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BACKGROUND: For early knee osteoarthritis in which total knee arthroplasty fails to achieve satisfactory results, high tibial osteotomy that has been found to promote regeneration of damaged cartilage and alleviate symptoms in patients is considered a classic knee-preserving procedure. OBJECTIVE: To review and discuss the effectiveness, mechanism, and application prospects of high tibial osteotomy in stimulating cartilage regeneration in knee osteoarthritis and to provide a theoretical basis for the use of high tibial osteotomy in the treatment of knee osteoarthritis. METHODS: A computerized search was conducted in PubMed, Web of Science, CNKI and WanFang databases for relevant literature published from 2013 to 2023. The search terms used were “knee osteoarthritis, high tibial osteotomy, limb alignment, chondrocytes, biomechanics, intra-articular” in both English and Chinese. Finally, 75 articles were included for review. RESULTS AND CONCLUSION: High tibial osteotomy correcting the lower limb alignment has been found to be effective in alleviating symptoms and potentially delaying or preventing the need for total knee arthroplasty. This is an important aspect of orthopedic step-down treatment in knee osteoarthritis. Maintaining a normal mechanical microenvironment is crucial for the proper functioning and maintenance of chondrocyte phenotype. Abnormal mechanical signals can be converted into intracellular chemical signals through mechanosensors like primary cilia, integrins, cytoskeleton and nucleoskeleton, resulting in disruptions to the balance of matrix metabolism and regulation of inflammatory responses. Chondrocytes after abnormal stress action still have the potential to revert to a normal phenotype under appropriate stress; correction of the mechanical microenvironment by high tibial osteotomy leads to spontaneous cartilage repair and remission of synovial inflammation. The combination of high tibial osteotomy and cartilage regeneration strategy holds promising prospects for patients with early knee osteoarthritis who are not candidates for total knee arthroplasty. [ABSTRACT FROM AUTHOR]

Purpose: Pain following arthroscopic knee surgery remains a controversial clinical problem. Intra-articular (IA) glucocorticoid injections have demonstrated the potential to provide better analgesia in some orthopedic surgeries; however, due to the lack of studies, its role in knee arthroscopies remain unclear. This systematic review aimed to evaluate the efficacy and safety of intra-articular glucocorticoids after arthroscopic knee surgery. Methods: A systematic review was conducted according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guideline, with literature search performed on Medline, Embase, and the Cochrane Library. This systematic review has been registered with the International Prospective Register of Systematic Reviews (PROSPERO; ID: CRD42024509749). Inclusion criteria included randomized controlled trials published in English comparing IA glucocorticoid to placebo in patients undergoing knee arthroscopy. Risk of bias for all included studies was assessed using the Cochrane Collaboration's risk of bias tool. Clinical outcomes compared were pain score: visual analogue scale (VAS) or International Knee Documentation Committee (IKDC), time to first analgesia requirement, analgesia consumption, range of motion (ROM), patient satisfaction, and complications. Results: A total of 7 studies (3 and 4 with evidence level I and II, respectively) involving 309 patients were included. All studies showed that IA glucocorticoids significantly decreased subjective pain scores. Three studies showed significantly longer duration to first postoperative analgesia use, while 6 showed significantly reduced postoperative analgesic administration with IA glucocorticoid use. Two studies showed significantly increased patient satisfaction with IA glucocorticoid (P = 0.001 and P = 0.01, respectively). No studies showed significant differences in complications such as nausea, vomiting, bradycardia, hypotension, or procedure-related adverse effects between the groups. Conclusion: Current available randomized controlled trials suggest that IA glucocorticoids can significantly reduce postoperative pain, delay, and minimize postoperative analgesia use, and improve patient satisfaction. No postoperative complications or adverse events were reported, reflecting its safety as a postoperative analgesic modality. [ABSTRACT FROM AUTHOR]

Objective: To investigate the highest opportunity skin puncture point and needle orientation according to facial asymmetry and classification. Methods: Computed tomography of 136 patients was analyzed. Horizontal and vertical angles and distances from the canthal-tragal line were investigated to determine the puncture point and needle's angle. Result: All patients' average points were 7.39 (±2.85) mm anterior to the tragus and 3.44 (±4.18) mm below the canthal-tragal line with an angle of 8.53 (±6.90)° anteriorly and 32.26 (±7.23)° superiorly. Regarding asymmetry, there was a statistical difference in horizontal angle, depth, and canthal-tragal distance between the deviated and non-deviated sides. Especially, vertical distances were 4.44 (±4.66) mm and 2.59 (±4.11) mm in the deviated and non-deviated sides, respectively (p < 0.001). Conclusion: In closed-mouth, the puncture point was closer to the tragus and lower than the conventional point. The point in the deviated side should be considered lower than the non-deviated side. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the radiographic characteristics of temporomandibular joint (TMJ) disorders using cone-beam computed tomography (CBCT) and magnetic resonance imaging (MRI), and to examine the therapeutic effectiveness of intra-articular betamethasone injection in the management of TMJ pathologies. Methods: A total of forty (40) patients diagnosed with suspected TMJ disorders (study group) and 40 healthy volunteers (control group) who underwent comprehensive examinations in the Department of Stomatology and Rehabilitation Medicine, Qiqihar City, Heilongjiang Province, China were enrolled in this study. All participants underwent CBCT and MRI imaging to assess structural characteristics of TMJ, evaluate changes in condylar morphology, presence of disc displacement, and detection of joint effusion. Results: There was no statistically significant difference in image quality between CBCT and MRI modalities (p > 0.05). There was significant difference in posterior joint space, condylar dimensions (internal and external), and anterior/posterior condylar dimensions in both CBCT and MRI assessments between study and control groups (p < 0.05). There was also significant difference in condylar bone morphology using CBCT and MRI scans between the study and control groups (p < 0.05). Furthermore, visual analog scale (VAS) scores of patients in the study group were significantly lower than those of control group (p < 0.05). Conclusion: Magnetic resonance imaging provides superior visualization of the articular disc and surrounding soft tissues, while CBCT offers better delineation of bony structures. Intra-articular betamethasone injection therapy significantly improves efficacy, reduces pain, improves joint function, and increases mouth opening in the management of TMJ disorders. Further studies should include comprehensive outcome measures and assessment tools to provide a more robust evaluation of treatment effects and overall patient well-being. [ABSTRACT FROM AUTHOR]

Septic arthritis (SA) represents an orthopedics urgency and mainly affects the knee joint. Due to its devastating effects on cartilage, immediate management is crucial. SA is characterized by an annual incidence of 2 to 10 cases per 100,000 individuals, with mortality rates fluctuating between 0.5% and 15%, with a substantially higher mortality rate observed in older people (15%) in contrast to younger cohorts (4%). The etiology of septic arthritis is multifactorial: a spectrum of Gram-positive and Gram-negative bacteria can contribute to the development of this condition, especially Staphylococcus aureus. The treatment involves urgent (arthroscopic or arthrotomic) debridement associated with adequate antibiotic therapy. Intra-articular antibiotic carriers can also be used to increase their local concentration and effectiveness. The case of a 67-year-old woman affected by knee SA from methicillin-susceptible S. aureus is presented. She was treated with an arthroscopic debridement enhanced by intra-articular antibiotic-loaded calcium sulphate beads, together with antibiotic therapy. At 2-year follow up, the infection had been eradicated and the patient fully recovered. This is the first description, to our knowledge, in the English literature, of the use of antibiotic-loaded calcium sulphate beads as an adjuvant in the surgical treatment of SA of a native knee joint. [ABSTRACT FROM AUTHOR]

Background: Adipose tissue-derived stem cells are an interesting therapeutic option for early knee osteoarthritis (OA) treatment due to their high plasticity, easiness of harvesting and rapidity of administration. The aim of this study was to evaluate the medium-term effectiveness and safety of Microfragmented Autologous Fat Tissue (MFAT) injection treatment at 4-year follow-up and to investigate potential correlations among patients' pre-treatment clinical condition and clinical outcomes to identify possible predicting factors for procedure success or failure. Patients and methods: This is a prospective trial enrolling 46 patients with diagnosis of symptomatic knee OA and failure of previous conservative measures who underwent diagnostic arthroscopy and single autologous MFAT injection between June 2017 and July 2018. Patients were assessed with repeated clinical scoring systems at baseline, 6 months, 1 and 4 years after surgery. The evaluation included demographic characteristics, arthroscopic findings, and stem cell number from injected tissue. Results: No major complications were reported during follow-up period and there was a significant increase of Lysholm knee score from baseline value of 61.7 ± 13.8 to 79.5 ± 16.9 at 4 years (p < 0.001). The WOMAC score increased from a baseline value of 66.5 ± 14.7 to 82.8 ± 15.7 at 4 years (p < 0.001) and there was a significant decrease of VAS pain score from baseline value of 6.3 ± 1.5 to 3.5 ± 2.6 at 4-year follow-up (p < 0.001). ROM improved significantly from 118.4 ± 2.6 to 122.5 ± 2.5 at 12 months (p < 0.001), but did not improve at 4 years (p > 0.05). 15 patients (32.6%) were considered treatment failures, because they required secondary surgery, further injection therapy or experienced symptoms persistence. Patient with synovitis had 75% failure rate, although synovitis did not result as a statistically significant factor influencing clinical outcome up to 4-year follow-up (p = 0.058). Age, cartilage defects severity, BMI, concomitant procedures, and stem cell number from injected MFAT did not show any significant correlation with the results. Conclusions: MFAT intra-articular injection is a safe procedure with positive improvements up to 4-year follow-up in patients with early knee OA. These findings suggest MFAT could be a minimally invasive treatment of early knee OA with durable benefits at mid-term evaluation. Trial registration: IRB number ID-3522. [ABSTRACT FROM AUTHOR]

Although frequently prescribed for frozen shoulder, it is not known if corticosteroid injections improve the course of frozen shoulder. This study aimed to assess the disease-modifying effects of an intra-articular corticosteroid administration at the freezing phase of frozen shoulder. Twenty-four Sprague-Dawley rats were divided into four groups. Their unilateral shoulders were immobilized for the first 3 days in all groups, followed by an intra-articular corticosteroid injection in Group A, an injection and the cessation of immobilization in Group B, no further intervention in Group C, and the cessation of immobilization in Group D. All rats were sacrificed in Week 3 of study, at which point the passive shoulder abduction angles were measured and the axillary recess tissues were retrieved for histological and Western blot analyses. The passive shoulder abduction angles at the time of sacrifice were 138° ± 8° (Group A), 146° ± 5° (Group B), 95° ± 11° (Group C), 132° ± 8° (Group D), and 158° ± 2° (Control). The histological assessments and Western blots showed greater fibrosis and inflammation in the groups that did not receive the corticosteroid injection (Groups C and D) compared to the corticosteroid-injected groups (Groups A and B). These findings demonstrate the anti-inflammatory and disease-modifying effects of corticosteroid injections during the freezing phase of frozen shoulder in an animal model. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to compare the effectiveness of intra-articular and peri-articular dextrose prolotherapy (DPT) in patients with knee osteoarthritis (KOA) without effusion. Patients and methods: Between August 2018 and November 2018, a total of 51 participants including 27 cases (12 males, 15 females; mean age: 55.7±5.2 years; range, 38 to 70 years) in Group A and 24 cases (9 males, 15 females; mean age: 54.7±4.6 years; range, 38 to 70 years) in Group B were recruited. Group A received intra-articular DPT, while Group B received peri-articular DPT. Treatment was administered two times with two-week intervals. The Visual Analog Scale (VAS), Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Oxford Knee Scale (OKS) questionnaires were filled at baseline, and four and eight weeks after first injection. Results: At four and eight weeks, the VAS, OKS, and WOMAC scores improved from baseline in both groups. There was no significant difference in the WOMAC and OKS scores between two methods. The VAS scores showed superiority of intra-articular method (p<0.05). Conclusion: Both peri-articular and intra-articular DPT were effective in patients with KOA. There was no superiority in terms of functional improvement between two groups. However, intra-articular prolotherapy was more effective in decreasing pain in these patients. [ABSTRACT FROM AUTHOR]

Abstract Purpose Pain following arthroscopic knee surgery remains a controversial clinical problem. Intra-articular (IA) glucocorticoid injections have demonstrated the potential to provide better analgesia in some orthopedic surgeries; however, due to the lack of studies, its role in knee arthroscopies remain unclear. This systematic review aimed to evaluate the efficacy and safety of intra-articular glucocorticoids after arthroscopic knee surgery. Methods A systematic review was conducted according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guideline, with literature search performed on Medline, Embase, and the Cochrane Library. This systematic review has been registered with the International Prospective Register of Systematic Reviews (PROSPERO; ID: CRD42024509749). Inclusion criteria included randomized controlled trials published in English comparing IA glucocorticoid to placebo in patients undergoing knee arthroscopy. Risk of bias for all included studies was assessed using the Cochrane Collaboration’s risk of bias tool. Clinical outcomes compared were pain score: visual analogue scale (VAS) or International Knee Documentation Committee (IKDC), time to first analgesia requirement, analgesia consumption, range of motion (ROM), patient satisfaction, and complications. Results A total of 7 studies (3 and 4 with evidence level I and II, respectively) involving 309 patients were included. All studies showed that IA glucocorticoids significantly decreased subjective pain scores. Three studies showed significantly longer duration to first postoperative analgesia use, while 6 showed significantly reduced postoperative analgesic administration with IA glucocorticoid use. Two studies showed significantly increased patient satisfaction with IA glucocorticoid (P = 0.001 and P = 0.01, respectively). No studies showed significant differences in complications such as nausea, vomiting, bradycardia, hypotension, or procedure-related adverse effects between the groups. Conclusion Current available randomized controlled trials suggest that IA glucocorticoids can significantly reduce postoperative pain, delay, and minimize postoperative analgesia use, and improve patient satisfaction. No postoperative complications or adverse events were reported, reflecting its safety as a postoperative analgesic modality.

Aims: The optimum type of antibiotics and their administration route for treating Gram-negative (GN) periprosthetic joint infection (PJI) remain controversial. This study aimed to determine the GN bacterial species and antibacterial resistance rates related to clinical GN-PJI, and to determine the efficacy and safety of intra-articular (IA) antibiotic injection after one-stage revision in a GN pathogen-induced PJI rat model of total knee arthroplasty. Methods: A total of 36 consecutive PJI patients who had been infected with GN bacteria between February 2015 and December 2021 were retrospectively recruited in order to analyze the GN bacterial species involvement and antibacterial resistance rates. Antibiotic susceptibility assays of the GN bacterial species were performed to screen for the most sensitive antibiotic, which was then used to treat the most common GN pathogen-induced PJI rat model. The rats were randomized either to a PJI control group or to three meropenem groups (intraperitoneal (IP), IA, and IP + IA groups). After two weeks of treatment, infection control level, the side effects, and the volume of antibiotic use were evaluated. Results: Escherichia coli was the most common pathogen in GN-PJI, and meropenem was the most sensitive antibiotic. Serum inflammatory markers, weightbearing activity, and Rissing score were significantly improved by meropenem, especially in the IA and IP + IA groups ( p < 0.05). Meropenem in the IA group eradicated E. coli from soft-tissue, bone, and prosthetic surfaces, with the same effect as in the IP + IA group. Radiological results revealed that IA and IP + IA meropenem were effective at relieving bone damage. Haematoxylin and eosin staining also showed that IA and IP + IA meropenem improved synovial inflammation and bone destruction. No pathological changes in the main organs or abnormal serum markers were observed in any of the meropenem-treated rats. The IA group required the lowest amount of meropenem, followed by the IP and IP + IA groups. Conclusion: IA-only meropenem with a two-week treatment course was effective and safe for PJI control following one-stage revision in a rat model, with less meropenem use. Cite this article: Bone Joint Res 2024;13(10):546–558.

Background: Platelet-rich-plasma (PRP) is rapidly spreading as a conservative treatment option for knee osteoarthritis (KOA), however, its therapeutic efficacy is controversial. This study aimed to investigate the factors affecting the therapeutic effect of intra-articular PRP therapy for KOA in patients who received multiple PRP injections (PRP-I). Methods: This is a historical cohort study included 1057 knees of 701 patients who received PRP-I during KOA treatment from 2018 to 2020. The difference in visual analog scale (VAS) scores before and after PRP-I was defined as the amount of change in VAS (ΔVAS). A linear mixed-effects model was employed with ΔVAS as a random effect and age, sex, BMI, KL classification, pre-treatment VAS, treatment duration, and the number of PRP injections as fixed effects. Evaluations using the Kellgren-Lawrence (KL) classification were added. Results: Age, KL grade, and VAS score before treatment and after three, four, and five PRP-I were significantly associated with ΔVAS score. According to KL grade, age was significantly associated with ΔVAS score in the KL grade 4 group. VAS score before treatment was significantly associated with ΔVAS score, regardless of KL grade. Three-time PRP-I were significantly associated with ΔVAS in the KL-grade 1 and 2 groups. For KL grade 4, two or more PRP-I were significantly associated with the high efficacy. Conclusions: Age, pain before treatment, KL grade and number of injections were associated with pain reduction after intra-articular PRP-I for KOA treatment. Pain reduction can be expected after PRP-I when patients are younger or experience severe pain before treatment. Three-time PRP-I are recommended to reduce pain in early-stage KOA and more than three times in advanced-stage KOA. Trial registration: Retrospectively registration.

Abstract Introduction Adhesive capsulitis, also known as “frozen shoulder,” is a debilitating shoulder condition increasingly linked to fibroadhesive bursitis, particularly after COVID-19 and related vaccinations. There is no definitive gold standard for its treatment, the primary therapeutic objectives of which are the reduction of pain and the restoration of shoulder range of motion. The aim of our study was to analyze treatment outcomes based on quantitative measures of shoulder function and symptom relief. Method Conducted between January 2022 and April 2023, the research involved 45 patients initially diagnosed with adhesive capsulitis and associated fibroadhesive bursitis. After excluding nine patients for other concomitant pathologies (five for calcific tendinopathy and four for rotator cuff injury), 36 patients were randomized into two groups: one group was treated with glenohumeral hydrodistension, the other with glenohumeral hydrodistension combined with bursal injection. Assessments were conducted at baseline and then 2, 4, and 6 months after treatment, focusing on changes in pain levels, functional scores, and range of motion in all planes. Each group followed a home-based rehabilitation protocol. Results Significant improvements were observed in both treatment groups, with the combined hydrodistension and bursal injection group showing notably superior outcomes. Specifically, the range of motion in flexion improved from an initial median of 80° to 155° in the combined treatment group, compared to an increase from 75.5° to 129° in the group treated with hydrodistension alone. This enhancement was statistically significant (p

Background: Osteoarthritis (OA) of the knee is a disabling disease. Recently, relatively younger patients with early OA and knee pain are increasing. Intra-articular (IA) therapies need to address the inflammation associated with OA along with pain relief. Recent reports suggest the presence of opioid receptors in peripheral locations and presence of their anti-inflammatory actions of IA opioid injections. AIM: To study the role of IA buprenorphine injection in the management of early OA of the knee joint. MATERIALS AND METHODS: A prospective study of 50 patients with early OA was carried out. Patients were administered 2 ml IA 0.5% buprenorphine on days 1 and 7. The results were assessed with Oxford Knee Score (OKS) and Visual Analog Scale (VAS) on days 1, 7, 15, 30, and 90. Results: There was a significant improvement in mean OKS till day 30 (P < 0.0001) with values at day 90 showing similar results to day 1. The mean VAS values also showed a significant improvement till day 30 (P < 0.0001). There was no significant change in total neutrophil counts in synovial fluid on day 7. The most common adverse effect reported was nausea and vomiting (24%), pointing to systemic absorption. Conclusion: IA injection of buprenorphine showed no reduction in neutrophil counts in synovial fluid in this study and the pain relief resulting may in part be attributable to systemic absorption of the drug. Better depot preparations and further research into chondroprotective action of IA opioid injections are still needed to recommend it as a viable therapeutic option in early OA of the knee.

Objective To investigate the clinical effect of low-load blood flow restriction training combined with intra-articular injection for elderly knee osteoarthritis. Methods A total of 126 elderly patients with knee osteoarthritis admitted to the Third Hospital of Shanxi Medical University in 2023 were selected as the study subjects by convenient sampling method, they divided into two groups according to the random number table, 63 cases for each group. The control group received simple intra-articular injection, and the observation group was additionally trained with low-load blood flow restriction. Western Ontario and the University of Manchester Osteoarthritis Index (WOMAC), efficacy, generic quality of life inventory 74 (GQOLI-74) score, knee extension moment, knee adduction moment, serum matrix metalloproteinase (MMP) -1, and MMP-3 levels were assessed before and after treatment. Results After treatment, the WOMAC dimensions and total score, MMP-1 and MMP-3 levels in the observation group were lower than those in the control group (P < 0.05), and the clinical total effective rate, GQOLI-74 score dimensions and total score, knee extension moment and knee adduction moment in the observation group were higher than those in the control group (P < 0.05) . Conclusion Low-load blood flow restriction training combined with intra-articular injection for elderly knee osteoarthritis has good clinical efficacy, which can significantly relieve pain, improve joint function and quality of life of patients, and its treatment mechanism may be related to lower levels of MMP-1 and MMP-3.

Objective: Intra‐articular injection of local anaesthetic provides safe and effective analgesia for patients with shoulder dislocation. We designed a three‐dimensional‐printed ultrasound model of the shoulder to educate ED clinicians on use of this technique. We aimed to evaluate the impact of a 1‐h training session using this model on participants' knowledge, skills and clinical practice. Methods: This was a prospective study of the clinicians working at two EDs in New Zealand. Participants (n = 20) took part in a 1‐h educational session. We tested participants' performance before the session, afterwards and at 3 months using a 10‐point objective structured clinical examination. We reviewed clinical records to determine whether there was increased utilisation of this technique among ED patients before and after the training. Results: There was improvement in participants' OCSE performance (median pre‐training score = 4.00, median 3‐month post‐training score = 7.00, P = 0.044) and self‐reported competence and knowledge, which were sustained to the end of the study. There was increased use of intra‐articular injection among ED patients with shoulder dislocation: 2 of 68 patients (3%) before and 11 of 76 patients (14.5%) after the study. Notably, most were performed by clinicians who did not take part in the study (n = 9). Conclusion: A 1‐h training session using a three‐dimensional‐printed model improved participants objective structured clinical examination performance in ultrasound‐guided injection of the shoulder joint. Although there was minimal change in the practice of participating clinicians, overall use of the procedure increased. [ABSTRACT FROM AUTHOR]

Introduction: Adhesive capsulitis, also known as "frozen shoulder," is a debilitating shoulder condition increasingly linked to fibroadhesive bursitis, particularly after COVID-19 and related vaccinations. There is no definitive gold standard for its treatment, the primary therapeutic objectives of which are the reduction of pain and the restoration of shoulder range of motion. The aim of our study was to analyze treatment outcomes based on quantitative measures of shoulder function and symptom relief. Method: Conducted between January 2022 and April 2023, the research involved 45 patients initially diagnosed with adhesive capsulitis and associated fibroadhesive bursitis. After excluding nine patients for other concomitant pathologies (five for calcific tendinopathy and four for rotator cuff injury), 36 patients were randomized into two groups: one group was treated with glenohumeral hydrodistension, the other with glenohumeral hydrodistension combined with bursal injection. Assessments were conducted at baseline and then 2, 4, and 6 months after treatment, focusing on changes in pain levels, functional scores, and range of motion in all planes. Each group followed a home-based rehabilitation protocol. Results: Significant improvements were observed in both treatment groups, with the combined hydrodistension and bursal injection group showing notably superior outcomes. Specifically, the range of motion in flexion improved from an initial median of 80° to 155° in the combined treatment group, compared to an increase from 75.5° to 129° in the group treated with hydrodistension alone. This enhancement was statistically significant (p < 0.001). Regarding pain reduction, the combined treatment group demonstrated a dramatic decrease in visual analogue scale (VAS) scores, from a baseline median of 7 to 1 at the 6-month follow-up. In contrast, the hydrodistension-only group showed a reduction from 7 to 3, with these differences also proving statistically significant (p < 0.001). Conclusions: Ultrasound-guided hydrodistension of the glenohumeral joint, if combined with bursal injection and specific exercises, effectively reduces pain, decreases disability, and improves range of motion in patients with second-stage adhesive capsulitis. This study highlights the importance of a combined approach in the management of this complex condition, especially after the histological changes that occurred after COVID-19 and related vaccinations. Trial Registration: ClinicalTrials.gov identifier NCT06062654. [ABSTRACT FROM AUTHOR]

Abstract Background Suction drainages are commonly used after total knee arthroplasty (TKA) procedures; however, their use is somewhat controversial. Recently, some reports have claimed that the administration of tranexamic acid (TXA) may prevent postoperative bleeding following TKAs. Although numerous studies have reported regarding different dosages, timings of administration, or drain clamping times for intravenous and intra-articular TXA injections (IA-TXAs), few have examined whether suction drainage is necessary when TXA is administered. In this study, we compared using suction drainage without TXA administration and IA-TXA without suction drainage and aimed to examine the need for suction drainage during IA-TXA. Methods This retrospective study was conducted on 217 patients who had received TKA for osteoarthritis; 104 were placed on suction drainage after TKA without TXA (Group A), whereas the remaining 113 received IA-TXA immediately after surgery without suction drainage (Group B). Our clinical evaluation included assessments of the need for transfusion, presence of postoperative complications, incidence of deep vein thrombosis (DVT), and changes in hemoglobin (Hb), hematocrit (Hct), and D-dimer levels. Results No significant differences were observed in terms of postoperative complications and preoperative Hb, Hct, or D-dimer levels between the two groups. Although the prevalence of DVT was significantly higher in Group B (p

Abstract Background We aimed to analyze the outcomes of intraarticular extra virgin olive oil (EVOO) injection on mechanically induced rabbit knee osteoarthritis (OA) by studying the morphological, histological, and radiological findings. Methods The study was conducted on 32 New Zealand White rabbits. The randomly numbered subjects were divided into two main groups. The rabbits numbered 1 to 16 were selected to be the group to receive EVOO, and the remaining were selected into a control group. Both groups were separated into two subgroups for short-term (five weeks) and long-term (10 weeks) follow-up. Anterior cruciate ligament transection was applied on the left knees of all the rabbits via medial parapatellar arthrotomy to simulate knee instability. Immediately after the surgical procedure, 0.2 cc of EVOO was injected into the knee joint of rabbits numbered 1–16, and the control group received 0.2 cc of sterile saline. On the 14th day, long-term group subjects were administered another dose of 0.2 cc EVOO intraarticularly. Results The gross morphological scores of the control group subjects were significantly different from the EVOO group for both short-term (p = 0,055) and long-term (p = 0,041) scores. In parallel, the MRI results of the EVOO subjects were significantly different from the control group for both short-term and long-term follow-up assessment scores (p = 0.017, p = 0.014, respectively). The Mankin scoring results showed that there were statistically significant differences between the EVOO and control group in the comparison of both total scores (p = 0.001 for short-term and p = 0.004 for long-term) and subgroup scoring, including macroscopic appearance, chondrocyte cell number, staining, and Tidemark integrity in both short-term (p = 0.005, p = 0.028, p = 0.001, p = 0.005, respectively) and long-term assessments (p = 0.002, p = 0.014, p

Abstract The interior environment of articular cartilage in osteoarthritis (OA) presents substantial hurdles, leading to the malfunction of chondrocytes and the breakdown of collagen II-enriched hyaline cartilage matrix. Despite this, most clinical treatments primarily provide temporary relief from OA discomfort without arresting OA progression. This study aimed to alleviate OA by developing intra-articular injectable dECM-enhanced hyaluronic (HE) microgels. The HE hydrogel was engineered and shaped into uniformly sized microgels using microfluidics and photopolymerization techniques. These microgels provided a spatiotemporal cascade effect, facilitating the rapid release of growth factors and a slower release of ECM macromolecules and proteins. This process assisted in the recovery of OA chondrocytes’ function, promoting cell proliferation, matrix synthesis, and cartilage-specific gene expression in vitro. It also effectively aided repair of the collagen II-enriched hyaline cartilage and significantly reduced the severity of OA, as demonstrated by radiological observation, gross appearance, histological/immunohistochemical staining, and analysis in an OA rat model in vivo. Collectively, the HE injectable microgels with spatiotemporal release of cartilage-specific molecules have shown promise as a potential candidate for a cell-free OA therapy approach. Graphical Abstract

Rheumatoid arthritis (RA) is an autoimmune disease characterized by systemic inflammation that primarily affects joint tissue and requires frequent medication. Recently, we developed cyclic phage-display-derived inhibitory peptides (CPs), which act as Toll-like Receptor 4 antagonists. These CPs exhibited therapeutic efficacy against joint diseases by alleviating inflammatory factors. Nonetheless, CP exhibits in vivo instability and a short half-life. Therefore, this study sought to improve the in vivo stability of CP, thereby reducing the frequency of CP administration through the development of an injectable hydrogel depot formulation. To improve in vivo stability, CP was chemically conjugated to hyaluronic acid (HA—CP) and subsequently mixed into a temperature-sensitive hydrogel [methoxy polyethylene glycol-b-poly(ε-caprolactone)- ran -poly(lactide) (PC)] as an injectable depot (PC+(HA—CP)). For comparison, CP was physically mixed with HA and PC (PC+(HA+CP)). Both PC+(HA—CP) and PC+(HA+CP) were found to rapidly form depots upon injection into the joint space. Cell viability assays confirmed the non-toxic nature of PC+(HA—CP) and PC+(HA+CP), whereas both formulations exhibited inhibition of inflammatory factors. Furthermore, PC+(HA—CP) retained CP for a longer duration compared to PC+(HA+CP) in the presence of hyaluronidase and within the RA joint space. Following intra-articular injection, both the PC+(HA—CP) and PC+(HA+CP) depots exhibited reductions in RA symptoms, cartilage regeneration, and suppression of pro-inflammatory cytokine levels. Specifically, by extending the in vivo retention of CP, PC+(HA—CP) demonstrated superior RA treatment efficacy compared to PC+(HA+CP). In conclusion, intra-articular injection of PC+(HA—CP) was validated as an effective strategy for treating RA, owing to its ability to prolong the in vivo retention of CP. This approach holds promise for improving RA management and patient outcomes. [Display omitted] • Extending in vivo retention of Toll-like receptor antagonistic peptides (CP). • Suppression of pro-inflammatory molecules by prolonged in vivo peptides. • Enhancing rheumatoid arthritis treatment by intra-articular injectable hydrogel formulation. [ABSTRACT FROM AUTHOR]

Objective：To investigate the clinical efficacy of intra - articular injection of chitosan combined with low - dose corticosteroids in the treatment of knee osteoarthritis (KOA)in the early and middle stages. Methods：A retrospective analysis was conducted on 164 patients with KOA who visited and were followed up at the outpatient department of orthopedics at the First Affiliated Hospital of Nanjing Medical University from June 2021 to December 2022. Based on the treatment methods, patients were divided into three groups：Group A (control group, oral administration) consisted of 55 patients, Group B (intra -articular injection of chitosan+oral administration) had 53 patients, Group C (intra-articular injection of chitosan combined with low-dose glucocorticoids) included 56 patients. Variations in pain visual analogue scale (VAS), Lysholm score, Hospital for Special Surgery (HSS) score, and the levels of inflammatory cytokines in the synovial fluid (interleukin-1, IL-1；interleukin-6, IL-6；tumor necrosis factor-alpha, TNF-α) were compared before and after treatment. Clinical efficacy was also evaluated. Results：All cases were followed up for 7-12 months and no cases were lost. Post-treatment VAS scores, Lysholm scores, HSS scores, and the levels of synovial fluid inflammatory cytokines (IL-1, IL-6, and TNF-α) were all significantly improved compared to pre-treatment levels in each group (P < 0.05). There were no significant differences in pre-treatment VAS scores, Lysholm scores, HSS scores and the levels of IL-1, IL-6, and TNF-α among the three groups (P > 0.05)；however, post-treatment comparisons showed significant differences (P < 0.05). Compared with each other, Group C showed better outcomes than Groups A and B, and Group B was superior to Group A, with significant statistical differences (P < 0.05).The comparison of clinical efficacy among the three groups also showed statistically significant differences (P < 0.05). Conclusion：Intra - articular injection of chitosan combined with low - dose corticosteroids shows significant clinical efficacy in the treatment of KOA in early and middle stages, with the advantages of minimal trauma, rapid onset, lasting efficacy and avoids the adverse reactions of external application or oral administration of non - steroidal anti - inflammatory drugs. As a first - line treatment option, its clinical promotion and use are recommended. [ABSTRACT FROM AUTHOR]

Background and Purpose: The discovery of new bromo‐ and extra‐terminal inhibitors presents new drugs to treat osteoarthritis (OA). Experimental Approach: The new drug, BBC0403, was identified in the DNA‐encoded library screening system by searching for compounds that target BRD (bromodomain‐containing) proteins. The binding force with BRD proteins was evaluated using time‐resolved fluorescence energy transfer (TR‐FRET) and binding kinetics assays. Subsequently, in vitro and ex vivo analyses demonstrated the effects of the BRD2 inhibitor, BBC0403, on OA. For animal experiments, medial meniscus destabilization was performed to create a 12‐week‐old male C57BL/6 mouse model, and intra‐articular (i.a.) injections were administered. Histological and immunohistochemical analyses were then performed. The underlying mechanism was confirmed by gene set enrichment analysis (GSEA) using RNA‐seq. Key Results: TR‐FRET and binding kinetics assays revealed that BBC0403 exhibited higher binding specificity for BRD2 compared to BRD3 and BRD4. The anti‐OA effects of BBC0403 were tested at concentrations of 5, 10 and 20 μM (no cell toxicity in the range tested). The expression of catabolic factors, prostaglandin E2 (PGE2) production and extracellular matrix (ECM) degradation was reduced. Additionally, the i.a. injection of BBC0403 prevented OA cartilage degradation in mice. Finally, BBC0403 was demonstrated to suppress NF‐κB and MAPK signalling pathways. Conclusion and Implications: This study demonstrated that BBC0403 is a novel BRD2‐specific inhibitor and a potential i.a.‐injectable therapeutic agent to treat OA. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effects of intra-articular glenohumeral joint triamcinolone injection in treating secondary adhesive capsulitis after breast cancer surgery. Methods: This study prospectively enrolled 37 participants, including 22 in the breast cancer surgery group and 15 in the idiopathic group. All participants received intra-articular glenohumeral joint triamcinolone injection in the affected shoulder joint. The clinical outcomes included the Shoulder Pain and Disability Index (SPADI), passive range of motion (PROM), and pain intensity on the Numeric Rating Scale (NRS), which were evaluated before the intervention and 1, 3, and 6 months after. The primary outcome of this study was the mean difference in the total SPADI from baseline to 6 months after the intervention. Results: The mean differences in the total SPADI scores from baseline to 6 months after the intervention were 36.2 ± 16.4 and 47.9 ± 15.2 in the breast cancer surgery group and the idiopathic group, respectively. There was no significant difference between the two groups (p = 0.1495). However, the improvements in the SPADI pain subscale at the 3- and 6-month follow-up visits (−31.2 vs. −48.8, p = 0.042; −34.1 vs. −50.7, p = 0.0006) and the PROM of abduction at the 3-month follow-up (52.4 vs. 70.3, p = 0.0072) were inferior in the breast cancer surgery group compared to the idiopathic group. There were no adverse events in either group. Conclusion: Intra-articular triamcinolone injection is an effective and safe treatment option for adhesive capsulitis after breast cancer surgery; however, it has less effect than for idiopathic adhesive capsulitis. [ABSTRACT FROM AUTHOR]

Stigmasterol, a plant-derived sterol, sharing structural similarity with cholesterol, has demonstrated anti-osteoarthritis (OA) properties, attributed to its antioxidant and anti-inflammatory capabilities. Given that OA often arises in weight bearing or overused joints, prolonged localized treatment effectively targets inflammatory aspects of the disease. This research explored the impact of stigmasterol-loaded nanoparticles delivered via intra-articular injections in an OA rat model. Employing mesoporous silica nanomaterials (MSNs) combined with β-cyclodextrin (β-CD) as a vehicle, stigmasterol was loaded in conjunction with tannic acid, forming stigmasterol/β-CD-MSNs to facilitate a sustained stigmasterol release. The study employed RAW 264.7 cells to examine the in vitro cytotoxicity and anti-inflammatory effect of stigmasterol/β-CD-MSNs. For in vivo experimentation, we used healthy control rats and monosodium iodoacetate (MIA)-induced OA rats, separated into five groups, varying the injection substances. In vitro findings indicated that stigmasterol/β-CD-MSNs suppressed the mRNA expression of key pro-inflammatory mediators such as interleukin-6, tumor necrosis factor-α, and matrix metalloproteinase-3 in a dose-dependent manner. In vivo experiments revealed a substantial decrease in the mRNA levels of pro-inflammatory factors in the stigmasterol(50 µg)/β-CD-MSN group compared to the others. Macroscopic, radiographic, and histological evaluations established that intra-articular injections of stigmasterol/β-CD-MSNs inhibited cartilage degeneration and subchondral bone deterioration. Therefore, in a chemically induced OA rat model, intra-articular stigmasterol delivery was associated with reduction in both local and systemic inflammatory responses, alongside a slowdown in joint degradation and arthritic progression. [ABSTRACT FROM AUTHOR]

BACKGROUND: In recent years, tranexamic acid has been extensively used to mitigate the substantial blood loss associated with total knee arthroplasty. However, the optimal method of topical application has not yet been established. OBJECTIVE: To evaluate the effectiveness and safety of intraoperative topical application of tranexamic acid combined with physical compression dressing in reducing perioperative blood loss in total knee arthroplasty. METHODS: A retrospective analysis was conducted on 90 patients who underwent total knee arthroplasty at the Honghui Hospital in Xi’an from January 2021 to December 2022. Based on the different topical use methods of tranexamic acid during surgery, patients were divided into three groups, with 30 cases in each group. In the compression dressing group, 2 g of tranexamic acid was placed in the articular cavity, and after packing the wound with gauze and cotton pads, a bandage was used to compress the wound. In the periarticular injection group, 2 g of tranexamic acid was injected into the surrounding tissue of the articular cavity. In the intra-articular injection group, 2 g of tranexamic acid was injected into the articular cavity. The blood loss, operation time, coagulation indicators, inflammatory indicators, and postoperative complications of the three groups were statistically analyzed. RESULTS AND CONCLUSION: (1) In terms of total blood loss, hidden blood loss, and maximum hemoglobin drop, the periarticular injection group had the least amount, and there was no statistically significant difference between the compression dressing group and periarticular injection group (P > 0.05). In terms of intraoperative blood loss, the compression dressing group had the least amount, and there were statistically significant differences compared with the periarticular injection group and intra-articular injection group (P < 0.05). There was no statistically significant difference in operation time among the three groups (P > 0.05). (2) There were no statistically significant differences in coagulation indicators (D-dimer and fibrinogen degradation products) and inflammation indicators (C-reactive protein and erythrocyte sedimentation rate) among the three groups preoperatively and on the first and third days after operation (P > 0.05). (3) There was no statistically significant difference observed among the three groups in terms of slow blood flow in the affected limb, intramuscular venous thrombosis, soft tissue swelling, and incidence of wound complications (P > 0.05). Additionally, no cases of deep vein thrombosis or pulmonary embolism were detected in any of the groups. (4) The topical application of tranexamic acid combined with compression dressing achieves the same effect as a periarticular injection in terms of simplicity of operation and reduced perioperative blood loss. This method also avoids the trauma caused by repeated punctures and does not increase the incidence of postoperative complications, making it a worthwhile option for clinical promotion. [ABSTRACT FROM AUTHOR]

Background: Suction drainages are commonly used after total knee arthroplasty (TKA) procedures; however, their use is somewhat controversial. Recently, some reports have claimed that the administration of tranexamic acid (TXA) may prevent postoperative bleeding following TKAs. Although numerous studies have reported regarding different dosages, timings of administration, or drain clamping times for intravenous and intra-articular TXA injections (IA-TXAs), few have examined whether suction drainage is necessary when TXA is administered. In this study, we compared using suction drainage without TXA administration and IA-TXA without suction drainage and aimed to examine the need for suction drainage during IA-TXA. Methods: This retrospective study was conducted on 217 patients who had received TKA for osteoarthritis; 104 were placed on suction drainage after TKA without TXA (Group A), whereas the remaining 113 received IA-TXA immediately after surgery without suction drainage (Group B). Our clinical evaluation included assessments of the need for transfusion, presence of postoperative complications, incidence of deep vein thrombosis (DVT), and changes in hemoglobin (Hb), hematocrit (Hct), and D-dimer levels. Results: No significant differences were observed in terms of postoperative complications and preoperative Hb, Hct, or D-dimer levels between the two groups. Although the prevalence of DVT was significantly higher in Group B (p < 0.05), all cases were asymptomatic. Hb and Hct levels were significantly lower in Group A than in Group B at 1, 3, 7, and 14 days postoperatively (p < 0.05), although none of the cases required blood transfusions. D-dimer levels were significantly higher in Group A than in Group B at 1 and 3 days postoperatively (p < 0.05). Conclusion: Suction drainage might not be necessary when IA-TXA is administered after TKA procedures. [ABSTRACT FROM AUTHOR]

Background: We aimed to analyze the outcomes of intraarticular extra virgin olive oil (EVOO) injection on mechanically induced rabbit knee osteoarthritis (OA) by studying the morphological, histological, and radiological findings. Methods: The study was conducted on 32 New Zealand White rabbits. The randomly numbered subjects were divided into two main groups. The rabbits numbered 1 to 16 were selected to be the group to receive EVOO, and the remaining were selected into a control group. Both groups were separated into two subgroups for short-term (five weeks) and long-term (10 weeks) follow-up. Anterior cruciate ligament transection was applied on the left knees of all the rabbits via medial parapatellar arthrotomy to simulate knee instability. Immediately after the surgical procedure, 0.2 cc of EVOO was injected into the knee joint of rabbits numbered 1–16, and the control group received 0.2 cc of sterile saline. On the 14th day, long-term group subjects were administered another dose of 0.2 cc EVOO intraarticularly. Results: The gross morphological scores of the control group subjects were significantly different from the EVOO group for both short-term (p = 0,055) and long-term (p = 0,041) scores. In parallel, the MRI results of the EVOO subjects were significantly different from the control group for both short-term and long-term follow-up assessment scores (p = 0.017, p = 0.014, respectively). The Mankin scoring results showed that there were statistically significant differences between the EVOO and control group in the comparison of both total scores (p = 0.001 for short-term and p = 0.004 for long-term) and subgroup scoring, including macroscopic appearance, chondrocyte cell number, staining, and Tidemark integrity in both short-term (p = 0.005, p = 0.028, p = 0.001, p = 0.005, respectively) and long-term assessments (p = 0.002, p = 0.014, p < 0.001, p = 0. 200, respectively). Conclusions: We have observed promising outcomes of intra-articular application of extra virgin olive oil in the treatment of acute degenerative osteoarthritis in rabbit knees. Due to its potential cartilage restorative and regenerative effects, EVOO, when administered intra-articularly, may be a promising agent to consider for further research in the treatment of OA. [ABSTRACT FROM AUTHOR]

Osteoarthritis (OA) is the most common complex musculoskeletal disorder, resulting from the degeneration of the articular cartilage and characterized by joint pain and dysfunction that culminate in progressive articular cartilage loss. We present our experience in the management of hip and knee OA by means of the intra-articular injection of fat micrograft, describing our approach, which was developed from the belief in the powerful reparative effect of autologous fat graft on damaged tissue, as well as its natural lubricating effect on the joints. Inclusion criteria were as follows: men and women, aged 20 to 80 years, that referred articular pain of the hips and/or knees, showing initial-stage degenerative OA. From October 2018 to July 2023, a total of 250 patients underwent treatment with the Sefficare® device (SEFFILINE srl, Bologna, Italy). The Superficial Enhanced Fluid Fat Injection device was used to perform autologous regenerative treatments in a safe, standardized, easy, and effective way on 160 women, 64%, and 90 men, 36%. A total of 190 procedures (76%) involved the knees, with 20 patients who were bilaterally treated, while 60 procedures, all unilateral, involved the hips (24%). The mean age at treatment was 52.4 years. Before treatment, each patient had undergone X-rays and Magnetic Resonance Imaging (MRI) of the painful hip/knee to evaluate and grade the articular OA. Postoperatively, each patient was assessed after one, three, six, and twelve months. The donor site postoperative course was uneventful other than minimal discomfort. Clinically, the ROM (range of motion) of the treated knee/hip increased an average of 10 degrees 3 months after treatment, but the stiffness was reduced, as reported by the patients. The VAS (Visual Analog Scale) was submitted at 3, 6, and 12 months, demonstrating a progressive reduction of pain, with the best score obtained at six months postoperatively. In total, 85% of patients were satisfied one year after treatment, with a considerable improvement in pain and quality of life. The satisfactory outcome of this minimally invasive procedure indicates that the intra-articular injection of fat micrograft can replace or considerably delay the need for the classical major joint replacement surgery, thanks to its impact on the quality of life of patients and financial cost. [ABSTRACT FROM AUTHOR]

As osteoarthritis (OA) of the trapeziometacarpal (TMC) joint leads to a high degree of disease burden with compromises in rudimentary and fine movements of the hand, intra-articular injections may be a desirable treatment option. However, because there are no evidence-based guidelines, the choice of intra-articular injection type is left to the discretion of the individual surgeon in collaboration with the patient. The purpose of our study was to perform a systematic review and meta-analysis using level I studies to compare outcomes following corticosteroid and alternative methods of intra-articular injections for the management of TMC OA. Our hypothesis was that intra-articular corticosteroid injections were no more effective than other methods of intra-articular injections for the management of TMC OA. A systematic literature search was performed. Eligible for inclusion were randomized control trials reporting on intra-articular corticosteroid injection for the management of TMC OA. Clinical outcomes were recorded. The 10 included studies comprised 673 patients. The mean age was 57.8 ± 8.3 years, with a mean follow-up of 6.4 ± 2.7 months. There was no significant difference in visual analog scale scores, grip strength and tip pinch strength between corticosteroids and hyaluronic acid at short- and medium-term follow-up. Further, there was no difference in visual analog scale pain scores at rest at medium-term follow-up between corticosteroids and platelet-rich plasma. Despite short-term improvement with intra-articular corticosteroid injections, there was no significant difference in pain and functional outcomes following intra-articular corticosteroid injections compared to hyaluronic acid or platelet-rich plasma administration. Given the affordability, ease of administration, and efficacy associated with corticosteroids, they are a favorable option when considering the choice of intra-articular injection for the management of TMC OA. Therapeutic II. [ABSTRACT FROM AUTHOR]

The interior environment of articular cartilage in osteoarthritis (OA) presents substantial hurdles, leading to the malfunction of chondrocytes and the breakdown of collagen II-enriched hyaline cartilage matrix. Despite this, most clinical treatments primarily provide temporary relief from OA discomfort without arresting OA progression. This study aimed to alleviate OA by developing intra-articular injectable dECM-enhanced hyaluronic (HE) microgels. The HE hydrogel was engineered and shaped into uniformly sized microgels using microfluidics and photopolymerization techniques. These microgels provided a spatiotemporal cascade effect, facilitating the rapid release of growth factors and a slower release of ECM macromolecules and proteins. This process assisted in the recovery of OA chondrocytes' function, promoting cell proliferation, matrix synthesis, and cartilage-specific gene expression in vitro. It also effectively aided repair of the collagen II-enriched hyaline cartilage and significantly reduced the severity of OA, as demonstrated by radiological observation, gross appearance, histological/immunohistochemical staining, and analysis in an OA rat model in vivo. Collectively, the HE injectable microgels with spatiotemporal release of cartilage-specific molecules have shown promise as a potential candidate for a cell-free OA therapy approach. [ABSTRACT FROM AUTHOR]

IntroductionOsteoarthritis (OA) is regarded as one of the most prevealent irreversible joint degenerative disorder worldwide. Recently, considerable interest in utilizing intra-articular (IA) injections for managing OA has been raised.MethodsIn this study, IA injectable surface modified iron oxide microparticles (SMIOMPs) loaded with Diacerein (DCN) were developed. The effects of formulation parameters on particle size, entrapment efficiency, and zeta potential were explored using factorial design. The optimized formulation was characterized regarding morphology and in vitro release. Differential scanning calorimetry (DSC) and Fourier-transform infrared spectroscopy (FTIR) were done to assess interactions. Further, sterilization and in vivo performance in rats with induced arthritis has been performed for the optimized formulation.Results and DiscussionThe selected optimized system included 2M FeCL3 and 1% chitosan as a surface modifier achieved high drug entrapment of 85.25% with a PS of 1.54 µm and sustained DCN release. Morphological examination of the optimized formulation revealed spherical particles with chitosan coat. DSC and FTIR results indicated the absence of undesired interactions between DCN and the used components. No significant change in the measured parameters was observed following sterilization using gamma radiation. In vivo assessment revealed superior performance for the optimized formulation in reducing cartilage inflammation and degradation. Plasma levels of tumor necrosis factor α and Interleukin-1 beta, as well as knee diameter, were significantly reduced in the treated groups compared to the untreated ones.ConclusionOverall, the results suggest that the proposed DCN-loaded SMIOMPs represent a promising advancement in the arena of cartilage regeneration.

Background: Knee osteoarthritis (KOA) is the most common cause of chronic knee pain causing functional disability and dependency. Multiple interventions have been used in reducing pain and improving functionality. We intend to compare the efficacy of intra-articular platelet-rich plasma (PRP) and hyaluronic acid (HA) with botulinum toxin type A and HA in bilateral Grade 3 and 4 KOA. Methods: Prospective single-blinded randomized controlled trial conducted for 6 months. Among 54 participants, 27 received intra-articular botulinum toxin type A with HA (Group A), and the other 27 received intra-articular PRP with HA (Group B), single session. Pain (Numerical Rating Scale [NRS]) and functional limitation (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]) were assessed at 2, 4, 12, and 24 weeks postintervention. Effect of weight and physiotherapy on NRS and WOMAC score were assessed. P

Abstract Our objective in this study is to determine whether intra-articular injection of miRNA-1 can attenuate the progression of OA in rats by down regulating Ihh. Knee chondrocytes were isolated from male Sprague–Dawley rats aged 2–3 days. Second-generation chondrocytes were transfected with miR-1 mimic and empty vector with lipo3000 for 6 h and then stimulated with 10 ng/mL IL-1β for 24 h. OA-related and cartilage matrix genes were quantified using real-time quantitative polymerase chain reaction (RT-qPCR). Two-month-old male Sprague–Dawley rats were divided into three groups (n = 30?): sham operation group + 50 µL saline, anterior cruciate ligament transection (ACLT) group + 50 µL miR-1 agomir (concentration), and control group ACLT + 50 µL miR-1 agomir. Treatment was started one week after the operation. All animals were euthanized eight weeks after the operation. X-rays and micro-CT were used to detect imaging changes in the knee joints. FMT was used to monitor joint inflammation in vivo. Safranin O staining was used to detect morphological changes in articular cartilage. Immunohistochemistry was used to detect Col2, Col10, metalloproteinase-13 (MMP-13). RT-qPCR was used to detect gene changes includingmiR-1, Col2, Col10, MMP-13, Ihh, Smo, Gli1, Gli2, and Gli3. Overexpression of miR-1 in IL-1β-stimulated chondrocytes reduced the levels of Ihh, MMP-13, and Col10 but increased the levels of Col2 and aggrecan. Intra-articular injection of miR-1 agomir reduced osteophyte formation, inflammation, and prevented cartilage damage. RT-qPCR results indicated that the miR-1 agomir increased articular cartilage anabolism and inhibited cartilage catabonism. miR-1 can attenuate the progression of OA by downregulating Ihh.

Aims: Osteoarthritis (OA) is the most common chronic pathema of human joints. The pathogenesis is complex, involving physiological and mechanical factors. In previous studies, we found that ferroptosis is intimately related to OA, while the role of Sat1 in chondrocyte ferroptosis and OA, as well as the underlying mechanism, remains unclear. Methods: In this study, interleukin-1β (IL-1β) was used to simulate inflammation and Erastin was used to simulate ferroptosis in vitro. We used small interfering RNA (siRNA) to knock down the spermidine/spermine N1-acetyltransferase 1 (Sat1) and arachidonate 15-lipoxygenase (Alox15), and examined damage-associated events including inflammation, ferroptosis, and oxidative stress of chondrocytes. In addition, a destabilization of the medial meniscus (DMM) mouse model of OA induced by surgery was established to investigate the role of Sat1 inhibition in OA progression. Results: The results showed that inhibition of Sat1 expression can reduce inflammation, ferroptosis changes, reactive oxygen species (ROS) level, and lipid-ROS accumulation induced by IL-1β and Erastin. Knockdown of Sat1 promotes nuclear factor-E2-related factor 2 (Nrf2) signalling. Additionally, knockdown Alox15 can alleviate the inflammation-related protein expression induced by IL-1β and ferroptosis-related protein expression induced by Erastin. Furthermore, knockdown Nrf2 can reverse these protein expression alterations. Finally, intra-articular injection of diminazene aceturate (DA), an inhibitor of Sat1, enhanced type II collagen (collagen II) and increased Sat1 and Alox15 expression. Conclusion: Our results demonstrate that inhibition of Sat1 could alleviate chondrocyte ferroptosis and inflammation by downregulating Alox15 activating the Nrf2 system, and delaying the progression of OA. These findings suggest that Sat1 provides a new approach for studying and treating OA. Cite this article: Bone Joint Res 2024;13(3):110–123.

Abstract Background Recently, in an open pilot study, we found up to two years, a potential pain-relieving effect of intra-articular gold micro-particles using the patient’s synovial fluid for patients with knee osteoarthritis (KOA). During the study the excluded group of patients, due to multisite pain, co-morbidities, and other exclusion criteria., received intra-articular gold micro-particles using hyaluronic acid,. We aimed to identify if pre-treatment characteristics influence the global outcome two years after intra-articular treatment for painful KOA with gold microparticles using hyaluronic acid. Methods Using hyaluronic acid as the carrier, 136 patients with KOA received intraarticular injections with 20 mg gold microparticles (72.000 particles, 20–40 μm in diameter). In the analysis, we included the Global Rating of Change Scale, Pain Detect Questionnaire (PDQ), Body Mass Index (BMI), and Kellgren & Lawrence score at the inclusion, Western Ontario, and McMaster Universities Osteoarthritis Index (WOMAC) sub-scores for pain, stiffness, and function at inclusion and two years. Results On the Global Rating Change Scale, 69.1% of patients reported a positive effect, 28.7% no effect, and 2.2% worse. PDQ and the three WOMAC subscores all improved at two years of follow-up. PDQ ≥ 13 (P = 0.028), BMI (P = 0.022) and Kellgren & Lawrence grade 4 (P = 0.028) at inclusion reduced the effect with a minor odds ratio compared to the baseline effect of treatment (P = 0.025). WOMAC subscores at inclusion did not influence the outcome (P > 0.5). Conclusions Severe osteoarthritis, obesity, and neuropathic pain, reduced the effect of intra-articular gold microparticles for knee OA. Trial registration The study followed the principles of the Declaration of Helsinki and was approved by the local ethics committee of the North Denmark Region by 27/07/2016 (N-20,160,045). The regional data protection agency approved the project by 06/07/2016 (2008-58-0028, ID 2016 − 116) and registered in ClinicalTrial.Gov by 04/01/2018 (NCT03389906).

Background: The ultrasound-guided viscosupplementation of the hip joint with hyaluronic acid (HA) is considered a standard procedure among the conservative treatments for hip arthritis. The aim of this study was to evaluate the clinical benefit and the incidence of adverse events of the technique in an observational study at one year follow up. Methods: We evaluated a consecutive series of 85 patients with a diagnosis of symptomatic arthritis who underwent intra-articular ultrasound-guided hyaluronic acid injections. The scales used for evaluation were modified Harris Hip Score (mHHS), WOMAC (Western Ontario and McMaster University), and Hip Outcome Score (HOS) with subscale Sport (HOSs), for pain the Visual Analogic Scale (VAS). The patients were classified according to Tonnis' radiological classification of arthritis (range 0–3): 20 patients (grade 0), 32 (grade 1), 18 (grade 2), 15 (grade 3). Results: At last follow up, all the scales increased: mHHS from 59.35 to 82.1, HOS from 69.45 to 78.53, HOss from 47.4 to 58.11, VAS from 6.09 to 3.97, WOMAC from 33.2 to 31.5 (p < 0.05 for all the parameters); the results were elaborated with GraphPad Prism v5.0 (Prism Software La Jolla, CA, USA) using Wilcoxon's test. A total of 13 patients out of 85 needed arthroplasty, all classified as Tonnis grade 3. No serious adverse events were noted due to the procedure. Conclusions: Based on our findings, indication for the use of hyaluronic acid is limited to patients with mild to moderate arthritis. Patients in advanced arthritis refusing replacement surgery and asking for this treatment should be informed about the poor results of the technique even in the short term. [ABSTRACT FROM AUTHOR]

Introduction: More than half of the patients with moderate and severe osteoarthritis (OA) report unsatisfactory pain relief, requiring consideration of intra‐articular (IA) injections as the second‐line management. Ultrasound‐guided IA injection has proven evidence of higher accuracy in administering IA injectates into the joints than landmark‐guided or blind IA injections. However, questions remain about translating higher accuracy rates of ultrasound‐guided injection into better clinical improvements. Therefore, we examined the symptomatic benefits (pain, function and patient satisfaction) of ultrasound‐guided injection in knee, hip and hand OA compared with blind injections by synthesising a systematic review and meta‐analysis of randomised controlled trials (RCT). Methods: PubMed, Medline and Embase databases were searched for eligible studies from their inception to August 28, 2023. Results: Out of 295 records, our meta‐analysis included four RCTs (338 patients with knee OA), demonstrating significant improvement in procedural pain [−0.89 (95% CI −1.25, −0.53)], pain at follow‐up [−0.51 (95% CI −0.98, −0.04)] and function [1.30 (95% CI 0.86, 1.73)], favouring ultrasound guidance. One single study showed higher patient satisfaction with ultrasound guidance. Conclusion: Ultrasound‐guided IA injection provided superior clinical outcomes compared with landmark‐guided IA injection. [ABSTRACT FROM AUTHOR]

BACKGROUND: Many formulations and dosing regimens are available for hyaluronic acid (HA). OBJECTIVE: To compare different doses of linear, high-molecular weight (HMW) HA injections among patients with knee osteoarthritis (OA). METHODS: Hundred patients were included in this randomized, single-blinded trial and randomly divided into three HA injection groups. The first group received five weekly 20 mg HA injections, the second group received three weekly 32 mg HA injections, and the third group received a single 48 mg HA injection. Patients were evaluated at baseline, 1, 3, and 6 months after the last injection for pain, stiffness, and function using the visual analog scale (VAS) and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire. Quality of life, patient's global assessment, and Timed Up and Go (TUG) test scores were also evaluated. RESULTS: There was significant improvement in the WOMAC, VAS-pain, quality of life, patient's global assessment, and TUG test mean scores at all follow-up time points (p < 0.001). However, the groups showed no significant differences in WOMAC, VAS-activity pain, and patient global scores at any follow-up point. CONCLUSION: Intra-articular injections of different doses of linear HMW HA can improve pain, stiffness, function, and quality of life in patients suffering from knee OA over a six-month period. [ABSTRACT FROM AUTHOR]

AbstractPurposeMaterials and methodsResultsConclusions\nIMPLICATIONS FOR REHABILITATIONTrapeziometacarpal osteoarthritis (TMC-OA) is a prevalent hand disorder affecting a growing number of people worldwide. While a multidisciplinary approach might provide additional advantages, the analgesic and anti-inflammatory role of intra-articular oxygen-ozone (O2O3) injections combined with physical therapy is still unknown. To assess the impact of a multimodal therapeutic approach combining O2O3 injections with physical therapy in patients with TMC-OA.A prospective open-label study conducted in the Physical and Rehabilitation Medicine Unit of the "Renato Dulbecco" University Hospital of Catanzaro. We assessed patients with TMC-OA who had not responded to standard medical therapy. Participants received O2O3 therapy and targeted physical therapy for 4 weeks. Pain relief, muscle strength, and physical functioning were assessed at baseline and after 4, 12 and 24 weeks (respectively T0, T1, T2, and T3)Seventeen patients with a mean age of 67.1 ± 6.1 years were included in the study. Short-term improvements in pain intensity were observed (T0: 6.221 ± 1.514; T1: 3.172 ± 1.1451; p < .001) and were maintained over a 24-week follow-up period (T0: 6.221 ± 1.514; T3: 4.393 ± 1.438; p: 0.006). Significant changes were reported also in terms of muscle strength and physical functioning. O2O3 therapy was well-tolerated with no adverse effects.A combination of O2O3 injections and physical therapy might be considered in patients with TMC-OA. Further investigation is warranted to assess the effectiveness of O2O3 therapy in managing TMC-OA.The addition of intra-articular trapeziometacarpal O2O3 injections to physical therapy is safe and reliable for thumb osteoarthritisO2O3 injection could be considered a second-line mini-invasive approach option when simple analgesic and non-pharmacologic interventions have failed, and surgical treatment is not yet indicatedO2O3 injections in combination with physical therapy may provide benefits in terms of pain relief in patients with TMC joint OA in whom previous conventional medical therapy has been unsuccessfulThe addition of intra-articular trapeziometacarpal O2O3 injections to physical therapy is safe and reliable for thumb osteoarthritisO2O3 injection could be considered a second-line mini-invasive approach option when simple analgesic and non-pharmacologic interventions have failed, and surgical treatment is not yet indicatedO2O3 injections in combination with physical therapy may provide benefits in terms of pain relief in patients with TMC joint OA in whom previous conventional medical therapy has been unsuccessful [ABSTRACT FROM AUTHOR]

Our objective in this study is to determine whether intra-articular injection of miRNA-1 can attenuate the progression of OA in rats by down regulating Ihh. Knee chondrocytes were isolated from male Sprague–Dawley rats aged 2–3 days. Second-generation chondrocytes were transfected with miR-1 mimic and empty vector with lipo3000 for 6 h and then stimulated with 10 ng/mL IL-1β for 24 h. OA-related and cartilage matrix genes were quantified using real-time quantitative polymerase chain reaction (RT-qPCR). Two-month-old male Sprague–Dawley rats were divided into three groups (n = 30?): sham operation group + 50 µL saline, anterior cruciate ligament transection (ACLT) group + 50 µL miR-1 agomir (concentration), and control group ACLT + 50 µL miR-1 agomir. Treatment was started one week after the operation. All animals were euthanized eight weeks after the operation. X-rays and micro-CT were used to detect imaging changes in the knee joints. FMT was used to monitor joint inflammation in vivo. Safranin O staining was used to detect morphological changes in articular cartilage. Immunohistochemistry was used to detect Col2, Col10, metalloproteinase-13 (MMP-13). RT-qPCR was used to detect gene changes includingmiR-1, Col2, Col10, MMP-13, Ihh, Smo, Gli1, Gli2, and Gli3. Overexpression of miR-1 in IL-1β-stimulated chondrocytes reduced the levels of Ihh, MMP-13, and Col10 but increased the levels of Col2 and aggrecan. Intra-articular injection of miR-1 agomir reduced osteophyte formation, inflammation, and prevented cartilage damage. RT-qPCR results indicated that the miR-1 agomir increased articular cartilage anabolism and inhibited cartilage catabonism. miR-1 can attenuate the progression of OA by downregulating Ihh. [ABSTRACT FROM AUTHOR]

Knee osteoarthritis (KOA) is a prevalent condition characterized by the progressive deterioration of the entire joint and has emerged as a prominent contributor to disability on a global scale. The nature of the disease and its impact on joint function significantly limit mobility and daily activities, highlighting its substantial influence on patients' overall well-being. Stromal vascular fraction (SVF) is a heterogenous, autologous cell product, containing mesenchymal stem cells, derived from the patient's subcutaneous adipose tissue with demonstrated safety and efficacy in the treatment of KOA patients. We conducted a single-arm, open-label, multisite, FDA approved clinical study in Kellgren–Lawrence severity grade 2–4 KOA patients. The cellular product was manufactured from patient-specific lipoaspirate in a centrally located FDA-compliant manufacturing facility. Twenty-nine subjects were treated with a quality tested single intra-articular injection of GMP manufactured SVF. Adverse events, laboratory values, vital signs, and physical examination findings were monitored during the study period. Robust tolerability, without any substantial safety issues, was demonstrated. Knee pain and function, assessed through the Knee Injury and Osteoarthritis Outcome Score (KOOS), demonstrated notable improvements. These positive benefits persisted for up to 12 months, and the majority of participants expressed satisfaction. SVF from each patient was stored in a liquid nitrogen freezer for future clinical treatments. Unique to this study of autologous cells is the shipment of lipoaspirate from the clinic to a central FDA-compliant manufacturing facility for cleanroom-controlled manufacturing. The cell product characterization data demonstrate that this method produces an equivalent product in terms of cell count and viability with the added benefit of further quality assurance testing, including sterility, endotoxin, and flow cytometry, before patient administration. Clinical Trial Registration Number: NCT 04043819. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effect of intra-articular sodium hyaluronate injections in knee osteoarthritis (KOA) patients. Methods: 110 patients with KOA admitted to Renmin Hospital, Hubei University of Medicine, Shiyan, China from September 2019 and October 2021 were enrolled in this study. Each patient was assigned a number based on the time of admission, and the patients were randomly divided into control and study groups. Total effectiveness (efficacy), and visual analog scale (VAS) scores in both groups were evaluated. Also, the levels of inflammatory factors, viz, IL-6, TNF-α, and TLR4 were investigated using enzyme-linked immunosorbent assay (ELISA) Results: The total effectiveness in the study group was significantly higher compared to control group (p < 0.05), while the visual analog scale (VAS) scores of the study group were significantly lower than those of the control group one week and three months after treatment (p < 0.05). Conclusion: Intra-articular injection of sodium hyaluronate relieves pain, restores knee function, and reduces joint inflammation. Future long-term studies utilizing a larger number of patients from multiple centers will be required to validate treatment effects, potential for relapse, and recurrence of symptoms. [ABSTRACT FROM AUTHOR]

Background: Intra-articular glucocorticoid injection (IAGI) is widely used for treatment of knee osteoarthritis (OA) flares. Response rates are generally around 70%. Several studies have tried to identify predictors of good response, but response to ultrasound (US)-guided injection has not yet been investigated. This study aimed to identify the predictors of response to IAGI performed under US guidance in patients with primary knee OA. Materials and methods: A total of 116 patients (116 knees) presenting with unilateral or bilateral primary knee OA were enrolled for this prospective single-center study. All were aged >40 years and met the American College of Rheumatology (ACR) criteria for knee OA. Demographic, clinical, laboratory, and imaging data were collected, injection was performed using US guidance, and tolerance was assessed. The primary efficacy endpoint was ≥40% reduction in total WOMAC score (WOMAC40). Univariate and multivariate logistic regression analyses were conducted to identify the predictors of response. Results: The mean age of the patients was 64.2 ± 9.4 years and mean BMI was 29.9 ± 3.8 kg/m2. Total WOMAC40 response rate was 61.2%. In multivariate analysis, the independent predictors of response were BMI <30 kg/m² (OR = 0.38 [0.16 -- 0.89], p = 0.025) and ESR <20 mm (OR = 0.27 [0.08 -- 0, 90], p = 0.033). Conclusion: Knee OA patients with BMI <30 kg/m2 and/or ESR <20 mm have higher chance of having satisfactory response to US-guided IAGI. Clinical and radiographic severity and age do not seem to affect the probability of response. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to compare the effects of different intra-articular injections using a mixture of hyaluronic acid (HA) and platelet-rich plasma (PRP) versus hyaluronic acid and corticosteroid in the management of TMJ internal derangement with reduction. Materials and Methods: Sixty patients were randomly divided into two equal groups. Group I was injected with hyaluronic acid and PRP, while group II was injected with hyaluronic acid and corticosteroid. Pain intensity according to the visual analogue scale, maximum inter-incisal opening (MIO), lateral movement, and joint sound were measured pre-operatively and at 1 week, 1 month, and 6 months post-operatively. Results: MIO and lateral movements were improved in both groups, with a reduction in the number of patients suffering from clicking sounds along the follow-up periods with no significant difference between the studied groups. However, regarding pain, the group injected with HA and PRP achieved the best results after 6 months, while patients treated with HA and corticosteroids obtained the best results at the end of the 1st week. Conclusion: Hyaluronic acid and platelet-rich plasma mixture performed better than hyaluronic acid and corticosteroid in the treatment of TMJ internal derangement with reduction at the long-term follow-up regarding pain intensity. [ABSTRACT FROM AUTHOR]

Background: Recently, in an open pilot study, we found up to two years, a potential pain-relieving effect of intra-articular gold micro-particles using the patient's synovial fluid for patients with knee osteoarthritis (KOA). During the study the excluded group of patients, due to multisite pain, co-morbidities, and other exclusion criteria., received intra-articular gold micro-particles using hyaluronic acid,. We aimed to identify if pre-treatment characteristics influence the global outcome two years after intra-articular treatment for painful KOA with gold microparticles using hyaluronic acid. Methods: Using hyaluronic acid as the carrier, 136 patients with KOA received intraarticular injections with 20 mg gold microparticles (72.000 particles, 20–40 μm in diameter). In the analysis, we included the Global Rating of Change Scale, Pain Detect Questionnaire (PDQ), Body Mass Index (BMI), and Kellgren & Lawrence score at the inclusion, Western Ontario, and McMaster Universities Osteoarthritis Index (WOMAC) sub-scores for pain, stiffness, and function at inclusion and two years. Results: On the Global Rating Change Scale, 69.1% of patients reported a positive effect, 28.7% no effect, and 2.2% worse. PDQ and the three WOMAC subscores all improved at two years of follow-up. PDQ ≥ 13 (P = 0.028), BMI (P = 0.022) and Kellgren & Lawrence grade 4 (P = 0.028) at inclusion reduced the effect with a minor odds ratio compared to the baseline effect of treatment (P = 0.025). WOMAC subscores at inclusion did not influence the outcome (P > 0.5). Conclusions: Severe osteoarthritis, obesity, and neuropathic pain, reduced the effect of intra-articular gold microparticles for knee OA. Trial registration: The study followed the principles of the Declaration of Helsinki and was approved by the local ethics committee of the North Denmark Region by 27/07/2016 (N-20,160,045). The regional data protection agency approved the project by 06/07/2016 (2008-58-0028, ID 2016 − 116) and registered in ClinicalTrial.Gov by 04/01/2018 (NCT03389906). [ABSTRACT FROM AUTHOR]

Glenohumeral joint osteoarthritis is a highly prevalent musculoskeletal disease in adults over the age of 65. The first line of treatment typically consists of nonsurgical modalities prior to consideration for definitive treatment with total shoulder arthroplasty. Within this systematic review, we aim to assess the value of conservative management of glenohumeral osteoarthritis by evaluating the quality of available research and the efficacy of nonoperative treatment on patient-reported pain scores and functional outcome measures. A systematic review was conducted in literature published between 2000 and 2022. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed, and the electronic databases, PubMed, EBSCO Host, Medline, and Google Scholar were searched. Studies included in analysis consisted of patients receiving nonoperative management of glenohumeral joint arthritis without concomitant additional shoulder pathologies with a measured intervention and reported patient outcome measure. Two blinded reviewers screened and evaluated the data quality using the Methodological Index for Nonrandomized Studies tool. Nineteen studies were included consisting of 1879 patients with a median follow-up of 6 months. Eighteen studies included intra-articular injections including hyaluronic acid, corticosteroid, bone marrow aspirate, leukocyte-poor platelet-rich plasma, and autologous-conditioned serum injections. Each study reported symptomatic improvement following injection. Hyaluronic acid was the most commonly used (13 of 18 studies) agent with multiple studies demonstrating temporary improvement in pain and function. Four studies reported the outcomes of noninjectable modalities including physical therapy, bracing, and radiofrequency ablation. Two studies demonstrate that injections combined with physical therapy can lead to greater improvement in Constant score and range over motion for a greater period of time. Conservative treatment modalities can be effective in lowering pain scores and improving functional outcome scores in patients with glenohumeral osteoarthritis. The effect of each individual modality may be most effective when combined with other treatments. However, these benefits appear to be short-term. Additional studies are necessary to further determine the long-term efficacy and establish guidelines for the mainstay of first-line therapy in the management of glenohumeral joint osteoarthritis. [ABSTRACT FROM AUTHOR]

Osteoarthritis (OA) is a degenerative disease linked to aging and obesity. The global aging population has led to an increasing number of OA patients, imposing a significant economic burden on society. Traditional drugs treatment methods often fail to achieve satisfactory outcomes. With the rapid advancement of nanomaterial delivery systems, numerous studies have focused on utilizing nanomaterials as carriers to achieve efficient OA treatment by effectively loading and delivering bioactive ingredients (e.g., drugs, nucleic acids) tailored to the unique pathological conditions, such as the weakly acidic microenvironment of synovial fluid in OA patients. This review highlights the latest advancements in the use of pH-responsive nanoparticles for OA treatment, emphasizing the principle of targeted drug delivery leveraging the acidic microenvironment of inflamed joints. It further discusses the composition, synthesis, response mechanism, target selection, application, and recent research findings of nanoparticles, while also addressing the challenges and future directions in this promising field.

BackgroundTotal knee arthroplasty (TKA) is a common and effective procedure. Optimizing pain control and reducing postoperative discomfort are essential for patient satisfaction. No studies have examined the safety and efficacy of intra-articular corticosteroid injections following TKA. This study aims to examine the safety and efficacy of corticosteroids in intra-articular multimodal analgesic injections.Materials and methodsThis was a historically controlled study conducted at a single academic institution. Before May 2019, patients received an intra-articular cocktail injection without corticosteroids during surgery, referred to as the non-corticosteroid (NC) group. After June 2019, intraoperatively, patients received an intra-articular cocktail injection containing corticosteroids, referred to as the corticosteroid (C) group. Finally, 738 patients were evaluated, 370 in the C cohort and 368 in the NC cohort. The mean follow-up duration was 30.4 months for the C group and 48.4 months for the NC group.ResultsThe mean VAS scores at rest on postoperative day (POD) 1 (2.35) and POD3 (3.88) were significantly lower in the C group than those in the NC group, which were 2.86 (POD1) and 5.26 (POD3) (p

Background. The intra-articular cortico-steroid (IA-CS) injections treatment are still debatable despite its effectiveness. The failure can cause sciatica which IA-CS injected at the sacroiliac joint (SIJ). The study was done to determine non-technical factors that cause recurrent LBP after optimal SIJ IA-CS injections. Methods. A prospective-clinical study was done that looked at recurring sciatica variables in the cases that received intra-articular injection of CS. Cases were diagnosed with sciatica according to the IASP criteria. All patients had intra-articular CS injections. The numerical rating scale (NRS) was used for rating the pain in the SIJ on a range of (0-10). The scale was reviewed 3, 6, and 9 months post treatment. Age, gender, BMI, trauma history, long-term standing, NSAID used and knee pain were all documented as intra-articular injection treatment possible failure factors. Results. In total, 50 subjects were enrolled, with more females (60%) than males (40%). The mean of age was 55.8±7.4 years. History of trauma was reported in 60%. Long sitting and standing history presented in 70% and 20%, respectively. The recurrence of sciatica affected 30(60%) patients. The right sciatica was affecting more than half of the cases (60%). The vast majority of cases (80%) used NSAID. The pain began within the last three months in 80% of the patients. History of CS injection was recorded in 38% of the cases. Lower limb pain was reported in 80% of the cases. Cases with and without recurrence had the mean age of 55.9 ± 9.5 years and 50.6 ± 14.9 years, respectively. The SIJ pain recurrence is strongly connected with elderly and long sitting in logistic regression analysis. Conclusions. Elderly, NSAID utilize, and uni-lateral sciatica involvement are protective factors against SIJ discomfort recurrence.