A pilot feasibility study for immediate relief of referred knee pain by hip traction in hip osteoarthritis

It is generally accepted that osteoarthritis of the hip is a common cause of pain and disability. In clinical practice, a variety of conservative and surgical methods are available for patients with hip osteoarthritis. Nonsurgical interventions are recommended as the first-line treatment for hip osteoarthritis [1]. As one of the conservative therapies used in nonsurgical interventions, physical therapy, including hip traction and stretching, has been shown to reduce pain and improve hip function in patients with hip osteoarthritis [2]. Pain originating from the hip joint is distributed not only in the groin area but also in the buttocks, anterior thighs, and knees [3, 4]. Knee pain arising from the hip joint is one of the characteristics of referred pain in hip osteoarthritis. However, the effects of physical therapy on referred pain have not been well documented. We developed an original hip traction technique using a lumbar traction machine. Of note, patients treated with this method experienced immediate relief of referred knee pain. This study describes the results of immediate relief of referred knee pain because using hip traction.     

Google Trends Analysis Shows Increasing Public Interest in Platelet-Rich Plasma Injections for Hip and Knee Osteoarthritis

BackgroundOsteoarthritis is a chronic musculoskeletal condition that frequently affects the hip and knee joints. Given the burden associated with surgical intervention for hip and knee osteoarthritis, patients continue to search for potential nonoperative treatments. One biologic therapy with mixed clinical and basic science evidence for treating osteoarthritis is platelet-rich plasma injections into the affected joint. We used the Google Trends tool to provide a quantitative analysis of national interest in platelet-rich plasma injections for hip and knee osteoarthritis.MethodsGoogle Trends parameters were selected to obtain search data from January 2009 to December 2019. Various combinations of “arthritis,” “osteoarthritis,” “PRP,” “platelet-rich plasma,” “knee,” and “hip” were entered into the Google Trends tool and trend analyses were performed.ResultsThree linear models were generated to display search volume trends in the United States for platelet-rich plasma and osteoarthritis, hip osteoarthritis, and knee osteoarthritis, respectively. All models showed increased Google queries as time progressed (P < .001), with R² ranging from 0.837 to 0.940. Seasonal, income-related, and geographic variations in public interest in platelet-rich plasma for osteoarthritis were noted.ConclusionOur results demonstrate a significant rise in Google queries related to platelet-rich plasma injections for osteoarthritis of the hip and knee since 2009. Surgeons treating hip and knee osteoarthritis patients can expect continued interest in platelet-rich plasma, despite inconclusive clinical and basic science data. Trends in public interest may inform patient counseling, shared decision-making, and directions for future clinical research.     

Explosive and maximal strength before and 6 months after total hip arthroplasty

Patients with unilateral hip osteoarthritis experience impairments in lower limb muscle function due to pain and disuse of the affected limb. The influence of hip osteoarthritis and subsequent total hip arthroplasty (THA) has mostly been evaluated by maximal strength tests, yet the functionally important explosive strength capabilities of hip and knee muscles are largely unknown. We aimed to evaluate hip and knee explosive and maximal strength in hip osteoarthritis patients before and after THA. Twenty‐one patients with unilateral hip osteoarthritis were evaluated before and 6 months after THA. They performed rapid maximal contractions of hip (flexor, extensor, abductor, adductor) and knee (flexor, extensor) muscles, from which explosive and maximal strength asymmetries were evaluated (involved versus uninvolved limb). Before THA, the involved limb showed significantly lower hip flexor, extensor, adductor, and knee extensor explosive and maximal strength compared to the uninvolved limb. Six months after THA surgery, hip flexor, extensor and adductor maximal and explosive strength asymmetries persisted, except for knee extensors. Explosive, but not maximal strength of hip abductors and knee extensors was lower in the involved limb before surgery and the reduced explosive strength capabilities may compromise daily living activities in hip osteoarthritis patients. After hip replacement, explosive strength asymmetries of knee extensors resolved, yet lingering asymmetries in hip flexor muscles should receive focused attention during postoperative rehabilitation. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:425–431, 2018.     

High prevalence of vitamin D deficiency in elderly patients with advanced osteoarthritis scheduled for total knee replacement associated with poorer preoperative functional state

Vitamin D deficiency has been reported previously in patients with osteoarthritis undergoing total hip arthroplasty. We found a high prevalence of vitamin D deficiency in elderly patients with advanced knee osteoarthritis scheduled for total knee replacement and also a significant association with a lower preoperative functional state. A review of the literature is given on vitamin D deficiency in patients with knee osteoarthritis and the association with lower outcome scores after arthroplasty is discussed.     

Pre-operative interventions (non-surgical and non-pharmacological) for patients with hip or knee osteoarthritis awaiting joint replacement surgery--a systematic review and meta-analysis

Objective

To determine if pre-operative interventions for hip and knee osteoarthritis provide benefit before and after joint replacement.

Method

Systematic review with meta-analysis of randomised controlled trials (RCTs) of pre-operative interventions for people with hip or knee osteoarthritis awaiting joint replacement surgery.Standardised mean differences (SMD) were calculated for pain, musculoskeletal impairment, activity limitation, quality of life, and health service utilisation (length of stay and discharge destination). The GRADE approach was used to determine the quality of the evidence.

Results

Twenty-three RCTs involving 1461 participants awaiting hip or knee replacement surgery were identified. Meta-analysis provided moderate quality evidence that pre-operative exercise interventions for knee osteoarthritis reduced pain prior to knee replacement surgery (SMD (95% CI) = 0.43 [0.13, 0.73]). None of the other meta-analyses investigating pre-operative interventions for knee osteoarthritis demonstrated any effect. Meta-analyses provided low to moderate quality evidence that exercise interventions for hip osteoarthritis reduced pain (SMD (95% CI) = 0.52 [0.04, 1.01]) and improved activity (SMD (95% CI) = 0.47 [0.11, 0.83]) prior to hip replacement surgery. Meta-analyses provided low quality evidence that exercise with education programs improved activity after hip replacement with reduced time to reach functional milestones during hospital stay (e.g., SMD (95% CI) = 0.50 [0.10, 0.90] for first day walking).

Conclusion

Low to moderate evidence from mostly small RCTs demonstrated that pre-operative interventions, particularly exercise, reduce pain for patients with hip and knee osteoarthritis prior to joint replacement, and exercise with education programs may improve activity after hip replacement.     

Muscular changes in osteoarthritis of the hip and knee.

Muscular abnormalities in the patients with degenerative osteoarthritis were examined histologically and histochemically. Enzyme stainings for DPNH-tetrazolium reductase and myosin ATP-ase at pH 10.4 and 4.6 were performed on 26 vastus lateralis biopsies from the patients with osteoarthritis of the knee and 21 gluteus medius specimens from those with osteoarthritis of the hip. All specimens were obtained at surgery. The patients were all female with their ages ranging from 40 to 74 years. Control specimens were obtained from 16 fractured females with absence of arthritis. Type 2 fiber atrophy and internal derangement of fibers were found in both osteoarthritic and control muscles, but were more frequently seen in the vastus lateralis of the patients with osteoarthritis of the knee. Abnormal mosaic patterns of fiber types, such as fiber type grouping and grouped atrophy of type 2 fibers, were frequently found in the vastus lateralis of the patients with osteoarthritis of the knee (73.1%), and less frequently in that of controls (6.3%). However, abnormal mosaic patterns were not found in the gluteus medius obtained from either osteoarthritic patients or control subjects. Abnormal changes in mosaic pattern of fiber types in the vastus lateralis of osteoarthritis of the knee may suggest associated motor neuron dysfunction; the abnormality was not observed in the gluteus medius specimens of the patients with osteoarthritis of the hip, for which a different background in neurological factors may be involved.     

Total knee arthroplasty for patients younger than 55 years

There are few reports in the literature that deal with the results of total knee arthroplasty in the younger patient. The present study was undertaken to evaluate the results of total knee arthroplasty in patients under the age of 55 years. Ninety-three knee arthroplasties in 62 patients were performed between 1974 and 1982. The preoperative diagnosis was rheumatoid arthritis in 76 knees and osteoarthritis in 17 knees. The total condylar knee prosthesis was used in all knees. Defects in the tibial plateau were noted in 13 knees, and supplemental support was required. Ninety knees (17 with osteoarthritis and 73 with rheumatoid arthritis) were available for follow-up study at a mean of 6.1 years. The knee rating for the entire group was 87.1. The subgroup scores for the osteoarthritis and rheumatoid arthritis groups were also 87.1. Roentgenographic evaluation revealed a lucency rate of 30%. Two implants were found to have global radiolucencies and were considered loose. Survivorship analysis resulted in a cumulative survivorship rate of 96% at ten years for the entire group. These results are comparable to the long-term results of total knee arthroplasty in the older patient and better than the results of total hip arthroplasty in the younger patient. Total knee arthroplasty in the younger patient is a reliable and durable procedure but should be used with caution despite the excellent results reported here.     

Osteoarthritis of the hip and knee: sex and gender differences

Osteoarthritis of the hip and knee is a leading cause of functional disability and compromised quality of life in older patients and a significant public health issue. Emerging research shows sex and gender differences in osteoarthritis which, to date, may not be appreciated by the orthopedic community. This article discusses sex and gender differences in osteoarthritis with a focus on disease involving the hip and knee. Understanding what we know (and do not know) about sex and gender differences in this disorder is critical to improving quality of care for our patients.     

Arthroplasty for the treatment of joint degeneration caused by ochronosis in two cases

Ochronosis is a rare metabolic disease caused by the deficiency of the homogentisic acid oxidase enzyme. With increasing age, accumulation of pigment deposits of homogentisic acid in the joint cartilage results in ochronotic osteoarthritis. We presented two female patients, with ages 55 and 60 years, who underwent staged bilateral uncemented total hip and bilateral cemented total knee arthroplasty, respectively, for osteoarthritis caused by ochronosis. Both patients had no significant complaints at final follow-up examinations made 12 months and 10 months after the second operation in the hip and knee, respectively. Plain radiographs did not show any abnormality in the components of the prostheses. Histopathologic examination of surgical specimens showed brown-black pigment deposits in the connective tissue and cartilage tissue.     

Sex differences in osteoarthritis of the hip and knee

The prevalence, incidence, and severity of osteoarthritis are different in women than in men. Women are more likely than men to suffer from osteoarthritis,and women experience more severe arthritis in the knee. Genetics, anatomy,and prior knee injury are risk factors for developing osteoarthritis. Although the presentation of osteoarthritis does not differ between men and women,symptom severity does. Additionally, women are three times less likely than men to undergo hip or knee arthroplasty. Patient education, particularly for women, must be improved so that women with osteoarthritis who are candidates for hip and knee arthroplasty not only receive treatment but also receive it in a timely manner.     

Harpagophytum procumbens in the treatment of knee and hip osteoarthritis. Four-month results of a prospective, multicenter, double-blind trial versus diacerhein

OBJECTIVE: To evaluate the efficacy and safety of Harpagophytum in the treatment of hip and knee osteoarthritis comparatively with the slow-acting drug for osteoarthritis, diacerhein. PATIENTS AND METHODS: A multicenter, randomized, double-blind, parallel-group study was conducted in 122 patients with hip and/or knee osteoarthritis. Treatment duration was four months and the primary evaluation criterion was the pain score on a visual analog scale. Harpagophytum 2,610 mg per day was compared with diacerhein 100 mg per day. RESULTS: After four months, considerable improvements in osteoarthritis symptoms were seen in both groups, with no significant differences for pain, functional disability, or the Lequesne score. However, use of analgesic (acetaminophen-caffeine) and nonsteroidal anti-inflammatory (diclofenac) medications was significantly reduced in the Harpagophytum group, which also had a significantly lower rate of adverse events. CONCLUSION: In this study, Harpagophytum was at least as effective as a reference drug (diacerhein) in the treatment of knee or hip osteoarthritis and reduced the need for analgesic and nonsteroidal anti-inflammatory therapy.     

Hip osteoarthritis: where is the pain?

BACKGROUND: Pain radiating below the knee is typically thought to originate from the lumbosacral spine rather than degenerative hip pathology. We investigated the lower limb distribution of pain using body image maps in 60 patients awaiting primary hip arthroplasty and in 60 patients awaiting spinal decompression for confirmed spinal stenosis. The perception of 33 orthopaedic registrars regarding distribution of hip pain was also assessed. RESULTS: Groin and buttock pain are significantly more common in hip osteoarthritis. The presence of groin pain is 84.3% of those sensitive for hip dysfunction with a specificity of 70.3%. Patients with hip osteoarthritis had pain below the knee in 47% of cases whereas 88.5% of orthopaedic trainees believed hip pain did not radiate below the knee. Radiographic features of osteoarthritis within the hip joint, visual analogue pain score or Oxford Hip Score have no significant association with a patient's distribution of hip pain. CONCLUSIONS: Hip pain referred below the knee is common with a degenerate hip joint and follows the distribution of the saphenous nerve, which branches from the femoral nerve. Radiographic deterioration of a hip joint does not correlate with pain distribution or patient dysfunction as measured by the Oxford Hip Score.     

Hip and knee replacement after longstanding hip arthrodesis

This study determined whether patients with severe knee disease below a hip arthrodesis can be treated successfully with total knee replacement alone or whether such patients require total hip arthroplasty followed by knee replacement. Eighteen patients who had hip arthrodesis for a mean of 33 years underwent total hip replacement alone, total knee replacement alone, or a combination of both. The Harris hip score improved from a mean of 55.3 to a mean of 86.9 points at 45 months after total hip arthroplasty. The Hospital for Special Surgery knee score improved from a mean of 33 to a mean of 78 points in patients who had total knee replacement after total hip arthroplasty. The Hospital for Special Surgery knee score improved from a mean of 35 to a mean of 44 points in patients having total knee replacement alone below a hip arthrodesis. The followup after total knee replacement averaged 53 months. These data suggest that a knee replacement alone in a patient with a fused hip is unlikely to provide a satisfactory result. Patients with severe knee disease below hip arthrodesis require total hip arthroplasty followed by knee replacement. This applies even when severe osteoarthritis of the knee is the primary complaint.     

Increasing Public Interest in Stem Cell Injections for Osteoarthritis of the Hip and Knee: A Google Trends Analysis

BackgroundStem cell injections are being offered to patients as a nonoperative treatment for osteoarthritis of the hip and knee. To our knowledge, no peer-reviewed data exist to document the usage frequency of these injections nor to quantify the public interest in these injections. We sought to use Google Trends to provide a quantitative analysis of interest in hip and knee stem cell injections at the population level.MethodsGoogle Trends search parameters were set to obtain query data from January 2010 through December 2017. ‘Arthritis,’ ‘osteoarthritis,’ ‘stem cell,’ ‘injection,’ ‘knee,’ and ‘hip’ were entered in various combinations to obtain the highest yield search volume. Trend analyses were performed.ResultsSix linear models were generated to show trends in the volume of searches for the United States and the World. Model fit was good, and regression analysis showed significant trends over time for all searches. Use of search terms increased significantly over time (all models P < .001). Adjusted R-square values ranged from 54.4% to 78.1%. All trends showed an upward trajectory for the entirety of the study time period.ConclusionThere has been a marked and statistically significant rise in search query volume related to stem cells and osteoarthritis of the hip and knee since 2010. Online interest in stem cell injections may suggest increased utilization of these procedures. Well-designed clinical studies are required to keep pace with the rising popularity and public interest in this intervention for hip and knee arthritis.     

Comparative outcomes of total joint arthroplasty

A prospective pre- and postoperative general health/quality-of-life factor comparison, using the Rand SF-36 Health Status Questionnaire (TyPE Specification, Quality Quest [Health Outcomes Institute, Minneapolis, MN]), was carried out on a consecutive series of patients with diagnosed osteoarthritis undergoing total hip and knee arthroplasty between March 1991 and March 1994. Study groups consisted of 85 total hip arthroplasty patients, 93 total knee arthroplasty patients, and 65 single-stage bilateral total knee arthroplasty patients, all treated at the same specialty hospital, under the care of three senior orthopaedic surgeons. The average patient age was 69 years. Significant improvements in quality-of-life measures including physical functioning, social functioning, role functioning/physical problem, role functioning/emotional problem, mental health, energy/fatigue, pain, and change in health were noted in all hip and knee arthroplasty patients 6 months, 1 year, and 2 years after surgery (P < .05). There appeared to be no significant differences in quality-of-life measures between hip and knee arthroplasty patients. Results therefore indicate that total hip and knee arthroplasty significantly improve the functional status and quality of life among patients suffering from osteoarthritis.     

Effects of changes in whole-body alignment on ipsilateral knee pain after total hip arthroplasty

BackgroundTotal hip arthroplasty decreases hip pain and often reduces knee pain in patients with hip osteoarthritis. Whole-body alignment may be associated with knee pain, but to our knowledge this relationship has not been previously investigated. The purpose of this study was to investigate the effect of changes in whole-body alignment on ipsilateral knee pain in patients after total hip arthroplasty.MethodsIn total, 94 patients with unilateral hip osteoarthritis who underwent total hip arthroplasty were enrolled in this study. A visual analog scale (VAS) was used to investigate perioperative knee pain. An EOS 2D/3D X-ray system was used to quantify the whole-body alignment of the spine, pelvis, and lower extremities in the standing position. The relationship between perioperative changes in knee pain and whole-body alignment was investigated.ResultsAmong 61 patients who had preoperative ipsilateral knee pain, pain resolved in 30 (50%) and persisted in 31 (50%) after surgery. In these patients, average ipsilateral knee pain decreased significantly after surgery, from 41 mm to 14 mm on the VAS (P < 0.01). Preoperative knee pain was correlated with femorotibial rotation, and postoperative knee pain was correlated with K-L grade, preoperative knee pain visualized analog scale, and preoperative sagittal vertical axis. Multiple linear regression identified preoperative sagittal vertical axis as significantly associated with residual postoperative ipsilateral knee pain.ConclusionsIpsilateral knee pain decreased in half of patients after total hip arthroplasty. Patients with a considerable forward-bent posture may have residual ipsilateral knee pain after total hip arthroplasty.     

Racial and ethnic disparities in hip and knee joint replacement: a review of research in the Veterans Affairs Health Care System

Elective total joint arthroplasty is an effective treatment option for end-stage osteoarthritis of the hip and knee. The demand for arthroplasty is anticipated to increase as the proportion of older patients with hip and knee osteoarthritis continues to rise in the United States and worldwide. Studies have documented marked racial and ethnic differences in the utilization rates of hip and knee arthroplasty in the United States. The reasons for these differences are complex and include patient-level factors, such as treatment preference; provider-level factors, such as physician-patient communication style; and system-level factors, such as access to specialist care. Most of the studies on racial and ethnic disparities in joint arthroplasty utilization have been based on data from the Medicare database. However, Veterans Administration-based studies have recently confirmed these findings and have indicated potential patient-level factors, such as patient perception of and familiarity with joint arthroplasty, that may play a role in this disparity.     

中老年女性骨关节炎患者骨密度的特点

目的　通过测量骨关节炎患者腰椎和髋部骨密度 ,探讨骨关节炎患者骨密度的特点及骨关节炎与骨质疏松症的关系。方法　本组研究对象均为中老年女性膝关节骨关节炎患者 ,其中 5 9例测量了腰椎和髋部骨密度 ,12例仅测量了腰椎骨密度。所有患者均按Kellgren分级标准对膝关节进行了评分。结果　绝经后妇女膝关节X线评分随Kellgren分级级数的增高患者腰椎骨密度均值逐渐增高 ,4级骨关节炎患者腰椎骨密度均值明显高于 2级患者 (P <0 0 5 ) ,而髋部骨密度均值随Kellgren分级级数的增高差异无显著性。如以低于同性别同部位峰值骨量的 2 0SD为骨质疏松诊断标准 ,腰椎和髋部符合骨质疏松症诊断的分别为 4 3 7%和 77%。在控制年龄和骨关节炎的影响后 ,股骨颈骨密度与体重指数的偏相关系数为 0 4 0 7(P <0 0 1)。结论　中老年女性骨关节炎患者中同时患有骨质疏松症的比例较高 ,同髋部骨密度测量相比 ,腰椎骨密度测量受骨关节炎影响较大。     

Pain threshold correlates with functional scores in osteoarthritis patients

Background and purpose — Pain sensitization may be one of the reasons for persistent pain after technically successful joint replacement. We analyzed how pain sensitization, as measured by quantitative sensory testing, relates preoperatively to joint function in patients with osteoarthritis (OA) scheduled for joint replacement.

Patients and methods — We included 50 patients with knee OA and 49 with hip OA who were scheduled for joint replacement, and 15 control participants. Hip/knee scores, thermal and pressure detection, and pain thresholds were examined.

Results — Median pressure pain thresholds were lower in patients than in control subjects: 4.0 (range: 0–10) vs. 7.8 (4–10) (p = 0.003) for the affected knee; 4.5 (2–10) vs. 6.8 (4–10) (p = 0.03) for the affected hip. Lower pressure pain threshold values were found at the affected joint in 26 of the 50 patients with knee OA and in 17 of the 49 patients with hip OA. The American Knee Society score 1 and 2, the Oxford knee score, and functional questionnaire of Hannover for osteoarthritis score correlated with the pressure pain thresholds in patients with knee OA. Also, Harris hip score and the functional questionnaire of Hannover for osteoarthritis score correlated with the cold detection threshold in patients with hip OA.

Interpretation — Quantitative sensory testing appeared to identify patients with sensory changes indicative of mechanisms of central sensitization. These patients may require additional pain treatment in order to profit fully from surgery. There were correlations between the clinical scores and the level of sensitization.     

Joint distraction as an alternative for the treatment of osteoarthritis

Irrespective of underlying mechanisms, the long-term efficacy of joint distraction in the treatment of severe ankle osteoarthritis at young age validates the concept of joint distraction in the treatment of osteoarthritis. Therefore, joint distraction in the case of severe ankle osteoarthritis may be a treatment of choice. This opens the possibility to study joint distraction as a treatment for other joints. Because knee osteoarthritis is much more common, it is a much greater social and economic problem. Beneficial effects of joint distraction in the case of ankle osteoarthritis, and specifically in the treatment of more common forms of osteoarthritis such as severe knee and hip osteoarthritis, may therefore have a great impact, especially in view of the increasing age of our population.