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Comparison of Various Modalities in the Treatment of Early Knee Osteoarthritis: An Unsolved Controversy

Introduction Osteoarthritis (OA) of the knee is a common degenerative disease, relatively more prevalent among middle-aged people. It is one of the major reasons for walking-related disability. Recently, early knee OA has been seen as an imperative concern in many younger patients who struggle with...

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Autores principales: Srinivasan, Vyshnav, Ethiraj, Prabhu, Agarawal, Sandesh, H S, Arun, Parmanantham, Madhavan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9912098/
https://www.ncbi.nlm.nih.gov/pubmed/36788843
http://dx.doi.org/10.7759/cureus.33630
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author Srinivasan, Vyshnav
Ethiraj, Prabhu
Agarawal, Sandesh
H S, Arun
Parmanantham, Madhavan
author_facet Srinivasan, Vyshnav
Ethiraj, Prabhu
Agarawal, Sandesh
H S, Arun
Parmanantham, Madhavan
author_sort Srinivasan, Vyshnav
collection PubMed
description Introduction Osteoarthritis (OA) of the knee is a common degenerative disease, relatively more prevalent among middle-aged people. It is one of the major reasons for walking-related disability. Recently, early knee OA has been seen as an imperative concern in many younger patients who struggle with the disabling effect of pain and management is extremely speckled. Degenerative changes such as loss of cartilage, subchondral bone changes, synovial inflammation, and meniscal degeneration are seen in OA. Symptoms are relieved by therapeutic strategies such as lifestyle behaviour changes, exercise, and oral and injectable medications. Intra-articular delivery of drugs acts as a direct effect on the target tissue, which grossly reduces side effects and is commonly preferred nowadays. The current study is a comparative assessment of the functional outcomes associated with various treatment modalities in osteoarthritis of the knee, i.e., arthroscopic debridement, arthroscopic debridement with microfracture, platelet-rich plasma (PRP) injection, and hyaluronic acid. Methods A retrospective observational hospital-based study was conducted among 139 cases of osteoarthritis. Patients aged between 40-60 years with diagnosed Kellgren- Lawrence grade 1 and 2 OA knee, who underwent arthroscopic debridement, arthroscopic debridement with microfracture, PRP injection, or hyaluronic acid in our institute were included. Results The mean age was 52.83 + 6.8 years. The mean BMI was 27.45 + 1.6 kg/m(2). At the time of diagnosis of OA, the mean visual analogue scale for pain (VAS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores were 7.26 +0.7 and 55.30 + 2.21 respectively. Out of the total, 88 (63.3%) were females and 51 (36.7%) were males. Right-sided OA knee was seen in the majority of study participants. Of the total, 93 (66.9%) patients had grade 2 and only 46 (33.1%) had grade 1 OA. A statistically significant difference was found between the mean VAS and WOMAC score at the time of diagnosis, three weeks, three months, as well as at six months of therapy. In the hyaluronic acid treatment, no significant difference was found in mean VAS and WOMAC scores. Conclusion Various treatments are available for early-diagnosed OA. According to the findings of this study, overall improvement was seen in VAS and WOMAC scores at the follow-up after six months of specific treatment. In a period over six months, arthroscopic debridement with micro-fracture was more effective and safe when compared with other modalities of treatment for early OA knee. Also, injection of PRP was superior to other methods for VAS pain reduction, and WOMAC-pain and WOMAC-stiffness scores improved at one month.
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spelling pubmed-99120982023-02-13 Comparison of Various Modalities in the Treatment of Early Knee Osteoarthritis: An Unsolved Controversy Srinivasan, Vyshnav Ethiraj, Prabhu Agarawal, Sandesh H S, Arun Parmanantham, Madhavan Cureus Pain Management Introduction Osteoarthritis (OA) of the knee is a common degenerative disease, relatively more prevalent among middle-aged people. It is one of the major reasons for walking-related disability. Recently, early knee OA has been seen as an imperative concern in many younger patients who struggle with the disabling effect of pain and management is extremely speckled. Degenerative changes such as loss of cartilage, subchondral bone changes, synovial inflammation, and meniscal degeneration are seen in OA. Symptoms are relieved by therapeutic strategies such as lifestyle behaviour changes, exercise, and oral and injectable medications. Intra-articular delivery of drugs acts as a direct effect on the target tissue, which grossly reduces side effects and is commonly preferred nowadays. The current study is a comparative assessment of the functional outcomes associated with various treatment modalities in osteoarthritis of the knee, i.e., arthroscopic debridement, arthroscopic debridement with microfracture, platelet-rich plasma (PRP) injection, and hyaluronic acid. Methods A retrospective observational hospital-based study was conducted among 139 cases of osteoarthritis. Patients aged between 40-60 years with diagnosed Kellgren- Lawrence grade 1 and 2 OA knee, who underwent arthroscopic debridement, arthroscopic debridement with microfracture, PRP injection, or hyaluronic acid in our institute were included. Results The mean age was 52.83 + 6.8 years. The mean BMI was 27.45 + 1.6 kg/m(2). At the time of diagnosis of OA, the mean visual analogue scale for pain (VAS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores were 7.26 +0.7 and 55.30 + 2.21 respectively. Out of the total, 88 (63.3%) were females and 51 (36.7%) were males. Right-sided OA knee was seen in the majority of study participants. Of the total, 93 (66.9%) patients had grade 2 and only 46 (33.1%) had grade 1 OA. A statistically significant difference was found between the mean VAS and WOMAC score at the time of diagnosis, three weeks, three months, as well as at six months of therapy. In the hyaluronic acid treatment, no significant difference was found in mean VAS and WOMAC scores. Conclusion Various treatments are available for early-diagnosed OA. According to the findings of this study, overall improvement was seen in VAS and WOMAC scores at the follow-up after six months of specific treatment. In a period over six months, arthroscopic debridement with micro-fracture was more effective and safe when compared with other modalities of treatment for early OA knee. Also, injection of PRP was superior to other methods for VAS pain reduction, and WOMAC-pain and WOMAC-stiffness scores improved at one month. Cureus 2023-01-11 /pmc/articles/PMC9912098/ /pubmed/36788843 http://dx.doi.org/10.7759/cureus.33630 Text en Copyright © 2023, Srinivasan et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Pain Management
Srinivasan, Vyshnav
Ethiraj, Prabhu
Agarawal, Sandesh
H S, Arun
Parmanantham, Madhavan
Comparison of Various Modalities in the Treatment of Early Knee Osteoarthritis: An Unsolved Controversy
title Comparison of Various Modalities in the Treatment of Early Knee Osteoarthritis: An Unsolved Controversy
title_full Comparison of Various Modalities in the Treatment of Early Knee Osteoarthritis: An Unsolved Controversy
title_fullStr Comparison of Various Modalities in the Treatment of Early Knee Osteoarthritis: An Unsolved Controversy
title_full_unstemmed Comparison of Various Modalities in the Treatment of Early Knee Osteoarthritis: An Unsolved Controversy
title_short Comparison of Various Modalities in the Treatment of Early Knee Osteoarthritis: An Unsolved Controversy
title_sort comparison of various modalities in the treatment of early knee osteoarthritis: an unsolved controversy
topic Pain Management
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9912098/
https://www.ncbi.nlm.nih.gov/pubmed/36788843
http://dx.doi.org/10.7759/cureus.33630
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