Humans ; Knee Joint ; physiopathology ; Osteoarthritis, Knee ; physiopathology ; therapy

Knee osteoarthritis (KOA) is the most common knee joint disease. Although KOA belongs to a disease of degeneration of knee joint cartilage, its pathology involves cartilage, subchondral bone, meniscus, synovial membrane, articular capsule and other joint tissue. The infrapatellar fat pad (IPFP), an intracapsular but extrasynovial structure, has some special characteristics of endocrine metabolism, then it has double roles in the development of KOA, but its protective effect is much more than harmful effect. Considering protective roles of IPFP in KOA and some serious complications after IPFP resection, the surgeon shall protect IPFP as far as possible if total knee arthroplasty surgical field is good. If it is necessary to improve the surgical field, its fibrotic tissue even all part can be removed.
Adipose Tissue ; physiology ; Arthroplasty, Replacement, Knee ; Humans ; Knee Joint ; physiopathology ; surgery ; Osteoarthritis, Knee ; surgery

PURPOSE: Pain from osteoarthritis (OA) is generally classified as nociceptive (inflammatory). Animal models of knee OA have shown that sensory nerve fibers innervating the knee are significantly damaged with destruction of subchondral bone junction, and induce neuropathic pain (NP). Our objective was to examine NP in the knees of OA patients using painDETECT (an NP questionnaire) and to evaluate the relationship between NP, pain intensity, and stage of OA. MATERIALS AND METHODS: Ninety-two knee OA patients were evaluated in this study. Pain scores using Visual Analogue Scales (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), painDETECT, duration of symptoms, severity of OA using the Kellgren-Lawrence (KL) system, and amount of joint fluid were evaluated and compared using a Spearman's correlation coefficient by rank test. RESULTS: Our study identified at least 5.4% of our knee OA patients as likely to have NP and 15.2% as possibly having NP. The painDETECT score was significantly correlated with the VAS and WOMAC pain severity. Compared with the painDETECT score, there was a tendency for positive correlation with the KL grade, and tendency for negative correlation with the existence and amount of joint fluid, but these correlations were not significant. CONCLUSION: PainDETECT scores classified 5.4% of pain from knee OA as NP. NP tended to be seen in patients with less joint fluid and increased KL grade, both of which corresponded to late stages of OA. It is important to consider the existence of NP in the treatment of knee OA pain.
Aged ; Aged, 80 and over ; Female ; Humans ; Knee/pathology/physiopathology ; Male ; Middle Aged ; Neuralgia/*physiopathology ; Osteoarthritis, Knee/*physiopathology

OBJECTIVETo investigate results of total knee arthroplasty using the long-stem tibial component combined with metallic wedge of knee prosthesis for the treatment of proximal defects.

METHODSFrom January 2011 to May 2013, 10 patients (11 knees) were treated with total knee arthroplasties using the long-stem tibial component with metallic tibial wedge of knee prosthesis. All the patients were female and the average age was 67 years old (ranged, 60 to 77 years old). All the patients were osteoarthritis. All the patients were classified as T2A style. The patients were evaluated according to knee score system (KSS).

RESULTSAll the patients were followed up for 12 months on average (ranged 3 to 29 months). The clinical outcome was assessed using KSS score, including knee pain score, knee stability score, knee range of motion score and knee walking score, knee stairs score. There were significantly differences at 6 weeks, 3 months, 6 months and 12 months between pre-and postoperative KSS score.

CONCLUSIONThe mechanical stability of tibial fixation in primary TKA is significantly increased by using the long-stem tibial component with metallic wedge of knee prosthesis, even in the presence of poor proximal bone.

Aged ; Arthroplasty, Replacement, Knee ; Female ; Humans ; Knee Joint ; physiopathology ; surgery ; Knee Prosthesis ; Male ; Osteoarthritis, Knee ; physiopathology ; surgery ; Range of Motion, Articular ; Tibia ; abnormalities ; physiopathology ; surgery

OBJECTIVETo study the gait characteristics of different syndrome types based on musculature zones of the knee osteoarthritis (KOA) and to discuss the application of modern biomechanical technology in objective study on syndrome differentiation which is based on musculature zones.

METHODSThirty knees out of 19 patients suffering from KOA with the different musculature zone syndrome types were measured the step angle, the heel impulse, the internal and external rotation figures and the percentage of the maximum vertical ground reaction time in the total time of the supporting period by using the Plantar Pressure Measurement System.

RESULTSIn the knees with abnormal musculature zones, the figures of step angle and the heel impulse of Foot Shaoyang Meridian and three foot yin meridians were significantly increased than normal (all P<0.05), while those figures of Foot Yangming Meridian were normal; in the knees of Foot Yangming Meridian with abnormal musculature zones, the external rotation mean figure in the midstance was significantly increased than normal (P<0.05); in the knees of Foot Shaoyang Meridian with abnormal musculature zones, the internal rotation mean figure in the propulsion was significantly increased than normal (P<0.05); in the knees of the three foot yin meridians with abnormal musculature zones, the mean external rotation figure in propulsion was significantly increased than normal (P<0.05); in the knees of the Foot Yangming Meridian with abnormal musculature zones, the time of maximum vertical ground reaction was significantly delayed (P<0.05).

CONCLUSIONThe figures of the gait index in KOA patients with different musculature zone types are different, including the step angle, heel impulse, the internal and external rotation figures, the time of the maximum vertical ground reaction and so on, which could be used as the objective basis of syndrome differentiation based on musculature zones for KOA patients. Therefore, biomechanical technology can be applied in the syndrome differentiation based on musculature zones for KOA patients.

Adult ; Foot ; physiopathology ; Gait ; Humans ; Male ; Meridians ; Middle Aged ; Osteoarthritis, Knee ; diagnosis ; physiopathology

OBJECTIVETo study the therapeutic effects of electroacupuncture for the treatment of osteoarthritis of knee joint.

METHODSForty patients with knee osteoarthritis were randomly divided into two groups: the electroacupuncture group (20 patients)and the control group (20 patients). The patients in electroacupuncture group (8 male and 12 female, with an average age of 62.50 +/- 9.23 years and mean course of disease 9.85 +/- 8.17 years)were treated with electroacupuncture for one month. At the same time, the patients in control group (7 male and 13 female, with an average age of 61.15 +/- 6.75 years and mean course of disease 8.60 +/- 6.89 years) were given Diclofenac sodium orally for one month. The motor function of knee joints were evaluated before and after treatment according to Lysholm knee scoring scale.

RESULTSMost scores in the electroacupuncture group improved significantly compared with those of before treatment (P < 0.01 or P < 0.05) except for the item demands for support. While in the control group, compared with those of before treatment, there were significant difference on the item of pain, inter locking and instability (P < 0.01 or P < 0.05), but there were no significant differences on other five items (P > 0.05). Between the two groups after treatment, differences on item of inter locking, instability, swelling, stair activity and squat were significant (P < 0.05), but no differences on limp, demands for support and pain (P > 0.05).

CONCLUSIONAcupuncture can effectively improve the clinical symptoms and knee joint's motor function of patients with knee osteoarthritis, and more superior than Diclofenac sodium oral. It is a proved effective method for osteoarthritis.

Aged ; Electroacupuncture ; Female ; Humans ; Knee Joint ; physiopathology ; Male ; Middle Aged ; Osteoarthritis, Knee ; physiopathology ; therapy ; Pain Measurement ; Treatment Outcome

The capacity to perform certain activities is frequently compromised after total knee arthroplasty (TKA) due to a functional decline resulting from decreased range of motion and a diminished ability to kneel. In this manuscript, the current biomechanical understanding of hyperflexion and kneeling before and after TKA will be discussed. Patellofemoral and tibiofemoral joint contact area, contact pressure, and kinematics were evaluated in cadaveric studies using a Tekscan pressure measuring system and Microscribe. Testing was performed on intact knees and following cruciate retaining and posterior stabilized TKA at knee flexion angles of 90degrees, 105degrees, 120degrees, and 135degrees. Three loading conditions were used to simulate squatting, double stance kneeling, and single stance kneeling. Following TKA with double stance kneeling, patellofemoral contact areas did not increase significantly at high knee flexion angle (135degrees). Kneeling resulted in tibial posterior translation and external rotation at all flexion angles. Moving from double to single stance kneeling tended to increase pressures in the cruciate retaining group, but decreased pressures in the posterior stabilized group. The cruciate retaining group had significantly larger contact areas than the posterior stabilized group, although no significant differences in pressures were observed comparing the two TKA designs (p < 0.05). If greater than 120degrees of postoperative knee range of motion can be achieved following TKA, then kneeling may be performed with less risk in the patellofemoral joint than was previously believed to be the case. However, kneeling may increase the likelihood of damage to cartilage and menisci in intact knees and after TKA increases in tibiofemoral contact area and pressures may lead to polyethyelene wear if performed on a chronic, repetitive basis.
*Arthroplasty, Replacement, Knee ; Biomechanical Phenomena ; Cadaver ; Humans ; Knee Joint/*physiopathology/surgery ; Osteoarthritis, Knee/*physiopathology/surgery ; Patellofemoral Joint/physiopathology/surgery ; Posture/physiology ; Range of Motion, Articular

OBJECTIVETo observe the change of clearance and range of joint improved situation during total knee arthroplasty (TKA) by operating extended release manipulation of the posterior knee clearance.

METHODSA total of 120 patients with knee osteoarthritis undergoing unilateral TKA from March 2010 to March 2012 were equally randomized prospectively assigned to the experimental group and control group, each 60 cases. There were 46 male and 74 female patients, the mean age was 63.6 years (range from 49 to 75 years). After the osteotomy of the tibia and the femoral condyle and before the release of soft tissue intraoperation, patients in experimental group were taken the extended release manipulation of the posterior knee clearence while the control group were cleaned the osteophyte of the posterior condyle only, 2-sided paired t test was used to compare the clearence intraoperation and the time to flexion angle of 90° and 120° and the maximum angle after 3 months' follow-up.

RESULTSThere was no significant difference of the index between the experimental group and control group (P > 0.05). Between experimental group and control group, the difference was significant in extention clearance ((18.9 ± 1.5) mm vs. (17.9 ± 1.6) mm, t = 3.53, P < 0.01) intraoperation, and no significant difference in flexion clearance ((20.7 ± 1.8) mm vs. (20.2 ± 1.9) mm, t = 1.48, P > 0.05). It took longer time for the knee flexion range of motion to 90°(t = 10.2399, P < 0.01) or 120°(t = 11.142, P < 0.01) of the control group than that of the experimental group, and the difference of the maximum range of motion between experimental group and control group was significant statistically at the 3-months follow-up (t = 4.4255, P < 0.01). All the patients were followed up for 3 - 24 months, average of 14.6 months, no femoral component loosening happened.

CONCLUSIONSExtended release of the posterior knee clearance benefits the knee extension clearence intraoperation and functional exercise of range of motion postoperation, while it is no meaning to the flexion clearence.

Aged ; Arthroplasty, Replacement, Knee ; Female ; Humans ; Joint Capsule Release ; methods ; Knee Joint ; physiopathology ; surgery ; Male ; Middle Aged ; Osteoarthritis, Knee ; physiopathology ; surgery ; Osteotomy ; Range of Motion, Articular ; Treatment Outcome

PURPOSETo determine the effect of the posterior condylar offset (PCO) on clinical results after total knee arthroplasty (TKA) using a high-flex posterior-stabilized (PS) fixed-bearing prosthesis.

METHODSWe prospectively studied the clinical and radiographic materials of 89 consecutive female patients (89 knees), who had undergone primary TKAs for end-stage osteoarthritis. All operations were performed by a single senior surgeon or under his supervision using the same operative technique. Based on the corrected PCO change, we divided all cases into two groups: group A (corrected PCO change ≥0 mm, 58 knees) and group B (corrected PCO change<0 mm, 31 knees). One-year postoperatively, clinical and radiographic variables from the two groups were compared by independent t-test. The associations between the corrected PCO changes and the improvements of clinical variables in all patients were analyzed by Pearson linear correlation.

RESULTSOne-year postoperatively, the Knee Society Scores, the Western Ontario and McMaster Universities Osteoarthritis Index, non-weight-bearing active and passive range of knee flexion, flexion contracture, extensor lag, and their improvements had no statistical differences between the two groups (all p>0.05). The corrected PCO change was not significantly correlated with the improvement of any clinical variable (all p>0.05). Group A demonstrated greater flexion than group B during active weight bearing (p<0.05).

CONCLUSIONSRestoration of PCO plays an important role in the optimization of active knee flexion during weight-bearing conditions after posterior-stabilized TKA, while it has no benefit to non-weight-bearing knee flexion or any other clinical result.

Aged ; Arthroplasty, Replacement, Knee ; methods ; Biomechanical Phenomena ; Female ; Humans ; Knee Joint ; physiopathology ; Knee Prosthesis ; Middle Aged ; Osteoarthritis ; physiopathology ; surgery ; Prospective Studies ; Range of Motion, Articular

OBJECTIVETo verify the clinical efficacy of heat-sensitive moxibustion in treatment of knee osteoarthritis (KOA).

METHODSSixty cases of KOA were randomly divided into a heat-sensitive moxibustion group and a conventional moxibustion group, 30 cases in each one. Dubi (ST 35), Yanglingquan (GB 34), Zusanli (ST 36) and Heding (EX-LE 2) on the affected side were selected in two groups. In heat-sensitive moxibustion group, the techniques of circling moxibustion, sparrow-pecking moxibustion, moving moxibustion and mild moxibustion were applied. In conventional moxibustion group, the mild moxibustion was used, 2 to 3 cm far from the skin of the acupoints selected. Lysholm scale for the assessment of knee joint function was adopted to evaluate the efficacy. The scores of joint pain, morning stiffness, joint swelling and walking ability were compared before and after treatment in two groups.

RESULTSThe scores of joint pain, morning stiffness, joint swelling and walking ability after treatment were all apparently improved as compared with those before treatment in either group (all P < 0.05). The improvement in the above-mentioned indices in heat-sensitive moxibustion group was much more apparent as compared with that in conventional moxibustion group (all P < 0.01). The effective rate was 90.0% (27/30) in heat-sensitive moxibustion group and was 73.3% (22/30) in conventional moxibustion group. The effective rate in heat-sensitive moxibustion group was obviously superior to that in conventional moxibustion group (P < 0.01).

CONCLUSIONThe efficacy of heat-sensitive moxibustion is superior to that of conventional moxibustion in the treatment of KOA. This therapy can more significantly improve the symptoms and physical signs of the patients with KOA.

Acupuncture Points ; Aged ; Female ; Humans ; Locomotion ; Male ; Middle Aged ; Moxibustion ; Osteoarthritis, Knee ; physiopathology ; therapy ; Treatment Outcome