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Jahn J, Ehlen QT, Huang CY. Finding the Goldilocks Zone of Mechanical Loading: A Comprehensive Review of Mechanical Loading in the Prevention and Treatment of Knee Osteoarthritis. Bioengineering (Basel) 2024; 11:110. [PMID: 38391596 PMCID: PMC10886318 DOI: 10.3390/bioengineering11020110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 02/24/2024] Open
Abstract
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.
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Affiliation(s)
- Jacob Jahn
- University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Quinn T Ehlen
- University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Chun-Yuh Huang
- Department of Biomedical Engineering, College of Engineering, University of Miami, Coral Gables, FL 33146, USA
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Xu Z, Wang Y, Zhang Y, Lu Y, Wen Y. Efficacy and safety of aquatic exercise in knee osteoarthritis: A systematic review and meta-analysis of randomized controlled trials. Clin Rehabil 2023; 37:330-347. [PMID: 36320162 DOI: 10.1177/02692155221134240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
OBJECTIVE To examine the efficacy and safety of aquatic exercise for people with knee osteoarthritis. DATA SOURCES PubMed, Web of Science, Embase, CENTRAL, CNKI and WanFang databases were searched from 1966 to September 2022. REVIEW METHODS Randomized controlled trials evaluating aquatic exercise for people with knee osteoarthritis compared with no exercise and land-based exercise were included. The Grading of Recommendations Assessment, Development and Evaluation system was used to evaluate the certainty of evidence. RESULTS Twenty-two studies with 1394 participants were included. Compared with no exercise (13 trials with 746 participants), low-to high-certainty evidence revealed that aquatic exercise yielded significant improvements in patient-reported pain (SMD -0.58, 95% CI -0.82 to -0.33), stiffness (SMD -0.57, 95% CI -1.03 to -0.11) and physical function (SMD -0.35, 95% CI -0.52 to -0.18) immediately postintervention. A sustained effect was observed only for pain at three months postintervention (SMD -0.48, 95% CI -0.91 to -0.06). The confidence intervals demonstrated that the pooled results do not exclude the minimal clinically important differences. There were no significant differences between the effects of aquatic exercise and land-based exercise (13 trials with 648 participants) on pain (SMD -0.12, 95% CI -0.29 to 0.04), stiffness (SMD -0.17, 95% CI -0.49 to 0.16) or physical function (SMD -0.13, 95% CI -0.28 to 0.02). No study reported a serious adverse event in relation to aquatic exercise. CONCLUSION Aquatic exercise provides a short-term clinical benefit that is sustained for at least three months postintervention in terms of pain in people with knee osteoarthritis.
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Affiliation(s)
- Zhen Xu
- Department of Physical Education, 12538Nankai University, Tianjin, China
| | - Yidi Wang
- China Swimming College, 47838Beijing Sport University, Beijing, China
| | - Yue Zhang
- Department of Physical Education, 12474Shanghai Jiao Tong University, Shanghai, China
| | - Yifan Lu
- School of Sports Medicine and Rehabilitation, 47838Beijing Sport University, Beijing, China.,Key Laboratory of Physical Fitness and Exercise, Ministry of Education, 47838Beijing Sport University, Beijing, China
| | - Yuhong Wen
- Key Laboratory of Physical Fitness and Exercise, Ministry of Education, 47838Beijing Sport University, Beijing, China.,School of Recreational Sports and Tourism, 47838Beijing Sport University, Beijing, China
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Effect of High-Power Laser Therapy Versus Shock Wave Therapy on Pain and Function in Knee Osteoarthritis Patients: A Randomized Controlled Trial. Photobiomodul Photomed Laser Surg 2022; 40:198-204. [DOI: 10.1089/photob.2021.0136] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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Zeng CY, Zhang ZR, Tang ZM, Hua FZ. Benefits and Mechanisms of Exercise Training for Knee Osteoarthritis. Front Physiol 2022; 12:794062. [PMID: 34975542 PMCID: PMC8716769 DOI: 10.3389/fphys.2021.794062] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/19/2021] [Indexed: 01/09/2023] Open
Abstract
Knee osteoarthritis is a chronic degenerative disease. Cartilage and subchondral bone degeneration, as well as synovitis, are the main pathological changes associated with knee osteoarthritis. Mechanical overload, inflammation, metabolic factors, hormonal changes, and aging play a vital role in aggravating the progression of knee osteoarthritis. The main treatments for knee osteoarthritis include pharmacotherapy, physiotherapy, and surgery. However, pharmacotherapy has many side effects, and surgery is only suitable for patients with end-stage knee osteoarthritis. Exercise training, as a complementary and adjunctive physiotherapy, can prevent cartilage degeneration, inhibit inflammation, and prevent loss of the subchondral bone and metaphyseal bone trabeculae. Increasing evidence indicates that exercise training can improve pain, stiffness, joint dysfunction, and muscle weakness in patients with knee osteoarthritis. There are several exercise trainings options for the treatment of knee osteoarthritis, including aerobic exercise, strength training, neuromuscular exercise, balance training, proprioception training, aquatic exercise, and traditional exercise. For Knee osteoarthritis (KOA) experimental animals, those exercise trainings can reduce inflammation, delay cartilage and bone degeneration, change tendon, and muscle structure. In this review, we summarize the main symptoms of knee osteoarthritis, the mechanisms of exercise training, and the therapeutic effects of different exercise training methods on patients with knee osteoarthritis. We hope this review will allow patients in different situations to receive appropriate exercise therapy for knee osteoarthritis, and provide a reference for further research and clinical application of exercise training for knee osteoarthritis.
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Affiliation(s)
- Chu-Yang Zeng
- Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China.,Department of Rehabilitation Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhen-Rong Zhang
- School of Rehabilitation, Capital Medical University, Beijing, China
| | - Zhi-Ming Tang
- Department of Orthopedics, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China
| | - Fu-Zhou Hua
- Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
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Pascoalino SD, Lüdtke DD, Heymanns AC, Salm D, Costa DM, Martins DF, Horewicz VV, Bobinski F, Piovezan AP. Antihyperalgesic effect of exercise is augmented by the oral pretreatment with extract of Casearia sylvestris in an animal model of osteoarthritis. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2020. [DOI: 10.1177/2210491720935614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background/Purpose: Osteoarthritis (OA) is the main orthopedic disease to cause pain and edema in humans. This study evaluated the influence of complementary medicine on the hyperalgesia and edema induced by exercise in an animal model of OA as well as possible role for interleukin (IL)-1β to these outcomes. Methods: Mice (25–35 g) were subjected to intraplantar injection of Freund’s complete adjuvant and were subjected to exercise and oral treatment with ethanolic crude extract of Casearia sylvestris (ECE-CS) or vehicle (alone or in combination) and evaluated through behavioral and biochemical tests. Results: At day 5, exercise and ECE-CS alone did not reduce hyperalgesia, while the combination of both enhanced this effect. In muscle and skin tissues from the treated paw of mice, both treatments alone or in combination reduced in similar extent the levels of IL-1β in relation to the control group. Conclusion: Association of both complementary therapies may bring benefits on pain associated with OA in humans.
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Affiliation(s)
- Shayany Dalbem Pascoalino
- Physical Education Undergraduate Course, University of Southern Santa Catarina (UNISUL), Palhoça, Santa Catarina, Brazil
| | - Daniela Dero Lüdtke
- Postgraduate Program in Health Sciences (PPGCS), University of Southern Santa Catarina (UNISUL), Palhoça, Santa Catarina, Brazil
- Laboratory of Experimental Neuroscience (LANEX), University of Southern Santa Catarina (UNISUL), Palhoça, Santa Catarina, Brazil
| | - Ana Caroline Heymanns
- Physical Education Undergraduate Course, University of Southern Santa Catarina (UNISUL), Palhoça, Santa Catarina, Brazil
- Postgraduate Program in Health Sciences (PPGCS), University of Southern Santa Catarina (UNISUL), Palhoça, Santa Catarina, Brazil
- Laboratory of Experimental Neuroscience (LANEX), University of Southern Santa Catarina (UNISUL), Palhoça, Santa Catarina, Brazil
| | - Daiana Salm
- Postgraduate Program in Health Sciences (PPGCS), University of Southern Santa Catarina (UNISUL), Palhoça, Santa Catarina, Brazil
- Laboratory of Experimental Neuroscience (LANEX), University of Southern Santa Catarina (UNISUL), Palhoça, Santa Catarina, Brazil
| | - Déborah M Costa
- Medicine Undergraduate Course, University of Southern Santa Catarina (UNISUL), Palhoça, Santa Catarina, Brazil
| | - Daniel Fernandes Martins
- Postgraduate Program in Health Sciences (PPGCS), University of Southern Santa Catarina (UNISUL), Palhoça, Santa Catarina, Brazil
- Laboratory of Experimental Neuroscience (LANEX), University of Southern Santa Catarina (UNISUL), Palhoça, Santa Catarina, Brazil
| | - Verônica V Horewicz
- Postgraduate Program in Health Sciences (PPGCS), University of Southern Santa Catarina (UNISUL), Palhoça, Santa Catarina, Brazil
- Laboratory of Experimental Neuroscience (LANEX), University of Southern Santa Catarina (UNISUL), Palhoça, Santa Catarina, Brazil
| | - Franciane Bobinski
- Postgraduate Program in Health Sciences (PPGCS), University of Southern Santa Catarina (UNISUL), Palhoça, Santa Catarina, Brazil
- Laboratory of Experimental Neuroscience (LANEX), University of Southern Santa Catarina (UNISUL), Palhoça, Santa Catarina, Brazil
| | - Anna Paula Piovezan
- Postgraduate Program in Health Sciences (PPGCS), University of Southern Santa Catarina (UNISUL), Palhoça, Santa Catarina, Brazil
- Laboratory of Experimental Neuroscience (LANEX), University of Southern Santa Catarina (UNISUL), Palhoça, Santa Catarina, Brazil
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A Better Way to Decrease Knee Swelling in Patients with Knee Osteoarthritis: A Single-Blind Randomised Controlled Trial. Pain Res Manag 2019; 2019:8514808. [PMID: 31191790 PMCID: PMC6525802 DOI: 10.1155/2019/8514808] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/22/2019] [Accepted: 03/31/2019] [Indexed: 11/18/2022]
Abstract
Objective In this study, we compared the effects of intermittent pneumatic compression along with conventional treatment with cold-pack treatment along with conventional treatment on clinical outcomes in patients with knee osteoarthritis. Methods Eighty-nine patients with knee osteoarthritis participated in this study. One group received ultrasound, transcutaneous electrical nerve stimulation, electrical stimulation, exercise, and cold packs. The second group received ultrasound, transcutaneous electrical nerve stimulation, electrical stimulation, exercise, and intermittent pneumatic compression. Range of motion, muscle strength, knee swelling, pain intensity, and functional status were measured at baseline and 4th week. Results We found significant improvements in range of motion, muscle strength, pain intensity, and functional status after the treatment in both groups (p < 0.05). When comparing the effects of these two treatment programs, it was observed that the intermittent pneumatic compression treatment group had a better outcome in terms of knee swelling (p=0.028). Conclusions According to the results, we could report that intermittent pneumatic compression therapy in addition to conventional treatment has significant positive effects on clinical outcomes in patients with knee osteoarthritis. We could also report that intermittent pneumatic compression therapy along with conventional treatment is superior to cold-pack therapy along with conventional treatment in terms of knee swelling in patients with knee osteoarthritis. This trial is registered with NCT03806322.
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Raad M, Amin RM, El Abiad JM, Puvanesarajah V, Best MJ, Oni JK. Preoperative Patient Functional Status Is an Independent Predictor of Outcomes After Primary Total Hip Arthroplasty. Orthopedics 2019; 42:e326-e330. [PMID: 30913294 DOI: 10.3928/01477447-20190321-01] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 09/12/2018] [Indexed: 02/03/2023]
Abstract
This study was designed to determine whether preoperative functional status of patients with osteoarthritis predicts outcomes after primary total hip arthroplasty. The American College of Surgeons National Surgical Quality Improvement Program database was queried for records of patients who underwent primary total hip arthroplasty for a principal diagnosis of osteoarthritis from 2009 to 2013 (N=43,179). Patients were categorized as dependent or independent according to their preoperative functional status. The groups were compared regarding several potential confounders using Student's t and chi-square tests. Logistic and Poisson regression models (inclusion threshold of P<.1) were used to assess the associations of functional status with outcomes. The alpha level was set at 0.05. Compared with independent patients, dependent patients were likely to be older (mean, 70 vs 66 years, P<.01) and to have more preoperative comorbidities. After controlling for potential confounders, preoperative dependent functional status was predictive of major complications (odds ratio, 2.34; 95% confidence interval, 1.67-3.28), nonroutine discharge (odds ratio, 2.80; 95% confidence interval, 2.35-3.34), and longer hospital stay (incidence risk ratio, 1.19; 95% confidence interval, 1.12-1.27). Rates of unplanned reoperation were similar between groups on multivariate analysis. Compared with preoperative independent functional status, preoperative dependent functional status was independently associated with worse outcomes after primary total hip arthroplasty for osteoarthritis. [Orthopedics. 2019; 42(3):e326-e330.].
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