one session every 2 months). The primary outcomes will be based on the observed changes from the baseline of the visual analogue scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for pain measured at 12 weeks after the end of treatment. Also to be included in the study are the possible changes in the secondary efficacy variables from baseline as assessed by the Short Form 36 version 2 health survey (patient-perceived quality of life), patient plasma cortisol and beta-endorphin levels at the different treatment stages, the Goldberg Anxiety and Depression Scale, pain medication use, functional capacity and stiffness (WOMAC subscales), and a VAS. These variables will be assessed at 1 month, 3 months, 6 months, and 1 year after study commencement. The findings from this study will help to determine whether electro-acupuncture is effective for chronic

  18. Association of Metabolic Syndrome and Its Components with Knee Osteoarthritis.

    PubMed

    Maddah, Shahpoor; Mahdizadeh, Jamileh

    2015-12-01

    The association of obesity and other metabolic conditions with osteoarthritis is under debate; however, a strong link between metabolic disturbances is suggested to contribute to increased incidences and progression of osteoarthritis. We examined the association of metabolic syndrome and its components with the incidence of knee osteoarthritis in Iranian population. A community-based study was conducted on a total of 625 Iranian volunteers with the complaint of knee pain. Weight-bearing and anteroposterior plain radiographs of both knees were taken on the day of admission. Metabolic syndrome was diagnosed using the modified Adult Treatment Panel III of the National Cholesterol Education Program criteria. Prevalence rates of metabolic syndrome were 22.5% in males and 11.6% in females (P=0.002). The prevalence rate of knee osteoarthritis was 20.0% in males and 43.8% of females (P<0.001). In both genders, osteoarthritis group had higher serum levels of triglyceride and systolic blood pressure in comparison with non-osteoarthritis group. Women with osteoarthritis had higher Body Mass Index (BMI), however, this association was not observed in men. In females, the presence of osteoarthritis was significantly associated with the presence of metabolic syndrome, with the risk of metabolic syndrome in the osteoarthritis group at 2.187 fold the risk in the non-osteoarthritis group. But, the presence of osteoarthritis was not associated with metabolic syndrome in males. Metabolic syndrome mainly through high BMI is associated with knee osteoarthritis in the Iranian women, but neither metabolic syndrome nor any related components are associated with knee osteoarthritis in men.

  19. Effects of therapeutic ultrasound on pain, physical functions and safety outcomes in patients with knee osteoarthritis: a systematic review and meta-analysis.

    PubMed

    Zhang, Chi; Xie, Yujie; Luo, Xiaotian; Ji, Qiaodan; Lu, Chunlan; He, Chengqi; Wang, Pu

    2016-10-01

    To explore the effects of therapeutic ultrasound with sham or no intervention on pain, physical function and safety outcomes in patients with knee osteoarthritis. This systematic review was searched on CENTRAL, EMBASE, MEDLINE, CINAHL, Physiotherapy Evidence Database, Open Gray on 4 September 2015. Trials included randomized controlled trials that compared therapeutic ultrasound with a sham or no intervention in patients with osteoarthritis of the knee. Eligible trials and extracted data were identified by two independent investigators. Standardized mean differences (SMDs) and 95% confidence interval (CI) were calculated for pain and physical function outcomes. Heterogeneity was assessed by the I(2) test and inverse-variance random-effects analysis was applied to all trials. Ten randomized controlled trials (645 patients) met the inclusion criteria. Therapeutic ultrasound showed a positive effect on pain (SMD = -0.93, 95%, CI = -1.22 to -0.64, p < 0.01, p for heterogeneity = 0.12, I(2) = 42%). For physical function, therapeutic ultrasound was advantageous for reducingWestern Ontario and McMaster Universities physical function score (SMD = -0.37, 95% CI = -0.73 to -0.01, p = 0.04, p for heterogeneity = 0.94, I(2) = 0%). In terms of safety, no occurrence of adverse events caused by therapeutic ultrasound was reported in any trial. The authors suggested that therapeutic ultrasound is beneficial for reducing knee pain and improving physical functions in patients with knee osteoarthritis and could be a safe treatment. © The Author(s) 2015.

  20. Role of viscosupplementation in osteo-arthritis of knee joint.

    PubMed

    Chandra, Rajesh; Mahajan, Sumit

    2013-05-01

    Osteo-arthritis is the chronic degenerative disease associated with joint pain and loss of joint function. It is caused by 'wear and tear' on a joint. Knee is the most commonly Involved joint. Disease is so crippling that patient is unable to walk independently from bed to bathroom. The major causes of osteo-arthritis are age, gender, obesity, medical condition and hereditary. The signs and symptoms of osteo-arthritis are pain, joint stiffness, joint swelling, and loss of function. No blood tests are helpful in diagnosing osteo-arthritis. Management of osteo-arthritis includes non-pharmacological, pharmacological and surgical. A relatively new procedure is viscosupplementation, in which a preparation of hyaluronic acid is injected into the knee joint. Hyaluronic acid is a naturally occurring substance found in the synovial fluid. It acts as a lubricant to enable bones to move smoothly over each other and a shock absorber for joint loads. The decrease in the elastic and viscous properties of synovial fluid in osteo-arthritis results from both a reduced molecular size and a reduced concentration of hyaluronic acid in the synovial fluid. Viscosupplementation may be a therapeutic option for individuals with osteo-arthritis of the knee. Viscosupplementation has been shown to relieve pain in many patients who cannot get relief from non-medicinal measures or analgesic drugs. This article is to know the mechanism of action, patients' selection criteria, rationale and efficacy of viscosupplimentation in the management of osteo-arthritis of knee.

  1. Predictors of self-reported knee instability among patients with knee osteoarthritis: results of the Amsterdam osteoarthritis cohort.

    PubMed

    van der Esch, Martin; van der Leeden, Marike; Roorda, Leo D; Lems, Willem F; Dekker, Joost

    2016-12-01

    The aims of the study were to (i) determine the prevalence and course of self-reported knee instability at 2-year follow-up and (ii) identify factors predictive of retention of self-reported knee instability among patients with established knee osteoarthritis (OA). Among 201 patients from the Amsterdam Osteoarthritis (AMS-OA) cohort, demographic characteristics, self-reported knee instability, muscle strength, proprioception, pain, and physical function were assessed at baseline and at 2 years. Exercise over the past 2 years was assessed by evaluating the medical files. The course of self-reported knee instability was determined in patients reporting instability at baseline. Baseline predictors of self-reported knee instability were determined by uni- and multivariable logistic regression analyses. At baseline, 123 (61 %) patients reported knee instability, and of these, 85 (64 %) patients reported instability 2 years later, while 38 (29 %) reported no instability 2 years later. Poor proprioception and high pain assessed at baseline predicted retention of self-reported knee instability at 2 years among patients with self-reported instability at baseline. Knee instability is highly prevalent among patients with knee osteoarthritis. In patients with self-reported knee instability, the majority retained instability over 2 years. Poor proprioception and high pain predicted retention of self-reported knee instability over time.

  2. Self-reported knee instability and activity limitations in patients with knee osteoarthritis: results of the Amsterdam osteoarthritis cohort.

    PubMed

    van der Esch, Martin; Knoop, Jesper; van der Leeden, Marike; Voorneman, Ramon; Gerritsen, Martijn; Reiding, Dick; Romviel, Suzanne; Knol, Dirk L; Lems, Willem F; Dekker, Joost; Roorda, Leo D

    2012-10-01

    The objective of this study was to evaluate whether self-reported knee instability is associated with activity limitations in patients with knee osteoarthritis (OA), in addition to knee pain and muscle strength. A cohort of 248 patients diagnosed with knee OA was examined. Self-reported knee instability was defined as the perception of any episode of buckling, shifting, or giving way of the knee in the past 3 months. Knee pain was assessed using a numeric rating scale, and knee extensor and flexor strength were measured using an isokinetic dynamometer. Activity limitations were measured by using the Western Ontario and McMasters Universities Osteoarthritis Index physical function questionnaire, the timed Get Up and Go, and the timed stair climbing and three questionnaires evaluating walking, climbing stairs, and rising from a chair. Other potential determinants of activity limitations were also collected, including joint proprioception, joint laxity, age, sex, body mass index (BMI), disease duration, and radiographic disease severity. Regression analyses evaluated the effect of adding self-reported knee instability to knee pain and muscle strength, when examining associations with the activity limitations measures. Self-reported knee instability was common (65 %) in this cohort of patients with knee OA. Analyses revealed that self-reported knee instability is significantly associated with activity limitations, even after controlling for knee pain and muscle strength. Joint proprioception, joint laxity, age, sex, BMI, duration of complaints, and radiographic severity did not confound the associations. In conclusion, self-reported knee instability is associated with activity limitations in patients with knee OA, in addition to knee pain and muscle strength. Clinically, self-reported knee instability should be assessed in addition to knee pain and muscle strength.

  3. Effect of Topical Application of Nigella Sativa Oil and Oral Acetaminophen on Pain in Elderly with Knee Osteoarthritis: A Crossover Clinical Trial.

    PubMed

    Kooshki, Akram; Forouzan, Reza; Rakhshani, Mohammad Hassan; Mohammadi, Maryam

    2016-11-01

    Limited evidence supports Nigella sativa's role as an effective complementary and alternative medicine and the anti-inflammatory effects of Nigella sativa on patients with allergic rhinitis. The aim of this study was to investigate the effect of topical application of Nigella sativa oil and oral acetaminophen on pain in the elderly with knee osteoarthritis residing in a parents' home in Sabzevar. This study is done as a crossover clinical trial. After obtaining written consent of elderly patients with osteoarthritis of the knee, they were randomly divided into two groups. In step 1, in group 1, 1 cc of Nigella sativa oil was applied on the knee joint every 8 hours for 3 weeks; for the second group, every 8 hours for 3 weeks, patients were given 1 tablet of 325 mg acetaminophen. After a period of 1 month without medication to wash out each group, in step 2, each treatment group received the drug interaction in the same way as above. Pain was determined using a visual scale (VAS) before and after the first and second stages. Treatment response was defined as a decrease in pain scores over 1.5. Data analysis was performed with an R software mixed model. This study was done on 40 elderly patients: 18 (45%) men and 22 (55%) women. Their mean year and weight were 75.66±8.9 years and 69.67±14.33 kg, respectively. Study results showed that topical application of Nigella sativa oil and oral acetaminophen reduced pain in elderly with knee osteoarthritis; after using Nigella sativa oil, the reduction of pain was higher (p=0.01). The results of this study showed that topical application of Nigella sativa oil was effective in reducing pain in patients with knee osteoarthritis; therefore, it is recommended as a safe supplement for these elderly. The trial was registered at TCTR (http://www.clinicaltrials.in.th/) with the ID: TCTR20160125003. This study was approved and supported by the Sabzevar University of Medical Sciences.

  4. Effect of Topical Application of Nigella Sativa Oil and Oral Acetaminophen on Pain in Elderly with Knee Osteoarthritis: A Crossover Clinical Trial

    PubMed Central

    Kooshki, Akram; Forouzan, Reza; Rakhshani, Mohammad Hassan; Mohammadi, Maryam

    2016-01-01

    Background Limited evidence supports Nigella sativa’s role as an effective complementary and alternative medicine and the anti-inflammatory effects of Nigella sativa on patients with allergic rhinitis. Objective The aim of this study was to investigate the effect of topical application of Nigella sativa oil and oral acetaminophen on pain in the elderly with knee osteoarthritis residing in a parents’ home in Sabzevar. Methods This study is done as a crossover clinical trial. After obtaining written consent of elderly patients with osteoarthritis of the knee, they were randomly divided into two groups. In step 1, in group 1, 1 cc of Nigella sativa oil was applied on the knee joint every 8 hours for 3 weeks; for the second group, every 8 hours for 3 weeks, patients were given 1 tablet of 325 mg acetaminophen. After a period of 1 month without medication to wash out each group, in step 2, each treatment group received the drug interaction in the same way as above. Pain was determined using a visual scale (VAS) before and after the first and second stages. Treatment response was defined as a decrease in pain scores over 1.5. Data analysis was performed with an R software mixed model. Results This study was done on 40 elderly patients: 18 (45%) men and 22 (55%) women. Their mean year and weight were 75.66±8.9 years and 69.67±14.33 kg, respectively. Study results showed that topical application of Nigella sativa oil and oral acetaminophen reduced pain in elderly with knee osteoarthritis; after using Nigella sativa oil, the reduction of pain was higher (p=0.01). Conclusion The results of this study showed that topical application of Nigella sativa oil was effective in reducing pain in patients with knee osteoarthritis; therefore, it is recommended as a safe supplement for these elderly. Trial registration The trial was registered at TCTR (http://www.clinicaltrials.in.th/) with the ID: TCTR20160125003. Funding This study was approved and supported by the Sabzevar

  5. Oral intake of purple passion fruit peel extract reduces pain and stiffness and improves physical function in adult patients with knee osteoarthritis.

    PubMed

    Farid, Reza; Rezaieyazdi, Zahra; Mirfeizi, Zahra; Hatef, Mohamad Reza; Mirheidari, Mahyar; Mansouri, Hassan; Esmaelli, Habib; Bentley, Gayle; Lu, Yinrong; Foo, Yeap; Watson, Ronald Ross

    2010-09-01

    Knee osteoarthritis (OA) is a common degenerative joint disorder and a major cause of pain and disability. The hypothesis tested in this study was that the passion fruit peel extract (PFP), a flavonoid-rich dietary supplement, would reduce symptoms due to knee OA. Thirty-three OA patients were enrolled in a randomized, double-blind, placebo-controlled trial with parallel-group design. Patients received either placebo or PFP pills (150 mg, daily) in a double-blinded fashion for 2 months. The OA clinical symptoms were evaluated monthly with Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index. In the PFP group, there was a significant improvement in total WOMAC score and WOMAC subscale score of physical function after 30 days and pain after 60 days. At 60 days, reductions of 18.6%, 18%, 19.6%, and 19.2% in pain, stiffness, physical function, and composite WOMAC score, respectively, were self-reported in the PFP group. Whereas, in the placebo group, the self-reported WOMAC scores increased in every category. The results of this study show that PFP substantially alleviated osteoarthritis symptoms. This beneficial effect of PFP may be due to its antioxidant and antiinflammatory properties. Copyright © 2010 Elsevier Inc. All rights reserved.

  6. The effectiveness and safety of intra-articular injection of sodium hyaluronate (500-730 kDa) in the treatment of patients with painful knee osteoarthritis.

    PubMed

    Phiphobmongkol, Vajara; Sudhasaneya, Vudhipong

    2009-10-01

    Sodium Hyaluronate (500-730 kilodalton (kDa); Hyalgan) is recommended to administer intra-articularly once a week for 3-5 weeks in patients with osteoarthritis of the knee which its efficacy has been shown, from many clinical studies, to persist for at least 6 months. However only a few studies were done in Thai patients. To assess the efficacy and safety of intra-articular Sodium Hyaluronate, administered once a week for four weeks (four injections) in Thai patients with painful Tibio-Femoral osteoarthritis of the knee over a six-month period. Thirty-one patients with painful knee osteoarthritis in grade I (32.3%) and grade II (67.7%) severity on Ahlback radiological criteria from Orthopedic Clinic in Bhumibol Adulyadej Hospital were included in this study. All patients were administered with 4-weekly injections of intra-articular Sodium Hyaluronate (500-730 kDa; Hyalgan; 20mg/2ml). Only paracetamol was permitted for escape analgesia. The efficacy parameters were the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for pain, stiffness and physical function, intake of paracetamol, and overall efficacy judgment by investigators and patients. The occurrence of adverse event was recorded at each visit. After the second injection of Sodium Hyaluronate, all WOMAC index revealed the significant improvement from baseline (p < 0.05). The WOMAC-VAS for pain at baseline, Day 14, 28, 84, and 168 were 50.3, 33.3, 29.1, 23.1, and 21.4 mm respectively. At the end of study, most patients and investigators evaluated treatment efficacy as moderate to very effective. There was a decrease in paracetamol consumption from baseline until the last follow-up. Nine adverse events were recorded, which were transient events; most of them consisted of pain at injection site. No systemic or serious adverse event was reported. The results of this study showed the efficacy and safety of 4-weekly injections of Sodium Hyaluronate in the treatment of knee osteoarthritis in

  7. Manual for guided home exercises for osteoarthritis of the knee.

    PubMed

    Carvalho, Nilza Aparecida de Almeida; Bittar, Simoni Teixeira; Pinto, Flávia Ribeiro de Souza; Ferreira, Mônica; Sitta, Robson Roberto

    2010-06-01

    Physiotherapy is one of the most important components of therapy for osteoarthritis of the knee. The objective of this prospective case series was to assess the efficiency of a guidance manual for patients with osteoarthritis of the knee in relation to pain, range of movement , muscle strength and function, active goniometry, manual strength test and function. Thirty-eight adults with osteoarthritis of the knee (>or= 45 years old) who were referred to the physiotherapy service at the university hospital (Santa Casa de Misericórdia de São Paulo) were studied. Patients received guidance for the practice of specific physical exercises and a manual with instructions on how to perform the exercises at home. They were evaluated for pain, range of movement, muscle strength and function. These evaluations were performed before they received the manual and three months later. Patients were seen monthly regarding improvements in their exercising abilities. The program was effective for improving muscle strength, controlling pain, maintaining range of movement of the knee joint, and reducing functional incapacity. A review of the literature showed that there are numerous clinical benefits to the regular practice of physical therapy exercises by patients with osteoarthritis of the knee(s) in a program with appropriate guidance. This study shows that this guidance can be attained at home with the use of a proper manual. Even when performed at home without constant supervision, the use of the printed manual for orientation makes the exercises for osteoarthritis of the knee beneficial.

  8. Naproxen effects on brain response to painful pressure stimulation in patients with knee osteoarthritis: a double-blind, randomized, placebo-controlled, single-dose study.

    PubMed

    Giménez, Mónica; Pujol, Jesús; Ali, Zahid; López-Solà, Marina; Contreras-Rodríguez, Oren; Deus, Joan; Ortiz, Héctor; Soriano-Mas, Carles; Llorente-Onaindia, Jone; Monfort, Jordi

    2014-11-01

    The aim of our study was to investigate the effects of naproxen, an antiinflammatory analgesic drug, on brain response to painful stimulation on the affected knee in chronic osteoarthritis (OA) using functional magnetic resonance imaging (fMRI) in a double-blind, placebo-controlled study. A sample of 25 patients with knee OA received naproxen (500 mg), placebo, or no treatment in 3 separate sessions in a randomized manner. Pressure stimulation was applied to the medial articular interline of the knee during the fMRI pain sequence. We evaluated subjective pain ratings at every session and their association with brain responses to pain. An fMRI control paradigm was included to discard global brain vascular effects of naproxen. We found brain activation reductions under naproxen compared to no treatment in different cortical and subcortical core pain processing regions (p≤0.001). Compared to placebo, naproxen triggered an attenuation of amygdala activation (p=0.001). Placebo extended its attenuation effects beyond the classical pain processing network (p≤0.001). Subjective pain scores during the fMRI painful task differed between naproxen and no treatment (p=0.037). Activation attenuation under naproxen in different regions (i.e., ventral brain, cingulate gyrus) was accompanied by an improvement in the subjective pain complaints (p≤0.002). Naproxen effectively reduces pain-related brain responses involving different regions and the attenuation is related to subjective pain changes. Our current work yields further support to the utility of fMRI to objectify the acute analgesic effects of a single naproxen dose in patients affected by knee OA. The trial was registered at the EuropeanClinicalTrials Database, "EudraCT Number 2008-004501-33".

  9. Getting Better or Getting Well? The Patient Acceptable Symptom State (PASS) Better Predicts Patient's Satisfaction than the Decrease of Pain, in Knee Osteoarthritis Subjects Treated with Viscosupplementation.

    PubMed

    Conrozier, Thierry; Monet, Matthieu; Lohse, Anne; Raman, Raghu

    2017-08-01

    Background In the management of knee osteoarthritis (OA), patient-reported-outcomes (PROs) are being developed for relevant assessment of pain. The patient acceptable symptom state (PASS) is a relevant cutoff, which allows classifying patients as being in "an acceptable state" or not. Viscosupplementation is a therapeutic modality widely used in patients with knee OA that many patients are satisfied with despite meta-analyses give conflicting results. Objectives To compare, 6 months after knee viscosupplementation, the percentage of patients who reached the PASS threshold (PASS +) with that obtained from other PROs. Methods Data of 53 consecutive patients treated with viscosupplementation (HANOX-M-XL) and followed using a standardized procedure, were analyzed at baseline and month 6. The PROs were Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function, patient's global assessment of pain (PGAP), patient's self-assessment of satisfaction, PASS for WOMAC pain and PGAP. Results At baseline, WOMAC pain and PGAP (range 0-10) were 4.6 (1.1) and 6.0 (1.1). At month 6, they were 1.9 (1.2) and 3.1 (5) ( P < 0.0001). At 6 months, 83% of patients were "PASS + pain," 100% "PASS + function," 79% "PASS + PGAP," 79% were satisfied, and 73.6% experienced a ≥50% decrease in WOMAC pain. Among "PASS + pain" and "PASS + PGAP" subjects, 90% and 83.3% were satisfied with the treatment, respectively. Conclusion In daily practice, clinical response to viscosupplementation slightly varies according to PROs. "PASS + PGAP" was the most related to patient satisfaction.

  10. A Cross-sectional Examination of Vitamin D, Obesity, and Measures of Pain and Function in Middle-aged and Older Adults With Knee Osteoarthritis.

    PubMed

    Glover, Toni L; Goodin, Burel R; King, Christopher D; Sibille, Kimberly T; Herbert, Matthew S; Sotolongo, Adriana S; Cruz-Almeida, Yenisel; Bartley, Emily J; Bulls, Hailey W; Horgas, Ann L; Redden, David T; Riley, Joseph L; Staud, Roland; Fessler, Barri J; Bradley, Laurence A; Fillingim, Roger B

    2015-12-01

    The prevalence of knee osteoarthritis (OA) is increasing with the aging population and is exacerbated by the growing numbers of obese older adults. Low levels of vitamin D, measured by serum 25-hydroxyvitamin D (25(OH)D), in older adults and obese individuals are correlated with several negative health conditions, including chronic pain. This cross-sectional study sought to examine the interactive influence of 25(OH)D levels and obesity on knee OA pain and functional performance measures. The sample consisted of 256 (63% female) racially diverse (55% black/African Americans) middle-aged and older adults (mean age 56.8 y). Blood was collected for analysis of 25(OH)D by high-performance liquid chromatography. Participants provided self-report regarding knee OA pain and underwent a lower extremity functional performance test. Results demonstrated that obesity was associated with lower levels of 25(OH)D. Participants with adequate 25(OH)D levels reported significantly less knee OA pain compared with participants with deficient or insufficient levels, regardless of obesity status. Furthermore, there was a significant interaction between obesity and 25(OH)D levels for lower extremity functional performance, such that obese individuals with adequate 25(OH)D levels demonstrated better performance than those obese participants with deficient or insufficient 25(OH)D levels. The mechanisms by which adequate 25(OH)D levels are associated with pain severity and improved function have not been completely elucidated. It may be that the pleiotropic role of biologically active 25(OH)D influences pain and pain processing through peripheral and central mechanisms. Alternatively, higher levels of pain may lead to reduced outdoor activity, which may contribute to both obesity and decreased vitamin D. Thus, investigating vitamin D status in obese and nonobese individuals with knee OA warrants further study.

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

    PubMed

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

    2016-01-01

    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). 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. 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. The Persian version of the ICOAP is a reliable and valid outcome measure that can be used in Iranian subjects with KOA.

  12. 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

  13. The efficacy of intra-articular lidocaine administration in chronic knee pain due to osteoarthritis: A randomized, double-blind, controlled study.

    PubMed

    Eker, H Evren; Cok, Oya Yalcin; Aribogan, Anis; Arslan, Gulnaz

    2017-04-01

    Intra-articular injections for the treatment of knee pain due to osteoarthritis are performed when conservative therapies have failed. The intra-articular injection of lidocaine may be an effective treatment modality due to its neuronal membrane-stabilizing effect and long-lasting anti-inflammatory action. In this study, we compared the efficacy of intra-articular 0.5% lidocaine versus saline injection on pain, stiffness and physical function in patients with osteoarthritis. Patients with osteoarthritis were randomly allocated to two groups. Group I (n=26) received 7mL 0.5% lidocaine and group II (n=26) received 7mL saline into the painful knee for a series of three injections spaced by 1 week intervals under ultrasound guidance. Knee pain was measured with a numeric rating score (NRS) at baseline and 3 months after the 3rd injection. WOMAC scales, including pain (WOMAC-P), stiffness (WOMAC-S) and physical function (WOMAC-F), were assessed and recorded at baseline, 30minutes after the 1st injection, immediately prior to the 2nd and 3rd injections and 3 months after the 3rd injection. Demographic data were comparable between groups. The NRS after 3 months was significantly lower in group I (P=0.001). The WOMAC-P, immediately prior to the 3rd injection and 3 months afterwards, was significantly lower in group I (P=0.006, P=0.001, respectively). The WOMAC-S was improved prior to the 3rd injection and sustained until 3 months in group I (P=0.035, P=0.004, respectively). The WOMAC-F was improved after the 1st injection and sustained until 3 months in group I (P=0.002, P<0.0001 and P<0.0001, respectively). Intra-articular 0.5% lidocaine injection under ultrasound guidance has a potential role in the management of chronic knee pain due to osteoarthritis for a 3-month period. Copyright © 2016 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

  14. The Epidemiology and Impact of Pain in Osteoarthritis

    PubMed Central

    Neogi, Tuhina

    2013-01-01

    Osteoarthritis is the most common form of arthritis and a leading cause of disability worldwide, largely due to pain, the primary symptom of the disease. The pain experience in knee osteoarthritis in particular is well-recognized as typically transitioning from intermittent weight-bearing pain to a more persistent, chronic pain. Methods to validly assess pain in osteoarthritis studies have been developed to address the complex nature of the pain experience. The etiology of pain in osteoarthritis is recognized to be multifactorial, with both intra-articular and extra-articular risk factors. Nonetheless, greater insights are needed into pain mechanisms in osteoarthritis to enable rational mechanism-based management of pain. Consequences of pain related to osteoarthritis contribute to a substantial socioeconomic burden. PMID:23973124

  15. 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

  16. Knowledge expectations of recently diagnosed patients with knee osteoarthritis.

    PubMed

    Pellinen, Tiina; Villberg, Jari; Raappana, Maarit; Leino-Kilpi, Helena; Kettunen, Tarja

    2016-11-01

    The aim of this study was to assess the socio-demographic and disease-related symptoms and emotions and knowledge expectations of patients recently diagnosed with knee osteoarthritis. A further aim was to determine associations between selected demographic variables and patients' expected knowledge. Patient counselling and information provision are recommended for all patients with knee osteoarthritis. In healthcare centres, there is a good possibility to establish the knowledge expectations of patients with knee osteoarthritis during counselling. Recent empirical evidence indicates a lack of research on knowledge expectations among recently diagnosed patients with knee osteoarthritis. A quantitative, descriptive inquiry design was adopted. The data were collected from 252 recently diagnosed patients with knee osteoarthritis by a postal survey in 2013, using the Hospital Patient's Knowledge Expectations Scale as well as additional questions and statements. The data were analysed using multivariate linear regression. Most of the respondents were female pensioners who also had other chronic diseases. Approximately half of the participants had had counselling on osteoarthritis. Knowledge expectations concerning pain management were emphasized. From the empowering knowledge perspective, the highest knowledge expectations concerned bio-physiological dimensions of knowledge, followed by ethical and financial dimensions. Age, employment status, pain and emotions of concern and hope among women and tiredness or fatigue and vocational/higher education among men were associated with knowledge expectations. Patients with knee osteoarthritis have high knowledge expectations and there is a need to improve the counselling and care of pain and tiredness or fatigue symptoms. The development of the counselling of recently diagnosed patients with knee osteoarthritis also needs further research. © 2016 John Wiley & Sons Ltd.

  17. Effect of aquatic physical therapy on pain perception, functional capacity and quality of life in older people with knee osteoarthritis: study protocol for a randomized controlled trial.

    PubMed

    Alcalde, Guilherme Eleutério; Fonseca, Ana Carolina; Bôscoa, Thais Fernanda; Gonçalves, Mirella Regina; Bernardo, Gabriele Candido; Pianna, Bruna; Carnavale, Bianca Ferdin; Gimenes, Camila; Barrile, Silvia Regina; Arca, Eduardo Aguilar

    2017-07-11

    Aquatic therapy promotes short-term benefits for patients with knee osteoarthritis (OA), and it may be the first therapeutic option for this pathological condition. The objective of this study was to investigate the effects of an aquatic therapy program on pain intensity, functional ability, and quality of life in older people with knee OA. This is a parallel, two-arm, open, randomized controlled clinical trial with older people with knee OA. Volunteers will be allocated to an aquatic intervention group (WG), subjected to the intervention, or to a control group, not be subjected to any kind of intervention. Data collection pre- and postintervention will be composed of the evaluation of the perception of pain by visual analogue scale with application of nociceptive stimuli in four anatomical points of the knee, functional fitness tests, and application of the World Health Organization Quality of Life Scale abbreviated version and Western Ontario and McMaster Universities Osteoarthritis Index. The program will last 12 weeks, consisting of aerobic and functional exercises in the form of circuit training. The objective of this clinical trial is to evaluate the effect of aquatic therapy in elderly patients with knee OA. The study is guided by practice-based scientific evidence for the use of aquatic rehabilitation exercises. It is expected that the WG volunteers will show reduced pain intensity, increased flexibility, and improved functional capacity and quality of life. It is believed that the desired results can be attributed to physical and physiological effects of immersion in warm water associated with the exercise protocol proposed. The data will be published after completion of the study. Brazilian Registry of Clinical Trials (ReBEC) registration number: RBR-78h48d . Registered on 19 August 2015.

  18. Does increasing step width alter knee biomechanics in medial compartment knee osteoarthritis patients during stair descent?

    PubMed

    Paquette, Max R; Zhang, Songning; Milner, Clare E; Klipple, Gary

    2014-06-01

    Research shows that one of the first complaints from knee osteoarthritis (OA) patients is difficulty in stair ambulation due to knee pain. Increased step width (SW) has been shown to reduce first and second peak internal knee abduction moments, a surrogate variable for medial compartment knee joint loading, during stair descent in healthy older adults. This study investigates the effects of increased step width (SW) on knee biomechanics and knee pain in medial compartment knee OA patients during stair descent. Thirteen medial compartment knee OA patients were recruited for the study. A motion analysis system was used to obtain three-dimensional joint kinematics. An instrumented staircase was used to collect ground reaction forces (GRF). Participants performed stair descent trials at their self-selected speed using preferred, wide, and wider SW. Participants rated their knee pain levels after each SW condition. Increased SW had no effect on peak knee abduction moments and knee pain. Patients reported low levels of knee pain during all stair descent trials. The 2nd peak knee adduction angle and frontal plane GRF at time of 2nd peak abduction moment were reduced with increasing SW. The findings suggest that increases in SW may not influence knee loads in medial compartment knee OA patients afflicted with low levels of knee pain during stair descent. Copyright © 2014 Elsevier B.V. All rights reserved.

  19. Efficacy of knee tape in the management of osteoarthritis of the knee: blinded randomised controlled trial.

    PubMed

    Hinman, Rana S; Crossley, Kay M; McConnell, Jenny; Bennell, Kim L

    2003-07-19

    To test the hypotheses that therapeutic taping of the knee improves pain and disability in patients with osteoarthritis of the knee and that benefits remain after stopping treatment. Randomised single blind controlled trial with three intervention arms (therapeutic tape, control tape, and no tape) of three weeks' duration and three week follow up. Outcome assessment was performed in a university based laboratory. Taping interventions were applied by eight physiotherapists in metropolitan private practice. 87 patients with symptoms of knee osteoarthritis as defined by the American College of Rheumatology. Primary outcome measure was pain as measured by visual analogue scale and participant perceived rating of change. Secondary measures of pain and disability included the Western Ontario and MacMaster Universities osteoarthritis index, knee pain scale, and the SF-36. The therapeutic tape group reported a greater reduction in pain on all primary outcomes than either of the other two groups. A significant association was evident between intervention and change in pain at three weeks (P=0.000), with 73% (21/29) of the therapeutic tape group reporting improvement compared with 49% (14/29) of the control tape group and 10% (3/29) of the no tape group. Significantly greater improvement in pain and disability was observed on most secondary outcomes in the therapeutic tape group compared with the no tape group. Benefits of therapeutic tape were maintained three weeks after stopping treatment. Therapeutic knee taping is an efficacious treatment for the management of pain and disability in patients with knee osteoarthritis.

  20. Effects of whole body vibration on pain, stiffness and physical functions in patients with knee osteoarthritis: a systematic review and meta-analysis.

    PubMed

    Wang, Pu; Yang, Xiaotian; Yang, Yonghong; Yang, Lin; Zhou, Yujing; Liu, Chuan; Reinhardt, Jan D; He, Chengqi

    2015-10-01

    To assess the effects of whole body vibration for pain, stiffness and physical functions in patients with knee osteoarthritis. We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Physiotherapy Evidence Database (PEDro) and EMBASE (up to October 2014) to identify relevant randomized controlled trials. The outcome measures were pain, stiffness and physical functions. Two investigators identified eligible studies and extracted data independently. The PEDro score was used to evaluate the methodological quality of the selected studies. Standard mean differences (SMDs) and 95% confidence intervals (CIs) were calculated, and heterogeneity was assessed using the I(2) test. A total of five randomized controlled trials involving 170 patients with knee osteoarthritis met the inclusion criteria. Only four studies involving 144 patients were deemed to be good quality trials (PEDro score = 6-7). Meta-analysis revealed that whole body vibration has a significant treatment effect in Western Ontario and McMaster Universities index physical function score (SMD = -0.72 points, 95% CI = -1.14 to -0.30, P = 0.0008), 12 weeks whole body vibration improved the 6-minute walk test (SMD 1.15 m, 95% CI 0.50 to 1.80, P = 0.0006) and balance (SMD = -0.78 points, 95% CI -1.40 to -0.16, P = 0.01). Whole body vibration was not associated with a significant reduction in Western Ontario and McMaster Universities index pain and stiffness score. Eight-week and 12-week whole body vibration is beneficial for improving physical functions in patients with knee osteoarthritis and could be included in rehabilitation programs. © The Author(s) 2014.

  1. Effect of Comorbid Knee and Hip Osteoarthritis on Longitudinal Clinical and Health Care Use Outcomes in Older Adults With New Visits for Back Pain.

    PubMed

    Rundell, Sean D; Goode, Adam P; Suri, Pradeep; Heagerty, Patrick J; Comstock, Bryan A; Friedly, Janna L; Gold, Laura S; Bauer, Zoya; Avins, Andrew L; Nedeljkovic, Srdjan S; Nerenz, David R; Kessler, Larry; Jarvik, Jeffrey G

    2017-01-01

    To examine if a comorbid diagnosis of knee or hip osteoarthritis (OA) in older adults with new back pain visits is associated with long-term patient-reported outcomes and back-related health care use. Prospective cohort study. Three integrated health systems forming the Back pain Outcomes using Longitudinal Data cohort. Participants (N=5155) were older adults (≥65y) with a new visit for back pain and a complete electronic health record data. Not applicable; we obtained OA diagnoses using diagnostic codes in the electronic health record 12 months prior to the new back pain visit. The Roland-Morris Disability Questionnaire (RDQ) and the EuroQol-5D (EQ-5D) were key patient-reported outcomes. Health care use, measured by relative-value units (RVUs), was summed for the 12 months after the initial visit. We used linear mixed-effects models to model patient-reported outcomes. We also used generalized linear models to test the association between comorbid knee or hip OA and total back-related RVUs. Of the 5155 participants, 368 (7.1%) had a comorbid knee OA diagnosis, and 94 (1.8%) had a hip OA diagnosis. Of the participants, 4711 (91.4%) had neither knee nor hip OA. In adjusted models, the 12-month RDQ score was 1.23 points higher (95% confidence interval [CI], 0.72-1.74) for patients with knee OA and 1.26 points higher (95% CI, 0.24-2.27) for those with hip OA than those without knee or hip OA, respectively. A lower EQ-5D score was found among participants with knee OA (.02 lower; 95% CI, -.04 to -.01) and hip OA diagnoses (.03 lower; 95% CI, -.05 to -.01) compared with those without knee or hip OA, respectively. Comorbid knee or hip OA was not significantly associated with total 12-month back-related resource use. Comorbid knee or hip OA in older adults with a new back pain visit was associated with modestly worse long-term disability and health-related quality of life. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All

  2. Early osteoarthritis of the knee.

    PubMed

    Madry, Henning; Kon, Elizaveta; Condello, Vincenzo; Peretti, Giuseppe M; Steinwachs, Matthias; Seil, Romain; Berruto, Massimo; Engebretsen, Lars; Filardo, Giuseppe; Angele, Peter

    2016-06-01

    There is an increasing awareness on the importance in identifying early phases of the degenerative processes in knee osteoarthritis (OA), the crucial period of the disease when there might still be the possibility to initiate treatments preventing its progression. Early OA may show a diffuse and ill-defined involvement, but also originate in the cartilage surrounding a focal lesion, thus necessitating a separate assessment of these two entities. Early OA can be considered to include a maximal involvement of 50 % of the cartilage thickness based on the macroscopic ICRS classification, reflecting an OARSI grade 4. The purpose of this paper was to provide an updated review of the current status of the diagnosis and definition of early knee OA, including the clinical, radiographical, histological, MRI, and arthroscopic definitions and biomarkers. Based on current evidence, practical classification criteria are presented. As new insights and technologies become available, they will further evolve to better define and treat early knee OA.

  3. Predicting knee osteoarthritis risk in injured populations.

    PubMed

    Long, Michael J; Papi, Enrica; Duffell, Lynsey D; McGregor, Alison H

    2017-08-01

    Individuals who suffered a lower limb injury have an increased risk of developing knee osteoarthritis. Early diagnosis of osteoarthritis and the ability to track its progression is challenging. This study aimed to explore links between self-reported knee osteoarthritis outcome scores and biomechanical gait parameters, whether self-reported outcome scores could predict gait abnormalities characteristic of knee osteoarthritis in injured populations and, whether scores and biomechanical outcomes were related to osteoarthritis severity via Spearman's correlation coefficient. A cross-sectional study was conducted with asymptomatic participants, participants with lower-limb injury and those with medial knee osteoarthritis. Spearman rank determined relationships between knee injury and outcome scores and hip and knee kinetic/kinematic gait parameters. K-Nearest Neighbour algorithm was used to determine which of the evaluated parameters created the strongest classifier model. Differences in outcome scores were evident between groups, with knee quality of life correlated to first and second peak external knee adduction moment (0.47, 0.55). Combining hip and knee kinetics with quality of life outcome produced the strongest classifier (1.00) with the least prediction error (0.02), enabling classification of injured subjects gait as characteristic of either asymptomatic or knee osteoarthritis subjects. When correlating outcome scores and biomechanical outcomes with osteoarthritis severity only maximum external hip and knee abduction moment (0.62, 0.62) in addition to first peak hip adduction moment (0.47) displayed significant correlations. The use of predictive models could enable clinicians to identify individuals at risk of knee osteoarthritis and be a cost-effective method for osteoarthritis screening. Copyright © 2017. Published by Elsevier Ltd.

  4. Mid-Treatment Sleep Duration Predicts Clinically Significant Knee Osteoarthritis Pain reduction at 6 months: Effects From a Behavioral Sleep Medicine Clinical Trial.

    PubMed

    Salwen, Jessica K; Smith, Michael T; Finan, Patrick H

    2017-02-01

    To determine the relative influence of sleep continuity (sleep efficiency, sleep onset latency, total sleep time [TST], and wake after sleep onset) on clinical pain outcomes within a trial of cognitive behavioral therapy for insomnia (CBT-I) for patients with comorbid knee osteoarthritis and insomnia. Secondary analyses were performed on data from 74 patients with comorbid insomnia and knee osteoarthritis who completed a randomized clinical trial of 8-session multicomponent CBT-I versus an active behavioral desensitization control condition (BD), including a 6-month follow-up assessment. Data used herein include daily diaries of sleep parameters, actigraphy data, and self-report questionnaires administered at specific time points. Patients who reported at least 30% improvement in self-reported pain from baseline to 6-month follow-up were considered responders (N = 31). Pain responders and nonresponders did not differ significantly at baseline across any sleep continuity measures. At mid-treatment, only TST predicted pain response via t tests and logistic regression, whereas other measures of sleep continuity were nonsignificant. Recursive partitioning analyses identified a minimum cut-point of 382 min of TST achieved at mid-treatment in order to best predict pain improvements 6-month posttreatment. Actigraphy results followed the same pattern as daily diary-based results. Clinically significant pain reductions in response to both CBT-I and BD were optimally predicted by achieving approximately 6.5 hr sleep duration by mid-treatment. Thus, tailoring interventions to increase TST early in treatment may be an effective strategy to promote long-term pain reductions. More comprehensive research on components of behavioral sleep medicine treatments that contribute to pain response is warranted.

  5. Relationship between decreased lower extremity muscle mass and knee pain severity in both the general population and patients with knee osteoarthritis: Findings from the KNHANES V 1-2

    PubMed Central

    Cheon, Yun-Hong; Kim, Hyun-Ok; Suh, Young Sun; Kim, Min Gyo; Yoo, Wan-Hee; Kim, Rock Bum; Yang, Hyun-Su

    2017-01-01

    Objective To identify the prevalence of and risk factors for knee pain and radiographic knee osteoarthritis (RKOA) and to investigate the relationship between decreased lower extremity muscle mass (DLEM) and knee pain severity. Methods Using data from the Korea National Health and Nutrition Examination Survey, 3,278 participants who were ≥50 years old and who underwent dual x-ray absorptiometry, plain knee radiographs and completed a knee pain questionnaire were enrolled. Lower extremity muscle mass (LEM) was defined as the sum of the fat-free soft tissue mass of the legs, and lower extremity muscle mass index (LMI) was calculated as LEM/body weight (%). DLEM was defined as an LMI more than two standard deviations below the mean of a gender-matched young reference group. Categorical variables were presented as numbers (weighted %). Results The prevalence of knee pain and RKOA were 22% (n = 721) and 34.7% (n = 1,234), respectively. Multivariate logistic regression analysis showed being female (OR 2.15, 95% CI 1.67–2.79), older (OR 1.03, 95% CI 1.01–1.04), less educated (OR 1.72, 95% CI 1.09–2.71), stiffness (OR 16.15, 95% CI 12.04–21.66), bed rest (OR 2.49, 95% CI 1.81–3.43), RKOA (OR 2.20, 95% CI 1.78–2.74) and DLEM (OR 1.54, 95% CI 1.09–2.17) were associated with knee pain. Participants with simultaneous RKOA and DLEM complained of more severe pain (pain score 7.18 ± 2.48) than those with knee pain without RKOA or DLEM (5.02 ± 2.44), those with only RKOA (6.29 ± 2.50), or those with only DLEM (6.78 ± 2.18) (P<0.001). These results remained after multivariate analyses of variance (MANOVAs). Conclusion The prevalence of knee pain and RKOA were 22% and 34.7%, respectively, in the general Korean population. DLEM was an independent risk factor for knee pain and it was associated with increased pain severity, regardless of RKOA. PMID:28296926

  6. Noxious counterirritation in patients with advanced osteoarthritis of the knee reduces MCC but not SII pain generators: A combined use of MEG and EEG

    PubMed Central

    Quante, Markus; Hille, Stephanie; Schofer, Markus D; Lorenz, Jürgen; Hauck, Michael

    2008-01-01

    Chronic pain is mainly a result of two processes: peripheral and central sensitization, which can result in neuroplastic changes. Previous psychophysical studies suggested a decrease of the so-called pain-inhibiting-pain effect (DNIC) in chronic pain patients. We aimed to study the DNIC effect on the neuronal level using magnetoencephalography and electroencephalography in 12 patients suffering from advanced unilateral knee osteoarthritis (OA). DNIC was induced in patients by provoking the typical OA pain by a slightly hyperextended joint position, while they received short electrical pain stimuli. Although the patients did not report a reduction of electrical pain perception, the cingulate gyrus showed a decrease of activation during provoked OA pain, while activity in the secondary somatosensory cortex did not change. Based on much stronger DNIC induction at comparable intensities of an acute counterirritant pain in healthy subjects this result suggests a deficit of DNIC in OA patients. We suggest that the strength of DNIC is subject to neuronal plasticity of descending inhibitory pain systems and diminishes during the development of a chronic pain condition. PMID:21197282

  7. Ankle strength impairments associated with knee osteoarthritis.

    PubMed

    Gonçalves, Glaucia Helena; Sendín, Francisco Alburquerque; da Silva Serrão, Paula Regina Mendes; Selistre, Luiz Fernando Approbato; Petrella, Marina; Carvalho, Cristiano; Mattiello, Stela Márcia

    2017-07-01

    Knee Osteoarthritis seems to negatively impact ankle biomechanics. However, the effect of knee osteoarthritis on ankle muscle strength has not been clearly established. This study aimed to evaluate the ankle strength of the plantar flexors and dorsiflexors of patients with knee osteoarthritis in different degrees of severity. Thirty-seven patients with knee osteoarthritis and 15 controls, subjected to clinical and radiographic analysis, were divided into three groups: control, mild, and moderate knee osteoarthritis. Participants answered a self-reported questionnaire and accomplished a muscle torque assessment of the ankle using the Biodex dynamometer in isometric, concentric and eccentric modes. The mild osteoarthritis group (peak torque=26.85(SD 3.58)) was significantly weaker than the control (peak torque=41.75(SD 4.42)) in concentric plantar flexion (P<0.05). The control and mild osteoarthritis groups were not significantly different from the moderate osteoarthritis group (peak torque=36.12(SD 4.61)) in concentric plantar flexion. There were no significant differences for dorsiflexion among the groups; however the control and moderate osteoarthritis groups presented large and medium standardized mean differences. The mild osteoarthritis group was significantly lower than the control and moderate osteoarthritis groups in the concentric plantar flexion by concentric dorsiflexion torque ratio. Ankle function exhibited impairments in patients with knee osteoarthritis, especially in the plantar flexion torque, in which the mild osteoarthritis group was weaker than the control. Interestingly, patients with moderate knee osteoarthritis showed results similar to the control group in plantar flexion torque. The results raise the possibility of a compensatory mechanism of the plantar flexors developed by patients in more advanced degrees to balance other muscle failures. Copyright © 2017 Elsevier Ltd. All rights reserved.

  8. Effectiveness of a healthy lifestyle intervention for low back pain and osteoarthritis of the knee: protocol and statistical analysis plan for two randomised controlled trials

    PubMed Central

    O’Brien, Kate M.; Williams, Amanda; Wiggers, John; Wolfenden, Luke; Yoong, Serene; Campbell, Elizabeth; Kamper, Steven J.; McAuley, James; Attia, John; Oldmeadow, Chris; Williams, Christopher M.

    2016-01-01

    ABSTRACT Background These trials are the first randomised controlled trials of telephone-based weight management and healthy lifestyle interventions for low back pain and knee osteoarthritis. This article describes the protocol and statistical analysis plan. Method These trials are parallel randomised controlled trials that investigate and compare the effect of a telephone-based weight management and healthy lifestyle intervention for improving pain intensity in overweight or obese patients with low back pain or knee osteoarthritis. The analysis plan was finalised prior to initiation of analyses. All data collected as part of the trial were reviewed, without stratification by group, and classified by baseline characteristics, process of care and trial outcomes. Trial outcomes were classified as primary and secondary outcomes. Appropriate descriptive statistics and statistical testing of between-group differences, where relevant, have been planned and described. Conclusions A protocol for standard analyses was developed for the results of two randomised controlled trials. This protocol describes the data, and the pre-determined statistical tests of relevant outcome measures. The plan demonstrates transparent and verifiable use of the data collected. This a priori protocol will be followed to ensure rigorous standards of data analysis are strictly adhered to. PMID:27683839

  9. Using viscosupplementation to treat knee osteoarthritis.

    PubMed

    Ray, Tracy R

    2013-11-01

    This article provides physicians specializing in nonsurgical sports medicine with an overview of viscosupplementation as a treatment for osteoarthritis (OA) pain. Osteoarthritis is a painful, disabling condition that is becoming more prevalent in patients and is generally treated using conservative nonpharmacologic measures. If conservative measures are unsuccessful at alleviating pain, current recommendations include prescribing acetaminophen and nonsteroidal anti-inflammatory drugs to patients. However, long-term use of these agents increases the risk for liver, cardiovascular, gastrointestinal, and/or renal complications in patients. Viscosupplementation is the term used for intra-articular injection of hyaluronic acid/hylans. Intra-articular injections of these agents have good safety profiles and have shown efficacy for treating knee OA pain. Viscosupplementation injections relieve pain for ≤ 26 weeks, which is longer than the short-term pain relief derived from nonsteroidal anti-inflammatory drugs and corticosteroid injections. Additionally, viscosupplementation administered to patients in earlier stages of OA may be more beneficial than when given later in the treatment of OA. As part of a multimodal algorithm, viscosupplementation combined with conventional therapy or other pharmacologic agents has been shown to be more effective at managing OA than conventional care alone. This article reviews the evidence for using viscosupplementation as part of a comprehensive program for managing OA in patients.

  10. A physiotherapist-delivered integrated exercise and pain coping skills training intervention for individuals with knee osteoarthritis: a randomised controlled trial protocol

    PubMed Central

    2012-01-01

    Background Knee osteoarthritis (OA) is a prevalent chronic musculoskeletal condition with no cure. Pain is the primary symptom and results from a complex interaction between structural changes, physical impairments and psychological factors. Much evidence supports the use of strengthening exercises to improve pain and physical function in this patient population. There is also a growing body of research examining the effects of psychologist-delivered pain coping skills training (PCST) particularly in other chronic pain conditions. Though typically provided separately, there are symptom, resource and personnel advantages of exercise and PCST being delivered together by a single healthcare professional. Physiotherapists are a logical choice to be trained to deliver a PCST intervention as they already have expertise in administering exercise for knee OA and are cognisant of the need for a biopsychosocial approach to management. No studies to date have examined the effects of an integrated exercise and PCST program delivered solely by physiotherapists in this population. The primary aim of this multisite randomised controlled trial is to investigate whether an integrated 12-week PCST and exercise treatment program delivered by physiotherapists is more efficacious than either program alone in treating pain and physical function in individuals with knee OA. Methods/design This will be an assessor-blinded, 3-arm randomised controlled trial of a 12-week intervention involving 10 physiotherapy visits together with home practice. Participants with symptomatic and radiographic knee OA will be recruited from the community in two cities in Australia and randomized into one of three groups: exercise alone, PCST alone, or integrated PCST and exercise. Randomisation will be stratified by city (Melbourne or Brisbane) and gender. Primary outcomes are overall average pain in the past week measured by a Visual Analogue Scale and physical function measured by the Western Ontario and Mc

  11. A physiotherapist-delivered integrated exercise and pain coping skills training intervention for individuals with knee osteoarthritis: a randomised controlled trial protocol.

    PubMed

    Bennell, Kim L; Ahamed, Yasmin; Bryant, Christina; Jull, Gwendolen; Hunt, Michael A; Kenardy, Justin; Forbes, Andrew; Harris, Anthony; Nicholas, Michael; Metcalf, Ben; Egerton, Thorlene; Keefe, Francis J

    2012-07-24

    Knee osteoarthritis (OA) is a prevalent chronic musculoskeletal condition with no cure. Pain is the primary symptom and results from a complex interaction between structural changes, physical impairments and psychological factors. Much evidence supports the use of strengthening exercises to improve pain and physical function in this patient population. There is also a growing body of research examining the effects of psychologist-delivered pain coping skills training (PCST) particularly in other chronic pain conditions. Though typically provided separately, there are symptom, resource and personnel advantages of exercise and PCST being delivered together by a single healthcare professional. Physiotherapists are a logical choice to be trained to deliver a PCST intervention as they already have expertise in administering exercise for knee OA and are cognisant of the need for a biopsychosocial approach to management. No studies to date have examined the effects of an integrated exercise and PCST program delivered solely by physiotherapists in this population. The primary aim of this multisite randomised controlled trial is to investigate whether an integrated 12-week PCST and exercise treatment program delivered by physiotherapists is more efficacious than either program alone in treating pain and physical function in individuals with knee OA. This will be an assessor-blinded, 3-arm randomised controlled trial of a 12-week intervention involving 10 physiotherapy visits together with home practice. Participants with symptomatic and radiographic knee OA will be recruited from the community in two cities in Australia and randomized into one of three groups: exercise alone, PCST alone, or integrated PCST and exercise. Randomisation will be stratified by city (Melbourne or Brisbane) and gender. Primary outcomes are overall average pain in the past week measured by a Visual Analogue Scale and physical function measured by the Western Ontario and McMaster Universities

  12. 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

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

    PubMed

    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

    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. 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. 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. This study demonstrates that sCOMP levels are predictive of subsequent structural changes and incidence of painful KOA, independently of age and BMI.

  14. Analgesic effect of raloxifene on back and knee pain in postmenopausal women with osteoporosis and/or osteoarthritis.

    PubMed

    Fujita, Takuo; Fujii, Yoshio; Munezane, Hiromi; Ohue, Mutsumi; Takagi, Yasuyuki

    2010-07-01

    To assess the effect of raloxifene on bone and joint pain, 24 postmenopausal women with back or knee pain or both were randomly divided into two groups, based on the chronological sequence of consultation, to be treated with 60 mg raloxifene and 1 microg alfacalcidol (RA)/day (group RA) or 1 microg alfacalcidol alone (A)/day (group A), respectively, for 6 months. Pain following knee loading (KL) by standing up from a chair and bending the knee by squatting, knee and spine loading (KSL) by walking horizontally and ascending and descending stairs, and spine loading (SL) by lying down supine on a bed and leaving the bed to stand was evaluated by electroalgometry (EAM), based on measurement of the fall of skin impedance, and a visual rating scale (VRS), recording subjective pain on a scale of 0-100 between no pain and unbearable pain. The two groups showed no significant difference as to age, indices of mineral metabolism, back and knee pain, and bone status. RA gave a significantly greater analgesic effect than A by both EAM (P = 0.0158) and VRS (P = 0.0268) on overall comparison of the mean response to all modalities of exercise loading. Paired comparison between pretreatment and posttreatment indicated a significant effect of RA by both EAM (P = 0.0045) and VRS (P = 0.0017), but not that of A. The analgesic effect was more clearly noted on combined knee-spine loading (KSL) and spine loading (SL) than simple knee loading (KL). Monthly comparison of the analgesic effect indicated a significantly better analgesic effect in the fifth month by VRS. RA effect greater than A was more evident by EAM than VRS and during months 3-6 than during 1-2 months, suggesting a slowly progressive effect of RA. Pain evaluation by EAM and VRS mostly gave parallel results, except for a few occasions such as knee loading and spine loading by sitting up and leaving a bed, when EAM detected a positive effect but VRS failed to do so. RA appeared to be more effective on bone and joint pain

  15. [Update on current care guidelines: knee and hip osteoarthriti].

    PubMed

    2012-01-01

    The goal of OA (osteoarthritis) treatment is to relieve pain and maintain/improve patient's functional capacity. First line medication is paracetamol and topical NSAIDs, and oral NSAIDs when needed. Tramadol and codeine may be considered in most severe cases. Glucosamine and chondroitin do not differ from placebo, but intra-articular glucocorticoids and hyaluronate may be useful. Supervised exercise is recommended especially for knee osteoarthritis. Cold, TENS and ultrasound therapies may offer short-term benefits in knee OA. Arthroscopic debridement does not alleviate OA symptoms. Arthroplasty is indicated if pain is not otherwise manageable.

  16. Dextrose Prolotherapy for Knee Osteoarthritis: A Randomized Controlled Trial

    PubMed Central

    Rabago, David; Patterson, Jeffrey J.; Mundt, Marlon; Kijowski, Richard; Grettie, Jessica; Segal, Neil A.; Zgierska, Aleksandra

    2013-01-01

    PURPOSE Knee osteoarthritis is a common, debilitating chronic disease. Prolotherapy is an injection therapy for chronic musculoskeletal pain. We conducted a 3-arm, blinded (injector, assessor, injection group participants), randomized controlled trial to assess the efficacy of prolotherapy for knee osteoarthritis. METHODS Ninety adults with at least 3 months of painful knee osteoarthritis were randomized to blinded injection (dextrose prolotherapy or saline) or at-home exercise. Extra- and intra-articular injections were done at 1, 5, and 9 weeks with as-needed additional treatments at weeks 13 and 17. Exercise participants received an exercise manual and in-person instruction. Outcome measures included a composite score on the Western Ontario McMaster University Osteoarthritis Index (WOMAC; 100 points); knee pain scale (KPS; individual knee), post-procedure opioid medication use, and participant satisfaction. Intention-to-treat analysis using analysis of variance was used. RESULTS No baseline differences existed between groups. All groups reported improved composite WOMAC scores compared with baseline status (P <.01) at 52 weeks. Adjusted for sex, age, and body mass index, WOMAC scores for patients receiving dextrose prolotherapy improved more (P <.05) at 52 weeks than did scores for patients receiving saline and exercise (score change: 15.3 ± 3.5 vs 7.6 ± 3.4, and 8.2 ± 3.3 points, respectively) and exceeded the WOMAC-based minimal clinically important difference. Individual knee pain scores also improved more in the prolotherapy group (P = .05). Use of prescribed postprocedure opioid medication resulted in rapid diminution of injection-related pain. Satisfaction with prolotherapy was high. There were no adverse events. CONCLUSIONS Prolotherapy resulted in clinically meaningful sustained improvement of pain, function, and stiffness scores for knee osteoarthritis compared with blinded saline injections and at-home exercises. PMID:23690322

  17. Dextrose prolotherapy for knee osteoarthritis: a randomized controlled trial.

    PubMed

    Rabago, David; Patterson, Jeffrey J; Mundt, Marlon; Kijowski, Richard; Grettie, Jessica; Segal, Neil A; Zgierska, Aleksandra

    2013-01-01

    Knee osteoarthritis is a common, debilitating chronic disease. Prolotherapy is an injection therapy for chronic musculoskeletal pain. We conducted a 3-arm, blinded (injector, assessor, injection group participants), randomized controlled trial to assess the efficacy of prolotherapy for knee osteoarthritis. Ninety adults with at least 3 months of painful knee osteoarthritis were randomized to blinded injection (dextrose prolotherapy or saline) or at-home exercise. Extra- and intra-articular injections were done at 1, 5, and 9 weeks with as-needed additional treatments at weeks 13 and 17. Exercise participants received an exercise manual and in-person instruction. Outcome measures included a composite score on the Western Ontario McMaster University Osteoarthritis Index (WOMAC; 100 points); knee pain scale (KPS; individual knee), post-procedure opioid medication use, and participant satisfaction. Intention-to-treat analysis using analysis of variance was used. No baseline differences existed between groups. All groups reported improved composite WOMAC scores compared with baseline status (P <.01) at 52 weeks. Adjusted for sex, age, and body mass index, WOMAC scores for patients receiving dextrose prolotherapy improved more (P <.05) at 52 weeks than did scores for patients receiving saline and exercise (score change: 15.3 ± 3.5 vs 7.6 ± 3.4, and 8.2 ± 3.3 points, respectively) and exceeded the WOMAC-based minimal clinically important difference. Individual knee pain scores also improved more in the prolotherapy group (P = .05). Use of prescribed postprocedure opioid medication resulted in rapid diminution of injection-related pain. Satisfaction with prolotherapy was high. There were no adverse events. Prolotherapy resulted in clinically meaningful sustained improvement of pain, function, and stiffness scores for knee osteoarthritis compared with blinded saline injections and at-home exercises.

  18. Perceived racial discrimination, but not mistrust of medical researchers, predicts the heat pain tolerance of African Americans with symptomatic knee osteoarthritis.

    PubMed

    Goodin, Burel R; Pham, Quyen T; Glover, Toni L; Sotolongo, Adriana; King, Christopher D; Sibille, Kimberly T; Herbert, Matthew S; Cruz-Almeida, Yenisel; Sanden, Shelley H; Staud, Roland; Redden, David T; Bradley, Laurence A; Fillingim, Roger B

    2013-11-01

    Studies have shown that perceived racial discrimination is a significant predictor of clinical pain severity among African Americans. It remains unknown whether perceived racial discrimination also alters the nociceptive processing of painful stimuli, which, in turn, could influence clinical pain severity. This study examined associations between perceived racial discrimination and responses to noxious thermal stimuli among African Americans and non-Hispanic Whites. Mistrust of medical researchers was also assessed given its potential to affect responses to the noxious stimuli. One-hundred and 30 (52% African American, 48% non-Hispanic White) community-dwelling older adults with symptomatic knee osteoarthritis completed two study sessions. In session one, individuals provided demographic, socioeconomic, physical and mental health information. They completed questionnaires related to perceived lifetime frequency of racial discrimination and mistrust of medical researchers. In session two, individuals underwent a series of controlled thermal stimulation procedures to assess heat pain sensitivity, particularly heat pain tolerance. African Americans were more sensitive to heat pain and reported greater perceived racial discrimination as well as greater mistrust of medical researchers compared with non-Hispanic Whites. Greater perceived racial discrimination significantly predicted lower heat pain tolerance for African Americans but not non-Hispanic Whites. Mistrust of medical researchers did not significantly predict heat pain tolerance for either racial group. These results lend support to the idea that perceived racial discrimination may influence the clinical pain severity of African Americans via the nociceptive processing of painful stimuli.

  19. Perceived racial discrimination, but not mistrust of medical researchers, predicts the heat pain tolerance of African Americans with symptomatic knee osteoarthritis

    PubMed Central

    Pham, Quyen T.; Glover, Toni L.; Sotolongo, Adriana; King, Christopher D.; Sibille, Kimberly T.; Herbert, Matthew S.; Cruz-Almeida, Yenisel; Sanden, Shelley H.; Staud, Roland; Redden, David T.; Bradley, Laurence A.; Fillingim, Roger B.

    2014-01-01

    Objective Studies have shown that perceived racial discrimination is a significant predictor of clinical pain severity among African Americans. It remains unknown whether perceived racial discrimination also alters the nociceptive processing of painful stimuli, which, in turn, could influence clinical pain severity. This study examined associations between perceived racial discrimination and responses to noxious thermal stimuli among African Americans and non-Hispanic whites. Mistrust of medical researchers was also assessed given its potential to affect responses to the noxious stimuli. Method One hundred and thirty (52% African American, 48% non-Hispanic white) community-dwelling older adults with symptomatic knee osteoarthritis completed two study sessions. In session one, individuals provided demographic, socioeconomic, physical and mental health information. They completed questionnaires related to perceived lifetime frequency of racial discrimination and mistrust of medical researchers. In session two, individuals underwent a series of controlled thermal stimulation procedures to assess heat pain sensitivity, particularly heat pain tolerance. Results African Americans were more sensitive to heat pain and reported greater perceived racial discrimination as well as greater mistrust of medical researchers compared to non-Hispanic whites. Greater perceived racial discrimination significantly predicted lower heat pain tolerance for African Americans but not non-Hispanic whites. Mistrust of medical researchers did not significantly predict heat pain tolerance for either racial group Conclusion These results lend support to the idea that perceived racial discrimination may influence the clinical pain severity of African Americans via the nociceptive processing of painful stimuli. PMID:24219416

  20. Agility and Perturbation Training Techniques in Exercise Therapy for Reducing Pain and Improving Function in People With Knee Osteoarthritis: A Randomized Clinical Trial

    PubMed Central

    Piva, Sara R.; Gil, Alexandra B.; Wisniewski, Stephen R.; Oddis, Chester V.; Irrgang, James J.

    2011-01-01

    Background Impairment-based exercise programs have yielded only small to moderate benefits in reducing pain and improving function in people with knee osteoarthritis (OA). It has previously been proposed that adding agility and perturbation training to exercise programs for people with knee OA may improve treatment effects for pain and function. Objective The purpose of this study was to examine the effectiveness of adding agility and perturbation techniques to standard exercise therapy compared with the standard exercise program alone for people with knee OA. Design This was a single-blinded randomized controlled trial. Setting The study was conducted in the outpatient physical therapy clinic of a large, university-based health center. Participants One hundred eighty-three people with knee OA (122 women, 61 men) participated. Interventions Participants were randomly assigned to either a group that received agility and perturbation training with standard exercise therapy or a group that received only the standard exercise program. Measurements The outcome measures were self-reported knee pain and function, self-reported knee instability, a performance-based measure of function, and global rating of change. Results Although both groups exhibited improvement in self-reported function and in the global rating of change at the 2-, 6-, and 12-month follow-up periods, there were no differences between groups on these outcomes. There was no reduction in knee pain or improvement in performance-based function in either group. Limitations It is possible that more-intense application of the interventions or application of the interventions to participants with knee OA who were at greater risk for falling may have yielded additive effects of the agility and perturbation training approach. Conclusions Both intervention groups exhibited improvement in self-reported function and the global rating of change. Our results, however, did not support an additive effect of agility and

  1. Knee Power Is an Important Parameter in Understanding Medial Knee Joint Load in Knee Osteoarthritis

    PubMed Central

    Calder, Kristina M; Acker, Stacey M; Arora, Neha; Beattie, Karen A; Callaghan, Jack P; Adachi, Jonathan D; Maly, Monica R

    2014-01-01

    Objective To determine the extent to which knee extensor strength and power explain variance in knee adduction moment (KAM) peak and impulse in clinical knee osteoarthritis (OA). Methods Fifty-three adults (mean ± SD age 61.6 ± 6.3 years, 11 men) with clinical knee OA participated. The KAM waveform was calculated from motion and force data and ensemble averaged from 5 walking trials. The KAM peak was normalized to body mass (Nm/kg). The mean KAM impulse reflected the mean total medial knee load during stride (Nm × seconds). For strength, the maximum knee extensor moment attained from maximal voluntary isometric contractions (MVIC) was normalized to body mass (Nm/kg). For power, the maximum knee extensor power during isotonic contractions, with the resistance set at 25% of MVIC, was normalized to body mass (W/kg). Covariates included age, sex, knee pain on the Knee Injury and Osteoarthritis Outcome Score, gait speed, and body mass index (BMI). Relationships of the KAM peak and impulse with strength and power were examined using sequential stepwise forward linear regressions. Results Covariates did not explain variance in the KAM peak. While extensor strength did not, peak knee extensor power explained 8% of the variance in the KAM peak (P = 0.02). Sex and BMI explained 24% of the variance in the KAM impulse (P < 0.05). Sex, BMI, and knee extensor power explained 31% of the variance in the KAM impulse (P = 0.02), with power contributing 7% (P < 0.05). Conclusion Knee extensor power was more important than isometric knee strength in understanding medial knee loads during gait. PMID:24920175

  2. Knee symptoms among adults at risk for accelerated knee osteoarthritis: data from the Osteoarthritis Initiative.

    PubMed

    Davis, Julie; Eaton, Charles B; Lo, Grace H; Lu, Bing; Price, Lori Lyn; McAlindon, Timothy E; Barbe, Mary F; Driban, Jeffrey B

    2017-05-01

    The purpose of this study was to examine if adults who develop accelerated knee osteoarthritis (KOA) have greater knee symptoms with certain activities than those with or without incident common KOA. We conducted a case-control study using data from baseline and the first four annual visits of the Osteoarthritis Initiative. Participants had no radiographic KOA at baseline (Kellgren-Lawrence (KL) <2). We classified 3 groups as follows: (1) accelerated KOA: > = 1 knee developed advance-stage KOA (KL = 3 or 4) within 48 months, (2) common KOA: > = 1 knee increased in radiographic severity (excluding those with accelerated KOA), and (3) no KOA: no change in radiographic severity by 48 months. We focused on individual items from the WOMAC pain/function subscales and KOOS pain/symptoms subscales. The index visit was a year before a person met the definition for accelerated, common, or no KOA. To examine group difference in knee symptoms, we used ordinal logistic regression models for each symptom. Results are reported as odds ratios (OR) and 95% confidence intervals (CI). Individuals who developed accelerated KOA were more likely to report greater difficulty with lying down (OR = 2.10, 95% CI = 1.04 to 4.25), pain with straightening the knee fully (OR = 2.04, 95% CI = 1.08, 3.85), and pain walking (OR = 2.49, 95% CI = 1.38, 4.84) than adults who developed common KOA. Individuals who develop accelerated KOA report greater symptoms with certain activities than those with common KOA. Our results may help identify individuals at risk for accelerated KOA or with early-stage accelerated KOA.

  3. Knee osteoarthritis prevalence, risk factors, pathogenesis and features: Part I

    PubMed Central

    Heidari, Behzad

    2011-01-01

    Osteoarthritis (OA) a common disease of aged population and one of the leading causes of disability. Incidence of knee OA is rising by increasing average age of general population. Age, weight, trauma to joint due to repetiting movements in particular squatting and kneeling are common risk factors of knee OA. Several factors including cytokines, leptin, and mechanical forces are pathogenic factors of knee OA. In patients with knee pain attribution of pain to knee OA should be considered with caution. Since a proportion of knee OA are asymptomatic and in a number of patients identification of knee OA is not possible due to low sensitivity of radiographic examination. In this review data presented in regard to prevalence, pathogenesis, risk factors. PMID:24024017

  4. The Role of Peripheral Nociceptive Neurons in the Pathophysiology of Osteoarthritis Pain

    PubMed Central

    Miller, Rachel E.; Tran, Phuong B.; Sondoqah, Alia; Raghu, Padmanabhan; Ishihara, Shingo; Miller, Richard J.; Malfait, Anne-Marie

    2015-01-01

    Knee osteoarthritis is characterized by progressive damage and remodeling of all tissues in the knee joint. Pain is the main symptom associated with knee osteoarthritis. Recent clinical and pre-clinical studies shed light on the mechanisms that drive the pain associated with joint destruction. In this narrative review, we describe current knowledge regarding the changes in the peripheral and central nervous system that occur during the progression of osteoarthritis and discuss how therapeutic interventions may provide pain relief. PMID:26233284

  5. Increased sensitivity to physical activity among individuals with knee osteoarthritis: relation to pain outcomes, psychological factors, and responses to quantitative sensory testing.

    PubMed

    Wideman, Timothy H; Finan, Patrick H; Edwards, Robert R; Quartana, Phillip J; Buenaver, Luis F; Haythornthwaite, Jennifer A; Smith, Michael T

    2014-04-01

    Recent findings suggest that certain individuals with musculoskeletal pain conditions have increased sensitivity to physical activity (SPA) and respond to activities of stable intensity with increasingly severe pain. This study aimed to determine the degree to which individuals with knee osteoarthritis (OA) show heightened SPA in response to a standardized walking task and whether SPA cross-sectionally predicts psychological factors, responses to quantitative sensory testing (QST), and different OA-related outcomes. One hundred seven adults with chronic knee OA completed self-report measures of pain, function, and psychological factors, underwent QST, and performed a 6-min walk test. Participants rated their discomfort levels throughout the walking task; an index of SPA was created by subtracting first ratings from peak ratings. Repeated-measure analysis of variance revealed that levels of discomfort significantly increased throughout the walking task. A series of hierarchical regression analyses determined that after controlling for significant covariates, psychological factors, and measures of mechanical pain sensitivity, individual variance in SPA predicted self-report pain and function and performance on the walking task. Analyses also revealed that both pain catastrophizing and the temporal summation of mechanical pain were significant predictors of SPA and that SPA mediated the relationship between catastrophizing and self-reported pain and physical function. The discussion addresses the potential processes contributing to SPA and the role it may play in predicting responses to different interventions for musculoskeletal pain conditions. Copyright © 2013 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  6. Mind-Body Therapies and Osteoarthritis of the Knee

    PubMed Central

    Selfe, Terry Kit; Innes, Kim E.

    2010-01-01

    Osteoarthritis of the knee is a major cause of disability among adults worldwide. Important treatment options include nonpharmacologic therapies, and especially symptom management strategies in which patients take an active role. Among these, mind-body therapies may have particular promise for alleviating the distressful symptoms associated with osteoarthritis of the knee. However, systematic reviews are lacking. The objective of this paper is to review English-language articles describing clinical studies evaluating the effects of patient-driven mind-body therapies on symptoms of knee osteoarthritis. Eight studies, representing a total of 267 participants, met the inclusion criteria. Interventions included tai chi, qigong, and yoga. Collectively, these studies suggest that specific mind-body practices may help alleviate pain and enhance physical function in adults suffering from osteoarthritis of the knee. However, sample sizes are small, rigorous investigations are few, and the potential benefits of several mind-body therapies have not yet been systematically tested. Additional high-quality studies are needed to clarify the effects of specific mind-body therapies on standardized measures of pain, physical function, and related indices in persons with osteoarthritis of the knee, and to investigate possible underlying mechanisms. PMID:21151770

  7. 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

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

    PubMed

    Bindawas, Saad M

    2016-01-01

    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. 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. 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. Frequent KP alone, obesity alone, and the combination of frequent KP and obesity were all associated with decreased GS in older adults. These associations did not change in any of the groups longitudinally; as

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

    USDA-ARS?s Scientific Manuscript database

    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....

  10. Impact of cane use on pain, function, general health and energy expenditure during gait in patients with knee osteoarthritis: a randomised controlled trial.

    PubMed

    Jones, A; Silva, P G; Silva, A C; Colucci, M; Tuffanin, A; Jardim, J R; Natour, J

    2012-02-01

    To assess the impact of daily cane use during gait in relation to pain, function, general health and energy expenditure among patients with knee osteoarthritis. Sixty-four patients were randomly assigned to an experimental group (EG) or control group (CG). The EG used a cane every day for 2 months, whereas the CG did not use a cane in this period. The first outcome was pain and the second were function (Lequesne and WOMAC), general health (SF-36) and energy expenditure (gas analysis during the 6-minute walk test (6MWT) with and without a cane). Evaluations were performed at baseline, 30 and 60 days. The groups were homogeneous for all parameters at baseline. Compared with the CG, the EG significantly improved pain (ES 0.18), function - Lequesne (ES 0.13), some domains of SF-36 (role physical, ES 0.07 and bodily pain, ES 0.08) and distance on the 6MWT with the cane (ES 0.16). At the end of the 6MWT with the cane, the EG significantly improved energy expenditure (ES 0.21), carbon dioxide production (ES 0.12) and metabolic equivalents (ES 0.15) compared with the CG. A cane can be used to diminish pain, improve function and some aspects of quality of life in patients with knee osteoarthritis. The prescription of a cane should take into account the substantial increase in energy expenditure in the first month of use, whereas energy expenditure is no longer a factor for concern by the end of the second month due to adaptation to cane use. The trial was registered in clinicaltrials.gov (NCT00698412).

  11. 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

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

    PubMed

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

    2016-01-01

    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). 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. 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. 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. EU clinical trials (EudraCT): 2012-002607-18.

  13. The influence of foot progression angle on the knee adduction moment during walking and stair climbing in pain free individuals with knee osteoarthritis.

    PubMed

    Guo, Mengtao; Axe, Michael J; Manal, Kurt

    2007-09-01

    The external knee adduction moment during walking and stair climbing has a characteristic double hump pattern. The magnitude of the adduction moment is associated with the development and progression of medial compartment knee osteoarthritis (OA). There is an inverse relationship between the magnitude of the second peak adduction moment and foot progression angle (FPA). Increasing FPA beyond a self-selected degree of toe-out may further reduce the magnitude of this moment for persons with knee OA. In this study, subjects with medial compartment knee OA walked and climbed stairs using their natural (i.e. self-selected) and an increased FPA (i.e. self-selected+15 degrees of additional toe-out). Increasing FPA did not change the magnitude of the first peak adduction moment but it did significantly decrease the second peak during walking. The first peak moment during stair ascent was significantly greater for the increased FPA condition, and a significant reduction was noted for the second peak. No significant differences were noted during stair descent. These results suggest that walking with a toe-out strategy may benefit persons with early stages of medial knee OA.

  14. Manual for guided home exercises for osteoarthritis of the knee

    PubMed Central

    de Almeida Carvalho, Nilza Aparecida; Bittar, Simoni Teixeira; de Souza Pinto, Flávia Ribeiro; Ferreira, Mônica; Sitta, Robson Roberto

    2010-01-01

    INTRODUCTION: Physiotherapy is one of the most important components of therapy for osteoarthritis of the knee. The objective of this prospective case series was to assess the efficiency of a guidance manual for patients with osteoarthritis of the knee in relation to pain, range of movement , muscle strength and function, active goniometry, manual strength test and function. METHODS: Thirty-eight adults with osteoarthritis of the knee (≥ 45 years old) who were referred to the physiotherapy service at the university hospital (Santa Casa de Misericórdia de São Paulo) were studied. Patients received guidance for the practice of specific physical exercises and a manual with instructions on how to perform the exercises at home. They were evaluated for pain, range of movement, muscle strength and function. These evaluations were performed before they received the manual and three months later. Patients were seen monthly regarding improvements in their exercising abilities. RESULTS: The program was effective for improving muscle strength, controlling pain, maintaining range of movement of the knee joint, and reducing functional incapacity. DISCUSSION: A review of the literature showed that there are numerous clinical benefits to the regular practice of physical therapy exercises by patients with osteoarthritis of the knee(s) in a program with appropriate guidance. This study shows that this guidance can be attained at home with the use of a proper manual. CONCLUSIONS: Even when performed at home without constant supervision, the use of the printed manual for orientation makes the exercises for osteoarthritis of the knee beneficial. PMID:20835554

  15. Energy recovery in individuals with knee osteoarthritis.

    PubMed

    Sparling, T L; Schmitt, D; Miller, C E; Guilak, F; Somers, T J; Keefe, F J; Queen, R M

    2014-06-01

    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). 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. 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. 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. Copyright © 2014 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  16. Pain Coping Skills Training and Lifestyle Behavioral Weight Management in Patients with Knee Osteoarthritis: A Randomized Controlled Study

    PubMed Central

    Somers, Tamara J.; Blumenthal, James A.; Guilak, Farshid; Kraus, Virginia B.; Schmitt, Daniel O.; Babyak, Michael A.; Craighead, Linda W.; Caldwell, David S.; Rice, John R.; McKee, Daphne C.; Shelby, Rebecca A.; Campbell, Lisa C.; Pells, Jennifer J.; Sims, Ershela L.; Queen, Robin; Carson, James W.; Connelly, Mark; Dixon, Kim E.; LaCaille, Lara J.; Huebner, Janet L.; Rejeski, W. Jack; Keefe, Francis J.

    2012-01-01

    Overweight and obese patients with osteoarthritis (OA) experience more OA pain and disability than patients who are not overweight. This study examined the long-term efficacy of a combined pain coping skills training (PCST) and lifestyle behavioral weight management (BWM) intervention in overweight and obese OA patients. Patients (N=232) were randomized to a 6-month program of: 1) PCST + BWM; 2) PCST-only; 3) BWM-only; or 4) standard care control. Assessments of pain, physical disability (Arthritis Impact Measurement Scales [AIMS] physical disability, stiffness, activity, and gait), psychological disability (AIMS psychological disability, pain catastrophizing, arthritis self-efficacy, weight self-efficacy), and body weight were collected at four time points (pretreatment, post-treatment, and 6 months and 12 months after the completion of treatment). Patients randomized to PCST+ BWM demonstrated significantly better treatment outcomes (average of all three post-treatment values) in terms of pain, physical disability, stiffness, activity, weight self-efficacy, and weight when compared to the other three conditions (p’s <.05). PCST+BWM also did significantly better than at least one of the other conditions (i.e., PCST-only, BWM-only, or standard care) in terms of psychological disability, pain catastrophizing, and arthritis self-efficacy. Interventions teaching overweight and obese OA patients pain coping skills and weight management simultaneously may provide the more comprehensive long-term benefits. PMID:22503223

  17. Thigh muscle strength predicts knee replacement risk independent of radiographic disease and pain in women – data from the Osteoarthritis Initiative

    PubMed Central

    Culvenor, Adam; Wirth, Wolfgang; Ruhdorfer, Anja; Eckstein, Felix

    2017-01-01

    Objective To determine whether thigh muscle strength predicts knee replacement (KR) risk, independent of radiographic severity and pain. Methods Osteoarthritis Initiative participants with KR at 12–60 month (M) follow-up (cases) were each matched with one control (no KR throughout 60M) by age, sex, height, body mass index, baseline radiographic stage, and location of joint space narrowing. Isometric knee extensor and flexor strength were recorded biennially. The strength examination prior to KR (≤2 years) was termed T0, that two years prior to T0 T−2, and that four years prior T−4. Muscle strength between cases and controls was compared using paired t-tests and conditional logistic regression adjusted for pain. Results 136 of 4796 participants (60% women, age 65±9 years, BMI 29±4 kg/m2) received a KR during follow-up, had at least T0 strength data, and a matched control. Knee extensor strength at T0 (primary outcome) was significantly lower in female cases than controls (p<0.001; pain-adjusted odds ratio [ORp] 1.72, 95% confidence interval [CI] 1.16 to 2.56), but no difference was seen in men (p=0.451; ORp 0.80, 95%CI 0.50 to 1.27). Results were similar for knee flexor strength at T0, and for longitudinal change in extensor and flexor strength between T0 and T−2. Thigh muscle strength at T−2 or T−4, or change between T−2 and T−4, did not predict KR risk in men or women. Conclusion Thigh muscle strength predicted KR risk in women, but not in men. These results may identify a window for modifying risk of KR surgery in women. PMID:26663882

  18. The safety and efficacy of an enzyme combination in managing knee osteoarthritis pain in adults: a randomized, double-blind, placebo-controlled trial.

    PubMed

    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.

  19. 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

  20. Patterns of knee osteoarthritis in Arabian and American knees.

    PubMed

    Hodge, W Andrew; Harman, Melinda K; Banks, Scott A

    2009-04-01

    This study illustrates differences in the cartilage degeneration in osteoarthritic knees in patients with more frequent hyperflexion activities of daily living compared with Western patients. Proximal tibial articular cartilage wear and cruciate ligament condition were assessed in Saudi Arabian and North American patients with varus osteoarthritis undergoing total knee arthroplasty. In anterior cruciate ligament (ACL) intact knees, there were significant differences in wear location, with a clearly more anterior pattern in Saudi Arabian knees. Complete ACL deficiency occurred in 25% of North American knees but only 14% of Saudi Arabian knees. These ACL-deficient knees showed the most severe cartilage wear in both groups and posterior medial wear patterns. Biomechanical descriptions of knee flexion and axial rotation during kneeling or squatting are consistent with the more pronounced anteromedial and posterolateral cartilage wear patterns observed on the Saudi Arabian knees. These observations provide insight into altered knee mechanics in 2 culturally different populations with different demands on knee flexion.

  1. Assessment of quality of life in patients with knee osteoarthritis

    PubMed Central

    Kawano, Marcio Massao; Araújo, Ivan Luis Andrade; Castro, Martha Cavalcante; Matos, Marcos Almeida

    2015-01-01

    ABSTRACT OBJECTIVE : To assess the quality of life of knee osteoarthritis patients using the SF-36 questionnaire METHODS : Cross-sec-tional study with 93 knee osteoarthritis patients. The sample was categorized according to Ahlbӓck score. All individuals were interviewed with the SF-36 questionnaire RESULTS : The main finding of the study is related to the association of edu-cation level with the functional capacity, functional limitation and pain. Patients with higher education level had better functional capacity when they were compared to patients with basic level of education CONCLUSION : Individuals with osteoarthritis have a low perception of their quality of life in functional capacity, functional limitation and pain. There is a strong association between low level of education and low perception of quality of life. Level of Evidence IV, Clinical Case Series. PMID:27057143

  2. Efficacy and safety of tanezumab monotherapy or combined with non-steroidal anti-inflammatory drugs in the treatment of knee or hip osteoarthritis pain.

    PubMed

    Schnitzer, Thomas J; Ekman, Evan F; Spierings, Egilius L H; Greenberg, H Scott; Smith, Michael D; Brown, Mark T; West, Christine R; Verburg, Kenneth M

    2015-06-01

    To evaluate whether subjects with knee or hip osteoarthritis (OA) pain on non-steroidal anti-inflammatory drugs (NSAIDs) received greater benefit when tanezumab monotherapy replaced or was coadministered with NSAIDs. Subjects (N=2700) received intravenous tanezumab (5 or 10 mg) or placebo every 8 weeks with or without oral naproxen 500 mg twice daily or celecoxib 100 mg twice daily. Efficacy was assessed as change from baseline to week 16 in three co-primary endpoints: Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain, WOMAC Physical Function and Patient's Global Assessment (PGA) of OA. Safety assessments included adverse events, physical and neurological examinations, laboratory tests and vital signs. Although all tanezumab treatments provided significant improvements in WOMAC Pain and Physical Function over either NSAID alone, only tanezumab+NSAIDs were significant versus NSAIDs with PGA and met the prespecified definition of superiority. Combination treatment did not substantially improve pain or function over tanezumab monotherapy. Adverse event frequency was higher with tanezumab than with NSAIDs and highest with combination therapy. Higher incidence of all-cause total joint replacements occurred with tanezumab+NSAID versus tanezumab monotherapy or NSAIDs. Rapidly progressive OA incidence was significantly greater versus NSAID in all tanezumab groups except tanezumab 5 mg monotherapy. Subjects receiving partial symptomatic relief of OA pain with NSAIDs may receive greater benefit with tanezumab monotherapy. While only coadministration of tanezumab with NSAIDs met the definition of superiority, combination treatment did not provide important benefits over tanezumab monotherapy; small differences in efficacy were negated by treatment-limiting or irreversible safety outcomes. NCT00809354. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  3. Use of viscosupplementation for knee osteoarthritis: an update.

    PubMed

    Divine, Jon G; Shaffer, Michael D

    2011-01-01

    Because of the rising numbers of patients affected by osteoarthritis (OA), management decisions on how to minimize pain and improve function in OA patients are important. Intra-articular hyaluronic acid (IAHA) knee injections have become a common treatment in the management of knee OA. In an editorial appearing in the 2007 National Knowledge Week on Osteoarthritis: National Health Service Evidence, four questions were asked about the clinical use of IAHA treatment for OA: 1) Who is the ideal candidate for HA viscosupplementation? 2) Do the mechanical and biological effects differ in importance in different stages of the disease? 3) What is the ideal dose in early- and late-stage OA? 4) Can the biological effect be delivered by means other than injection? These key issues are addressed. On the basis of results from several systemic reviews and meta-analyses, we conclude that IAHA knee injections in patients with knee OA result in modest improvements when measured by validated outcomes.

  4. Effects of an integrated approach of hatha yoga therapy on functional disability, pain, and flexibility in osteoarthritis of the knee joint: a randomized controlled study.

    PubMed

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

    2012-05-01

    The study objectives were to evaluate the efficacy of integrating hatha yoga therapy with therapeutic exercises for osteoarthritis (OA) of the knee joints. This was a prospective, randomized, active controlled trial. Two hundred and fifty (250) participants who had OA knees and who were between 35 and 80 years (yoga 59.56±9.54) and (control 59.42±10.66) from the outpatient department of Ebnezar Orthopedic Center, Bengaluru, were randomly assigned to receive hatha yoga therapy or therapeutic exercises after transcutaneous electrical stimulation and ultrasound treatment (20 minutes per day). Both of the groups practiced supervised interventions (40 minutes per day) for 3 months. One hundred and eighteen (118) (yoga) and 117 (control) subjects were available for the final analysis. There were significant differences within (Wilcoxon's, p<0.001) and between the groups (Mann-Whitney U, p<0.001) on all the variables, with better improvements in the yoga than the control groups. Walking pain in the yoga (37.3%, 64.9%) and control (24.9%, 42%), knee disability in the yoga (59.7%, 83%) and control (32.7%, 53.6%), range of knee flexion in yoga (12.7%, 26.5% right, 13.5%, 28% left) and control (6.9%, 13.3% right, 5.6%, 11.5% left), joint tenderness in yoga (52.3%, 86.1%) and control (28%, 57.1%), swelling in yoga (55.4%, 85.9%) and control (32.1%, 60%), crepitus in yoga (44.0%, 79.9%) and control (27.0%, 47.8%) and walking time in yoga (26.6%, 52.8%) and control (9.3%, 21.6%), all improved more in the yoga than the control groups on the 15th and 90th day, respectively. An integrated approach of hatha yoga therapy is better than therapeutic exercises as an adjunct to transcutaneous electrical stimulation and ultrasound treatment in improving walking pain, range of knee flexion, walking time, tenderness, swelling, crepitus, and knee disability in patients with OA knees.

  5. The effect of Ai Chi aquatic therapy on individuals with knee osteoarthritis: a pilot study.

    PubMed

    So, Billy C L; Kong, Iris S Y; Lee, Roy K L; Man, Ryan W F; Tse, William H K; Fong, Adalade K W; Tsang, William W N

    2017-05-01

    [Purpose] To examine the efficacy of Ai Chi in relieving the pain and stiffness of knee osteoarthritis and improving, physical functioning, proprioception and quality of life. [Subjects and Methods] Twenty-five persons with knee osteoarthritis completed 5 weeks Ai Chi practice (60 minutes per session, twice per week, 10 sessions in total). Knee pain and stiffness were measured before and after the intervention program. [Results] Significant improvements in pain, self-perceived physical functioning and self-perceived stiffness were observed after the Ai-Chi intervention. On average, no significant change in knee range of motion, 6-minute walk test distances or proprioception was observed. [Conclusion] A five-week Ai Chi intervention can improve the pain and stiffness of knee osteoarthritis and self-perceived physical functions and quality of life improvement. Ai Chi may be another treatment choice for people with knee OA to practice in the community.

  6. Biomechanical effectiveness of a distraction-rotation knee brace in medial knee osteoarthritis: preliminary results.

    PubMed

    Laroche, Davy; Morisset, Claire; Fortunet, Clementine; Gremeaux, Vincent; Maillefert, Jean-Francis; Ornetti, Paul

    2014-06-01

    Non-pharmacological therapies are recommended for the care of knee osteoarthritis patients. Unloader knee braces provide an interesting functional approach, which aims to modulate mechanical stress on the symptomatic joint compartment. We aimed to confirm the biomechanical effects and evaluate functional benefits of a new knee brace that combines a valgus effect with knee and tibial external rotation during gait in medial osteoarthritis patients. Twenty patients with unilateral symptomatic medial knee osteoarthritis were included and they performed two test sessions of 3D gait analysis with and without the brace at the initial evaluation (W0) and after 5weeks (W5) of wearing the brace. VAS-pain, satisfaction scores, WOMAC scores, spatio-temporal gait parameters (gait speed, stride length, stance and double stance phases, step width), and biomechanical data of the ipsilateral lower limb (hip, knee, ankle and foot progression angles) were recorded at each session. VAS-pain and WOMAC significantly decreased at W5. Walking speed was not significantly modified by knee bracing at W0, but increased significantly at W5. Knee adduction moments and foot progression angles significantly decreased in the terminal stance and push off, respectively, with bracing at W0 and W5. Lower-limb joint angles, moments and powers were significantly modified by wearing the brace at W0 and W5. This new knee brace with distraction-rotation effects significantly alters knee adduction moments and foot progression angles during gait, which might lead to significant functional gait improvements and have carry-over effects on pain at the short term in osteoarthritis patients (<2 months). level IV. Copyright © 2014 Elsevier B.V. All rights reserved.

  7. 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.

  8. Is impaired knee confidence related to worse kinesiophobia, symptoms, and physical function in people with knee osteoarthritis after anterior cruciate ligament reconstruction?

    PubMed

    Hart, Harvi F; Collins, Natalie J; Ackland, David C; Crossley, Kay M

    2015-09-01

    To compare knee confidence and kinesiophobia (fear of re-injury) in those with and without knee osteoarthritis following anterior cruciate ligament reconstruction, and determine whether poorer knee confidence is associated with greater kinesiophobia, worse knee-related symptoms, and functional impairments in those with knee osteoarthritis. Cross-sectional. Sixty-six individuals, 5-12 years following anterior cruciate ligament reconstruction, with (n=30) and without (n=36) knee osteoarthritis were included. Knee injury and Osteoarthritis Outcome Score quality-of-life question (Q3), assessed knee confidence and Tampa Scale of Kinesiophobia assessed kinesiophobia. In the osteoarthritis group, knee-related symptoms (International Knee Documentation Committee and Anterior Knee Pain Scale), self-reported function (Knee injury and Osteoarthritis Outcome Score activities daily living), sport/recreation (Knee injury and Osteoarthritis Outcome Score-sport and recreation), and performance-based function (hopping, one leg rise tasks) were assessed. Between-group differences in knee confidence and kinesiophobia were evaluated with the Chi square test and analysis of variance, respectively. In the osteoarthritis group, between-group differences (none, mild/moderate and severe/extreme problems with knee confidence) in kinesiophobia, symptoms and function were determined with analysis of variances: p<0.05. Following anterior cruciate ligament reconstruction, participants with knee osteoarthritis had significantly worse knee confidence (p=0.010) and greater kinesiophobia (p=0.006) than those without osteoarthritis. In those with knee osteoarthritis, poorer knee confidence was significantly associated with worse symptoms (Anterior Knee Pain Scale, p=0.001; International Knee Documentation Committee, p<0.001), kinesiophobia (p=0.030), Knee injury and Osteoarthritis Outcome Score-activities of daily living (p=0.005), Knee injury and Osteoarthritis Outcome Score-sport and recreation (p

  9. Benefits of antioxidant supplements for knee osteoarthritis: rationale and reality.

    PubMed

    Grover, Ashok Kumar; Samson, Sue E

    2016-01-05

    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.

  10. The effect of exercise therapy on knee adduction moment in individuals with knee osteoarthritis: A systematic review.

    PubMed

    Ferreira, Giovanni E; Robinson, Caroline Cabral; Wiebusch, Matheus; Viero, Carolina Cabral de Mello; da Rosa, Luis Henrique Telles; Silva, Marcelo Faria

    2015-07-01

    Exercise therapy is an evidence-based intervention for the conservative management of knee osteoarthritis. It is hypothesized that exercise therapy could reduce the knee adduction moment. A systematic review was performed in order to verify the effects of exercise therapy on the knee adduction moment in individuals with knee osteoarthritis in studies that also assessed pain and physical function. A comprehensive electronic search was performed on MEDLINE, Cochrane CENTRAL, EMBASE, Google scholar and OpenGrey. Inclusion criteria were randomized controlled trials with control or sham groups as comparator assessing pain, physical function, muscle strength and knee adduction moment during walking at self-selected speed in individuals with knee osteoarthritis that underwent a structured exercise therapy rehabilitation program. Two independent reviewers extracted the data and assessed risk of bias. For each study, knee adduction moment, pain and physical function outcomes were extracted. For each outcome, mean differences and 95% confidence intervals were calculated. Due to clinical heterogeneity among exercise therapy protocols, a descriptive analysis was chosen. Three studies, comprising 233 participants, were included. None of the studies showed significant differences between strengthening and control/sham groups in knee adduction moment. In regards to pain and physical function, the three studies demonstrated significant improvement in pain and two of them showed increased physical function following exercise therapy compared to controls. Muscle strength and torque significantly improved in all the three trials favoring the intervention group. Clinical benefits from exercise therapy were not associated with changes in the knee adduction moment. The lack of knee adduction moment reduction indicates that exercise therapy may not be protective in knee osteoarthritis from a joint loading point of view. Alterations in neuromuscular control, not captured by the knee

  11. The Effectiveness of Manual Therapy for Relieving Pain, Stiffness, and Dysfunction in Knee Osteoarthritis: A Systematic Review and Meta-Analysis.

    PubMed

    Xu, Qinguang; Chen, Bei; Wang, Yueyi; Wang, Xuezong; Han, Dapeng; Ding, Daofang; Zheng, Yuxin; Cao, Yuelong; Zhan, Hongsheng; Zhou, Yao

    2017-05-01

    Knee osteoarthritis (KOA) is the most common form of arthritis, leading to pain disability in seniors and increased health care utilization. Manual therapy is one widely used physical treatment for KOA. To evaluate the effectiveness and adverse events (AEs) of manual therapy compared to other treatments for relieving pain, stiffness, and physical dysfunction in patients with KOA. A systematic review and meta-analysis of manual therapy for KOA. We searched PubMed, EMBASE, the Cochrane Library, and Chinese databases for relevant randomized controlled trials (RCTs) of manual therapy for patients with KOA from the inception to October 2015 without language restrictions. RCTs compared manual therapy to the placebo or other interventional control with an appropriate description of randomization. Two reviewers independently conducted the search results identification, data extraction, and methodological quality assessment. The methodological quality was assessed by PEDro scale. Pooled data was expressed as standard mean difference (SMD), with 95% confident intervals (CIs) in a random effects model. The meta-analysis of manual therapy for KOA on pain, stiffness, and physical function were conducted. Fourteen studies involving 841 KOA participants compared to other treatments were included. The methodological quality of most included RCTs was poor. The mean PEDro scale score was 6.6. The meta-analyses results showed that manual therapy had statistically significant effects on relieving pain (standardized mean difference, SMD = -0.61, 95% CI -0.95 to -0.28, P = 76%), stiffness (SMD = -0.58, 95% CI -0.95 to -0.21, P = 81%), improving physical function (SMD = -0.49, 95% CI -0.76 to -0.22, P = 65%), and total score (SMD = -0.56, 95% CI -0.78 to -0.35, P = 50%). But in the subgroups, manual therapy did not show significant improvements on stiffness and physical function when treatment duration was less than 4 weeks. And the long-term information for manual therapy was

  12. Conservative biomechanical strategies for knee osteoarthritis.

    PubMed

    Reeves, Neil D; Bowling, Frank L

    2011-02-01

    Knee osteoarthritis (OA) is one of the most prevalent forms of this disease, with the medial compartment most commonly affected. The direction of external forces and limb orientation during walking results in an adduction moment that acts around the knee, and this parameter is regarded as a surrogate measure of medial knee compression. The knee adduction moment is intimately linked with the development and progression of knee OA and is, therefore, a target for conservative biomechanical intervention strategies, which are the focus of this Review. We examine the evidence for walking barefoot and the use of lateral wedge insoles and thin-soled, flexible shoes to reduce the knee adduction moment in patients with OA. We review strategies that directly affect the gait, such as walking with the foot externally rotated ('toe-out gait'), using a cane, lateral trunk sway and gait retraining. Valgus knee braces and muscle strengthening are also discussed for their effect upon reducing the knee adduction moment.

  13. Quantitative Cartilage Imaging in Knee Osteoarthritis

    PubMed Central

    Eckstein, Felix; Wirth, Wolfgang

    2011-01-01

    Quantitative measures of cartilage morphology (i.e., thickness) represent potentially powerful surrogate endpoints in osteoarthritis (OA). These can be used to identify risk factors of structural disease progression and can facilitate the clinical efficacy testing of structure modifying drugs in OA. This paper focuses on quantitative imaging of articular cartilage morphology in the knee, and will specifically deal with different cartilage morphology outcome variables and regions of interest, the relative performance and relationship between cartilage morphology measures, reference values for MRI-based knee cartilage morphometry, imaging protocols for measurement of cartilage morphology (including those used in the Osteoarthritis Initiative), sensitivity to change observed in knee OA, spatial patterns of cartilage loss as derived by subregional analysis, comparison of MRI changes with radiographic changes, risk factors of MRI-based cartilage loss in knee OA, the correlation of MRI-based cartilage loss with clinical outcomes, treatment response in knee OA, and future directions of the field. PMID:22046518

  14. Responsiveness and Minimally Important Differences for 4 Patient-Reported Outcomes Measurement Information System Short Forms: Physical Function, Pain Interference, Depression, and Anxiety in Knee Osteoarthritis.

    PubMed

    Lee, Augustine C; Driban, Jeffrey B; Price, Lori Lyn; Harvey, William F; Rodday, Angie Mae; Wang, Chenchen

    2017-09-01

    Patient-Reported Outcomes Measurement Information System (PROMIS) instruments can provide valid, interpretable measures of health status among adults with osteoarthritis (OA). However, their ability to detect meaningful change over time is unknown. We evaluated the responsiveness and minimally important differences (MIDs) for 4 PROMIS Short Forms: Physical Function, Pain Interference, Depression, and Anxiety. We analyzed adults with symptomatic knee OA from our randomized trial comparing Tai Chi and physical therapy. Using baseline and 12-week scores, responsiveness was evaluated according to consensus standards by testing 6 a priori hypotheses of the correlations between PROMIS and legacy change scores. Responsiveness was considered high if ≥5 hypotheses were confirmed, and moderate if 3 or 4 were confirmed. MIDs were evaluated according to prospective change for people achieving previously-established MID on legacy comparators. The lowest and highest MIDs meeting a priori quality criteria formed a MID range for each PROMIS Short Form. Among 165 predominantly female (70%) and white (57%) participants, mean age was 61 years and body mass index was 33. PROMIS Physical Function had 5 confirmed hypotheses and Pain Interference, Depression, and Anxiety had 3 or 4. MID ranges were: Depression = 3.0 to 3.1; Anxiety = 2.3 to 3.4; Physical Function = 1.9 to 2.2; and Pain Interference = 2.35 to 2.4. PROMIS Physical Function has high responsiveness, and Depression, Anxiety, and Pain Interference have moderate responsiveness among adults with knee OA. We established the first MIDs for PROMIS in this population, and provided an important standard of reference to better apply or interpret PROMIS in future trials or clinical practice. This study examined whether PROMIS Short Form instruments (Physical Function, Pain Interference, Depression, and Anxiety) were able to detect change over time among adults with knee OA, and provided minimally important change estimates

  15. Patellar Skin Surface Temperature by Thermography Reflects Knee Osteoarthritis Severity

    PubMed Central

    Denoble, Anna E.; Hall, Norine; Pieper, Carl F.; Kraus, Virginia B.

    2010-01-01

    Background: Digital infrared thermal imaging is a means of measuring the heat radiated from the skin surface. Our goal was to develop and assess the reproducibility of serial infrared measurements of the knee and to assess the association of knee temperature by region of interest with radiographic severity of knee Osteoarthritis (rOA). Methods: A total of 30 women (15 Cases with symptomatic knee OA and 15 age-matched Controls without knee pain or knee OA) participated in this study. Infrared imaging was performed with a Meditherm Med2000™ Pro infrared camera. The reproducibility of infrared imaging of the knee was evaluated through determination of intraclass correlation coefficients (ICCs) for temperature measurements from two images performed 6 months apart in Controls whose knee status was not expected to change. The average cutaneous temperature for each of five knee regions of interest was extracted using WinTes software. Knee x-rays were scored for severity of rOA based on the global Kellgren-Lawrence grading scale. Results: The knee infrared thermal imaging procedure used here demonstrated long-term reproducibility with high ICCs (0.50–0.72 for the various regions of interest) in Controls. Cutaneous temperature of the patella (knee cap) yielded a significant correlation with severity of knee rOA (R = 0.594, P = 0.02). Conclusion: The skin temperature of the patellar region correlated with x-ray severity of knee OA. This method of infrared knee imaging is reliable and as an objective measure of a sign of inflammation, temperature, indicates an interrelationship of inflammation and structural knee rOA damage. PMID:21151853

  16. Patellar skin surface temperature by thermography reflects knee osteoarthritis severity.

    PubMed

    Denoble, Anna E; Hall, Norine; Pieper, Carl F; Kraus, Virginia B

    2010-10-15

    Digital infrared thermal imaging is a means of measuring the heat radiated from the skin surface. Our goal was to develop and assess the reproducibility of serial infrared measurements of the knee and to assess the association of knee temperature by region of interest with radiographic severity of knee Osteoarthritis (rOA). A total of 30 women (15 Cases with symptomatic knee OA and 15 age-matched Controls without knee pain or knee OA) participated in this study. Infrared imaging was performed with a Meditherm Med2000™ Pro infrared camera. The reproducibility of infrared imaging of the knee was evaluated through determination of intraclass correlation coefficients (ICCs) for temperature measurements from two images performed 6 months apart in Controls whose knee status was not expected to change. The average cutaneous temperature for each of five knee regions of interest was extracted using WinTes software. Knee x-rays were scored for severity of rOA based on the global Kellgren-Lawrence grading scale. The knee infrared thermal imaging procedure used here demonstrated long-term reproducibility with high ICCs (0.50-0.72 for the various regions of interest) in Controls. Cutaneous temperature of the patella (knee cap) yielded a significant correlation with severity of knee rOA (R = 0.594, P = 0.02). The skin temperature of the patellar region correlated with x-ray severity of knee OA. This method of infrared knee imaging is reliable and as an objective measure of a sign of inflammation, temperature, indicates an interrelationship of inflammation and structural knee rOA damage.

  17. Surgery for osteoarthritis of the knee.

    PubMed

    Richmond, John C

    2013-02-01

    Although total knee replacement is an excellent treatment of end-stage osteoarthritis of the knee in the older (>65 years) population, many patients with less severe disease are significantly impacted by their symptoms and have failed to respond to less invasive treatment alternatives. For this group, there are several less invasive surgical alternatives, including arthroscopic meniscectomy, grafting of symptomatic areas of bone marrow lesions, unloading osteotomy, and unicompartmental knee replacement. Current total knee arthroplasty designs can be expected to survive 20 years or more in the older, less active population. New materials may extend that survivorship.

  18. Effects of Meditation on Symptoms of Knee Osteoarthritis.

    PubMed

    Selfe, Terry Kit; Innes, Kim E

    2013-06-01

    The aim of this study was to investigate changes in knee pain, function, and related indices in older adults with osteoarthritis (OA) of the knee, following an 8-week meditation program. Eleven community-dwelling adults with physician- confirmed knee OA were enrolled in the study. Core outcomes included recommended measures of knee pain (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] and 11-point numeric rating scale [NRS]), function (WOMAC), and perceived global status (patient global assessment). Additional outcomes included: perceived stress; stress hardiness; mood; sleep; and sympathetic activation. Following baseline assessment, participants were trained briefly in mantra meditation and instructed to meditate for 15-20 minutes twice daily for 8 weeks, and to record each practice session on a daily log. Changes over time were analyzed using paired t-tests. Nine participants (82%) completed the study. Participants had statistically significant improvements in all core outcomes: knee pain (WOMAC: 47.7% ± 25.1% reduction, P = 0.001; NRS: 42.6% ± 34.6% reduction, P < 0.01); function (44.8% ± 29.9, P = 0.001); and global status (45.7% ± 36.5, P = 0.01); as well as knee stiffness (P = 0.005), mood (P = 0.05), and a WOMAC proxy for sleep disturbance (P = 0.005). Findings from this pilot study suggest that a mantra meditation program may help reduce knee pain and dysfunction, as well as improving mood and related outcomes in adults with knee OA.

  19. Current state of unloading braces for knee osteoarthritis.

    PubMed

    Steadman, J Richard; Briggs, Karen K; Pomeroy, Shannon M; Wijdicks, Coen A

    2016-01-01

    Unicompartmental knee osteoarthritis (OA) is often treated with the prescription of an unloading knee brace to decrease pain and stiffness. Braces have been shown to improve the quality of life by applying an external moment to offset increased compressive tibiofemoral contact loads, but evidence regarding mechanical efficacy at the joint is controversial. Thus, the purpose of this study was to review the current state of unloading braces on knee mechanics, clinical impact, and long-term disease progression. A literature search was performed through the PubMed MEDLINE database for the search terms "osteoarthritis," "knee," "brace," and derivatives of the keyword "unload." Articles published since January 1, 1980 were reviewed for their relevance. Evidence for the effectiveness of unloading braces for disease management both biomechanically and clinically was considered. While significant research has been done to show improvement in OA symptoms with the use of an unloading brace, current literature suggests a debate regarding the effectiveness of these braces for biomechanical change. Clinical findings reveal overall improvements in parameters such as pain, instability, and quality of life. Although clinical evidence supports brace use to improve pain and functional ability, current biomechanical evidence suggests that unloading of the affected knee compartment does not significantly hinder disease progression. III.

  20. Knee osteoarthritis image registration: data from the Osteoarthritis Initiative

    NASA Astrophysics Data System (ADS)

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

    2015-03-01

    Knee osteoarthritis is a very common disease, in early stages, changes in joint structures are shown, some of the most common symptoms are; formation of osteophytes, cartilage degradation and joint space reduction, among others. Based on a joint space reduction measurement, Kellgren-Lawrence grading scale, is a very extensive used tool to asses radiological OA knee x-ray images, based on information obtained from these assessments, the objective of this work is to correlate the Kellgren-Lawrence score to the bilateral asymmetry between knees. Using public data from the Osteoarthritis initiative (OAI), a set of images with different Kellgren-Lawrencescores were used to determine a relationship of Kellgren-Lawrence score and the bilateral asymmetry, in order to measure the asymmetry between the knees, the right knee was registered to match the left knee, then a series of similarity metrics, mutual information, correlation, and mean squared error where computed to correlate the deformation (mismatch) of the knees to the Kellgren-Lawrence score. Radiological information was evaluated and scored by OAI radiologist groups. The results of the study suggest an association between Radiological Kellgren-Lawrence score and image registration metrics, mutual information and correlation is higher in the early stages, and mean squared error is higher in advanced stages. This association can be helpful to develop a computer aided grading tool.

  1. Managing Hip and Knee Osteoarthritis with Exercise: What is the Best Prescription?

    PubMed Central

    Iversen, Maura Daly

    2010-01-01

    Hip and knee osteoarthritis are common, chronic, and disabling. Therapeutic exercise is a component of all major rheumatologic society guidelines, yet the frequency, dose, duration, and therapeutic threshold for exercise are not clearly delineated. This review summarizes current studies of exercise for hip and knee osteoarthritis, discusses issues that influence the design, interpretation, and aggregation of results and how these factors impact the translation of data into clinical practice. A review of databases to identify current randomized controlled trials (2000 to present) of exercise to manage the symptoms of hip and knee osteoarthritis is discussed here. One study enrolling only hip patients was identified. Six studies of outcomes for individuals with hip or knee osteoarthritis and 11 studies of persons with knee osteoarthritis were found. Limited studies focus specifically on exercise for persons with hip osteoarthritis. Exercise is provided as a complex intervention combining multiple modes and provided in various settings under a range of conditions. Regardless of the variability in results and inherent biases in trials, exercise appears to reduce pain and improve function for persons with knee osteoarthritis and provide pain relief for persons with hip osteoarthritis. Given the complexity of exercise interventions and the specific issues related to study design, novel approaches to the evaluation of exercise are warranted. PMID:22870454

  2. Prevalence of Osteoarthritis of Knee Among Elderly Persons in Urban Slums Using American College of Rheumatology (ACR) Criteria.

    PubMed

    Singh, Arvind Kumar; Kalaivani, Mani; Krishnan, Anand; Aggarwal, Praveen Kumar; Gupta, Sanjeev Kumar

    2014-09-01

    The prevalence of osteoarthritis among elderly is high and it majorly affects the quality of life. Knee osteoarthritis is the most common form of osteoarthritis. Timely diagnosis using clinical criteria and effective intervention is of utmost importance. To estimate the prevalence and determinants of osteoarthritis of knee joint among elderly persons residing in an urban slum of Delhi using ACR clinical criteria. We did a community-based cross-sectional study among 496 elderly (>= 60 years) persons residing in urban slum of Delhi, India from December 2009 to February 2010. The American College of Rheumatology (ACR) criteria was used to clinically diagnose osteoarthritis knee. Bivariate analysis using Chi-square test and multivariate analysis was done to identify the determinants. Sensitivity and specificity of individual factors to diagnose osteoarthritis knee was calculated. The prevalence of osteoarthritis was estimated to be 41.1% (95% C.I., 36.7-45.6). Female sex and age >= 70 y were found to be independent risk factor for osteoarthritis knee. Among those having knee pain, presence of crepitus and tenderness were the most sensitive factors whereas bone overgrowth and bone warmth were most specific factors. The prevalence of osteoarthritis knee was high among this elderly population and increased with age. Overall, individual factors of ACR criteria were both sensitive and specific in diagnosing osteoarthritis knee. In resource constrained setting of urban India, it can be an effective tool in clinical diagnosis of osteoarthritis knee.

  3. Involvement of the proximal tibiofibular joint in osteoarthritis of the knee.

    PubMed

    Oztuna, Volkan; Yildiz, Altan; Ozer, Caner; Milcan, Abtullah; Kuyurtar, Fehmi; Turgut, Akin

    2003-12-01

    This study was performed to evaluate the possible involvement of the proximal tibiofibular joint in primary osteoarthritis of the knee. A total of 40 patients with primary osteoarthritis of the knee who had magnetic resonance imaging scans were reexamined for proximal tibiofibular joint involvement. The patient was questioned if pain was present in the proximal tibiofibular joint while at rest, when walking and climbing stairs. Symptoms were evaluated by applying moderate compression over the proximal tibiofibular joint during active ankle and knee motions. Magnetic resonance imaging scans were reexamined by two radiologists. Three of the 40 patients had minimal or moderate pain in the proximal tibiofibular joint during stair-climbing and on clinical examination. Magnetic resonance imaging scans of these three patients revealed osteophyte or subchondral cyst formation, or both. Degenerative changes in the proximal tibiofibular joint may be evident in association with osteoarthritis of the knee and may result in lateral-sided pain at the knee.

  4. Prodromal symptoms in knee osteoarthritis: a nested case-control study using data from the Osteoarthritis Initiative.

    PubMed

    Case, R; Thomas, E; Clarke, E; Peat, G

    2015-07-01

    In order to gain a better understanding of the timing of emergent symptoms of osteoarthritis, we sought to investigate the existence, duration and nature of a prodromal symptomatic phase preceding incident radiographic knee osteoarthritis (ROA). Data were from the incidence cohort of the Osteoarthritis Initiative (OAI) public use datasets. Imposing a nested case-control design, ten control knees were selected for each case of incident tibiofemoral ROA between 2004 and 2010 from participants aged 45-79 years. Candidate prodromal symptoms were Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC) and Knee injury and Osteoarthritis Outcome Score (KOOS) subscale scores and individual items, available up to 4 years prior to the time of incident ROA. Multi-level models were used to estimate the length of the prodromal phases. The prodromal phase for subscale scores ranged from 29 months (KOOS Other Symptoms) to 37 months (WOMAC Pain). Pain and difficulty on activities associated with higher dynamic knee loading were associated with longer prodromal phases (e.g., pain on twisting/pivoting (39 months, 95% confidence interval: 13, 64) vs pain on standing (25 months: 7, 42)). Our analysis found that incident ROA is preceded by prodromal symptoms lasting at least 2-3 years. This has potential implications for understanding phasic development and progression of osteoarthritis and for early recognition and management. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  5. Factors affecting radiographic progression of knee osteoarthritis.

    PubMed

    Ledingham, J; Regan, M; Jones, A; Doherty, M

    1995-01-01

    To evaluate the prognostic significance of patient characteristics and radiographic features at the knee for outcome of knee osteoarthritis. This was a prospective observational study of 350 osteoarthritic knees. Clinical and radiographic data were obtained on 188 hospital referred patients (mean age 70, range 34-91 years). Median duration of follow up was two years (range 1-5 years). The majority of patients (48%) reported deterioration, but 23% experienced improvement in symptoms during the study period. Reported exercise tolerance remained unchanged in the majority (62%) and deteriorated in 35%. Change in at least one individual radiographic feature of osteoarthritis was seen in 252 (72%) knees: increase in joint space narrowing occurred in 52%, osteophyte in 32%, cysts in 19%, sclerosis in 14%, and attrition in 30%. Increase in Kellgren grade occurred in 137 (39%) knees. Knee effusion, osteoarthritis at multiple joint sites, and nodal change associated with change in Kellgren grade (odds ratios 1.03, 2.39, and 1.80; 95% confidence intervals (CI) 1.01 to 1.05, 1.16 to 4.93, and 1.02 to 3.17, respectively); warmth at the knee associated with change in any radiographic feature (odds ratio 2.22; 95% CI 1.19 to 4.14). Development of, or increase in, attrition and joint space narrowing associated with worsening symptoms and function and occurred with increased frequency in knees with effusions, clinical warmth and calcium pyrophosphate crystals in synovial fluid (p < 0.05). A high rate of change, radiographic more than clinical, was seen in osteoarthritic knees during this study. Poor clinical and radiographic outcome associated with calcium pyrophosphate crystal deposition and clinical inflammation as reflected by knee effusion and warmth.

  6. Hypertonic dextrose injection (prolotherapy) for knee osteoarthritis: Long term outcomes.

    PubMed

    Rabago, David; Mundt, Marlon; Zgierska, Aleksandra; Grettie, Jessica

    2015-06-01

    Knee osteoarthritis (OA) is a common, debilitating chronic disease. Prolotherapy is an injection therapy for chronic musculoskeletal pain. Recent 52-week randomized controlled and open label studies have reported improvement of knee OA-specific outcomes compared to baseline status, and blinded saline control injections and at-home exercise therapy (p<0.05). However, long term effects of prolotherapy for knee OA are unknown. We therefore assessed long-term effects of prolotherapy on knee pain, function and stiffness among adults with knee OA. Post clinical-trial, open-label follow-up study. Outpatient; adults with mild-to-severe knee OA completing a 52-week prolotherapy study were enrolled. Participants received 3-5 monthly interventions and were assessed using the validated Western Ontario McMaster University Osteoarthritis Index, (WOMAC, 0-100 points), at baseline, 12, 26, 52 weeks, and 2.5 years. 65 participants (58±7.4 years old, 38 female) received 4.6±0.69 injection sessions in the initial 17-week treatment period. They reported progressive improvement in WOMAC scores at all time points in excess of minimal clinical important improvement benchmarks during the initial 52-week study period, from 13.8±17.4 points (23.6%) at 12 weeks, to 20.9±2.8 points, (p<0.05; 35.8% improvement) at 2.5±0.6 years (range 1.6-3.5 years) in the current follow-up analysis. Among assessed covariates, none were predictive of improvement in the WOMAC score. Prolotherapy resulted in safe, significant, progressive improvement of knee pain, function and stiffness scores among most participants through a mean follow-up of 2.5 years and may be an appropriate therapy for patients with knee OA refractory to other conservative care. Copyright © 2015 Elsevier Ltd. All rights reserved.

  7. 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

  8. Comparative effectiveness of Tai Chi versus physical therapy for knee osteoarthritis: a randomized trial

    USDA-ARS?s Scientific Manuscript database

    Background: Few remedies effectively treat long-term pain and disability from knee osteoarthritis. Studies suggest that Tai Chi alleviates symptoms, but no trials have directly compared Tai Chi with standard therapies for osteoarthritis. Objective: To compare Tai Chi with standard physical therapy f...

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

    USDA-ARS?s Scientific Manuscript database

    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...

  10. 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

  11. Effectiveness of diclofenac versus paracetamol in knee osteoarthritis: a randomised controlled trial in primary care.

    PubMed

    Verkleij, Saskia P J; Luijsterburg, Pim A J; Willemsen, Sten P; Koes, Bart W; Bohnen, Arthur M; Bierma-Zeinstra, Sita M A

    2015-08-01

    The effectiveness of diclofenac versus paracetamol in primary care patients with pain caused by knee osteoarthritis is unclear. To assess the effectiveness of diclofenac compared with paracetamol over a period of 2, 4, and 12 weeks in patients with knee osteoarthritis. Randomised controlled trial in general practice. There were 104 patients included in the study, they were aged ≥45 years consulting their GP with knee pain caused by knee osteoarthritis. Patients were randomly allocated to diclofenac (n = 52) or paracetamol (n = 52) for at least 2 weeks. Primary outcomes were daily knee pain severity, and knee pain and function measured with the Knee Injury and Osteoarthritis Outcome Score (KOOS). Over a period of 2- and 4-weeks follow-up, no significant difference in daily knee pain was found between the patient groups: estimated differences of 0.5 (95% CI = -0.2 to 1.3) and -0.2 (95% CI = -1.0 to 0.7), respectively. Over the 12-weeks follow-up, no significant differences were found between both groups for KOOS pain: estimated difference of -2.8 (95% CI = -10.7 to 5.1) and KOOS function of -2.7 (-10.6 to 5.0). Over a period of 2- and 4-weeks follow-up no significant difference in daily measured knee pain severity was found between primary care patients with knee osteoarthritis taking paracetamol or diclofenac. Also, over a period of 12-weeks follow-up no significant differences were found regarding KOOS pain and KOOS function between both groups. Patients more frequently reported minor adverse events after taking diclofenac (64%) than paracetamol (46%). © British Journal of General Practice 2015.

  12. The Oxford unicompartmental knee replacement for osteoarthritis.

    PubMed

    Brown, A

    2001-09-01

    The Oxford unicompartmental knee replacement is a reliable treatment for medial knee compartment osteoarthritis, provided patients with the correct indications are chosen and the appropriate surgical expertise is available. The Oxford knee has been available since fall 2000 in Canada and since the early 1980's in Europe. The latest version, Phase III, has generated interest since it uses both a minimally invasive surgical technique, as well as a free-floating, fully congruent meniscal bearing. This has the potential for faster recovery of the patient, as well as improved wear characteristics.

  13. Investigating racial differences in coping with chronic osteoarthritis pain.

    PubMed

    Jones, Alvin C; Kwoh, C Kent; Groeneveld, P W; Mor, Maria; Geng, Ming; Ibrahim, Said A

    2008-12-01

    Osteoarthritis is a prevalent disease in older patients of all racial groups, and it is known to cause significant pain and functional disability. Racial differences in how patients cope with the chronic pain of knee or hip osteoarthritis may have implications for utilization of treatment modalities such as joint replacement. Therefore, we examined the relationships between patient race and pain coping strategies (diverting attention, reinterpreting pain, catastrophizing, ignoring sensations, hoping and praying, coping self-statements, and increasing behavior activities) for hip and knee osteoarthritis. This is a cross-sectional survey of 939 veterans 50 to 79 years old with chronic hip or knee osteoarthritis pain recruited from VA primary care clinics in Philadelphia and Pittsburgh. Patients had to have moderate to severe hip or knee osteoarthritis symptoms as measured by the WOMAC index. Standard, validated instruments were used to obtain information on attitudes and use of prayer, pain coping strategies, and arthritis self-efficacy. Analysis included separate multivariable models adjusting for demographic and clinical characteristics. Attitudes on prayer differed, with African Americans being more likely to perceive prayer as helpful (adjusted OR = 3.38, 95% CI 2.35 to 4.86) and to have tried prayer (adjusted OR = 2.28, 95% 1.66 to 3.13) to manage their osteoarthritis pain. Upon evaluating the coping strategies, we found that, compared to whites, African Americans had greater use of the hoping and praying method (beta = 0.74, 95% CI 0.50 to 0.99). Race was not associated with arthritis pain self-efficacy, arthritis function self-efficacy, or any other coping strategies. This increased use of the hoping and praying coping strategy by African Americans may play a role in the decreased utilization of total joint arthroplasty among African Americans compared to whites. Further investigation of the role this coping strategy has on the decision making process for

  14. [Knee joint pain with signs of arthrosis].

    PubMed

    Bender, T T A; Marinova, M; Radbruch, L; Conrad, R; Jobst, D; Mücke, M

    2017-03-14

    Chronic pain in the knee joint is most commonly caused by osteoarthritis, especially in elderly patients but can be due to other causes, such as rheumatoid arthritis. The diagnostics include an exact patient medical history and a clinical examination, which often already provide clear indications of the cause of the knee pain. Subsequently, further diagnostics can then be considered, such as radiological procedures and laboratory diagnostics. The treatment is determined by the cause and the individual patient and aims to reduce pain and to preserve the mobility of the joint. Generally, therapy consists of pain management and physiotherapy as well as alternative therapeutic procedures, mostly in combination. Proximal tibial opening wedge osteotomy can be useful; however, partial or total knee arthroplasty should only be considered when conservative treatment options have been exhausted.

  15. Lower body positive pressure: an emerging technology in the battle against knee osteoarthritis?

    PubMed Central

    Takacs, Judit; Anderson, Judy E; Leiter, Jeff RS; MacDonald, Peter B; Peeler, Jason D

    2013-01-01

    Background Knee osteoarthritis (OA) is the most prevalent medical condition in individuals over the age of 65 years, and is a progressive joint degenerative condition with no known cure. Research suggests that there is a strong relationship between knee pain and loss of physical function. The resulting lifestyle modifications negatively impact not only disease onset and progression but also overall health, work productivity, and quality of life of the affected individual. Purpose The goal of this investigation was to examine the feasibility of using an emerging technology called lower body positive pressure (LBPP) to simulate weight loss and reduce acute knee pain during treadmill walking exercise in overweight individuals with radiographically confirmed symptomatic knee OA. Design Prospective case series. Methods Twenty-two overweight individuals with knee OA completed two 20-minute treadmill walking sessions (one full weight bearing and one LBPP supported) at a speed of 3.1 mph, 0% incline. Acute knee pain was assessed using a visual analog scale, and the percentage of LBPP support required to minimize knee pain was evaluated every 5 minutes. Knee Osteoarthritis Outcome Scores were used to quantify knee pain and functional status between walking sessions. The order of testing was randomized, with sessions occurring a minimum of 1 week apart. Results A mean LBPP of 12.4% of body weight provided participants with significant pain relief during walking, and prevented exacerbation of acute knee pain over the duration of the 20-minute exercise session. Patients felt safe and confident walking with LBPP support on the treadmill, and demonstrated no change in Knee Osteoarthritis Outcome Scores over the duration of the investigation. Conclusion Results suggest that LBPP technology can be used safely and effectively to simulate weight loss and reduce acute knee pain during weight-bearing exercise in an overweight knee OA patient population. These results could have

  16. Lower body positive pressure: an emerging technology in the battle against knee osteoarthritis?

    PubMed

    Takacs, Judit; Anderson, Judy E; Leiter, Jeff R S; MacDonald, Peter B; Peeler, Jason D

    2013-01-01

    Knee osteoarthritis (OA) is the most prevalent medical condition in individuals over the age of 65 years, and is a progressive joint degenerative condition with no known cure. Research suggests that there is a strong relationship between knee pain and loss of physical function. The resulting lifestyle modifications negatively impact not only disease onset and progression but also overall health, work productivity, and quality of life of the affected individual. The goal of this investigation was to examine the feasibility of using an emerging technology called lower body positive pressure (LBPP) to simulate weight loss and reduce acute knee pain during treadmill walking exercise in overweight individuals with radiographically confirmed symptomatic knee OA. Prospective case series. Twenty-two overweight individuals with knee OA completed two 20-minute treadmill walking sessions (one full weight bearing and one LBPP supported) at a speed of 3.1 mph, 0% incline. Acute knee pain was assessed using a visual analog scale, and the percentage of LBPP support required to minimize knee pain was evaluated every 5 minutes. Knee Osteoarthritis Outcome Scores were used to quantify knee pain and functional status between walking sessions. The order of testing was randomized, with sessions occurring a minimum of 1 week apart. A mean LBPP of 12.4% of body weight provided participants with significant pain relief during walking, and prevented exacerbation of acute knee pain over the duration of the 20-minute exercise session. Patients felt safe and confident walking with LBPP support on the treadmill, and demonstrated no change in Knee Osteoarthritis Outcome Scores over the duration of the investigation. Results suggest that LBPP technology can be used safely and effectively to simulate weight loss and reduce acute knee pain during weight-bearing exercise in an overweight knee OA patient population. These results could have important implications for the development of future

  17. The Knee Pain Map: Reliability of a Method to Identify Knee Pain Location and Pattern

    PubMed Central

    THOMPSON, LAURA R.; BOUDREAU, ROBERT; HANNON, MICHAEL J.; NEWMAN, ANNE B.; CHU, CONSTANCE R.; JANSEN, MARY; NEVITT, MICHAEL C.; KWOH, C. KENT

    2009-01-01

    Objective To describe the location and pattern of knee pain in patients with chronic, frequent knee pain using the Knee Pain Map, and to evaluate the inter- and intrarater reliability of the map. Methods A cohort of 799 participants from the University of Pittsburgh Osteoarthritis Initiative Clinical Center who had knee pain in the last 12 months were studied. Trained interviewers assessed and recorded participant-reported knee pain patterns into 8 local areas, 4 regional areas, or as diffuse. Inter- and intrarater reliability were assessed using Fleiss’ kappa. Results Participants most often reported localized (69%) followed by regional (14%) or diffuse (10%) knee pain. In those with localized pain, the most commonly reported locations were the medial (56%) and lateral (43%) joint lines. In those with regional pain, the most commonly reported regions were the patella (44%) and medial region (38%). There was excellent interrater reliability for the identification of localized and regional pain patterns (κ = 0.7–0.9 and 0.7–0.8, respectively). The interrater reliability for specific locations was also excellent (κ = 0.7–1.0) when the number of participants with pain in a location was >4. For regional pain, the kappa for specific regions varied from 0.7–1.0. Conclusion The majority of participants could identify the location of their knee pain, and trained interviewers could reliably record those locations. The variation in locations suggests that there are multiple sources of pain in knee OA. Additional studies are needed to determine whether specific knee pain patterns correlate with discrete pathologic findings on radiographs or magnetic resonance images. PMID:19479703

  18. 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

  19. Longitudinal effects of physical inactivity and obesity on gait speed in older adults with frequent knee pain: data from the Osteoarthritis Initiative.

    PubMed

    Bindawas, Saad M; Vennu, Vishal

    2015-02-05

    Physical inactivity (PI) and obesity are risk factors for many health conditions, including knee pain (KP). The purpose of the present study was to examine the 6-year effects of PI and obesity on gait speed (GS) among older adults with frequent KP. This prospective cohort study used data from the Osteoarthritis Initiative (OAI). At baseline, we studied 1788 adults aged 45 to 79 years old. We grouped the participants into four categories according to baseline scores on the Physical Activity Scale for the Elderly (PASE) and body mass index (BMI). GS was measured using the 20-m timed walk test. Frequent KP was assessed with a self-report questionnaire, and obesity was assessed by BMI (30 kg/m² or greater). General linear mixed models were conducted using data collected at baseline and 12, 24, 36, 48, and 72 months. After adjusting for all covariates, lower levels of physical activity and obesity were associated with a decrease in GS (β = -0.095, SE = 0.011, p < 0.0001). Our results suggest that both PI and obesity are associated with decreased GS over time in older adults with frequent KP.

  20. The OA Trial Bank: meta-analysis of individual patient data from knee and hip osteoarthritis trials show that patients with severe pain exhibit greater benefit from intra-articular glucocorticoids.

    PubMed

    van Middelkoop, M; Arden, N K; Atchia, I; Birrell, F; Chao, J; Rezende, M U; Lambert, R G W; Ravaud, P; Bijlsma, J W; Doherty, M; Dziedzic, K S; Lohmander, L S; McAlindon, T E; Zhang, W; Bierma-Zeinstra, S M A

    2016-07-01

    To evaluate the efficacy of intra-articular (IA) glucocorticoids for knee or hip osteoarthritis (OA) in specific subgroups of patients with severe pain and inflammatory signs using individual patient data (IPD) from existing trials. Randomized trials evaluating one or more IA glucocorticoid preparation in patients with knee or hip OA, published from 1995 up to June 2012 were selected from the literature. IPD obtained from original trials included patient and disease characteristics and outcomes measured. The primary outcome was pain severity at short-term follow-up (up to 4 weeks). The subgroup factors assessed included severe pain (≥70 points, 0-100 scale) and signs of inflammation (dichotomized in present or not) at baseline. Multilevel regression analyses were applied to estimate the magnitude of the effects in the subgroups with the individuals nested within each study. Seven out of 43 published randomized clinical trials (n = 620) were included. Patients with severe baseline pain had a significantly larger reduction in short-term pain, but not in mid- and long-term pain, compared to those with less severe pain at baseline (Mean Difference 13.91; 95% Confidence Interval 1.50-26.31) when receiving IA glucocorticoid injection compared to placebo. No statistical significant interaction effects were found between inflammatory signs and IA glucocorticoid injections compared to placebo and to tidal irrigation at all follow-up points. This IPD meta-analysis demonstrates that patients with severe knee pain at baseline derive more benefit from IA glucocorticoid injection at short-term follow-up than those with less severe pain at baseline. Copyright © 2016 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  1. ASSOCIATIONS OF LEG LENGTH INEQUALITY WITH PREVALENT, INCIDENT, AND PROGRESSIVE KNEE OSTEOARTHRITIS: A COHORT STUDY

    PubMed Central

    Harvey, WF; Yang, M; Cooke, TDV; Segal, N; Lane, N; Lewis, CE; Felson, DT

    2010-01-01

    Background Leg length inequality is common in the general population and may accelerate development of knee osteoarthritis. Objective To determine if leg length inequality is associated with prevalent, incident and progressive knee osteoarthritis, Design Prospective observational cohort study. Setting Subjects recruited from the community in Birmingham, AL and Iowa City, IA Patients 3026 subjects, age 50-79, with or at high risk for knee osteoarthritis. Measurements The exposure was leg length inequality measured from full limb radiographs. The outcomes were prevalent, incident, and progressive knee osteoarthritis. Radiographic osteoarthritis was defined as Kellgren and Lawrence grade ≥2 and symptomatic osteoarthritis was defined as radiographic disease in a consistently painful knee. Results Leg length inequality ≥1 cm was associated with prevalent radiographic (53% vs. 36%, OR 1.9, 95%CI 1.5-2.4) and symptomatic (30% vs. 17%, OR 2.0, 95%CI 1.6-2.6) osteoarthritis in the shorter limb. Inequality ≥1 cm was associated with incident symptomatic osteoarthritis in the shorter (15% vs. 9%, OR 1.7, 95%CI 1.2-2.4) and longer (13% vs. 9%, OR 1.5, 95%CI 1.0-2.1) limb. Inequality ≥1 cm was associated with increased odds (29% vs. 24%, OR 1.3, 95%CI 1.0-1.7) of progressive osteoarthritis in the shorter limb. Limitations The duration of follow-up may not be long enough to adequately identify cases of incidence and progression. Measurements of leg length, including radiographic, have measurement error which could result in misclassification. Conclusions Radiographic leg length inequality was associated with prevalent, incident symptomatic and progressive knee osteoarthritis. These results point to leg length inequality as a potentially modifiable risk factor for knee osteoarthritis. Primary Funding Source National Institute on Aging PMID:20194234

  2. [Arthroscopic treatment for osteoarthritis: knee and shoulder].

    PubMed

    Almazán, Arturo; Cruz, Francisco; Pérez, Francisco; Bravo, César; Ibarra, Clemente

    2007-10-01

    We discuss the role of arthroscopy in the treatment of knee and shoulder osteoarthritis. The most widely used arthroscopic techniques used in these joints for the treatment of osteoarthritis are arthroscopic lavage, arthroscopic debridement, abrasion arthrosplasty and microfractures. Even though arthroscopic techniques are only useful for a specific group of patients and that the procedure does not modify disease's natural history, it is an accessible therapeutic option. Copyright © 2007 Elsevier España S.L Barcelona. Published by Elsevier Espana. All rights reserved.

  3. Can Glucosamine Supplements Protect My Knee Cartilage from Osteoarthritis?

    MedlinePlus

    ... cartilage in osteoarthritis? Can glucosamine supplements protect my knee cartilage from osteoarthritis? Answers from Brent A. Bauer, M.D. Study results on this question have been mixed, with some suggesting possible ...

  4. Tolerability of tapentadol immediate release in patients with lower back pain or osteoarthritis of the hip or knee over 90 days: a randomized, double-blind study.

    PubMed

    Hale, Martin; Upmalis, David; Okamoto, Akiko; Lange, Claudia; Rauschkolb, Christine

    2009-05-01

    Tapentadol is a novel, centrally acting analgesic with two mechanisms of action, mu-opioid receptor agonism and norepinephrine reuptake inhibition, in a single molecule. This phase III, randomized, double-blind, active-controlled study evaluated the tolerability of tapentadol immediate release (IR) and oxycodone IR for low back pain or osteoarthritis pain (hip or knee), using flexible dosing over 90 days. Patients (N = 878) were randomly assigned (4:1 ratio) to receive tapentadol IR (50 or 100 mg, q4-6h, p.o.) or oxycodone IR (10 or 15 mg, q4-6h, p.o.). Tapentadol IR was evaluated for tolerability over 90 days, tolerability relative to oxycodone IR, withdrawal symptoms, and pain intensity. This study was not placebo-controlled, which limited efficacy evaluations. In total, 849 intent-to-treat patients received tapentadol IR (n = 679) or oxycodone IR (n = 170), and among these, 391 patients (57.6%) in the tapentadol IR group and 86 patients (50.6%) in the oxycodone IR group completed the study. Gastrointestinal events, including nausea (18.4% vs 29.4%), vomiting (16.9% vs 30.0%), and constipation (12.8% vs 27.1%), were reported by 44.2% of patients receiving tapentadol IR and 63.5% of patients receiving oxycodone IR, respectively. Nervous system events, including dizziness (18.1% vs 17.1%), headache (11.5% vs 10.0%), and somnolence (10.2% vs 9.4%), were reported by 36.7% of patients receiving tapentadol and 37.1% of patients receiving oxycodone, respectively. Odds ratios (tapentadol:oxycodone) showed that the incidences of somnolence and dizziness were similar; however, nausea, vomiting, and constipation were significantly less likely with tapentadol IR compared with oxycodone IR. The pattern of withdrawal symptoms suggests that drug tapering may not be necessary after tapentadol IR treatment of this duration. Pain intensity measurements showed similar efficacy for tapentadol and oxycodone. During this 90-day study, tapentadol IR was associated with improved

  5. The Effect of Preoperative Intra-Articular Methylprednisolone on Pain After TKA: A Randomized Double-Blinded Placebo Controlled Trial in Patients With High-Pain Knee Osteoarthritis and Sensitization.

    PubMed

    Luna, Iben E; Kehlet, Henrik; Jensen, Claus M; Christiansen, Thorbjørn G; Lind, Thomas; Stephensen, Snorre L; Aasvang, Eske K

    2017-08-24

    In a randomized, double-blind, placebo controlled trial, we investigated the postoperative analgesic effect of a single intra-articular injection of 40 mg methylprednisolone acetate (MP) administered 1 week before total knee arthroplasty (TKA). Forty-eight patients with high pain osteoarthritis (≥5 on a numeric rating scale during walk) and sensitization (pressure pain threshold <250 kPa), aged 50 to 80 years and scheduled for primary unilateral TKA under spinal anaesthesia were included. The primary outcome was the proportion of patients with moderate/severe pain during a 5-m walk test 24 hours postoperatively. Secondary outcomes included pain at 48 hours, during the first 14 days, sensitization (quantitative sensory testing with pressure pain threshold and wind-up from temporal summation), and inflammatory changes (systemic C-reactive protein, intra-articular interleukin [IL]-6). No difference in the proportion of patients with moderate/severe pain was found between MP/placebo groups at 24 hours (67% and 74%, χ(2) = .2, P = .63, odds ratio = .7, 95% confidence interval = .2-2.8) or at 48 hours (57% and 68%, χ(2) = .5, P = .46, odds ratio = .6, 95% confidence interval = .2-2.3), and no difference between groups in postoperative sensitization was found (P > .4) despite reduced preoperative intra-articular inflammation (IL-6) in the MP group versus placebo (median change in IL-6 = -70 pg/mL, interquartile range = -466 to 0 vs. 32 pg/mL, interquartile range = -26 to 75, P = .029). Alternative central or peripheral analgesic interventions in this high-risk group are required. Peripherally driven inflammatory pain and nociceptive changes before TKA has been suggested to be a cause for increased acute postoperative pain. However, preoperative intra-articular MP in patients with high pain osteoarthritis and sensitization did not reduce acute post-TKA pain or sensitization despite a preoperative reduction of intra-articular inflammatory

  6. Anterior knee pain after a total knee arthroplasty: What can cause this pain?

    PubMed Central

    Breugem, Stéfanus Jacob Martinus; Haverkamp, Daniël

    2014-01-01

    Total Knee Arthroplasty has been shown to be a successful procedure for treating patients with osteoarthritis, and yet approximately 5%-10% of patients experience residual pain, especially in the anterior part of the knee. Many theories have been proposed to explain the etiology of this anterior knee pain (AKP) but, despite improvements having been made, AKP remains a problem. AKP can be described as retropatellar or peripatellar pain, which limits patients in their everyday lives. Patients suffering from AKP experience difficulty in standing up from a chair, walking up and down stairs and riding a bicycle. The question asked was: “How can a ‘perfectly’ placed total knee arthroplasty (TKA) still be painful: what can cause this pain?”. To prevent AKP after TKA it is important to first identify the different anatomical structures that can cause this pain. Greater attention to and understanding of AKP should lead to significant pain relief and greater overall patient satisfaction after TKA. This article is a review of what pain is, how nerve signalling works and what is thought to cause Anterior Knee Pain after a Total Knee Arthroplasty. PMID:25035818

  7. Topical capsaicin for pain in osteoarthritis: A literature review.

    PubMed

    Guedes, Vânia; Castro, João Paulo; Brito, Iva

    2016-08-26

    Osteoarthritis is the most common joint disorder worldwide. The predominant symptom, pain, is usually treated with acetaminophen or oral non-steroidal anti-inflammatory drugs, although they are associated with a significant risk of side effects. Topical capsaicin may represent an effective and safe alternative. The aim of this review is to examine the evidence for the efficacy and safety profile of topical capsaicin in the management of pain caused by osteoarthritis. Databases were searched for articles published between 2004 and 2016, in Portuguese, English or Spanish, using the search terms "capsaicin" and "osteoarthritis". When compared to placebo, it was found that topical capsaicin has a good safety profile and efficacy in reducing osteoarthritis pain of the hand, knee, hip or shoulder. However, the studies have significant limitations, the most important the difficulty of blinding. It is attributed to this review the strength of recommendation B.

  8. Synovial inflammation in patients with different stages of knee osteoarthritis.

    PubMed

    Ene, Răzvan; Sinescu, Ruxandra Diana; Ene, Patricia; Cîrstoiu, Monica Mihaela; Cîrstoiu, Florin Cătălin

    2015-01-01

    The synovium is an intra-articular mesenchymal tissue and essential for the normal joint function. It is involved in many pathological characteristic processes and sometimes specific for this distinctive tissue. In this study, we refer to synovial proliferative disorders according to the stage of osteoarthritis (OA) disease. Forty-three patients with knee OA were treated in the Department of Orthopedics and Traumatology, Emergency University Hospital of Bucharest, Romania, in the last two years. In all cases, we used at least five criteria for the knee OA: knee pain, knee joint tenderness, no palpable warmth over the knee, stiffness, erythrocyte sedimentation rate and C-reactive protein levels. In all the cases the synovial tissue was selected by the orthopedic surgeon. X-ray examination was taken in every case of the affected joint. Patients who were considered to have early OA underwent arthroscopic synovial biopsy of the symptomatic joint. Synovial tissue samples from patients with late OA were obtained at the time of knee joint arthroplasty. Microscopic examination in early osteoarthritis revealed for more than half of patients with synovial biopsy through arthroscopic technique having synovitis lesions with mononuclear infiltrates, diffuse fibrosis, thickening of the lining layer, macrophages appearance and neoformation vessels also. The synovitis seen in advanced OA knees tends to be diffuse and is not mandatory localized to areas of chondral defects, although an association has been reported between chondral defects and associated synovitis in the knee medial tibio-femoral compartment. The overexpression of mediators of inflammation and the increased mononuclear cell infiltration were seen in early OA, compared with late OA.

  9. Osteoarthritis after sports knee injuries.

    PubMed

    Bartz, Reed L; Laudicina, Lawrence

    2005-01-01

    Recent advances in the knowledge of tissue homeostasis, including the tissue homeostasis theory and the envelope of function theory as proposed by Dye, have greatly increased our knowledge of the pathophysiology of osteoarthrosis after sports knee injuries. The development of these two theories has not only advanced our understanding of the treatment and prevention of osteoarthrosis after acute injuries to the knee, but has also given us guidance as to directions for future research.

  10. Laterality of radiographic osteoarthritis of the knee.

    PubMed

    Komatsu, Daigo; Ikeuchi, Kazuma; Kojima, Toshihisa; Takegami, Yasuhiko; Amano, Takafumi; Tsuboi, Masaki; Ishiguro, Naoki; Hasegawa, Yukiharu

    2017-05-01

    There are few reports of the laterality in radiological knee osteoarthritis (ROA). This study aimed to evaluate laterality in terms of the minimum joint space width (mJSW) and osteophyte areas (OFs) in a cross-sectorial general population screen and elucidate the association between laterality and risk of osteoarthritis. We enrolled 330 participants (mean age 64.6 years) and examined the presence of ROA (Kellgren-Lawrence grade ≧ 2) laterality in terms of the mJSW and OF on the medial tibia using auto-measuring software. Moreover, we examined the association between laterality and leg dominance. The right and left medial mJSWs were 4.02 ± 0.98 mm and 4.05 ± 1.01 mm, respectively, showing no laterality; the laterals were also similar. The participants who had osteophytes ≥1 mm(2) in the right, left, and bilateral knees were 15, 37, and 57 respectively, with osteophytes being significantly more common in the left knee. The OF was significantly larger in the left knee. Conversely, the medial and lateral mJSWs and OF did not differ according to leg dominance. The prevalence of ROA was higher and the OF was more pronounced in the left knee. However, the mJSW showed no laterality. Additionally, the mJSW and OF showed no differences according to leg dominance.

  11. Management of the Retired Athlete with Osteoarthritis of the Knee

    PubMed Central

    Garrett, William E.

    2012-01-01

    Purpose: Osteoarthritis of the knee is a complex interaction of biological, mechanical, and biochemical factors that are further complicated by injury, which accelerates pathological processes within the joint. As a result, athletes, particularly those with a history of knee injury, have an earlier onset and higher prevalence of osteoarthritis that would be expected based on their age. This can present a clinical dilemma to the physician managing the patient who, despite the presence of radiologically confirmed disease, has few symptoms and wishes to maintain an active lifestyle. Methods: We reviewed meta-analyses and systematic reviews of randomized controlled trials about clinical management of knee osteoarthritis with special interest on effect sizes. Results: Numerous management options have undergone the rigor of clinical trials and subsequently have been summarized in meta-analyses and systematic reviews, the results of which offer evidence regarding varying degrees of effect. Based on the available evidence, most summaries and clinical practice guidelines suggest a regimen of patient education, self-management, weight control, and exercise supported by individualized pain management strategies. Other noninvasive or less invasive strategies are available that have varying degrees of effect. Conclusions: Although the evidence supporting many of the clinical management options might be considered modest, those effects are sufficient to permit an active lifestyle and have, given the prevalence of the disease, a public health impact. PMID:26069611

  12. Evaluating Meridian-Sinew Release Therapy for the Treatment of Knee Osteoarthritis

    PubMed Central

    Wei, Song; Chen, Zhi-Huang; Sun, Wei-Feng; Zhang, Geng-Peng; Li, Xiao-Hao; Hou, Chun-Fu; Lu, Liu-Dan; Zhang, Lu

    2013-01-01

    Objective. In recent years, public health experts have concluded that the impact of osteoarthritis is equal in magnitude to that of cardiovascular disease. Osteoarthritis of the knee is prevalent in the elderly population; however, there are currently no effective treatments for this condition. In this study, we investigated the efficacy of “meridian-sinew release,” a newly developed technique which entails using a meridian-sinew scope and a meridian-sinew knife to treat osteoarthritis of the knee. Methods. Patients (N = 90) with knee osteoarthritis were prospectively randomized to meridian-sinew release therapy, acupuncture therapy, or drug therapy groups, respectively. Outcome evaluation included pain, stiffness, physiological function, total symptom score, and overall changes in the condition. Results. After 12 weeks, patients' general assessment (GA) and doctors' general assessment (GA) of the condition were not significantly different among the three groups. However, significant differences in primary endpoint pain, joint stiffness, and total symptom score were found between the meridian-sinew group and the acupuncture group and between the meridian-sinew group and the control group (P < 0.05). No adverse events occurred during the trial. Conclusion. Our study suggests that meridian-sinew release therapy can improve knee osteoarthritis, alleviate joint pain, and improve functional movement disorder. It is a safe and effective treatment for knee osteoarthritis. PMID:23861698

  13. Multi-joint postural behavior in patients with knee osteoarthritis.

    PubMed

    Turcot, Katia; Sagawa, Yoshimasa; Hoffmeyer, Pierre; Suvà, Domizio; Armand, Stéphane

    2015-12-01

    Previous studies have demonstrated balance impairment in patients with knee osteoarthritis (OA). Although it is currently accepted that postural control depends on multi-joint coordination, no study has previously considered this postural strategy in patients suffering from knee OA. The objectives of this study were to investigate the multi-joint postural behavior in patients with knee OA and to evaluate the association with clinical outcomes. Eighty-seven patients with knee OA and twenty-five healthy elderly were recruited to the study. A motion analysis system and two force plates were used to investigate the joint kinematics (trunk and lower body segments), the lower body joint moments, the vertical ground reaction force ratio and the center of pressure (COP) during a quiet standing task. Pain, functional capacity and quality of life status were also recorded. Patients with symptomatic and severe knee OA adopt a more flexed posture at all joint levels in comparison with the control group. A significant difference in the mean ratio was found between groups, showing an asymmetric weight distribution in patients with knee OA. A significant decrease in the COP range in the anterior-posterior direction was also observed in the group of patients. Only small associations were observed between postural impairments and clinical outcomes. This study brings new insights regarding the postural behavior of patients with severe knee OA during a quiet standing task. The results confirm the multi-joint asymmetric posture adopted by this population. Copyright © 2014 Elsevier B.V. All rights reserved.

  14. Diclofenac Topical (osteoarthritis pain)

    MedlinePlus

    ... extreme tiredness unusual bleeding or bruising lack of energy loss of appetite pain in the upper right ... overdose may include the following: drowsiness lack of energy nausea vomiting stomach pain bloody, black, or tarry ...

  15. Treating knee osteoarthritis with intra-articular hyaluronans.

    PubMed

    Brzusek, Daniel; Petron, David

    2008-12-01

    Intra-articular hyaluronan (HA) or hylan is approved for the treatment of osteoarthritis (OA) knee pain. The authors review here published evidence of efficacy and safety of intra-articular HA for the treatment of knee pain. Since the systemic safety of nonsteroidal anti-inflammatory drugs (NSAIDs) and cyclo-oxygenase (COX-2) inhibitors for OA knee treatment are a current concern, the authors also offer recommendations for repositioning HA in the OA treatment paradigm. Relevant HA literature was identified by searching MEDLINE and EMBASE from their inception to April 2008 using the search words hyaluronan, hyaluronic acid, sodium hyaluronate, and hylan G-F 20, with knee and OA. Data from randomized, placebo-controlled trials were reviewed and summarized in this article. While not a systematic review, this article reviews the best available evidence for the use of HA to treat knee OA. For the most part, patients in the reviewed studies were adults over the age of 40 with mild to severe symptomatic OA of the knee. Reviewed studies demonstrated significant improvements in pain and physical function with HA or sodium hyaluronate and hylan G-F 20. HA or hylan products were most effective between 5 and 13 weeks after injection with improvements also observed at 14-26 weeks or sometimes longer, and were well tolerated with a low incidence of adverse events. HA also provides beneficial treatment effects when administered in conjunction with other therapies. Intra-articular HA or hylan has proven to be an effective, safe, and tolerable treatment for symptomatic knee OA. In an effort to limit cardiovascular, gastrointestinal, and renal safety concerns with COX-2 selective and nonselective NSAIDs and maximize HA efficacy, the authors proposed using HA earlier in the treatment paradigm for knee OA and also as part of a comprehensive treatment strategy.

  16. Medial unicompartimental knee arthroplasty for osteonecrosis or osteoarthritis.

    PubMed

    Servien, E; Verdonk, P C M; Lustig, S; Paillot, J L; Kara, A D; Neyret, P

    2008-11-01

    We report a prospective series of 33 unicompartmental knee arthroplasties (UKAs) operated for a spontaneous osteonecrosis of the knee (SPONK) compared with 35 UKAs operated for osteoarthritis (OA). The mean follow-up was 5 years. Preoperative functional score in the SPONK group was significantly lower than that in the OA group. The results were comparable in terms of pain, knee score and function. At the last follow-up, the survival rate was 92.8% for the SPONK group and 95.4% for the OA group. We found a higher rate of radiolucencies in the SPONK group, however, without any clinical symptoms. The UKA is a good option in the treatment of SPONK.

  17. Comparison of three knee braces in the treatment of medial knee osteoarthritis.

    PubMed

    Dessery, Yoann; Belzile, Etienne L; Turmel, Sylvie; Corbeil, Philippe

    2014-12-01

    Conservative orthotic treatments rely on different mechanisms, such as three-point bending systems or hinges forcing external rotation of the leg and knee stabilization, to alter the biomechanics of the lower limbs and thus reduce knee loading on the affected compartment in patients with knee osteoarthritis (KOA). No previous study had compared the effects of these mechanisms on external loading and leg kinematics in patients with KOA. Twenty-four patients with medial KOA (Kellgren-Lawrence grade II or III) wore three custom knee braces: a valgus brace with a three-point bending system (V3P-brace), an unloader brace with valgus and external rotation functions (VER-brace) and a functional knee brace used in ligament injuries (ACL-brace). Pain relief, comfort, lower extremity kinematics and kinetics during walking were compared with and without each knee brace. Knee pain was alleviated with all three braces (p<0.01). The VER- and ACL-braces allowed a significant reduction in peak knee adduction moment (KAM) during terminal stance from 0.313 to 0.280 Nm/Bw∗Ht (p<0.001) and 0.293 to 0.268 (p<0.05), respectively, while no significant reduction was observed with the V3P-brace (p=0.52). Reduced knee adduction and lower ankle and knee external rotation were observed with the V3P-brace but not with the VER-brace. The ACL-brace did not modify lower limb kinematics. No difference between the knee braces was found for pain reduction, discomfort or KAM. The VER-brace was slightly more comfortable, which could ensure better compliance with treatment over the long term. Copyright © 2014 Elsevier B.V. All rights reserved.

  18. Painful knee but not hand osteoarthritis is an independent predictor of mortality over 23 years follow-up of a population-based cohort of middle-aged women.

    PubMed

    Kluzek, S; Sanchez-Santos, M T; Leyland, K M; Judge, A; Spector, T D; Hart, D; Cooper, C; Newton, J; Arden, N K

    2016-10-01

    To assess whether joint pain or radiographic osteoarthritis (ROA) of the knee and hand is associated with all-cause and disease-specific mortality in middle-aged women. Four subgroups from the prospective community-based Chingford Cohort Study were identified based on presence/absence of pain and ROA at baseline: (Pain-/ROA-; Pain+/ROA-; Pain-/ROA+; Pain+/ROA+). Pain was defined as side-specific pain in the preceding month, while side-specific ROA was defined as Kellgren-Lawrence grade ≥2. All-cause, cardiovascular disease (CVD) and cancer-related mortality over the 23-year follow-up was based on information collected by the Office for National Statistics. Associations between subgroups and all-cause/cause-specific mortality were assessed using Cox regression, adjusting for age, body mass index, typical cardiovascular risk factors, occupation, past physical activity, existing CVD disease, glucose levels and medication use. 821 and 808 women were included for knee and hand analyses, respectively. Compared with the knee Pain-/ROA- group, the Pain+/ROA- group had an increased risk of CVD-specific mortality (HR 2.93 (95% CI 1.47 to 5.85)), while the knee Pain+/ROA+ group had an increased HR of 1.97 (95% CI 1.23 to 3.17) for all-cause and 3.57 (95% CI 1.53 to 8.34) for CVD-specific mortality. We found no association between hand OA and mortality. We found a significantly increased risk of all-cause and CVD-specific mortality in women experiencing knee pain with or without ROA but not ROA alone. No relationship was found between hand OA and mortality risk. This suggests that knee pain, more than structural changes of OA is the main driver of excess mortality in patients with OA. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  19. Intensive Gait Training for Older Adults with Symptomatic Knee Osteoarthritis

    PubMed Central

    Segal, Neil A.; Glass, Natalie A.; Teran-Yengle, Patricia; Singh, Bhupinder; Wallace, Robert B.; Yack, H. John

    2014-01-01

    Objective To determine whether individualized gait training is more effective than usual care for reducing mobility disability and pain in individuals with symptomatic knee osteoarthritis (OA). Design Adults age ≥60 with symptomatic knee OA and mobility limitations were randomized to physical therapist-directed gait training on an instrumented treadmill, with biofeedback individualized to optimize knee movements, biweekly for 3 months or usual care (control). Mobility disability was defined by LLFDI Basic Lower Limb Function score (primary); limitations by timed 400m walk, chair-stand, and stair-climb tests at baseline, 3, 6 and 12 months; and symptoms by the Knee Injury/Osteoarthritis Outcome Score. Analyses used longitudinal mixed models. Results There were no significant inter-group differences between the 35 gait-training (74.3% women; age 69.7±8.2 years) and 21 control (57.1% women; age 68.9±6.5 years) participants at baseline. At 3 months, gait-training participants had greater improvement in mobility disability (4.3±1.7; p=0.0162) and symptoms (8.6±4.1; p=0.0420). However, there were neither intergroup differences detected for pain, 400m walk, chair-stand or stair-climb times at 3 months nor for any outcomes at 6 or 12 months. Conclusions Compared with usual care, individualized gait-training resulted in immediate improvements in mobility disability and knee symptoms in adults with symptomatic knee OA, but these effects were not sustained. PMID:25768068

  20. Knee stabilization in patients with medial compartment knee osteoarthritis

    PubMed Central

    Lewek, Michael D.; Ramsey, Dan K.; Snyder-Mackler, Lynn; Rudolph, Katherine S.

    2005-01-01

    OBJECTIVE Individuals with medial knee osteoarthritis (MKOA) experience knee laxity and instability. Muscle stabilization strategies may influence the long term integrity of the joint. In this study we determined how individuals with medial knee OA respond to a rapid valgus knee movement to investigate the relationship between muscle stabilization strategies and knee instability. METHODS Twenty one subjects with MKOA and genu varum, and 19 control subjects were tested. Subjects stood with the test limb on a moveable platform that translated laterally to rapidly stress the knee’s medial periarticular structures and create a potentially destabilizing feeling at the knee joint. Knee motion and muscle responses were recorded. Subjects rated their knee instability with a self-report questionnaire about knee instability during daily activities. RESULTS Prior to plate movement the OA subjects demonstrated more medial muscle co-contraction (p=0.014). Following plate movement the OA subjects shifted less weight off the test limb (p = 0.013) and had more medial co-contraction (p=0.037). Those without instability had higher VMMH co-contraction than those who reported more instability (p=0.038). Knee stability correlated positively with VMMH co-contraction prior to plate movement (r = 0.459; p = 0.042). CONCLUSION This study demonstrates that individuals with MKOA attempt to stabilize the knee with greater medial muscle co-contraction in response to laxity that appears on only the medial side of the joint. This strategy presumably contributes to higher joint compression and could exacerbate joint destruction and needs to be altered to slow or stop the progression of the OA disease process. PMID:16142714

  1. Effect of knee sleeve on static and dynamic balance in patients with knee osteoarthritis.

    PubMed

    Chuang, Shih-Hung; Huang, Mao-Hsiung; Chen, Tien-Wen; Weng, Ming-Chang; Liu, Chin-Wei; Chen, Chia-Hsin

    2007-08-01

    Patients with knee osteoarthritis (OA) find that use of elastic knee sleeves gives them partial pain relief and a greater sense of joint stability. However, the scientific effects of knee OA patients wearing braces are unclear. The purpose of this study was to investigate the effects of knee sleeves on static and dynamic balance in knee OA patients. Fifty patients with knee OA were enrolled in the study and all subjects were randomly divided into two groups. Initially, subjects in group A did not wear a neoprene sleeve while receiving balance tests but then wore them to be re-tested. Subjects in group B did just the reverse procedure. In this investigation, an instrument (KAT 2000; Breg Inc., Vista, CA, USA), which quantified motor control performance of the lower extremities was used and balance scores from the KAT 2000 software were obtained. The results revealed that the scores of patients wearing braces were significantly lower than those of patients without braces (p < 0.05).The finding of this study demonstrated that knee OA patients wearing knee sleeves could experience increased balance ability in both static and dynamic conditions. The improvement might prevent knee OA patients from falling down and increase their sense of security during physical activities.

  2. 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

  3. Anterior knee pain after total knee arthroplasty: a narrative review.

    PubMed

    Petersen, Wolf; Rembitzki, Ingo Volker; Brüggemann, Gerd-Peter; Ellermann, Andree; Best, Raymond; Koppenburg, Andreas Gösele-; Liebau, Christian

    2014-02-01

    Anterior knee pain is one of the most common causes of persistent problems after implantation of a total knee replacement. It can occur in patients with or without patellar resurfacing. As a result of the surgical procedure itself many changes can occur which may affect the delicate interplay of the joint partners in the patello-femoral joint. Functional causes of anterior knee pain can be distinguished from mechanical causes. The functional causes concern disorders of inter- and intramuscular coordination, which can be attributed to preoperative osteoarthritis. Research about anterior knee pain has shown that not only the thigh muscles but also the hip and trunk stabilising muscles may be responsible for the development of a dynamic valgus malalignment. Dynamic valgus may be a causative factor for patellar maltracking. The mechanical causes of patello-femoral problems after knee replacement can be distinguished according to whether they increase instability in the joint, increase joint pressure or whether they affect the muscular lever arms. These causes include offset errors, oversizing, rotational errors of femoral or tibial component, instability, maltracking and chondrolysis, patella baja and aseptic loosening. In these cases, reoperation or revision is often necessary.

  4. Best performing definition of accelerated knee osteoarthritis: data from the Osteoarthritis Initiative

    PubMed Central

    Driban, Jeffrey B.; Stout, Alina C.; Lo, Grace H.; Eaton, Charles B.; Price, Lori Lyn; Lu, Bing; Barbe, Mary F.; McAlindon, Timothy E.

    2016-01-01

    Background: We evaluated agreement among several definitions of accelerated knee osteoarthritis (AKOA) and construct validity by comparing their individual associations with injury, age, obesity, and knee pain. Methods: We selected knees from the Osteoarthritis Initiative that had no radiographic knee osteoarthritis [Kellgren–Lawrence (KL) 0 or 1] at baseline and had high-quality quantitative medial joint space width (JSW) measures on two or more consecutive visits (n = 1655 knees, 1143 participants). Quantitative medial JSW was based on a semi-automated method and was location specific (x = 0.25). We compared six definitions of AKOA: stringent JSW (averaged): average JSW loss greater than 1.05 mm/year over 4 years; stringent JSW (consistent): JSW loss greater than 1.05 mm/year for at least 2 years; lenient JSW (averaged): average JSW loss greater than 0.25 mm/year over 4 years; lenient JSW (consistent): JSW loss greater than 0.25 mm/year for at least 2 years; comprehensive KL based: progression from no radiographic osteoarthritis to advance-stage osteoarthritis (KL 3 or 4; development of definite osteophyte and joint space narrowing) within 4 years; and lenient KL based: an increase of at least two KL grades within 4 years. Results: Over 4 years the incidence rate of AKOA was 0.4%, 0.8%, 15.5%, 22.1%, 12.4%, and 7.2% based on the stringent JSW (averaged and consistent), lenient JSW (averaged and consistent), lenient KL-based definition, and comprehensive KL-based definition. All but one knee that met the stringent JSW definition also met the comprehensive KL-based definition. There was fair substantial agreement between the lenient JSW (averaged), lenient KL-based, and comprehensive KL-based definitions. A comprehensive KL-based definition led to larger effect sizes for injury, age, body mass index, and average pain over 4 years. Conclusions: A comprehensive KL-based definition of AKOA may be ideal because it represents a broader definition of joint

  5. Best performing definition of accelerated knee osteoarthritis: data from the Osteoarthritis Initiative.

    PubMed

    Driban, Jeffrey B; Stout, Alina C; Lo, Grace H; Eaton, Charles B; Price, Lori Lyn; Lu, Bing; Barbe, Mary F; McAlindon, Timothy E

    2016-10-01

    We evaluated agreement among several definitions of accelerated knee osteoarthritis (AKOA) and construct validity by comparing their individual associations with injury, age, obesity, and knee pain. We selected knees from the Osteoarthritis Initiative that had no radiographic knee osteoarthritis [Kellgren-Lawrence (KL) 0 or 1] at baseline and had high-quality quantitative medial joint space width (JSW) measures on two or more consecutive visits (n = 1655 knees, 1143 participants). Quantitative medial JSW was based on a semi-automated method and was location specific (x = 0.25). We compared six definitions of AKOA: stringent JSW (averaged): average JSW loss greater than 1.05 mm/year over 4 years; stringent JSW (consistent): JSW loss greater than 1.05 mm/year for at least 2 years; lenient JSW (averaged): average JSW loss greater than 0.25 mm/year over 4 years; lenient JSW (consistent): JSW loss greater than 0.25 mm/year for at least 2 years; comprehensive KL based: progression from no radiographic osteoarthritis to advance-stage osteoarthritis (KL 3 or 4; development of definite osteophyte and joint space narrowing) within 4 years; and lenient KL based: an increase of at least two KL grades within 4 years. Over 4 years the incidence rate of AKOA was 0.4%, 0.8%, 15.5%, 22.1%, 12.4%, and 7.2% based on the stringent JSW (averaged and consistent), lenient JSW (averaged and consistent), lenient KL-based definition, and comprehensive KL-based definition. All but one knee that met the stringent JSW definition also met the comprehensive KL-based definition. There was fair substantial agreement between the lenient JSW (averaged), lenient KL-based, and comprehensive KL-based definitions. A comprehensive KL-based definition led to larger effect sizes for injury, age, body mass index, and average pain over 4 years. A comprehensive KL-based definition of AKOA may be ideal because it represents a broader definition of joint deterioration compared with those focused on just joint

  6. Neuromuscular alterations during walking in persons with moderate knee osteoarthritis.

    PubMed

    Hubley-Kozey, C L; Deluzio, K J; Landry, S C; McNutt, J S; Stanish, W D

    2006-08-01

    This paper compared the neuromuscular responses during walking between those with early-stage knee osteoarthritis (OA) to asymptomatic controls. The rationale for studying those with mild to moderate knee OA was to determine the alterations in response to dynamic loading that might be expected before severe pain, joint space narrowing and joint surface changes occur. We used pattern recognition techniques to explore both amplitude and shape changes of the surface electromyograms recorded from seven muscles crossing the knee joint of 40 subjects with knee OA and 38 asymptomatic controls during a walking task. The principal patterns for each muscle grouping explained over 83% of the variance in the waveforms. This result supported the notion that the main neuromuscular patterns were similar between asymptomatic controls and those with OA, reflecting the specific roles of the major muscles during walking. ANOVA revealed significant (p<0.05) differences in the principal pattern scores reflecting both amplitude and shape alterations in the OA group and among muscles. These differences captured subtle changes in the neuromuscular responses of the subjects with OA throughout different phases of the gait cycle and most likely reflected changes in the mechanical environment (joint loading, instability) and pain. The subjects with OA attempted to increase activity of the lateral sites and reduce activity in the medial sites, having minimal but prolonged activity during late stance. Therefore, alterations in neuromuscular responses were found even in this high functioning group with moderate knee OA.

  7. Radiographic knee osteoarthritis in ex-elite table tennis players

    PubMed Central

    2012-01-01

    Background Table tennis involves adoption of the semi-flexed knee and asymmetrical torsional trunk movements creating rotational torques on the knee joint which may predispose players to osteoarthritis (OA) of the knee. This study aims to compare radiographic signs of knee OA and associated functional levels in ex-elite male table tennis players and control subjects. Methods Study participants were 22 ex-elite male table tennis players (mean age 56.64 ± 5.17 years) with 10 years of involvement at the professional level and 22 non-athletic males (mean age 55.63 ± 4.08 years) recruited from the general population. A set of three radiographs taken from each knee were evaluated by an experienced radiologist using the Kellgren and Lawrence (KL) scale (0-4) to determine radiographic levels of OA severity. The intercondylar distance was taken as a measure of lower limb angulation. Participants also completed the pain, stiffness, and physical function categories of the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) 3.1 questionnaire. Results The results showed 78.3% of the ex-elite table tennis players and 36.3% of controls had varying signs of radiographic knee OA with a significant difference in the prevalence levels of definite radiographic OA (KL scale > 2) found between the two groups (P ≤ 0.001). Based on the WOMAC scores, 68.2% of the ex-elite table tennis players reported symptoms of knee pain compared with 27.3% of the controls (p = 0.02) though no significant differences were identified in the mean physical function or stiffness scores between the two groups. In terms of knee alignment, 73.7% of the ex-elite athletes and 32% of the control group had signs of altered lower limb alignment (genu varum) (p = 0.01). Statistical differences were found in subjects categorized as having radiographic signs of OA and altered lower limb alignment (p = 0.03). Conclusions Ex-elite table tennis players were found to have increased levels of

  8. Radiographic knee osteoarthritis in ex-elite table tennis players.

    PubMed

    Rajabi, Reza; Johnson, Gillian M; Alizadeh, Mohammad H; Meghdadi, Nazanin

    2012-02-06

    Table tennis involves adoption of the semi-flexed knee and asymmetrical torsional trunk movements creating rotational torques on the knee joint which may predispose players to osteoarthritis (OA) of the knee. This study aims to compare radiographic signs of knee OA and associated functional levels in ex-elite male table tennis players and control subjects. Study participants were 22 ex-elite male table tennis players (mean age 56.64 ± 5.17 years) with 10 years of involvement at the professional level and 22 non-athletic males (mean age 55.63 ± 4.08 years) recruited from the general population. A set of three radiographs taken from each knee were evaluated by an experienced radiologist using the Kellgren and Lawrence (KL) scale (0-4) to determine radiographic levels of OA severity. The intercondylar distance was taken as a measure of lower limb angulation. Participants also completed the pain, stiffness, and physical function categories of the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) 3.1 questionnaire. The results showed 78.3% of the ex-elite table tennis players and 36.3% of controls had varying signs of radiographic knee OA with a significant difference in the prevalence levels of definite radiographic OA (KL scale > 2) found between the two groups (P ≤ 0.001). Based on the WOMAC scores, 68.2% of the ex-elite table tennis players reported symptoms of knee pain compared with 27.3% of the controls (p = 0.02) though no significant differences were identified in the mean physical function or stiffness scores between the two groups. In terms of knee alignment, 73.7% of the ex-elite athletes and 32% of the control group had signs of altered lower limb alignment (genu varum) (p = 0.01). Statistical differences were found in subjects categorized as having radiographic signs of OA and altered lower limb alignment (p = 0.03). Ex-elite table tennis players were found to have increased levels of radiological signs of OA in the knee joint though

  9. Effect of rocker-soled shoes on parameters of knee joint load in knee osteoarthritis.

    PubMed

    Madden, Elizabeth G; Kean, Crystal O; Wrigley, Tim V; Bennell, Kim L; Hinman, Rana S

    2015-01-01

    This study evaluated the immediate effects of rocker-soled shoes on parameters of the knee adduction moment (KAM) and pain in individuals with knee osteoarthritis (OA). Three-dimensional gait analysis was performed on 30 individuals (mean (SD): age, 61 (7) yr; 15 (50%) male) with radiographic and symptomatic knee OA under three walking conditions in a randomized order: i) wearing rocker-soled shoes (Skechers Shape-ups), ii) wearing non-rocker-soled shoes (ASICS walking shoes), and iii) barefoot. Peak KAM and KAM angular impulse were measured as primary indicators of knee load distribution. Secondary measures included the knee flexion moment (KFM) and knee pain during walking. Peak KAM was significantly lower when wearing the rocker-soled shoes compared with that when wearing the non-rocker-soled shoes (mean difference (95% confidence interval), -0.27 (-0.42 to -0.12) N·m/BW × Ht%; P < 0.001). Post hoc tests revealed no significant difference in KAM impulse between rocker-soled and non-rocker-soled shoe conditions (P = 0.13). Both peak KAM and KAM impulse were significantly higher during both shoe conditions compared with those during the barefoot condition (P < 0.001). There were no significant differences in KFM (P = 0.36) or knee pain (P = 0.89) between conditions. Rocker-soled shoes significantly reduced peak KAM when compared with non-rocker-soled shoes, without a concomitant change in KFM, and thus may potentially reduce medial knee joint loading. However, KAM parameters in the rocker-soled shoes remained significantly higher than those during barefoot walking. Wearing rocker-soled shoes did not have a significant immediate effect on walking pain. Further research is required to evaluate whether rocker-soled shoes can influence symptoms and progression of knee OA with prolonged wear.

  10. Conservative management of symptomatic knee osteoarthritis: a flawed strategy?

    PubMed Central

    Crawford, Dennis C.; Miller, Larry E.; Block, Jon E.

    2013-01-01

    Conservative management of medial compartment knee osteoarthritis (OA) is a misleading term used to describe the application of medical, orthotic, and/or rehabilitative therapies exclusive of surgical interventions. The implication of this nomenclature is that these therapies offer satisfactory symptom relief, alter disease progression, and have limited side effects. Unfortunately, conservative therapeutic options possesses few, if any, characteristics of an ideal treatment, namely one that significantly alleviates pain, improves knee function, and reduces medial compartmental loading without adverse side effects. As uncompensated mechanical loading is a primary culprit in the development and progression of knee OA, we propose that the therapeutic perspective of conservative treatment should shift from pharmacological treatments, which have no influence on joint loading, minimal potential to alter joint function, substantial associated risks, and significant financial costs, towards minimally invasive load absorbing therapeutic interventions. A safe and effective minimally invasive medical device specifically engineered for symptomatic relief of medial knee OA by limiting joint contact forces has the potential to reduce the clinical and economic knee OA burden. This review characterizes the current standard of care recommendations for conservative management of medial compartment knee OA with respect to treatment efficacy, risk profile, and economic burden. PMID:23705060

  11. 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

    More than 20 million individuals in the United States are affected by knee osteoarthritis (OA), which can lead to altered biomechanics and excessive joint loading. The use of an unloader pneumatic brace with extension assist has been proposed as a nonoperative treatment modality that may improve gait mechanics and correct knee malalignment. We assessed the following parameters in patients who have knee OA treated with and without a brace: (1) changes in temporospatial parameters in gait; (2) knee range of motion, knee extension at heel strike, and foot placement; (3) knee joint moments and impulse; and (4) changes in dynamic stiffness and rate of change of knee flexion during midstance to terminal stance. This 2:1 prospective, randomized, single-blinded trial evaluated 36 patients (24 brace and 12 matching). OA knee patients were randomized to receive either a pneumatic unloader brace or a standard nonoperative treatment regimen as the matching cohort for a 3-month period. They underwent evaluation of gait parameters using a three-dimensional gait analysis system at their initial appointment and at 3 months follow-up. All the testing, pre- and postbracing were performed without wearing the brace to examine for retained effects. Treatment with the brace led to significant improvements versus standard treatment in various gait parameters. Patients in the brace group had improvements in walking speed, knee extension at heel strike, total range of motion, knee joint forces, and rate of knee flexion from midstance to terminal stance when compared with the matching cohort. Knee OA patients who used a pneumatic unloader brace for 3 months for at least 3 hours per day had significant improvements various gait parameters when compared with a standard nonoperative therapy cohort. Braced patients demonstrated gait-modifying affects when not wearing the brace. These results are encouraging and suggest that this device represents a promising treatment modality for knee OA that

  12. 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.

  13. Relationship of bone mineral density to progression of knee osteoarthritis

    USDA-ARS?s Scientific Manuscript database

    Objective. To evaluate the longitudinal relationship between bone mineral density (BMD) and BMD changes and the progression of knee osteoarthritis (OA), as measured by cartilage outcomes. Methods. We used observational cohort data from the Vitamin D for Knee Osteoarthritis trial. Bilateral femoral ...

  14. Anterior knee pain.

    PubMed

    LLopis, Eva; Padrón, Mario

    2007-04-01

    Anterior knee pain is a common complain in all ages athletes. It may be caused by a large variety of injuries. There is a continuum of diagnoses and most of the disorders are closely related. Repeated minor trauma and overuse play an important role for the development of lesions in Hoffa's pad, extensor mechanism, lateral and medial restrain structures or cartilage surface, however usually an increase or change of activity is referred. Although the direct relation of cartilage lesions, especially chondral, and pain is a subject of debate these lesions may be responsible of early osteoarthrosis and can determine athlete's prognosis. The anatomy and biomechanics of patellofemoral joint is complex and symptoms are often unspecific. Transient patellar dislocation has MR distinct features that provide evidence of prior dislocation and rules our complication. However, anterior knee pain more often is related to overuse and repeated minor trauma. Patella and quadriceps tendon have been also implicated in anterior knee pain, as well as lateral or medial restraint structures and Hoffa's pad. US and MR are excellent tools for the diagnosis of superficial tendons, the advantage of MR is that permits to rule out other sources of intraarticular derangements. Due to the complex anatomy and biomechanic of patellofemoral joint maltracking is not fully understood; plain films and CT allow the study of malalignment, new CT and MR kinematic studies have promising results but further studies are needed. Our purpose here is to describe how imaging techniques can be helpful in precisely defining the origin of the patient's complaint and thus improve understanding and management of these injuries.

  15. Nonoperative Treatment Approach to Knee Osteoarthritis in the Master Athlete

    PubMed Central

    Huleatt, Joel B.; Campbell, Kevin J.; LaPrade, Robert F.

    2014-01-01

    Context: Middle-age and elderly participants in athletic activities frequently encounter the chronic disabling process of osteoarthritis. Knowledge of the treatment of knee osteoarthritis is needed to keep the master athlete active. Objective: This article reviews the current scientific evidence regarding recommendations for the maturing athlete, specifically discussing the strengths and weaknesses of dietary and lifestyle modifications, physical therapy, bracing, supplements, pharmacotherapies, and biologics in the management of knee osteoarthritis. Level of Evidence: Level 4. Conclusion: These treatment modalities can help keep the aging athlete active, which in itself plays an important role in reducing the symptoms of knee osteoarthritis. PMID:24427443

  16. The Effectiveness of a Newly Designed Orthosis on Knee Contact Forces in Subjects with Knee Osteoarthritis.

    PubMed

    Karimi, Mohammad Taghi; Saljoghian, Parastoo; Fatoye, Francis

    2015-01-01

    This study was aimed to assess the effectiveness of a newly designed orthosis on knee contact forces in subjects with knee osteoarthritis (OA). Five patients with OA participated in the study. All had knee OA on the medial side according to the American College of Rheumatology criteria, medial knee pain and radiographic osteophyte on the medial side of knee joint. The knee joint contact forces were determined by the use of Open Simm software under two conditions, namely, walking with and without the orthosis. There was no significant difference between the mean values of walking speed, stride length and cadence during walking with and without the orthosis. The mean and standard deviation (SD) values of the first and second peaks of the knee joint contact force in a vertical direction were 2.83±0.26 and 3.17±1.16 N/BW, respectively, compared to 2.54±0.22 and 2.54±0.958 N/BW in walking with and without the orthosis (p <0.05). The results of this study confirmed that the new design of orthosis decreases the joint contact forces, due to reduction in muscle performance needed to stabilize the knee joint.

  17. Vitamin K deficiency is associated with incident knee osteoarthritis

    USDA-ARS?s Scientific Manuscript database

    Osteoarthritis is the most common form of arthritis, with knee osteoarthritis being the leading cause of lower extremity disability among older adults in the US. There are no treatments available to prevent the structural pathology of osteoarthritis. Because of vitamin K’s role in regulating skeleta...

  18. [Osteoarthritis of knee joint treated with acupuncture and moxibustion].

    PubMed

    Zhang, Qian-Ru; Fu, Wen-Bin

    2010-05-01

    To compare the clinical efficacy of osteoarthritis of knee joint treated by acupuncture and moxibustion and simple acupuncture. Sixty-two cases were randomized into an observation group (32 cases) and a control group (30 cases). In the observation group, acupuncture and non-scarring moxibustion were applied. Acupuncture was applied on the local acupoints of knee and moxibustion was performed on Shenshu (BL 23) and Xuehai (SP 10). In the control group, only acupuncture was adopted. The clinical efficacy was observed after 2 courses of treatment. Lysholm knee joint motor function scale, visual analogue scale (VAS) and WHO quality of life (WHOQOL-BREF) were used for the assessment of scores before and after treatment and the statistical analysis of clinical efficacy. The total effective rate (93.8%, 30/32) in the observation group was superior to that (87.7%, 26/30) in the control group (P < 0.05). The scores in Lysholm knee joint motor function scale and VAS were improved after treatment compared with those before treatment in two groups (P < 0.05, P < 0.01). The degree of improvement in the observation group was superior to that in the control group (P < 0.05, P < 0.01). There was no statistical significance in the scores of WHOQOL-BREF before and after treatment in two groups as well as in intra-group comparison (all P > 0.05). Acupuncture and moxibustion in combination achieve the definite clinical efficacy on osteoarthritis of knee joint and this therapy is superior to simple acupuncture in the improvement of motor function of knee joint and the alleviation of pain.

  19. Factors associated with stair climbing ability in patients with knee osteoarthritis and knee arthroplasty: a systematic review.

    PubMed

    Whitchelo, Tara; McClelland, Jodie A; Webster, Kate E

    2014-01-01

    People with knee osteoarthritis (OA) report ongoing limitations in climbing stairs, even after total knee arthroplasty (TKA). The aim of this systematic review was to synthesise the available evidence of factors affecting stair climbing ability in patients with knee OA before and after TKA. A systematic search was conducted of common electronic databases. All English language abstracts where stair-climbing was assessed in patients with either knee OA or at least 6 months after TKA, and a relationship to any physical, psychological or demographic factors was reported. Thirteen studies were included in the final review, nine investigated a knee OA population, and four investigated a TKA population. For patients with knee OA there was consistent and convincing evidence that greater stair-climbing ability was related to stronger lower limb muscles and less knee pain. For patients with TKA there was much less research, and no conclusions could be reached. For people with knee OA there is evidence that some physical, demographic and psychosocial factors are related to stair-climbing ability. However, the evidence for similar relationships in the TKA population is scarce and needs more extensive research. Implications for Rehabilitation People with knee osteoarthritis experience difficulty when climbing stairs, and this remains challenging even after knee replacement. For people with knee osteoarthritis, a range of physical, demographic and psychosocial factors contribute to stair-climbing ability, however, evidence for similar relationships in the TKA population is scarce. Rehabilitation that is multi-faceted may be the best approach to improve stair-climbing in people with knee osteoarthritis.

  20. Intra-articular corticosteroid for knee osteoarthritis.

    PubMed

    Jüni, Peter; Hari, Roman; Rutjes, Anne W S; Fischer, Roland; Silletta, Maria G; Reichenbach, Stephan; da Costa, Bruno R

    2015-10-22

    Knee osteoarthritis is a leading cause of chronic pain, disability, and decreased quality of life. Despite the long-standing use of intra-articular corticosteroids, there is an ongoing debate about their benefits and safety. This is an update of a Cochrane review first published in 2005. To determine the benefits and harms of intra-articular corticosteroids compared with sham or no intervention in people with knee osteoarthritis in terms of pain, physical function, quality of life, and safety. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and EMBASE (from inception to 3 February 2015), checked trial registers, conference proceedings, reference lists, and contacted authors. We included randomised or quasi-randomised controlled trials that compared intra-articular corticosteroids with sham injection or no treatment in people with knee osteoarthritis. We applied no language restrictions. We calculated standardised mean differences (SMDs) and 95% confidence intervals (CI) for pain, function, quality of life, joint space narrowing, and risk ratios (RRs) for safety outcomes. We combined trials using an inverse-variance random-effects meta-analysis. We identified 27 trials (13 new studies) with 1767 participants in this update. We graded the quality of the evidence as 'low' for all outcomes because treatment effect estimates were inconsistent with great variation across trials, pooled estimates were imprecise and did not rule out relevant or irrelevant clinical effects, and because most trials had a high or unclear risk of bias. Intra-articular corticosteroids appeared to be more beneficial in pain reduction than control interventions (SMD -0.40, 95% CI -0.58 to -0.22), which corresponds to a difference in pain scores of 1.0 cm on a 10-cm visual analogue scale between corticosteroids and sham injection and translates into a number needed to treat for an additional beneficial outcome (NNTB) of 8 (95% CI 6 to 13). An I(2) statistic of 68

  1. 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.

  2. 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.

  3. Knee Osteoarthritis Affects the Distribution of Joint Moments During Gait

    PubMed Central

    Zeni, Joseph A; Higginson, Jill S.

    2010-01-01

    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 the 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 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

  4. Signs of knee osteoarthritis common in 620 patients undergoing arthroscopic surgery for meniscal tear.

    PubMed

    Pihl, Kenneth; Englund, Martin; Lohmander, L Stefan; Jørgensen, Uffe; Nissen, Nis; Schjerning, Jeppe; Thorlund, Jonas B

    2017-02-01

    Background and purpose - Recent evidence has questioned the effect of arthroscopic knee surgery for middle-aged and older patients with degenerative meniscal tears with or without concomitant radiographic knee osteoarthritis (OA). We investigated the prevalence of early or more established knee OA and patients' characteristics in a cohort of patients undergoing arthroscopic surgery for a meniscal tear. Patients and methods - 641 patients assigned for arthroscopy on suspicion of meniscus tear were consecutively recruited from February 2013 through January 2015. Of these, 620 patients (mean age 49 (18-77) years, 57% men) with full datasets available were included in the present study. Prior to surgery, patients completed questionnaires regarding onset of symptoms, duration of symptoms, and mechanical symptoms along with the knee injury and osteoarthritis outcome score (KOOS). At arthroscopy, the operating surgeon recorded information about meniscal pathology and cartilage damage. Early or more established knee OA was defined as the combination of self-reported frequent knee pain, cartilage damage, and the presence of degenerative meniscal tissue. Results - 43% of patients (269 of 620) had early or more established knee OA. Of these, a large proportion had severe cartilage lesions with almost half having a severe cartilage lesion in at least 1 knee compartment. Interpretation - Based on a definition including frequent knee pain, cartilage damage, and degenerative meniscal tissue, early or more established knee OA was present in 43% of patients undergoing knee arthroscopy for meniscal tear.

  5. Signs of knee osteoarthritis common in 620 patients undergoing arthroscopic surgery for meniscal tear

    PubMed Central

    Pihl, Kenneth; Englund, Martin; Lohmander, L Stefan; Jørgensen, Uffe; Nissen, Nis; Schjerning, Jeppe; Thorlund, Jonas B

    2017-01-01

    Background and purpose — Recent evidence has questioned the effect of arthroscopic knee surgery for middle-aged and older patients with degenerative meniscal tears with or without concomitant radiographic knee osteoarthritis (OA). We investigated the prevalence of early or more established knee OA and patients’ characteristics in a cohort of patients undergoing arthroscopic surgery for a meniscal tear. Patients and methods — 641 patients assigned for arthroscopy on suspicion of meniscus tear were consecutively recruited from February 2013 through January 2015. Of these, 620 patients (mean age 49 (18–77) years, 57% men) with full datasets available were included in the present study. Prior to surgery, patients completed questionnaires regarding onset of symptoms, duration of symptoms, and mechanical symptoms along with the knee injury and osteoarthritis outcome score (KOOS). At arthroscopy, the operating surgeon recorded information about meniscal pathology and cartilage damage. Early or more established knee OA was defined as the combination of self-reported frequent knee pain, cartilage damage, and the presence of degenerative meniscal tissue. Results — 43% of patients (269 of 620) had early or more established knee OA. Of these, a large proportion had severe cartilage lesions with almost half having a severe cartilage lesion in at least 1 knee compartment. Interpretation — Based on a definition including frequent knee pain, cartilage damage, and degenerative meniscal tissue, early or more established knee OA was present in 43% of patients undergoing knee arthroscopy for meniscal tear. PMID:27798972

  6. Anterior cruciate ligament reconstruction and knee osteoarthritis

    PubMed Central

    Paschos, Nikolaos K

    2017-01-01

    Anterior cruciate ligament (ACL) injury is a traumatic event that can lead to significant functional impairment and inability to participate in high-level sports-related activities. ACL reconstruction is considered the treatment of choice for symptomatic ACL-deficient patients and can assist in full functional recovery. Furthermore, ACL reconstruction restores ligamentous stability to normal, and, therefore, can potentially fully reinstate kinematics of the knee joint. As a consequence, the natural history of ACL injury could be potentially reversed via ACL reconstruction. Evidence from the literature is controversial regarding the effectiveness of ACL reconstruction in preventing the development of knee cartilage degeneration. This editorial aims to present recent high-level evidence in an attempt to answer whether ACL injury inevitably leads to osteoarthritis and whether ACL reconstruction can prevent this development or not. PMID:28361013

  7. Role of Ultrasonography in Knee Osteoarthritis.

    PubMed

    Oo, Win Min; Bo, Myat Thae

    2016-09-01

    Ultrasound has become popular among rheumatologists as the first-choice imaging investigation for the evaluation and monitoring of osteoarthritis (OA). Because of recent improvement in technology, ultrasound has the ability to demonstrate and assess the minimal structural abnormalities, which involve the pathophysiology and progression of OA, such as articular cartilage, synovial tissue, bony cortex, and other soft tissue. Nowadays, ultrasonography is a promising technique for assessing soft tissue abnormalities such as joint effusion, synovial hypertrophy, Baker cyst, and other structural changes including the decrease in cartilage thickness, meniscus bulging, and formation of osteophyte. Ultrasonography not only possesses diagnostic potential in knee OA but also reveals long-term predictability for disease progress as imaging biomarker. Ultrasonography has also been proven as a useful tool in guiding therapeutic interventions and monitoring treatment effectiveness. This review addresses the utility, reliability, and potential utilization of ultrasonography as an imaging technique in knee OA.

  8. Long-term experience with hylan GF-20 in the treatment of knee osteoarthritis.

    PubMed

    Conrozier, Thierry; Chevalier, Xavier

    2008-07-01

    Osteoarthritis is the most frequent musculoskeletal disease and a major cause of disability in the elderly. Knee osteoarthritis is the first cause of consultations for osteoarthritis-related symptoms. Its current management requires the combination of pharmaceutical and non-pharmacological strategies, including intra-articular injections of hyaluronic acid that are aimed at decreasing pain and improving joint function by restoring joint homeostasis (viscosupplementation). Hylan GF-20 is a cross-linked hyaluronic acid derivative, FDA approved as a medical device since 1997 for the treatment of patients with symptomatic knee osteoarthritis. This review aims to summarise recently published evidence and offer practical suggestions to clinical colleagues who are considering including viscosupplementation in their practices. The authors reviewed extensively the published papers on the topic, but selected only those that appeared to be the most relevant, on the mechanisms of action, efficacy and safety of the treatment, clinical predictors of response, ideal dosing regimen and differences between commercial preparations. They also give their own clinical experience with hylan GF-20 as a symptomatic treatment of knee osteoarthritis. Data of the literature clearly demonstrate that hylan GF-20 is a safe and effective treatment for decreasing pain and improving function in patients suffering from knee osteoarthritis. Its long-term (10 years) use allows knowing with accuracy the main indications, contraindications, side effects and prognostic factors of response, which are all extensively discussed throughout this review.

  9. Randomized clinical trial of peganum oil for knee osteoarthritis.

    PubMed

    Abolhassanzadeh, Zohreh; Aflaki, Elham; Yousefi, Gholamhossein; Mohagheghzadeh, Abdolali

    2015-04-01

    Osteoarthritis affects about 50% of people aged older than 65 years. Pain is the most important symptom in this disease. Today public interest in the use of complementary medicine, especially traditional herbal medicines has increased. The present study was designed to investigate the efficacy of traditional preparation of Peganum harmala L oil on patients with knee osteoarthritis. The product has been analyzed and standardized by high-performance liquid chromatography. A double blind controlled randomized clinical trial consisting of 54 patients were performed. Patients rubbed the drug or control (olive oil) on the knee 4 drops 3 times a day for 4 weeks. The patients were asked to fill out the Western Ontario and McMaster Universities Arthritis Index and Visual Analogue Scale questionnaires at week 0 and 4. The adapted results from the questionnaires showed that pain and difficulty in function were significantly decreased in Peganum oil group after 4 weeks. There was no significant difference in stiffness change between 2 groups.

  10. Effects of Electroacupuncture for Knee Osteoarthritis: A Systematic Review and Meta-Analysis

    PubMed Central

    Jung, Jae-Young

    2016-01-01

    Purpose. This study aims to verify the effects of electroacupuncture treatment on osteoarthritis of the knee. Methods. MEDLINE/PubMed, EMBASE, CENTRAL, AMED, CNKI, and five Korean databases were searched by predefined search strategies to screen eligible randomized controlled studies meeting established criteria. Any risk of bias in the included studies was assessed with the Cochrane Collaboration's tool. Meta-analysis was conducted using RevMan version 5.3 software. Results. Thirty-one randomized controlled studies of 3,187 participants were included in this systematic review. Meta-analysis was conducted with eight studies including a total of 1,220 participants. The electroacupuncture treatment group showed more significant improvement in pain due to knee osteoarthritis than the control group (SMD −1.86, 95% CI −2.33 to −1.39, I 2 75%) and in total WOMAC score than the control group (SMD −1.34, CI 95% −1.85 to −0.83, I 2 73%). Compared to the control group, the electroacupuncture treatment group showed more significant improvement on the quality of life scale. Conclusion. Electroacupuncture treatment can relieve the pain of osteoarthritis of the knees and improve comprehensive aspects of knee osteoarthritis and the quality of life of patients with knee osteoarthritis. PMID:27818699

  11. Cost-effectiveness analysis of intra-articular injections of a high molecular weight bioengineered hyaluronic acid for the treatment of osteoarthritis knee pain.

    PubMed

    Hatoum, Hind T; Fierlinger, Anke L; Lin, Swu-Jane; Altman, Roy D

    2014-05-01

    To determine the cost-effectiveness of bioengineered hyaluronic acid (BioHA, 1% sodium hyaluronate) intra-articular injections in treating osteoarthritis knee pain in poor responders to conventional care (CC) including non-steroidal anti-inflammatory drugs (NSAIDs) and analgesics. Two decision analytic models compared BioHA treatment with either continuation of patient's baseline CC with no assumption of disease progression (Model 1), or CC including escalating care costs due to disease progression (NSAIDs and analgesics, corticosteroid injections, and surgery; Model 2). Analyses were based on patients who received two courses of 3-weekly intra-articular BioHA (26-week FLEXX Trial + 26-week Extension Study). BioHA group costs included fees for physician assessment and injection regimen, plus half of CC costs. Cost-effectiveness ratios were expressed as averages and incremental costs per QALY. One-way sensitivity analyses used the 95% confidence interval (CI) of QALYs gained in BioHA-treated patients, and ±20% of BioHA treatment and CC costs. Probabilistic sensitivity analyses were performed for Model 2. For 214 BioHA patients, the average utility gain was 0.163 QALYs (95% CI = -0.162 to 0.488) over 52 weeks. Model 1 treatment costs were $3469 and $4562 for the BioHA and CC groups, respectively; sensitivity analyses showed BioHA to be the dominant treatment strategy, except when at the lower end of the 95% CI. Model 2 annual treatment costs per QALY gained were $1446 and $516 for the BioHA and CC groups, respectively. Using CC as baseline strategy, the incremental cost-effectiveness ratio (ICER) of BioHA was $38,741/QALY gained, and was sensitive to response rates in either the BioHA or CC groups. BioHA is less costly and more effective than CC with NSAIDs and analgesics, and is the dominant treatment strategy. Compared with escalating CC, the $38,741/QALY ICER of BioHA remains within the $50,000 per QALY willingness-to-pay threshold to adopt a new

  12. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) in Persian Speaking Patients with Knee Osteoarthritis

    PubMed Central

    Ebrahimzadeh, Mohammad H; Makhmalbaf, Hadi; Birjandinejad, Ali; Keshtan, Farideh Golhasani; Hoseini, Hosein A; Mazloumi, Seyed Mahdi

    2014-01-01

    Background: Osteoarthritis of the knee is the most common chronic joint disease that involves middle aged and elderly persons. There are different clinical instruments to quantify the health status of patients with knee osteoarthritis and one example is the WOMAC score that has been translated and adapted into different languages. The purpose of this study was cultural adaptation, validation and reliability testing of the Persian version of the WOMAC index in Iranians with knee osteoarthritis. Methods: We translated the original WOMAC questionnaire into Persian by the forward and backward technique, and then its psychometric study was done on 169 native Persian speaking patients with knee degenerative joint disease. Mean age of patients was 53.9 years. The SF-36 and KOOS were used to assess construct validity. Results: Reliability testing resulted in a Cronbach’s alpha of 0.917, showing the internal consistency of the questionnaire to be a reliable tool. Inter-correlation matrix among different scales of the Persian WOMAC index yielded a highly significant correlation between all subscales including stiffness, pain, and physical function. In terms of validity, Pearson`s correlation coefficient was significant between three domains of the WOMAC with PF, RP, BP, GH, VT, and PCS dimensions of the SF-36 health survey (P<0.005) and KOOS (P<0.0001) . Conclusions: The Persian WOMAC index is a valid and reliable patient- reported clinical instrument for knee osteoarthritis. PMID:25207315

  13. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) in Persian Speaking Patients with Knee Osteoarthritis.

    PubMed

    Ebrahimzadeh, Mohammad H; Makhmalbaf, Hadi; Birjandinejad, Ali; Keshtan, Farideh Golhasani; Hoseini, Hosein A; Mazloumi, Seyed Mahdi

    2014-03-01

    Osteoarthritis of the knee is the most common chronic joint disease that involves middle aged and elderly persons. There are different clinical instruments to quantify the health status of patients with knee osteoarthritis and one example is the WOMAC score that has been translated and adapted into different languages. The purpose of this study was cultural adaptation, validation and reliability testing of the Persian version of the WOMAC index in Iranians with knee osteoarthritis. We translated the original WOMAC questionnaire into Persian by the forward and backward technique, and then its psychometric study was done on 169 native Persian speaking patients with knee degenerative joint disease. Mean age of patients was 53.9 years. The SF-36 and KOOS were used to assess construct validity. Reliability testing resulted in a Cronbach's alpha of 0.917, showing the internal consistency of the questionnaire to be a reliable tool. Inter-correlation matrix among different scales of the Persian WOMAC index yielded a highly significant correlation between all subscales including stiffness, pain, and physical function. In terms of validity, Pearson`s correlation coefficient was significant between three domains of the WOMAC with PF, RP, BP, GH, VT, and PCS dimensions of the SF-36 health survey (P<0.005) and KOOS (P<0.0001) . The Persian WOMAC index is a valid and reliable patient- reported clinical instrument for knee osteoarthritis.

  14. Effect of exercise and gait retraining on knee adduction moment in people with knee osteoarthritis.

    PubMed

    Khalaj, Nafiseh; Abu Osman, Noor A; Mokhtar, Abdul H; Mehdikhani, Mahboobeh; Wan Abas, Wan A B

    2014-02-01

    The knee adduction moment represents the medial knee joint load, and greater value is associated with higher load. In people with knee osteoarthritis, it is important to apply proper treatment with the least side effects to reduce knee adduction moment and, consequently, reduce medial knee joint load. This reduction may slow the progression of knee osteoarthritis. The research team performed a literature search of electronic databases. The search keywords were as follows: knee osteoarthritis, knee adduction moment, exercise program, exercise therapy, gait retraining, gait modification and knee joint loading. In total, 12 studies were selected, according to the selection criteria. Findings from previous studies illustrated that exercise and gait retraining programs could alter knee adduction moment in people with knee osteoarthritis. These treatments are noninvasive and nonpharmacological which so far have no or few side effects, as well as being low cost. The results of this review revealed that gait retraining programs were helpful in reducing the knee adduction moment. In contrast, not all the exercise programs were beneficial in reducing knee adduction moment. Future studies are needed to indicate best clinical exercise and gait retraining programs, which are most effective in reducing knee adduction moment in people with knee osteoarthritis.

  15. Unloader braces for medial compartment knee osteoarthritis: implications on mediating progression.

    PubMed

    Ramsey, Dan K; Russell, Mary E

    2009-09-01

    For persons with unicompartment knee osteoarthritis (OA), off-unloader braces are a mechanical intervention designed to reduce pain, improve physical function, and possibly slow disease progression. Pain relief is thought to be mediated by distracting the involved compartment via external varus or valgus forces applied to the knee. In so doing, tibiofemoral alignment is improved, and load is shifted off the degenerative compartment, where exposure to potentially damaging and provocative mechanical stresses are reduced. To provide a synopsis of the evidence documented in the scientific literature concerning the efficacy of off-loader knee braces for improving symptomatology associated with painful disabling medial compartment knee OA. Relevant peer-reviewed publications were retrieved from a MEDLINE search using the terms with the reference terms osteoarthritis, knee, and braces (per Medical Subject Headings), plus a manual search of bibliographies from original and review articles and appropriate Internet resources. For persons with combined unicompartment knee OA and mild to moderate instability, the strength of recommendation reported by the Osteoarthritis Research Society International in the ability of off-loader knee braces to reduce pain, improve stability, and diminish the risk of falling was 76% (95% confidence interval, 69%-83%). The more evidence the treatment is effective, the higher the percentage. Given the encouraging evidence that off-loader braces are effective in mediating pain relief in conjunction with knee OA and malalignment, bracing should be fully used before joint realignment or replacement surgery is considered. With the number of patients with varus deformities and knee pain predicted to increase as the population ages, a reduction of patient morbidity for this widespread chronic condition in combination with this treatment modality could have a positive impact on health care costs and the economic productivity and quality of life of the

  16. [Osteoarthritis].

    PubMed

    Flugsrud, Gunnar B; Nordsletten, Lars; Reinholt, Finn P; Risberg, May Arna; Rydevik, Karin; Uhlig, Till

    2010-11-04

    Osteoarthritis is among the most common causes of functional disability and severe pain, and the prevalence of arthritic symptoms among adults is more than 50%. The article discusses epidemiology, pathology and treatment options. The review is based on a non-systematic search in PubMed and the authors' experience with treating this patient group. Osteoarthritis is a degenerative disease which leads to loss of joint functioning. Symptoms usually present in the hip, hands and knees. Women are affected more often than men and the prevalence increases with increasing age. Some families have an increased prevalence of osteoarthritis, but the genetic etiology is not clear. Mechanic conditions such as overweight and heavy physical work explain some of the pathogenesis, but non-mechanical factors are probably involved as well. Loss of weight is likely to have a preventive effect, and surgical correction of mechanic conditions such as hip dysplasia and varus deformity can prevent development of osteoarthritis. Treatment of symptomatic osteoarthritis includes educating the patient and continues with stretching, physical exercise, weight reduction, technical aids (supporting braces, walking sticks) and analgesics. Subsequent options are treatment with paracetamol, NSAIDs and possibly opiates and finally insertion of an artificial joint. Many patients with disabling osteoarthritis function much better and have markedly less pain with an artificial joint. Current treatment options alleviate but do not cure arthritic symptoms; preventive actions should be instigated when possible. Treatment of osteoarthritis involves many medical specialties and treatment modalities.

  17. 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

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

    2014-08-01

    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. 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. The demographic results among the three groups did not indicate any statistical difference. The mean VAS in erythropoietin group in the 2(nd), 4(th), and 12(th) 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 2(nd), 4(th), and 12(th) weeks was 124 ± 1.50, 124 ± 1.4, and 123 ± 1.53 respectively (P ≤ 0.005). Satisfaction score in the 12(th) week in erythropoietin group was extremely satisfied 15%, satisfied 55%, and moderately satisfied 30%, (P = 0.005). No specific side-effects were observed. Intra-articular prolotherapy with erythropoietin was more effective in terms of pain level reduction and ROM improvement compared with dextrose and pulsed radiofrequency.

  18. 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

  19. Post-traumatic knee osteoarthritis in the young patient: therapeutic dilemmas and emerging technologies.

    PubMed

    Stiebel, Matthew; Miller, Larry E; Block, Jon E

    2014-01-01

    Traumatic knee injury is common in young adults and strongly contributes to premature development of knee osteoarthritis (OA). Post-traumatic knee OA poses a therapeutic dilemma to the physician, since no known therapy has an acceptable safety profile, effectively relieves joint pain, and enjoys reasonable patient acceptance. Consequently, these young patients will ultimately be faced with the decision to either undergo surgical intervention, despite prosthesis durability concerns, or to continue with ineffective nonsurgical treatment. Emerging therapies, such as biologics, disease-modifying drugs, partial joint resurfacings, and minimally invasive joint-unloading implants are currently being studied to fill this therapeutic void in the young patient with post-traumatic knee OA.

  20. Total Knee Arthroplasty for Knee Osteoarthritis: Support for a Foregone Conclusion?

    PubMed

    Steinhaus, Michael E; Christ, Alexander B; Cross, Michael B

    2017-07-01

    Total knee arthroplasty (TKA) is generally accepted as the definitive treatment for advanced knee arthritis after patients fail nonoperative treatments; however, the safety and efficacy of TKA compared to continued nonoperative treatment has never been proven in high-quality, randomized controlled trials. Recently, a 2015 Danish study published a 12-month follow-up on a cohort of patients randomized to either a TKA or continued nonsurgical management for advanced knee osteoarthritis (OA). The authors reported significantly greater improvement in the TKA group in functional outcome scores such as the overall Knee Injury and Osteoarthritis Outcome Score (KOOS4 score), the KOOS subscales, EQ-5D descriptive index, and timed get up-and-go and 20-m walk tests; however, patients in the TKA did suffer significantly more serious adverse events (SAE). The authors concluded that TKA combined with additional nonoperative care postoperatively is more efficacious than nonsurgical treatment alone in terms of improving pain, function, and quality of life at 12 months but is associated with more SAE. The purpose of this review is to identify the strengths and weaknesses of this trial, interpret its outcomes within the context of prior literature, and evaluate the validity of its conclusions.

  1. Examining the feasibility of radiofrequency treatment for chronic knee pain after total knee arthroplasty.

    PubMed

    Protzman, Nicole M; Gyi, Jennifer; Malhotra, Amit D; Kooch, Jason E

    2014-04-01

    Recently, investigators began using radiofrequency to manage knee osteoarthritis pain in patients at high risk who cannot undergo surgical intervention. To our knowledge, no study has investigated the use of radiofrequency ablation of the genicular nerves to alleviate chronic knee pain after total knee replacement. A single case is presented here in which genicular nerve ablation successfully improved pain and restored function. We believe that these preliminary results could be used in the development of future prospective cohort studies and randomized controlled trials that focus on the use of radiofrequency ablation to treat persistent knee pain after total knee replacement. Copyright © 2014 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  2. Dietary Fiber Intake in Relation to Knee Pain Trajectory.

    PubMed

    Dai, Zhaoli; Lu, Na; Niu, Jingbo; Felson, David T; Zhang, Yuqing

    2017-09-01

    Dietary fiber may reduce knee pain, in part by lowering body weight and reducing inflammation. In this study, we assessed whether fiber intake was associated with patterns of knee pain development. In a prospective, multicenter cohort of 4,796 men and women ages 45-79 years with or at risk of knee osteoarthritis, participants underwent annual followups for 8 years. Dietary fiber intake was estimated using a validated food frequency questionnaire at baseline. Group-based trajectory modeling was used to identify Western Ontario and McMaster Universities Osteoarthritis Index pain trajectories, which were assessed for associations with dietary fiber intake using polytomous regression models. Of the eligible participants (4,470 persons and 8,940 knees, mean ± SD age 61.3 ± 9.1 years, 58% women), 4.9% underwent knee replacement and were censored at the time of surgery. Four distinct knee pain patterns were identified: no pain (34.5%), mild pain (38.1%), moderate pain (21.2%), and severe pain (6.2%). Dietary total fiber was inversely related to membership in the moderate or severe pain groups (P ≤ 0.006 for trend for both). Subjects in the highest versus those in the lowest quartile of total fiber intake had a lower risk of belonging to the moderate pain pattern group (odds ratio [OR] 0.76 [95% confidence interval (95% CI) 0.61-0.93]) and severe pain pattern group (OR 0.56 [95% CI 0.41-0.78]). Similar results were found with grain fiber and these 2 pain pattern groups. Our findings suggest that a high intake of dietary total or grain fiber, particularly the recommended daily fiber average intake of 25 gm per day, is associated with a lower risk of developing moderate or severe knee pain over time. © 2016, American College of Rheumatology.

  3. Unloading Shoes for Self-management of Knee Osteoarthritis: A Randomized Trial.

    PubMed

    Hinman, Rana S; Wrigley, Tim V; Metcalf, Ben R; Campbell, Penny K; Paterson, Kade L; Hunter, David J; Kasza, Jessica; Forbes, Andrew; Bennell, Kim L

    2016-09-20

    Appropriate footwear is recommended for self-management of knee osteoarthritis. Shoes that reduce harmful knee loads are available, but symptomatic effects are uncertain. To evaluate the efficacy of unloading shoes in alleviating knee osteoarthritis symptoms. Participant- and assessor-blinded comparative effectiveness randomized, controlled trial. (Australian New Zealand Clinical Trials Registry: ACTRN12613000851763). Community. 164 persons with medial knee osteoarthritis. Walking shoes with triple-density, variable-stiffness midsoles and mild lateral-wedge insoles designed to unload the medial knee and worn daily (intervention) versus conventional walking shoes (comparator). Primary outcomes were pain with walking (assessed on a numerical rating scale [NRS]) and physical function (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]) at 6 months. Secondary outcomes were knee pain and stiffness (WOMAC), average pain (NRS), intermittent and constant knee pain (Intermittent and Constant Osteoarthritis Pain questionnaire), quality of life (Assessment of Quality of Life instrument), physical activity (Physical Activity Scale for the Elderly), and global change in pain and function (Likert scales). A total of 160 participants (98%) completed primary outcome measures at 6 months. Changes in pain (mean difference, 0.0 units [95% CI, -0.9 to 0.8 unit]) and function (mean difference, 0.3 unit [CI, -3.2 to 3.7 units]) did not differ between groups at 6 months, with both groups showing clinically relevant improvements in function and the intervention group showing clinically relevant improvements in pain. There were no differences in secondary outcomes. Pain was globally improved in 54% of participants, and function was globally improved in 44% to 48%. Unloading shoes were not associated with increased probability of improvement (odds ratios, 0.99 [CI, 0.53 to 1.86] for pain and 0.85 [CI, 0.45 to 1.61] for function). Effects on joint structure were not

  4. Knee motion variability in patients with knee osteoarthritis: the effect of self-reported instability

    PubMed Central

    Gustafson, Jonathan A.; Robinson, Megan E.; Fitzgerald, G. Kelley; Tashman, Scott; Farrokhi, Shawn

    2015-01-01

    Background Knee osteoarthritis has been previously associated with a stereotypical knee-stiffening gait pattern and reduced knee joint motion variability due to increased antagonist muscle co-contractions and smaller utilized arc of motion during gait. However, episodic self-reported instability may be a sign of excessive motion variability for a large subgroup of patients with knee osteoarthritis. The objective of this work was to evaluate the differences in knee joint motion variability during gait in patients with knee osteoarthritis with and without self-reported instability compared to a control group of older adults with asymptomatic knees. Methods Forty-three subjects, 8 with knee osteoarthritis but no reports of instability (stable), 11 with knee osteoarthritis and self-reported instability (unstable), and 24 without knee osteoarthritis or instability (control) underwent Dynamic Stereo X-ray analysis during a decline gait task on a treadmill. Knee motion variability was assessed using parametric phase plots during the loading response phase of decline gait. Findings The stable group demonstrated decreased sagittal-plane motion variability compared to the control group (p=0.04), while the unstable group demonstrated increased sagittal-plane motion variability compared to the control (p=0.003) and stable groups (p<0.001). The unstable group also demonstrated increased anterior-posterior joint contact point motion variability for the medial tibiofemoral compartment compared to the control (p=0.03) and stable groups (p=0.03). Interpretation The finding of decreased knee motion variability in patients with knee osteoarthritis without self-reported instability supports previous research. However, presence of self-reported instability is associated with increased knee motion variability in patients with knee osteoarthritis and warrants further investigation. PMID:25796536

  5. Knee injuries account for the sports-related increased risk of knee osteoarthritis.

    PubMed

    Thelin, N; Holmberg, S; Thelin, A

    2006-10-01

    Increased risk of osteoarthritis has been found among athletes active in different kinds of sports. Knee injury is an established risk factor for knee osteoarthritis. In this population-based case-control study we investigated the risk of knee osteoarthritis with respect to sports activity and previous knee injuries. A total of 825 cases with x-ray-verified femorotibial osteoarthritis were identified at six hospitals in southern Sweden. The cases were matched (age, sex and residential area) with 825 controls from the general population. Mailed questionnaire data on sports activity for more than 1 year after the age of 16, knee injuries and confounding variables (weight, height, heredity, smoking and occupation) were collected and analyzed using logistic regression models. The response frequency was 89%. Among men knee osteoarthritis was related to soccer (odds ratio (OR) 1.6, 95% confidence interval (CI) 1.1-2.2), ice hockey (OR 1.9, 95% CI 1.2-3.0) and tennis (OR 2.0, 95% CI 1.1-3.8) but not to track and field sports, cross-country skiing, and orienteering. After adjustment for confounding variables soccer and ice hockey remained significantly related to knee osteoarthritis, but after adjustment for knee injuries no significant relation remained. The sports-related increased risk for knee osteoarthritis was explained by knee injuries.

  6. Spa therapy and knee osteoarthritis: A systematic review.

    PubMed

    Forestier, Romain; Erol Forestier, Fatma Begüm; Francon, Alain

    2016-06-01

    Osteoarthritis (OA) is a public health problem that will probably increase in the future with the aging of the population. Crenobalneotherapy is commonly used to treat OA, but evidence from previous reviews was not sufficient. This systematic review aimed to identify the best evidence for the clinical effect of crenobalneotherapy for knee OA. We systematically searched MEDLINE via PubMed, PEDRO and the Cochrane Central Register of Controlled Trials for articles published up to September 2015. Articles were included if trials were comparative, if one or more of the subgroups had knee OA with separate data, and if spa therapy or any hydrotherapy techniques involving mineral water or mineral mud was compared to any other intervention or no treatment. Statistical validity, external validity and quality of side effects assessment were evaluated by personal checklists. Risk of bias was assessed by the CLEAR NTP. Treatments (hot mineral water baths, mud therapy, hot showers, and sometimes massage and supervised water exercises) delivered in spa centers across Europe and the Middle East seem to improve symptoms in knee OA. They may be effective for pain and function. There are conflicting results about the effect on quality of life and drug consumption. Improvements with spa therapy for knee OA appear to be clinically relevant until 3 to 6 months and sometimes 9 months. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  7. [Clinical study on the treatment of knee osteoarthritis by acupuncture plus manipulative regulation of knee muscle].

    PubMed

    Sun, Kui; Bao, Xue-Mei; Song, Yang-Chun; Liu, De-Chun

    2010-12-01

    To investigate and research the appraisal scores of the symptoms and physical signs index for the evaluation of the clinical efficacy of acupuncture and manipulative regulation of knee muscle balance for the treatment of knee osteoarthritis, and provide clinical basis for the treatment. From January 2008 to December 2009, 121 patients with knee osteoarthritis were randomly divided into two groups. In the treatment group there were 63 cases of 83 knees including 16 males and 47 females, with an average age of (59.88 +/- 7.97) years; in the control group there were 58 cases of 73 knees including 13 males and 45 females, with an average age of (57.95 +/- 10.37) years. The patients in the treatment group were treated with acupuncture plus manipulative regulation of knee muscle balance, and the patients in the control group were treated with Diclofenac Sodium Sustained Release Tablets. The appraisal scores of the symptoms and physical signs index, numerical rating scale of pain, joint function, joint swelling were evaluated before and after the treatment, as well as 3 months after the treatment. All data were statistical analyzed by package SPSS 10.0. 1) In the treatment group, before and after treatment the appraisal scores of the symptoms and physical signs index were (39.81 +/- 3.92) and (9.69 +/- 8.08); numerical rating scale of pain were (7.61 +/- 0.97) and (2.17 +/- 2.09); joint function were (1.47 +/- 0.50) and (0.61 +/- 0.58); joint swelling were (1.23 +/- 0.79) and (0.42 +/- 0.52). As well in the control group, above data were (39.89 +/- 3.78), (13.62 +/- 7.83), (7.55 +/- 0.71), (3.34 +/- 2.32), (1.33 +/- 0.47), (0.93 +/- 0.67), an (0.97 +/- 0.88), (0.58 +/- 0.52) respectively. Both group had obvious differences in the appraisal scores of the symptoms and physical signs index, numerical rating scale of pain, joint function, joint swelling between after and before treatment. The comparison between the two groups suggested that after the treatments the treatment

  8. Depressive symptoms and structural disease progression in knee osteoarthritis: data from the Osteoarthritis Initiative.

    PubMed

    Rathbun, Alan M; Yau, Michelle S; Shardell, Michelle; Stuart, Elizabeth A; Hochberg, Marc C

    2017-01-01

    Depressive symptoms are associated with increases in pain and functional limitations in knee osteoarthritis (OA). The aim was to determine whether depressive symptoms are also associated with greater structural knee OA progression. Four years of annual radiographic and clinical assessments from the Osteoarthritis Initiative were analyzed. The Center for Epidemiological Studies Depression Scale was used to identify depressive symptoms (threshold = ≥16) at the baseline visit. Propensity scores were used to match participants with and without baseline depressive symptoms on multiple potential confounders. Assessment of radiographic knee OA was based on changes in individual radiographic features, which included osteophyte (OST) grade and joint space narrowing (JSN) grade. Mixed effect models were used to examine structural progression between depressed and non-depressed participants with definitive radiographic knee OA. Depressive symptoms were significantly associated with a higher risk of OST progression (odds ratio [OR] = 1.74; 95% confidence interval [CI]: 1.01, 3.00) and a non-significant lower risk of JSN progression (OR = 0.40; 95% CI: 0.14, 1.15) 1 year after baseline. Conversely, there was a non-significant lower risk of OST progression (OR = 0.71; 95% CI: 0.28, 1.79) and higher risk of JSN progression (OR = 1.89; 95% CI: 0.71, 5.06) from year 3 to year 4 of follow-up. However, the patterns of OST progression and JSN progression were not significantly different between the depressed and non-depressed (P = 0.25 and 0.15, respectively). The findings provide no evidence that depressive symptoms have a detectable effect on changes in radiographic disease severity in knee OA.

  9. Association between Knee Osteoarthritis, Cardiovascular Risk Factors, and the Framingham Risk Score in South Koreans: A Cross-Sectional Study

    PubMed Central

    Kim, Ho Sun; Shin, Joon-Shik; Lee, Jinho; Lee, Yoon Jae; Kim, Me-riong; Bae, Young-Hyeon; Park, Ki Byung; Lee, Eun-Jung; Kim, Joo-Hee

    2016-01-01

    Background Osteoarthritis is a significant burden on personal health and for social cost, and its prevalence is rising. Recent research has revealed an association between osteoarthritis and cardiovascular disease, and this study uses the Framingham risk score (FRS), which is widely used as a composite index of cardiovascular risk factors, to investigate the association between osteoarthritis and various cardiovascular risk factors. Methods A total 9,514 participants aged 50 years or older who received knee X-ray diagnosis of the 5th Korean National Health and Nutrition Examination Survey (total surveyees = 24,173) released by the Korean Centers for Disease Control and Prevention was included for analysis. Knee osteoarthritis patients were defined as participants with K-L grade ≥2 on knee X-ray regardless of knee pain. The association between major cardiovascular risk factors (blood pressure, diabetes, cholesterol, and smoking habits), FRS, and knee osteoarthritis was analyzed, adjusting for various covariates. Results Prevalence of knee osteoarthritis in Koreans aged ≥50 years was 36.6%, and higher in women (men: 24.9%, women: 45.4%). Prevalence of knee osteoarthritis in participants with hypertension was significantly higher than those without hypertension (fully adjusted odds ratio (OR) 1.26; 95% confidence interval (CI) 1.08–1.48). Knee osteoarthritis prevalence was also higher in participants with impaired fasting glucose or diabetes than those without (age, sex adjusted OR 1.19; 95% CI 1.00–1.41). Also, OR values increased statistically significantly with FRS as a continuous variable (fully adjusted OR 1.007; 95% CI 1.00–1.01). Conclusions Prevalence of knee osteoarthritis was associated with hypertension and diabetes, which are major cardiovascular risk factors, and the FRS. Further studies on FRS pertaining to its relationship with osteoarthritis are warranted. PMID:27764239

  10. ARE UNILATERAL AND BILATERAL KNEE OSTEOARTHRITIS PATIENTS UNIQUE SUBSETS OF KNEE OSTEOARTHRITIS? A BIOMECHANICAL PERSPECTIVE

    PubMed Central

    Messier, Stephen P.; Beavers, Daniel P.; Herman, Cassandra; Hunter, David J.; DeVita, Paul

    2016-01-01

    Objective To compare the gait of adults with unilateral and bilateral symptomatic and radiographic knee osteoarthritis (OA) to determine whether these subgroups can be treated similarly in the clinic and when recruiting for randomized clinical trials, and to use these data to generate future hypotheses regarding gait in these subsets of knee OA patients. Methods Cross-sectional investigation of patients with unilateral and bilateral knee OA on gait mechanics using 136 older adults (age ≥ 55 yrs.; 27 kg.m−2 ≥ BMI ≤ 41 kg.m−2; 82% female) with radiographic knee OA. Comparisons were made between the most affected side of the bilateral group (Bi) and the affected side of the unilateral group (Uni), and between symmetry indices of each group. Results There were no significant differences in any temporal, kinematic, or kinetic measures between the Uni and Bi cohorts. Comparison of symmetry indices between groups also revealed no significant differences. Conclusion The similarity in lower extremity mechanics between unilateral and bilateral knee OA patients is sufficiently robust to consider both subsets as a single cohort. We hypothesize that biomechanical adaptations to knee OA are at least partially systemic in origin and not based solely on the physiological characteristics of an affected knee joint. PMID:26706699

  11. Pain Coping Strategies in Osteoarthritis Patients.

    ERIC Educational Resources Information Center

    Keefe, Francis J.; And Others

    1987-01-01

    Investigated the relation of pain coping strategies to pain, health status, and psychological distress in a group of osteoarthritis patients with chronic pain. Patients completed various questionnaires. Medical status variables were also used. The Pain Control and Rational Thinking factor derived from the Coping Strategies Questionnaire proved to…

  12. Pain Coping Strategies in Osteoarthritis Patients.

    ERIC Educational Resources Information Center

    Keefe, Francis J.; And Others

    1987-01-01

    Investigated the relation of pain coping strategies to pain, health status, and psychological distress in a group of osteoarthritis patients with chronic pain. Patients completed various questionnaires. Medical status variables were also used. The Pain Control and Rational Thinking factor derived from the Coping Strategies Questionnaire proved to…

  13. Role of Agnikarma in Sandhigata Vata (osteoarthritis of knee joint)

    PubMed Central

    Jethava, Nilesh G.; Dudhamal, Tukaram S.; Gupta, Sanjay Kumar

    2015-01-01

    Introduction: Sandhigata Vata is one of Vata Vyadhi characterized by the symptoms such as Sandhishoola (joint pain) and Sandhishopha (swelling of joint). Osteoarthritis (OA) is degenerative joint disorder, represents failure of the diarthrodial (movable, synovial-lined) joint. OA of knee joint comes under the inflammatory group which is almost identical to Sandhigata Vata described in Ayurveda with respect to etiology, pathology, and clinical features. Agnikarma (therapeutic heat burn) is one which gives instant relief from pain by balancing local Vata and Kapha Dosha without any untoward effects. Aim: To evaluate the efficacy of Agnikarma with Rajata and Loha Dhatu Shalaka in the management of Janugata Sandhivata (OA of knee joint). Materials and Methods: A total of 28 diagnosed patients of Janugata Sandhivata were registered and randomly divided into two groups. In Group-A, Agnikarma was done with Rajata Shalaka while in Group-B Agnikarma was performed by Loha Shalaka in four sittings. Assessment in relief of signs and symptoms was done by weekly interval, and Student's t-test was applied for statistical analysis. Results: Group-A provided 76.31% relief in pain while Group-B provided 83.77% relief. Relief from crepitus was observed in 57.13% of patients of Group-A, while 57.92% of patients of Group-B. There was statistically insignificant difference between both the groups. Loha Shalaka provided better result in pain relief than Rajata Shalaka. Conclusion: Agnikarma is effective nonpharmacological, parasurgical procedure for pain management in Sandhigata Vata (OA of knee joint). PMID:26730134

  14. Effects of tai chi for patients with knee osteoarthritis: a systematic review.

    PubMed

    Ye, Jiajia; Cai, Shufang; Zhong, Weihong; Cai, Shuhe; Zheng, Qikai

    2014-07-01

    [Purpose] The aim of the present study was to seek evidence for the effectiveness of Tai Chi for patients with knee osteoarthritis (KOA). [Subjects and Methods] Systematic searches were conducted of the China Journals Full-text Database, Pubmed, Medline, Science Direct-Online Journals and CINAHL for studies published between 2000 and 2012. Studies were evaluated based on following inclusion criteria: 1) design: randomized control, clinical trial; 2) subjects: patients with a knee osteoarthritis diagnosis; 3) intervention: exercise involving Tai Chi; 4) studies published in English or Chinese. [Results] Six randomized control studies involving Tai Chi and knee osteoarthritis were found. [Conclusion] Tai Chi was an effective way of relieving pain and improving physical function. Further randomized controlled trials with large sample sizes and long training period are needed to compare groups who perform Tai Chi training with other groups who undergo other forms of physical exercise in order to confirm the efficacy of Tai Chi.

  15. Effects of Tai Chi for Patients with Knee Osteoarthritis: A Systematic Review

    PubMed Central

    Ye, Jiajia; Cai, Shufang; Zhong, Weihong; Cai, Shuhe; Zheng, Qikai

    2014-01-01

    [Purpose] The aim of the present study was to seek evidence for the effectiveness of Tai Chi for patients with knee osteoarthritis (KOA). [Subjects and Methods] Systematic searches were conducted of the China Journals Full-text Database, Pubmed, Medline, Science Direct-Online Journals and CINAHL for studies published between 2000 and 2012. Studies were evaluated based on following inclusion criteria: 1) design: randomized control, clinical trial; 2) subjects: patients with a knee osteoarthritis diagnosis; 3) intervention: exercise involving Tai Chi; 4) studies published in English or Chinese. [Results] Six randomized control studies involving Tai Chi and knee osteoarthritis were found. [Conclusion] Tai Chi was an effective way of relieving pain and improving physical function. Further randomized controlled trials with large sample sizes and long training period are needed to compare groups who perform Tai Chi training with other groups who undergo other forms of physical exercise in order to confirm the efficacy of Tai Chi. PMID:25140112

  16. 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

    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

    2016-03-01

    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. 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. 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). 2013-004313-41; Pre-results. Published by the BMJ Publishing Group Limited. For permission to use (where not already

  17. Unloading shoes for osteoarthritis of the knee: protocol for the SHARK randomised controlled trial.

    PubMed

    Hinman, Rana S; Wrigley, Tim V; Metcalf, Ben R; Hunter, David J; Campbell, Penny; Paterson, Kade; Staples, Margaret P; Bennell, Kim L

    2014-02-21

    Knee osteoarthritis (OA) is a common and disabling condition. Abnormalities in knee loading play an important role in disease pathogenesis, yet there are few non-surgical treatments for knee OA capable of reducing knee load. This two-arm randomised controlled trial is investigating the efficacy of specially-designed unloading shoes for the treatment of symptoms in people with knee OA. 164 people with symptomatic medial tibiofemoral joint OA will be recruited from the community and randomly allocated to receive either unloading shoes or control shoes. Unloading shoes have a specially-designed triple-density midsole where the medial side is softer than normal and the lateral side harder as well as a lateral wedge between the sole and sock-liner. Control shoes are standard athletic shoes and do not contain these features. Participants will be blinded to shoe allocation and will be instructed to wear the shoes as much as possible every day for 6 months, for a minimum of 4 hours per day. The primary outcomes are knee pain (numerical rating scale) and self-reported physical function (Western Ontario and McMaster Universities Osteoarthritis Index) measured at baseline and 6 months. Secondary outcomes include additional measures of knee pain, knee stiffness, participant global ratings of change in symptoms, quality-of-life and physical activity. The findings from this study will help determine whether specially-designed unloading shoes are efficacious in the management of knee OA. Australian New Zealand Clinical Trials Registry reference: ACTRN12613000851763.

  18. Ipsilateral and contralateral foot pronation affect lower limb and trunk biomechanics of individuals with knee osteoarthritis during gait.

    PubMed

    Resende, Renan A; Kirkwood, Renata N; Deluzio, Kevin J; Hassan, Elizabeth A; Fonseca, Sérgio T

    2016-05-01

    Lateral wedges have been suggested for the treatment of individuals with knee osteoarthritis, but it may have undesirable effects on the biomechanics of gait through increased foot pronation. This study investigated the effects of increased unilateral foot pronation on the biomechanics of individuals with knee osteoarthritis during gait. Biomechanical data of twenty individuals with knee osteoarthritis were collected while they walked in three conditions: i) flat sandals; ii) wedged sandal on the knee osteoarthritis limb and flat sandal on the healthy limb; and iii) flat sandal on the osteoarthritis and wedged sandal on the healthy limb. Knee pain and comfort were evaluated. Principal Component Analysis followed by ANOVA was implemented to identify differences between conditions. The wedged sandal on the osteoarthritis limb increased rearfoot eversion (P<0.001; ES=0.79); increased shank rotation range of motion (P<0.001; ES=0.70); reduced knee internal rotation moment (P<0.001; ES=0.83); reduced hip internal rotation moment (P=0.001; ES=0.66); increased ipsilateral trunk lean (P=0.031; ES=0.47); and increased trunk rotation range of motion (P=0.001; ES=0.69). Walking with the wedged sandal on the healthy limb increased hip (P=0.003; ES=0.61) and knee (P=0.002; ES=0.63) adduction moments. Individuals reported greater comfort walking with the flat sandals (P=0.004; ES=0.55). Increased unilateral foot pronation of the knee osteoarthritis and healthy limbs causes lower limb and trunk mechanical changes that may overload the knee and the lower back, such as increased knee adduction moment, shank rotation and trunk lateral lean. Foot motion of both lower limbs should be evaluated and care must be taken when suggesting lateral wedges for individuals with knee osteoarthritis. Copyright © 2016 Elsevier Ltd. All rights reserved.

  19. The effects of an oral preparation containing hyaluronic acid (Oralvisc®) on obese knee osteoarthritis patients determined by pain, function, bradykinin, leptin, inflammatory cytokines, and heavy water analyses.

    PubMed

    Nelson, F R; Zvirbulis, R A; Zonca, B; Li, K W; Turner, S M; Pasierb, M; Wilton, P; Martinez-Puig, D; Wu, W

    2015-01-01

    The purpose of this study was to determine the effects of an oral preparation containing hyaluronic acid on osteoarthritic knee joint pain and function as well as changes in inflammatory cytokines, bradykinin, and leptin. We also used heavy water to determine the turnover rates of glycosaminoglycans in synovial fluid. This was a double-blind, random