A combination of the "disease-syndrome-symptom" approach was used to study the syndrome characterization and features of dampness-heat obstruction syndrome in papain-induced knee osteoarthritis(KOA) model rats during the disease process. Forty-eight male SD rats were randomly divided into sham and model groups. The KOA model was established by injecting a mixture of papain and L-cysteine into the joint cavity on days 1, 3, and 5. During the 8 weeks following model establishment, the rats were assessed weekly for the plantar mechanical pain threshold, knee joint diameter, local skin temperature of the knee joint, weight-bearing difference between the two hind feet, and the modified Lequesne MG score of the knee joint. Samples were collected at 1, 2, 4, 6, and 8 weeks after model establishment to observe the gross lesions in cartilage and synovium. Histopathological changes in joint tissues were examined using hematoxylin-eosin, Masson's trichrome, and Senna red O-solid green staining. ELISA and immunohistochemical analysis were performed to detect the levels of interleukin(IL)-1β, IL-6, tumor necrosis factor(TNF)-α, prostaglandin E2(PGE2), and the expression of aquaporins(AQP) 1 and 3 in serum and synovium. The results showed that the ink score of articular cartilage in the model group significantly increased from 4 to 8 weeks, the cartilage Mankin's score and the percentage of Masson-positive area in cartilage increased significantly from 1 to 8 weeks. The percentage of red-stained area for cartilage proteoglycans decreased significantly from 1 to 8 weeks. The synovitis score from 1 to 6 weeks and the percentage of blue-stained collagen fibers in the synovium from 1 to 8 weeks increased significantly, with statistically significant differences compared to the sham group. The mechanical pain threshold in the model group significantly decreased from 1 to 8 weeks, the knee joint diameter significantly increased from 1 to 6 weeks, and the local skin temperature of the knee joint, the weight-bearing difference between the two hind feet, and the modified Lequesne MG score from 1 to 5 weeks significantly increased, all with statistically significant differences compared to the sham group. The levels of IL-1β, IL-6, TNF-α, and PGE2 in serum and synovium of the model group significantly increased from 1 to 6 weeks. Serum TNF-α and PGE2, and synovial IL-1β, also significantly increased at 8 weeks. The levels of cartilage AQP1 and AQP3 significantly increased from 1 to 4 weeks, while synovial AQP1 and AQP3 increased significantly from 1 to 6 weeks, with all differences statistically significant compared to the sham group. In conclusion, papain-induced KOA rats exhibited pathological changes, including articular cartilage degeneration and synovial inflammation, within 1 week of induction. The KOA rats showed characteristics of dampness-heat obstruction syndrome, such as joint pain, swelling, elevated skin temperature, and decreased function, as well as increased inflammatory factors and AQP1、AQP3 in serum and joint tissues within 5 to 6 weeks of disease onset. These results provide an experimental model for studying the syndromes of KOA with dampness-heat obstruction syndrome.
Animals ; Male ; Rats, Sprague-Dawley ; Rats ; Osteoarthritis, Knee/physiopathology* ; Disease Models, Animal ; Humans ; Interleukin-1beta/metabolism* ; Interleukin-6/metabolism* ; Tumor Necrosis Factor-alpha/metabolism* ; Knee Joint/pathology*

OBJECTIVETo investigate the effect of eletroacupuncture with close-to-bone needling treatment on expression of Sox9, vascular endothelial growth factor (VEGF) and type X collagen (ColX) in impaired cartilage of rabbits with knee osteoarthritis (KOA) and explore its possible mechanisms.

METHODSForty New Zealand rabbits were randomized equally into normal control group, KOA model group, eletroacupuncture with close-to-bone needling group (CN group), and normal thrust needing group (NTN group). In the latter 3 groups, KOA was induced by Hulth-Telhag treatment and evaluated with X-ray examination, and 6 weeks after the modeling, eletroacupuncture for 20 min was administered in CN and NTN groups at the acupoints "Zusanli", "Waixiyan", "Neixiyan", "Liangqiu" and "Yinlingquan" in the left knee joints once daily for 5 days as a treatment cycle. After 5 treatment cycles, the rabbits were examined for behavioral changes, cartilage morphology, and Mankin scores; The protein and mRNA expressions of S0x9, VEGF, and ColX were examined using Westen blotting, immunohistochemistry, and RT-PCR as appropriate.

RESULTSThe rabbits in the model, CN and NTN groups showed significant changes in behaviors and cartilage histomorphology after the modeling and after the treatments. HE staining showed that cartilage injury was repaired and tended to recovery in CN and NTN groups. The cartilage pathologies was severer in the model group than in the normal control, CN and NTN groups (P<0.01); Sox9 protein increased and VEGF mRNA level decreased in CN and NTN groups after treatment as compared with those in the model group (P<0.01).

CONCLUSIONEletroacupuncture with close-to-bone needling can effectively improve KOA in rabbits probably by enhancing Sox9 and reducing VEGF and ColX expressions in the cartilage to inhibit hypertrophic differentiation of the chondrocytes, maintain chondrogenic phenotype and repair cartilage cells.

Acupuncture Points ; Animals ; Cartilage, Articular ; metabolism ; pathology ; Cell Differentiation ; Chondrocytes ; cytology ; Chondrogenesis ; Collagen Type X ; metabolism ; Electroacupuncture ; Knee Joint ; physiopathology ; Osteoarthritis, Knee ; therapy ; Rabbits ; SOX9 Transcription Factor ; metabolism ; Vascular Endothelial Growth Factor A ; metabolism

PURPOSE: The purpose of the study was to investigate the effects of the Thera-Band exercise program following total knee arthroplasty. METHODS: The research design for this study was a nonequivalent control group non-synchronized design. Participants were 30 patients for the experimental group and 30 patients for the control group. The experimental group participated in the Thera- Band exercise program in addition to conventional CPM (continuous passive motion) exercise. The control group received conventional CPM exercise only. Outcome measures were pain, knee flexion range of motion, CRP, and psychological parameters (self-efficacy and fear of falling). Data were analyzed using chi2-test, Fisher's exact test, t-test, and repeated measure ANOVA with SPSS/PC version 21.0. RESULTS: There were significant improvement in self-efficacy, and decreases in pain, and fear of falling in the experimental group compared to the control group. However, no significant differences were found between the two groups for CRP and knee flexion ROM. CONCLUSION: The Thera-Band exercise program gave an additional benefit over the conventional CPM exercise for patients following total knee arthroplasty, and is recommended for use as an effective nursing intervention for patients after total knee arthroplasty.
Accidental Falls ; Aged ; Arthroplasty, Replacement, Knee ; C-Reactive Protein/analysis ; Exercise Therapy ; Female ; Humans ; Knee/*physiopathology ; Knee Injuries/*psychology/therapy ; Male ; Middle Aged ; Pain/*pathology ; Pain Management ; Range of Motion, Articular ; Self Efficacy ; Surveys and Questionnaires

Intra-articular haemangioma is a rare and uncommon condition that sometimes presents in infants. The lesion can be a diagnostic challenge, with misdiagnosis often leading to delayed diagnosis and treatment. It is essential to establish and treat the condition early, as intra-articular haemangioma can lead to destruction of the joint and secondary arthrosis. Herein, we report the case of a five-year-old boy who presented with intra-articular haemangioma and discuss the management of his condition.
Arthralgia ; physiopathology ; Biopsy, Needle ; Child, Preschool ; Follow-Up Studies ; Hemangioma ; diagnosis ; pathology ; surgery ; Humans ; Immunohistochemistry ; Joint Capsule ; pathology ; surgery ; Knee Joint ; pathology ; surgery ; Magnetic Resonance Imaging ; methods ; Male ; Orthopedic Procedures ; methods ; Rare Diseases ; Risk Assessment ; Synovectomy ; Synovial Membrane ; pathology ; Treatment Outcome

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 therapeutic effects of stiletto needle and Dichofenac Diethylammon in treating knee osteoarthritis pain at early and medium-term.

METHODSSixty-seven patients with early and medium-term knee osteoarthritis were randomly divided into two groups, 34 cases in stiletto needle group (treatment group) and 33 cases in Dichofenac Diethylammon (control group). Among them, 60 patients finished treatment and followed-up for 1 months (7 cases fall off totally, 4 cases in treatment group and 3 cases in control group). In treatment group, there were 5 males and 25 females with a mean age of (55.90 +/- 9.34) years (ranged, 40 to 68 years), the course of disease for 0.25 to 1 year, mean (0.87 +/- 0.34) years, treated by stiletto needle once a week, and 3 weeks were a course. In control group, there were 6 males and 24 females with a mean age of (58.67 +/- 7.39) years (ranged, 40 to 70 years), the course of disease for 0.25 to 2 years, mean (0.93 +/- 0.60) years, treated by Dichofenac Diethylammon, three times a day for 3 weeks. Soft tissue displacement and banana area were tested by soft tissue tension tester, pressure value were measured by pressure measuring instrument, VAS score were recorded by pain visual analog scale record, HSS scoring and effects were used to evaluated and statistical analyzed.

RESULTSThere were significant differences in tissue displacement, banana area, pressure value, VAS scoring and HSS scoring between two groups before and after treatment, and tissue displacement, pressure value, HSS scoring in treatment group were higher than control group, while banana area and VAS scoring were lower than control group. According to HSS scoring and VAS scoring, 3 cases were healed, 8 cases were markedly improved, 18 cases were effective and 1 case was effectiveless in treatment group;while 1 case was healed, 4 cases were markedly improved, 20 cases were effective and 5 cases were effectiveless in control group. There was no significant meaning in therapeutic effects.

CONCLUSIONStiletto needle for knee osteoarthritis pain can effectively reduce high tension of local soft tissue ,alleviate symptom of pain, and improve knee function.

Adult ; Aged ; Biomechanical Phenomena ; Case-Control Studies ; Diclofenac ; analogs & derivatives ; therapeutic use ; Female ; Humans ; Male ; Middle Aged ; Needles ; Osteoarthritis, Knee ; complications ; Pain ; complications ; drug therapy ; pathology ; physiopathology ; Pain Management ; methods ; Treatment Outcome

Aged ; Female ; Femur ; pathology ; Humans ; Knee Joint ; diagnostic imaging ; physiopathology ; surgery ; Synovitis, Pigmented Villonodular ; diagnostic imaging ; pathology ; physiopathology ; surgery ; Tomography, X-Ray Computed ; Treatment Outcome

Osteoarthritis (OA) is an age-related joint disease that is characterized by degeneration of articular cartilage and chronic pain. Oxidative stress is considered one of the pathophysiological factors in the progression of OA. We investigated the effects of grape seed proanthocyanidin extract (GSPE), which is an antioxidant, on monosodium iodoacetate (MIA)-induced arthritis of the knee joint of rat, which is an animal model of human OA. GSPE (100 mg/kg or 300 mg/kg) or saline was given orally three times per week for 4 weeks after the MIA injection. Pain was measured using the paw withdrawal latency (PWL), the paw withdrawal threshold (PWT) and the hind limb weight bearing ability. Joint damage was assessed using histological and microscopic analysis and microcomputerized tomography. Matrix metalloproteinase-13 (MMP13) and nitrotyrosine were detected using immunohistochemistry. Administration of GSPE to the MIA-treated rats significantly increased the PWL and PWT and this resulted in recovery of hind paw weight distribution (P < 0.05). GSPE reduced the loss of chondrocytes and proteoglycan, the production of MMP13, nitrotyrosine and IL-1beta and the formation of osteophytes, and it reduced the number of subchondral bone fractures in the MIA-treated rats. These results indicate that GSPE is antinociceptive and it is protective against joint damage in the MIA-treated rat model of OA. GSPE could open up novel avenues for the treatment of OA.
Analgesics/*administration & dosage ; Animals ; Antioxidants/*administration & dosage ; Bone Resorption ; Disease Models, Animal ; Gene Expression Regulation ; Humans ; Interleukin-1beta/genetics/metabolism ; Iodoacetates/administration & dosage ; Knee Joint/*drug effects/metabolism/pathology ; Male ; Matrix Metalloproteinase 13/genetics/metabolism ; Osteoarthritis/chemically induced/*drug therapy/physiopathology ; Pain ; Plant Extracts/administration & dosage ; Proanthocyanidins/*administration & dosage ; Rats ; Rats, Wistar ; Seeds ; Tomography, Emission-Computed ; Tyrosine/analogs & derivatives/metabolism ; Vitis/immunology

Osteoarthritis (OA) is an age-related joint disease that is characterized by degeneration of articular cartilage and chronic pain. Oxidative stress is considered one of the pathophysiological factors in the progression of OA. We investigated the effects of grape seed proanthocyanidin extract (GSPE), which is an antioxidant, on monosodium iodoacetate (MIA)-induced arthritis of the knee joint of rat, which is an animal model of human OA. GSPE (100 mg/kg or 300 mg/kg) or saline was given orally three times per week for 4 weeks after the MIA injection. Pain was measured using the paw withdrawal latency (PWL), the paw withdrawal threshold (PWT) and the hind limb weight bearing ability. Joint damage was assessed using histological and microscopic analysis and microcomputerized tomography. Matrix metalloproteinase-13 (MMP13) and nitrotyrosine were detected using immunohistochemistry. Administration of GSPE to the MIA-treated rats significantly increased the PWL and PWT and this resulted in recovery of hind paw weight distribution (P < 0.05). GSPE reduced the loss of chondrocytes and proteoglycan, the production of MMP13, nitrotyrosine and IL-1beta and the formation of osteophytes, and it reduced the number of subchondral bone fractures in the MIA-treated rats. These results indicate that GSPE is antinociceptive and it is protective against joint damage in the MIA-treated rat model of OA. GSPE could open up novel avenues for the treatment of OA.
Analgesics/*administration & dosage ; Animals ; Antioxidants/*administration & dosage ; Bone Resorption ; Disease Models, Animal ; Gene Expression Regulation ; Humans ; Interleukin-1beta/genetics/metabolism ; Iodoacetates/administration & dosage ; Knee Joint/*drug effects/metabolism/pathology ; Male ; Matrix Metalloproteinase 13/genetics/metabolism ; Osteoarthritis/chemically induced/*drug therapy/physiopathology ; Pain ; Plant Extracts/administration & dosage ; Proanthocyanidins/*administration & dosage ; Rats ; Rats, Wistar ; Seeds ; Tomography, Emission-Computed ; Tyrosine/analogs & derivatives/metabolism ; Vitis/immunology

OBJECTIVETo determine the effect of the posterior condylar offset (PCO) on intra- and post-operative knee flexion after total knee arthroplasty (TKA) using a high-flex posterior-stabilized (PS) fixed-bearing prosthesis and to discuss it's importance in femoral prosthesis design.

METHODSThe clinical and radiographic materials of 100 consecutive patients (100 knees) were prospectively studied, including 50 men and 50 women, who had undergone primary NexGen LPS-Flex TKAs for end-stage osteoarthritis. All operations were performed by a single surgeon using the same operative technique between March 2005 and October 2006. Pearson's regression analysis was used to assess the relationship between the difference in the pre- and post-operative PCO on true lateral radiographs and the change in knee range of flexion (ROF) under non-weight-bearing conditions.

RESULTSThe decrease of the corrected PCO was (3.4 ± 3.3) mm compared with the preoperative value, the restoration of PCO was better in male than female [female (-5.4 ± 3.1) mm vs. male (-1.5 ± 2.0) mm, P < 0.05]. The difference in the corrected PCO after PS TKA demonstrated significantly correlated with the change in 2 years postoperative ROF in male and female, respectively (P < 0.05). While no statistically correlation was observed in the overall group (P > 0.05). Intraoperatively, the difference in the corrected PCO was significantly correlated with the change in ROF in male, female, and the overall group, respectively (P < 0.05).

CONCLUSIONSRestoration of PCO plays an important role in the optimization of knee flexion after high-flex PS TKA. Femoral components based on Caucasian anatomic characteristics could not match the native anatomy of distal femurs of Chinese population especially female Chinese. Rotated resection of distal femur with anterior referencing technique usually leads to a decreased PCO and therefore reduces maximal obtainable flexion. Sexual dimorphism in humans and anatomic variations in various ethnic groups should be seriously considered in total knee prosthesis design.

Aged ; Arthroplasty, Replacement, Knee ; methods ; Biomechanical Phenomena ; Female ; Femur ; pathology ; Humans ; Knee Joint ; physiopathology ; Male ; Middle Aged ; Osteoarthritis ; pathology ; surgery ; Prospective Studies ; Prosthesis Design ; Range of Motion, Articular ; Treatment Outcome