New research June 2024

Current research we are reading: June 2024

Back pain

  • Failed back surgery

Shoulder pain

  • Does prior cortisone injections increase risk of shoulder replacement complications?
  • Who does reverse total shoulder replacement work for best? Glenohumeral osteoarthritis with intact rotator cuff.
  • Frozen shoulder and cervical radiculopathy, links and misdiagnosis risks.
  • Effects of extracorporeal shockwave therapy (ESWT) with intra-articular lidocaine / steroid injection in individuals with frozen shoulder.

Knee pain

  • Pain in the front of the knee focusing on chondromalacia patellae.
  • Decreased hamstring strength and symptoms of knee osteoarthritis and patellofemoral pain.
  • PRP combined with exercise therapy in the treatment of knee osteoarthritis.
  • Multiple PRP knee injection treatments versus one treatment.
  • Return to athletics after total knee replacement.
  • Return to cycling after total joint replacement.

Failed back surgery

A June 2024 paper examined the causes and problems of failed back surgery syndrome. The paper points out there are many causes for failed back surgery. Among them: “Incorrect selection of the surgical procedure is a significant risk factor for failed back surgery syndrome. Performing decompression at the wrong level or single-level decompression without recognizing multilevel spinal involvement is unlikely to yield satisfactory outcomes. Inadequate lateral recess (not enough bone was removed)  and neural foraminal decompression are significant causes of failed back surgery syndrome. Errors during spinal surgery can exacerbate preoperative pain and create new sources of pain. Poor surgical techniques can lead to segmental instability and increased pain resulting from direct nerve damage and intraoperative spinal cord ischemia.” Further, if the first surgery fails, the prospects for better success in a second surgery are as follows:

“Revision surgery is often recommended for patients with pain that is refractory (not responding) to other treatments and has an anatomical or pathological source identified by imaging. For example, chronic pain caused by recurrent disc herniation and adjacent segment degeneration usually requires surgical intervention. However, surgical revision is associated with significant morbidity, a higher risk of developing new neurological deficits, and low success rates, with insufficient evidence supporting its efficacy. Given the unsatisfactory outcomes of revision surgery, surgical treatment should be considered a limited therapeutic option. ”

Yeo J. Failed back surgery syndrome-terminology, etiology, prevention, evaluation, and management: a narrative review. Journal of Yeungnam medical science. *

Does prior cortisone injections increase risk of shoulder replacement complications?

A June 2024 study suggests, when cortisone is used, judiciously, prior to shoulder replacement, post surgical complications are minimal. Here are this study’s highlights.

The data:

  • Researchers examined the patient records of 230 patients who had shoulder replacement or  reverse total shoulder replacement.
  • Of the 230 patients – 134 patients had cortisone injections prior to surgery and 96 did not.
  • In assessing outcomes, the researchers found the 134 patients who received an injection within 12 months prior to anatomic and reverse total shoulder replacement, do not report worse  pain and function outcomes during a minimum of 2-year follow-up than the 96 patients who did not have a cortisone injection. Although more complications occurred in the injection group, it did not reach statistical significance and warrants further study in a larger population.

Cooper BJ, Kesinger A, Welch GE, Carroll JM, Lutz A, Shanley E, Thigpen CA, Tolan SJ, Kissenberth MJ, Pill SG. Judicious use of corticosteroid injections prior to shoulder arthroplasty does not compromise outcomes at a minimum of 2 years following surgery. Journal of Shoulder and Elbow Surgery. 2024 Jun 1;33(6):S49-54. *

This research is discussed further included in our article: Shoulder Osteoarthritis: Conservative care and shoulder replacement






Who does reverse total shoulder replacement work for best? Glenohumeral osteoarthritis with intact rotator cuff.

A May 2024 study reviewed the previously published data of patient outcomes following total shoulder replacement to determine patient satisfaction following the surgery at a minimum two-year follow-up.

  • There were a total of 5234 patients and 5288 shoulders from the 45 included studies.
  • The overall study population was 61.2% female and the average age was 71.1 years (range 23 being the age of the youngest patient and 99 being the age of the oldest patient).
  • Overall patient satisfaction ranged from 77.7 to 87.8%, depending on patient satisfaction surveys.
    • Patients with a diagnosis of glenohumeral osteoarthritis rated better satisfaction on all metrics when compared to patients with a diagnosis of cuff tear arthropathy  or massive rotator cuff tear.

Smith KL, Karimi A, Harlow ER, Gillespie RJ, Chen RE. Defining Patient Satisfaction after Reverse Total Shoulder Arthroplasty: A Systematic Review. Journal of Shoulder and Elbow Surgery. 2024 May 6. *

This research is included in our article: Shoulder Osteoarthritis: Conservative care and shoulder replacement






Frozen shoulder and cervical radiculopathy, links and misdiagnosis risks.

A May 2024 study investigated the connection between adhesive capsulitis (frozen shoulder) and cervical radiculopathy.

The data:

  • 438 patients who underwent glenohumeral hydrodistension (filling and stretching the shoulder joint with water and steroids).
  • Included were individuals with unilateral frozen shoulder investigated using ultrasound and cervical spine MRI to investigate cervical spondylosis.
  • Among the 438 patients, 107 reported frozen shoulder and neck pain (24.5%)
  • A significant association between ipsilateral frozen shoulder and C4/5 foraminal stenosis was observed.
    • Ipsilateral (same side of body) foraminal stenosis was observed in 57.3% of these cases, with bilateral stenosis in 29.1%.
    • Additionally, 78% had neck pain on the same side as their frozen shoulder, and 44% had pain radiating to the shoulder.
    • 48% patients underwent nerve-targeted interventions, with 44% addressing the C5 nerve (25% C5 steroid injection and 19% C4/5 anterior cervical discectomy and fusion).

Conclusion from the researchers: A substantial association between C5 foraminal stenosis and ipsilateral frozen shoulder was found. C5 radiculopathy could be a risk factor for “neurogenic frozen shoulder.” Those diagnosing frozen shoulder and cervicobrachialgia (neck and shoulder pain) should recognize that frozen shoulder and C5 radiculopathy may coexist.”

Russo S, Sharma A, Vardanyan R, Thavarajasingam SG, Riew KD. The Association Between Cervical Foraminal Stenosis and Adhesive Capsulitis: An Imaging-based Case-Control Study. Spine. 2024 May 8:10-97. *

A July 2024 study reviewed the effectiveness of PRP treatments for frozen shoulder. In this review, patient data from six previous studies and 578 patients with 263 patients receiving PRP (45.5%).

  • All six studies used PRP as part of non-operative treatment. PRP was compared to another intervention in all six studies. Four of these studies found PRP to be more effective.

The authors concluded: “PRP is a safe treatment option that can be added to the investigative treatment arsenal of adhesive shoulder capsulitis”

El-Swaify ST, Refaat MA, AbdelWahab AA, Seddik ME, Mostafa Abdelrazek AE, Doas Y, Beshay PW. Is platelet-rich plasma a new solution for shoulder adhesive capsulitis? A systematic scoping review of the literature. Shoulder & Elbow. 2023 May 17:17585732231174184.

This research is included in our article Information on Frozen shoulder – Adhesive capsulitis and Platelet Rich Plasma Therapy.

Effects of extracorporeal shockwave therapy (ESWT) with intra-articular lidocaine / steroid injection in individuals with frozen shoulder

An April 2024 study examined the evidence related to the additional effects of extracorporeal shockwave therapy (ESWT) with intra-articular lidocaine / steroid injection in individuals with frozen shoulder.

In this study 60 eligible participants with frozen shoulder were included:

  • The active (treatment) group of thirty receiving a lidocaine injection (1% lidocaine (Xylocaine) and 2cc (80 mg) methylprednisolone acetate) with ESWT  three sessions a week for 4 weeks.
  • The placebo group of thirty people received lidocaine injection with placebo treatment (a special head that blocked the shock waves) three sessions a week for 4 weeks.
  • Both groups received progressive resistance exercises to the shoulder muscles.

At four weeks the treatment group showed an improvement in pain and function compared to the placebo group. Similar effects were noted after 8 weeks and at the 6-month follow-up. The study concluded that “the addition of extracorporeal shockwave therapy after intra-articular lidocaine injection improves pain, functional disability, range of motion, kinesiophobia, depression status, and quality of life in people with frozen shoulder.”

Nambi G, Alghadier M, Eltayeb MM, Aldhafian OR, Saleh AK, Alsanousi N, Ibrahim MN, Attallah AA, Ismail MA, Elfeshawy M, Wahd YE. Additional Effect of Extracorporeal Shockwave Therapy with Lidocaine Injection on Clinical and MRI Findings in Frozen Shoulder: A Prospective, Randomized, Double-Blinded, Placebo-Controlled Trial. Pain and Therapy. 2024 Feb 5:1-8. *

This research is included in our article Information on Frozen shoulder – Adhesive capsulitis and Platelet Rich Plasma Therapy.








Pain in the front of the knee focusing on chondromalacia patellae

A May 2024 study examined possible causes of pain in the front of the knee focusing on chondromalacia patellae. The objective of this study, according to the researchers, “is to investigate the effect of injectable PRP on patients with anterior knee pain in absence of altered patellofemoral joint anatomy.”

  • 43 patients with anterior knee pain were recruited to participate in this non-randomized controlled trial, 28 patients in the injection group and 15 in the only-physiotherapy group.
  • While the 28 patients in the experimental group received three PRP injections and one injection of hyaluronic acid (HA), comparators received the standard physical therapy regimen.
  • Although an improvement was seen in both groups, a statistically significant difference favoring the injection of PRP over the physiotherapy-only group was observed.
  • The superiority of outcomes in the injection group was observed at 3 and 6 months after the initial diagnosis was made. Furthermore, the results of this study revealed a significant improvement at 3 and 6 months when compared to baseline measures.
  • This study “affirm(s) the positive effects of PRP and HA for the treatment of anterior knee pain described by previous research and the subsequent improvement of the quality of life.”

Ostojic M, Hakam HT, Lovrekovic B, Ramadanov N, Prill R. Treatment of anterior knee pain due to chondromalacia patellae with platelet-rich plasma and hyaluronic acid in young and middle-aged adults, a cohort study. Arch Orthop Trauma Surg. 2024 May 23. *

We cover this research in our extended article: Runner’s Knee – Patellofemoral Pain Syndrome

Joint hypermobility is a risk factor for patellar instability

In a May 2024 study, researchers examined the relationship between joint hypermobility and patellar instability looking to see if joint hypermobility lead to an increased risk of patellar instability. In reviewing data from 18 studies (4,391 patients) the researchers found: “Joint hypermobility is a risk factor for patellar instability. Identification of at-risk groups may aid prevention of dislocations and allow for appropriate treatment. . . “

Further: Patients with Ehlers Danlos Syndrome (EDS) experience poor outcomes following patellar stabilization surgery, with post-operative monitoring required. with conflicting evidence regarding if hypermobile patients have worse outcomes than non-hypermobile patients following. Medial patellofemoral ligament reconstruction had a 19.1% failure rate in patients with Ehlers Danlos Syndrome (EDS).

Heighes LA, Lastoria DA, Beni R, Iftikhar A, Hing CB. The relationship between joint hypermobility and patellar instability: A systematic review. Journal of Orthopaedics. 2024 May 13. *

We cover this research in our extended article: Runner’s Knee – Patellofemoral Pain Syndrome






Decreased hamstring strength and symptoms of knee osteoarthritis and patellofemoral pain

A July 2024 study looked at the  hamstring strength, flexibility, and morphology in individuals with gradual-onset knee disorders. In a data review of 79 papers with outcomes in patients with knee osteoarthritis, patellofemoral pain, chondromalacia patellae, and patellar tendinopathy, individuals with knee osteoarthritis presented with reduced hamstring strength compared to pain-free controls during isometric and concentric contractions. Individuals with patellofemoral pain presented with reduced hamstring strength compared to pain-free controls during isometric,  concentric, and eccentric contractions. No differences were observed in individuals with patellar tendinopathy. The researchers suggest: “that assessing and targeting impairments in hamstring strength and flexibility during rehabilitation may be recommended for individuals with knee osteoarthritis or patellofemoral pain.”

Lopes HS, Waiteman MC, Priore LB, Glaviano NR, Bazett-Jones DM, Briani RV, Azevedo FM. There is more to the knee joint than just the quadriceps: A systematic review with meta-analysis and evidence gap map of hamstring strength, flexibility, and morphology in individuals with gradual-onset knee disorders. Journal of Sport and Health Science. 2023 Sep 3. *

We cover this research in our extended article: Runner’s Knee – Patellofemoral Pain Syndrome







PRP combined with exercise therapy in the treatment of knee osteoarthritis

A May 2024 study examined the impact of physical therapy when combined with platelet-rich plasma.

Exercise and treatments targeting inflammatory factors have shown the potential to alleviate knee osteoarthritis to some extent. The aim of this study was to assess the intra-articular injection of autologous platelet-rich plasma (PRP) combined with physical therapy (PT) in reducing inflammation, pain, and swelling in knee osteoarthritis.

  • A total of 128 patients with knee osteoarthritis were included in the study, including 64 males and 64 females.
  • The 128 patients were divided into sodium hyaluronate group (hyaluronic acid), PRP group, PRP + PT group, and PT group, with 32 cases in each group.
  • Standard pain, function and disability patient reporting surveys were employed to evaluate the recovery of patients from pain and osteoarthritis.
  • Compared to the (hyaluronic acid) group, the PT group, PRP group, and PRP combined with PT (PRP + PT) group all showed reduced pain and disability scores, better function, less inflammation.
  • The researchers concluded: “The efficacy of intra-articular injection of PRP combined with exercise therapy in the treatment of knee osteoarthritis is superior to that of single interventions such as simple interventions of hyaluronic acid, PRP injection, and physical therapy. Furthermore, intra-articular injection of PRP combined with exercise therapy demonstrates enhanced effectiveness in improving the inflammatory levels associated with knee osteoarthritis and facilitating the rehabilitation process.”

Yan Y, Liu X, Chen Y, He M, Xie J, Xiao G. Effects of Platelet-Rich Plasma Combined with Physical Therapy on IL-1β, TGF-β1, and MMP-3 in Patients with Knee Osteoarthritis. Molecular Biotechnology. 2024 May 21:1-1. *

We cover this research in our extended article: Information on non-surgical care of knee osteoarthritis






Multiple PRP knee treatments versus one treatment

In a May 2024 study, researchers took one hundred twenty patients with grade I-III knee osteoarthritis and randomly assigned them to three groups who would then receive either one PRP injection for knee pain; three PRP injections for knee pain, spaced at one week apart; or five PRP injections for knee pain spaced at one week apart. The goal  of the study was to assess the superiority, if any, of multiple PRP knee treatments versus one treatment.

Outcomes were measured using standard pain, function, disability and quality-of-life patient outcome surveys at baseline and 6, 12, 24, and 52 weeks follow up.

Out of the total participants, 106 patients (30 males and 76 females) completed the study. The primary outcome measure, WOMAC pain score (no pain to 20 extreme pain), registered significant improvements across all groups when compared to pre-treatment levels. However, the application of 3 and 5 injections of platelet-rich plasma was substantially more effective than that of a single injection in reducing knee pain and stiffness, as well as enhancing physical function in patients with knee osteoarthritis. No statistically discernable difference was observed between three PRP injections and five PRP injections groups at all follow-up intervals.

Zhuang W, Li T, Li Y, Zhang Y, Gao J, Wang X, Ding Q, Li W. The varying clinical effectiveness of single, three and five intraarticular injections of platelet-rich plasma in knee osteoarthritis. Journal of Orthopaedic Surgery and Research. 2024 Dec;19(1):1-4. *

We cover this research in our extended article: Platelet Rich Plasma Injections for knee osteoarthritis

 





Intra-articular injections used in the treatment of knee osteoarthritis

A May 2024 study compared the efficacy of common intra-articular injections used in the treatment of knee osteoarthritis, including corticosteroid, hyaluronic acid, platelet-rich plasma (PRP), and bone marrow aspirate concentrate (BMAC), with a minimum follow-up of 6-months. In this paper researchers reviewed patient data from forty-eight studies comprising a total of 9,338 knees.

Hyaluronic acid and PRP both led to a significant improvement in pain compared with placebo. hyaluronic acid, PRP, and BMAC all led to a significant improvement in function scores when compared with placebo.

Further analysis revealed that PRP, BMAC, and hyaluronic acid were the treatments with the highest likelihood of improvement in both pain and function, with PRP exhibiting the highest  outcomes when compared with BMAC, hyaluronic acid, and corticosteroid.

Jawanda H, Khan ZA, Warrier AA, Acuña AJ, Allahabadi S, Kaplan DJ, Ritz E, Jackson GR, Mameri ES, Batra A, Dornan G. Platelet Rich Plasma, Bone Marrow Aspirate Concentrate and Hyaluronic Acid Injections Outperform Corticosteroids in Pain and Function Scores at a Minimum of 6 Months as Intra-Articular Injections for Knee Osteoarthritis: A Systematic Review and Network Meta-Analysis. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2024 Feb 7. *



Return to athletics after total knee replacement

A May 2024 study examined postoperative return to recreational activity following total knee replacement, patient population.

  • A survey of recreational sports participation among primary, elective total knee replacement patients from a single academic center between June 2011 and January 2022 was conducted.
  • Of 1,063 patients who responded to the survey, 784 indicated being active in sport. Among them:
    • Cycling 273 – [34.8% of those who responded they were active in sports],
    • 33 indicated being active in running [4.2% of those who responded they were active in sports],
    • 68 indicated being active in jogging [8.7% of those who responded they were active in sports],
    • 228 indicated being active in swimming [29.1% of those who responded they were active in sports],
    • 63 indicated being active in tennis [8.0% of those who responded they were active in sports],
    • 55 indicated being active in skiing [7.0% of those who responded they were active in sports],
    • 64 indicated being active in high-impact team sports [8.2% of those who responded they were active in sports] between two years preoperatively and time of survey administration.

Overall: Cycling and swimming demonstrated the most favorable participation rate changes, while running and skiing demonstrated the least favorable participation rate changes. The majority of respondents were “satisfied” or “very satisfied” with their return across all sports, though dissatisfaction was highest among runners and joggers.

Lawrence KW, Bloom DA, Rajahraman V, Cardillo C, Schwarzkopf R, Rozell JC, Arshi A. Return to athletics after total knee arthroplasty: a survey study of 784 recreational athletes across 12 sports. Archives of Orthopaedic and Trauma Surgery. 2024 May 22:1-0. *

Return to cycling after total joint replacement

A May 2024 paper saw doctors surveying their total knee or hip replacement patients about their ability to return to cycling. Following up at least three months after surgery, patients who had single total hip replacement, single total knee replacement, multiple joints, either both knees, both hips, combination of hip and knees, and a revision joint replacement surgery. The average age of the patient was 69 years old, with an average of 4.08 years from their time of most recent surgery.

Nearly all those who were able to bike prior to surgery were able to return to cycling, with only 6% not being able to do so. There were 41.8% who returned to cycling less than three months after surgery. Most cyclists were able to return to their previous level.

Patients who had a revision joint replacement surgery had significantly lower rates of returning to cycling in comparison to single total knee replacement, single total hip replacement, and multi-total joint replacement. Patients who never returned to cycling had higher revision rates in comparison to those who were able to get back on a bike.

Driesman A, Johnson RM, Yang CC, Miner TM, Dennis DA, Jennings JM. Return to Cycling After Total Joint Arthroplasty. The Journal of Arthroplasty. 2024 May 18. *



Osteoporosis and hip replacement

A July 2024 paper provides an updated analysis for patients with osteoporosis following total hip replacement.

  • Osteoarthritis patients who suffer from alcohol abuse, chronic kidney disease, cerebrovascular disease, obesity, and rheumatoid arthritis continue to be significant risk factors for periprosthetic femur fracture  and aseptic loosening. Further, the patient population with severe osteoporosis may have higher risks for aseptic loosening and periprosthetic femur fracture  than previously recognized.

Layson JT, Hameed D, Dubin JA, Moore MC, Mont M, Scuderi GR. Patients with Osteoporosis Are at Higher Risk for Periprosthetic Femoral Fractures and Aseptic Loosening Following Total Hip Arthroplasty. Orthopedic Clinics. 2024 Mar 23.


Thumb osteoarthritis

A June 2024 study explored the long-term changes in pain and hand function over a 2-year period in patients with thumb osteoarthritis. The researchers looked at those who received occupational therapy or brief information on how to manage their thumb pain while waiting for a surgical consultation.

When comparing groups receiving occupational therapy only, occupational therapy and surgery, brief information only, and brief information and surgery, patients receiving brief information and surgery had significantly more pain and poorer function at four months compared to the other groups, whereas no difference was found between the four groups at 24 months. (Eventually the occupational; therapy and surgery performed equally).

In patients who received surgery after having received occupational therapy, pain and function did not change between 4 and 24 months, suggesting that surgery did not provide additional improvement in this group.

Tveter AT, Østerås N, Nossum R, Eide REM, Klokkeide Å, Matre KH, Olsen M, Kjeken I. Long-term changes in pain and function in patients with thumb base osteoarthritis receiving brief information, occupational therapy and/or surgery. Musculoskeletal Care. 2024 Jun;22(2):e1883. doi: 10.1002/msc.1883. PMID: 38629865. *


Sarcopenic obesity increases the odds of knee osteoarthritis

A May 2024 study revealed that low muscle mass index and sarcopenic obesity were associated with an increased risk of developing knee osteoarthritis especially in women. The researchers wrote: “The findings with moderate-quality evidence indicated that sarcopenic obesity increases the odds of knee osteoarthritis by approximately 90% in females. . . ”

Wu Q, Xu Z, Ma X, Li J, Du J, Ji J, Ling X, Kan J, Zhao M. Association of low muscle mass index and sarcopenic obesity with knee osteoarthritis: a systematic review and meta-analysis. Journal of the International Society of Sports Nutrition. 2024 Dec 31;21(1):2352393. *


How surgeons and physical therapists see the role of PT in shoulder arthritis

In a May 2024 study, researchers asked  the opinions of expert providers-orthopedic surgeons and physical therapists-regarding the utility of physical therapy in treating glenohumeral arthritis in different stages of radiographic severity.

  • 190 surgeons and 39 physical therapists completed the survey.
  • Surgeons and therapists demonstrated different opinions.
  • They agreed on the benefits of physical therapy for mild arthritis, the benefits of corticosteroid injections, the frequency of strengthening exercises, and that physical therapy failure should not be required for surgical approval in patients with severe arthritis. They disagreed on the whether physical therapy exacerbates symptoms in patients with moderate arthritis, and whether preoperative physical therapy influences postoperative outcomes.

Kane LT, Mahmood H, Singh J, Tate A, Namdari S. Provider Opinions on Effectiveness of Physical Therapy as Treatment for Glenohumeral Arthritis. Journal of Shoulder and Elbow Surgery. 2024 May 10. *


Rapidly progressive hip osteoarthritis leading to femoral head collapse following intra-articular corticosteroid injections

A May 2024 study writes: “Rapidly progressive hip osteoarthritis leading to femoral head collapse following intra-articular corticosteroid injections is a perplexing variant of osteoarthritis.: In this study, the authors “explored eight cases of chronic joint pain treated with intra-articular corticosteroid injections. Subsequently, they experienced swift deterioration of the femoral head integrity within as little as 10 weeks.” The patients exhibited various health factors, including obesity, smoking history, cancer treatment, and deficiencies in Vitamin D levels, which have been found to increase the risk of femoral head collapse.

Rana P, Johnson A, Turcotte J, King P. Rapid Osteoarthritis and Femoral Head Collapse: A Case Series. Journal of Orthopaedic Case Reports. 2024 May;14(5):141.


Greater Trochanteric Pain Syndrome

A June 2024 study explored the effectiveness of exercise versus other conservative treatments in patients with Greater Trochanteric Pain Syndrome (GTPS). In this study, 733 patient outcomes from six previously published studies were examined. In these six studies, three compared exercise to sham exercise or wait-and-see control groups, two trials compared exercise to corticosteroid injection, two trials compared exercise to shockwave therapy, and one trial compared exercise to another type of exercise.

When the outcomes were compared, the researchers wrote: “The current evidence supports a strong recommendation for exercise as first line treatment in patients clinically diagnosed with Greater Trochanteric Pain Syndrome (GTPS). Compared to corticosteroid injection, exercise is superior in increasing the likelihood that a patient experiences a meaningful global improvement.”

Kjeldsen T, Hvidt KJ, Bohn MB, Mygind-Klavsen B, Lind M, Semciw AI, Mechlenburg I. Exercise compared to a control condition or other conservative treatment options in patients with Greater Trochanteric Pain Syndrome: a systematic review and meta-analysis of randomized controlled trials. Physiotherapy. 2024 Jan 5.

This research is included in our article Information on Greater trochanteric pain syndrome.

 


TMJ Disorders

A July 2024 study  evaluated the effects of low doses of botulinum toxin type A to control pain in patients with sleep bruxism, awake bruxism, and temporomandibular disorder (TMD) during a 180 day treatment period.

  • thirty-five patients with chronic pain related to TMD, sleep bruxism, and awake bruxism received a single dose of 20 U of botulinum toxin type A in masseter and temporalis muscles. The pain was assessed with a visual analog scale (VAS recording pain scores from 0 – 10) before and after 15, 30, 60, 90, and 180 days of the application.

The three clinical conditions sleep bruxism, awake bruxism, and temporomandibular disorder (TMD) experienced decrease in pain after 15 days of treatment, the maximum pain relief persisted for up to 90 days after botulinum toxin type A application in patients with sleep bruxism and awake bruxism and 15 days for patients with TMD. Conclusion: A low dose of BoNT-A may be effective for controlling chronic pain related to sleep bruxism and awake bruxism, but TMD pain reduction was short-lived.

de Lima MC, Rizzatti Barbosa CM, Duarte Gaviao MB, Ferreira Caria PH. Is low dose of botulinum toxin effective in controlling chronic pain in sleep bruxism, awake bruxism, and temporomandibular disorder?. CRANIO®. 2021 Sep 16:1-8. *

This research is included in our article Research on different types of TMJ injections.


Early meniscal surgery did not appear superior to exercise and education in providing better knee function and pain relief after 12 months

A May 2024 paper (x) compared the effect of early meniscal surgery versus exercise and education with the option of later surgery on pain, function, and quality of life in young patients with a meniscal tear.

  • 121 patients aged 18-40 years with a meniscal tear were randomized to surgery or 12 weeks of supervised exercise and patient education. Forty-two patients (69%) in the exercise therapy group and 47 (78%) in the surgery group were categorized as having a traumatic tear.
  • In patients with traumatic and nontraumatic meniscus tears, early meniscal surgery did not appear superior to exercise and education in improving pain, function, and quality of life after 12 months.

Damsted C, Skou ST, Hölmich P, Lind M, Varnum C, Jensen HP, Hansen MS, Thorlund JB. Early surgery versus exercise therapy and patient education for traumatic and non-traumatic meniscal tears in young adults-an exploratory analysis from the DREAM-trial. Journal of Orthopaedic & Sports Physical Therapy. 2024 May;54(0):1-25. *


Patients dissatisfied with their results of their knee replacement

A May 2024 study looked to predict which patients would be most dissatisfied with their results of their knee replacement (knee arthroplasty ) surgery. The authors write: “Dissatisfaction after total knee arthroplasty is a prevalent and clinically relevant problem that affects approximately 10%-20% of patients. The aim of this study is to identify factors associated with dissatisfaction one year after total knee arthroplasty.

  • A total of 236 patients who had total knee arthroplasty (TKA) were included in this prospective cohort study.
  • One year after total knee arthroplasty (TKA), 16% of the patients were dissatisfied with the surgery outcome.
    • Dissatisfied patients were significantly younger and had a higher body mass index (BMI). Although patients over 63 years old had greater risk for dissatisfaction after surgery.
    • Further, greater pain, reduced functionality and unmet expectation 1 month postoperatively lead to greater long-term dissatisfaction.

Strahl A, Delsmann MM, Simon A, Ries C, Rolvien T, Beil FT. A clinical risk score enables early prediction of dissatisfaction 1 year after total knee arthroplasty. Knee Surgery, Sports Traumatology, Arthroscopy. 2024.

This research is part of our article: Dissatisfaction after knee replacement.






A May 2024 study found that patients who had a minimal clinically important difference ((MCID) this is the smallest amount of change to the better) in patient-reported outcomes following total knee replacement is common, yet up to 20% patient dissatisfaction persists. Unmet expectations may explain post-total knee arthroplasty dissatisfaction.

  • In this study, 93 patients were asked what were their expectations, what did they want from their knee replacement? This question was asked 12 months after the replacement. Using these answers the researchers established baseline goals. Were these goals met?
  • When measured against outcomes scores that would signify minimal clinically important difference (MCID) in physical function, patients had twice the expectation of functionality improvement.
  • The patients also expected significantly more pain relief than the minimal clinically important difference (MCID) scores.

Because of these outcomes, the researchers concluded: “This discrepancy challenges currently accepted standards of success after total knee arthroplasty and indicates a need for improved expectation setting prior to surgery.”

Arpey NC, Tanenbaum JE, Selph TJ, Suleiman LI, Franklin PD, Patel AA, Edelstein AI. Quantifying Patient Expectations for Total Knee Arthroplasty: Expectations for Improvement are Greater than MCID. The Journal of Arthroplasty. 2024 May 14.






A May 2024 paper found patient anxiety and depression were associated with postoperative knee replacement symptoms and dissatisfaction. The researchers of this study found anxiety or depression increased the risk of dissatisfaction preoperatively and postoperatively. Patients younger than 65 years reported preoperative anxiety or depression to a greater extent but did not have an increased risk of dissatisfaction.  The researchers concluded: “Patient-reported anxiety or depression preoperatively and postoperatively are important and potentially treatable factors to consider, as they were found to increase the risk of dissatisfaction after total knee replacement despite improvements in pain or function.”

There were 8,745 patients who participated in this research, 11% were defined as dissatisfied. The proportion of patients who reported anxiety or depression was 35% preoperatively and 17% postoperatively.

Heijbel S, Annette W, Josefine E, Hedström M. Patient-Reported Anxiety or Depression Increased the Risk of Dissatisfaction Despite Improvement in Pain or Function Following Total Knee Arthroplasty: A Swedish Register-Based Observational Study of 8,745 Patients. The Journal of Arthroplasty. 2024 May 1.






High Cholesterol causes worse knee pain?

A June 2024 study looked at 183 patients aged 40-75 years, with a confirmed diagnosis of stage I-III osteoarthritis of the knee joints to gauge the impact a diagnosis of high cholesterol or hypercholesterolemia had on their knee pain.

In the 183 patients with knee pain, hypercholesterolemia was detected in 59% of patients. Individuals with elevated total cholesterol levels had higher VAS pain scores (0 = no pain to 10 = extreme pain), total Western Ontario and McMaster Universities Arthritis Index (WOMAC Scores measure more pain and less functionality). Hypercholesterolemia patients showed high levels of cholesterol, low-density lipoproteins (bad cholesterol0l) and high triglycerides. The researchers also found that patients with increased total cholesterol have more intense pain in the knee joints.

This study is included in our article: Do statins for cholesterol problems accelerate or worsen osteoarthritis?

Taskina EA, Alekseeva LI, Kashevarova NG, Strebkova EA, Mikhaylov KM, Sharapova EP, Savushkina NM, Alekseeva OG, Raskina TA, Averkieva JV, Usova EV. Relationship between hypercholesterolemia and osteoarthritis (preliminary results). Terapevticheskii arkhiv. 2024 Jun 3;96(5):471-8.








Achilles tendon surgery

A June 2024 study (x) writes: “While controversy remains as to the relative benefit of operative versus non-operative management of Achilles tendon ruptures, few studies have examined the effect on high impact maneuvers such as jumping and hopping.” The researchers continue that the “purpose of this study was to determine if functional performance including strength, jumping, and hopping outcomes differed between operative (patients who had surgery) and non-operative management of acute Achilles tendon ruptures. The secondary objective was to assess the degree of association between Achilles tendon morphology (possible degenerative progression) and performance outcomes.”

Study highlights:

  • 12 patients who had Achilles tendon surgery.
  • 12 patients who DID NOT have Achilles tendon surgery.
  • Patients were treated within three weeks of injury and were evaluated a minimum 20 months following the Achilles tendon ruptures.
  • Achilles tendon length, thickness and gastrocnemius muscle thickness were assessed. Isokinetic plantar flexor strength, hop tests and countermovement and drop jumps were completed.

What the researchers found was not much difference between the two groups. Single leg drop vertical jump was higher in surgery group with no difference for hop and jump tests. Achilles tendon length was related to plantar flexor torque but had no relationship with hopping performance.

Zhu S, Garofalo J, Abuhantash M, McRae S, MacDonald P, Longstaffe R, Ogborn D. Functional Performance and Tendon Morphology After Operative or Nonoperative Treatment of Achilles Tendon Ruptures. International Journal of Sports Physical Therapy. 2024;19(6):670.

 

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