ObjectiveTo systematically review the risk factors for knee osteoarthritis among Chinese population.MethodsCNKI, WanFang Data, PubMed and EMbase databases were electronically searched to collect studies related to risk factors for knee osteoarthritis in Chinese population from January 2005 to November 2020. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies; meta-analysis was then performed using RevMan 5.4 software.ResultsA total of 18 studies involving 46 375 patients were included. The results of meta-analysis showed that body mass index (BMI)≥28 kg/m2 (OR=1.78, 95%CI 1.47 to 2.14, P<0.000 1), females (OR=2.20, 95%CI 1.98 to 2.45, P<0.000 1), family history of osteoarthritis (OR=3.56, 95%CI 1.88 to 6.73, P<0.000 1), age≥60 years old (OR=1.42, 95%CI 1.26 to 1.59, P<0.000 1), history of joint trauma (OR=4.11, 95%CI 2.85 to 5.93, P<0.000 1), manual labor (OR=1.57, 95%CI 1.32 to 1.86, P<0.000 1), heavy housework (OR=1.63, 95%CI 1.20 to 2.22, P<0.000 1), humid environment (OR=4.33, 95%CI 2.99 to 6.29, P<0.000 1), drinking habit (OR=1.69, 95%CI 1.21 to 2.36, P=0.002), non-elevator building (OR=1.78, 95%CI 1.18 to 2.70, P=0.006), joint load (OR=9.14, 95%CI 3.05 to 27.45, P<0.000 1), cold environment (OR=2.13, 95%CI 1.32 to 3.44, P=0.002), and habit of sitting cross-legged (OR=7.56, 95%CI 1.74 to 32.79, P=0.007) were risk factors for knee osteoarthritis among Chinese population.ConclusionsControlling and reducing weight, preventing knee injuries, keeping joints warm, controlling alcohol consumption, improving humid and cold living environment, appropriately reducing heavy physical labor, reducing joint weight, and changing the habit of sitting cross-legged can prevent the occurrence of knee osteoarthritis.
ObjectiveTo investigate the accuracy, safety, and short-term effectiveness of a domestic robot-assisted system in total knee arthroplasty (TKA) by a multicenter randomized controlled trial. Methods Between December 2021 and February 2023, 138 patients with knee osteoarthritis who received TKA in 5 clinical centers were prospectively collected, and 134 patients met the inclusion criteria were randomly assigned to either a trial group (n=68) or a control group (n=66). Seven patients had lost follow-up and missing data, so they were excluded and the remaining 127 patients were included for analysis, including 66 patients in the trial group and 61 patients in the control group. There was no significant difference (P>0.05) in gender, age, body mass index, side, duration of osteoarthritis, Kellgren-Lawrence grading, preoperative Knee Society Score (KSS) and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score between the two groups. The trial group completed the TKA by domestic robot-assisted osteotomy according to the preoperative CT-based surgical planning. The control group was performed by traditional osteotomy plate combined with soft tissue release. Total operation time, osteotomy time of femoral/tibial side, intraoperative blood loss, and postoperative complications were recorded and compared between the two groups. The radiographs were taken at 5 and 90 days after operation, and hip-knee-ankle angle (HKA), lateral distal angle of femur (LDFA), and posterior tibial slope (PTS) were measured. The difference between the measured values of the above indexes at two time points after operation and the preoperative planning target values was calculated, and the absolute value (absolute error) was taken for comparison between the two groups. The postoperative recovery of lower limb alignment was judged and the accuracy was calculated. KSS score and WOMAC score were used to evaluate the knee joint function of patients before operation and at 90 days after operation. The improvement rates of KSS score and WOMAC score were calculated. The function, stability, and convenience of the robot-assisted system were evaluated by the surgeons. ResultsThe total operation time and femoral osteotomy time of the trial group were significantly longer than those of the control group (P<0.05). There was no significant difference in the tibial osteotomy time and the amount of intraoperative blood loss between the two groups (P>0.05). The incisions of both groups healed by first intention after operation, and there was no infection around the prosthesis. Nine patients in the trial group and 8 in the control group developed lower extremity vascular thrombosis, all of which were calf intermuscular venous thrombosis, and there was no significant difference in the incidence of complications (P>0.05). All patients were followed up 90 days. There was no significant difference in KSS score and WOMAC score between the two groups at 90 days after operation (P>0.05). There was significant difference in the improvement rate of KSS score between the two groups (P<0.05), while there was no significant difference in the improvement rate of WOMAC score between the two groups (P>0.05). Radiological results showed that the absolute errors of HKA and LDFA in the trial group were significantly smaller than those in the control group at 5 and 90 days after operation (P<0.05), and the recovery accuracy of lower limb alignment was significantly higher than that in control group (P<0.05). The absolute error of PTS in the trial group was significantly smaller than that in the control group at 5 days after operation (P<0.05), but there was no significant difference at 90 days between the two groups (P>0.05). The functional satisfaction rate of the robot-assisted system was 98.5% (65/66), and the satisfaction rates of stability and convenience were 100% (66/66). ConclusionDomestic robot-assisted TKA is a safe and effective surgical treatment for knee osteoarthritis, which can achieve favorable lower limb alignment reconstruction, precise implant of prosthesis, and satisfactory functional recovery.
ObjectiveTo systematically evaluate the efficacy and safety of intra-articular injection of hyaluronic acid for knee osteoarthritis. MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 1, 2016), WanFang Data, CBM, and CNKI were searched to collect randomized controlled trials (RCTs) about intra-articular injection of hyaluronic acid for knee osteoarthritis from inception to February 2016. The meta-analysis was conducted using RevMan 5.3 software. ResultsA total of 17 RCTs involving 4 070 patients were included. The results of metaanalysis showed that: there were no significant differences in WOMAC pain scores (7 weeks: MD=-0.01, 95%CI -0.46 to 0.44, P=0.98; 13 weeks: MD=-0.01, 95%CI -0.46to 0.43, P=0.95; 26 weeks: MD=0.32, 95%CI -0.04 to 0.67, P=0.08), stiffness scores (7 weeks: MD=0.10, 95%CI -0.26 to 0.45, P=0.59; 13 weeks: MD=0.24, 95%CI -0.11 to 0.60, P=0.17; 26 weeks: MD=0.06, 95%CI -0.09 to 0.22, P=0.42), and life function scores (7 weeks: MD=-0.20, 95%CI -0.75to 0.36, P=0.49; 13 weeks: MD=-0.02, 95%CI -0.57 to 0.52, P=0.93; 26 weeks: MD=0.30, 95%CI -0.07 to 0.67, P=0.11) between the hyaluronic acid group and the control group in 7-, 13- and 26 weeks. However, the hyaluronic acid group was superior to the control group in 50-step test (MD=-0.49，95%CI -7.36 to -3.61，P<0.000 01). ConclusionCurrent evidence suggests that intra-articular injection of hyaluronic acid has better effect than control treatment for pain at movement. However, due to the limited quantity of the included studies, the above conclusion still need to be verified by more high quality studies．
Objective To investigate the effect of knee suspension during titanium plate fixation on postoperative posterior tibial slope (PTS) in knee osteoarthritis (KOA) with medial opening-wedge high tibial osteotomy (OWHTO). Methods The clinical data of 47 patients with KOA treated by OWHTO between January 2019 and December 2020 was retrospectively analyzed. In 24 cases, the knee joint was suspended when titanium plate was fixed (research group), and in 23 cases, the knee joint was naturally straightened when titanium plate was fixed (control group). There was no significant difference in gender, age, side, body mass index, disease duration, preoperative visual analogue scale (VAS) score, American Hospital for Special Surgery (HSS) score, Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score, Lysholm score, and preoperative PTS between the two groups (P>0.05). PTS were measured at 1 day after operation and last follow-up, and were compared with that before operation. Before operation and at last follow-up, VAS score was used to evaluate the knee pain, HSS score, WOMAC score, and Lysholm score were used to evaluate the knee function. Results The patients in both groups were followed up 13-24 months, with an average of 19.9 months. There was no complication such as incision infection, screw fracture, and deep venous thrombosis of lower limbs in two groups. At last follow-up, the VAS score, HSS score, WOMAC score, and Lysholm score in two groups were significantly improved when compared with those before operation (P<0.05), but there was no significant difference between the two groups in the each score difference of before and after operation (P>0.05). There was no significant difference in PTS at each time point before and after operation in the research group (P>0.05), but PTS in the control group significantly increased at 1 day after operation and last follow-up (P<0.05). PTS of the research group at 1 day after operation and last follow-up were significantly lower than those of the control group (P<0.05). ConclusionOWHTO can effectively relieve knee pain and improve knee function in KOA, and the increase of postoperative PTS can be effectively avoided by suspending knee joint.
ObjectivesTo systematically review the prevalence and disease burden of knee osteoarthritis (KOA) in China.MethodsPubMed, EMbase, CNKI, WanFang Data and VIP databases were searched to collect cross-sectional studies about the prevalence and disease burden of KOA in China from January 1st 1995 to August 31st 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed by using R statistical software.ResultsA total of thirty-three studies were included. The results of meta-analysis showed the prevalance rate of KOA was 18% (95%CI 14% to 22%), and it was higher in women (19%, 95%CI 16% to 23%) than in men (11%, 95%CI 9% to 13%) (P<0.05). The prevalence rates of KOA in different regions were as follows: 11% (95%CI 8% to 14%) in north, 17% (95%CI 15% to 20%) in north-east, 21% (95%CI 13% to 32%) in east, 21% (95%CI 13% to 33%) in north-west, 22% (95%CI 6% to 57%) in south-west, and 18% (95%CI 13% to 23%) in south-central, respectively.ConclusionsThe prevalence of KOA in China is high, and the disease burden is heavy. Due to the quantity and quality of included studies, more high-quality studies are required to verify the above conclusions in future.
Objective To investigate the effects of ergometer cycling training based on the internet of things and quadriceps strengthening based on internet mobile phones on joint stiffness, function and walking ability in patients with knee osteoarthritis (KOA) in a community setting. Methods KOA patients attending West China Hospital, Sichuan University were selected between April and July 2022. The patients were randomly divided into ergometer cycling group, quadriceps strengthening group and control group (treated with traditional therapy) using a random number table method. The patient underwent a 12 week intervention. The Western Ontario and McMaster Universities Arthritis Index (WOMAC) scale, Timed Up and Go Test (TUG) were used to evaluate the degree of joint stiffness, joint function and walking ability of patients. Data was collected and evaluated before intervention and at 4, 8, and 12 weeks after the initial intervention.Results A total of 72 patients were included, with 24 cases in each group. There were interactive effects between group and time in WOMAC joint stiffness score, joint functional score and TUG test time (P<0.05). At 8 and 12 weeks after intervention, the joint stiffness scores of the ergometer cycling group and the quadriceps strengthening group were better than those of the control group. At 4, 8 and 12 weeks after intervention, the joint function scores of the ergometer cycling group and the quadriceps strengthening group were better than those of the control group (P<0.05). At 8, 12 weeks after intervention, the TUG test scores of the ergometer cycling group were better than those of the control group and the quadriceps strengthening group (P<0.05). Conclusions In a community setting, both 12-week Internet of thing-based ergometer cycling and internet video-based quadriceps strengthening were effective on improving knee stiffness and function in KOA patients and were superior to traditional methods, the two effects were comparable. Ergometer cycling is superior to quadriceps strengthening and traditional methods in improving walking ability.
Objective To observe the treatment efficacy and safety of glucosamine hydrochloride tablets on uremia patients with knee osteoarthritis (OA). Methods A total of 118 uremia patients with knee OA were selected and randomly divided into the glucosamine hydrochloride tablets treatment group (treatment group) and the coated aldehyde oxystarch capsules group (control group) with 59 cases in each group. The course was 8 weeks. The Lequesne Index was assessed for curative effect evaluation, and the change of blood indexes was observed to evaluate drug safety. Results The total effective rate of Lequesne Index in the treatment group was 72.9%, while that in the control group was 13.6%; the difference was statistically significant (χ2=42.303, P<0.001). There was no significant change in the two groups before and after treatment in terms of the patients’ dialysis adequacy, routine blood, blood electrolytes, liver and kidney function (P>0.05). Conclusion Glucosamine hydrochloride tablets is curative and safe in the treatment of uremia patients with OA.
Knee osteoarthritis (KOA) is a common chronic degenerative osteoarthritic disease with a high incidence especially among middle-aged and elderly people, and patients with KOA usually suffer from joint pain and dyskinesia, which is disabling and seriously affects their quality of life. Acupotomy therapy, as one of the characteristic treatments of traditional Chinese medicine, has been proven to significantly reduce the pain of KOA patients and effectively slow down the rapid deterioration of the disease. Therefore, this article reviews the pathogenic factors of KOA and explores the mechanism of action of acupotomy therapy for KOA from the perspectives of mechanical structure, level of inflammatory factors, cartilage repair, and cellular autophagy and apoptosis, in order to provide a more solid theoretical basis and therapeutic strategy for the application of acupotomy therapy in the clinical practice of KOA.
Objective To investigate the load distribution on the more painful and less painful limbs in patients with mild-to-moderate and severe bilateral knee osteoarthritis (KOA) and explore the compensatory mechanisms in both limbs among bilateral KOA patients with different severity levels. Methods A total of 113 participants were enrolled between July 2022 and September 2023. This cohort comprised 43 patients with mild-to-moderate bilateral KOA (Kellgren-Lawrence grade 2-3), 43 patients with severe bilateral KOA (Kellgren-Lawrence grade 4), and 27 healthy volunteers (healthy control group). The visual analogue scale (VAS) score for pain, the Hospital for Special Surgery (HSS) score, passive knee range of motion (ROM), and hip-knee-ankle angle (HKA) were used to assess walking pain intensity, joint function, and lower limb alignment in KOA patients, respectively. Motion trajectories of reflective markers and ground reaction force data during walking were captured using a gait analysis system. Musculoskeletal modeling was then employed to calculate biomechanical parameters, including the peak knee adduction moment (KAM), KAM impulse, peak joint contact force (JCF), and peak medial/lateral contact forces (MCF/LCF). Statistical analyses were performed to compare differences in clinical and gait parameters between bilateral limbs. Additionally, one-dimensional statistical parametric mapping was utilized to analyze temporal gait data. Results Mild-to-moderate KOA patients showed the significantly higher HSS score (67.7±7.9) than severe KOA patients (51.9±8.9; t=8.747, P<0.001). The more painful limb in all KOA patients exhibited significantly greater HKA and higher VAS scores compared to the less painful limb (P<0.05). While bilateral knee ROM did not differ significantly in mild-to-moderate KOA patients (P>0.05), the severe KOA patients had significantly reduced ROM in the more painful limb versus the less painful limb (P<0.05). Healthy controls showed no significant bilateral difference in any biomechanical parameters (P>0.05). All KOA patients demonstrated longer stance time on the less painful limb (P<0.05). Critically, severe KOA patients exhibited significantly higher peak KAM, KAM impulse, and peak MCF in the more painful limb (P<0.05), while mild-to-moderate KOA patients showed the opposite pattern with lower peak KAM and KAM impulse in the more painful limb (P<0.05) and a similar trend for peak MCF. Conclusion Patients with mild-to-moderate KOA effectively reduce load on the more painful limb through compensatory mechanisms in the less painful limb. Conversely, severe bilateral varus deformities in advanced KOA patients nullify compensatory capacity in the less painful limb, paradoxically increasing load on the more painful limb. This dichotomy necessitates personalized management strategies tailored to disease severity.
Objective To study the effect of multi-disciplinary treatment (MDT) on the surgical efficacy and satisfaction of patients undergoing total knee arthroplasty (TKA) for the first time. Methods The clinical data of patients who underwent unilateral TKA for single-compartment osteoarthritis of the knee in the General Hospital of Ningxia Medical University between January and September 2022 were retrospectively collected and analyzed. According to whether MDT was performed on patients during the perioperative period, they were divided into MDT group and traditional group. Perioperative nutrition-related indicators, perioperative complications, total hospitalization time, Visual Analogue Scale (VAS), and Hospital for Special Surgery Knee Score (HSS) before and after surgery were detected and recorded. Results A total of 95 patients were included. Among them, there were 42 cases in the MDT group and 53 cases in the traditional group. The postoperative complications and total hospital stay of patients in the MDT group were lower than those in the traditional group, and their satisfaction scores were higher than those in the traditional group (P<0.05). The perioperative serum total protein (TP), hemoglobin (Hb), serum albumin (ALB) levels, VAS score, and HSS score of both groups of patients changed over time. The intra group comparison results showed that compared with preoperative, the levels of TP, Hb, and ALB in both groups decreased on the 1st and 3rd postoperative days (P<0.05). On the 3rd day after surgery, the levels of TP, Hb, ALB in the MDT group and Hb, ALB in the traditional group were lower than on the 1st day after surgery (P<0.05). There was no statistically significant difference in TP levels between the traditional group on the 3rd day after surgery and the 1st day after surgery (P>0.05). The results of intra group comparison at different time points showed that there were statistically significant differences in VAS score and HSS score between the two groups (P<0.05). Conclusion The application of MDT in elderly patients undergoing unilateral TKA for the first time can shorten the total hospitalization time, reduce the incidence of perioperative complications, and improve the surgical efficacy and patient satisfaction.