Treatment options for symptomatic knee osteoarthritis in adults

Pathogen Distribution, Drug Resistance, and Postoperative High-Quality Nursing Intervention Effectiveness in Knee Osteoarthritis Patients After Knee Arthroplasty With Postoperative Infection

Objective

To analyze the distribution and drug resistance of pathogens in patients with postoperative infection following knee arthroplasty (TKA) for knee osteoarthritis (KOA) and to explore the effectiveness of high-quality nursing interventions postoperatively.

Methods

A retrospective analysis was conducted on clinical data from 87 KOA patients who underwent TKA and developed postoperative wound infections (infection group) at the first Affiliated Hospital of Harbin Medical University from July 2022 to September 2024. Another 87 patients without postoperative infection during the same period were selected as the control group. Deep wound exudate samples were collected from the infection group for pathogen culture, isolation, and identification. Drug susceptibility testing was performed using the K-B disk diffusion method. Additionally, venous blood samples were collected from both the infection and control groups one week after surgery, and serum levels of inflammatory markers [interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), procalcitonin (PCT)] were measured using enzyme-linked immunosorbent assay (ELISA). According to the type of nursing interventions received, the infection group was divided into the conventional care group (n=43, receiving standard orthopedic perioperative care) and the high-quality care group (n=44, receiving comprehensive high-quality care based on routine care). The pain levels [Visual Analog Scale (VAS) scores], knee joint function [Hospital for Special Surgery (HSS) knee scores], activities of daily living (modified Barthel index), and patient satisfaction [Newcastle Satisfaction with Nursing Service (NSNS) scale] were compared between the two groups.

Results

Among the 87 KOA patients with postoperative infection after TKA, 83 patients had a single pathogen infection, and 4 patients had mixed infections with two pathogens, resulting in the cultivation and isolation of 91 pathogens. Of these, 63 (69.23%) were Gram-positive bacteria, primarily Staphylococcus aureus (29.67%) and Staphylococcus epidermidis (17.58%). There were 25 (27.47%) Gram-negative bacteria, primarily Escherichia coli (9.89%) and Pseudomonas aeruginosa (6.59%). Three (3.30%) fungal strains were isolated, all identified as Candida albicans. Gram-positive bacteria showed high resistance to penicillin, benzylpenicillin, ampicillin, erythromycin, clindamycin, ciprofloxacin, and gentamicin, but low resistance to gatifloxacin, and no resistance to vancomycin or teicoplanin. Gram-negative bacteria showed high resistance to ciprofloxacin, levofloxacin, gentamicin, and tobramycin, but low resistance to cefepime, imipenem, meropenem, gatifloxacin, and amikacin. The infection group had significantly higher serum levels of IL-6, TNF-α, and PCT compared to the control group (P<0.05). The VAS scores at 24 hours, 3 days, and 7 days postoperatively were significantly lower in the high-quality care group compared to the conventional care group (P<0.05). The HSS scores and modified Barthel index scores at 3 months postoperatively were higher than preoperative values in both groups, with a greater improvement observed in the high-quality care group (P<0.05). The satisfaction rate in the high-quality care group (93.18%) was significantly higher than in the conventional care group (74.42%) (P<0.05).

Conclusion

The primary pathogens causing postoperative wound infections in KOA patients after TKA are Gram-positive bacteria, with Staphylococcus aureus and Staphylococcus epidermidis being predominant. Serum levels of inflammatory markers are significantly higher in infection patients compared to non-infection patients. High-quality nursing interventions can effectively alleviate postoperative pain, promote recovery of knee joint function, enhance activities of daily living, and improve patient satisfaction.

Anxiety and depression prevalence and associated factors in patients with knee osteoarthritis

Objective

With the evolving spectrum of diseases, psychological conditions such as anxiety and depression have emerged as significant global public health concerns. Notably, these psychological disorders are prevalent among patients suffering from knee osteoarthritis (KOA). Consequently, this study included 360 hospitalized patients diagnosed with KOA to examine their levels of anxiety and depression and to analyze the factors influencing these psychological states.

Methods

A cohort of KOA patients from the Second Hospital of Shanxi Medical University was assessed using a general condition questionnaire, European five-dimensional health status scale (EQ5D), Western Ontario and McMaster University Osteoarthritis (WOMAC), Social Support Rating Scale (SSRS), and Hospital Anxiety and Depression Scale (HADS). Logistic regression analysis was employed to identify the factors affecting anxiety and depression.

Results

Among 360 patients with KOA, 28.06% experienced anxiety, and 30.27% experienced depression. Multivariate logistic regression analysis showed that lower BMI, QOL, and utilization of social support scores are risk factors for anxiety and depression in KOA patients (P<0.05). Additionally, in patients with KOA, younger age, lower subjective support, and higher scores in function and daily activities emerged as significant risk factors for depression (P<0.05).

Conclusion

Anxiety and depression in patients with KOA warrant significant attention due to their impact on overall well-being. The factors influencing these mental health conditions are multidimensional. In clinical practice, it is essential to integrate these various influencing factors to develop targeted mental health care services. By doing so, healthcare providers can enhance the overall mental health and QOL for individuals suffering from KOA.

Incidence of Total Knee Arthroplasty in Older Females with Knee Osteoarthritis and Osteoporosis Treated with Denosumab Compared with Those Treated Using Bisphosphonates: A Population-Based Cohort Study

This study aimed to evaluate the incidence of total knee arthroplasty (TKA), a marker of severe knee osteoarthritis (OA), among older females with concurrent knee OA and osteoporosis (OP) who were treated with denosumab or bisphosphonates. By analyzing a large population-based cohort, we sought to clarify how these treatments influence the progression of knee OA to the point of requiring surgical intervention. We used data from the Taiwan National Health Insurance Research Database, including data from females aged ≥ 50 years diagnosed with knee OA and OP who initiated treatment between 2012 and 2019. Propensity score matching (1:1) resulted in the selection of 13,774 patients (6897 per group). The TKA incidence was analyzed using Cox proportional hazards models. Patients treated with denosumab had a lower TKA incidence than those treated with bisphosphonates (6.9 vs. 8.5 per 1000 person-years). The adjusted hazard ratio (aHR) for TKA in the denosumab group was 0.77 (95% CI: 0.62-0.97; p = 0.024), with the most pronounced effect observed in patients aged ≥ 80 years (aHR = 0.39, 95% CI: 0.20-0.77; p = 0.007). These findings suggest that denosumab reduces TKA risk more effectively than bisphosphonates and may serve as a superior treatment option for mitigating severe knee OA progression, especially in older adults.

Effect of warm needle therapy guided by ultrasound on pain relief and improvement of physical function in patients with knee osteoarthritis

BACKGROUND

Conventional treatments for knee osteoarthritis (KOA) often fall short in providing optimal outcomes.

OBJECTIVE

To evaluate the effect of warm needle therapy guided by ultrasound on pain relief and physical function in patients with KOA.

METHODS

In this retrospective study, the clinical records of patients with KOA undergoing either meloxicam alone or meloxicam combined with warm needle therapy were reviewed. Various parameters, including pain evaluations, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, range of motion for knee flexion, knee society scores, quality of life scores, inflammatory factor levels, and patient satisfaction were comparatively analyzed.

RESULTS

A total of 140 patients were included, including 68 patients treated by Meloxicam and 72 patients treated by Meloxicam and warm needle therapy. Following treatment, the meloxicam combined with warm needle therapy group exhibited lower pain scores (3.62±1.98 vs. 4.38±1.95, P=0.023), improved WOMAC scores (27.82±8.75 vs. 31.25±8.82, P=0.022), increased range of motion (136.82°±8.58° vs. 133.43°±8.86°, P=0.023), higher knee society scores (93.32±7.21 vs. 90.21±7.78, P=0.016), and superior Short Form-36 Health Survey (SF-36) scores (81.24±6.33 vs. 78.43±6.85, P=0.013). Furthermore, a significant reduction in inflammatory factors including interleukin-8 (IL-8), matrix metalloproteinase-3 (MMP-3), Interleukin-1 beta (IL-1β), Tumor Necrosis Factor-alpha (TNF-α), and cyclooxygenase-2 (COX-2) levels was observed in the meloxicam combined with warm needle therapy group compared to the meloxicam alone group (all P<0.05). Patient satisfaction was likewise notably higher in the meloxicam combined with warm needle therapy group (8.43±2.15 vs. 7.58±2.24, P=0.024), with a greater proportion of patients willing to recommend the treatment (81.94% vs. 64.71%, P=0.034).

CONCLUSION

Warm needle therapy guided by ultrasound, in combination with meloxicam, significantly improves pain relief, physical function, inflammatory modulation, and patient satisfaction in KOA patients.

Needle knife therapy combined with chinese herbal medicine in the treatment of knee osteoarthritis: a meta-analysis

OBJECTIVE

To systematically evaluate the effectiveness of the combined Needle Knife Therapy (NKT) and Chinese Herbal Medicine (CHM) treatment for knee osteoarthritis (KOA) and to provide clinical evidence supporting its application in managing the condition.

METHODS

Relevant articles were retrieved from PubMed, Medline, Embase, Wanfang, and China National Knowledge Network (CNKI) from the inception of the databases up to February 18, 2023. Randomized controlled trials (RCTs) on the efficacy of NKT combined with CHM were appraised for inclusion. The meta-analysis was conducted using RevMan 5.3 and was registered with the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY) (202470051).

RESULTS

A total of 11 RCTs involving 880 patients were included. The meta-analysis showed that the combined therapy was superior to NKT alone in the treatment of KOA [relative risk (RR) = 1.09; 95% confidence interval (CI): (1.03, 1.14); P = 0.002]. The combined therapy showed a significant reduction in the Visual Analog Scale (VAS) score [RR = -0.98; 95% CI: -1.12, -0.84; P < 0.00001] and symptom scores [RR = -1.75; 95% CI: (-1.87, -1.63); P < 0.00001] compared to single NT therapy. There was no significant difference in the Traditional Chinese Medicine (TCM) syndrome scores between the two groups [RR = -0.23; 95% CI: (-0.56, 0.10); P = 0.18]. Furthermore, we observed a marked increase in lysholmy scores in the combination group than in the control group [RR = -1.04; 95% CI: (-1.31, -0.77); P < 0.00001].

CONCLUSIONS

The combination of needle-knife therapy and Chinese herbal medicine exhibits promising clinical efficacy in the treatment of KOA.

A systematic review and meta-analysis of the efficacy and safety of iguratimod in the treatment of inflammatory arthritis and degenerative arthritis

Objective

To assess the efficacy and safety of iguratimod (IGU) in the treatment of inflammatory arthritis and degenerative arthritis.

Methods

Initially, randomized controlled trials (RCTs) on using IGU in treating inflammatory arthritis and degenerative arthritis were systematically gathered from various databases up to February 2024. Subsequently, two researchers independently screened the literature, extracted data, assessed the risk of bias in included studies, and conducted a meta-analysis using RevMan 5.4 software.

Results

Fifty-four RCTs involving three inflammatory arthritis were included, including ankylosing spondylitis (AS), osteoarthritis (OA), and rheumatoid arthritis (RA). For AS, the meta-analysis results showed that IGU may decrease BASDAI (SMD -1.68 [-2.32, -1.03], P < 0.00001) and BASFI (WMD -1.29 [-1.47, -1.11], P < 0.00001); IGU may also decrease inflammatory factor [ESR: (WMD -10.33 [-14.96, -5.70], P < 0.0001); CRP: (WMD -10.11 [-14.55, -5.66], P < 0.00001); TNF-α: (WMD -6.22 [-7.97, -4.47], P < 0.00001)]. For OA, the meta-analysis results showed that IGU may decrease VAS (WMD -2.20 [-2.38, -2.01], P < 0.00001) and WOMAC (WMD -7.27 [-12.31, -2.24], P = 0.005); IGU may also decrease IL-6 (WMD -8.72 [-10.00, -7.45], P < 0.00001). For RA, the meta-analysis results showed that IGU may improve RA remission rate [ACR20: (RR 1.18 [1.02, 1.35], P = 0.02); ACR50: (RR 1.32 [1.05, 1.64], P = 0.02); ACR70: (RR 1.44 [1.02, 2.04], P = 0.04)] and decrease DAS28 (WMD -0.92 [-1.20, -0.63], P < 0.00001); IGU may also decrease inflammatory factors [CRP: (SMD -1.36 [-1.75, -0.96], P < 0.00001); ESR: (WMD -9.09 [-11.80, -6.38], P < 0.00001); RF: (SMD -1.21 [-1.69, -0.73], P < 0.00001)]. Regarding safety, adding IGU will not increase the incidence of adverse events.

Conclusion

IGU might emerge as a promising and secure therapeutic modality for addressing AS, OA, and RA.

Systematic Review Registration

Identifier PROSPERO: CRD42021289249.

Intraarticular botulinum toxin type A versus corticosteroid or hyaluronic acid for painful knee osteoarthritis: A meta-analysis of head-to-head randomized controlled trials

Intraarticular botulinum toxin type A (BTA) has been shown to be effective for painful knee osteoarthritis (KOA), while the efficacy and safety of intraarticular BTA compared to corticosteroid and hyaluronic acid (HA) remains unknown. A meta-analysis was performed to compare. A search was conducted in Medline (PubMed), CENTER (Cochrane Library), Embase (Ovid), Web of Science, Wanfang, and CNKI to find head-to-head randomized controlled trials (RCTs) directly compare the efficacy and safety between intraarticular BTA and intraarticular corticosteroid or HA for patients with painful KOA. The Cochrane Q test and estimation of I2 were used to assess heterogeneity among studies. After incorporating heterogeneity, a random-effects model was employed for data pooling. Overall, six RCTs involving 348 adults with KOA were included. Intraarticular BTA showed similar efficacy with corticosteroid as evidenced by the changes of pain visual analog scale (VAS: -0.35 [-0.97, 0.28]), total Western Ontario McMaster Universities Arthritis Index (WOMAC: 0.28 [-4.13, 4.69]), and WOMAC for pain (0.64 [-0.42, 1.70]), stiffness (-0.02 [-0.54, 0.50]), and function (0.00 [-2.99, 3.00]). Intraarticular BTA was shown to be more effective than HA in improving pain VAS (-1.31 [-1.97, -0.64]) and WOMAC for pain (-4.81 [-8.73, -0.89]), while the influence on WOMAC for knee stiffness (-1.01 [-4.43, 2.41]) and knee function (-1.86 [-6.71, 2.99]) were similar between groups. No serious adverse events were reported. Evidence from pilot RCTs suggests that intraarticular BTA may confer similar efficacy to corticosteroid for KOA, while BTA may be superior to HA for improving knee pain.