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Louis F McIntyre
A considerable body of literature with high-level evidence has been published in the past 15 years calling into question the value of arthroscopic surgery in treating osteoarthritis of the knee (OAK). This, plus recent guidelines advising against the use of conservative treatments such as hyaluronic viscosupplementation, threatens to limit patient access to treatment for a chronic disease state with no known cure. The disease burden of OAK is considerable and represents one of the largest health care dollar expenditures in the United States and the world...
March 2018: Arthroscopy: the Journal of Arthroscopic & related Surgery
D Filippiadis, G Velonakis, A Mazioti, C Konstantos, E Brountzos, N Kelekis, A Kelekis
OBJECTIVES: To prospectively evaluate the effectiveness of intra-articular application of pulsed radiofrequency (PRF) combined with viscosupplementation in patients with knee osteoarthritis suffering from chronic pain refractory to conservative therapies. METHODS: During a 30-month period, PRF combined with viscosupplementation was performed on 53 cases of knee osteoarthritis (45 patients, 8/45 with bilateral knee osteoarthritis). Pre-operational imaging included standard knee X-rays on anterior-posterior and lateral views used to evaluate patients according to the Kellgren-Lawrence classification...
February 8, 2018: International Journal of Hyperthermia
Marie Laure Louis, Jeremy Magalon, Elizabeth Jouve, Charles Eric Bornet, Jean Camille Mattei, Christophe Chagnaud, Alexandre Rochwerger, Julie Veran, Florence Sabatier
PURPOSE: To assess the noninferiority of a single platelet-rich plasma (PRP) injection compared with hyaluronic acid (HA), to alleviate pain and enhance functional capacity in knee osteoarthritis, and identify biological characteristics of PRP that may affect their efficacy. METHODS: Fifty-four patients with symptomatic knee osteoarthritis received a single injection of either PRP (26 patients) or HA (28 patients). They were assessed at baseline and at 1, 3, and 6 months...
January 20, 2018: Arthroscopy: the Journal of Arthroscopic & related Surgery
Timothy M Simon, Douglas W Jackson
Articular cartilage injury and degeneration is a frequent occurrence in synovial joints. Treatment of these articular cartilage lesions are a challenge because this tissue is incapable of quality repair and/or regeneration to its native state. Nonoperative treatments endeavor to control symptoms, and include anti-inflammatory medication, viscosupplementation, bracing, orthotics, and activity modification. Techniques to stimulate the intrinsic repair (fibrocartilage) process include drilling, abrasion, and microfracture of the subchondral bone...
March 2018: Sports Medicine and Arthroscopy Review
R Papalia, F Russo, G Torre, E Albo, V Grimaldi, G Papalia, S Sterzi, G Vadalà, F Bressi, V Denaro
Osteoarthritis (OA) of the knee is one of the most relevant and debilitating health problems. Obesity represents one of the major risk factor for early development of OA. In the obese population, knee replacement should be delayed and eventually avoided and prefer conservative treatments including intrarticular hyaluronic acid (HA) viscosupplementation. In the present clinical randomized trial, we present a comparison between two groups of 24 obese patients which were randomized to be treated with two intrarticular injections of hybrid (low and high molecular weight) hyaluronic acid (Group A) or two injections of high molecular weight hyaluronic acid (Group B)...
December 27, 2017: Journal of Biological Regulators and Homeostatic Agents
R Papalia, E Albo, F Russo, A Tecame, G Torre, S Sterzi, F Bressi, V Denaro
Ankle osteoarthritis (OA) is a progressive degenerative joint disease that causes ankle pain and functional limitation especially during walking. It tends to involve younger people with high functional request and has often a post-traumatic origin. Symptoms control through conservative treatment is essential to procrastinate as long as possible the need for surgery. Although few data are present in literature about the use of local viscosupplementation in ankle OA, their potential use for ankle OA has been suggested...
December 27, 2017: Journal of Biological Regulators and Homeostatic Agents
Daniele Clementi, Riccardo D'Ambrosi, Paride Bertocco, Miguel Simon Bucci, Carlo Cardile, Paolo Ragni, Graziella Giaffreda, Vincenza Ragone
BACKGROUND: Viscosupplementation with hyaluronic acid (HA) is increasingly used for the treatment of hip osteoarthritis (OA). The purpose of this study was to compare the efficacy of intra-articular injections of an ultra-high molecular weight viscosupplement (UHMW-HA, Fermathron S) with a medium molecular weight hyaluronan (MMW-HA, Hyalubrix 60) in hip OA. METHODS: Fifty-four patients with hip OA grade 3 on the Kellgren/Lawrence scale were randomized. All infiltrations were performed under ultrasound guidance...
November 21, 2017: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
Cláudia Gouvinhas, Dalila Veiga, Liliane Mendonça, Rute Sampaio, Luís Filipe Azevedo, José Manuel Castro-Lopes
Background: Interventional Pain Management (IPM) is performed in multidisciplinary chronic pain clinics (MCPC), including a range of invasive techniques to diagnose and treat chronic pain (CP) conditions. Current patterns of use of those techniques in MCPC have not yet been reported. Objective: We aimed to describe quantitatively and qualitatively the use of IPM and other therapeutic procedures performed on-site at four Portuguese MCPC. Methods: A prospective cohort study with one-year follow-up was performed in adult patients...
2017: Pain Research and Treatment
Raghu Raman, Yves Henrotin, Xavier Chevalier, Alberto Migliore, Jörg Jerosch, Jordi Montfort, Hervé Bard, Dominique Baron, Pascal Richette, Thierry Conrozier
Background Viscosupplementation (VS) is a symptomatic treatment of knee osteoarthritis. Although systematic reviews of its repeat use showed favorable benefit/risk ratio, no study has focused on the indication of retreatment. Methods A task force was created to look at issues regarding retreatment with VS in knee osteoarthritis. An attempt was made to reach consensus on several issues: (1) to define treatment "success" and "failure," (2) to determine when to retreat patients successfully treated by a previous VS, (3) to determine how to retreat patients in whom VS failed, (4) to define what to do in case of adverse reaction following previous VS, and (5) to examine the interests of soluble biomarkers to manage retreatment...
February 1, 2017: Cartilage
John C Cianca, Prathap Jayaram
Regenerative medicine has gained increasing popularity in its clinical applications, particularly in the field of musculoskeletal medicine. Regenerative medicine, a broad term, can be thought of as a particular medical strategy that strives to rebuild and restore diseased tissue to normal physiologic tissue baseline. Simply put, regenerative strategies augment the body's innate physiology to heal pathologic processes. This article focuses on specific regenerative strategies and the uses of them for common pathologies in the aging adult, including platelet-rich plasma, mesenchymal stem cells, viscosupplementation, and prolotherapy...
November 2017: Physical Medicine and Rehabilitation Clinics of North America
Cesáreo Trueba Vasavilbaso, Carlos David Rosas Bello, Erla Medina López, Maria Pilar Coronel Granado, José Mario Navarrete Álvarez, Cesáreo Angel Trueba Davalillo, Félix Isaac Gil Orbezo
PURPOSE: To assess the effectiveness of viscosupplementation or platelet-rich plasma (PRP), compared to standard care, for pain relief after knee arthroscopic debridement in patients with meniscal pathology and osteoarthritis (OA), under normal clinical practice conditions. PATIENTS AND METHODS: We conducted a prospective, randomized, evaluator-blind, pilot study. After arthroscopy, patients were randomized to receive 1) five injections of HA1 (Suprahyal®/Adant®); 2) four injections of HA2 (Orthovisc®); 3) three injections of HA3 (Synvisc®); 4) a single injection of PRP (GPS™ II); or 5) standard care (control)...
2017: Open Access Rheumatology: Research and Reviews
Vijaya Kumar L Suppan, Chew Yu Wei, Tan Chin Siong, Tew Mei Mei, Wong Bor Chern, Vijay Kumar Nanta Kumar, Kee Rong Sheng, Ashutosh Sadashiva Rao
BACKGROUND: Intra-articular hyaluronic acid (HA) injection is used in management of knee, hand and hip osteoarthritis. While HA injection is included in the list of evaluated therapies, its efficacy and optimum dosing still have no consensus. This study was conducted to explore the possibility of using single injection HA to increase patient convenience while maintaining the therapeutic efficacy. METHODS: We present a prospective, open label, non-blinded, randomized controlled trial performed in accordance with guidelines in principles of good clinical practice...
September 2017: Journal of Orthopaedic Surgery
E Carlos Rodriguez-Merchan
Musculo-skeletal pain treatment is inadequate in many haemophilic patients. Analgesics are used only by 36% of adult patients. FVIII/FIX intravenous infusion is mainly used to lessen pain, followed in frequency by usage of NSAIDS (primarily COX-2 inhibitors). In about 30% of patients, pain continues after infusion of F VIII/IX. In acute haemarthroses pain treatment must continue until total disappearance (checked by ultrasonography) and include haematologic treatment, short-term rest of the involved joint, cryotherapy, joint aspiration and analgesic medication (paracetamol in mild pain, metamizole for more intense pain, and in a few precise patients, soft opioids such as codeine or tramadol)...
September 19, 2017: Blood Reviews
André Luiz Siqueira Campos, Rodrigo Satamini Pires E Albuquerque, Edmilson Barbosa da Silva, Sami Gobbi Fayad, Lucas Delunardo Acerbi, Felipe Nunes de Almeida, Nelson Hiroyuki Myiabe Ooka, José Sergio Franco, Vinícius Schott Gameiro
PURPOSE: To analyze the early outcomes of viscosupplementation in patients with severe knee osteoarthritis. METHOD: A randomized, double-blind clinical trial of 143 knees divided into three groups: Group 1 - intra-articular injection of triamcinolone; Group 2 - hylan GF20; and Group 3 - triamcinolone + hylan GF20. Outcomes were evaluated using Lysholm and KSS scores before treatment and after one, three and six months. RESULTS: Within-group comparisons revealed improvements in Lysholm scores in all groups in the one month evaluation relative to pre-treatment levels (p < 0...
November 2017: International Orthopaedics
Mathew A Nicholls, Anke Fierlinger, Faizan Niazi, Mohit Bhandari
Hyaluronic acid (HA) has been a treatment modality for patients with knee osteoarthritis (OA) for many years now. Since HA was first introduced for the treatment of painful knee OA, much has been elucidated regarding both the etiology of this disease and the mechanisms by which HA may mitigate joint pain and tissue destruction. The objectives of this article are to (1) describe the etiology and pathophysiology of OA including both what is known about the genetics and biochemistry, (2) describe the role of HA on disease progression, (3) detail the antinociceptive and anti-inflammatory actions of HA in OA, and (4) present evidence of disease-modifying effects of HA in the preservation and restoration of the extracellular matrix...
2017: Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders
Dharmesh R Chejara, Mostafa Mabrouk, Pradeep Kumar, Yahya E Choonara, Pierre P D Kondiah, Ravindra V Badhe, Lisa C du Toit, Divya Bijukumar, Viness Pillay
A microporous hydrogel was developed using sodium alginate (alg) and 4-aminosalicylic acid (4-ASA). The synthesized hydrogel was characterized using various analytical techniques such as Fourier transform infrared spectroscopy (FTIR), Carbon-13 nuclear magnetic resonance ((13)C-NMR), X-ray powder diffraction (XRD), scanning electron microscopy (SEM), and differential scanning calorimetry (DSC). Additonal carboxyl and hydroxyl functional groups of 4-ASA provided significant lubrication and stress-triggered sol-gel transition to the conjugated hydrogel...
August 16, 2017: Marine Drugs
R Rieger, C Boulocher, S Kaderli, T Hoc
BACKGROUND: To investigate the effect of intra-articular injection of Chitosan (Cs) added to hyaluronic acid (HA) on subchondral bone during osteoarthritis (OA), microarchitectural parameters and mineral density were measured in a rabbit model of early OA. A novel hybrid hydrogel adding reacetylated Cs of fungal origin to HA was compared to high molecular weight HA commercial formulation. METHOD: Eighteen rabbits underwent unilateral anterior cruciate ligament transection (ACLT) and were divided into three groups (Saline-group, HA-group and Hybrid-group) depending on the intra-articular injection compound...
August 15, 2017: BMC Musculoskeletal Disorders
Victor Figueiredo Leite, João Eduardo Daud Amadera, Anna Maria Buehler
OBJECTIVE: To assess the efficacy of viscosupplementation (hyaluronic acid [HA]) on the pain and disability caused by hip osteoarthritis, and to determine the occurrence of adverse events. DATA SOURCES: PubMed, EMBASE, Cochrane Library, database, and specific journals up to March 2017. STUDY SELECTION: Randomized controlled trials (RCTs) comparing HA with any other intra-articular injection. DATA EXTRACTION: Performed according to Cochrane/Grades of Recommendation, Assessment, Development, and Evaluation criteria...
August 11, 2017: Archives of Physical Medicine and Rehabilitation
Thierry Conrozier, Matthieu Monet, Anne Lohse, Raghu Raman
Background In the management of knee osteoarthritis (OA), patient-reported-outcomes (PROs) are being developed for relevant assessment of pain. The patient acceptable symptom state (PASS) is a relevant cutoff, which allows classifying patients as being in "an acceptable state" or not. Viscosupplementation is a therapeutic modality widely used in patients with knee OA that many patients are satisfied with despite meta-analyses give conflicting results. Objectives To compare, 6 months after knee viscosupplementation, the percentage of patients who reached the PASS threshold (PASS +) with that obtained from other PROs...
August 1, 2017: Cartilage
S Raymond Golish
BACKGROUND: The United States Food and Drug Administration (FDA) reviews class III orthopedic devices submitted for premarket approval with pivotal clinical trials. The purpose of this study was to determine the types of orthopedic devices reviewed, the design of their pivotal clinical trials, and the subjective factors affecting the interpretation of clinical trial data. METHODS: Meetings of the FDA Orthopaedic and Rehabilitation Devices Panel were identified from 2000-2016...
July 24, 2017: Trials
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