Epidemiology of knee osteoarthritis using Kellgren and Lawrence scale in Indian population

Physical therapy options for knee osteoarthritis: A review

In recent years, osteoarthritis of the knee, a common degenerative joint disease, often occurs in the elderly population. This disease has a significant impact on the quality of life of patients. For treating knee osteoarthritis, physical therapy is highly regarded as a very effective treatment method. This article delves deeply into commonly used physical therapy methods and analyzes their therapeutic effects, cost-effectiveness, and applicability, aiming to find treatments with broader applicability and better cost-effectiveness. The goal is to help a large number of patients effectively alleviate the discomfort caused by knee osteoarthritis, enhance the clinical therapeutic effects, and introduce home treatment methods to reduce financial burdens. The article also compares various physical therapy methods and finds that moxibustion and electrotherapy are more suitable for home use. Other treatment methods provide a reliable scientific basis for patient treatment.

Exploring the impact of integrated polyvagal exercises and knee reinforcement in females with grade II knee osteoarthritis: a randomized controlled trial

This study aimed to compare the effects of knee strengthening exercises to those of polyvagal theory-based exercises combined with knee strengthening exercises on selected outcomes in women with grade II knee osteoarthritis (OA). A randomized controlled trial was conducted, in which 60 female participants diagnosed with grade II knee OA, with a mean age of 57.27 ± 7.81 years and knee pain rated between 4 and 7 on the visual analog scale (VAS), were assigned to either the knee strengthening exercise group (Group 1, n = 30) or the polyvagal theory-based exercise plus knee strengthening exercise group (Group 2, n = 30). Pre- and posttreatment assessment of outcome variables, including WOMAC scores (joint pain, joint stiffness, functional limitations, and the overall index), WHOQOL scores (overall quality of life, general health, physical, psychological, social, and environmental domains), and heart rate variability (HRV, time and frequency domains), were analyzed. Group 2 demonstrated significantly greater reductions in joint pain, stiffness, and functional limitations than Group 1 after the intervention. Group 2 presented with significantly improved WOMAC scores, indicating better overall outcomes. Group 2 showed significant improvements in the psychological and social domains regarding quality of life. There were no significant differences in the physical domain or the environmental domain. Group 2 showed a significant increase in high-frequency power (HF) and a significant decrease in the LF/HF ratio, suggesting improved autonomic regulation. A combination of polyvagal exercise and knee strengthening training resulted in superior outcomes compared to knee strengthening exercises alone in women with grade II knee OA. These findings support the potential effectiveness of incorporating polyvagal exercises as an adjunctive intervention for osteoarthritis management.

Validation of a Wearable System for Lower Extremity Assessment

OBJECTIVE

Remote assessment and diagnosis of functional impairment caused by osteoarthritis (OA) of the knee can achieve early intervention of patients' functional impairment, prevent the deterioration of OA of the knee, and provide functional remote screening for patients with knee OA. This study introduced an inertial measurement unit (IMU) sensor-based system to assess lower extremity function and perform gait analysis. Then, we compared its accuracy to gold-standard motion capture and gait measurement systems.

METHODS

Nine adults were selected to participate in a comparative study of gait assessment outcomes using an IMU sensor-based wearable system, a gold-standard motion capture system, and a pressure-based gait analysis system. The subject walked on a path that incorporated all three systems. Data analysis was performed on spatiotemporal gait parameters, including velocity, cycle time, cadence, and stride length. This was followed by gait phases, including stance, swing, double stance, and single limb support phases. Data were processed using the data processing software of each system. An independent sample t-test was conducted for inter-group comparison to analyze the data.

RESULTS

The spatiotemporal gait parameters of the systems demonstrated excellent consistency, and the gait phases showed high consistency. Compared to the gold-standard pressure-based gait analysis system (the GATERite system), the mean gait cycle time results were 1.124 s vs. 1.127 s (p = 0.404); cadence was 93.333 steps/min vs. 94.189 steps/min (p = 0.482); stance phase was 60.89% vs. 63.26% (p < 0.001); swing phase was 39.11% vs. 36.74% (p < 0.001); stride length was 1.404 m vs. 1.420 m (p = 0.743); speed was 1.093 m/s vs. 1.110 m/s (p = 0.725). Compared to the gold-standard video-based motion capture system, the root mean square error was 2.7° for the hip angle and 2.6° for the knee angle.

CONCLUSIONS

This IMU-based wearable system delivered precise measuring results to evaluate patients with knee OA. This technology can also be used to guide rehabilitation exercises for patients with knee OA.

Correlation Between Synovial Fluid Levels of Matrix Metalloproteinase's (MMP-1, MMP-3, and MMP-9) and TNF-α with the Severity of Osteoarthritis Knee in Rural Indian Population

Background

In India, 22% to 39% of the ageing population suffers from degenerative knee osteoarthritis (OA), making it the most prevalent joint disorder in the knee. MMP-1, MMP-3, and MMP-9 protein expression levels have all been associated with OA. The aim of the present study was to establish a relationship between synovial fluid levels of matrix metalloproteinases (MMP-1, MMP-3, and MMP-9), and tumour necrosis factor-alpha (TNF-α) with different Kellgren-Lawrence Grading scale as per the severity of knee osteoarthritis (OA).

Methods

This hospital-based observational study included 87 individuals with knee osteoarthritis examined at the orthopaedics department outpatient clinic at the tertiary care teaching hospital in rural area of north India. In-person interviews were conducted to gather data, through a semi-structured, pretested interview schedule. To determine the degree and severity of OA, the levels of the enzymes matrix metalloproteinase MMP-1, MMP-3, and MMP-9 as well as tumour necrosis factor (TNF-α) were assessed in the synovial fluid of knee of each study participant.

Results

The levels of MMP-1, MMP-3, MMP-9, and TNF-α in synovial fluid were significantly correlated with the severity of osteoarthritis as determined by the Kellgren-Lawrence Grading Scale. Age, duration of symptoms and BMI showed a strong positive and significant correlation with biochemical markers (MMP-1, MMP-3, MMP-9, and TNF-α) in synovial fluid of Knee.

Conclusion

Level of biochemical markers (MMP-1, -3, -9, and TNF-α) in synovial fluid act as diagnostic markers and have a positive correlation with the severity of osteoarthritis knee, age, weight/BMI and duration of disease. However, no significant correlation was found between the level of aforementioned biochemical markers with sex, height, inflammation of the knee, morning stiffness, and age of onset of disease.

Efficacy of undenatured collagen in knee osteoarthritis: review of the literature with limited meta-analysis

BACKGROUND

Early knee osteoarthritis (OA) treatment is multimodal, with physical therapy and pharmacotherapy commonly used. Although popular, oral supplements like glucosamine and diacerein have not been reported to have high efficacy. Undenatured collagen type II (UC-II) has been introduced for therapy in early OA; it helps in cartilage repair and preservation. The present review was done to ascertain its efficacy in pain relief and knee function.

MATERIALS AND METHODS

A systematic literature search was performed on MEDLINE (PubMed), Embase, Scopus, and Cochrane Library for published literature; studies comparing the outcome of UC-II supplementation with placebo/control in adult humans with early knee OA were included. The outcomes evaluated were VAS Score, quality of life - Western Ontario and McMaster Universities (WOMAC-score), Knee function, Knee range of motion, and any complications during the course of treatment.

RESULTS

A total of 293 results were obtained after a primary search; 8 randomized control trials (RCT) were finally included. A total of 243 patients received UC-II supplementation (91 men and 152 women). The overall mean age range for the intervention group was 53.5±0.99 to 68.7±5.3 years across all included studies, and the mean follow-up duration was 3 to 6 months. Outcome measures like WOMAC and VAS scores showed better outcomes with UC-II in comparison to placebo. Walking measurements improved significantly from the baseline, reflected in improved timed up-and-go and 6-minute walk tests (6MWT). The overall complications were similar to other supplements.

CONCLUSION

With limited literature, UC-II has shown promise as a potent supplement in early knee OA with good pain relief and improved function. However, further large-scale studies are needed to substantiate these findings.

Effect of multi-component exercises program on pain-related gait adaptations among individuals with osteoarthritis of the knee joint

BACKGROUND

Osteoarthritis of the knee causes pain and gait disturbances, as well as a distinct gait pattern. Patients with knee OA have decreased range of motion (ROM) and increased ground reaction force. OA reduces stride length and walking speed.

OBJECTIVES

To determine the effect of a multi-component exercise program on pain-related gait adaptations among individuals with osteoarthritis of the knee joint and to compare the effect of multi-component exercises with traditional exercises on pain-related gait adaptations among individuals with osteoarthritis of the knee joint.

MATERIALS AND METHODS

This was an experimental study done between 120 patients having knee OA, of both genders, and between the age group of 50-65 years. These individuals were residents of the city of Karad and they were randomly divided into group A (conventional/traditional) and group B (experimental). A pretest assessment was done and the treatment was given for 6 weeks. The later posttest assessment was done and further statistical tests like paired and unpaired t tests were used.

RESULTS

Among the 120 subjects with OA knee, the age group of 60-65 years (44%) was found to be commonly affected. Thirty-nine were males (32.5%) and 81 were females (67.5%). Fifty-eight subjects (48%) were found to be commonly overweight. Thirty-two subjects (27%) had Genu Valgum deformity, and 88 subjects (73%) had Genu Varum deformity at the knee joint. The Pvalue within both group A and group B was found to be statistically significant for the entire outcome measures used for assessment. The pretest vs post test values of the WOMAC scale for patients with knee OA within both groups were found to be extremely significant (P < 0.0001). As for the MMT score in these patients, the Knee Flexors of Group A were not significant for right side (P = 0.7088) as well as for left side (P = 0.083) and in Group B they were extremely significant (P < 0.0001) for both sides. For the ROM scores within both groups, Knee Flexion of Group A for both sides was found to be extremely significant (P < 0.0001) for both sides. And for the pretest vs posttest values of within the groups'gait parameters among these patients with OA knees, for cadence both groups B were found to be extremely significant (P < 0.0001). The stride length for Group A was found to be very significant (P = 0.0060) and for Group B it was (P < 0.0001). Also, the P values of the various outcome measures between both groups were found to have statistical significance of their own.

CONCLUSION

Effect of Multi-Component Exercise Program on Pain-Related Gait Adaptations Among Individuals with Osteoarthritis of the Knee joint was found to be significant in pain reduction, improving strength, range of motion, and the gait parameters such as an increase in cadence, stride length, step length and decrease in the step width.

Unraveling the role of natural functional oils in modulating osteoarthritis related complications

Osteoarthritis (OA) is a common joint disease and has been studied extensively in recent years as no promising therapy available so far for its treatment and remains a great challenge for health care specialists. Although the identification of some major mechanisms that contribute to this disease suggests a plethora of bioactive agents in tackling the associated complications yet OA's pathophysiology is still poorly understood owing to complex mechanistic changes observed. Experimental research is now exploring a wide range of therapeutically effective agents in an effort to find a way to repair OA-related joint degeneration and halt it from getting worse. Data was acquired and reviewed from most relevant and recent studies. This review summarizes the studies that are currently available and focuses on how various unconventional functional oils affect osteoarthritis and the affected joint tissues. An analysis of the recent scientific literature allowed us to highlight the potential anti-arthritic properties of edible oils and their main constituents, which seems to suggest an interesting new potential therapeutic application. Due to eccentric nature of OA, it is necessary to concentrate initially on the management of symptoms. The evidence supporting functional oils chondroprotective potential is still accumulating, underpinning a global need for more sustainable natural sources of treatment. More clinical research that focuses on the consequences of long-term treatment, possible negative effects, and epigenetic implications is necessary to get optimistic results. However, different animal or clinical studies suggest that linolenic and linoleic fatty acids decreased chondrocyte oxidative stress, cartilage breakdown, and expression of inflammatory markers. Distinct fatty acids along with minor components of oils also reduced the generation of prostaglandins and decreased oxidative stress. Furthermore, the potential roles of the main components of edible oils and possible negative results (if any) are also reported. While no severe side effects have been reported for any edible oils. Overall, these studies identify and support the use of functional oils as an adjuvant therapy for the management of OA and as a means of symptomatic alleviation for OA patients. However, to prove the effectiveness or to draw precise conclusions, high-quality clinical trials are required.

Small molecule inhibitors of osteoarthritis: Current development and future perspective

Osteoarthritis (OA) is one of the common degenerative joint diseases in clinic. It mainly damages articular cartilage, causing pain, swelling and stiffness around joints, and is the main cause of disability of the elderly. Due to the unclear pathogenesis of osteoarthritis and the poor self-healing ability of articular cartilage, the treatment options for this disease are limited. At present, NSAIDs, Glucocorticoid and Duloxetine are the most commonly used treatment choice for osteoarthritis. Although it is somewhat effective, the adverse reactions are frequent and serious. The development of safer and more effective anti-osteoarthritis drugs is essential and urgent. This review summarizes recent advances in the pharmacological treatment of OA, focusing on small molecule inhibitors targeting cartilage remodeling in osteoarthritis as well as the research idea of reducing adverse effects by optimizing the dosage form of traditional drugs for the treatment of osteoarthritis. It should provide a reference for exploration of new potential treatment options.

Short- to Mid-Term Outcomes in Arthroscopic Debridement of the Knee: A Prospective Case Series

Introduction Osteoarthritis of the knee is a common debilitating disease in the elderly population. There are many treatment options available including physiotherapy, analgesics, steroid injections, arthroscopic debridement, high tibial osteotomy (HTO) and arthroplasty. Arthroscopic debridement is beneficial when patients are chosen with certain characteristics. This is a prospective case series where we have correlated the patient and disease characteristics, with the pre- and post-operative Oxford Knee Scores (OKS). Methods This study was done in a single centre with appropriate ethical committee approval and consent. Forty-nine patients were enrolled in the study. The scores were recorded pre-operatively and at 12 months after the interventions. Analysis was done for correlation of the outcome with patient characteristics, radiological and arthroscopic grading. Results Patients below the age of 56 years, with partial thickness chondral lesions, grade I-III Kellgren-Lawrence (KL) radiological grading and grade I-II Outerbridge arthroscopic grading showed significant improvement at 12 months. Conclusion Arthroscopic debridement is effective in younger patients with mild to moderate arthroscopic and radiologically graded osteoarthritis of the knee joint.

Detection and Classification of Knee Osteoarthritis

Osteoarthritis (OA) affects nearly 240 million people worldwide. Knee OA is the most common type of arthritis, especially in older adults. Physicians measure the severity of knee OA according to the Kellgren and Lawrence (KL) scale through visual inspection of X-ray or MR images. We propose a semi-automatic CADx model based on Deep Siamese convolutional neural networks and a fine-tuned ResNet-34 to simultaneously detect OA lesions in the two knees according to the KL scale. The training was done using a public dataset, whereas the validations were performed with a private dataset. Some problems of the imbalanced dataset were solved using transfer learning. The model results average of the multi-class accuracy is 61%, presenting better performance results for classifying classes KL-0, KL-3, and KL-4 than KL-1 and KL-2. The classification results were compared and validated using the classification of experienced radiologists.

A Review on Osteoarthritis Knee Management via Contrast Bath Therapy and Physical Therapy

One of the body's main weight-bearing joints is the knee joint. For this reason, osteoarthritis typically involves it. Osteoarthritis of the knee joint is the condition in which sub-chondral sclerosis of bone occurs, narrowing of joint space is present, and osteophyte formation is seen at the edges of the bone; because of this, there is pain, reduced knee range of motion, and this leads to functional activity limitations. This prevalence is increasing because of a reduced active lifestyle; this is becoming usual in younger populations. Non-pharmacological management of this condition using contrast bath therapy given by different methods like using hot and cold water, towel compression, and smart knee pad device, causes alternate vasodilatation and vasoconstriction helps to reduce pain symptoms. Physical therapy exercises like stretching, strengthening hip and knee muscles, and balance training showed beneficial effects on a range of motion and activities. Articles using keywords were searched on Google Scholar and PubMed, 70 articles were seen of which eight were reviewed that meet the inclusion criteria. Contrast therapy helps to remove metabolic waste by improving blood flow thus reducing pain. Strengthening the hip and knee muscles helps to stabilize the knee joint, and balance exercises help to improve proprioception. From this review, it is concluded that contrast bath therapy is effective in reducing pain when given with different methods of application as compared to individual hot or cold treatment, and given with the help of a device will be more effective than the traditional method. Along with this strengthening of the knee and hip musculature, stretching and balance exercise helps to improve range and functional activity. Exercise and electrotherapy aid in symptom relief and slow the progression rate of this condition.

Effect of osteoarthritic knee flexion deformity correction by total knee arthroplasty on sagittal spinopelvic alignment in Indian population

BACKGROUND

Sagittal alignment of the spine, pelvis, and lower extremities is essential for maintaining a stable and efficient posture and ambulation. Imbalance in any element can result in compensatory changes in the other elements. Knee flexion is a compensatory mechanism for spinopelvic sagittal alignment and is markedly affected in severe knee osteoarthritis (OA). The correction of knee flexion deformity (KFD) by total knee arthroplasty (TKA) can lead to complementary changes in the sagittal spinopelvic parameters (SSPs).

AIM

To determine the SSP changes in patients with knee OA, with or without KFD undergoing TKA.

METHODS

The study was conducted in 32 patients who underwent TKA. A neutral standing whole-spine lateral radiograph was performed before surgery and 3 mo after surgery in these patients. Subjects were divided into two groups (Group 1 obtained > 10° corrections in KFD; group B obtained < 10° correction). The pelvic tilt (PT), pelvic incidence (PI), sacral slope (SS), lumbar lordosis (LL), and sagittal vertical axis (SVA) were measured.

RESULTS

The median of change in PT, PI, SS, LL, and SVA was 0.20 mm, 1.00 mm, 2.20 mm, −0.40 mm, and 6.8 mm, respectively. The difference in the change in SSPs between the two groups was statistically non-significant.

CONCLUSION

SSPs, such as PI, PT, SS, LL, and SVA, do not change significantly following TKA in end-stage knee OA despite a significant correction (> 10°) in KFD.

The Effect of Local Heat Therapy versus Cold Rub Gel on Pain and Joint Functions in Patients with Knee Osteoarthritis

This study was compared the effect of local heat therapy versus cold rub gel on pain and joint function in patients with knee osteoarthritis. One hundred seventeen patients with knee osteoarthritis were randomly assigned to cold rub gel, local heat therapy, and control group. Data were collected by knee injury and osteoarthritis outcome score at a week prior to the interventions and on weeks of 1, 2, 3, and 4 of the interventions. A significant difference was found between the three groups in terms of pain severity (p = .001), joint symptoms (p = .001), ADL function (p = .001), Sport and Recreation function (p = .001), except Knee related QOL (p = .3). Cold rub gel and heat therapy were both effective in improving pain and joint function in patients with knee osteoarthritis.

Effect of dry cupping versus soft and prolonged massage in the management of knee osteoarthritis - a randomized controlled clinical trial

OBJECTIVES

Osteoarthritis is one of the most common musculoskeletal diseases which leads to functional decline and loss of quality of life. Knee osteoarthritis is considered as highly burdensome disease as well as highest contributor to global disability. Ḥijāmah (Cupping Therapy) and Dalk (Massage) are claimed effective in the treatment of Waja'ul Mafāṣil (osteoarthritis). Present study was framed to compare the efficacy of Ḥijāmah bilā Sharṭ (Dry Cupping) and Dalk-i-Layyin Kathīr (soft and prolonged massage) with Roghan-i-Bābūna (chamomile oil) in the management of Waja' ur Rukbah (knee osteoarthritis).

METHODS

In present randomised controlled clinical trial, a total of 48 diagnosed patients of knee osteoarthritis were allocated randomly into group A (n=24) and group B (n=24). Group A was treated with soft and prolonged massage with Roghan-i-Bābūna while group B was managed with dry cupping on alternate day for 15 min. Visual Analog Scale (VAS) and Knee osteoarthritis outcome score (KOOS) were used for the assessment of efficacy. A total of 40 patients, group A (n=20) and group B (n=20), were completed the allocated duration of protocol therapy and were restricted to statistical analysis.

RESULTS

Statistically highly significant improvement was observed in objective parameters using both paired and unpaired t-tests. VAS and all KOOS subscales were found to be strongly significant at 20th day when compared with baseline (p<0.001). In intergroup comparison significant change (p>0.05) was not observed. Safety parameters were in their normal range after treatment.

CONCLUSIONS

Dalk-i-Layyin Kathīr with Roghan-i-Bābūna and Ḥijāmah bilā Sharṭ both were found safe and effective in the management of Waja'ur Rukbah. Hence, it may be concluded that both regimenal therapies are safe, effective and almost equal in their efficacy in the management of Knee Osteoarthritis.