Objective To assess the efficacy of topical non-steroidal anti-inflammatory drugs （NSAIDs） in the treatment of osteoarthritis （OA）. Methods MEDLINE, EMBASE, Scientific Citation Index, CINAHL, The Cochrane Library, CBMdisc and abstracts from conference were searched from 1966 to March 30, 2005. Randomized controlled trials （R.CT） comparing topical non-steroidal anti-inflammatory drug （NSAIDs） with placebo or oral NSAIDs in OA were induded. Effect size （ES） was calculated for pain, function and stiffness. Relative risk （RR） was calculated for dichotomous data such as clinical response rate and adverse effect rate. Number needed to treat to obtain the clinical response was estimated. The quality of trials was assessed and sensitivity analyses were undertaken. Results Topical NSAIDs were superior to placebo in relieving pain due to osteoarthritis only in the first 2 weeks of treatment; ES （95% CI） were 0.41 （0. 16 to 0.66） and 0.40 （0.15 to 0.65） at week 1 and 2 respectively. However, the effects were short-lived and no benefit was observed over placebo at the third and fourth week. A similar pattern was observed with function, stiflhess and clinical response RR and number needed to treat. Topical NSAIDs were inferior to oral NSAIDs at week 1, and associated with more local side effects such as rash, itch or burning （RR 5.29, 95% CI 1.14 to 24. 51 ）. Conclusions Only very shortterm （less than 4 weeks） RCTs have assessed topical NSAID efficacy in OA ; after 2 weeks no efficacy above placebo has been obsevrved. There are no trial data to support the long-term use of topical NSAIDs in osteoarthritis.
ObjectiveTo investigate the effectiveness of extracorporeal shock wave therapy combined with platelet-rich plasma (PRP) injection in treatment of knee osteoarthritis (KOA) by prospective clinical study.MethodsBetween June 2015 and June 2018, 180 patients with KOA met the inclusion criteria were included in study and randomly allocated to group A (n=60), group B (n=60), and group C (n=60). The patients were treated with autologous PRP intra-articular injection in group A, extracorporeal shock wave therapy in group B, and extracorporeal shock wave therapy combined with autologous PRP intra-articular injection in group C, once a week and 5 times a duration of treatment. There was no significant difference in age, gender, disease duration, side of KOA, and Kellgren-Lawrence grading between groups (P>0.05). The pain and function of knee joint were assessed by visual analogue scale (VAS) score, Lequesne Index score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and knee joint activity before treatment and at 1, 3, and 5 weeks after the first treatment.ResultsThere were significant differences in VAS score, Lequesne Index score, WOMAC score, and knee joint activity between pre- and post-treatment in all groups (P<0.05). VAS score, Lequesne Index score, and WOMAC score gradually decreased with the prolongation of treatment time (P<0.05); but there was no significant difference in knee joint activity between different time points (P>0.05). There was no significant difference in VAS score, Lequesne Index score, WOMAC score, and knee joint activity between groups before treatment (P>0.05); the scores of group C were superior to groups A and B (P< 0.05) at different time points after treatment; while the knee joint activities of 3 groups were similar (P>0.05).ConclusionThe extracorporeal shock wave therapy combined with PRP injection can relieve the pain synergistically for KOA.
Objective To prepare a novel hyaluronic acid methacrylate (HAMA) hydrogel microspheres loaded polyhedral oligomeric silsesquioxane-diclofenac sodium (POSS-DS) patricles, then investigate its physicochemical characteristics and in vitro and in vivo biological properties. Methods Using sulfhydryl POSS (POSS-SH) as a nano-construction platform, polyethylene glycol and DS were chemically linked through the “click chemistry” method to construct functional nanoparticle POSS-DS. The composition was analyzed by nuclear magnetic resonance spectroscopy and the morphology was characterized by transmission electron microscopy. In order to achieve drug sustained release, POSS-DS was encapsulated in HAMA, and hybrid hydrogel microspheres were prepared by microfluidic technology, namely HAMA@POSS-DS. The morphology of the hybrid hydrogel microspheres was characterized by optical microscope and scanning electron microscope. The in vitro degradation and drug release efficiency were observed. Cell counting kit 8 (CCK-8) and live/dead staining were used to detect the effect on chondrocyte proliferation. Moreover, a chondrocyte inflammation model was constructed and cultured with HAMA@POSS-DS. The relevant inflammatory indicators, including collagen type Ⅱ, aggrecan (AGG), matrix metalloproteinase 13 (MMP-13), recombinant A disintegrin and metalloproteinase with thrombospondin 5 (Adamts5), and recombinant tachykinin precursor 1 (TAC1) were detected by immunofluorescence staining and real-time fluorescence quantitative PCR, with normal cultured chondrocytes and the chondrocyte inflammation model without treatment as control group and blank group respectively to further evaluate their anti-inflammatory activity. Finally, by constructing a rat model of knee osteoarthritis, the effectiveness of HAMA@POSS-DS on osteoarthritis was evaluated by X-ray film and Micro-CT examination. Results The overall particle size of POSS-DS nanoparticles was uniform with a diameter of about 100 nm. HAMA@POSS-DS hydrogel microspheres were opaque spheres with a diameter of about 100 μm and a spherical porous structure. The degradation period was 9 weeks, during which the loaded POSS-DS nanoparticles were slowly released. CCK-8 and live/dead staining showed no obvious cytotoxicity at HAMA@POSS-DS, and POSS-DS released by HAMA@POSS-DS significantly promoted cell proliferation (P<0.05). In the chondrocyte anti-inflammatory experiment, the relative expression of collagen type Ⅱ mRNA in HAMA@POSS-DS group was significantly higher than that in control group and blank group (P<0.05). The relative expression level of AGG mRNA was significantly higher than that of blank group (P<0.05). The relative expressions of MMP-13, Adamts5, and TAC1 mRNA in HAMA@POSS-DS group were significantly lower than those in blank group (P<0.05). In vivo experiments showed that the joint space width decreased after operation in rats with osteoarthritis, but HAMA@POSS-DS delayed the process of joint space narrowing and significantly improved the periarticular osteophytosis (P<0.05). Conclusion HAMA@POSS-DS can effectively regulate the local inflammatory microenvironment and significantly promote chondrocyte proliferation, which is conducive to promoting cartilage regeneration and repair in osteoarthritis.
Objective To review the research progress of surgical methods of osteotomy around the knee in the treatment of valgus knee osteoarthritis. MethodsThe relevant literature on the surgical treatment of valgus knee osteoarthritis at home and abroad in recent years was reviewed, and the advantages, disadvantages, and effectiveness of different surgical methods of osteotomy around the knee were summarized. Results For young and active patients with symptomatic valgus knee osteoarthritis, osteotomy around the knee is a safe and reliable treatment option. At present, the main surgical methods include medial closing wedge distal femoral osteotomy, lateral opening wedge distal femoral osteotomy, medial closing wedge high tibial osteotomy, and lateral opening wedge high tibial osteotomy. The indications, advantages, and disadvantages of different osteotomies are different, and the selection of appropriate surgical method is the key to achieve good effectiveness. ConclusionThere are many osteotomies in the treatment of valgus knee osteoarthritis. In order to achieve good results, improve survival rate, and reduce postoperative complications, the most reasonable surgical strategy needs to be developed according to different situations.
ObjectiveTo investigate the effect of body mass index (BMI) on the short- and medium-term effectiveness of unicompartmental knee arthroplasty (UKA) in the treatment of anterior medial compartmental osteoarthritis of knee joint.MethodsThe clinical data of 55 patients (61 knees) with anterior medial compartmental osteoarthritis of knee joint treated with minimally invasive UKA between May 2014 and May 2019 were retrospectively analyzed. According to BMI, the patients were divided into 3 groups: normal body mass group [group A, BMI 18.50-24.99 kg/m2, 23 cases (25 knees)], overweight group [group B, BMI 25.00-29.99 kg/m2, 23 cases (25 knees)], obesity group [group C, BMI 30.00-39.99 kg/m2, 9 cases (11 knees)]. There was no significant difference in gender, age, sides, disease duration, and preoperative American Special Surgery Hospital (HSS) score, pain visual analogue scale (VAS) score, and knee range of motion (ROM) among 3 groups (P>0.05). The operation time, intraoperative dominant blood loss, and the postoperative decreased amount of hemoglobin at 1 week were recorded and compared among 3 groups. The HSS score, VAS score, and ROM were used to evaluate the knee function and pain improvement.ResultsThere was no significant difference in the operation time, the intraoperative dominant blood loss, and the postoperative decreased amount of hemoglobin at 1 week among 3 groups (P>0.05). All the 55 patients were followed up 5-60 months, with an average of 24 months. No complication such as infection, fat embolism, or deep venous thrombosis of lower extremity occurred after operation. The anteroposterior and lateral X-ray films of the knee joint showed that no dislocation or loosening of the prosthesis occurred and the position of the prosthesis was good. At last follow-up, the HSS score, VAS score, and ROM of the 3 groups were significantly improved when compared with preoperative ones (P<0.05); but there was no significant difference among 3 groups (P>0.05).ConclusionFor obese and overweight patients with anterior medial compartmental osteoarthritis of the knee joint, the use of minimally invasive UKA can achieve satisfactory short- and medium-term effectiveness, and the long-term effectiveness needs further follow-up.
Objective To evaluate the effectiveness of one-stage total knee arthroplasty (TKA) for femoral supracondylar fracture combined with knee osteoarthritis. Methods Between January 2012 and March 2015, a total of 19 patients (19 knees) with femoral supracondylar fracture and knee osteoarthritis were treated with one-stage TKA. Of 19 cases, 8 were male and 11 were female with an average age of 69.6 years (range, 60-85 years). The mean body mass index was 22.6 kg/m2 (range, 22.0-27.5 kg/m2). The left knee was involved in 13 cases, and the right knee in 6 cases. The causes of femoral supracondylar fracture were falls in 10 cases, traffic accidents in 8 cases, and other injury in 1 case. All fractures were classified as type A according to AO/Association for the Study of Internal Fixation (AO/ASIF) classification. The interval of injury and operation was 4-13 days (mean, 8.6 days). The disease duration of osteoarthritis ranged from 30 to 90 months (mean, 52.6 months). During follow-up, the knee society score (KSS) and the range of motion (ROM) were used to evaluate the knee function; anteroposterior and lateral X-ray films of the knee were used to observe the position of the prosthesis. Results All the incisions healed at the first stage, and there was no early complication such as pulmonary infection, pressure ulcer, and urinary tract infection. All patients were followed up 2-4 years with an average of 2.6 years. The ROM and KSS functional scores and clinical scores were significantly improved at 15 days and 2 years after operation, showing significant differences when compared with those before operation (P<0.05). There were significant differences in the ROM and KSS functional scores and clinical scores between two time points after operation (P<0.05). X-ray films showed the fracture bone healing, good alignment, no loosening of prosthesis at 2 years after operarion. Conclusion One-stage TKA for femoral supracondylar fracture combined with knee osteoarthritis can achieve good effectiveness. It can not only reconstruct joint function, but also cure osteoarthritis and fracture at the same time, shorten the healing time, reduce the incidence of related complications.
Objective To examine the research status and predict trends in ME research findings from 1997-2023 on a global scale. Methods Web of Science Core Collection database was searched for original articles on ME published between 1997 and 2023, and then analyzed using CiteSpace, VOSviewer and the Online Analysis Platform of Literature Metrology to map scientific knowledge. Results A total of 748 articles were eventually included. The number of ME publications increased year by year, with the USA being the most productive country. Osteoarthritis, MRI, medial meniscus posterior root repair, biomechanical evaluation, lateral meniscus allograft transplantation, radiographic joint space narrowing are the high frequency keywords in co-occurrence cluster analysis and cocited reference cluster analysis. Medial meniscus posterior root tear and lateral meniscus allograft transplantation are current and evolving research hotspots in citation burst detection analysis. Conclusions The understanding of ME has been improved significantly during the past decades. Current research focuses on optimizing surgical repair methods and obtaining long-term follow-up outcomes for medial meniscal posterior root repair and developing methods to reduce ME after lateral meniscal allograft, as well as they are the highlights of future research on ME.
ObjectiveTo investigate the short-term effectiveness of unicompartmental knee arthroplasty (UKA) in the treatment of knee osteoarthritis of super-age patients over 85 years old.MethodsSenile patients with unilateral compartment osteoarthritis of the knee who received UKA between November 2013 and May 2017 and met the inclusion criteria were enrolled as the research objects. Among them, 40 patients (50 knees) were more than 85 years old (super-age group) and 44 patients (50 knees) were 52-81 years old (control group). There was significant difference in age between the two groups (t=17.33, P=0.00). There was no significant difference in body mass index, degenerative classification of medial and lateral compartments, varus deformity of knee, disease duration, complicating diseases, and preoperative hemoglobin, hematocrit (HCT), American Hospital for Special Surgery (HSS) score, range of motion (ROM) of knee, visual analogue scale (VAS) score, and femoral-tibial angle (FTA) between the two groups (P>0.05). Hospital stay, hemoglobin, and HCT of the two groups were recorded before operation and on the first day after operation. The changes of hemoglobin and HCT after operation were calculated. During follow-up period, the ROM of the knee, HSS score, and VAS score were measured; the position of the prosthesis and FTA were observed by X-ray films.ResultsThere was no significant difference in hospital stay between the two groups (t=1.05, P=0.29). Hemoglobin and HCT of the two groups on the first day after operation were significantly lower than those before operation (P<0.05). There was no significant difference in the postoperative changes of hemoglobin and HCT between the two groups (P>0.05). All the patients were followed up completely except 4 cases (5 knees) in the super-age group. The follow-up time ranged from 14 to 44 months of super-age group (mean, 29 months) and 21 to 33 months of control group (mean, 24 months). There were significant differences in HSS score, VAS score, ROM of the knee, and FTA between pre-operation and last follow-up in the two groups (P<0.05). There was significant difference in HSS score between the two groups (P<0.05), and no significant difference was found in ROM, VAS score, and FTA between the two groups (P>0.05). X-ray film showed no adverse position of the prosthesis, infection around the prosthesis, prosthesis loosening, or pathological bright lines.ConclusionUKA combined with reasonable perioperative management in the treatment of super-age patients over 85 years with knee osteoarthritis is safe and feasible, and can obtain satisfactory short-term effectiveness.
【Abstract】 Objective To evaluate the results of glucosamine hydrochloride in the treatment of knee degenerativeosteoarthritis (DOA) . Methods From February 2006 to January 2007, 60 patients with knee DOA were treated with glucosaminehydrochloride,including 15 males and 45 females. The ages of patients ranged from 41 to 67 years with an average ageof 57.5 years. The disease course ranged from 6 months to 3 years. Oral glucosamine hydrochloride was given twice a day, each750 mg, for a 6-week course of treatment; another course of treatment was repeated after 4 months. After two courses of treatment,the international standard DOA score of Lequesne index was used to evaluate the rest of knee pain, sports pain, tenderness,joints activity, morning stiffness and walking abil ity. Results All 60 patients finished treatment, various cl inical symptomsfor DOA disappeared completely in 31 cases and subsided in 27 cases; the cure rate was 51.7% and the total response rate was96.7%. The scores of rest pain, sport pain, tenderness, joints activity, morning stiffness and the abil ity to walk for knee after treatmentwere 0.5±0.2,0.7±0.4,0.8±0.3,0.9±0.4,0.6±0.3 and 0.9±0.4, showing statistically significant differences (P lt; 0.01) whencompared with preoperation (1.6±0.5,2.1±0.4,2.2±0.5,1.8±0.6,1.7±0.4 and 2.0±0.4). Adverse effect occurred in 3 cases (5%)and the patients recovered without special treatment. Conclusion Glucosamine hydrochloride can cure knee DOA withsymptom-rel ieving and joint function-improving action.
Objective To study the effect of multi-disciplinary treatment (MDT) on the surgical efficacy and satisfaction of patients undergoing total knee arthroplasty (TKA) for the first time. Methods The clinical data of patients who underwent unilateral TKA for single-compartment osteoarthritis of the knee in the General Hospital of Ningxia Medical University between January and September 2022 were retrospectively collected and analyzed. According to whether MDT was performed on patients during the perioperative period, they were divided into MDT group and traditional group. Perioperative nutrition-related indicators, perioperative complications, total hospitalization time, Visual Analogue Scale (VAS), and Hospital for Special Surgery Knee Score (HSS) before and after surgery were detected and recorded. Results A total of 95 patients were included. Among them, there were 42 cases in the MDT group and 53 cases in the traditional group. The postoperative complications and total hospital stay of patients in the MDT group were lower than those in the traditional group, and their satisfaction scores were higher than those in the traditional group (P<0.05). The perioperative serum total protein (TP), hemoglobin (Hb), serum albumin (ALB) levels, VAS score, and HSS score of both groups of patients changed over time. The intra group comparison results showed that compared with preoperative, the levels of TP, Hb, and ALB in both groups decreased on the 1st and 3rd postoperative days (P<0.05). On the 3rd day after surgery, the levels of TP, Hb, ALB in the MDT group and Hb, ALB in the traditional group were lower than on the 1st day after surgery (P<0.05). There was no statistically significant difference in TP levels between the traditional group on the 3rd day after surgery and the 1st day after surgery (P>0.05). The results of intra group comparison at different time points showed that there were statistically significant differences in VAS score and HSS score between the two groups (P<0.05). Conclusion The application of MDT in elderly patients undergoing unilateral TKA for the first time can shorten the total hospitalization time, reduce the incidence of perioperative complications, and improve the surgical efficacy and patient satisfaction.