The role of physiotherapy after total knee arthroplasty in patients with haemophilia

Summary. With the availability of clotting factor concentrates, advances in surgical techniques, better implant design, and improvements in postoperative management, total knee arthroplasty has become the treatment of choice for haemophilia patients suffering from end‐stage haemophilic knee arthropathy. The success of this surgery is also dependent on close collaborations among the orthopaedic surgeon, the haematologist and the physiotherapist. Although haemophilic patients undergoing this surgery would likely benefit from a targeted rehabilitation programme, its specificities, modalities and limitations have thus far not been extensively studied. Employing the published data of rehabilitation after knee prosthesis in patients with osteoarthritis and haemophilic arthropathy along with clinical experience, the authors present a comprehensive and original review of the role of physiotherapy for patients with haemophilia undergoing knee arthroplasty.     

Cardiovascular benefits of bariatric surgery in morbidly obese patients

Morbid obesity is associated with increased morbidity and represents a major healthcare problem with increasing incidence worldwide. Bariatric surgery is considered an effective option for the management of morbid obesity. We searched MEDLINE, Current Contents and the Cochrane Library for papers published on bariatric surgery in English from 1 January 1990 to 20 July 2010. We also manually checked the references of retrieved articles for any pertinent material. Bariatric surgery results in resolution of major comorbidities including type 2 diabetes mellitus, hypertension, dyslipidemia, metabolic syndrome, non‐alcoholic fatty liver disease, nephropathy, left ventricular hypertrophy and obstructive sleep apnea in the majority of morbidly obese patients. Through these effects and possibly other independent mechanisms bariatric surgery appears to reduce cardiovascular morbidity and mortality. Laparoscopic Roux‐en‐Y gastric bypass (LRYGB) appears to be more effective than laparoscopic adjustable gastric banding (LAGB) in terms of weight loss and resolution of comorbidities. Operation‐associated mortality rates after bariatric surgery are low and LAGB is safer than LRYGB. In morbidly obese patients bariatric surgery is safe and appears to reduce cardiovascular morbidity and mortality.     

Should synovectomy be performed during total knee arthroplasty for knee osteoarthritis: A protocol for systematic review and meta-analysis

Background:To evaluate the effect of synovectomy performed during primary total knee arthroplasty for knee osteoarthritis on patients’ postoperative pain and knee function.Methods:We will search the following electronic databases from inception to June 2021, including PubMed, EMBASE, Web of Science, the Cochrane Library, the China National Knowledge Infrastructure, the Chinese Scientific Journals Database, the Wanfang database, and the Chinese Biomedicine Database. Eligible references will be all randomized controlled trials of initial total knee arthroplasty for primary knee osteoarthritis with or without synovectomy. Two reviewers will independently extract the data. Reviewer Manager 5.3 software will be used for statistical analysis.Result:It will provide results on the short- and long-term efficacy and safety of synovectomy in total knee arthroplasty by various comprehensive assessments.Conclusion:This study will provide solid evidence on whether and when synovectomy treatment should be performed during total knee arthroplasty.     

Proprioceptive training on the recovery of total knee arthroplasty patients: A meta-analysis protocol of randomized controlled trial

Background:Total knee arthroplasty is a common surgery for end-stage of knee osteoarthritis. Proprioceptive training has become an important part in athletes training programmes in different sports. However, the effects of proprioceptive training on the recovery of total knee arthroplasty were unknown. This meta-analysis, with its comprehensive and rigorous methodology, will provide better insight into this problem.Methods and analysis:Electronic databases including PubMed, EMBASE, Web of Science, China National Knowledge Infrastructure (CNKI) database, Wanfang Database and Chinese Biomedical Literature Database (CBM) were searched from its inception to October 21, 2020. We only included proprioceptive training vs placebo in patients after total knee arthroplasty and pooled results were summarized by STATA 12.0 software. Two researchers independently selected the study and assessed the quality of the included studies. The heterogeneity was measured by I² tests (I² < 50 indicates little heterogeneity, I² ≥ 50 indicates high heterogeneity). Publication bias was ruled out by funnel plot and statistically assessed by Beggs test (P > .05 as no publication bias).Results:Results will be published in relevant peer-reviewed journals.Conclusion:Our study aims to systematically present the clinical effects of proprioceptive training after total knee arthroplasty patients, which will be provide clinical guidance for total knee arthroplasty patients.     

Current status of bariatric surgery in the treatment of type 2 diabetes

Bariatric surgery (from the Greek words baros meaning ‘weight’ and iatrikos‘the art of healing’) is a rapidly evolving branch of surgical science. The aim is to induce major weight loss in those whose obesity places them at high risk of serious health problems. In an attempt to balance the risks of surgery against the benefits of weight loss, bariatric operations are currently performed only in the morbidly obese, or those with a body mass index (BMI) > 35 kgm^?2 who already have developed comorbidity such as type 2 diabetes. Although weight loss is beneficial for obese patients with diabetes, current medical treatment for obesity is difficult. In contrast, observational studies show a major impact of bariatric surgery on diabetes, raising the question whether this approach should be used more widely to treat diabetes in obese patients? If bariatric surgery were shown to be the best way to treat diabetes in obese subjects the implications for health services would be wide‐ranging. Bariatric surgery leads to withdrawal of diabetic treatment in about 60% or more of patients, and reductions of therapy for many others. Although data on bariatric surgery in subjects with diabetes are provocative, most studies have been uncontrolled or flawed in other ways. Most importantly, bariatric surgery has not yet been compared against standard medical treatment for diabetes in randomized controlled trials with diabetes‐specific endpoints in all relevant patient groups. Potential indications for bariatric surgery are discussed, and the unanswered questions that need to be addressed by clinical trials are summarized. Although small numbers of patients may be interested in bariatric surgery for type 2 diabetes, current data are insufficient to endorse its wide scale use for this indication. Until essential studies are undertaken the role and economics of bariatric surgery in the diabetic clinic will remain uncertain.     

Personality Subtypes in Female Pre‐Bariatric Obese Patients: Do They Differ in Eating Disorder Symptoms,Psychological Complaints and Coping Behaviour?

In the pre‐bariatric psychological assessment of 102 morbidly obese women, two personality subtypes emerged: a resilient/high functioning subtype with a ‘normal’ personality profile and an emotional dysregulated/undercontrolled subtype, characterized by high neuroticism and low extraversion/conscientiousness. Emotional dysregulated/undercontrolled patients showed more concerns about eating/weight/shape, more binge eating driven by emotions and external triggers, more psychological complaints (such as depression and anxiety) and more avoidance and depressive coping reactions than resilient/high functioning patients. Further research should clarify whether these clearly different psychological profiles are related to different outcomes (weight loss or well‐being) of bariatric surgery. Copyright © 2012 John Wiley & Sons, Ltd and Eating Disorders Association.     

Bariatric Surgery Prior to Total Joint Arthroplasty,Does it Decrease the Risk of Obesity Related Perioperative Complications?

Purpose of Review

The purpose of this review paper is to provide an overview of the relationship between obesity, osteoarthritis, arthroplasty outcomes, and the potential use of bariatric surgery to improve these outcomes.

Recent Findings

Unfortunately, the findings in the currently available literature evaluating the role of bariatric surgery prior to arthroplasty surgery largely rely on retrospective data and their results are somewhat conflicting.

Summary

Future prospective studies are needed to further evaluate whether or not bariatric surgery prior to arthroplasty surgery may be of benefit for patients. Additional research is needed to identify other methods to minimize complications that obese patients are particularly prone to developing following arthroplasty surgery.

     

Thermotherapy for knee osteoarthritis: A protocol for systematic review

Background:Osteoarthritis of the knee is one of the leading causes of pain and disability among adults. Thermotherapy has been widely used to treat knee osteoarthritis. But its efficiency has not been scientifically and methodically evaluated. The aim of this study is to assess the benefits of thermotherapy for people with osteoarthritis of the knee, in terms of pain, stiffness, and physical dysfunction.Methods:Eight databases will be searched from their inception to September 2020. They are as follows: PubMed, Embase, Cochrane Library, ClinicalTrials.gov, China Knowledge Resource Integrated Database (CNKI), Weipu Database for Chinese Technical Periodicals (VIP), Chinese Biomedical Literature Database (CBM), and Wanfang Database. Two researchers will independently select studies, collect data, and assess the methodology quality by the Cochrane risk of bias tool.Results:The systematic review will provide high-quality evidence to assess the benefits and harms of thermotherapy for people with osteoarthritis of the knee, in terms of pain, stiffness, and dysfunction of knee joint, and quality of life, as well as adverse events.Conclusion:The systematic review will provide evidence to assess the effectiveness and safety of thermotherapy for knee osteoarthritis patients.INPLASY registration number:INPLASY202140038.     

A case report of ultrasound-guided knee nerve pulse radiofrequency combined with platelet-rich plasma in the treatment of knee osteoarthritis

Rationable:Knee osteoarthritis (KOA) is a disease characterized by noninflammatory degenerative changes of articular cartilage. The main clinical manifestations are joint pain and stiffness. Pulsed radiofrequency (PRF) is thought to treat pain by destroying nerve tissue and changing the physical characteristics of nerve tissue membrane.Patient concerns:The patients presents with joint pain and tenderness. Touching around the knee joint will induce pain and joint stiffness when the hand is pressed hard.Interventions:Four patients with knee osteoarthritis underwent pulsed radiofrequency thermocoagulation in the knee joint cavity under ultrasound guidance and injected 2 mL of 10 mg/mL platelet-rich plasma into the joint cavity once a week for a total of 4 times. Record the patient''s Visual Analogue Scale (VAS) score and the degree of knee movement limitation before treatment, 1, 3, and 6 months after treatment.Diagnoses:Four patients with knee osteoarthritis.Outcomes:After treatment, the patient''s VAS score improved, and the knee joint mobility function recovered well. Ultrasound-guided knee nerve pulse radiofrequency combined with intra-articular injection of platelet-rich plasma can effectively improve the knee joint function and reduce the pain of the patient. The clinical effect is significant, and it is worthy of clinical application.     

A meta‐analysis of the effects of bariatric surgery on fracture risk

Bariatric surgery effectively treats morbid obesity. However, the negative effect of this surgery on the bone is concerning. The aim of this meta‐analysis was to investigate the fracture risk associated with bariatric surgery in morbidly obese subjects. Relevant studies published from database inception to September 2017 were identified in PubMed, Embase and the Cochrane Library. The Newcastle‐Ottawa Scale was used to evaluate the quality of the observational studies, and the Jadad score evaluated randomized controlled trials. Among the 1003 studies initially identified, five observational trials and one randomized controlled trial were eligible for inclusion. All studies included in the meta‐analysis were considered high quality. Risk for any type of fracture was higher in the surgical group than in the non‐surgical group (risk ratio [RR] 1.29, 95% confidence interval [CI] 1.18–1.42). After surgery, the fracture risk in non‐vertebral sites was significantly increased, especially in the upper limbs (RR 1.42, 95% CI 1.08–1.87; and RR 1.68, 95% CI 1.15–2.45). Compared with those with restrictive procedures, subjects who underwent mixed restrictive and malabsorptive procedures tended to have an increased fracture risk (RR 1.54, 95% CI 0.96–2.46). To conclude, bariatric surgery is associated with an increased risk of total and non‐vertebral fractures, especially in the upper limbs.     

自拟四肢洗方对全膝关节置换术后患者疼痛及膝功能康复影响的研究

目的评估自拟四肢洗方对全膝关节置换术后患者膝关节疼痛及功能康复的影响。方法回顾性分析自2018年1月至2019年6月在复旦大学附属中山医院骨科行全膝关节置换术的患者,根据是否进行了2个疗程自拟四肢洗方的治疗,分为四肢洗方组和对照组;分析2组患者术后1、3、6月随访时的疼痛评分(VAS),膝关节功能评分(KSS)。结果四肢洗方组共纳入122例患者,对照组纳入109例,2组患者在年龄、性别、BMI、手术侧和内/外翻膝比例差异无统计学意义;四肢洗方组患者在1月和3月随访时VAS评分和KSS评分优于对照组,6月时2组差异无统计学意义。结论使用自拟四肢洗方可对全膝关节置换术后患者膝关节疼痛及功能康复有积极的意义。     

Preoperative education prior to elective knee arthroplasty surgery does not change patient outcomes

Enhanced recovery programmes have improved outcomes following elective arthroplasty surgery. There are few studies assessing the role of patient education. In our enhanced recovery programme, all patients are offered the chance to attend a preoperative education class. Not all patients attend, enabling a comparison of outcomes. We have published data demonstrating that patients undergoing hip arthroplasty have improved outcomes. In the present article, we present data for total knee arthroplasty. Using a prospectively collected database, we identified all patients undergoing elective primary total knee arthroplasty. Data were assessed to look at patient outcomes. This was analysed using non‐parametric tests. Between April 2009 and March 2013, 563 patients underwent elective total knee replacement. A total of 503 attended the class and 60 did not. Patients attending had a reduced length of stay when compared with the non‐attenders but this did not reach statistical significance (4.13 days versus 4.57 days; p = 0.118). The spread of length of stay was slightly larger in the group that attended. Our analysis demonstrated that, for these patients, there is no statistically significant difference in length of stay or outcome scores. Therefore, in tougher economic times it may be prudent to focus preoperative education on total hip arthroplasty patients if resources are limited.     

Changes in Pain Sensitization After Bariatric Surgery

Objective

To evaluate changes in pain (at the knee and elsewhere) and pain sensitization in obese subjects with knee pain who were having bariatric surgery compared with similarly obese individuals who were undergoing medical management.

Methods

This study included a cohort of subjects who were having bariatric surgery and those undergoing medical management. Knee pain severity of the more painful knee (index knee) was assessed at baseline and at 12 months using the Western Ontario and McMaster Universities Osteoarthritis Index. The pressure pain threshold (PPT) was evaluated at the index patella and the right wrist. Low patella PPT may reflect peripheral and/or central sensitization, and low wrist PPT may reflect central sensitization. The mean change in measures of pain and pain sensitization was analyzed in the surgery and medical management groups separately.

Results

A total of 45 subjects in the surgery group and 22 in the medical management group completed baseline and follow‐up visits. The mean weight loss was 32.7 kg (29.0%) and 4.6 kg (4.1%) in the surgery and medical management groups, respectively. Knee pain decreased only in the surgery group, in which the PPT at the patella improved by 38.5% (P = 0.0007) and at the wrist by 30.9% (P = 0.005). There was no significant change in PPT in the medical management group.

Conclusion

Persons who underwent bariatric surgery experienced an improvement in pain sensitization, reflected by improvements in PPT. This improvement was observed not only at the patella, but also at the wrist, suggesting that central sensitization improved after bariatric surgery.

     

Clinical and radiological profile of symptomatic knee osteoarthritis in Malaysia

Aims: To create a clinical and radiological profile of patients with symptomatic osteoarthritis of the knee in Malaysia. Methods: One hundred consecutive patients presenting with symptomatic knee osteoarthritis at a private rheumatology clinic were profiled for demographic and clinical features. Anteroposterior weight‐bearing, skyline and lateral knee X‐rays were taken. Statistical Package for Social Sciences was used for data analysis. Results: Women predominated (93%). Fifty‐eight percent of the patients reported bilateral knee pain. Difficulty in walking, climbing and squatting was high (85%, 97% and 93% respectively). Patients with knee pain had a higher BMI than controls. Radiological abnormality, related to osteoarthritis was present in 97%. Osteophytes were generally tricompartmental while joint space narrowing was less evident in the lateral tibiofemoral joint than in the medial tibiofemoral joint and the patellofemoral joint. Almost half (49%) the patients manifested radiological varus deformity The severity of radiological abnormality increased with age. Although patients with unilateral pain had milder radiological abnormality, it tended to be bilateral. Clinically detectable hip abnormality and nodal osteoarthritis were uncommon, as was radiological chondrocalcinosis. Conclusions: Patients presenting with symptomatic knee osteoarthritis to a rheumatology service had a high degree of disability, radiological abnormality and varus deformity. Radiological abnormalities were essentially bilateral and tricompartmental.     

Bariatric surgery and the kidneys

Overweight and obesity are connected with increased risk of obesity related co-morbidities, such as T2DM, hypertension, cardiovascular diseases, dyslipidaemia and others, as well as in higher risk of some malignant diseases. In obese population there is 2.5-3.3 fold increased risk of renal cell carcinoma in comparison with non-obese population of similar age. It has been proven in many studies that for severely obese patients there is no other more effective treatment of their obesity and co-morbidities than bariatric. Bariatric surgery decreases mortality risks, treat existing, obesity related co-morbidities, and can act as prevention of onset of new obesity related co-morbidities. Moreover at the end bariatric surgery lowers economic burden of health care systems. Nowadays, bariatric surgery is considered to be standard treatment option and pathway in complex management of morbidly obese patients.     

Basal GLP-1 Levels in Morbidly Obese Patients following Biliopancreatic Diversion Surgery

Background: Previous studies addressing the changes of glucagon-like peptide-1 (GLP-1) concentrations in morbidly obese patients after bariatric surgery have demonstrated conflicting results. The aim of the present study was to investigate the changes in serum GLP-1 levels 9 months after biliopancreatic diversion in morbidly obese patients without diabetes mellitus. Methods: A sample of 40 morbidly obese patients without diabetes mellitus was enrolled. Biochemical and anthropometrical evaluations were conducted at basal and 9 months after surgery. Results: The mean patient age was 46.6 ± 13.1 years, and the mean preoperative body mass index (BMI) was 47.1 ± 18.1. A significant decrease in BMI, weight, waist circumference, fat mass, glucose, LDL cholesterol, total cholesterol, and triglyceride levels was observed after 9 months. Serum basal GLP-1 levels did not change after surgery (0.65 ± 0.18 ng/ml vs. 0.66 ± 0.17 ng/ml; n.s.). Postsurgical correlation analysis showed a negative association between basal GLP-1 and HDL cholesterol (r = -0.57; p < 0.01). Conclusions: Fasting GLP-1 concentrations did not change after massive weight loss with biliopancreatic diversion in morbidly obese patients without diabetes mellitus.     

膝骨性关节炎的外科治疗选择

目的 评价膝骨性关节炎的外科治疗方法.方法 69例78膝膝骨性关节炎分别采用关节切开清理术、关节镜下清理术及膝关节置换术治疗.结果 所有病人均获得6～18月随访,优良率达87.9%.结论 对Ⅰ期、Ⅱ期OA患者,关节清理术是一种较好的方法,对Ⅲ期OA患者,膝关节置换的效果也不错.     

The effect of balneotherapy on pain relief,stiffness, and physical function in patients with osteoarthritis of the knee: a meta-analysis

This meta-analysis was performed to determine the effect of balneotherapy on relieving pain and stiffness and improving physical function, compared to controls, among patients with knee osteoarthritis. We searched electronic databases for eligible studies published from 2004 to December 31, 2016, with language restrictions of English or Japanese. We screened publications in Medline, Embase, Cochrane library, and the Japan Medical Abstracts Society Database using two approaches, MeSH terms and free words. Studies that examined the effect of balneotherapy for treating knee osteoarthritis of a ≥2-week duration were included. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were used as the outcome measure. A total of 102 publications were assessed according to the exclusion criteria of the study; eight clinical trial studies, which comprised a total of 359 cases and 375 controls, were included in this meta-analysis. The meta-analysis analyzed improvement in WOMAC score at the final follow-up visit, which varied from 2 to 12 months post-intervention. Our meta-analysis indicates that balneotherapy was clinically effective in relieving pain and stiffness, and improving function, as assessed by WOMAC score, compared to controls. However, there was high heterogeneity (88 to 93%). It is possible that balneotherapy may reduce pain and stiffness, and improve function, in individuals with knee osteoarthritis, although the quality of current publications contributes to the heterogeneity observed in this meta-analysis.     

Endoscopic bariatric procedures: Assessment of postintervention safety and success

Morbid obesity has become one of the largest health care crises facing modern medicine. Medical intervention alone has proven inadequate in addressing this issue. Although bariatric surgery has been proven to be the most effective treatment for the medical comorbidities associated with morbid obesity, only a fraction of obese patients will undergo bariatric surgery owing to fear, financial restraint, and limited access to surgical expertise. There exists a void for which endoscopic therapies can provide substantial improvements in the care of the morbidly obese patient. Compared to traditional surgical therapies, endoscopic approaches may potentially speed recovery with decreased pain, incisional hernia development, and surgical site infections. Primary endoscopic bariatric procedures can be classified as space-occupying, restrictive, or bypass. These procedures, as well as foresight into endoscopic bridges to surgery and revisional approaches, are discussed herein.