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Total knee replacement and non-surgical treatment of knee osteoarthritis: 2-year outcome from two parallel randomized controlled trials.
Skou, ST, Roos, EM, Laursen, MB, Rathleff, MS, Arendt-Nielsen, L, Rasmussen, S, Simonsen, O
Osteoarthritis and cartilage. 2018;(9):1170-1180
Abstract
OBJECTIVES To compare 2-year outcomes of total knee replacement (TKR) followed by non-surgical treatment to that of non-surgical treatment alone and outcomes of the same non-surgical treatment to that of written advice. DESIGN In two randomized trials, 200 (mean age 66) adults with moderate to severe knee osteoarthritis (OA), 100 eligible for TKR and 100 not eligible for TKR, were randomized to TKR followed by non-surgical treatment, non-surgical treatment alone, or written advice. Non-surgical treatment consisted of 12 weeks of supervised exercise, education, dietary advice, use of insoles, and pain medication. The primary outcome was the mean score of the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales, covering pain, symptoms, activities of daily living (ADL), and quality of life (QOL). RESULTS Patients randomized to TKR had greater improvements than patients randomized to non-surgical treatment alone (difference of 18.3 points (95% CI; 11.3 to 25.3)), who in turn improved more than patients randomized to written advice (difference of 7.0 points (95% CI; 0.4 to 13.5)). Among patients eligible for TKR, 16 (32%) from the non-surgical group underwent TKR during 2 years and among those initially ineligible, seven patients (14%) from the non-surgical group and ten (20%) from the written advice group underwent TKR. CONCLUSIONS TKR followed by non-surgical treatment is more effective on pain and function than non-surgical treatment alone, which in turn is more effective than written advice. Two out of three patients with moderate to severe knee OA eligible for TKR delayed surgery for at least 2 years following non-surgical treatment. TRIAL REGISTRATION ClinicalTrials.gov numbers NCT01410409 and NCT01535001.
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Bath thermal waters in the treatment of knee osteoarthritis: a randomized controlled clinical trial.
Branco, M, Rêgo, NN, Silva, PH, Archanjo, IE, Ribeiro, MC, Trevisani, VF
European journal of physical and rehabilitation medicine. 2016;(4):422-30
Abstract
BACKGROUND Osteoarthritis is a degenerative disease associated with pain, reduced range of motion, and impaired function. Balneotherapy or bathing in thermal or mineral waters is used as a non-invasive treatment for various rheumatic diseases. AIM: To evaluate the effectiveness of hot sulfurous and non-sulfurous waters in the treatment of knee osteoarthritis. DESIGN A randomized, assessor-blind, controlled trial. SETTING A spa resort. POPULATION One hundred and forty patients of both genders, mean age of 64.8±8.9 years, with knee osteoarthritis and chronic knee pain. METHODS Patients were randomized into three groups: the sulfurous water (SW) group (N.=47), non-sulfurous water (NSW) group (N.=50), or control group (N.=43) who received no treatment. Patients were not blinded to treatment allocation. Treatment groups received 30 individual thermal baths (three 20-minute baths a week for 10 weeks) at 37-39 °C. The outcome measures were pain (visual analog scale, VAS), physical function (Western Ontario and McMaster Universities Osteoarthritis Index, WOMAC; Lequesne Algofunctional Index, LAFI; Stanford Health Assessment Questionnaire, HAQ), and use of pain medication. Patients were assessed before treatment (T1), at treatment endpoint (T2), and two months post-intervention (T3). Intra- and intergroup comparisons were performed at a significance level of 0.05 (P<0.05). RESULTS A significant decrease in VAS pain scores (pain during movement, at rest, and at night) and use of pain medication, and improvement in WOMAC, LAFI and HAQ scores were observed from baseline to T2 and T3 within treatment groups (P<0.001), and between controls and both treatment groups at T2 and T3 (P<0.001). No significant differences in these variables were observed between treatment groups at T2, but patients in the SW group reported less pain and better functional status than those in the NSW group at T3, showing a lasting effect of sulfurous water baths. CONCLUSIONS Both therapeutic methods were effective in the treatment of knee osteoarthritis; however, sulfurous baths yielded longer-lasting effects than non-sulfurous water baths. CLINICAL REHABILITATION IMPACT Baths in thermal waters, especially those in sulfurous waters, are effective in reducing pain and improving physical function in patients with knee osteoarthritis.
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Femoral Head Penetration of Vitamin E-Infused Highly Cross-Linked Polyethylene Liners: A Randomized Radiostereometric Study of Seventy Hips Followed for Two Years.
Shareghi, B, Johanson, PE, Kärrholm, J
The Journal of bone and joint surgery. American volume. 2015;(16):1366-71
Abstract
BACKGROUND Highly cross-linked polyethylene infused with vitamin E (E-poly) was developed to increase oxidative resistance without affecting mechanical properties. We evaluated this type of polyethylene in a randomized clinical study that used radiostereometric analysis. Our objective was to compare the early-term femoral head penetration of an E-poly liner with that of a heat-treated polyethylene liner, ArComXL. We hypothesized that the clinical outcome at two years following total hip arthroplasty would be unaffected by the choice of polyethylene. METHODS In this prospective study, sixty-one patients (seventy hips) with noninflammatory hip osteoarthritis and a median age of fifty-eight years were randomized to receive either an implant with an E-Poly or a heat-treated highly cross-linked polyethylene liner. The patients were followed for two years and evaluated at three time points (three months, one year, and two years). RESULTS The median proximal penetration in the E-poly group increased from 0.04 mm at three months to 0.06 mm at two years of follow-up. Corresponding values for the ArComXL group were 0.03 mm and 0.10 mm. In both groups, significantly increased penetration was observed between three months and two years (E-poly, p = 0.02; ArComXL, p < 0.001), but between one and two years, the increase was significant only in the control group (E-poly, p = 0.23; ArComXL, p = 0.002). CONCLUSIONS The femoral head penetration of E-poly was very low at two years. Whether the increase observed between three months and two years was caused by creep, deformation, wear, or a combination of these cannot be determined by our study. There were no significant differences observed in femoral head penetration rates between E-poly and ArComXL. Currently, the theoretical advantages of E-poly remain to be confirmed.
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Multiple psychological factors are associated with poorer functioning in a sample of community-dwelling knee osteoarthritis patients.
Sinikallio, SH, Helminen, EE, Valjakka, AL, Väisänen-Rouvali, RH, Arokoski, JP
Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases. 2014;(5):261-7
Abstract
BACKGROUND Knee osteoarthritis (OA) is the most common type of arthritis and imposes a heavy burden on individual welfare among elderly people. There is preliminary evidence that psychological factors play a role in functional ability and pain in knee OA patients, particularly with respect to the surgery outcome. Less is known about psychological factors among community-dwelling patients with knee OA. OBJECTIVES We aimed to determine which psychological factors are associated with pain and functional ability among community-dwelling knee OA patients using a comprehensive set of psychological questionnaires. METHODS In the cross-sectional baseline setting of a prospective, randomized controlled intervention study, 111 patients aged from 35 to 75 years with clinical symptoms and radiographic grading of knee OA were included. They completed a comprehensive set of psychological questionnaires, including measures of resources and coping, fear and catastrophizing, and distress. RESULTS In cross-sectional comparisons, pain self-efficacy, fear of movement, pain catastrophizing, and elevated anxiety were associated with pain and a poorer functional ability. In logistic regression analysis, independent association was seen between pain self-efficacy and poorer functioning. Knee OA patients also reported elevated levels of anxiety. CONCLUSIONS The results reveal that both pain self-efficacy and negatively charged emotion and expectations toward pain are important factors when dealing with knee OA patients. Failure to consider these will probably contribute to prolonged disability and further pain. The results call for the routine assessment of multiple psychological factors in knee OA.
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Biomechanical properties of the plantar flexor muscle-tendon complex 6 months post-rupture of the Achilles tendon.
McNair, P, Nordez, A, Olds, M, Young, SW, Cornu, C
Journal of orthopaedic research : official publication of the Orthopaedic Research Society. 2013;(9):1469-74
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Abstract
We compared the effects of a non-weight bearing protocol (NWB) and a weight bearing (WB) protocol on energy stored, stiffness, and shock absorption in the plantar flexor muscle-tendon unit of patients managed non-operatively following an Achilles tendon rupture. Thirty-eight subjects were randomized to a WB cast fitted with a Bohler iron or a traditional non-weight-bearing cast. At a 6-month follow-up, a biomechanical assessment utilizing an isokinetic dynamometer allowed measurement of peak passive torque, energy stored, shock absorption, and stiffness. The WB group had greater peak passive torque (≈ 20%). Irrespective of group, peak passive torque in unaffected legs was greater (≈ 26%) than affected legs. Across the groups, energy stored in the NWB group was 74% of the WB group. The energy stored in affected legs was 80% of that in unaffected legs. Shock absorption was not significantly different across legs or groups. Irrespective of group, affected legs had significantly less stiffness (20-40%). While the augmentation of plaster with a Bohler iron to allow increased weight bearing had positive effects, deficits in affected compared to unaffected legs irrespective of group were notable, and should be addressed prior to participation in vigorous physical activities.
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Effects of eccentric exercise on systemic concentrations of pro- and anti-inflammatory cytokines and prostaglandin (E2): comparison between young and postmenopausal women.
Conceição, MS, Libardi, CA, Nogueira, FR, Bonganha, V, Gáspari, AF, Chacon-Mikahil, MP, Cavaglieri, CR, Madruga, VA
European journal of applied physiology. 2012;(9):3205-13
Abstract
The present study aimed to analyze the magnitude of muscle damage and inflammatory responses induced by eccentric exercise in young (YW) and postmenopausal women (PMW). Seventeen healthy women (nine YW, 23.89 ± 2.03 years; and eight PMW, 51.13 ± 5.08 years) performed five sets of six maximal eccentric actions of the elbow flexors. Changes in isometric strength, range of motion, muscle soreness, and upper-arm circumference were evaluated pre, post, 24, 48, and 72 h following eccentric exercise. Changes in creatine kinase activity, interleukin 6 (IL-6), interleukin 10 (IL-10), tumor necrosis factor-α (TNF-α), and prostaglandin E(2) (PGE(2)) were measured pre, 24, 48, and 72 h following eccentric exercise. For intra and inter-group analysis, a two-way repeated measures ANOVA was applied followed by a Tukey's post hoc test. Pearson's correlation was used to analyze the correlations between variables. It was observed no differences between groups for the markers of muscle damage, although significant modifications (p < 0.05) occurred within groups throughout time for all variables. Post menopausal women showed significantly higher values for TNF-α (p < 0.05). Also, IL-6 presented superior pre value for PMW. For YW, IL-6 and IL-10 values increased 72 h post-eccentric exercise compared to pre. Further, IL-10 was higher for YW than PMW 72 h post-eccentric exercise. Significant correlations (p < 0.05) were found between age and soreness, and between age and PGE(2). In conclusion, YW do not have attenuated muscle damage compared to PMW who do not make use of hormonal replacement therapy. In addition, YW have a greater anti-inflammatory response after eccentric exercise compared to PMW.
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Comparison in eccentric exercise-induced muscle damage among four limb muscles.
Chen, TC, Lin, KY, Chen, HL, Lin, MJ, Nosaka, K
European journal of applied physiology. 2011;(2):211-23
Abstract
This study tested the hypothesis that changes in indirect markers of muscle damage following maximal eccentric exercise would be smaller for the knee extensors (KE) and flexors (KF) compared with the elbow flexors (EF) and extensors (EE). A total of 17 sedentary men performed five sets of six maximal isokinetic (90° s(-1)) eccentric contractions of EF (range of motion, ROM: 90°-0°, 0 = full extension), EE (55°-145°), KF (90°-0°), and KE (30°-120°) using a different limb with a 4-5-week interval in a counterbalanced order. Changes in maximal isometric and concentric isokinetic strength, optimum angle, limb circumference, ROM, plasma creatine kinase activity and myoglobin concentration, muscle soreness, and echo-intensity of B-mode ultrasound images before and for 5 days following exercise were compared amongst the four exercises using two-way repeated-measures ANOVA. All variables changed significantly following EF, EE, and KF exercises, but KE exercise did not change the optimum angle, limb circumference, and echo-intensity. Compared with KF and KE, EF and EE showed significantly greater changes in all variables, without significant differences between EF and EE. Changes in all variables were significantly greater for KF than KE. For the same subjects, the magnitude of change in the dependent variables following exercise varied among the exercises. These results suggest that the two arm muscles are equally more susceptible to muscle damage than leg muscles, but KF is more susceptible to muscle damage than KE. The difference in the susceptibility to muscle damage seems to be associated with the use of muscles in daily activities.
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Effect of topical aerosol skin refrigerant (spray and stretch technique) on passive and active stretching.
Kostopoulos, D, Rizopoulos, K
Journal of bodywork and movement therapies. 2008;(2):96-104
Abstract
OBJECTIVES The purpose of this study was to examine the effects of the use of a vapocoolant blend of pentafluoropropane and tetrafluoroethane (Gebauer's Spray and Stretch) on hip flexion stretching. METHODS Thirty volunteers were randomly assigned to spray and stretch treatment and stretch only control groups. Each group was assessed pre- and posttest on passive and active hip flexion range of motion (ROM). RESULTS Findings indicated greater posttest hip flexion gains for the spray and stretch group over the stretch only group for both active and passive ROM. Additionally, females achieved greater pre- and posttest differences on active ROM compared to males. CONCLUSIONS Study findings suggest that spray and stretch techniques can be an effective treatment in increasing hip flexion ROM.
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Systemic inflammatory responses to maximal versus submaximal lengthening contractions of the elbow flexors.
Peake, JM, Nosaka, K, Muthalib, M, Suzuki, K
Exercise immunology review. 2006;:72-85
Abstract
We compared changes in markers of muscle damage and systemic inflammation after submaximal and maximal lengthening muscle contractions of the elbow flexors. Using a cross-over design, 10 healthy young men not involved in resistance training completed a submaximal trial (10 sets of 60 lengthening contractions at 10% maximum isometric strength, 1 min rest between sets), followed by a maximal trial (10 sets of three lengthening contractions at 100% maximum isometric strength, 3 min rest between sets). Lengthening contractions were performed on an isokinetic dynamometer. Opposite arms were used for the submaximal and maximal trials, and the trials were separated by a minimum of two weeks. Blood was sampled before, immediately after, 1 h, 3 h, and 1-4 d after each trial. Total leukocyte and neutrophil numbers, and the serum concentration of soluble tumor necrosis factor-alpha receptor 1 were elevated after both trials (P < 0.01), but there were no differences between the trials. Serum IL-6 concentration was elevated 3 h after the submaximal contractions (P < 0.01). The concentrations of serum tumor necrosis factor-alpha, IL-1 receptor antagonist, IL-10, granulocyte-colony stimulating factor and plasma C-reactive protein remained unchanged following both trials. Maximum isometric strength and range of motion decreased significantly (P < 0.001) after both trials, and were lower from 1-4 days after the maximal contractions compared to the submaximal contractions. Plasma myoglobin concentration and creatine kinase activity, muscle soreness and upper arm circumference all increased after both trials (P < 0.01), but were not significantly different between the trials. Therefore, there were no differences in markers of systemic inflammation, despite evidence of greater muscle damage following maximal versus submaximal lengthening contractions of the elbow flexors.
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Masticatory motion after surgical or nonsurgical treatment for unilateral fractures of the mandibular condylar process.
Throckmorton, GS, Ellis, E, Hayasaki, H
Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons. 2004;(2):127-38
Abstract
PURPOSE We sought to compare mandibular motion during mastication in patients treated in either an open or a closed fashion for unilateral fractures of the mandibular condylar process. PATIENTS AND METHODS Eighty-one male patients with unilateral condylar process fractures were treated either with (n = 37) or without (n = 44) surgical reduction and rigid fixation of their condylar process fractures. At 6 weeks, 6 months, 1 year, and 2 years after treatment, the subjects' chewing cycles were recorded using a magnetic sensor array (Sirognathograph; Siemens Corp, Bensheim, Germany) while chewing Gummi-Bears (HARIBO, Bonn, Germany) unilaterally on the same side as the fracture and on the opposite side. The chewing cycles were analyzed using a custom computer program, and the duration, excursive ranges, and 3-dimensional cycle shape were compared between the 2 treatment groups at each time interval using multilevel linear modeling statistics. RESULTS The 2 treatment groups did not differ significantly for any measure of cycle duration or any excursive range (except lateral excursions at 1 year post-treatment) at any of the time intervals. However, the 3-dimensional cycle shapes of the 2 groups did differ significantly at all time intervals. CONCLUSION Surgical correction of unilateral condylar process fractures has relatively little effect on the more standard measures (duration and excursive ranges) of masticatory function. However, surgical correction better normalizes opening incisor pathways during mastication on the side opposite the fracture.