References/More Data Page
Knee Osteoarthritis Bibliography
More Sports Medicine Information/EMEDx
J Bone Joint Surg
Am. 2004;86-A Suppl 2:26-32.
Minimally invasive total knee arthroplasty.
Bonutti
PM, Mont
MA, McMahon
M, Ragland
PS, Kester
M.
Currently, minimally invasive total knee arthroplasty is defined as an incision
length of < 14 cm. However, the length of the incision is not the primary
influence on potential postoperative benefits to the patient and should not be
the only characteristic of the minimally invasive approach for knee arthroplasty.
Some other factors that should also be included in this definition are: 1. The
amount of soft-tissue dissection (including muscle, ligament, and capsular
damage). 2. Patellar retraction or eversion. 3. Tibiofemoral dislocation.
Minimally invasive surgery should not be considered to be a cosmetic procedure
but rather one that addresses patients' concerns with regard to postoperative
pain and slow rehabilitation. Standard total knee arthroplasties provide pain
relief, but returning to activities of daily living remains a challenge for some
individuals, who may take several weeks to recover. Several studies have
demonstrated long-term success (at more than ten years) of standard total knee
arthroplasties. However, many patients remain unsatisfied with the results of
the surgery. In a study of functional limitations of patients with a Knee
Society score of > or = 90 points after total knee arthroplasty, only 35% of
patients stated that they had no limitations. This finding was highlighted in a
study by Dickstein et al., in which one-third of the elderly patients who
underwent knee replacement were unhappy with the outcome at six and twelve
months postoperatively. Although many surgeons utilize objective functional
scoring systems to evaluate outcome, it is likely that the criteria for a
successful result of total knee arthroplasty differ between the patient and the
surgeon. This was evident in a report by Bullens et al., who concluded that
surgeons are more satisfied with the results of total knee arthroplasty than are
their patients. Trousdale et al. showed that, in addition to concerns about
long-term functional outcome, patients' major concerns were postoperative pain
and the time required for recovery. Patients undergoing total knee arthroplasty
have specific functional goals, such as climbing stairs, squatting, kneeling,
and returning to some level of low-impact sports after surgery. Our clinical
investigations demonstrated that the minimally invasive surgical approach
reduces hospital stays, decreases postoperative pain, and decreases
rehabilitation needs as well as enables patients to return to normal function
more quickly. It is important for surgeons to take an evolutionary, rather than
a revolutionary, approach when performing minimally invasive total knee
arthroplasty. The surgeon should downsize incisions progressively to prevent
severe damage to the quadriceps mechanism. Extensive open exposure, prolonged
patellar eversion, and dislocation of the tibiofemoral joint should evolve into
a vastus medialis muscle split with patellar subluxation, retraction but not
dislocation of the patella, and avoidance of gross dislocation of the
tibiofemoral joint. Developing the techniques of minimally invasive total knee
arthroplasty may be difficult and time-consuming, but patient benefits and
satisfaction should outweigh the extra effort required. These changes require
well-designed clinical studies to further document their effectiveness.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16188417&query_hl=13
Eur J Radiol. 2005
Sep 24; [Epub ahead of print]
Cartilage repair: Generations of autologous chondrocyte transplantation.
Marlovits
S, Zeller
P, Singer
P, Resinger
C, Vecsei
V.
Department of Traumatology, Center for Joint and Cartilage, Medical University
of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
Articular cartilage in adults has a limited capacity for self-repair after a
substantial injury. Surgical therapeutic efforts to treat cartilage defects have
focused on delivering new cells capable of chondrogenesis into the lesions.
Autologous chondrocyte transplantation (ACT) is an advanced cell-based
orthobiologic technology used for the treatment of chondral defects of the knee
that has been in clinical use since 1987 and has been performed on 12,000
patients internationally. With ACT, good to excellent clinical results are seen
in isolated post-traumatic lesions of the knee joint in the younger patient,
with the formation of hyaline or hyaline-like repair tissue. In the classic ACT
technique, chondrocytes are isolated from small slices of cartilage harvested
arthroscopically from a minor weight-bearing area of the injured knee. The
extracellular matrix is removed by enzymatic digestion, and the cells are then
expanded in monolayer culture. Once a sufficient number of cells has been
obtained, the chondrocytes are implanted into the cartilage defect, using a
periosteal patch over the defect as a method of cell containment. The major
complications are periosteal hypertrophy, delamination of the transplant,
arthrofibrosis and transplant failure. Further improvements in tissue
engineering have contributed to the next generation of ACT techniques, where
cells are combined with resorbable biomaterials, as in matrix-associated
autologous chondrocyte transplantation (MACT). These biomaterials secure the
cells in the defect area and enhance their proliferation and differentiation.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16125942&query_hl=5
Knee. 2005 Aug 25;
[Epub ahead of print]
Autologous osteochondral transplantation for the treatment of chondral
defects of the knee.
Karataglis
D, Green
MA, Learmonth
DJ.
Royal Orthopaedic Hospital,
Full-thickness chondral defects of weight-bearing articular surfaces of the knee
are a difficult condition to treat. Our aim is to evaluate the mid- and
long-term functional outcome of the treatment of osteochondral defects of the
knee with autologous osteochondral transplantation with the OATS technique.
Thirty-six patients (37 procedures) were included in this study. Twenty-three
patients were male and thirteen were female with a mean age of 31.9 years
(range: 18-48 years). The cause of the defect was OCD in 10 cases, AVN in 2,
lateral patellar maltracking in 7, while in the remaining 17 patients the defect
was post-traumatic. The lesion was located on the femoral condyles in 26 cases
and the patellofemoral joint in the remaining 11. The average area covered was
2.73 cm(2) (range: 0.8-12 cm(2)) and patients were followed for an average of
36.9 months (range: 18-73 months). The average score in their Tegner Activity
Scale was 3.76 (range: 1-8), while their score in Activities of Daily Living
Scale of the Knee Outcome Survey ranged from 18 to 98 with an average of 72.3.
Thirty-two out of 37 patients (86.5%) reported improvement of their
pre-operative symptoms. All but 5 patients returned to their previous occupation
while 18 went back to sports. No correlation was found between patient age at
operation, the size or site of the chondral lesion and the functional outcome.
We believe that autologous osteochondral grafting with the OATS technique is a
safe and successful treatment option for focal osteochondral defects of the
knee. It offers a very satisfactory functional outcome and does not compromise
the patient's future options.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15846755&query_hl=1
Cochrane Database
Syst Rev. 2005 Apr 18;(2):CD005328.
Intraarticular corticosteroid for treatment of osteoarthritis of the knee.
Bellamy
N, Campbell
J, Robinson
V, Gee
T, Bourne
R, Wells
G.
Medicine, Centre of National Research on Disability and Rehabilitation Medicine
(CONROD), C Floor, Clinical Sciences Bldg., Royal Brisbane Hospital, Herston
Road, Brisbane, Queensland 4029, Australia. nbellamy@medicine.uq.edu.au
BACKGROUND: Osteoarthritis (OA) is a common joint disorder. In the knee,
injections of corticosteroids into the joint (intra-articular (IA)) may relieve
inflammation, and reduce pain and disability. OBJECTIVES: To evaluate the
efficacy and safety of IA corticosteroids in treatment of OA of the knee. SEARCH
STRATEGY: We searched the Cochrane Central Register of Controlled Trials
(CENTRAL) (Issue 2, 2003), MEDLINE, EMBASE, PREMEDLINE (all to July 2003), and
Current Contents (Sept 2000). Specialised journals, trial reference lists and
review articles were handsearched. SELECTION CRITERIA: Randomised controlled
trials of IA corticosteroids for patients with OA of the knee: single/double
blind, placebo-based/comparative studies, reporting at least one core OMERACT
III outcome measure. DATA COLLECTION AND ANALYSIS: Methodological quality of
trials was assessed, and data were extracted in duplicate. Fixed effect and
random effects models, giving weighted mean differences (WMD), were used for
continuous variables. Dichotomous outcomes were analysed by relative risk (RR).
MAIN RESULTS: Twenty-six trials (1721 participants) comparing IA corticosteroid
against placebo, against IA hyaluronan/hylan (HA products), against joint lavage,
and against other IA corticosteroids, were included.IA corticosteroid was more
effective than IA placebo for pain reduction (WMD -17.79; 95% confidence
interval (CI) -25.02 to -10.55) and patient global assessment (the RR was 1.44
(95% CI 1.13 to 1.82)) at one week post injection with an NNT of 3 to 4 for
both, based on n=185 for pain on 100 mm visual analogue scale (VAS) and n=158
for patient global assessment. Data on function were sparse at one week post
injection and neither statistically significant nor clinically important
differences were detected.There was evidence of pain reduction between two weeks
(the RR was 1.81 (95% CI 1.09 to 3.00)) to three weeks (the RR was 3.11 (95% CI
1.61 to 6.01), but a lack of evidence for efficacy in functional improvement.At
four to 24 weeks post injection, there was lack of evidence of effect on pain
and function (small studies showed benefits which did not reach statistical or
clinical importance, i.e. less than 20% risk difference). For patient global,
there were three studies which consistently showed lack of effect longer than
one week post injection. However, all were fairly small sample sizes (less than
50 patients per group). This was supported by another study which did not find
statistically significant differences, at any time point, on a continuous
measure of patient global assessment (100 mm VAS).In comparisons of
corticosteroids and HA products, no statistically significant differences were
in general detected at one to four weeks post injection. Between five and 13
weeks post injection, HA products were more effective than corticosteroids for
one or more of the following variables: WOMAC OA Index, Lequesne Index, pain,
range of motion (flexion), and number of responders. One study showed a
difference in function between 14 to 26 weeks, but no differences in efficacy
were detected at 45 to 52 weeks. In general, the onset of effect was similar
with IA corticosteroids, but was less durable than with HA products.Comparisons
of IA corticosteroids showed triamcinolone hexacetonide was superior to
betamethasone for number of patients reporting pain reduction up to four weeks
post injection (the RR was 2.00 (95% CI 1.10 to 3.63). Comparisons between IA
corticosteroid and joint lavage showed no differences in any of the efficacy or
safety outcome measures. AUTHORS' CONCLUSIONS: The short-term benefit of IA
corticosteroids in treatment of knee OA is well established, and few side
effects have been reported. Longer term benefits have not been confirmed based
on the RevMan analysis. The response to HA products appears more durable. In
this review, some discrepancies were observed between the RevMan 4.1 analysis
and the original publication. These are likely the result of using secondary
rather than primary data and the statistical methods available in RevMan 4.1.
Future trials should have standardised outcome measures and assessment times,
run longer, investigate different patient subgroups, and clinical predictors of
response (those associated with inflammation and structural damage).
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15855241&query_hl=1
Ann Pharmacother.
2005 Jun;39(6):1080-7. Epub 2005 Apr 26.
Glucosamine long-term treatment and the progression of knee osteoarthritis:
systematic review of randomized controlled trials.
Poolsup
N, Suthisisang
C, Channark
P, Kittikulsuth
W.
Department of Pharmacy, Faculty of Pharmacy,
OBJECTIVE: To investigate the structural and symptomatic efficacy and safety of
glucosamine in knee osteoarthritis (OA). DATA SOURCES: Clinical trials of
glucosamine were identified through electronic searches (MEDLINE, EMBASE, BIOSIS,
EMB review, the Cochrane Library) using the key words glucosamine,
osteoarthritis, degenerative joint disease, degenerative arthritis,
osteoarthrosis, gonarthrosis, knee, disease progression, and clinical trial. The
bibliographic databases were searched from their respective inception dates to
August 2004. We also hand-searched reference lists of relevant articles. STUDY
SELECTION AND DATA EXTRACTION: Studies were included if they were double-blind,
randomized, controlled trials that evaluated oral glucosamine long-term
treatment in knee OA; lasting at least one year; and reporting as outcome
measures the symptom severity and disease progression as assessed by joint space
narrowing. Two authors interpreted data independently. Disagreements were
resolved through discussion. DATA SYNTHESIS: Glucosamine sulfate was more
effective than placebo in delaying structural progression in knee OA. The risk
of disease progression was reduced by 54% (pooled RR 0.46; 95% CI 0.28 to 0.73;
p = 0.0011). The number-needed-to-treat was 9 (95% CI 6 to 20). The pooled
effect sizes for pain reduction and improvement in physical function were 0.41
(95% CI 0.21 to 0.60; p < 0.0001) and 0.46 (95% CI 0.27 to 0.66; p <
0.0001), respectively, in favor of glucosamine sulfate. Glucosamine sulfate
caused no more adverse effects than placebo. CONCLUSIONS: The available evidence
suggests that glucosamine sulfate may be effective and safe in delaying the
progression and improving the symptoms of knee OA. Due to the sparse data on
structural efficacy and safety, further studies are warranted.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15995426&query_hl=1
Clin Orthop Relat
Res. 2005 Jul;(436):91-9.
The appropriate use of patellofemoral arthroplasty: an analysis of reported
indications, contraindications, and failures.
Leadbetter
WB, Ragland
PS, Mont
MA.
Rubin Institute for Advanced Orthopaedics,
Patellofemoral arthroplasty is going through a recent resurgence in interest
with various new designs being introduced for general orthopaedic use. With this
renewed enthusiasm for the procedure, it is important to understand the various
indications and contraindications for using patellofemoral arthroplasty devices
with the expectation that proper patient selection will improve outcome. Our
purpose was to analyze the appropriate usage of these prostheses based on
published historical results. A literature search was done to review the
indications, contraindications, and factors contributing to the failure of these
devices. We analyzed 12 studies reporting results of patellofemoral arthroplasty
between 1979 and 2005. Commonly cited contraindications for using these devices
have been tibiofemoral arthritis, uncorrected patellofemoral or tibiofemoral
malalignment, and inflammatory arthritis. The highest failure rates were in
patients with progression of osteoarthritis in other compartments or persistence
of congenital or surgically uncorrected malalignment. In analyzing the reasons
for failures in these reports together with issues already known to affect total
knee arthroplasty surgery, we suggest an expanded list of outcome-altering
factors to consider when choosing to do a patellofemoral arthroplasty. Finally,
based on these observations and our own experience, suggestions on the best
approach to the patient with patellofemoral arthritis are made to avoid less
than optimal results if patellofemoral arthroplasty is considered. LEVEL OF
EVIDENCE: Prognostic Study, Level II-3 (systematic review of Level-II studies.
See the Guidelines for Authors for a complete description of levels of evidence.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15934131&query_hl=1
Arthritis Rheum.
2005 Jun 15;53(3):388-94.
Cost effectiveness of a two-year home exercise program for the treatment of
knee pain.
Thomas
KS, Miller
P, Doherty
M, Muir
KR, Jones
AC, O'Reilly
SC.
OBJECTIVE: To assess the cost effectiveness of a 2-year home exercise program
for the treatment of knee pain. METHODS: A total of 759 adults aged > or = 45
years were randomized to receive exercise therapy, monthly telephone contact,
exercise therapy and telephone contact, or no intervention. Efficacy was
measured using self-reported knee pain at 2 years. Costs to both the National
Health Service and to the patient were included. RESULTS: Exercise therapy was
associated with higher costs and better effectiveness. Direct costs for the
interventions were pound 112 for the exercise program and pound 61 for the
monthly telephone support. Participants allocated to receive exercise therapy
were significantly more likely to incur higher medical costs than those in the
no-exercise groups (mean difference pound 225; 95% confidence interval pound
218, pound 232; P < 0.001). CONCLUSION: Exercise therapy is associated with
improvements in knee pain, but the cost of delivering the exercise program is
unlikely to be offset by any reduction in medical resource use.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15996071&query_hl=1
J Rheumatol. 2005
Jul;32(7):1317-23.
Safety study of intraarticular injection of interleukin 1 receptor antagonist
in patients with painful knee osteoarthritis: a multicenter study.
Chevalier
X, Giraudeau
B, Conrozier
T, Marliere
J, Kiefer
P, Goupille
P.
Department of Rheumatology, Hospital Henri Mondor, University Paris XII,
OBJECTIVE: Interleukin 1 (IL-1) plays a pivotal role in the pathogenesis of
osteoarthritis (OA). In animal models of OA, IL-1 blockade by IL-1 receptor
antagonist (IL-1Ra) can slow the progression of disease. We examined the safety
of intraarticular (IA) injections of recombinant human IL-1Ra in patients with
knee OA. METHODS: A prospective multicenter trial was conducted using the
continual reassessment method. Six doses were considered, 0.05 mg up to 150 mg
IL-1Ra, and the trial was double-blind regarding the dose administered. Patients
with symptomatic knee OA and without synovial fluid effusion were included.
Acute inflammatory reaction (the primary endpoint defining intolerance) was
recorded if pain increase over 30 mm on 100 mm visual analog scale and synovial
fluid effusion occurred within 72 h after the IA injection. As a secondary aim,
efficacy was estimated (by total pain and
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16005336&query_hl=1
Lancet. 2005 Jul
9-15;366(9480):136-43.
Acupuncture in patients with osteoarthritis of the knee: a randomised trial.
Witt
C, Brinkhaus
B, Jena
S, Linde
K, Streng
A, Wagenpfeil
S, Hummelsberger
J, Walther
HU, Melchart
D, Willich
SN.
Institute of Social Medicine, Epidemiology, and Health Economics,
BACKGROUND: Acupuncture is widely used by patients with chronic pain although
there is little evidence of its effectiveness. We investigated the efficacy of
acupuncture compared with minimal acupuncture and with no acupuncture in
patients with osteoarthritis of the knee. METHODS: Patients with chronic
osteoarthritis of the knee (Kellgren grade < or =2) were randomly assigned to
acupuncture (n=150), minimal acupuncture (superficial needling at
non-acupuncture points; n=76), or a waiting list control (n=74). Specialised
physicians, in 28 outpatient centres, administered acupuncture and minimal
acupuncture in 12 sessions over 8 weeks. Patients completed standard
questionnaires at baseline and after 8 weeks, 26 weeks, and 52 weeks. The
primary outcome was the
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16056047&query_hl=1
Clin Orthop Relat
Res. 2005 Aug;(437):176-85.
Fresh osteochondral allografts.
Jamali
AA, Emmerson
BC, Chung
C, Convery
FR, Bugbee
WD.
Department of Orthopaedic Surgery, UC
Twenty knees in 18 patients were treated (mean age, 42 years; range, 19-64
years) with fresh osteochondral allografting limited to the patellofemoral
joint. The knees were analyzed retrospectively to determine the rate of
successful outcomes. The trochlea and patella were treated in 12 patients and
the patella was treated in eight patients. There were 11 women and seven men.
The primary outcome measures were revision allografting, arthrodesis, or
arthroplasty, and clinical scoring using a modified Merle D'Aubigne-Postel
18-point scale. Radiographs were available for 12 knees. There were five
failures. For the remaining knees, the clinical scores increased from a mean of
11.7 points (range, 7-15 points) to 16.3 points (range, 12-18 points). Of the
knees evaluated radiographically, four had no evidence of patellofemoral
arthrosis, and six had only mild arthrosis. Fresh osteochondral allografting is
a salvage procedure for the young, active patient with severe articular
cartilage disease of the patellofemoral joint. The results of this procedure are
comparable to results of described other techniques in the literature. If
allograft incorporation does occur, the procedure is associated with improved
pain, function, range of motion, and a low risk of progressive arthritis. LEVEL
OF EVIDENCE: Level IV (case series--no, or historical control group). See the
Guidelines for Authors for a complete description of levels of evidence.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16078345&query_hl=1
J Rheumatol. 2005
Aug;32(8):1615-8.
Transplant of mesenchymal stem cells and hydroxyapatite ceramics to treat
severe osteochondral damage after septic arthritis of the knee.
Adachi
N, Ochi
M, Deie
M, Ito
Y.
Department of Orthopaedic Surgery,
We describe a 21-year-old man with a large osteochondral defect of the knee
after septic arthritis, successfully treated by transplant of mesenchymal stem
cells (MSC) from bone marrow and a new type of interconnected porous
hydroxyapatite ceramic (IP-CHA). We confirmed successful cartilage-like tissue
regeneration by a second arthroscopy. Biopsy of the repaired tissue revealed
cartilage-like regeneration and bone formation. We were able to regenerate new
bone and cartilage-like tissue in a one-stage operation, without sacrificing
autologous bone or other tissue. This cultured MSC and IP-CHA hybrid material
transplant represents a novel treatment for a severe osteochondral defect after
septic arthritis.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16093845&query_hl=1
Curr Opin Rheumatol.
2005 Sep;17(5):634-40.
Exercise as a treatment for osteoarthritis.
Bennell
K, Hinman
R.
Centre for Health, Exercise and Sports Medicine,
PURPOSE OF REVIEW: This review highlights recent important research, future
directions, and clinical applications for exercise and osteoarthritis. It
focuses on knee osteoarthritis because of its prevalence and the dearth of
research involving other joint osteoarthritis. The review covers exercise
prescription for symptomatic relief, and its potential role in reducing
development and slowing progression of osteoarthritis. RECENT FINDINGS:
Meta-analyses support recommendations that exercise is important in
osteoarthritis management. Benefits appear to be additive when exercise is
delivered with other interventions such as weight loss. Mode of exercise
delivery has cost implications and may influence overall outcome. It appears
that supervised exercise sessions are superior to home exercises for pain
reduction. The challenge remains to increase the proportion of patients
exercising. Areas of emerging interest are exercise to prevent disease or slow
its progression and recognition of patient subgroups that may respond
differently to treatment. Based on studies showing a relation between weaker
quadriceps strength and increased risk of developing knee osteoarthritis,
particularly in women, strength training may be able to prevent knee
osteoarthritis. Novel exercise programs that strengthen hip muscles or alter
impairments in knee neuromuscular control may also influence disease
progression. SUMMARY: Future studies must identify cost-effective exercise
modes, strategies to maximize exercise compliance and optimal treatment
combinations. The role of muscle strength and altered neuromuscular control in
the prevention and development of osteoarthritis must be evaluated with the view
to devising and testing novel exercise interventions.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16093848&query_hl=1
Curr Opin Rheumatol.
2005 Sep;17(5):653-6.
Footwear alterations and bracing as treatments for knee osteoarthritis.
Krohn
K.
Department of Clinical Research, Mercy
PURPOSE OF REVIEW: 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. RECENT FINDINGS: 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. SUMMARY: 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.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16144589&query_hl=1
J Fam Pract. 2005
Sep;54(9):758-67
relieve knee pain.
Modawal
A, Ferrer
M, Choi
HK, Castle
JA.
Department of Family Medicine, Section of Geriatric Medicine, University of
Cincinnati Medical Center, Cincinnati, Ohio 45267-0582, USA. modawaa@fammed.uc.edu
OBJECTIVE: To evaluate the efficacy of intra-articular viscosupplementation
therapy with hyaluronic acid for pain relief of knee osteoarthritis, we
conducted a meta-analysis of randomized, double-blinded, placebo-controlled
trials. METHODS: We searched systematically for randomized, double-blinded,
placebo-controlled trials of hyaluronic acid (hyaluronan and hylan G-F20) for
pain relief of knee osteoarthritis. Studies reporting pain visual analogue scale
(VAS) differences were included in the meta-analysis. Changes in pain were
measured by VAS for placebo and treatment, and summary estimates of the
differences between the 2 arms were calculated at 1 week, 5 to 7 weeks, 8 to 12,
and 15 to 22 weeks after the last intra-articular injection. Sources of
heterogeneity were assessed using information on quality score, type of
viscosupplementation, and VAS change in pain with activity or rest.
Heterogeneity across the studies was significant in all analyses (P<.01);
therefore a random effect model was used. Pain was measured either on activity
or at rest. RESULTS: Eleven trials (9 hyaluronan and 2 hylan G-F 20) allowed
calculation of the summary estimate of difference in change of VAS pain at 1
week, 6 of the 11 allowed the estimation between 5 to 7 weeks and 8 to 12 weeks,
and only 3 at 15 to 22 weeks. The summary estimates of VAS differences between
therapy and placebo injection: at 1 week, 4.4 (95% confidence interval [CI],
1.1-7.2); at 5 to 7 weeks, 17.7 (7.5-28.0); at 8 to 12 weeks, 18.1 (6.3-29.9)
and at 15 to 22 weeks, 4.4 (-15.3 to 24.1). CONCLUSION: Intra-articular
viscosupplementation was moderately effective in relieving knee pain in patients
with osteoarthritis at 5 to 7 and 8 to 10 weeks after the last injection but not
at 15 to 22 weeks.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16164954&query_hl=1
Orthop Clin North
Am. 2005 Oct;36(4):497-504.
High tibial osteotomy for the treatment of unicompartmental arthritis of the
knee.
Amendola
A, Panarella
L.
Department of Orthopaedics, University of Iowa Hospitals and Clinics, 200
Hawkins Drive, 01018 JPP, Iowa City, IA 52242-1088, USA.
Knee axial deformities associated with medial or lateral compartment
osteoarthritis can be reliably addressed with high tibial osteotomies. Different
surgical techniques can be successfully used for achieving the correction.
Whatever the technique used, accurate patient selection and precise surgical
procedure are critical to the success of the operation. The authors believe that
proximal tibial osteotomy is a valuable procedure to achieve pain relief and to
restore knee function in selected patients. Localized knee osteoarthritis of the
highly motivated, older, active patient can also be included in the extended
indications of the high tibial osteotomy.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16200033&query_hl=1
Eura Medicophys.
2005 Jun;41(2):163-71.
Therapeutic exercise for knee osteoarthritis: considering factors that may
influence outcome.
Fitzgerald
GK.
Department of Physical Therapy, School of Health and Rehabilitation Sciences,
University of Pittsburgh, Pittsburgh, PA, USA.
While exercise has been shown to be beneficial for reducing pain and improving
physical function in individuals with knee osteoarthritis (OA), there are still
individuals who do not always respond well to this treatment approach. There are
a number of factors that have been shown to influence either the degree of
disability and/or the progression of disease in individuals with knee OA. These
factors include quadriceps inhibition or activation failure, obesity, passive
knee laxity, knee alignment, fear of physical activity and self efficacy. It may
be possible that varying levels of these factors might also interfere with an
individual's ability to participate in an exercise or physical activity program
or minimize the benefits that can be achieved by such programs. This paper
examines the influence of these factors on physical function and their potential
for altering the outcome of exercise therapy programs for individuals with knee
OA. Implications and suggestions for potential adjunctive interventions to
address these factors in future research and clinical practice are also
discussed.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16206349&query_hl=1
J Rheumatol. 2005 Oct;32(10):1928-36.
Clinical effects
of intraarticular injection of high molecular weight hyaluronan (orthovisc(r))
in osteoarthritis of the knee: a randomized, controlled, multicenter trial.
Neustadt
D, Caldwell
J, Bell
M, Wade
J, Gimbel
J.
Department of Medicine, Section on Rheumatic Diseases, University of Louisville
School of Medicine, Louisville, Kentucky, USA.
OBJECTIVE: To evaluate the efficacy and safety of injection of high molecular
weight (HMW) hyaluronan (Orthovisc(R)) in patients with mild, moderate, and
severe knee osteoarthritis (OA). METHODS: A randomized, arthrocentesis-controlled,
multicenter trial. Patients (n = 372) were randomized to 4 weekly HMW hyaluronan
injections (O4, n = 128), 3 weekly HMW hyaluronan injections followed by one
arthrocentesis (O3A1, n = 120), or 4 arthrocenteses without injection (control
group, A4, n = 124). All patients had knee OA, as determined by Kellgren-Lawrence
(K-L) grade, and