Orthopaedic and Traumatology Unit, Ospedale Regionale di Lugano, EOC, Lugano, Ticino, Switzerland.
Published: December 2021
AI Article Synopsis
Article Abstract
Objectives: To quantify the placebo effect of intraarticular injections for knee osteoarthritis in terms of pain, function, and objective outcomes. Factors influencing placebo effect were investigated.
Design: Meta-analysis of randomized controlled trials; Level of evidence, 2. PubMed, Web of Science, Cochrane Library, and grey literature databases were searched on January 8, 2020, using the string: . The following inclusion criteria were used: double-blind, randomized controlled trials on knee osteoarthritis, including a placebo arm on saline injections. The primary outcome was pain variation. Risk of bias was assessed using the RoB 2.0 tool, and quality of evidence was graded following the GRADE (Grading of Recommendations Assessment, Development and Evaluation) guidelines.
Results: Out of 2,363 records, 50 articles on 4,076 patients were included. The meta-analysis showed significant improvements up to the 6-month follow-up: Visual Analogue Scale (VAS)-pain -13.4 mean difference (MD) (95% confidence interval [CI]: -21.7/-5.1; < 0.001), Western Ontario and McMaster Osteoarthritis Index (WOMAC)-pain -3.3 MD (95% CI: -3.9/-2.7; < 0.001). Other significant improvements were WOMAC-stiffness -1.1 MD (95% CI: -1.6/-0.6; < 0.001), WOMAC-function -10.1 MD (95% CI: -12.2/-8.0; < 0.001), and Evaluator Global Assessment -21.4 MD (95% CI: -29.2/-13.6; < 0.001). The responder rate was 52% (95% CI: 40% to 63%). Improvements were greater than the "minimal clinically important difference" for all outcomes (except 6-month VAS-pain). The level of evidence was moderate for almost all outcomes.
Conclusions: The placebo effect of knee injections is significant, with functional improvements lasting even longer than those reported for pain perception. The high, long-lasting, and heterogeneous effects on the scales commonly used in clinical trials further highlight that the impact of placebo should not be overlooked in the research on and management of knee osteoarthritis.
Knee osteoarthritis is a chronic degenerative disease associated with pain and decreased mobility that affects advanced-age individuals, thus causing further debilitation. Radiofrequency ablation can benefit patients who are not ideal candidates for surgical intervention and for whom conservative management has been unsatisfactory. Currently, radiofrequency ablation is performed using either ultrasonography or fluoroscopy.
Objectives: In this study, the Kellgren and Lawrence system was used as the most common radiographic grading system for diagnosis of osteoarthritis in patients defined as Grade III and IV. It is aimed to reveal oxidative stress and cellular immunity status. In this context, the aim is to discuss possible risk parameters regarding disease process and treatment effectiveness.
Knee pain is a prevalent issue among older adults, often resulting from degenerative joint changes, and significantly impacts functionality and quality of life. While arthroscopic meniscal surgery is a common intervention for managing knee pain, its effectiveness compared to conservative treatments remains debated. This meta-analysis aims to compare the efficacy of arthroscopic meniscal surgery versus conservative management in alleviating knee pain and enhancing functional outcomes in patients with degenerative meniscal tears.
Introduction: Total knee arthroplasty (TKA) in severe varus deformity still remains a challenge. Alternative alignment TKA aims to improve outcomes and satisfaction. The purpose of this study is to report on the outcomes of a functionally aligned TKA in severe varus deformity.
Objectives: This study aims to compare the radiographic results with and without postoperative metal augmentation in varus knee patients with primary total knee arthroplasty (TKA) with a hip-knee-ankle (HKA) angle >10° and to determine a cut-off value using radiographic parameters to predict the need for metal augmentation.
Patients And Methods: Between October 2022 and April 2024, a total of 87 knees (51 right and 36 left) of 82 patients (11 males, 71 females; mean age: 68.7±8 years; range, 53 to 86 years) who underwent primary TKA were retrospectively analyzed.
