Effects of low-intensity pulsed ultrasound on pain and recovery of range of motion after total knee arthroplasty: preliminary study

Introduction: Pain and limitation in knee range of motion (ROM) during the immediate postoperative period are the common outcomes after total knee arthroplasty (TKA) procedure. Low-intensity pulsed ultrasound in combination with cryotherapy is a promising physiotherapy intervention which has been shown to help in relieving inflammation and improving recovery of joint function of patients with TKA. However, the documentation on the effects of combining low-intensity pulsed ultrasound in post-operative rehabilitation programme is limited. Therefore, this study was conducted to determine the effects of low-intensity pulsed ultrasound as in-addition to conventional physiotherapy on pain and knee ROM in patients with TKA. This study also aimed to assess the relationship between the recovery of knee ROM and pain following the combined intervention. Method: This was an assessor-blinded quasi-experimental study among patients with TKA at the Universiti Kebangsaan Malaysia Medical Centre. Participants were alternately allocated to receive either pulsed ultrasound-added conventional physiotherapy (n=10, experimental group) or conventional physiotherapy alone (n=10, control group) for 3 weeks. Visual analogue scale and goniometer were used to assess post-operative pain and active knee ROM, respectively. The outcomes were evaluated at baseline (post-operative day 2), week 1 and week 4 after TKA. Mixed model ANOVA and Spearman’s rho were used to analyze the data. Result: This study showed a significant time and group effects for pain and knee ROM following interventions. The pain score decreased (p0.05). Discussion and Conclusion: The findings from this study provide physiotherapists and other healthcare providers knowledge regarding the effects of combining low-intensity pulsed ultrasound in post-operative rehabilitation following TKA. The combined intervention demonstrated more promising results in pain alleviation and recovery of knee motion following TKA. Further study with larger sample size is needed to establish this study findings. Keywords: low-intensity pulsed ultrasound, physiotherapy, total knee arthroplast

Effects of PLGA nanofibre on osteoarthritic chondrocytes

Chondrocytes obtained from osteoarthritis (OA) joints has been recognized as an abnormal cell; however, it’s proven to have potential in supporting cartilage regeneration. We have isolated chondrocytes from OA joints (OAC) and expanded chondrocytes growth medium (CGM). The growth kinetic, immunophenotyping and cell multilineage differentiation were analyzed to confirm the OAC stemness. The optimal condition to developed PLGA nanofibre with ratio 50:50 were 20% concentration of PLGA, flow rate with 0.3 mL/h, 10 kv voltage and 10 cm distance from nozzle to the collector. The toxicity level, scanning electron microscopy (SEM) and q-PCR analysis was performed in the present study. OAC fulfills the minimal criteria to be known to have stem cell as the cell easily adheres to the culture plate, shows high expression (≥95%) for CD13, CD29, CD44, CD73 and CD90 and less expression (≤2%) for CD45 and HLA-DR and potentially induced to mesodermal multilineage, which is osteocytes, adipocytes and chondrocytes. Toxicity test showed no adverse effect of PLGA towards the cell. Based on the cell-PLGA nanofibre interaction, difference in fibre size will influence the proliferation of the cell. Nanofibres with 100 nm in size showed high proliferation of OAC and better gene and protein expression compared to monolayer culture. Thus, we concluded that OAC has the potential to be used in cartilage regeneration based on the presence of stem cell markers as similar to the human bone marrow. The cartilage regeneration will be more efficient if OAC cultured on 3D microenvironment as showed in the present study

Cartilage regeneration by chondrogenic induced adult stem cells in osteoarthritic sheep model

Objectives: In this study, Adipose stem cells (ADSC) and bone marrow stem cells (BMSC), multipotent adult cells with the potentials for cartilage regenerations were induced to chondrogenic lineage and used for cartilage regenerations in surgically induced osteoarthritis in sheep model. Methods: Osteoarthritis was induced at the right knee of sheep by complete resection of the anterior cruciate ligament and medial meniscus following a 3-weeks exercise regimen. Stem cells from experimental sheep were culture expanded and induced to chondrogenic lineage. Test sheep received a single dose of 2×107 autologous PKH26-labelled, chondrogenically induced ADSCs or BMSCs as 5 mls injection, while controls received 5 mls culture medium. Results: The proliferation rate of ADSCs 34.4±1.6 hr was significantly higher than that of the BMSCs 48.8±5.3 hr (P = 0.008). Chondrogenic induced BMSCs had significantly higher expressions of chondrogenic specific genes (Collagen II, SOX9 and Aggrecan) compared to chondrogenic ADSCs (P = 0.031, 0.010 and 0.013). Grossly, the treated knee joints showed regenerated de novo cartilages within 6 weeks post-treatment. On the International Cartilage Repair Society grade scores, chondrogenically induced ADSCs and BMSCs groups had significantly lower scores than controls (P = 0.0001 and 0.0001). Fluorescence of the tracking dye (PKH26) in the injected cells showed that they had populated the damaged area of cartilage. Histological staining revealed loosely packed matrixes of de novo cartilages and immunostaining demonstrated the presence of cartilage specific proteins, Collagen II and SOX9. Conclusion: Autologous chondrogenically induced ADSCs and BMSCs could be promising cell sources for cartilage regeneration in osteoarthritis

Role of QuantiFERON TB gold test for diagnosis of tuberculosis infection in prosthetic knee joint: a case report

Mycobacterium tuberculosis (MTB) is a rare cause of prosthetic joint infection. The diagnosis is challenging especially in cases of latent tuberculosis. QuantiFERON-TB Gold (QFT®) is an interferon-gamma relative assay (IGRA) which is highly specific and sensitive for detection of MTB infection. We report a case of 76-year-old lady diagnosed with tuberculous prosthetic joint infection following total knee replacement. Histological examination of abnormal synovial tissue taken intraoperatively reveals chronic granulomatous lesion and raised suspicion of tuberculous infection in otherwise asymptomatic patient. The tuberculin skin test, MTB acid-fast stain and tuberculosis polymerase chain reaction were negative. The diagnosis dilemma was solved with positive result of QuantiFERON TB Gold Test. The patient was treated with anti-tuberculous drug without any surgical intervention. At five months follow-up, patient was clinically well with no symptoms and signs of infection

Effects of low-intensity pulsed ultrasound on knee range of motion of patients with total knee arthroplasty after controlling for postoperative pain

Background: Low-intensity pulsed ultrasound is a physiotherapy treatment modality that has shown positive effect on the recovery of knee range of motion (ROM) after total knee arthroplasty (TKA) other than helps to relieve inflammation and improve joint function. However, whether the recovery of knee ROM of post-TKA following the low-intensity pulsed ultrasound is influenced by the recovery of postoperative pain or not, is still unknown. Purpose: This study aimed to examine the effect of low-intensity pulsed ultrasound on the recovery of knee flexion range of post-TKA after controlling for postoperative pain following the intervention. Methodology: This was an assessor-blinded quasi-experimental study. Thirty-two post-TKA patients at the Hospital Canselor T uanku Muhriz Universiti Kebangsaan Malaysia were alternately allocated to an experimental group (n = 16, received low-intensity pulsed ultrasound and conventional physiotherapy) and a control group (n = 16, received conventional physiotherapy alone). Intervention was administered for 3 weeks (postoperative week 1 had 4 sessions/week, postoperative week 2–3 had 1 session/week). Pain and active knee flexion range were assessed using visual analogue scale and goniometer respectively: at baseline (postoperative day-2) and 1-week follow-up after the intervention. Data was analyzed using independent t-test and one-way ANCOVA. Results: The postoperative pain following the intervention was significantly different between the groups (meanSD = 1.641.40 vs 3.401.50, p < 0.01). After controlling for the postoperative pain following the intervention, there was a statistically significant effect of the intervention on the active knee flexion range (F(1,29) = 13.50, p = 0.001, p2 = 0.32), where the participants in the experimental group showed significantly greater knee flexion range than the control group. Conclusion: Low-intensity pulsed ultrasound as an adjunct to conventional physiotherapy provides better effect in the recovery of active knee flexion range of patients with TKA

Effects of low-intensity pulsed ultrasound as an adjunct to conventional physiotherapy on post-operative pain and functional ability of total knee arthroplasty patients

Introduction Low-intensity pulsed ultrasound as an adjunct treatment modality for acute management has shown bene cial for recovery of in ammation and joint function of patients after total knee arthroplasty (TKA). However, there is limited documentation on the effects of combining low-intensity pulsed ultrasound in TKA rehabilitation. This study aimed to determine the effect of low-intensity pulsed ultrasound as an adjunct to conventional physiotherapy on the recovery of post-operative pain and functional ability after TKA. Methodology This assessor-blinded quasi-experimental study was conducted among TKA patients at a university medical center. Participants were alternately allocated to receive either low-intensity pulsed ultrasound-added conventional physiotherapy (n = 16, experimental group) or conventional physiotherapy alone (n = 16, control group). The intervention was conducted for 12 weeks (4 times for the rst week post-TKA, once a week for the following 2 weeks, and once in every two weeks for another 9 weeks). The low-intensity pulsed ultrasound in the experimental group was conducted at the rst 3 weeks of post-operation. Visual analogue scale and Lower Extremity Functional Scale were used to assess pain and functional ability respectively: at post-operative day 2 (baseline assessment for pain and functional ability), week 4 of intervention (to assess pain) and week 12 of intervention (to assess functional ability). Collected data was analyzed using mixed model ANOVA. Results The study showed a signi cant interaction between time and group for pain (p 0.05, 2 = 0.11). Conclusion Integration of low-intensity pulsed ultrasound and conventional physiotherapy provides better effect in pain alleviation following TKA

Changes in Metabolism and Mitochondrial Bioenergetics during Polyethylene-Induced Osteoclastogenesis

Changes in mitochondrial bioenergetics are believed to take place during osteoclastogenesis. This study aims to assess changes in mitochondrial bioenergetics and reactive oxygen species (ROS) levels during polyethylene (PE)-induced osteoclastogenesis in vitro. For this purpose, RAW264.7 cells were cultured for nine days and allowed to differentiate into osteoclasts in the presence of PE and RANKL. The total TRAP-positive cells, resorption activity, expression of osteoclast marker genes, ROS level, mitochondrial bioenergetics, glycolysis, and substrate utilization were measured. The effect of tocotrienols-rich fraction (TRF) treatment (50 ng/mL) on those parameters during PE-induced osteoclastogenesis was also studied. During PE-induced osteoclastogenesis, as depicted by an increase in TRAP-positive cells and gene expression of osteoclast-related markers, higher proton leak, higher extracellular acidification rate (ECAR), as well as higher levels of ROS and NADPH oxidases (NOXs) were observed in the differentiated cells. The oxidation level of some substrates in the differentiated group was higher than in other groups. TRF treatment significantly reduced the number of TRAP-positive osteoclasts, bone resorption activity, and ROS levels, as well as modulating the gene expression of antioxidant-related genes and mitochondrial function. In conclusion, changes in mitochondrial bioenergetics and substrate utilization were observed during PE-induced osteoclastogenesis, while TRF treatment modulated these changes

The potential of intra-articular injection of chondrogenic-induced bone marrow stem cells to retard the progression of osteoarthritis in a sheep model

In recent years, the use of bone marrow mesenchymal stem cell (BMSC) implantation has provided an alternative treatment for osteoarthritis. The objective of this study is to determine whether or not an intraarticular injection of a single dose of autologous chondrogenic induced BMSC could retard the progressive destruction of cartilage in a surgically induced osteoarthritis in sheep. The study was carried out between August 2007 and July 2009 at the Universiti Kebangsaan Malaysia Hospital and Faculty of Veterinary Universiti Putra Malaysia

The potential of intra-articular injection of chondrogenic-induced bone marrow stem cells to retard the progression of osteoarthritis in a sheep model

In recent years, the use of bone marrow mesenchymal stem cell (BMSC) implantation has provided an alternative treatment for osteoarthritis. The objective of this study is to determine whether or not an intraarticular injection of a single dose of autologous chondrogenic induced BMSC could retard the progressive destruction of cartilage in a surgically induced osteoarthritis in sheep. The study was carried out between August 2007 and July 2009 at the Universiti Kebangsaan Malaysia Hospital and Faculty of Veterinary Universiti Putra Malaysia

Self-management of osteoarthritis while waiting for total knee arthroplasty during the COVID-19 pandemic among older Malaysians

BACKGROUND The study sought to understand the self-management strategies used by patients during the postponement of their total knee arthroplasty (TKA) procedure, as well as the associations between the length of waiting time, pain, and physical frailty and function. The study focused on individuals aged 50 years and above, as they are known to be more vulnerable to the negative impacts of delayed elective surgery and rehabilitation. This study hypothesizes that delayed TKR due to coronavirus disease 2019 (COVID-19) will bear negative effect in self-management, pain, and physical frailty and function in older adults. AIM To investigate the effects of COVID-19 pandemic on self-management, pain, and physical function in older adults awaiting TKA in Malaysia. METHODS This cross-sectional study has the data of participants, who matched the criteria and scheduled for TKA for the first time, extracted from the TKA registry in the Department of Orthopaedics and Traumatology, Hospital Canselor Tuanku Mukhriz. Data on pain status, and self-management, physical frailty, and instrumental activities daily living were also collected. Multiple linear regression analysis with a significant level of 0.05 was used to identify the association between waiting time and pain on physical frailty and functional performance. RESULTS Out of 180 had deferred TKA, 50% of them aged 50 years old and above, 80% were women with ethnic distribution Malay (66%), Chinese (22%), Indian (10%), and others (2%) respectively. Ninety-two percent of the participants took medication to manage their pain during the waiting time, while 10% used herbs and traditional supplements, and 68% did exercises as part of their osteoarthritis (OA) self-management. Thirty-six participants were found to have physical frailty (strength, assistance with walking, rising from a chair, climbing stairs, and falls questionnaire score > 4) which accounted for 72%. Increased pain was associated with physical frailty with odds ratio, odds ratio (95% confidence interval): 1.46 (1.04-2.05). This association remained significant even after the adjustment according to age and self-management. CONCLUSION While deferring TKA during a pandemic is unavoidable, patient monitoring for OA treatment during the waiting period is important in reducing physical frailty, ensuring the older patients’ independence