Meta-analysis of factors influencing anterior knee pain after total knee arthroplasty

BACKGROUND Total knee arthroplasty(TKA)is a mature procedure recommended for correcting knee osteoarthritis deformity,relieving pain,and restoring normal biomechanics.Although TKA is a successful and cost-effective procedure,patient dissatisfaction is as high as 50%.Knee pain after TKA is a significant cause of patient dissatisfaction;the most common location for residual pain is the anterior region.Between 4%and 40%of patients have anterior knee pain(AKP).AIM To investigate the effect of various TKA procedures on postoperative AKP.METHODS We searched PubMed,EMBASE,and Cochrane from January 2000 to September 2022.Randomized controlled trials with one intervention in the experimental group and no corresponding intervention(or other interventions)in the control group were collected.Two researchers independently read the title and abstract of the studies,preliminarily screened the articles,and read the full text in detail according to the selection criteria.Conflicts were resolved by consultation with a third researcher.And relevant data from the included studies were extracted and analyzed using Review Manager 5.4 software.RESULTS There were 25 randomized controlled trials;13 were comparative studies with or without patellar resurfacing.The meta-analysis showed no significant difference between the experimental and control groups(P=0.61).Six studies were comparative studies of circumpatellar denervation vs non-denervation,divided into three subgroups for meta-analysis.The two-subgroup meta-analysis showed no significant difference between the experimental and the control groups(P=0.31,P=0.50).One subgroup meta-analysis showed a significant difference between the experimental and control groups(P=0.001).Two studies compared fixed-bearing TKA and mobile-bearing TKA;the results meta-analysis showed no significant difference between the experimental and control groups(P=0.630).Two studies compared lateral retinacular release vs non-release;the meta-analysis showed a significant difference between the experimental and control groups(P=0.002);two other studies compared other factors.CONCLUSION Patellar resurfacing,mobile-bearing TKA,and fixed-bearing TKA do not reduce the incidence of AKP.Lateral retinacular release can reduce AKP;however,whether circumpatellar denervation can reduce AKP is controversial.

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.

Non-Responding Knee Pain with Osteoarthritis, Meniscus and Ligament Tears Treated with Ultrasound Guided Autologous, Micro-Fragmented and Minimally Manipulated Adipose Tissue

Background: Chronic knee pain from advanced osteoarthritis is often associated with tears in the fibro-cartilaginous meniscus and cruciate ligaments. The result is substantial pain and impairments and loss of daily function, thus limiting activity and quality of life. These often include pain, loss of range of 116 motion, inability to elevate the leg, pain increased with activity and gradual worsening over time. This represents a challenging clinical picture for which few non-surgical options are available. Most patients failing to respond to current methods of care are offered arthroplasty. Current therapies are focused on the relief of the symptoms but cannot repair the damage nor stop the degenerative process. Objective: This is a case study of the first subject in a continuing IRB to reach a 2.5 year end-point. Our intention was to investigate the potential benefits of using autologous, minimally manipulated fat graft in subjects with advanced osteoarthritis and meniscus pathology who had failed to obtain benefit from previous, standards of care. Study description: 73 YO male, end stage bone-on-bone right knee pain. First subject to reach the 2 1/2 year follow up after Lipogems®?precision ultrasound guided injections. Material and Methods: Micro-fragmented fat was obtained using a minimal manipulation technology in a closed system, Lipogems®, without the addition of enzymes or other additives. Fat graft was injected under continuous ultrasound guidance. Results: VAS pain, KOOS function, range of motion and quadriceps strength improved after treatment. Conclusion: Autologous, micronized, and minimally manipulated adipose tissue resulted in significant improvement in pain, function and quality of life. No adverse events were reported.

Anterior knee pain following primary total knee arthroplasty

Despite improvements in technique and technology for total knee arthroplasty(TKA),anterior knee pain impacts patient outcomes and satisfaction.Addressing the prosthetic and surgical technique related causes of pain after TKA,specifically as it relates to anterior knee pain,can aid surgeons in addressing these issues with their patients.Design features of the femoral and patellar components which have been reported as pain generators include: Improper femoral as well as patellar component sizing or designs that result in patellofemoral stuffing; a shortened trochlear groove distance from the flange to the intercondylar box; and then surgical technique related issues resulting in: Lateral patellar facet syndrome; overstuffed patella/flange combination; asymmetric patellar resurfacing,improper transverse plane component rotation resulting in patellar subluxation/tilt.Any design consideration that allows impingement of extensor mechanism anatomical elements has the possibility of impacting outcome by becoming a pain generator.As the number of TKA procedures continues to increase,it is increasingly critical to develop improved,evidence based prostheses that maximize function and patient satisfaction while minimizing pain and other complications.

Anterior knee pain after a total knee arthroplasty: What can cause this pain?

Total Knee Arthroplasty has been shown to be a successful procedure for treating patients with osteoarthritis,and yet approximately 5%-10%of patients experience residual pain,especially in the anterior part of the knee.Many theories have been proposed to explain the etiology of this anterior knee pain(AKP)but,despite improvements having been made,AKP remains a problem.AKP can be described as retropatellar or peripatellar pain,which limits patients in their everyday lives.Patients suffering from AKP experience difficulty in standing up from a chair,walking up and down stairs and riding a bicycle.The question asked was:"How can a‘perfectly’placed total knee arthroplasty(TKA)still be painful:what can cause this pain?".To prevent AKP after TKA it is important to first identify the different anatomical structures that can cause this pain.Greater attention to and understanding of AKP should lead to significant pain relief and greater overall patient satisfaction after TKA.This article is a review of what pain is,how nerve signalling works and what is thought to cause Anterior Knee Pain after a Total Knee Arthroplasty.

Synovial lipomatosis: A rare cause of knee pain in an adolescent female

Synovial lipomatosis is a benign proliferative disease of the subsynovial adipose which can lead to a variety of presentations. Cases of synovial lipomatosis in children or adolescents are rare. This case report describes an adolescent patient with a rare bilateral presentation of synovial lipomatosis. She had been treated for years prior to her presentation for juvenile idiopathic arthritis. She presented with chronic bilateral knee pain, swelling, and mechanical symptoms. Bilateral MR imaging demonstrated effusions, hypertrophy of the synovium, and polyp-like projections of tissue with the same signal intensity as fat which is pathognomonic for synovial lipomatosis. Arthroscopic synovectomy and extensive debridement of polyp like fat projections of the right knee was performed. Histopathology was consistent with the synovial lipomatosis diagnosis. Postoperatively, the patient was satisfied with her outcome with improved pain relief and function in her right knee.

Short-term differences in anterior knee pain and clinical outcomes between rotating and fixed platform posterior stabilized total knee arthroplasty with a new femoral component design

AIM To compare rotating versus fixed-bearing Press-Fit Condylar(PFC) Sigma posterior stabilized(PS) total knee arthroplasty(TKA) with the new "J curve"femoral design in terms of clinical outcomes and anterior knee pain.METHODS We retrospectively analyzed 39 patients who underwent primary total knee replacement surgery for knee osteoarthritis using the PFC Sigma PS TKA with either fixed(FP group, 20 cases) or rotating platform(RP group, 19 cases) treated between 2009 and 2013 by the same surgeon. The two groups were homogeneous for age, gender, weight, American Society of Anesthesiologists status, preoperative clinical and functional scores, and prosthetic alignment at two years after surgery. We analyzed clinical outcomes score at two years follow-up using Knee Society Score(KSS), Knee Injury and Osteoarthritis Outcome Score(KOOS),Knee Performance Score, Short Form(SF) 36, and anterior knee pain assessed by the Hospital for Special Surgery(HSS) patellar score.RESULTS No differences were found in KSS, Knee Performance Score, and SF-36 outcome scores. A statistically significant difference was found in the HSS Patella score objective(FP: 22.36; RP: 28.75; P < 0.05), HSS Patella score total(FP: 73.68; RP:86.50; P < 0.05), and KOOS symptoms(FP: 73.49; RP: 86.44; P < 0.05).CONCLUSION Rotating platform in PFC Sigma PS TKA appears to reduce the short-term incidence of anterior knee pain compared to the fixed platform.

The Relationship between Incorrect Restoration of the Joint Line and Lateral Knee Pain in Patients Undergoing Total Knee Arthroplasty

Aim: In this study, the relationship between the change in the joint line and lateral knee pain was evaluated after primary total knee arthroplasty. Material and method: Between 2005 and 2012, patients who underwent primary total knee arthroplasty were included in the study. Patients having “cruciate retaining total knee arthroplasty” and with a change of the joint line ≥8 mm and patients having “posterior stabilized total knee arthroplasty” and with a change of the joint line ≥5 mm were selected as the study group (group 1, n = 32). A total of 47 patients having similar demographic characteristics with the study group and the joint line changing below the predetermined level or remaining unchanged were included as the control group (group 2). The 2 groups were compared according to the presence of knee pain, the localization and spread of the pain, iliotibial band, tension and pain in the patellar tendon and quadriceps tendon, front knee pain during squatting, VAS pain score, OBER test positivity, Knee Society knee and function score, and general patient satisfaction. Results: There were statistically significant more lateral knee pain (p < 0.001), OBER test positivity (p < 0.001) and iliotibial band tension (p < 0.001) in group 1 compared to group 2. However, there were no statistically significant differences between the 2 groups regarding rest pain (p = 0.855), pain during squatting (p = 0.761), exertional pain (p = 0.322), pain in the patellar tendon (p = 0.643) and quadriceps tendon (p = 0.873), Knee Society knee (p = 0.954) and function (p = 0.955) scores, and general satisfaction (p = 0.968). Conclusion: In total knee prosthesis operations, distal displacement of the joint line can result in lateral knee pain and iliotibial band tension. However, considering the results of total knee arthroplasty our findings have showed that this condition has no effect on knee functions and patient satisfaction.

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.

Spa therapy relieves knee and shoulder pain:a randomized controlled trial

Objective:To study the effect of spa therapy on relieving knee and shoulder pain.Methods:Participants were randomized to an intervention group(n=26)or a control group(n=23).The intervention group received the hot spring intervention program(1-2 times a day for two weeks),while the control group didn’t receive any intervention.Primary outcomes were assessed by the Western Ontario and McMaster University Osteoarthritis Index(WOMAC)and Shoulder Pain and Disability Index(SPADI).Secondary outcomes were assessed by general physical symptoms and Short Form-36(SF-36)health survey.Results:All parameters before intervention were homogenous between the groups.At baseline,there was no significant difference in WOMAC and SPADI index between the two groups,but there was a statistically significant difference in blurred vision,which was worse in the intervention group than in the control group(P<0.05).After intervention,general physical symptoms were relieved significantly in the intervention group compared with the control group(P<0.05).WOMAC index,SPADI index,social functioning,and general physical symptoms were relieved significantly after intervention in the intervention group(P<0.05).There is a significant difference in the blurred vision before and after the comparison of the control group(P<0.05).Conclusion:Spa therapy may relieve knee and shoulder pain and improve general physical symptoms and quality of life.

Warm needling on the four knee acupoints combined with Chinese herb in the treatment of knee pain after stroke

Objective To observe the clinical efficacy of warm needling on the four knee acupoints in the treatment of knee pain after stroke on the basis of Chinese herb. Methods Sixty patients with knee pain after stroke were divided into a group A and a group B by random allocation, with 30 patients in each group. Patients in the group B only received the treatment by Chinese herb, which called Dúhuó Jìshēng Tāng（独活寄生汤 Pubescent Angelica and Mistletoe Decoction, add or remove ingredients depending on conditions）; patients in the group A additionally received warm needling on the basis of Chinese herb. Four knee acupoints were selected as master acupoints and Hèd ng（鹤顶 EXLE 2）, Yánglíngquán（阳陵泉 GB 34） and Zúsānl（足三里 ST 36） as combining acupoints. Perpendicular insertion was conducted on Xuèh i（血海 SP 10） and Liángqiū（梁丘 ST 34） for approximately 1 cun, and oblique insertion on Nèixīy n（内膝眼 EX-LE 4） and Dúbí（犊鼻 ST 35） for approximately 1 cun at 45° in inner and upper direction to push needle tip into joint cavity. After deqi, moxibustion stick was cut to 1.5 cm long, ignited, and inserted into the needle handles in the four knee acupoints. 1–2 strips were applied. After the moxa cones were burned up, needles were retained for 10 min. 7 d was a course of treatment and observation lasted for consecutive four courses. Visual analogue scale（VAS） and Barthel Index（BI） were adopted as observational indices. Clinical efficacy was classified as clinical cured, markedly effective, effective and ineffective according to the standards described in Guidelines of Clinical Research on Chinese New Herbal Medicine. Results After treatment, total effective rate was 93.3% in the group A, including full recovery in 8 cases, markedly effective in 15 cases, effective in 5 cases, and ineffective in 2 cases; while the total effective rate was 73.3% in the group B. The difference between the two groups was statistically significant（P0.05）. In the group A, VAS scores were 6.53 ± 1.39 before treatment and 1.53 ± 0.80 after treatment and BI scores were 58.38±8.67 before treatment and 67.55 ± 12.99 after treatment; in the group B, VAS scores were 6.63 ± 1.81 before treatment and 3.33 ± 0.96 after treatment and BI scores were 57.89 ± 9.65 before treatment and 64.87 ± 12.18 after treatment. Both VAS and BI scores were improved significantly in the two groups after treatment and the improvements were statistically significant（all P0.05）. Furthermore, both VAS and BI scores of group A were superior to that of group B（P0.05）. Conclusion Additional treatment of warm needling on the four knee acupoints on the basis of Chinese herb can enhance the clinical efficacy in treatment of knee pain after stroke, contribute to the rapid recovery of knee function and improve the life quality of stroke patients.

Tackling Osteoarthritic Knee Pain with Electroacupuncture

Electroacupuncture（EA） has been widely used in pain relief. Clinical evidence has revealed its unique advantages and effectiveness in alleviating pain. Studies on EA and pain relief have revealed that EA displays greater analgesic effects for different types of pain in comparison to manual acupuncture. Here, we reviewed the clinical application and mechanism of EA in treating osteoarthritic knee pain and its influence factors in curative effect.

Case studies of Chinese acupuncture's comprehensive effectiveness on knee pain

Conventional Western medicine（CWM） and traditional Chinese medicine（TCM） have different approaches and lead to different practices in experimental design, research methodology, regulation, and standards. TCM emphasizes on the optimal or holistic health. In contrast, CWM is an allopathic medicine primarily based on anatomy, biology, biochemistry,molecular biology and modern technology, and rejects the concept of invisible substances and quantum entanglement.Consequently, CWM emphasizes on abnormal lab tests or obvious diseases. In the early 1970 s, TCM and acupuncture quickly emerged as an alternative to CWM as Westerners explored new TCM concepts while questioning the side effects of CWM. Many countries accept traditional acupuncture as a legal alternative medical practice. Some CWM physicians nowadays are more enthusiastic and are receptive to learning and practicing acupuncture. The common goal of CWM and TCM is to enhance human health, but problems arise over differences in approach. As a response to some Western journal papers that failed to validate the real acupuncture effect because of their incorrect methodologies and their ignorance of the holistic acupuncture approaches, the authors hereby present a group of case studies to demonstrate the real and unique effects of genuine acupuncture. The objective was to explore the clinical effects of acupuncture for knee pain.Thirty-six patients with knee pain were divided into five groups based on age. Holistic TCM diagnosis was performed at the beginning of each case and then made a personalized acupuncture treatment prescription according to the root of illness found by the diagnosis. The symptoms and signs were recorded before and after every treatment, and the treatment effects were assessed based upon the self-reported feeling and the observed changes of the patient following the numeric rating scale（NRS）. The results were summarized after the completion of the minimal 5 acupuncture treatments or the standard 10 acupuncture treatments. Among the 36 patients who participated in the cases studies, 17 patients reported a complete healing for knee pain（47.2%）. About 60 kinds of illness other than knee pain were improved（98.9%） and the complete healing rate was about 44.2%. This leads to the conclusion that TCM acupuncture is remarkably effective in treating knee pain. TCM and CWM share a common goal in promoting the health of human being. The efficacy of TCM acupuncture in treating knee pain shouldn＇t be denied or distorted.

Persistent post-surgical pain and neuropathic pain after total knee replacement

AIM: To study the prevalence of persistent post-surgical pain(PPSP) and neuropathic pain(NP) after total knee replacement(TKR).METHODS: MEDLINE and Embase databases were searched for articles published until December 2014 in English language. Published articles were included if they referred to pain that lasts at least 3 mo after primary TKR for knee osteoarthritis, and measured pain with pain specific instruments. Studies that referred to pain caused by septic reasons and implant malalignment were excluded. Both prospective and retrospective studies were included and only 14 studies that match the inclusion criteria were selected for this review.RESULTS: The included studies were characterized by the heterogeneity on the scales used to measure pain and pre-operative factors related to PPSP and NP. The reported prevalence of PPSP and NP seems to be relatively high, but it varies among different studies. There is also evidence that the prevalence of post-surgical pain is related to the scale used for pain measurement. The prevalence of PPSP is ranging at 6 mo from 16% to 39% and at 12 mo from 13.1% to 23% and even 38% of the patients. The prevalence of NP at 6 mo post-operatively is ranging from 5.2% to13%. Pre-operative factors related to the development of PPSP also differ, including emotional functioning, such as depression and pain catastrophizing, number of comorbidities, pain problems elsewhere and operations in knees with early grade of osteoarthritis.CONCLUSION: No firm conclusions can be reached regarding the prevalence of PPSP and NP and the related factors due to the heterogeneity of the studies.

Perioperative pain control after total knee arthroplasty: An evidence based review of the role of peripheral nerve blocks

Over the last decades,the number of total knee arthroplasty procedures performed in the United States has been increasing dramatically.This very successful intervention,however,is associated with significant postoperative pain,and adequate postoperative analgesia is mandatory in order to allow for successful rehabilitation and recovery.The use of regional anesthesia and peripheral nerve blocks has facilitated and improved this goal.Many different approaches and techniques for peripheral nerve blockades,either landmark or,more recently,ultrasound guided have been described over the last decades.This includes but is not restricted to techniques discussed in this review.The introduction of ultrasound has improved many approaches to peripheral nerves either in success rate and/or time to block.Moreover,ultrasound has enhanced the safety of peripheral nerve blocks due to immediate needle visualization and as consequence needle guidance during the block.In contrast to patient controlled analgesia using opioids,patients with a regional anesthetic technique suffer from fewer adverse events and show higher patient satisfaction;this is important as hospital rank-ings and advertisement have become more common worldwide and many patients use these factors in order to choose a certain institution for a specific procedure.This review provides a short overview of currently used regional anesthetic and analgesic techniques focusing on related implications,considerations and outcomes.

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.

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.

Associations among pain catastrophizing, muscle strength, and physical performance after total knee and hip arthroplasty

AIM To investigate whether reductions in pain catastrophizing associated with physical performance in the early period after total knee arthroplasty(TKA) or total hip arthroplasty(THA).METHODS The study group of 46 participants underwent TKA or THA. The participants were evaluated within 7d before the operation and at 14d afterwards. Physical performance was measured by the Timed Up and Go(TUG) test, and 10-m gait time was measured at comfortable and maximum speeds. They rated their knee or hip pain using a visual analog scale(VAS) for daily life activities. Psychological characteristics were measured by the Pain Catastrophizing Scale(PCS). Physical characteristics were measured by isometric muscle strength of knee extensors and hip abductors on the operated side. The variables of percent changes between pre-and postoperation were calculated by dividing post-operation score by pre-operation score.RESULTS Postoperative VAS and PCS were better than preoperative for both TKA and THA. Postoperative physical performance and muscle strength were poorer than preoperative for both TKA and THA. The percent change in physical performance showed no correlation with preoperative variables. In TKA patients, the percent change of PCS showed correlation with percent change of TUG(P = 0.016), 10-m gait time at comfortable speeds(P = 0.003), and 10-m gait time at maximum speeds(P = 0.042). The percent change of muscle strength showed partial correlation with physical performances.The percent change of VAS showed no correlation with physical performances. On the other hand, in THA patients, the percent change of hip abductor strength showed correlation with percent change of TUG(P =0.047), 10-m gait time at comfortable speeds(P = 0.001),and 10-m gait time at maximum speeds(P = 0.021). The percent change of knee extensor strength showed partial correlation with physical performances. The percent change of VAS and PCS showed no correlation with physical performances.CONCLUSION Changes in pain catastrophizing significantly associated with changes in physical performance in the early period after TKA. It contributes to future postoperative rehabilitation of arthroplasty.

Efficacy of Slow Reversal Hold and Isometrics in Improving Muscle Strength, Increasing Range of Motion, and Reducing Pain in Patients with Osteoarthritis of Knee

Osteoarthritis of knee is a common problem in the elderly population worldwide. Physical therapy has been shown to be useful in decreasing pain and increasing mobility in this population. The aim of this study was to study the effectiveness of slow reversal hold and isometric exercise techniques in reducing pain, increasing muscle strength, and increasing range of motion for knee flexion in patients with osteoarthritis of knee. The other aim of this study was to compare the relative effectiveness of these two interventions. 60 subjects participated in this study and were randomly assigned either to the slow reversal hold group (n = 30) or, to the isometrics exercise group (n = 30). All subjects performed their respective exercises for 3 weeks. Pain scores using the visual analog scale, muscle strength using manual muscle testing of quadriceps and hamstrings, and range of motion (ROM) for knee flexion using a goniometer were recorded both pre-treatment and post-treatment for both left and right knees. Both the interventions showed a significant decrease in pain scores, an increase in muscle strength, as well as an increase in the ROM. However, ROM was significantly increased in the slow reversal hold group as compared to the isometrics group in both knees. It was concluded that both exercise techniques could be useful in patients with osteoarthritis of knee for decreasing pain and increasing muscle strength. Slow reversal hold technique might be a better technique than isometrics for increasing ROM for knee flexion.

Effects of Mild and Severe Knee Joint Pain on the Frequency of Falls and Fall Risk in Elderly Females

This study aimed to examine differences in the frequency of falls during the past year and fall risk among 392 elderly females was categorized into five groups on the basis of the knee pain expe-rienced: no knee pain, mild unilateral knee pain, mild bilateral knee pain, severe unilateral knee pain, and severe bilateral knee pain. The subjects participated in a fall risk survey comprising 50 items representing five risk factors: “symptoms of falling”, “disease and physical symptoms”, “en-vironment”, “behavior and character”, and “physical function”. The frequency of falls during the past year, score for each risk factor, and the total fall risk score were not significantly different between the mild unilateral and mild bilateral knee pain groups, and between the severe unilateral and severe bilateral knee pain groups. Therefore, these groups were pooled to form a mild knee pain group and a severe knee pain group and analyzed. The severe knee pain group had experienced a significantly greater number of falls during the past year compared with the no knee pain group. Furthermore, the symptom of falling score was significantly higher in the severe knee pain group than in the no knee pain group, while the disease and physical symptoms score was significantly higher in the mild and severe knee pain groups than in the no knee pain group. The physical function score and total fall risk score were significantly higher in the following order: the severe knee pain group, the mild knee pain group, and the no knee pain group. Our results indicate that for elderly females who can achieve ADL independently, the degree of knee pain (mild or severe) has a marked effect on fall risk, irrespective of laterality of the pain (unilateral or bilateral). Factors such as symptoms of falling, disease and physical symptoms, and physical function are also related to fall risk in this population. Furthermore, elderly individuals with severe knee pain experience frequent falls.