Osteoarthritis: an ancient disease, an unsolved conundrum

Matteo, Berardo Di; Murrell, William; Görtz, Simon; Kon, Elizaveta

doi:10.1007/s00264-020-04934-x

Cited by 5 publications

(2 citation statements)

References 32 publications

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“…In total, 93 (66.9%) patients had grade 2 and only 46 (33.1%) had grade 1 OA. Similar findings were seen in studies done by Di Matteo et al [ 18 ] and Wang et al [ 19 ]. However, in a study by Evans et al [ 20 ], most participants were affected on the left side of the knee joint.…”

Section: Discussionsupporting

confidence: 92%

Comparison of Various Modalities in the Treatment of Early Knee Osteoarthritis: An Unsolved Controversy

Srinivasan¹,

Ethiraj²,

Agarawal³

et al. 2023

Cureus

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IntroductionOsteoarthritis (OA) of the knee is a common degenerative disease, relatively more prevalent among middleaged people. It is one of the major reasons for walking-related disability. Recently, early knee OA has been seen as an imperative concern in many younger patients who struggle with the disabling effect of pain and management is extremely speckled. Degenerative changes such as loss of cartilage, subchondral bone changes, synovial inflammation, and meniscal degeneration are seen in OA. Symptoms are relieved by therapeutic strategies such as lifestyle behaviour changes, exercise, and oral and injectable medications. Intra-articular delivery of drugs acts as a direct effect on the target tissue, which grossly reduces side effects and is commonly preferred nowadays. The current study is a comparative assessment of the functional outcomes associated with various treatment modalities in osteoarthritis of the knee, i.e., arthroscopic debridement, arthroscopic debridement with microfracture, platelet-rich plasma (PRP) injection, and hyaluronic acid. MethodsA retrospective observational hospital-based study was conducted among 139 cases of osteoarthritis. Patients aged between 40-60 years with diagnosed Kellgren-Lawrence grade 1 and 2 OA knee, who underwent arthroscopic debridement, arthroscopic debridement with microfracture, PRP injection, or hyaluronic acid in our institute were included. ResultsThe mean age was 52.83 + 6.8 years. The mean BMI was 27.45 + 1.6 kg/m 2 . At the time of diagnosis of OA, the mean visual analogue scale for pain (VAS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores were 7.26 +0.7 and 55.30 + 2.21 respectively. Out of the total, 88 (63.3%) were females and 51 (36.7%) were males. Right-sided OA knee was seen in the majority of study participants. Of the total, 93 (66.9%) patients had grade 2 and only 46 (33.1%) had grade 1 OA. A statistically significant difference was found between the mean VAS and WOMAC score at the time of diagnosis, three weeks, three months, as well as at six months of therapy. In the hyaluronic acid treatment, no significant difference was found in mean VAS and WOMAC scores. ConclusionVarious treatments are available for early-diagnosed OA. According to the findings of this study, overall improvement was seen in VAS and WOMAC scores at the follow-up after six months of specific treatment. In a period over six months, arthroscopic debridement with micro-fracture was more effective and safe when compared with other modalities of treatment for early OA knee. Also, injection of PRP was superior to other methods for VAS pain reduction, and WOMAC-pain and WOMAC-stiffness scores improved at one month.

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Section: Discussionsupporting

confidence: 92%

Comparison of Various Modalities in the Treatment of Early Knee Osteoarthritis: An Unsolved Controversy

Srinivasan¹,

Ethiraj²,

Agarawal³

et al. 2023

Cureus

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“…Radiologic and biochemical strategies for early diagnosis, a better understanding of the pathogenesis and prognostic factors of OA, which is a multi-faceted disease with different genotypes and phenotypes, and the patient’s individual features should drive the choice of the ‘right’ injectables, modelling a more personalized therapeutic plan for each patient. 70 …”

Section: Future Perspectivesmentioning

confidence: 99%

Injections in the osteoarthritic knee: a review of current treatment options

et al. 2021

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Knee osteoarthritis is a degenerative condition characterized by progressive cartilage degradation, subchondral damage, and bone remodelling. Among the approaches implemented to achieve symptomatic and functional improvements, injection treatments have gained increasing attention due to the possibility of intra-articular delivery with reduced side effects compared to systemic therapies. In addition to well-established treatment options such as hyaluronic acid (HA), cortico-steroids (CS) and oxygen-ozone therapy, many other promising products have been employed in the last decades such as polydeoxyribonucleotide (PDRN) and biologic agents such as platelet-rich plasma (PRP) and mesenchymal stem cells (MSCs). Moreover, ultrasound-guided intra-meniscal injection and X-ray-guided subchondral injection techniques have been introduced into clinical practice. Even when not supported by high evidence consensus, intra-articular CS and HA injections have gained precise indications for symptomatic relief and clinical improvement in OA. Biological products are strongly supported by in vitro evidence but there is still a lack of robust clinical evidence. PRP and MSCs seem to relieve OA symptoms through a regulation of the joint homeostasis, even if their capability to restore articular cartilage is still to be proved in vivo. Due to increasing interest in the subchondral bone pathology, subchondral injections have been developed with promising results in delaying joint replacement. Nevertheless, due to their recent development and the heterogeneity of the injected products (biologic agents or calcium phosphate), this approach still lacks strong enough evidence to be fully endorsed. Combined biological treatments, nano-molecular approaches, monoclonal antibodies and ‘personalized’ target therapies are currently under development or under investigation with the aim of expanding our armamentarium against knee OA. Cite this article: EFORT Open Rev 2021;6:501-509. DOI: 10.1302/2058-5241.6.210026

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