Effect of sodium hyaluronate combined with rehabilitation training on knee joint injury caused by golf

BACKGROUND In high-intensity sports like golf,knee joints are prone to injury,leading to pain,limited mobility,and decreased quality of life.Traditional treatment methods typically involve rehabilitation exercises,but their effectiveness may be limited.In recent years,sodium hyaluronate has emerged as a widely used biomedical material in the treatment of joint diseases.AIM To explore the effect of sodium hyaluronate combined with rehabilitation training on pain degree,flexion range of motion and motor function of knee joint injured by golf.METHODS Eighty patients with knee joint injury caused by golf were randomly divided into control(group B)and observation group(group A).The group B was treated with rehabilitation training,and the group A was treated with sodium hyaluronate combined with rehabilitation training.The clinical efficacy,range of motion and function of knee joint,quality of life and inflammatory factors were compared.RESULTS The excellent and good rate of rehabilitation in the group A was raised than group B.At 6 weeks and 3 months after treatment,the range of motion of the two groups was raised than that before treatment,and that of the group A was raised than group B.After treatment,the scores of Lysholm and International Knee Documentation Committee(IKDC)in the group A were raised,and those in the group A were raised than group B.The VAS score of the two groups was reduced than that of the group B,and the SF-36 score of the group A was reduced than group B.The interleukin(IL)-1β,IL-8 and tumor necrosis factor-αin the two groups were reduced,and those in the group A were reduced than group B.CONCLUSION Sodium hyaluronate combined with rehabilitation training has a good clinical effect in the treatment of patients with knee joint injury caused by golf,which relieve pain,maintain knee joint function and improve patients'life quality.

Dental Treatment Using Quantum Mechanics for Knee Joint Pain

In clinical practice, dentists sometimes encounter phenomena that cannot be explained by modern western medical concepts;for example, the patient’s medical symptoms improve by bringing medicines or dentures close to the body. Although it seems difficult to completely elucidate the mechanism through modern western medicine, it can be explained using quantum mechanics. The quantum, the smallest unit of matter composition, exhibits wave-particle duality. The fact that symptoms can be improved simply by bringing dentures or medicines closer to the body indicates that the waves emitted by dentures or medicines interfere with the pathological waves emitted by the pathological site. Thus, the pathological waves are deformed and lead to a change in symptoms. In this way, quantum theory can explain phenomena that are difficult to elucidate in conventional medicine, which are encountered in clinical practice. So far, the author has presented a case of difficulty in raising the upper limb where the symptoms improved without the need for dentures in the mouth by adjusting the dentures outside the mouth. This time, the author would like to introduce a case which the patient’s knee pain improved by adjusting the dentures outside the mouth.

全膝关节置换中BrainlabKnee3导航辅助间隙平衡技术的应用优势

背景:近年来,计算机导航技术辅助关节置换逐渐受到医疗领域的关注。文献报道计算机导航在全膝关节置换中的应用临床效果不一。为了探索新一代Brainlab Knee 3导航系统的临床效果,进行了此项研究。目的:分析计算机导航系统(Brainlab Knee 3)结合间隙平衡技术在全膝关节置换中的应用效果。方法:2020年11月至2021年5月大连市第二人民医院关节外科收治71例行全膝关节置换患者,导航组35例,术中采用计算机导航结合间隙平衡技术行全膝关节置换;传统组36例,术中采用传统手术器械定位截骨。比较两组患者术中内、外侧关节间隙差;膝关节活动度、KSS评分;髋膝踝角;冠状面股骨组件角、冠状面胫骨组件角和矢状面胫骨组件角偏差值。结果与结论:①导航组伸直位内外侧间隙差0,1,2 mm的患者分别为19,14,2例;屈膝90°位内外侧间隙差0,1,2 mm的患者分别为18,15,2例。传统组伸直位内外侧间隙差0,1,2 mm的患者分别为10,20,6例;屈膝90°位内外侧间隙差0,1,2 mm的患者分别为10,15,8例。②导航组手术时间长于传统组(P<0.05),导航组有2例患者术后形成下肢肌间静脉血栓,传统组患者均无并发症。③置换后6,12个月两组患者膝关节活动度均明显增加,导航组膝关节活动度高于传统组(P<0.05)。④置换后12个月两组患者KSS评分均明显增加,导航组KSS评分高于传统组(P<0.05)。⑤置换后6个月髋膝踝角、冠状面股骨组件角、冠状面胫骨组件角、矢状面胫骨组件角偏差值均显著小于传统组(P<0.05)。⑥结果表明,采用计算机导航结合间隙平衡技术辅助全膝关节置换对关节活动度、下肢力线、胫骨假体组件位置的准确性方面具有优势,置换后关节功能恢复良好。

Formation process of extension knee joint contracture following external immobilization in rats

BACKGROUND Current research lacks a model of knee extension contracture in rats.AIM To elucidate the formation process of knee extension contracture.METHODS We developed a rat model using an aluminum external fixator.Sixty male Sprague-Dawley rats with mature bones were divided into the control group(n=6)and groups that had the left knee immobilized with an aluminum external fixator for 1,2,and 3 d,and 1,2,3,4,6,and 8 wk(n=6 in each group).The passive extension range of motion,histology,and expression of fibrosis-related proteins were compared between the control group and the immobilization groups.RESULTS Myogenic contracture progressed very quickly during the initial 2 wk of immobilization.After 2 wk,the contracture gradually changed from myogenic to arthrogenic.The arthrogenic contracture progressed slowly during the 1^(st) week,rapidly progressed until the 3^(rd) week,and then showed a steady progression until the 4^(rd) week.Histological analyses confirmed that the anterior joint capsule of the extended fixed knee became increasingly thicker over time.Correspondingly,the level of transforming growth factor beta 1(TGF-β1)and phosphorylated mothers against decapentaplegic homolog 2(p-Smad2)in the anterior joint capsule also increased with the immobilization time.Over time,the cross-sectional area of muscle fibers gradually decreased,while the amount of intermuscular collagen and TGF-β1,p-Smad2,and p-Smad3 was increased.Unexpectedly,the amount of intermuscular collagen and TGF-β1,p-Smad2,and p-Smad3 was decreased during the late stage of immobilization(6-8 wk).The myogenic contracture was stabilized after 2 wk of immobilization,whereas the arthrogenic contracture was stabilized after 3 wk of immobilization and completely stable in 4 wk.CONCLUSION This rat model may be a useful tool to study the etiology of joint contracture and establish therapeutic approaches.

Two-stage revision in periprosthetic knee joint infections

Periprosthetic joint infection(PJI)following total knee arthroplasty is one of the most catastrophic and costly complications that carries significant patient wellness as well as economic burdens.The road to efficiently diagnosing and treating PJI is challenging,as there is still no gold standard method to reach the diagnosis as early as desired.There are also international controversies with respect to the best approach to manage PJI cases.In this review,we highlight recent advances in managing PJI following knee arthroplasty surgery and discuss in depth the two-stage revision method.

Shock-wave impact on the knee joint affected with osteoarthritis and after arthroplasty

Degenerative diseases significantly reduce the quality of human life.Non-invasive treatments are used in the initial stages of osteoarthritis(OA).Total knee arthroplasty is used in the late stages of osteoarthritis of the knee joint.Non-invasive methods based on mechanical action are also used for the rehabilitation of a patient after arthroplasty.This paper presents numerical models of the knee joint with degenerative OA changes and arthroplasty.Using these models,a computational study was made of the influence of the intensity of shock-wave exposure on the conditioning for the regeneration of bone and cartilage tissues.Based on the modeling results,it was found that in the knee joint with degenerative OA changes,conditions for the regeneration of cartilage and meniscus tissues were fulfilled under medium and highintensity loading.Under high-intensity loading(up to 0.9 m J/mm^(2)),the stress level was significantly below the ultimate value required for fracture.At knee arthroplasty,the conditions for bone tissue regeneration around the tibia component are fulfilled only under high-intensity loading.

Effect of weight-adjusted antimicrobial antibiotic prophylaxis on postoperative dosage and surgical site infection incidence in total joint arthroplasty

Surgical site infections(SSI)following total joint arthroplasty pose a significant concern for both providers and patients across the globe.Currently,administration of antimicrobial antibiotic prophylaxis is used throughout the world to reduce the incidence of SSI.However,the correct dosage and frequency of administration remains debatable.In this editorial,we emphasized the determination of the effect of administration of weight-adjusted antimicrobial antibiotic prophylaxis regime on the incidence of SSI and postoperative dosage reduction compared to the conventionally used regime during total joint arthroplasty.The results demonstrated similar efficacy between both regimes with respect to the incidence of SSI.In addition,weight-adjustment led to reduced postoperative dosage and has the potential to reduce chances of achieving lower therapeutic concentration,drug resistance,drug toxicity,and costs.

The Immediate Analgesic Effect and Impact on Gait Function of Transcutaneous Electrical Nerve Stimulation in Late-Stage Elderly Individuals with Knee Pain: Examination of Gait Function Using an IoT-Based Gait Analysis Device

Purpose: This study verified the effects of transcutaneous electrical nerve stimulation (TENS), which can be worn during walking and exercise, in elderly individuals with late-stage knee pain who exercise regularly. Methods: Thirty-two late-stage elderly individuals were evaluated for knee pain during rest, walking, and program exercises, with and without TENS. Gait analysis was performed using an IoT-based gait analysis device to examine the effects of TENS-induced analgesia on gait. Results: TENS significantly reduced knee pain during rest, walking, and programmed exercises, with the greatest analgesic effect observed during walking. The greater the knee pain without TENS, the more significant the analgesic effect of TENS. A comparison of gait parameters revealed a significant difference only in the gait cycle time, with a trend towards faster walking with TENS;however, the effect was limited. Conclusion: TENS effectively relieves knee pain in late-stage elderly individuals and can be safely applied during exercise. Pain management using TENS provides important insights into the implementation of exercise therapy in this age group.

Biomechanical research of knee joint during the process of running

To study the effect of speed on the biomechanics of a knee joint during running, a biomechanical model of human lower limb joints is established based on the Kane method and semi-physical simulation. Experiments on the running process were made at different speeds for healthy young men. The influence of running speed on knee Joint motion is analyzed quantitatively and a mathematical model of the knee angle is established with speed as the independent variable. Results show that, at the moment of the heel contacting with theground, with the increase of speed, the more, and the calf and thigh are closer to the same line. In the middle stage of a gait cycle, the thigh stretches back, and then the calf and thigh are close to collineation. At that moment, the stretch of the posterior cruciate ligament is the largest, and the slower the speed, the more obvious the collineation. The maximal joint angle of the calf relative to the thigh appears in the later stage, and themaximal joint angle increases with the increase of the velocity. With the increase of the running speed, the phase of the cure of knee angle moves forward. The results can be used in the field of rehabilitation robotics and humanoid robot.

The Knee Joint Design and Control of Above-knee Intelligent Bionic Leg Based on Magneto-rheological Damper

The above-knee intelligent bionic leg is very helpful to amputees in the area of rehabilitation medicine. This paper first introduces the functional demand of the above-knee prosthesis design. Then, the advantages of the four-bar link mechanism and the magneto-rheological （MR） damper are analyzed in detail. The fixed position of the MR damper is optimized and a virtual prototype of knee joint is given. In the end, the system model of kinematics, dynamics, and controller are given and a control experiment is performed. The control experiment indicates that the intelligent bionic leg with multi-axis knee is able to realize gait tracking of the amputee＇s healthy leg based on semi-active control of the MR damper.

Stem cell application for osteoarthritis in the knee joint: A minireview

Knee osteoarthritis is a chronic, indolent disease that will affect an ever increasing number of patients, especially the elderly and the obese. It is characterized by degeneration of the cartilage substance inside the knee which leads to pain, stiffness and tenderness. By some estimations in 2030, only in the United States, this medical condition will burden 67 million people. While conventional treatments like physiotherapy or drugs offer temporary relief of clinical symptoms, restoration of normal cartilage function has been difficult to achieve. Moreover, in severe cases of knee osteoarthritis total knee replacement may be required. Total knee replacements come together with high effort and costs and are not always successful. The aim of this review is to outline the latest advances in stem cell therapy for knee osteoarthritis as well as highlight some of the advantages of stem cell therapy over traditional approaches aimed at restoration of cartilage function in the knee. In addition to the latest advances in the field, challenges associated with stem cell therapy regarding knee cartilage regeneration and chondrogenesis in vitro and in vivo are also outlined and analyzed. Furthermore, based on their critical assessment of the present academic literature the authors of this review share their vision about the future of stem cell applications in the treatment of knee osteoarthritis.

Establishing minimum clinically important difference values for the Patient-Reported Outcomes Measurement Information System Physical Function, hip disability and osteoarthritis outcome score for joint reconstruction, and knee injury and osteoarthritis out

AIM To establish minimum clinically important difference(MCID) for measurements in an orthopaedic patient population with joint disorders.METHODS Adult patients aged 18 years and older seeking care for joint conditions at an orthopaedic clinic took the Patient-Reported Outcomes Measurement Information System Physical Function(PROMIS~? PF) computerized adaptive test(CAT), hip disability and osteoarthritis outcome score for joint reconstruction(HOOS JR), and the knee injury and osteoarthritis outcome score for joint reconstruction(KOOS JR) from February 2014 to April 2017. MCIDs were calculated using anchorbased and distribution-based methods. Patient reports of meaningful change in function since their first clinic encounter were used as an anchor.RESULTS There were 2226 patients who participated with a mean age of 61.16(SD = 12.84) years, 41.6% male, and 89.7% Caucasian. Mean change ranged from 7.29 to 8.41 for the PROMIS~? PF CAT, from 14.81 to 19.68 for the HOOS JR, and from 14.51 to 18.85 for the KOOS JR. ROC cut-offs ranged from 1.97-8.18 for the PF CAT, 6.33-43.36 for the HOOS JR, and 2.21-8.16 for the KOOS JR. Distribution-based methods estimated MCID values ranging from 2.45 to 21.55 for the PROMIS~? PF CAT; from 3.90 to 43.61 for the HOOS JR, and from 3.98 to 40.67 for the KOOS JR. The median MCID value in the range was similar to the mean change score for each measure and was 7.9 for the PF CAT, 18.0 for the HOOS JR, and 15.1 for the KOOS JR.CONCLUSION This is the first comprehensive study providing a wide range of MCIDs for the PROMIS? PF, HOOS JR, and KOOS JR in orthopaedic patients with joint ailments.

THREE-DIMENSIONAL FINITE ELEMENT SIMULATION OF TOTAL KNEE JOINT IN GAIT CYCLE

Based on CT scanning pictures from a volunteer＇s knee joint, a three-dimensional finite element model of the healthy human knee joint is constructed including complete femur, tibia, fibular, patellar and the main cartilage and ligaments. This model was validated using experimental and numerical results obtained from other authors. The pressure distribution of contact surfaces of knee joint are calculated and analyzed under the load action of ‘heel strike＇, ‘single limb stance＇ and ‘toe-off＇. The results of the gait cycle are that the contact areas of medial cartilage are larger than that of lateral cartilage; the contact force and contact areas would grow larger with the load increasing; the pressure of lateral meniscus is steady, relative to the significant variation of peak pressure in medial meniscus; and the peak value of contact pressure on all components are usually found at about 4570 of the gait cycle.

Dynamic knee valgus kinematics and their relationship to pain in women with patellofemoral pain compared to women with chronic hip joint pain

Background:Dynamic knee valgus(DKV)is an abnormal movement pattern visually characterized by excessive medial movement of the lower extremity during weight bearing.Differences in hip and knee kinematic components of DKV may explain the emergence of different pain problems in people who exhibit the same observed movement impairment.Using a secondary analysis of exiting data sets,we sought to determine whether hip and knee frontal and transverse plane angles during a functional task differed between women with patellofemoral pain and women with chronic hip joint pain and the relationship between joint-specific kinematics and pain in these 2 pain populations.Methods:In the original studies,3-dimensional hip and knee kinematics during a single-limb squat were obtained in 20 women with patellofemoral pain and 14 women with chronic hip joint pain who demonstrated visually classified DKV.Pain intensity during the squat was assessed in both groups.For the secondary analysis,kinematic data were compared between pain groups using their respective control groups as a reference.Within each pain group,correlation coefficients were used to determine the relationship between kinematics and pain during the squat.Results:Hip adduction and contralateral pelvic drop were greater in those with chronic hip joint pain compared to those with patellofemoral pain(effect sizes ≥0.40).Greater knee external rotation(r= 0.47,p= 0.04)was correlated with greater knee pain in those with patellofemoral pain,while greater hip adduction(r = 0.53,p = 0.05)and greater hip internal rotation(r = 0.55,p = 0.04)were correlated with greater hip pain in those with chronic hip joint pain.Conclusion:Hip frontal plane motion was greater in those with chronic hip joint pain compared to those with patellofemoral pain.In both groups,greater abnormal movement at the respective joint(e.g.,knee external rotation in the patellofemoral pain group and hip adduction and internal rotation in the chronic hip joint pain group)was associated with greater pain at that joint during a single-limb squat.

Expression of mu-opioid receptors in human chronic inflamed knee joint synovium tissue

Objective: To examine the changes of mu-opioid receptors (MORs) expression in human chronic inflamed knee joint synovium tissue. Methods:Knee joint synovium tissues were taken from 21 patients with chronic arthritis (inflamed group) and 6 fresh bodies with normal knee joints (control group). And the expression of MORs was detected by using immunohistochemistry. flow cytometry(FCM) and reverse-transcription polymerase chain reaction (RT-PCR). Results: The expression of MORs in the inflamed group was significantly higher than that in the normal group by using the 3 techniques(P<0. 05). Conclusion: Chronic inflammation enhances the up-regulation of MORs in human knee joint synovium tissue.

Two-stage revision arthroplasty for coagulase-negative staphylococcal periprosthetic joint infection of the hip and knee

BACKGROUND Periprosthetic joint infections(PJIs)are frequently caused by coagulase-negative Staphylococci(CoNS),which is known to be a hard-to-treat microorganism.Antibiotic resistance among causative pathogens of PJI is increasing.Two-stage revision is the favoured treatment for chronic CoNS infection of a hip or knee prosthesis.We hypothesised that the infection eradication rate of our treatment protocol for two-stage revision surgery for CoNS PJI of the hip and knee would be comparable to eradication rates described in the literature.AIM To evaluate the infection eradication rate of two-stage revision arthroplasty for PJI caused by CoNS.METHODS All patients treated with two-stage revision of a hip or knee prosthesis were retrospectively included.Patients with CoNS infection were included in the study,including polymicrobial cases.Primary outcome was infection eradication at final follow-up.RESULTS Forty-four patients were included in the study.Twenty-nine patients were treated for PJI of the hip and fifteen for PJI of the knee.At final follow-up after a mean of 37 mo,recurrent or persistent infection was present in eleven patients.CONCLUSION PJI with CoNS can be a difficult to treat infection due to increasing antibiotic resistance.Infection eradication rate of 70%-80%may be achieved.

Combined effects of knee extension strength, visual acuity, and knee-joint pain on older women’s gait

The purpose of this study was to examine the combined effects of knee extension strength (KES), visual acuity (VA), and knee joint pain (KP) on gait in 212 older women. Including, walking speed, cadence, were selected as gait parameters. Knee extension strength was measured by isometric knee extension strength, while knee joint pain and decreased visual acuity were evaluated by subjective judgment. The combine effect of KP and KES factors was examined. Stance time was significantly longer in persons with both-KP than in persons with no KP. In addition, people with superior KES had significantly greater values in walking speed, cadence, and step length, and lower values in stance time and walking angle than those with inferior KES. Furthermore, double support time showed that persons with both-KP have significantly greater values than persons with no or one-KP in the inferior KES group. Also, persons with the inferior KES had significantly greater values in persons with both-KP. The combine effect of KES and VA factors was examined. There are significant differences between the superior and the inferior KES groups. In conclusion, the elderly with both the factors of decreasing KES and both-KP, as compared to the elderly with just one of those factors, have markedly different gait properties.

Risk of methicillin-resistant staphylococcus aureus prosthetic joint infection in elective total hip and knee arthroplasty following eradication therapy

BACKGROUND Prosthetic joint infection(PJI)is a devastating complication requiring prolonged treatment and multiple operations,leading to significant morbidity for the patient.Patients are routinely tested for methicillin-resistant staphylococcus aureus(MRSA)colonisation.MRSA positive patients are given eradication therapy.We hypothesise that patients who are MRSA positive pre-operatively,have increased risk of developing PJI.AIM To identify deep wound infection(PJI)rates in patients who are colonised MRSA positive compared with those who are not colonised;and long term clinical and radiological outcomes.METHODS All patients who underwent total hip and knee replacements(THR/TKR)between December 2009 and December 2019 were identified.Patients who were also identified as being MRSA positive at pre-operative assessment were then selected.Confirmation of prescribing eradication treatment was recorded.Patient records,including consultation letters,operation notes and microbiology results were reviewed retrospectively.Comparison of outcomes for each MRSA positive patient was made with 2 MRSA negative patients undergoing the same operation of a similar age by the same consultant.RESULTS Screening identified 42 knee and 32 hip arthroplasty patients as MRSA positive,84 MRSA negative knee and 64 hip patients were reviewed.Patients were matched with medical co-morbidities in each group.Mean follow up was 5 years.PJI was identified in 4/32(12.5%)of THR MRSA positive and 3/42(7%)of TKR patients.All patients had PJI within one year of surgery.CONCLUSION MRSA positive patients are given eradication therapy routinely.However,no confirmation of eradication is sought.Patients who have MRSA colonisation preoperatively,in our study had a significantly increased risk of PJI,when compared to negative patients.We would recommend establishing true eradication after treatment prior to arthroplasty.

Synovial Neuronal Changes in Knee Joint Osteoarthritis

Purpose: The purpose is to study whether pain and inflammation in knee joint osteoarthritis (OA) are associated with local synovial neuronal changes. Methods: Synovial biopsies were harvested from the medial and lateral knee compartments from OA patients undergoing total joint replacement surgery. All patients had predominant pain at the medial joint compartment. Pain and knee joint function were evaluated by knee society score (KSS). Synovial inflammation was analyzed by histopathological analysis and expression of growth associated protein-43 (GAP-43), sensory (SP, CGRP) and autonomic (NPY, VIP, TH) neuropeptides was studied by single and double immunohistochemistry techniques. Results: We observed reduced KSS and increased inflammatory score in synovial membrane of medial knee compartment. A significant increase in GAP-43 [P = 0.001], SP [P = 0.05], CGRP [P = 0.05] and TH [P = 0.05] expression was observed and SP, CGRP and NPY were found to be co-existed predominantly with GAP-43 in synovial membrane collected from medial compared to the lateral knee compartment. Conclusions: Regenerating nerve fibers containing sensory and autonomic neuropeptides are associated with pain and inflammation in knee joint OA.

“Meniscal” scar as a landmark for the joint line in revision total knee replacement

AIM To determine whether tissue identified at the joint line was actually remnant "meniscal" scar tissue or not. METHODS Nine patients undergoing revision knee surgery following informed consent had meniscal scar tissue sent to the histology department for analyses. All revisions were performed where joint line had been raised or lowered at earlier surgery. Although preoperative radiographic evaluations suggested that the joint line had been altered, intraoperatively there was scar tissue at the level of the recreated joint line. This scar tissue has traditionally been described as meniscal scar, and to identify the origins of this tissue, samples were sent for histological analyses. The tissue samples were stored in formalin, and embedded and sectioned before undergoing histochemical staining. All samples underwent macroscopic and microscopic examination by a histopathologist who was blind to the study aims. The specific features that were examined included tissue organisation, surface and central composition, cellular distribution including histiocytes, nuclear ratio and vasculature. Atypical and malignant features, inflammation and degeneration were specifically looked for. A statistical review of the study was performed by a biomedical statistician.RESULTS The histological findings for the nine patients showingthe macroscopic and microscopic findings, and the conclusion are outlined in a Table. The histological analyses were reviewed to determine whether the tissue samples were likely to be meniscal scar tissue. The response was yes(2, 22%), no(6, 67%) and maybe(1,11%) based on the conclusions. The results were "yes"when on macroscopy, firm cream tissue was identified.In these two "yes" samples, microscopic analyses showed organised fibrous tissue with focal degenerative areas with laminated pattern associated with histiocytes peripherally but no inflammation. The "no" samples were assessed macroscopically and microscopically and were deemed to have appearances representing fibrous synovial tissue and features in keeping with degenerate scar tissue or connective tissue. One sample was indeterminate and microscopically contained fibrocollagenous tissue with synovial hyperplasia. It also contained some degenerate hyalinised tissue that may represent cartilage, but the appearances were not specific. CONCLUSION Based on our pilot study, we recommend reliance on a number of markers to identify the joint line as outlined above, and to exercise caution in using the "meniscal"scar.