The effect of lateral wedge insoles in patients with medial compartment knee osteoarthritis: balancing biomechanics with pain neuroscience

Effects of high tibial osteotomy compared with unicondylar knee arthroplasty on the surgical site wound infection and pain in patients with medial knee osteoarthritis

This study aims to comprehensively compare the effects of unicondylar knee arthroplasty (UKA) and high tibial osteotomy (HTO) on wound infection and pain in patients with medial knee osteoarthritis. A computerized search was conducted in Embase, PubMed, Google Scholar, China National Knowledge Infrastructure, Cochrane Library and Wanfang databases, from database inception to October 2023, for studies comparing UKA and HTO for medial knee osteoarthritis. Studies selection, data extraction and study quality evaluation were independently conducted by two researchers. Stata 17.0 software was employed for data analysis. Overall, 10 studies involving 870 patients with medial knee osteoarthritis were included. It was found that the UKA group had significantly lower wound visual analogue scale scores compared to the HTO group (SMD = -0.53, 95%CI: -0.87 to -0.20, p < 0.001). The incidence of wound infection in the UKA group was higher than in the HTO group (OR = 1.92, 95%CI: 0.65-5.69, p = 0.240), and the incidence of complications was lower (OR = 0.89, 95%CI: 0.52-1.54, p = 0.684), though these differences were not statistically significant. This study indicates that UKA is effective in alleviating postoperative wound pain in medial knee osteoarthritis. However, the rates of postoperative wound infection and complications are comparable to those of HTO. Clinicians should consider factors such as patient age and disease severity in making individualized treatment decisions.

Finding the Goldilocks Zone of Mechanical Loading: A Comprehensive Review of Mechanical Loading in the Prevention and Treatment of Knee Osteoarthritis

In this review, we discuss the interaction of mechanical factors influencing knee osteoarthritis (KOA) and post-traumatic osteoarthritis (PTOA) pathogenesis. Emphasizing the importance of mechanotransduction within inflammatory responses, we discuss its capacity for being utilized and harnessed within the context of prevention and rehabilitation of osteoarthritis (OA). Additionally, we introduce a discussion on the Goldilocks zone, which describes the necessity of maintaining a balance of adequate, but not excessive mechanical loading to maintain proper knee joint health. Expanding beyond these, we synthesize findings from current literature that explore the biomechanical loading of various rehabilitation exercises, in hopes of aiding future recommendations for physicians managing KOA and PTOA and athletic training staff strategically planning athlete loads to mitigate the risk of joint injury. The integration of these concepts provides a multifactorial analysis of the contributing factors of KOA and PTOA, in order to spur further research and illuminate the potential of utilizing the body's own physiological responses to mechanical stimuli in the management of OA.

Impact of in shoe and barefoot placed frontal wedges on plantar loading: A systematic review

PURPOSE

The main aim of this review is to report the effect of different types of in-shoe and barefoot wedges on the distribution of the plantar loading of the human foot. We hypothesise that frontal plane wedges modify this parameter.

METHODS

A systematic review was performed, using the PubMed, CINAHL, Prospero and Scopus databases, consulted from their date of first publication to May 2020. Only observational (cross-over studies), randomised controlled trials (RCTs) and quasi-experimental studies addressing the effects of in-shoe and barefoot frontal plane wedges on plantar loading were included. All articles were subjected to quality assessment, using the Newcastle-Ottawa scale for the observational (cross-over) studies, TREND for quasi-experimental studies and the Cochrane Collaboration's tool for the RCTs.

RESULTS

Eleven papers were included in the final review. Four were cross-over studies, other four were quasi-experimental studies and three were RCTs. These eleven studies included 320 patients, with ages ranging from 20 to 60 years. Regarding the risk of bias, most of the observational studies and RCTs had a moderate level of quality.

CONCLUSIONS

The results suggest that lateral wedges are more effective, producing a lateral shift of the centre of pressure and increasing the pressure. Regarding the impact on the peak impact force there seems to be less consensus among the published data.

Immediate preoperative outcomes of pain neuroscience education for patients undergoing total knee arthroplasty: A case series

BACKGROUND

Standard preoperative education for total knee arthroplasty (TKA) has been shown to have no effect on postoperative outcomes. This may be because such education programs fail to educate patients about pain. Pain neuroscience education (PNE) focuses on teaching people more about pain from a neurobiological and neurophysiological perspective.

DESIGN AND SETTING

Case Series.

AIM

To determine the immediate effects, if any, of providing PNE before TKA surgery on patient self-report measures.

PARTICIPANTS

Twelve patients (female = 10) prior to TKA for knee osteoarthritis (OA).

INTERVENTION

Preoperative educational session by a physical therapist on the neuroscience of pain, accompanied by an evidence-based booklet.

MAIN OUTCOME MEASURES

Comparison of pre- and post-PNE self-report measures on knee pain (NPRS), Pain Catastrophization Scale (PCS), fear of movement (TSK), and beliefs about TKA; as well as three physical performance measures - knee flexion active range of motion, 40 m self-paced walk, and pressure pain threshold (PPT).

RESULTS

Immediately following the PNE, patients had statistically significant lower TSK scores, increased PPT, and improved beliefs about their upcoming surgery. There were no significant changes in knee pain, function, or flexion active range of motion.

CONCLUSIONS

Results appear to suggest that immediately after PNE, patients scheduled for TKA had statistically significant changes in fear of movement, decreased sensitivity to pain and positive shifts in their beliefs about their future knee surgery. Larger trials with control/comparison groups are warranted to determine the true effects of preoperative PNE for patients about to undergo TKA.