体外冲击波治疗早中期膝骨关节炎的效果

目的探讨体外冲击波疗法(ESWT)治疗早中期膝骨关节炎的有效性。方法70 例膝骨关节炎患者随机分为ESWT组(n=34)和对照组(n=36)。ESWT组予放射状ESWT干预,对照组将能流密度调整为0。在干预前和12 周后,采用活动时疼痛视觉模拟评分(VAS)、Lequesne 指数评分和WOMAC骨关节炎指数评分进行评定。结果干预后,ESWT组VAS评分、Lequesne 指数评分和WOMAC骨关节炎指数评分均明显优于对照组(P<0.01)。结论ESWT对早中期膝骨关节炎治疗有效。     

体外冲击波结合经穴治疗膝关节骨性关节炎的疗效观察

目的：本研究拟通过临床随机对照研究探讨体外冲击波结合经穴治疗膝关节骨性关节炎的临床疗效。方法：将39例早中期膝关节骨性关节炎患者随机分为观察组19例和对照组20例。2组均采用发散式体外冲击波治疗,对照组单纯给予冲击波痛点治疗,观察组在冲击波痛点治疗的基础上依据循经取穴原则增加对血海穴和梁丘穴的刺激。所有受试者分别在治疗前、治疗4周后行疼痛视觉模拟评分法（VAS）、西安大略和麦克马斯特大学骨关节炎指数评分（WOMAC）、6分钟步行实验（6MWT）等评定,并在治疗后记录《中医病证诊断疗效标准》中骨痹的疗效评价以及不良反应。结果：治疗4周后,2组患者VAS评分和WOMAC评分均较治疗前明显降低（P<0.01）,6MWT行走距离较治疗前明显增加（P<0.05）;且观察组VAS评分较对照组降低（P<0.05）;WOMAC评分及6MWT 2组间比较差异无统计学意义。治疗后,治疗后观察组《中医病症诊断疗效标准》中骨痹的疗效评价标准评估临床优良率为89%,对照组为80%。2组患者均未出现明显不良反应。结论：体外冲击波结合经穴治疗可减轻膝关节骨性关节炎患者的疼痛、改善膝关节功能、提高步行能力。     

Comparison of Intra-articular Hyaluronic Acid Injections With Transcutaneous Electric Nerve Stimulation for the Management of Knee Osteoarthritis: A Randomized Controlled Trial

Objective

To compare the effects of intra-articular hyaluronic acid (HA; ARTZ) and transcutaneous electric nerve stimulation (TENS) in the treatment of patients with knee osteoarthritis.

Design

A prospective, randomized controlled trial.

Setting

Rehabilitation clinic of a teaching hospital.

Participants

Patients with knee osteoarthritis (N=50; aged 51–80y) were randomly assigned to the HA group (n=27) or the TENS group (n=23).

Interventions

The HA group received intra-articular HA injection into the affected knee once a week for 5 consecutive weeks, and the TENS group received a 20- minute session of TENS 3 times a week for 4 consecutive weeks.

Main Outcome Measures

The primary outcome measures used were the visual analog scale (VAS) for pain and the Lequesne index. The secondary outcome measures were range of motion of the knee, walking time, pain threshold, patient global assessment, and disability in activities of daily living. All subjects were assessed at baseline, and at 2 weeks, 2 months, and 3 months after the treatments were completed.

Results

The TENS group exhibited a significantly greater improvement in VAS than the HA group at 2 weeks' follow-up (4.17±1.98 vs 5.31±1.78, respectively; P=.03). In addition, the TENS group also exhibited a significantly greater improvement in the Lequesne index than the HA group at 2 weeks' follow-up (7.78±2.08 vs 9.85±3.54, respectively; P=.01) and at 3 months' follow-up (7.07±2.85 vs 9.24±4.04, respectively; P=.03).

Conclusions

TENS with silver spike point electrodes was observed to be more effective than intra-articular HA injection for patients with knee osteoarthritis in improving the VAS for pain at 2 weeks' follow-up as well as the Lequesne index at 2 weeks' and 3 months' follow-up.     

Extracorporeal shock wave therapy for treating dyspareunia: A prospective,randomized, double-blind,placebo-controlled study

BackgroundDyspareunia is a genital pain during or after penile-vaginal sexual intercourse. It is a painful spasm of the pelvic muscles that partly or entirely disables vaginal penetration.ObjectivesWe examined the effect of extracorporeal shock wave therapy (ESWT) on idiopathic non-organic dyspareunia in women. A prospective, randomized, double-blind, placebo-controlled study was conducted.MethodsThe study included 62 women who reported dyspareunia. Patients in the treatment and placebo groups received ESWT perineally weekly for 4 consecutive weeks; placebo patients received placebo stand-off treatment. The grade of dyspareunia was estimated by using the Marinoff Dyspareunia Scale and subjective pain intensity on a visual analog scale (VAS) before and after treatment. Follow-ups were conducted 1, 4 and 12 weeks after the final ESWT session.ResultsThe study included 61 women. The treatment but not placebo group differed by the Marinoff Dyspareunia Scale and VAS. Differences before and after treatment within groups were all P < 0.001 and between groups, P < 0.001. Pain reduction was always > 30%. The effect sizes were both large: Marinoff 0.825 and VAS 0.883.ConclusionsESWT significantly reduced subjective pain in our women treated for dyspareunia.     

Efficacy and safety of topical diclofenac containing dimethyl sulfoxide (DMSO) compared with those of topical placebo,DMSO vehicle and oral diclofenac for knee osteoarthritis

While topical non-steroidal anti-inflammatory drugs are considered safe, their long-term efficacy for osteoarthritis has been suspect. We conducted a 12-week, double-blind, double-dummy, randomized controlled trial of topical diclofenac (TDiclo) in a vehicle solution containing dimethyl sulfoxide (DMSO) in 775 subjects with radiologically confirmed, symptomatic primary osteoarthritis of the knee. This 5-arm study compared TDiclo with a placebo solution, the DMSO vehicle, oral diclofenac (ODiclo) and the combination of TDiclo + ODiclo for relieving the signs and symptoms of knee osteoarthritis. Subjects applied study solution, 40 drops four times daily, and took one study tablet daily for 12 weeks. Co-primary efficacy variables were WOMAC pain and physical function and a patient overall health assessment. Secondary variables were WOMAC stiffness and patient global assessment (PGA) of the knee osteoarthritis. TDiclo was superior to placebo for pain (−6.0 vs. −4.7, P = 0.015), physical function (−15.8 vs. −12.3, P = 0.034), overall health (−0.95 vs. −0.37, P < 0.0001), and PGA (−1.36 vs. −1.01, P = 0.016), and was superior to DMSO vehicle for all efficacy variables. No significant difference was observed between DMSO vehicle and placebo or between TDiclo and ODiclo. The commonest adverse event associated with TDiclo was dry skin (18.2%). Fewer digestive system and laboratory abnormalities were observed with TDiclo than with ODiclo. Addition of TDiclo to ODiclo did not increase the incidence of systemic adverse events. TDiclo in DMSO vehicle is an effective treatment option for knee osteoarthritis with efficacy similar to, but tolerability better than ODiclo. DMSO vehicle was no more efficacious than placebo.     

Poster 28: Effects of glucosamine on pain and functioning in canadians with osteoarthritis of the knee

Objective: To determine the effects of glucosamine sulphate on morbidity in osteoarthritis (OA) of the knee. Design: Randomized controlled trial. Groups were stratified on age, body mass index, gender, pain ratings, and medications. Setting: Outpatient teaching hospital in Ontario, Canada. Participants: 18 men and women, age 18 to 65 years, with moderately severe, radiologically confirmed OA. Sample size estimates indicated samples of 14 subjects would detect ’20% improvements in pain (α=.05, power=.80). Interventions: 1500mg of purified glucosamine versus color-coded drug placebo self-administered twice daily for 8 weeks. Participants were asked to refrain from all other treatments for OA, including medications. Main Outcome Measures: Baseline and 8-week measures, including visual analog pain ratings, peak torque strength on a Biodex isokinetic strength tester, quality of life using the Western Ontario and McMaster Universities Osteoarthiritis Index (WOMAC), and range of motion (ROM). Results: Both groups improved in treatment on pain (P<.05), and there were trends toward improvement on ROM in both groups, suggesting a placebo effect. There were no trends for changes in peak torque or WOMAC measures. Rate of drop out prior to completion of all study requirements was high (42%) and all patients admitted using other pain medications during the trial. The desire for more pain control was implicated in dropping out. Conclusion: The efficacy of glucosamine for treating Canadians who have OA of the knee remains unclear despite positive industry-linked trials.     

Efficacy of low-level laser therapy applied at acupuncture points in knee osteoarthritis: a randomised double-blind comparative trial

Objective

To evaluate the efficacy of low-level laser therapy (LLLT) applied to acupuncture points on the knee joint in combination with exercise and advice in patients with knee osteoarthritis.

Design

Randomised, double-blind, comparative clinical trial.

Participants

Forty-nine patients with knee osteoarthritis were assigned at random into two groups: active laser group (n = 26) and placebo laser group (n = 23).

Intervention

Using a gallium aluminium arsenide laser device, patients received either active or placebo LLLT at five acupuncture points on the affected knee during nine sessions.

Outcome measures

Patients were assessed using a visual analogue scale (VAS) and the Saudi Knee Function Scale (SKFS) at baseline, the fifth treatment session, the last treatment session, 6 weeks post intervention and 6 months post intervention.

Results

VAS scores showed a significant improvement in the active laser group compared with the placebo laser group at 6 weeks post intervention [mean difference −1.3, 95% confidence interval (CI) of the difference −2.4 to −0.3; P = 0.014] and 6 months post intervention (mean difference −1.8, 95% CI of the difference −3.0 to −0.7; P = 0.003) using the independent samples test. SKFS scores also showed a significant improvement in the active laser group compared with the placebo laser group at the last treatment session (median difference −15, 95% CI of the difference −27 to −2; P = 0.035) and 6 months post intervention (median difference −21, 95% CI of the difference −34 to −7; P = 0.006) using the Mann–Whitney U test.

Conclusions

The results demonstrate that short-term application of LLLT to specific acupuncture points in association with exercise and advice is effective in reducing pain and improving quality of life in patients with knee osteoarthritis.     

A Single-Blind,Placebo Run-in Study of Duloxetine for Activity-Limiting Osteoarthritis Pain

Osteoarthritis pain is a significant problem for our aging population. Antidepressants that are serotonin-norepinephrine reuptake inhibitors are effective for other forms of chronic pain and may provide a new treatment option for osteoarthritis pain. We performed a single-blind, placebo run-in trial of 60 to 90 mg of duloxetine in 25 subjects with activity-limiting osteoarthritis pain. Each subject received 2 weeks of placebo followed by 10 weeks of duloxetine. The primary outcome was reduction in average pain intensity between 2 and 12 weeks for subjects completing the trial. Average pain on the Brief Pain Inventory (BPI) was 5.7 at baseline, 4.8 after the 2-week placebo run-in, and 3.5 at 12 weeks for the 17 patients completing the trial (28% decrease between 2 and 12 weeks, P = .122). Eight of 15 study completers who had nonmissing BPI results (53%) reported at least 30% pain reduction between weeks 2 and 12. The Western Ontario McMaster Osteoarthritis Index (WOMAC) pain score at baseline was 2.3, 1.8 after 2 weeks, and 1.3 after 12 weeks (30% decrease between 2 and 12 weeks, P = .018). Ten of 17 patients (59%) reported at least 30% pain relief between weeks 2 and 12 on the WOMAC. Significant improvements in self-reported physical and role function were reported but observed physical function did not improve.PerspectiveDuloxetine did not significantly reduce pain intensity on the BPI but did improve pain intensity and self-reported function on the WOMAC. Duloxetine warrants further investigation as a novel treatment for osteoarthritis pain.     

Comparison of therapeutic duration of therapeutic ultrasound in patients with knee osteoarthritis

[Purpose] The aim of study was to compare different durations of ultrasound in patients with knee osteoarthritis. [Subjects and Methods] One hundred patients diagnosed with bilateral knee osteoarthritis (OA) were enrolled in this study. Patients were divided into two groups. The first group (G1) received 4 minutes of ultrasound. The second group (G2) received the exact same treatment, but the duration of ultrasound was longer at 8 minutes. Patients in both groups underwent a total of 10 ultrasound over 2 weeks. Following treatment, all patients provided self-evaluations of pain via the Visual Analog Scale (VAS), overall physical function with WOMAC, disability via the Lequesne index (Leq), and depressive symptoms with the Beck Depression Index (BDI). [Results] There were no significant differences in VAS, WOMAC Leq, and BDI values between groups 1 and 2. After treatment, VAS, WOMAC, Leq, and BDI values improved for both treatment groups. However, following treatment, G2 had significantly greater values for WOMAC functional and total scores than G1. No statistically significant differences were observed for VAS scores while inactive, WOMAC pain and stiffness scores, and BDI values after treatment between both groups. VAS pain scores while active and Leq index values were significantly lower in G1 than G2. [Conclusion] Patients in both groups demonstrated improved functionality, pain and psychological status following a consistent, 2-week regimen of 4-minute or 8-minute treatments with ultrasound. Yet, patients that experienced longer treatment durations of 8 minutes demonstrated better outcomes in pain and the ability to carry out activities of daily living.Key words: Knee, Ultrasound, Osteoarthritis     

Hydrotherapy versus conventional land-based exercise for the management of patients with osteoarthritis of the knee: a randomized clinical trial

BACKGROUND AND PURPOSE: This study was designed to evaluate the effectiveness of hydrotherapy in subjects with osteoarthritis (OA) of the knee compared with subjects with OA of the knee who performed land-based exercises. SUBJECTS AND METHODS: Sixty-four subjects with OA of the knee were randomly assigned to 1 of 2 groups that performed exercises for 18 weeks: a water-based exercise group and a land-based exercise group. The outcome measures included a visual analog scale (VAS) for pain in the previous week, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), pain during gait assessed by a VAS at rest and immediately following a 50-foot (15.24-m) walk test (50FWT), walking time measured at fast and comfortable paces during the 50FWT, and the Lequesne Index. Measurements were recorded by a blinded investigator at baseline and at 9 and 18 weeks after initiating the intervention. RESULTS: The 2 groups were homogenous regarding all parameters at baseline. Reductions in pain and improvements in WOMAC and Lequesne index scores were similar between groups. Pain before and after the 50FWT decreased significantly over time in both groups. However, the water-based exercise group experienced a significantly greater decrease in pain than the land-based exercise group before and after the 50FWT at the week-18 follow-up. DISCUSSION AND CONCLUSION: Both water-based and land-based exercises reduced knee pain and increased knee function in participants with OA of the knee. Hydrotherapy was superior to land-based exercise in relieving pain before and after walking during the last follow-up. Water-based exercises are a suitable and effective alternative for the management of OA of the knee.     

A double-blind trial of clinical effects of therapeutic ultrasound in knee osteoarthritis

A randomized double blind clinical trial was conducted to determine the effectiveness of ultrasound (US) therapy in knee osteoarthritis (OA). Sixty-seven patients (mean age 54.8 +/-7) were randomized to receive either 1 MHz frequency or 1 watt/cm(2) power continuous ultrasound for 5 min (n = 34) or sham US (n = 33) as a placebo. Ten sessions of treatment were applied to the target knee of the patient. A blinded evaluation at baseline and after treatment was made. Primary outcome was pain on movement assessed by visual analog scale (VAS). Secondary outcomes consisted of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores and 50 meters walking time. Both groups showed significant improvements in knee pain on movement. In the treatment group, the improvement in VAS score was statistically and significantly higher (p < 0.001) and more pronounced than in the placebo group. Pain reduction averaged 47.76% in the treatment group (p = 0.013). Secondary outcomes improved in both groups but reached statistical significance only in the treatment group: p = 0.006 for the mean change in total WOMAC scores and p = 0.041 for 50 meters walking time. Results suggest that therapeutic US is safe and effective treatment modality in pain relief and improvement of functions in patients with knee OA.     

Physical function and properties of quadriceps femoris muscle in men with knee osteoarthritis

Liikavainio T, Lyytinen T, Tyrväinen E, Sipilä S, Arokoski JP. Physical function and properties of quadriceps femoris muscle in men with knee osteoarthritis.

Objectives

To examine the objective physical function of the lower extremities, to measure the properties of quadriceps femoris muscle (QFM), and to assess subjective disabilities in men with knee osteoarthritis (OA) and to compare the results with those obtained from age- and sex-matched control subjects.

Design

Cross-sectional study.

Setting

Rehabilitation clinic in a university hospital.

Participants

Male volunteers (n=54) (age range, 50-69y) with knee OA and randomly selected healthy, age- and sex-matched control subjects (n=53).

Interventions

Not applicable.

Main Outcome Measures

Physical function evaluated with a test battery including the QFM composition measurement, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the RAND 36-Item Short-Form Health Survey, version 1.0.

Results

Knee OA patients had 13% to 26% poorer (P range, .050-.001) physical function and muscle strength compared with the controls. There were also significant differences in QFM composition. WOMAC (P range, .050-.001) and muscle strength (P<.001) associated with physical function tests, but subjective pain correlated with neither physical function nor muscle strength in knee OA patients. The radiographic knee OA grade did not have any significant effect on physical function, but passive knee motion, knee extension strength, and WOMAC were related to the severity of the disease (P<.05).

Conclusions

The patients with knee OA exhibited impaired physical function and muscle strength and QFM composition compared with healthy controls. The severity of radiographic knee OA clearly had adverse effects on functional ability at the later stages of the disease. The results highlight the effect of QFM strength on physical function as well as the importance of patient's subjective and objective physical function when deciding on knee OA treatment policy.     

关节镜清理术配合盐酸氨基葡萄糖治疗轻度单侧膝骨关节炎的疗效研究

目的 探讨关节镜清理术配合盐酸氨基葡萄糖对膝骨关节炎的治疗作用。 方法 2009 年 6 月－ 2011年 6 月纳入轻度膝骨关节炎（Ahlback Ⅰ级）患者 135 例,随机分成 3 组。A 组（n=45）接受关节镜清理术治疗;B 组口服盐酸氨基葡萄糖胶囊治疗;C 组先行关节镜清理术治疗,术后口服盐酸氨基葡萄糖胶囊。观察 3 组 Lequesne 评分和 WOMAC 指数,用以评价治疗效果。 结果 成功随访患者 123 例,随访时间 8 个月。治疗后各组 Lequesne 评分和 WOMAC 指数较治疗前均显著好转（P ＜ 0.01）,其中治疗后 C 组好转较 A 组和 B 组具有显著性（P ＜ 0.01）,但 B 组和 C 组之间差异无统计学意义（P ＞ 0.05）。 结论 关节镜清理术配合盐酸氨基葡萄糖,较之单用关节镜清理术或盐酸氨基葡萄糖,对膝关节骨关节炎的治疗有更好的效果。     

Poster 2: Postural control in elderly women with knee osteoarthritis

Objective: To examine the effect of painful knee osteoarthritis on baseline balance and the relationship between balance measures and clinical measures. Design: Cross-sectional, observational, and controlled study. Setting: Sports medicine laboratory. Participants: 22 healthy women and 26 women with unilateral knee pain (age range, 60-80y). Interventions: Not applicable. Main Outcome Measures: Outcome measures included 6 force platform measures, ambulatory and transfer knee-pain intensity score (visual analog scale [VAS]), and disease burden (Kellgren-Lawrence score). The force platform measures obtained using the Balance Master System, which included weight-bearing symmetry, sway, and movement time during performing 6 tasks: weight bearing and squat, unilateral stance with eyes open, rhythmic weight shift, sit to stand, tandem walk, and step up and over. Results: On-axis velocity (deg/s) and directional control (%) in front and back rhythmic weight shift, and rising index (% body weight) in sit to stand were lower in women with unilateral knee pain (P<.05). Center of gravity (COG) sway velocity (deg/s) during unilateral stance in painful legs was greater than that in subjects’ other legs. The weight of women with unilateral knee pain loaded less on the painful side during 30° and 60° squats and during sit to stand (P<.05). Movement time during step up and over on the painful side was longer than that on the pain-free side (P<.05). Ambulatory knee-pain intensity (VAS) had a linear relationship with the movement time during step up and over on the painful side (r=.42). Conclusion: Avoidance of pain associated with limb loading and decline in postural control ability were demonstrated in elderly women with unilateral knee pain. Based on these results, further studies should be carried out to correlate the avoidance and decline with the falls in patients with painful knee osteoarthritis.     

Duloxetine,a centrally acting analgesic,in the treatment of patients with osteoarthritis knee pain: A 13-week,randomized, placebo-controlled trial

Pain is a common cause of disability in osteoarthritis. Duloxetine, a serotonin and norepinephrine reuptake inhibitor (SNRI), has demonstrated analgesic effects in diabetic peripheral neuropathy and fibromyalgia. Considering its central mechanism of action, duloxetine may be effective in other pain states with evidence of central sensitization. Herein, we report the results of a 13-week, randomized, double-blind, placebo-controlled trial of duloxetine (60–120 mg/day) versus placebo in the treatment of knee pain in 231 patients meeting clinical and radiographic criteria for osteoarthritis of the knee. Duloxetine was superior to placebo on the primary efficacy measure (weekly mean 24-h pain scores) beginning at Week 1 and continuing through the treatment period (P ? .05). There was also a significant improvement in the WOMAC physical functioning subscale and several other secondary outcomes. Adverse-event rates did not differ significantly between treatment groups (49.5% for duloxetine 60–120 mg/day, and 40.8% for placebo).     

The efficacy and tolerability of glucosamine sulfate in the treatment of knee osteoarthritis: A randomized, double-blind, placebo-controlled trial

Background: Osteoarthritis (OA) is the most common form of arthritis and is often associated with disability and impaired quality of life.Objective: The aim of the study was to assess the efficacy and tolerability of glucosamine sulfate (GS) in the treatment of knee OA.Methods: Consecutive outpatients affected by primary monolateral or bilateral knee OA were enrolled in this double-blind, double-dummy, prospective, randomized, placebo-controlled trial. One group received GS 1500 mg QD for 12 weeks, and the other group received placebo QD for 12 weeks. The treatment period was followed by a 12-week treatment-free observation phase. Each patient was examined at baseline and at weeks 4, 8, 12, 16, 20, and 24. The primary efficacy criteria were pain at rest and during movement, assessed on a visual analog scale (VAS) of 0 to 100 mm. The secondary criteria included the Western Ontario and McMaster Universities (WOMAC) index for total pain score (W-TPS), total stiffness score (W-TSS), and total physical function score (W-TPFS). VAS, W-TPS, W-TSS, and W-TPFS were evaluated at baseline and at weeks 4, 8, 12, 16, 20, and 24. Analgesic drug consumption (ie, acetaminophen or NSAIDs) was also assessed.Results: Patient demographics were similar in the GS and placebo groups. Of 60 randomized patients (30 per group), 56 completed the study (28 treated with GS and 28 who received placebo). Statistically significant improvements in symptomatic knee OA were observed, as measured by differences in resting pain at weeks 8, 12, and 16 (all, P < 0.05 vs placebo) and in pain during movement at weeks 12 and 16 (both, P < 0.05). W-TPS was lower with GS than placebo at weeks 8, 12, and 16 (all, P < 0.01), and at week 20 (P < 0.05). W-TSS was also lower with GS than placebo at weeks 8, 12, 16, and 20 (all, P < 0.05). W-TPFS was lower with GS than placebo at weeks 8 (P < 0.05), 12 (P < 0.01), 16 (P < 0.05), and 20 (P < 0.05). Drug consumption was lower in the GS group than the placebo group at weeks 8, 12, 16, and 20 (all, P < 0.05). The incidence of adverse events was 36.7% with GS and 40.0% with placebo.Conclusions: GS 1500 mg QD PO for 12 weeks was associated with statistically significant reductions in pain and improvements in functioning, with decreased analgesic consumption, compared with baseline and placebo in these patients with knee OA. A carryover effect was detected after treatment ended.     

Change of impairment, disability and patient satisfaction after total knee arthroplasty in secondary care practice

Objectives

To assess the evolution of impairment and disability after total knee arthroplasty (TKA) for osteoarthritis and to seek an association with patient satisfaction with surgery.

Method

Consecutives patients (n = 45, 18 women) with osteoarthritis undergoing primary TKA in two secondary care inpatient clinics were prospectively assessed before one month and six months after surgery. Disability was assessed by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC; range 0-900) and the Lequesne Index (range 1-24). Patients’ perceived handicap was assessed on a visual analog scale (VAS, range 1-100). At one month and six months postoperatively, kinetic strength of quadriceps and hamstrings was obtained by isokinetics measures and patient satisfaction on a VAS (range 1-100).

Results

Mean age was 71.7 ± 7.0 years; mean duration of symptoms was 38.3 ± 33.4 months. Patient satisfaction was 83.9 ± 17.7 and 83.1 ± 22.4 at one month and six months after TKA, respectively. At one month, significant improvements were observed over baseline for pain (−30.73 ± 32.2; p < 0.01), physical function (Lequesne Index −2.28 ± 3.6, p < 0.01; and WOMAC score, −82.60 ± 148.5, p < 0.01), and patient perceived handicap (−21.84 ± 29.6, p < 0.01). A significant decrease in global knee range of motion was also observed. At six months, significant improvement was observed for pain (−47.96 ± 26.8; p < 0.01), physical function (Lequesne Index, −5.08 ± 3.66, p < 0.01; and WOMAC score, −157.04 ± 153.2, p < 0.01) and patient perceived handicap (−39.60 ± 24.1; p < 0.01). All isokinetics measures for quadriceps and hamstring were significantly improved between one month and six months after surgery. At one month and six months, the correlation between patient satisfaction and change in impairment, disability and patient perceived handicap was weak.

Discussion and conclusion

Impairment, disability and patient perceived handicap improved significantly after TKA for osteoarthritis. However, these improvements were poorly correlated with patient overall satisfaction with surgery.     

玻璃酸钠关节腔灌注联合治疗膝骨关节炎疗效观察

目的观察玻璃酸钠关节腔灌注治疗对膝骨关节炎患者的疗效。方法将57例膝骨关节炎患者随机分为玻璃酸钠治疗组和常规治疗组,用VAS标准评估所有患者基线和5周、12周后20 m步行痛、关节触痛、WOMAC骨关节炎指数。结果在5周、12周后玻璃酸钠治疗组和常规治疗组患者20 m步行痛程度、关节触痛、WOMAC（VAS法）均较基线时有明显改善（P〈0.05）。5周、12周后玻璃酸钠治疗组的20 m步行痛程度、关节触痛、WOMAC（VAS）均较常规治疗组有明显改善（P〈0.05）。结论常规治疗能明显改善膝骨关节炎患者临床症状、提高患者生活质量,联合玻璃酸钠关节腔灌注疗效更佳。     

Geotherapy combined with kinesiotherapy is efficient in reducing pain in patients with osteoarthritis

IntroductionPatients with osteoarthritis (OA) suffer from a degenerative disease that causes several physical disabilities and pain. Despite the few studies involving exercise combined with geotherapy (a therapy using poultices made from earth materials such as clay or mud) for patients with OA, this subject is still under debate, as effect of the earth material remains unclear. The aim of this study was to compare pain, joint stiffness and disability in patients who underwent kinesiotherapy (K) or geotherapy combined with kinesiotherapy (GK).MethodThis was a clinical randomized single-blinded prospective study, in which 48 individuals participated. Volunteers were evaluated for pain perception, pressure pain tolerance thresholds, and responded to questionnaires about pain, joint stiffness and physical disability (WOMAC) and about symptoms and disability (Lequesne Algofunctional Index). Patients in K group underwent 15 twice-weekly sessions of kinesiotherapy consisting of stretching and strengthening exercises for lower limbs. GK patients received a poultice of powder dolomite mixed with hot water on the knees for 25 min before each of the 15 sessions of the same kinesiotherapy program.ResultsBoth interventions were effective in reducing pain, joint stiffness and physical disability (p < 0.001), and in increasing pressure pain thresholds (p < 0.05); however, patients who underwent GK presented a more pronounced reduction in pain perception (p = 0.006) than those in K group. They also exhibited more tolerance to pain in all sites evaluated.ConclusionBoth interventions were effective in reducing pain, joint stiffness and physical disability, but GK produced significantly better results in pain perception.