Bisphosphonate for spontaneous osteonecrosis of the knee: A protocol for systematic review and meta-analysis of randomized controlled trials

Treatment options for secondary osteonecrosis of the knee

Knee osteonecrosis is a debilitating progressive degenerative disease characterized by subchondral bone ischemia. It can lead to localized necrosis, tissue death, and progressive joint destruction. For this reason, it is essential to diagnose and treat this disease early to avoid subchondral collapse, chondral damage, and end-stage osteoarthritis, where the only solution is total knee arthroplasty. Three types of knee osteonecrosis have been documented in the literature: spontaneous or primitive, secondary, and post arthroscopy. Spontaneous osteonecrosis is the most common type studied in the literature. Secondary osteonecrosis of the knee is a rare disease and, unlike the spontaneous one, involves patients younger than 50 years. It presents a particular set of pathological, clinical, imaging, and progression features. The management of secondary osteonecrosis is determined by the stage of the disorder, the clinical manifestation, the size and location of the lesions, whether the involvement is unilateral or bilateral, the patient's age, level of activity, general health, and life expectancy. This review aims to present the recent evidence on treatment options for secondary osteonecrosis of the knee, including conservative treatment, joint preserving surgery, and knee replacement.

Effects of Korean Traditional Medicine Treatment on Spontaneous Osteonecrosis of the Knee: A Case Report

Spontaneous osteonecrosis of the knee (SONK) is a common form of osteonecrosis of the knee and mainly affects the medial condyle due to localized vascular insufficiency. We report a case of SONK in a 65-year-old woman who had severe knee pain in her left knee whichimpeded her capacityto walk beyond 10 minutes. Bilateral knee X-rays revealed degenerative osteoarthritis of both knees and magnetic resonance imaging revealed R/O SONK in the lateral aspect of the medial femoral condyle, as well as a medial meniscal posterior horn root tear, and a Grade 1 medial collateral ligament injury. She was hospitalized at Jaseng Hospital of Korean Medicine for 21 days and receivedcombination therapy includingacupuncture, pharmacopuncture, and herbal medicine. Patient-reported scales indicated that her pain and physical functional limitations were alleviated. Combination therapy consisting of Korean traditional medicine may bean alternative non-operative treatment approach for patients with SONK.

Efficacy and safety of acupuncture in postoperative ileus after gynecological surgery: A protocol for system review and meta-analysis of randomized controlled trials

BACKGROUND

Acupuncture is widely used in treatment of postoperative ileus (POI), but the safety and efficacy of acupuncture in POI after gynecological surgery still lack of evidence-based basis.

METHODS

PubMed, CINAHL, EMBASE, Web of science, Google Scholar, Wangfang database, Chinese Biomedical Literature Database (SinoMed), Chinese Science and Technology Periodical Database, and China National Knowledge Infrastructure database will be searched until December 31, 2020. Two independent investigators will screen the relevant randomized controlled trials from Data one by one by using prespecified criteria. The relevant data from included studies will be extracted and analyzed by using RevMan V.5.3 software. Quality of the included studies will be estimated by using the Cochrane Collaboration risk of bias tool, and publication bias will be assessed by using Egger test and Begg test. In addition, quality of evidence will be evaluated by using Grading of Recommendations Assessment, Development, and Evaluation.

RESULTS

We will analyze the effect of acupuncture on time to first flatus and time to bowel sound recovery as the primary outcomes of this review. Meanwhile, frequency of bowel sounds, time to defecation, time of hospital stay, biochemical indicators related to gastrointestinal motility, inflammation factors, responder rate, and adverse events for patients receiving gynecological surgery.

CONCLUSION

Our findings will benefit researchers and provide reference for the treatment and prevention of POI for the patients undergoing gynecological surgery.