Objective To explore the effect of internet of things-based power bicycle training or quadriceps training alone on pain and quality of life in patients with knee osteoarthritis in a community setting. Methods Patients with knee osteoarthritis who were admitted to West China Hospital of Sichuan University between April and July 2022 were selected. They were randomly divided into a power bicycle training group, a quadriceps muscle training group and a control group by random number table method. The primary outcome was improvement in knee pain, assessed by the Numerical Rating Scale (NRS) score. The secondary outcome was health-related quality of life, assessed by the 36-Item Short Form Health Survey (SF-36) score. Outcomes were assessed at baseline and 4, 8, and 12 weeks after the initial intervention. The statistical analysis was conducted using generalized estimating equations. Results A total of 72 patients were included, with 24 in each group. There was no significant difference in age, gender or other demographic characteristics among the three groups (P>0.05). The results of generalized estimating equations showed that there were interaction effects (group × time) on the NRS score, SF-36 physical functioning score, SF-36 bodily pain score, and SF-36 vitality score (P<0.05), while there was no interaction effect (group × time) on the role physical score, general health score, social functioning score, role emotional score or mental health score of SF-36 (P>0.05). At baseline, there was no statistically significant difference in the NRS score or SF-36 scores among the three groups (P>0.05). After 12 weeks of intervention, the two training groups were better than the control group in the NRS score, SF-36 physical functioning score, and SF-36 bodily pain score, the power bicycle training group was better than the quadriceps training group in the NRS score, the power bicycle training group was better than the control group in the SF-36 social functioning score, and the differences were statistically significant (P<0.05). Conclusions In a community setting, 12 weeks of internet of things-based power bicycle training and quadriceps training can significantly improve joint pain, physiological function and physical pain indicators in patients with knee osteoarthritis, and the power bicycle training is better than the quadriceps training in improving the knee pain of patients.
Knee osteoarthritis (KOA) is one of the common degenerative joint diseases, which is more common in the middle-aged and elderly population. It shows significant gender differences, with a significantly higher incidence rate in women than in men, seriously affecting the quality of life of patients. However, there are few research reports on the correlation between gender differences and the incidence of KOA both domestically and internationally. Therefore, this article will summarize and analyze the potential causes of gender differences related to the incidence of KOA from five aspects: hormone levels, anatomical biomechanical characteristics, genes, obesity, and exercise-muscle factors. Through a comprehensive review of research progress, the aim is to provide a theoretical basis for gender based personalized treatment of KOA in clinical practice.
Objective To investigate the effects of ergometer cycling training based on the internet of things and quadriceps strengthening based on internet mobile phones on joint stiffness, function and walking ability in patients with knee osteoarthritis (KOA) in a community setting. Methods KOA patients attending West China Hospital, Sichuan University were selected between April and July 2022. The patients were randomly divided into ergometer cycling group, quadriceps strengthening group and control group (treated with traditional therapy) using a random number table method. The patient underwent a 12 week intervention. The Western Ontario and McMaster Universities Arthritis Index (WOMAC) scale, Timed Up and Go Test (TUG) were used to evaluate the degree of joint stiffness, joint function and walking ability of patients. Data was collected and evaluated before intervention and at 4, 8, and 12 weeks after the initial intervention.Results A total of 72 patients were included, with 24 cases in each group. There were interactive effects between group and time in WOMAC joint stiffness score, joint functional score and TUG test time (P<0.05). At 8 and 12 weeks after intervention, the joint stiffness scores of the ergometer cycling group and the quadriceps strengthening group were better than those of the control group. At 4, 8 and 12 weeks after intervention, the joint function scores of the ergometer cycling group and the quadriceps strengthening group were better than those of the control group (P<0.05). At 8, 12 weeks after intervention, the TUG test scores of the ergometer cycling group were better than those of the control group and the quadriceps strengthening group (P<0.05). Conclusions In a community setting, both 12-week Internet of thing-based ergometer cycling and internet video-based quadriceps strengthening were effective on improving knee stiffness and function in KOA patients and were superior to traditional methods, the two effects were comparable. Ergometer cycling is superior to quadriceps strengthening and traditional methods in improving walking ability.
Objective To investigate the effect of knee suspension during titanium plate fixation on postoperative posterior tibial slope (PTS) in knee osteoarthritis (KOA) with medial opening-wedge high tibial osteotomy (OWHTO). Methods The clinical data of 47 patients with KOA treated by OWHTO between January 2019 and December 2020 was retrospectively analyzed. In 24 cases, the knee joint was suspended when titanium plate was fixed (research group), and in 23 cases, the knee joint was naturally straightened when titanium plate was fixed (control group). There was no significant difference in gender, age, side, body mass index, disease duration, preoperative visual analogue scale (VAS) score, American Hospital for Special Surgery (HSS) score, Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score, Lysholm score, and preoperative PTS between the two groups (P>0.05). PTS were measured at 1 day after operation and last follow-up, and were compared with that before operation. Before operation and at last follow-up, VAS score was used to evaluate the knee pain, HSS score, WOMAC score, and Lysholm score were used to evaluate the knee function. Results The patients in both groups were followed up 13-24 months, with an average of 19.9 months. There was no complication such as incision infection, screw fracture, and deep venous thrombosis of lower limbs in two groups. At last follow-up, the VAS score, HSS score, WOMAC score, and Lysholm score in two groups were significantly improved when compared with those before operation (P<0.05), but there was no significant difference between the two groups in the each score difference of before and after operation (P>0.05). There was no significant difference in PTS at each time point before and after operation in the research group (P>0.05), but PTS in the control group significantly increased at 1 day after operation and last follow-up (P<0.05). PTS of the research group at 1 day after operation and last follow-up were significantly lower than those of the control group (P<0.05). ConclusionOWHTO can effectively relieve knee pain and improve knee function in KOA, and the increase of postoperative PTS can be effectively avoided by suspending knee joint.
Objective To investigate the load distribution on the more painful and less painful limbs in patients with mild-to-moderate and severe bilateral knee osteoarthritis (KOA) and explore the compensatory mechanisms in both limbs among bilateral KOA patients with different severity levels. Methods A total of 113 participants were enrolled between July 2022 and September 2023. This cohort comprised 43 patients with mild-to-moderate bilateral KOA (Kellgren-Lawrence grade 2-3), 43 patients with severe bilateral KOA (Kellgren-Lawrence grade 4), and 27 healthy volunteers (healthy control group). The visual analogue scale (VAS) score for pain, the Hospital for Special Surgery (HSS) score, passive knee range of motion (ROM), and hip-knee-ankle angle (HKA) were used to assess walking pain intensity, joint function, and lower limb alignment in KOA patients, respectively. Motion trajectories of reflective markers and ground reaction force data during walking were captured using a gait analysis system. Musculoskeletal modeling was then employed to calculate biomechanical parameters, including the peak knee adduction moment (KAM), KAM impulse, peak joint contact force (JCF), and peak medial/lateral contact forces (MCF/LCF). Statistical analyses were performed to compare differences in clinical and gait parameters between bilateral limbs. Additionally, one-dimensional statistical parametric mapping was utilized to analyze temporal gait data. Results Mild-to-moderate KOA patients showed the significantly higher HSS score (67.7±7.9) than severe KOA patients (51.9±8.9; t=8.747, P<0.001). The more painful limb in all KOA patients exhibited significantly greater HKA and higher VAS scores compared to the less painful limb (P<0.05). While bilateral knee ROM did not differ significantly in mild-to-moderate KOA patients (P>0.05), the severe KOA patients had significantly reduced ROM in the more painful limb versus the less painful limb (P<0.05). Healthy controls showed no significant bilateral difference in any biomechanical parameters (P>0.05). All KOA patients demonstrated longer stance time on the less painful limb (P<0.05). Critically, severe KOA patients exhibited significantly higher peak KAM, KAM impulse, and peak MCF in the more painful limb (P<0.05), while mild-to-moderate KOA patients showed the opposite pattern with lower peak KAM and KAM impulse in the more painful limb (P<0.05) and a similar trend for peak MCF. Conclusion Patients with mild-to-moderate KOA effectively reduce load on the more painful limb through compensatory mechanisms in the less painful limb. Conversely, severe bilateral varus deformities in advanced KOA patients nullify compensatory capacity in the less painful limb, paradoxically increasing load on the more painful limb. This dichotomy necessitates personalized management strategies tailored to disease severity.
ObjectivesTo systematically review the efficacy of unicompartmental knee arthroplasty on forgotten joint score (FJS) in patients with knee osteoarthritis.MethodsPubMed, EMbase, The Cochrane Library, Web of Science, CNKI, CBM, WanFang Data and VIP databases were electronically searched to collect randomized controlled trials (RCTs) and cohort studies on unicompartmental knee arthroplasty on FJS in patients with knee osteoarthritis from inception to December 31st, 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 2 RCTs and 11 cohort studies were included. The results of meta-analysis based on RCTs showed that: compared to posterior stabilized total knee arthroplasty (PS-TKA), unicompartmental knee arthroplasty could improve FJS on 12-month (MD=9.23, 95%CI 0.53 to 17.93, P=0.04) after operation. The results of meta-analysis based on cohort studies showed that: compared to PS-TKA, unicompartmental knee arthroplasty could improve FJS on 6-week (MD=8.90, 95%CI 6.87 to 10.94, P<0.000 01), 6-month (MD=18.72, 95%CI 8.71 to 28.74, P=0.000 2), 1-year after operation (MD=13.41, 95%CI 8.87 to 17.95, P<0.000 01), and the last follow-up (MD=0.99, 95%CI 0.47 to 1.54, P=0.000 2).ConclusionsCurrent evidence shows that, comparing with PS-TKA, unicompartmental knee arthroplasty in knee osteoarthritis shows advantage in the improvement of FJS. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusions.
Objective To investigate the influence of tibial component posterior slope angle (TCPSA) on the short- and mid-term effectiveness of unicompartmental knee arthroplasty (UKA). MethodsThe clinical data of the patients with anterior medial knee osteoarthritis (KOA) treated by UKA between May 2014 and May 2019 were retrospectively analysed. There were 10 males and 45 females with a median age of 68 years (range, 49-83 years). The body mass index (BMI) was 27.63-52.26 kg/m2, with an average of 40.04 kg/m2. There were 28 cases of left knee, 21 cases of right knee, and 6 cases of double knees. The disease duration was from 7 months to 12 years, with an average of 4.33 years. Measurements of posterior tibial slope (PTS) and TCPSA were performed on the knee joint X-ray films of patients before operation and at last follow-up, respectively. According to the postoperative TCPSA, patients were divided into TCPSA<4° group (group A), 4°≤TCPSA<9° group (group B), and TCPSA>9° group (group C) with the quartile method. Baseline data such as age, gender, BMI, and affected side were compared among the 3 groups, as well as the Hospital for Special Surgery (HSS) score, visual analogue scale (VAS) score, and range of motion (ROM) before and after operation. ResultsAll 55 patients were followed up 17-72 months, with an average of 36 months. No complication such as prosthesis loosening, infection, tibial plateau collapse, and dislocation of the meniscus pad occurred. The preoperative PTS was (7.38±3.37)°, and the postoperative TCPSA was (6.25±3.22)°, showing no significant difference (t=1.815, P=0.074). According to postoperative TCPSA, there were 12 knees in group A, 32 in group B, and 17 in group C. There was no significant difference in age, gender, BMI, affected side, and preoperative HSS scores, ROM, and VAS scores among the 3 groups (P>0.05). At last follow-up, the HSS scores, ROM, and VAS scores of the 3 groups significantly improved when compared with preoperative ones (P<0.05). There was no significant difference in the difference of the above indicators before and after operation among 3 groups (P>0.05). ConclusionThe patients with anterior medial KOA may have good short- and mid-term effectiveness after UKA. Among the recommended range of TCPSA, there is no significant influence on the postoperative short- and mid-term effectiveness. Long-term effectiveness need to extend the follow-up time and expand the sample size for research verification.
Objective To investigate the short-term effectiveness of joint distraction by Ilizarov combined with arthroscopic debridement in the treatment of knee osteoarthritis (KOA). Methods Between January 2014 and January 2015, 15 patients (15 knees) with KOA were treated using arthroscopic debridement assisting with the Ilizarov distraction technology. There were 7 males and 8 females, aged from 45 to 64 years (mean, 55 years). The left knee and the right knee were involved in 6 and 9 cases respectively. The disease duration was 2.0-9.5 years (median, 6 years). They all had received conservative treatment for 6 months and got poor clinical improvement. The preoperative visual analogue scale (VAS) score, the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score, the knee injury and osteoarthritis outcome score (KOOS), the range of motion (ROM) for knee, and the radiographic joint space width were 76.2±8.8, 59.3±5.7, 44.3±7.2, (75±21)°, and (2.5±0.4) mm respectively. According to Kellgren-Lawrence grade system, 11 cases were rated as grade III and 4 cases as grade IV. Results There was no poor incision healing, infection, and deep vein thrombosis. All the 15 patients were followed up 12-18 months (mean, 15.5 months). Patients achieved pain relief. The knee activity was obviously improved. The postoperative VAS score, WOMAC score, KOOS score, and ROM at 12 months were 20.9±7.8, 38.2±5.5, 92.1±6.9, and (118±14)° respectively, showing significant difference when compared with preoperative ones (t=18.213, P=0.000; t=10.317, P=0.000; t=18.564, P=0.000; t=6.599, P=0.000). Postoperative X-ray film showed that joint space width at 12 months was (3.8±0.3) mm, showing significant difference when compared with preoperative one (t=10.070, P=0.000). Conclusion Joint distraction by Ilizarov combined with arthroscopic debridement can effectively relieve pain, improve the function and quality of life. It was beneficial to cartilaginous tissue repair and delaying the degenerative process of KOA. The short-term effectiveness is satisfactory.
Objective To compare the mid- and long-term effectiveness of patellar resurfacing versus non-resurfacing in primary total knee arthroplasty (TKA). Methods Twenty-six patients who underwent bilateral TKA between March 2013 and September 2015 were selected as the study subjects. One side was randomly chosen for patellar resurfacing (resurfacing group), and the other side was not (control group). There were 4 males and 22 females, the age ranged from 51 to 65 years, with an average of 59 years. According to Kellgren-Lawrence classification, there were 21 cases of grade Ⅳ and 5 cases of grade Ⅲ in both knees. There was no significant difference in the surgical side, and preoperative clinical and functional scores of the Knee Society Score (KSS), visual analogue scale (VAS) score, and the composition ratio of anterior knee pain localization points between the two groups (P>0.05). The operation time, intraoperative blood loss, postoperative abnormal signs such as patellar clunk, feeling of constraint, patellar tendon weakness, crepitus, or snow-on-glass sensation, and the occurrence of complications were recorded and compared. Patient subjective evaluations included Forgotten Joint Score (FJS) and the degree of difficulty in high-level knee activities (including flexion with load bearing, going upstairs, going downstairs, squatting and standing up, kneeling, knee extension, and crossing legs for 7 items); KSS clinical/functional scores and VAS scores were used to evaluate the recovery of knee joint function, and the location of anterior knee pain was determined by a localization diagram. Results The operation time of the resurfacing group was significantly longer than that of the control group (P<0.05), and there was no significant difference in intraoperative blood loss between the two groups (P>0.05). All patients’ incisions healed by first intention; the hospital stay ranged from 8 to 23 days, with an average of 12.6 days. All patients were followed up 9-11 years, with an average of 9.7 years. Except for 1 case who died of multiple organ failure due to internal diseases at 9 years after operation and 5 cases with incomplete radiological data, the rest 20 patients were assessed radiologically and found that 1 side of the knee joint in the control group had patellar dislocation; the remaining patients had no prosthetic failure (fracture, loosening, displacement, etc.), patellar fracture, patellar necrosis, patellar instability, patellar tendon rupture, prosthetic revision, etc. No patients had reoperations due to patellar-related complications or anterior knee pain in both knee joints. At 2 years postoperatively and at last follow-up, there was no significant difference in the incidence of abnormal signs such as patellar clunk, feeling of constraint, patellar tendon weakness, crepitus, or snow-on-glass sensation, the incidence of high-level knee activity difficulty, and the composition ratio of anterior knee pain localization between the two groups (P>0.05). The KSS clinical scores, functional scores, and VAS scores of both groups significantly improved compared to preoperative ones (P<0.05); there was no significant difference in the comparison between the two groups at the two time points postoperatively (P>0.05). At 2 years postoperatively and at last follow-up, there was no significant difference in FJS scores between the two groups (P>0.05). ConclusionPatellar resurfacing or not has similar mid- and long-term effectiveness in primary TKA.
Objective To investigate the correlation of elderly knee osteoarthritis with bone marrow edema and osteoprotegerin, DKK-1 (dickkopf-1), sclerostin. Methods A total of 100 elderly patients with knee osteoarthritis in Sichuan Province Orthopedic Hospital from September 2017 to December 2018 were selected and divided into bone marrow edema group (50 cases) and non-bone marrow edema group (50 cases). The patients’ basic data, Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scores and Visual Analogue Scale scores were collected. The patients’ serum osteoprotegerin, DKK-1, sclerostin, C-reactive protein, and erythrocyte sedimentation rate were tested, and the differences between the two groups were compared. The correlation of the detection indicators and bone marrow edema and its clinical indicators was explored. Results There was no significant difference in age, gender, course of disease, C-reactive protein and erythrocyte sedimentation rate between the two groups (P>0.05). WOMAC scores (76.1±5.4 vs. 67.5±6.6), Visual Analogue Scale scores (8.4±1.1 vs. 5.5±0.9), proportion of synovitis (84.0% vs. 52.0%), osteoprotegerin [(1.3±1.1) vs. (0.6±0.5) μg/L], DKK-1 [(18.4±16.9) vs. (6.9±6.0) μg/L] and sclerostin [(147.3±119.4) vs. (99.7±70.7) pg/mL] in the bone marrow edema group were higher than those in the non-bone marrow edema group (P<0.05). There was no statistically significant correlation of the bone marrow edema volume score and degree score and serum osteoprotegerin of patients in the bone marrow edema group (P>0.05). The bone marrow edema volume score and degree score of patients in the bone marrow edema group were positively correlated with serum DKK-1 (volume score rs=0.464, P=0.001; degree score rs=0.379, P=0.007) and sclerostin (volume score rs=0.316, P=0.025; degree score rs=0.461, P=0.003). Conclusion In elderly patients with knee osteoarthritis and bone marrow edema, the local bone metabolism indicators of osteoprotegerin, DKK-1 and sclerostin are up-regulated, especially DKK-1 and sclerostin are related to the severity of bone marrow edema.