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.
【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 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 a common chronic degenerative osteoarthritic disease with a high incidence especially among middle-aged and elderly people, and patients with KOA usually suffer from joint pain and dyskinesia, which is disabling and seriously affects their quality of life. Acupotomy therapy, as one of the characteristic treatments of traditional Chinese medicine, has been proven to significantly reduce the pain of KOA patients and effectively slow down the rapid deterioration of the disease. Therefore, this article reviews the pathogenic factors of KOA and explores the mechanism of action of acupotomy therapy for KOA from the perspectives of mechanical structure, level of inflammatory factors, cartilage repair, and cellular autophagy and apoptosis, in order to provide a more solid theoretical basis and therapeutic strategy for the application of acupotomy therapy in the clinical practice of KOA.
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.
A novel structural dynamics test method and device were designed to test the biomechanical effects of dynamic axial loading on knee cartilage and meniscus. Firstly, the maximum acceleration signal-to-noise ratio of the experimental device was calculated by applying axial dynamic load to the experimental device under unloaded condition with different force hammers. Then the experimental samples were divided into non-specimen group (no specimen loaded), sham specimen group (loaded with polypropylene samples) and bovine knee joint specimen group (loaded with bovine knee joint samples) for testing. The test results show that the experimental device and method can provide stable axial dynamic load, and the experimental results have good repeatability. The final results confirm that the dynamic characteristics of experimental samples can be distinguished effectively by this device. The experimental method proposed in this study provides a new way to further study the biomechanical mechanism of knee joint structural response under axial dynamic load.
Knee osteoarthritis (KOA) is the most common degenerative joint disease and one of the most disabling diseases in China, causing a huge economic burden to patients, families and society. Standardized KOA rehabilitation treatment is an important means to prevent and treat the disease and promote the development of high-quality medical services. This guideline was updated based on the 2016 and 2019 editions, and was initiated by the Chinese Medical Association Physical Medicine and Rehabilitation Branch and West China Hospital of Sichuan University. The guideline development was guided by domestic and international guideline development methods and principles, and 11 core clinical issues in two categories (rehabilitation assessment and treatment) were selected through clinical issue screening and deconstruction, and multiple rounds of Delphi questionnaire consultation. The International Classification of Functioning, Disability and Health (ICF) was used as the theoretical framework, and the Grading of Recommendations Assessment, Development and Evaluation (GR) was used based on the best available evidence. The International Classification of Functioning, Disability and Health (ICF) is a theoretical framework based on the best available evidence, and uses the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method to grade the quality of evidence and recommendations, and reports them according to the Reporting Items for Practice Guidelines in Healthcare (RIGHT), taking into account patients' preferences and values and the needs of Chinese clinical practice, resulting in 11 key points and 28 recommendations to systematically standardize the rehabilitation of knee osteoarthritis.
ObjectiveTo explore the clinical efficacy of the ultrasound-guided intra-articular injection of platelet-rich plasma (PRP) in the treatment of patients with different stages of knee osteoarthritis.MethodsWe retrospectively analyzed the clinical characteristics and X-ray data of patients with knee osteoarthritis who received ultrasound-guided intra-articular injection of PRP in the Department of Rehabilitation Medicine at Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University between May 2018 and June 2019. The patients were grouped according to the Kellgren & Lawrence Classification (K&L 0, Ⅰ, Ⅱ, Ⅲ, and Ⅳ). All the patients received four injections with a one-week interval. The Visual Analogue Scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were used to evaluate the clinical efficacy before the injection, and 3 and 6 months after the injection. Adverse reactions were recorded.ResultsA total of 102 patients were included without any grade 0 cases. There were 20 patients in K&L Ⅰ group, 37 in Ⅱ group, 31 in Ⅲ group, and 14 in Ⅳ group. No adverse event was reported. Significant differences of VAS scores and WOMAC index were observed in Ⅰ, Ⅱ and Ⅲ groups at the 3rd and 6th month follow-up (P<0.05). VAS and WOMAC scores of the three groups at the 3rd and 6th month after the treatment were significantly improved compared with those before the treatment (P<0.05). There was no significant difference in VAS score at the 3rd or 6th month after the treatment three groups (P>0.05). For K&L Ⅰ group, there was no statistically significant difference in WOMAC score at the 3rd or 6th month after the treatment (P>0.05). However, the WOMAC scores at the 3rd month after the treatment were better than those at the 6th month in K&L Ⅱ and Ⅲ groups (P<0.05). There was no significant time-depended changes in VAS score or WOMAC score in K&L Ⅳ group (P>0.05).ConclusionThe ultrasound-guided intra-articular PRP injection is safe and effective for pain relief and function improvement in patients with knee osteoarthritis at the early and middle stage.
Objective To explore the effects of intra-articular injection of platelet-rich plasma (PRP) on improving pain, joint function, and muscle strength of knee osteoarthritis (KOA). Methods From March 2017 to August 2019, 100 cases of KOA diagnosed and treated in the First Affiliated Hospital of Harbin Medical University were selected. They were divided into intervention group and control group with 50 cases in each group by random number table method. The patients in the intervention group were given intra-articular injection of PRP (5 mL/time, 1 time/week, 6 times in total) combined with isokinetic strength training (2 times/d, 3 d/week, for 12 consecutive weeks) treatment, and the patients in the control group were given intra-articular injection of sodium hyaluronate (2 mL/time, 1 time/week, for 12 consecutive weeks) combined with isokinetic strength training (2 times/d, 3 d/week, for 12 consecutive weeks). The incidence of adverse reactions during the treatment process and the clinical efficacy at 12 weeks of treatment and 6 months after treatment were recorded, and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scoring system was used to evaluate the knee joint function. When the isokinetic strength training instrument measured an angle of 90°/s, the knee joint flexor and extensor peak torque (PT), total work (TW), and average power (AP) were recorded. Results Forty-nine patients of each group completed the study. The between-group differences in WOMAC pain, stiffness, and joint function scores, and extensor and flexor PT, TW, and AP before treatment were not statistically significant (P>0.05). At 12 weeks of treatment and 6 months after treatment, the WOMAC scores of pain, stiffness, and joint function in the two groups were lower than those before treatment (P<0.05), and the extensor and flexor PT, TW, and AP were higher than those before treatment (P<0.05). Six months after treatment, the WOMAC scores of pain, stiffness, and joint function in the intervention group were lower than those in the control group (P<0.05), and the extensor and flexor PT, TW, and AP in the intervention group were higher than those in the control group (P<0.05). There was no significant difference in the effective rate between the two groups at 12 weeks of treatment (95.9% vs. 89.8%, P>0.05). The effective rate in the intervention group was higher than that in the control group 6 months after treatment (93.9% vs. 79.6%, P<0.05). No serious adverse reaction occurred in the two groups during the treatment. Conclusion Intra-articular injection of PRP can reduce pain, improve muscle strength, and improve joint function in patients with KOA, and the long-term effect is better than that of conventional drugs.
ObjectiveTo systematically evaluate the risk prediction model of knee osteoarthritis (KOA). MethodsThe CNKI, WanFang Data, VIP, PubMed, Embase, Web of Science and Cochrane Library databases were electronically searched to collect relevant studies on KOA’s risk prediction model from inception to April, 2024. After study screening and data extraction by two independent researchers, the PROBAST bias risk assessment tool was used to evaluate the bias risk and applicability of the risk prediction model. ResultsA total of 12 studies involving 21 risk prediction models for KOA were included. The number of predictors ranged from 3 to 12, and the most common predictors were age, sex, and BMI. The range of modeling AUC included in the model was 0.554-0.948, and the range of testing AUC was 0.6-0.94. The overall predictive performance of the models was mediocre and the risk of overall bias was high, and more than half of the models were not externally verified. ConclusionAt present, the overall quality and applicability of the KOA morbidity risk prediction model still have great room for improvement. Future modeling should follow the CHARMS and PROBAST to reduce the risk of bias, explore the combination of multiple modeling methods, and strengthen the external verification of the model.