Effect of Biomechanical Footwear on Knee Pain in People With Knee Osteoarthritis: The BIOTOK Randomized Clinical Trial

Comparison of the asymmetries in foot posture, gait and plantar pressure between patients with unilateral and bilateral knee osteoarthritis based on a cross-sectional study

This study aimed to observe the characteristics of foot posture asymmetry and abnormal gait in patients with unilateral and bilateral knee osteoarthritis (KOA) and to explore the association between foot posture asymmetry, abnormal gait and the clinical symptoms and severity of KOA. Sixty patients with KOA were allocated as follows: unilateral group (UG; n = 30) and bilateral group (BG; n = 30). We accessed foot posture, foot posture asymmetry, gait and plantar pressure parameters and symmetry index, clinical symptom-related scores and disease severity, and investigated the relationship between these variables. The results showed that the overall percentage of asymmetry and severe asymmetry in foot posture were lower in BG than in UG. There was substantial asymmetry in many gait indicators within the two groups, but no significant differences were observed between the two groups. Moreover, foot posture asymmetry, multiple gait and plantar pressure parameters and symmetry indices were closely related to clinical symptoms and disease severity. In conclusion, both unilateral and bilateral KOA patients have foot posture asymmetry and gait asymmetry, but the foot posture asymmetry of the former is more severe than that of the latter. Intervention for this population should treat simultaneously both knee joints. The evaluation and monitoring of foot posture asymmetry, gait and plantar pressure parameters and symmetry indices can provide a more comprehensive and scientific basis for the prevention and treatment of KOA.

A RANKL-UCHL1-sCD13 negative feedback loop limits osteoclastogenesis in subchondral bone to prevent osteoarthritis progression

Abnormal subchondral bone remodeling plays a pivotal role in the progression of osteoarthritis (OA). Here, we analyzed subchondral bone samples from OA patients and observed a significant upregulation of ubiquitin carboxy-terminal hydrolase L1 (UCHL1) specifically in subchondral bone osteoclasts. Notably, we found a strong correlation between UCHL1 expression and osteoclast activity in the subchondral bone during OA progression in both human and murine models. Conditional UCHL1 deletion in osteoclast precursors exacerbated OA progression, while its overexpression, mediated by adeno-associated virus 9, alleviated this process in male mice. Mechanistically, RANKL stimulates UCHL1 expression in osteoclast precursors, subsequently stabilizing CD13, augmenting soluble CD13 (sCD13) release, and triggering an autocrine inhibitory effect on the MAPK pathway, thereby suppressing osteoclast formation. These findings unveil a previously unidentified negative feedback loop, RANKL-UCHL1-sCD13, that modulates osteoclast formation and presents a potential therapeutic target for OA.

Recommendations from the French Societies of Rheumatology and Physical Medicine and Rehabilitation on the non-pharmacological management of knee osteoarthritis

BACKGROUND

Although non-pharmacological therapies for knee osteoarthritis (OA) are essential pillars of care, they are often poorly considered and inconsistently applied.

OBJECTIVES

Under the umbrella of the French Society of Rheumatology (SFR) and the French Society of Physical Medicine and Rehabilitation (SOFMER), we aimed to establish consensual recommendations for the non-pharmacological management of people with knee OA.

METHODS

A group of fellows performed a systematic literature review on the efficacy and safety of non-pharmacological modalities (up to October 2021). The fellows then took part in discussions with a multidisciplinary group of experts to draft a list of recommendations. The list was then submitted to an independent reading committee who rated their level of agreement with each recommendation. Each recommendation was assigned a strength of recommendation and a level of evidence.

RESULTS

Five general principles were unanimously accepted: (A) the need to combine non-pharmacological and pharmacological measures; (B) the need for personalized management; (C) the need to promote adherence; (D) the need for adapted physical activity; and (E) the need for person-centered education. Specific positive or negative recommendations were defined for 11 modalities: (1) unloading knee brace; (2) kinesiotaping or knee sleeves; (3) shoes and/or insoles; (4) using a cane; (5) physical exercise program; (6) joint mobilization; (7) electro- or thermo-therapy; (8) acupuncture; (9) weight loss; (10) thermal spa therapy; and (11) workplace accommodation.

CONCLUSIONS

These SFR/SOFMER recommendations provide important and consensual knowledge to assist health professionals in decision-making for non-pharmacological treatments for knee OA.

Influencing factors of chronic pain after total knee replacement in osteoarthritis patients: a nomogram prediction model

OBJECTIVES

To analyze the factors influencing chronic pain in patients with knee osteoarthritis after total knee replacement surgery (TKRS) and to construct a nomogram risk prediction model, providing an economically effective screening method for clinical use.

METHODS

This retrospective study included 100 consecutive patients at the Jinan Central Hospital, with knee osteoarthritis who underwent TKRS from January 2023 to December 2023. Patients were divided into the observation group (n=55) and the control group (n=45) based on the presence of chronic pain. Logistic regression was performed to explore factors associated with chronic pain, including medical records, laboratory data, previous history, and independent clinical risk factors. The identified independent factors were then incorporated to construct a nomogram for chronic pain prediction.

RESULTS

Six variables were identified as independent predictors of chronic pain after TKRS: age, BMI, diabetes, severity of preoperative pain, severity of postoperative acute pain, and postoperative wound infection (P<0.05). The area under the curve (AUC) of this nomogram was 0.836 [95% confidence interval (CI): 0.615-0.884], demonstrating good calibration and clinical practicability.

CONCLUSION

Age, BMI, diabetes, severity of preoperative pain, severity of postoperative acute pain, and postoperative wound infection are risk factors for chronic pain after TKRS. The predictive nomogram developed in this study shows good prediction ability and accuracy for chronic pain in patients with knee osteoarthritis after surgery.

An exploration of footwear preferences, attitudes and beliefs in people with knee osteoarthritis: A qualitative study

BACKGROUND

Although footwear can improve pain and function in individuals with knee osteoarthritis (OA), perspectives about footwear in this population have not been explored.

OBJECTIVES

This qualitative study explored preferences, attitudes and beliefs about footwear in adults with knee OA.

METHODS

Twenty individuals with a clinical diagnosis of knee OA (aged 45-79 years, 65% women) participated in semi-structured interviews about factors which influence footwear selection, the effect of footwear on knee symptoms, and footwear modifications. Data were analysed thematically.

RESULTS

Four themes, with sub-themes, were identified: i) there are specific footwear characteristics people look for, with comfort as their top priority; ii) shoe appearance is important; iii) footwear can aggravate or ease symptoms; and iv) people with knee OA find footwear in a variety of ways. Participants related built-in arch support, a cushioned insole and low/no heel, without addition of foot orthoses, to comfort, and were willing to pay more for comfort and quality. Appearance was also a consideration, and participants indicated they would tolerate short periods of symptom aggravation for aesthetic shoes. Participants felt that footwear choice affected their knee symptoms and risk of slipping/twisting. Participants reported that their footwear choices were determined through trial-and-error, and sometimes on advice from health professionals or shoe store salespersons.

CONCLUSIONS

There are specific footwear features important to individuals with knee OA. Knowledge of these features can be used by health professionals to inform footwear discussions with knee OA patients and serve as considerations when developing footwear targeted for this population.

Updates in the Treatment of Knee Osteoarthritis

Knee osteoarthritis (OA) is an inflammatory and degenerative condition resulting in articular cartilage destruction and functional loss. Its prevalence has grown considerably due to increased life expectancy and obesity, and its diagnosis relies on evaluation, medical examination, and confirmation by supplementary radiographic images. Knee OA is multifactorial and influenced by several local, systemic, and external aspects. In addition, its progress and therapeutic responses highly depend on the characteristics of each subject. The initial recommendation is drug treatment and alternative therapies to improve quality of life. However, if these treatments are unsuccessful, one must consider surgical treatment. Surgical options include arthroscopies, osteotomies, and partial and total arthroplasties, while non-surgical treatments include medications and alternative therapies such as infiltrations, acupuncture, and physical exercise. It is worth highlighting that biomarkers can be a significant strategy for early disease detection, assessment of disease activity, prediction of prognosis, and monitoring a better response to therapy. Nevertheless, this topic must be the focus of further research to confirm its findings.

Reduction in Healthcare Resource Utilization Following Treatment With a Home-Based Footworn Device in Patients With Knee Osteoarthritis: A Retrospective Claims Analysis

Background: One in 7 US adults has knee osteoarthritis (OA) and almost two-thirds of them suffer from low back pain. OA is the third most rapidly rising condition associated with disability and leads to a significant burden on the healthcare system and society. Objective: This study looked at the healthcare resource utilization (HCRU) in patients with knee OA and low back pain before and after the utilization of a new, home-based, noninvasive, biomechanical intervention. Methods: This was a retrospective claims analysis of 585 patients treated with a personalized, noninvasive, home-based, biomechanical treatment that aims to alleviate knee pain and improve function (AposHealth®). The date of the first AposHealth claim was the index date. Data prior to the index date and post-index date were used to monitor changes in HCRU while in treatment. Descriptive statistics, including frequencies, means and standard deviations, were used to present patient characteristics. To standardize the results, an average monthly claims data rate was calculated and an expected annual rate was extrapolated. Annual HCRU rate per 1000 members was calculated. Results: HCRU decreased after utilizing the new intervention including a decrease of 79% in diagnostic claims, a 70% decrease in outpatient services, a 22% decrease in non-operative treatments, a 61% decrease in pain medications including an 85% drop in opioids use, and a 44% decrease in intra-articular injections. The pre-index estimated rate for total knee replacement (TKR), which is based on existing literature, was 15.1%, whereas the post-index rate of TKR was 0.9%. Conclusions: Patients with knee OA treated with a home-based, noninvasive, biomechanical intervention incurred fewer healthcare resources, leading to an overall reduction in the cost of care.

EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis: 2023 update

INTRODUCTION

Hip and knee osteoarthritis (OA) are increasingly common with a significant impact on individuals and society. Non-pharmacological treatments are considered essential to reduce pain and improve function and quality of life. EULAR recommendations for the non-pharmacological core management of hip and knee OA were published in 2013. Given the large number of subsequent studies, an update is needed.

METHODS

The Standardised Operating Procedures for EULAR recommendations were followed. A multidisciplinary Task Force with 25 members representing 14 European countries was established. The Task Force agreed on an updated search strategy of 11 research questions. The systematic literature review encompassed dates from 1 January 2012 to 27 May 2022. Retrieved evidence was discussed, updated recommendations were formulated, and research and educational agendas were developed.

RESULTS

The revised recommendations include two overarching principles and eight evidence-based recommendations including (1) an individualised, multicomponent management plan; (2) information, education and self-management; (3) exercise with adequate tailoring of dosage and progression; (4) mode of exercise delivery; (5) maintenance of healthy weight and weight loss; (6) footwear, walking aids and assistive devices; (7) work-related advice and (8) behaviour change techniques to improve lifestyle. The mean level of agreement on the recommendations ranged between 9.2 and 9.8 (0-10 scale, 10=total agreement). The research agenda highlighted areas related to these interventions including adherence, uptake and impact on work.

CONCLUSIONS

The 2023 updated recommendations were formulated based on research evidence and expert opinion to guide the optimal management of hip and knee OA.

Phototherapy techniques for the management of musculoskeletal disorders: strategies and recent advances

Musculoskeletal disorders (MSDs), which include a range of pathologies affecting bones, cartilage, muscles, tendons, and ligaments, account for a significant portion of the global burden of disease. While pharmaceutical and surgical interventions represent conventional approaches for treating MSDs, their efficacy is constrained and frequently accompanied by adverse reactions. Considering the rising incidence of MSDs, there is an urgent demand for effective treatment modalities to alter the current landscape. Phototherapy, as a controllable and non-invasive technique, has been shown to directly regulate bone, cartilage, and muscle regeneration by modulating cellular behavior. Moreover, phototherapy presents controlled ablation of tumor cells, bacteria, and aberrantly activated inflammatory cells, demonstrating therapeutic potential in conditions such as bone tumors, bone infection, and arthritis. By constructing light-responsive nanosystems, controlled drug delivery can be achieved to enable precise treatment of MSDs. Notably, various phototherapy nanoplatforms with integrated imaging capabilities have been utilized for early diagnosis, guided therapy, and prognostic assessment of MSDs, further improving the management of these disorders. This review provides a comprehensive overview of the strategies and recent advances in the application of phototherapy for the treatment of MSDs, discusses the challenges and prospects of phototherapy, and aims to promote further research and application of phototherapy techniques.

Fundamentals of osteoarthritis. Rehabilitation: Exercise, diet, biomechanics, and physical therapist-delivered interventions

Insights related to the pathogenesis of osteoarthritis (OA) have informed rehabilitative treatments that aim to mitigate the influence of several known impairments and risk factors for OA, with the goal to improve pain, function, and quality of life. The purpose of this invited narrative review is to provide fundamental knowledge to non-specialists about exercise and education, diet, biomechanical interventions, and other physical therapist-delivered treatments. In addition to summarizing the rationale for common rehabilitative therapies, we provide a synthesis of current core recommendations. Robust evidence based on randomized clinical trials supports exercise with education and diet as core treatments for OA. Structured, supervised exercise therapy is advised. The mode of exercise may vary but should be individualized. The dose should be based on an initial assessment, the desired physiological changes, and progressed when appropriate. Diet combined with exercise is strongly recommended and studies demonstrate a dose-response relationship between the magnitude of weight loss and symptom improvement. Recent evidence suggests the use of technology to remotely deliver exercise, diet and education interventions is cost-effective. Although several studies support the mechanisms for biomechanical interventions (e.g., bracing, shoe inserts) and physical therapist-delivered (passive) treatments (e.g., manual therapy, electrotherapeutic modalities) fewer rigorous randomized trials support their clinical use; these therapies are sometimes recommended as adjuncts to core treatments. The mechanisms of action for all rehabilitative interventions include contextual factors such as attention and placebo effects. These effects can challenge our interpretation of treatment efficacy from clinical trials, yet also provide opportunities to maximize patient outcomes in clinical practice. When evaluating rehabilitative interventions, the field may benefit from increased emphasis on research that considers contextual factors while evaluating mechanistic, longer-term, clinically-important and policy-relevant outcome measures.

Reliability of foot posture index (FPI-6) for evaluating foot posture in patients with knee osteoarthritis

Objective: To determine the reliability of FPI-6 in the assessment of foot posture in patients with knee osteoarthritis (KOA). Methods: Thirty volunteers with KOA (23 females, 7 males) were included in this study, assessed by two raters and at three different moments. Inter-rater and test-retest reliability were assessed with Cohen's Weighted Kappa (Kw) and Intraclass Correlation Coefficient (ICC). Bland-Altman plots and respective 95% limits of agreement (LOA) were used to assess both inter-rater and test-retest agreement and identify systematic bias. Moreover, the internal consistency of FPI-6 was assessed by Spearman's correlation coefficient. Results: FPI-6 total score showed a substantial inter-rater (Kw = .66) and test-retest reliability (Kw = .72). The six items of FPI-6 demonstrated inter-rater and test-retest reliability varying from fair to substantial (Kw = .33 to .76 and Kw = .40 to .78, respectively). Bland-Altman plots and respective 95% LOA indicated that there appeared no systematic bias and the acceptable agreement of FPI-6 total score for inter-rater and test-retest was excellent. There was a statistically significant positive correlation between each item and the total score of FPI-6, which indicated that FPI-6 had good internal consistency. Conclusion: In conclusion, the reliability of FPI-6 total score and the six items of FPI-6 were fair to substantial. The results can provide a reliable way for clinicians and researchers to implement the assessment of foot posture in patients with KOA.

Adjunctive therapies in addition to land-based exercise therapy for osteoarthritis of the hip or knee

BACKGROUND

Land-based exercise therapy is recommended in clinical guidelines for hip or knee osteoarthritis. Adjunctive non-pharmacological therapies are commonly used alongside exercise in hip or knee osteoarthritis management, but cumulative evidence for adjuncts to land-based exercise therapy is lacking.

OBJECTIVES

To evaluate the benefits and harms of adjunctive therapies used in addition to land-based exercise therapy compared with placebo adjunctive therapy added to land-based exercise therapy, or land-based exercise therapy only for people with hip or knee osteoarthritis.

SEARCH METHODS

We searched CENTRAL, MEDLINE, PsycINFO, EMBASE, CINAHL, Physiotherapy Evidence Database (PEDro) and clinical trials registries up to 10 June 2021.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) or quasi-RCTs of people with hip or knee osteoarthritis comparing adjunctive therapies alongside land-based exercise therapy (experimental group) versus placebo adjunctive therapies alongside land-based exercise therapy, or land-based exercise therapy (control groups). Exercise had to be identical in both groups. Major outcomes were pain, physical function, participant-reported global assessment, quality of life (QOL), radiographic joint structural changes, adverse events and withdrawals due to adverse events. We evaluated short-term (6 months), medium-term (6 to 12 months) and long-term (12 months onwards) effects.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed study eligibility, extracted data, and assessed risk of bias and certainty of evidence for major outcomes using GRADE.

MAIN RESULTS

We included 62 trials (60 RCTs and 2 quasi-RCTs) totalling 6508 participants. One trial included people with hip osteoarthritis, one hip or knee osteoarthritis and 59 included people with knee osteoarthritis only. Thirty-six trials evaluated electrophysical agents, seven manual therapies, four acupuncture or dry needling, or taping, three psychological therapies, dietary interventions or whole body vibration, two spa or peloid therapy and one foot insoles. Twenty-one trials included a placebo adjunctive therapy. We presented the effects stratified by different adjunctive therapies along with the overall results. We judged most trials to be at risk of bias, including 55% at risk of selection bias, 74% at risk of performance bias and 79% at risk of detection bias. Adverse events were reported in eight (13%) trials. Comparing adjunctive therapies plus land-based exercise therapy against placebo therapies plus exercise up to six months (short-term), we found low-certainty evidence for reduced pain and function, which did not meet our prespecified threshold for a clinically important difference. Mean pain intensity was 5.4 in the placebo group on a 0 to 10 numerical pain rating scale (NPRS) (lower scores represent less pain), and 0.77 points lower (0.48 points better to 1.16 points better) in the adjunctive therapy and exercise therapy group; relative improvement 10% (6% to 15% better) (22 studies; 1428 participants). Mean physical function on the Western Ontario and McMaster (WOMAC) 0 to 68 physical function (lower scores represent better function) subscale was 32.5 points in the placebo group and reduced by 5.03 points (2.57 points better to 7.61 points better) in the adjunctive therapy and exercise therapy group; relative improvement 12% (6% better to 18% better) (20 studies; 1361 participants). Moderate-certainty evidence indicates that adjunctive therapies did not improve QOL (SF-36 0 to 100 scale, higher scores represent better QOL). Placebo group mean QOL was 81.8 points, and 0.75 points worse (4.80 points worse to 3.39 points better) in the placebo adjunctive therapy group; relative improvement 1% (7% worse to 5% better) (two trials; 82 participants). Low-certainty evidence (two trials; 340 participants) indicates adjunctive therapies plus exercise may not increase adverse events compared to placebo therapies plus exercise (31% versus 13%; risk ratio (RR) 2.41, 95% confidence interval (CI) 0.27 to 21.90). Participant-reported global assessment was not measured in any studies. Compared with land-based exercise therapy, low-certainty evidence indicates that adjunctive electrophysical agents alongside exercise produced short-term (0 to 6 months) pain reduction of 0.41 points (0.17 points better to 0.63 points better); mean pain in the exercise-only group was 3.8 points and 0.41 points better in the adjunctive therapy plus exercise group (0 to 10 NPRS); relative improvement 7% (3% better to 11% better) (45 studies; 3322 participants). Mean physical function (0 to 68 WOMAC subscale) was 18.2 points in the exercise group and 2.83 points better (1.62 points better to 4.04 points better) in the adjunctive therapy plus exercise group; relative improvement 9% (5% better to 13% better) (45 studies; 3323 participants). These results are not clinically important. Mean QOL in the exercise group was 56.1 points and 1.04 points worse in the adjunctive therapies plus exercise therapy group (1.04 points worse to 3.12 points better); relative improvement 2% (2% worse to 5% better) (11 studies; 1483 participants), indicating no benefit (low-certainty evidence). Moderate-certainty evidence indicates that adjunctive therapies plus exercise probably result in a slight increase in participant-reported global assessment (short-term), with success reported by 45% in the exercise therapy group and 17% more individuals receiving adjunctive therapies and exercise (RR 1.37, 95% CI 1.15 to 1.62) (5 studies; 840 participants). One study (156 participants) showed little difference in radiographic joint structural changes (0.25 mm less, 95% CI -0.32 to -0.18 mm); 12% relative improvement (6% better to 18% better). Low-certainty evidence (8 trials; 1542 participants) indicates that adjunctive therapies plus exercise may not increase adverse events compared with exercise only (8.6% versus 6.5%; RR 1.33, 95% CI 0.78 to 2.27).

AUTHORS' CONCLUSIONS

Moderate- to low-certainty evidence showed no difference in pain, physical function or QOL between adjunctive therapies and placebo adjunctive therapies, or in pain, physical function, QOL or joint structural changes, compared to exercise only. Participant-reported global assessment was not reported for placebo comparisons, but there is probably a slight clinical benefit for adjunctive therapies plus exercise compared with exercise, based on a small number of studies. This may be explained by additional constructs captured in global measures compared with specific measures. Although results indicate no increased adverse events for adjunctive therapies used with exercise, these were poorly reported. Most studies evaluated short-term effects, with limited medium- or long-term evaluation. Due to a preponderance of knee osteoarthritis trials, we urge caution in extrapolating the findings to populations with hip osteoarthritis.

Physical therapy as a promising treatment for osteoarthritis: A narrative review

Osteoarthritis (OA) is the most prevalent joint disease and a leading cause of disability in older adults. With an increasing population ageing and obesity, OA is becoming even more prevalent than it was in previous decades. Evidence indicates that OA is caused by the breakdown of joint tissues from mechanical loading and inflammation, but the deeper underlying mechanism of OA pathogenesis remains unclear, hindering efforts to prevent and treat this disease. Pharmacological treatments are mostly related to relieving symptoms, and there is no drug for radical cure. However, compelling evidence suggests that regular practice of resistance exercise may prevent and control the development of several musculoskeletal chronic diseases including OA, which may result in improved quality of life of the patients. In this review, we introduced the current understanding of the mechanism and clinical treatments of OA pathogenesis. We also reviewed the recent study of physical therapy in the treatment of skeletal system disorders, especially in OA. Finally, we discuss the present challenges and promising advantages of physical therapy in OA treatment.

Effectiveness of gait retraining interventions in individuals with hip or knee osteoarthritis: A systematic review and meta-analysis

BACKGROUND

Osteoarthritis is a chronic synovial joint disease leading to pain, stiffness, and gait dysfunction, resulting in a significant health and economic burden. Gait retraining strategies and tools are used to address biomechanical gait dysfunction and symptoms in individuals with osteoarthritis. However, there is limited evidence relating to their effectiveness.

QUESTION

Do gait retraining strategies and tools improve gait biomechanics and symptoms in individuals with hip or knee osteoarthritis compared to control or alternate intervention?

METHODS

Seven databases were searched using key words relating to osteoarthritis, gait retraining, and biomechanics. A best evidence synthesis was conducted on included studies. Where available, a meta-analysis was performed, and the standardised mean difference (SMD) and 95% confidence internals (CI) were reported.

RESULTS

Eighteen studies were included. One study investigated gait retraining in participants with hip osteoarthritis and demonstrated limited evidence for improving gait biomechanics. Seventeen studies on knee osteoarthritis were included in the best evidence synthesis with six included in the meta-analysis. Gait retraining strategies which incorporated a real-time biofeedback tool, appear to have strong evidence for effectively modifying walking biomechanics. Moderate evidence was identified to support kinesiology taping improving pain scores. The meta-analysis pooled effect demonstrated significant improvements for knee adduction moment [SMD, -1.10; 95% CI. -1.85, -0.35] and the Western Ontario and McMaster Osteoarthritis Index in favour of gait retraining than a control intervention [SMD, -0.86; 95% CI. -1.33, -0.39]. All other interventions demonstrated evidence that was conflicting, limited, or not in favour of gait retraining.

CONCLUSION

Gait retraining may be beneficial for improving biomechanics and symptoms in knee osteoarthritis, however due to the high heterogeneity and limited studies in the analysis, further research is required. Further high quality randomised controlled trials for knee and especially hip osteoarthritis investigating the effects of gait retraining on biomechanics and symptoms are required.

The Effect of Biomechanical Footwear on Pain from Knee Osteoarthritis

The effect of biomechanical footwear on pain from knee osteoarthritis (OA) is still unclear and controversial. The purpose of this article is to review the literature with the aim of answering the following question: What is the impact of biomechanical footwear on pain from knee OA? A Cochrane Library and PubMed (MEDLINE) search related to the effect of biomechanical footwear on pain from knee OA was performed. Several authors have reported knee pain alleviation in people with knee OA using biomechanical footwear. However, many of them have also stated that further investigation was required to evaluate its long-run effectiveness and safety, as well as replication, prior to reaching conclusions about the clinical value of this treatment. The cost of biomechanical footwear treatment is around 5,000 US dollars. Considering the weak evidence currently available on the efficacy of biomechanical footwear and its high cost, we do not advise the routine use of that treatment until it can be unequivocally confirmed that it is truly effective for pain alleviation in patients with knee OA.

Osteoarthritis year in review 2021: mechanics

Osteoarthritis (OA) has a complex, heterogeneous and only partly understood etiology. There is a definite role of joint cartilage pathomechanics in originating and progressing of the disease. Although it is still not identified precisely enough to design or select targeted treatments, the progress of this year's research demonstrates that this goal became much closer. On multiple scales - tissue, joint and whole body - an increasing number of studies were done, with impressive results. (1) Technology based instrument innovations, especially when combined with machine learning models, have broadened the applicability of biomechanics. (2) Combinations with imaging make biomechanics much more precise & personalized. (3) The combination of Musculoskeletal & Finite Element Models yield valid personalized cartilage loads. (4) Mechanical outcomes are becoming increasingly meaningful to inform and evaluate treatments, including predictive power from biomechanical models. Since most recent advancements in the field of biomechanics in OA are at the level of a proof op principle, future research should not only continue on this successful path of innovation, but also aim to develop clinical workflows that would facilitate including precision biomechanics in large scale studies. Eventually this will yield clinical tools for decision making and a rationale for new therapies in OA.

PTH (1-34) enhances the therapeutic effect of bone marrow mesenchymal stem cell-derived exosomes by inhibiting proinflammatory cytokines expression on OA chondrocyte repair in vitro

Background

The effects of bone marrow mesenchymal stem cells (BMSCs) during the treatment of cartilage damage have been proven to be attributed to paracrine mechanisms, particularly the effect of exosomes. Exosomes from different batches are inhomogeneous, and different treatment effects are observed between samples. The purpose of this research was to find more effective and homogeneous exosomes for the repair of chondrocytes in osteoarthritis (OA). We observed the potential effects and possible mechanisms of exosomes derived from parathyroid hormone (PTH) (1-34)-preconditioned BMSCs (Exo^PTH) in the alleviation of OA.

Materials and methods

Exosomes derived from BMSCs (Exo^BMSC) and Exo^PTH were isolated by differential centrifugation. Primary rat chondrocytes were used to establish the OA model by interleukin 1 beta (IL-1β) in vitro. The effects of these two types of exosomes on OA chondrocyte proliferation, migration, apoptosis, and extracellular matrix formation were measured and compared. We observed changes in IL-2, TNF-α, and IL-6 levels via Western blotting (WB), and quantitative real-time PCR (qRT–PCR).

Results

We successfully extracted Exo^BMSC and Exo^PTH and established an IL-1β-induced OA model in primary chondrocytes from rats. Our study showed that IL-2, TNF-α, and IL-6 levels increased significantly in OA chondrocytes; however, both Exo^BMSC and Exo^PTH reduced the levels of IL-2, TNF-α, and IL-6. In addition, Exo^PTH exhibited stronger anti-inflammatory effects. Exo^PTH had a more marked effect on proliferation, migration, and production of the extracellular matrix (Col-II) in OA chondrocytes than Exo^BMSC at 24 h.

Conclusion

Exo^PTH increased the migration, proliferation, and chondral matrix formation of OA chondrocytes in vitro. In OA chondrocyte therapy, the potential mechanism of Exo^PTH might involve the inhibition of production of proinflammatory cytokines. Although the two types of exosomes had some similar effects, most effects of Exo^PTH were better than those of Exo^BMSC, so Exo^PTH may have a better ability to alleviate OA.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13075-022-02778-x.

Avoidance of Total Knee Replacement in a Population Health Setting: Introducing a Noninvasive Biomechanical Intervention for Patients with Knee Osteoarthritis

The observed increase in osteoarthritis (OA) of the knee as a result of an aging population and the obesity epidemic has led to a concomitant increase in the rates of total knee replacement (TKR), placing an additional financial and social burden on the ability of health care systems to control medical costs. Our study shows how a home-based, noninvasive biomechanical intervention reduced the rate of progression to surgery for a cohort of 237 patients with knee OA deemed eligible for TKR based on pre-established clinical selection criteria. Over the 24-month study period, 204 patients (86%) avoided surgery, with only 33 patients (14%, 95% confidence interval 82%-91%) progressing to a TKR with an average length of time to TKR of 324 days (ranging from 31 to 671 days). The application of this intervention provides health plans and provider networks managing patient care under financial risk arrangements an opportunity to realize significant cost savings without compromising quality of care or clinical outcomes.

Proprioceptive Training for Knee Osteoarthritis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background: There is increased interest in proprioceptive training for knee osteoarthritis (KOA). However, little consensus supports the effectiveness of this intervention. Objective: This meta-analysis aimed to assess the effects of proprioceptive training on symptoms, function, and proprioception in people with KOA. Methods: The PubMed, Cochrane Library, Web of Science, and EMBASE databases were systematically searched from the inception dates to April 16, 2021 for relevant randomized controlled trials (RCTs). Data were pooled by calculating the standardized mean differences (SMDs) and 95% confidence intervals (CIs). A random-effects model was used for the analyses. Results: A total of 24 RCTs involving 1,275 participants were included in our analysis. This study indicated that compared to no intervention, proprioceptive training significantly improved pain, stiffness, physical function, joint position sense (JPS), muscle strength, mobility, and knee ROM (P < 0.05) in people with KOA. When compared to other non-proprioceptive training, proprioceptive training provided better results in terms of JPS (SMD = -1.28, 95%CI: [-1.64, -0.92], I 2 = 0%, P < 0.00001) and mobility (timed walk over spongy surface) (SMD = -0.76, 95%CI: [-1.33, -0.18], I 2 = 64%, P = 0.01), and other results are similar. When proprioceptive training plus other non-proprioceptive training compared to other non-proprioceptive training, the two groups showed similar outcomes, but there was a greater improvement for JPS (SMD = -1.54, 95%CI: [-2.74, -0.34], I 2 = 79%, P = 0.01), physical function (SMD = -0.34, 95%CI: [-0.56, -0.12], I 2 = 0%, P = 0.003), and knee ROM (P < 0.05) in the proprioceptive training plus other non-proprioceptive training group. When proprioceptive training plus conventional physiotherapy compared against conventional physiotherapy, the two groups demonstrated similar outcomes, but there was a significant improvement for JPS (SMD = -0.95, 95%CI: [-1.73, -0.18], I 2 = 78%, P = 0.02) in the proprioceptive training plus conventional physiotherapy group. Conclusions: Proprioceptive training is safe and effective in treating KOA. There is some evidence that proprioceptive training combined with general non-proprioceptive training or conventional physiotherapy appears to be more effective and should be considered as part of the rehabilitation program. However, given that the majority of current studies investigated the short-term effect of these proprioceptive training programs, more large-scale and well-designed studies with long-term follow up are needed to determine the long-term effects of these proprioceptive training regimes in KOA. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/#recordDetails, PROSPERO, identifier: CRD42021240587.

The Effect of Flat Flexible Versus Stable Supportive Shoes on Knee Osteoarthritis Symptoms : A Randomized Trial

BACKGROUND

Experts recommend that persons with knee osteoarthritis wear stable supportive shoes; however, evidence suggests that flat flexible shoes may be more beneficial.

OBJECTIVE

To compare flat flexible with stable supportive shoes for knee osteoarthritis symptoms.

DESIGN

Participant- and assessor-blinded randomized trial. (Prospectively registered with the Australian New Zealand Clinical Trials Registry [ACTRN12617001098325]).

SETTING

Community.

PARTICIPANTS

164 patients with moderate to severe symptomatic radiographic medial knee osteoarthritis.

INTERVENTION

Flat flexible (n = 82) or stable supportive shoes (n = 82), worn for at least 6 hours a day for 6 months.

MEASUREMENTS

Primary outcomes were changes in walking pain (measured by an 11-point numerical rating scale) and physical function (as assessed by the Western Ontario and McMaster Universities Osteoarthritis Index subscale of 0 to 68 points) at 6 months. Secondary outcomes included additional pain and function measures, physical activity, and quality of life. Other measures included adverse events.

RESULTS

Of 164 participants recruited, 161 (98%) completed 6-month primary outcomes. No evidence was found that flat flexible shoes were superior to stable supportive shoes in primary outcomes. Evidence did show a between-group difference in change in pain favoring stable supportive shoes (mean difference, 1.1 units [95% CI, 0.5 to 1.8 units]; P = 0.001) but not function (mean difference, 2.3 units [CI, -0.9 to 5.5 units]; P = 0.167). Improvements in knee-related quality of life and ipsilateral hip pain favored stable supportive shoes (mean difference, -5.3 units [CI, -10.0 to -0.5 units] and 0.7 units [CI, 0.0 to 1.4 units], respectively). Flat flexible shoes were not superior to stable supportive shoes for any secondary outcome. Fewer participants reported adverse events with stable supportive shoes (n = 12 [15%]) compared with flat flexible shoes (n = 26 [32%]) (risk difference, -0.17 [CI, -0.30 to -0.05]).

LIMITATION

No "usual shoes" control group and a select patient subgroup, which may limit generalizability.

CONCLUSION

Flat flexible shoes were not superior to stable supportive shoes. Contrary to our hypothesis, stable supportive shoes improved knee pain on walking more than flat flexible shoes.

PRIMARY FUNDING SOURCE

National Health and Medical Research Council.

Diagnosis and Treatment of Hip and Knee Osteoarthritis: A Review

Importance

Osteoarthritis (OA) is the most common joint disease, affecting an estimated more than 240 million people worldwide, including an estimated more than 32 million in the US. Osteoarthritis is the most frequent reason for activity limitation in adults. This Review focuses on hip and knee OA.

Observations

Osteoarthritis can involve almost any joint but typically affects the hands, knees, hips, and feet. It is characterized by pathologic changes in cartilage, bone, synovium, ligament, muscle, and periarticular fat, leading to joint dysfunction, pain, stiffness, functional limitation, and loss of valued activities, such as walking for exercise and dancing. Risk factors include age (33% of individuals older than 75 years have symptomatic and radiographic knee OA), female sex, obesity, genetics, and major joint injury. Persons with OA have more comorbidities and are more sedentary than those without OA. The reduced physical activity leads to a 20% higher age-adjusted mortality. Several physical examination findings are useful diagnostically, including bony enlargement in knee OA and pain elicited with internal hip rotation in hip OA. Radiographic indicators include marginal osteophytes and joint space narrowing. The cornerstones of OA management include exercises, weight loss if appropriate, and education-complemented by topical or oral nonsteroidal anti-inflammatory drugs (NSAIDs) in those without contraindications. Intra-articular steroid injections provide short-term pain relief and duloxetine has demonstrated efficacy. Opiates should be avoided. Clinical trials have shown promising results for compounds that arrest structural progression (eg, cathepsin K inhibitors, Wnt inhibitors, anabolic growth factors) or reduce OA pain (eg, nerve growth factor inhibitors). Persons with advanced symptoms and structural damage are candidates for total joint replacement. Racial and ethnic disparities persist in the use and outcomes of joint replacement.

Conclusions and Relevance

Hip and knee OA are highly prevalent and disabling. Education, exercise and weight loss are cornerstones of management, complemented by NSAIDs (for patients who are candidates), corticosteroid injections, and several adjunctive medications. For persons with advanced symptoms and structural damage, total joint replacement effectively relieves pain.

Effect of biomechanical footwear on upper and lower leg muscle activity in comparison with knee brace and normal walking

AIM

To evaluate the activity of knee stabilizing muscles while using custom-made biomechanical footwear (BF) and to compare it when walking barefoot and with a knee brace (Unloader®).

METHODS

Seventeen healthy working-aged (mean age: 29 years; standard deviation: 8 years) individuals participated. The knee brace was worn on the right knee and BF in both legs. Surface electromyography (sEMG) data was recorded bilaterally from vastus medialis (VM), semitendinosus (ST), tibialis anterior (TA) and lateral gastrocnemius (LG) muscles during walking, and repeated-measures ANOVA with a post-hoc t-test was used to determine differences between the different walking modalities (barefoot, brace and BF).

RESULTS

Averaged sEMG was significantly higher when walking with BF than barefoot or knee brace in the ST muscles, in the right LG, and left TA muscle. It was significantly lower when walking with the brace compared to barefoot in the right ST and LG muscles, and left TA muscle. Analysis of the ensemble-averaged sEMG profiles showed earlier activation of TA muscles when walking with BF compared to other walking modalities.

CONCLUSION

BF produced greater activation in evaluated lower leg muscles compared to barefoot walking. Thus BF may have an exercise effect in rehabilitation and further studies about its effectiveness are warranted.