Should Loose Bodies In Knee Be Removed
Exp Ther Med. 2022 February; 15(ii): 1666–1671.
Efficacy of arthroscopic loose body removal for articulatio genus osteoarthritis
Baoxiang Zhao
iDepartment of Orthopaedics, Linyi People's Hospital, Linyi, Shandong 276000, P.R. China
Yibo Yu
2Department of Orthopaedics, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. Red china
3Section of Orthopaedics, Chinese Medicine Hospital in Linyi Urban center, Linyi, Shandong 276002, P.R. Cathay
Wenquan Liu
3Department of Orthopaedics, Chinese Medicine Hospital in Linyi City, Linyi, Shandong 276002, P.R. Communist china
Jian Du
4Department of Orthopaedics, Lanshan District People'south Hospital, Linyi, Shandong 276000, P.R. Mainland china
Received 2022 Jul xiv; Accustomed 2022 Apr 28.
Abstract
The purpose of the present study was to explore the efficacy of arthroscopic loose body removal for knee joint osteoarthritis (KOA). A total of 23 patients with KOA were enrolled and randomly received bourgeois handling (conservative grouping; north=x) or loose trunk removal surgery (surgery group; due north=13). The serum levels of disease activeness indices, including hypersensitive C-reactive protein (hs-CRP), erythrocyte sedimentation rate (ESR) and synovial inflammatory factors [interleukin (IL)-1 and IL-6] were detected prior to surgery, and at 4 days, 2 or 4 weeks later on surgery. All patients were followed upward for 2 years and the cure rate was estimated. No meaning difference was identified in pre-operative plasma levels of hs-CRP and ESR as well every bit the synovial concentration of IL-1 and IL-half dozen between the 2 groups (all P>0.05). At 2 and 4 weeks later on treatment, the levels of these parameters in the surgery group were significantly lower than those in the conservative group (all P<0.05), although the maximum value of these parameters was higher in the surgery group than in the conservative group at 4 days subsequently surgery. The cure rate for KOA in the surgery group was significantly college than that in the conservative group. In conclusion, the results demonstrated that arthroscopic loose body removal is a more effective treatment than bourgeois therapy for KOA.
Keywords: arthroscopy, loose body removal, knee osteoarthritis, therapy
Introduction
Osteoarthritis (OA) is a joint disease characterized by articular cartilage fibrosis, derangement, ulceration and loss caused by a variety of factors (ane). OA primarily occurs in weight-bearing joints, including knees, hips, ankles, hands and spine joints, and is a major brunt on individuals and social care systems (ii). Human knee osteoarthritis (KOA) is a disease characterized by the degeneration of articular cartilage, leading to subchondral bone proliferation, cartilage exfoliation and the gradual destruction and dysfunction of the knee articulation (3–vi). The clinical features of this disorder include articulation pain, motility limitation, poor musculus strength and stability, and walking impairment, which severely affect the quality of life of affected individuals (seven).
At present, the master therapeutic options for KOA are bourgeois or surgical treatment (eight). The conservative treatment includes drug treatment and not-drug therapy. The first-line drugs, including non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen, finer alleviate the symptoms of osteoarthritis (9). Furthermore, intra-articular injection of corticosteroids and hyaluronic acid has a meaning consequence on the remission of symptoms, reduction of articulation effusion and protection of cartilage (ten). Notwithstanding, the long-term utilize of these drugs inevitably leads to gastrointestinal side effects or other severe agin outcomes (11).
Alternatively, patients with severe KOA may be treated by surgeries, including arthroscopic removal of loose torso, joint debridement, osteotomy, arthrodesis and arthroplasty (artificial joint replacement) (12). Intra-articular loose bodies, which are formed due to articular cartilage atrophy, degeneration and necrosis after cartilage malnutrition or developmental disorders, are chondral, osseous or osteochondral fragments located in the articular cavity (13). Loose bodies that movement freely in the articulation cavity may atomic number 82 to joint pain, locking and swelling (12). According to their construction, intra-articular loose bodies may be divided into fibrous, cartilaginous bony, cartilaginous, bony and crystalline loose bodies or exogenous articular strange affair (14). The most mutual type is bony loose bodies, which have a core of bone structure covering the outer periphery of the cartilage, or cartilaginous loose bodies with a round shape and smooth surface, which are entirely composed of cartilage (fifteen). Smaller loose bodies tend to move easier in the joint crenel, causing joint hurting and locking in unpredictable positions (sixteen). Removal of loose bodies non just relieves long-term suffering of patients, but also restores joint role and the power to alive independently (17). The aim of the present study was to compare the therapeutic efficacy of bourgeois treatment and arthroscopic loose trunk removal for KOA.
Materials and methods
Patients
A total of 23 patients with KOA were eligible for enrollment in the nowadays study. KOA was diagnosed according to the clinical and radiographic criteria of the American College of Rheumatology from 1995, which were as follows: i) Genu pain persisting for ≥14 days within 1 month prior to treatment; ii) bony crepitus occurred during activity of knee joints; ii) 10-ray demonstrated osteophyte formation in articulatio genus joints; 4) swelling of knee joint articulation; 5) morning stiffness of the human knee joint for ≤xxx min; and vi) Patient historic period >50 years. Patients fulfilling the criteria i and iii or i, ii, 4 and five may be diagnosed with KOA. Prior written informed consent was obtained from each patient and the study was approved by the ideals review lath of Linyi People's Hospital (Linyi, Mainland china).
Patient grouping and therapy
Based on the balance of indications and the wishes of the patients or their family members, 23 patients received conservative treatment (conservative group; n=ten) or loose body removal surgery (surgery group; north=13). In the bourgeois group, the indications were as follows: Symptoms of genu hurting, swelling and articulation dysfunction; joint space narrowing without loose torso germination as demonstrated by Ten-ray. Intra-articular injection of NSAIDs (acetaminophen, <4,000 mg per twenty-four hour period) was administered to these patients.
In the surgery group, loose body removal surgery was performed in patients who had the following indications: Age, 40–fifty years; normal blood coagulation; no history of hemophilia, anemia, malnutrition or severe disorders of middle, lung, liver or kidney; knee joint motions were severely afflicted but without fluctuant swelling; and Ten-ray demonstrated the germination of loose bodies in the knee. Showtime, patients with loose bodies above the patella (due north=3) received local anesthesia, while epidural anesthesia was given to patients with loose bodies in the rear side of the knee (n=5) and the knee space (northward=5). Minimally invasive techniques were then performed to remove the loose bodies, using an Southward-shaped incision for loose bodies in the rear side of the knee and an oblique incision for those in the knee space. After surgery, the surgical wound was dressed without arthrodesis. Anti-infective treatment was given for 5–7 days and threads were removed at twenty-four hours 12 postal service-surgery. Most patients ambulated at 1 week post surgery and the office of knee joints was restored subsequently 4 weeks.
Clinical assessment
Peripheral blood from all patients was collected from a cubital vein prior to treatment and at 4 days, 2 and iv weeks later handling. Synovial liquid was nerveless at the same time points. Briefly, the patients were in a supine position with limb flexion of 70–xc degrees. Following the administration of local anesthesia with two% lidocaine, 0.5–1 ml of synovial fluid was collected from the articulation cavity. The supernatant was isolated by centrifugation at 800 × g for 10 min at room temperature. The serum levels of hypersensitive C-reactive protein (hs-CRP), the erythrocyte sedimentation charge per unit (ESR) and synovial inflammatory factors [interleukin (IL)-1 and IL-6] were detected by immunoturbidimetry (BodiTech Med Inc., Gang-won-do, Republic of korea), the Westergren method (xviii) and ELISA [IL-i ELISA kit; cat. no. 70-EK101B2; Hangzhou MultiSciences (Lianke) Biotech, Co., Ltd., Hangzhou, China; IL-6 ELISA kit; cat. no. KB2730; Ke Min Biological Technology Co., Ltd., Shanghai, China].
Cure rate assay
All patients were followed upwardly for 2 years later the offset of the treatment, and the cure rate was estimated co-ordinate to a study past Lequesne et al (19) based on the severity index of osteoarthritis (including the degree of joint swelling, the class of floating patella, articulation pain and the degree of joint dysfunction). Joint swelling was graded as mild (faded peel texture and evident os markers), moderate (obvious swelling and faint bone markers, without skin texture) and severe (significant swelling with tight skin, without bone markers). The floating patella examination was evaluated past rating joints as class I (negative), II (slightly elevated patella), 3 (manifestly elevated patella) and IV (disability of pushing the femoral condyle of the patella into the normal position). Finally, joint pain was scored every bit follows: Patients received one score each for pain whilst walking, hurting using stairs, night pain, sitting pain and standing hurting, which were added up. In the present report, KOA was considered cured if a patient presented with mild joint swelling, evident os markers, negative floating patella test and no knee pain.
Statistical analysis
All information were analyzed using SPSS 13.0 (SPSS, Inc., Chicago, IL, USA). Normality and homogeneity of variance tests were performed for each prepare of information. For the data with a normal distribution and homogeneity of variance, 1-way assay of variance was used to assess the differences between the groups, and a Q test was performed for pairwise comparison among unlike time-points within the same grouping; otherwise, for data with a non-normal distribution, Dunnett's T3 multiple comparisons examination was performed. P<0.05 was considered to indicate a statistically meaning divergence.
Results
Demographic and clinical characteristics of KOA
A total of 23 patients with KOA (16 males and 7 females; age range, 25–45 years; xi left and 12 right knees) were enrolled in the present report. All patients had a history of trauma with the clinical manifestations of varying degrees of joint hurting or locking. The patients were previously healthy without underlying diseases of the coagulation, respiratory or circulatory system.
Plasma levels of hs-CRP in KOA patients
The plasma levels of hs-CRP and the ESR were measured to assess the illness action in the two groups. The results demonstrated that prior to handling, there was no significant deviation in the plasma levels of hs-CRP between the conservative group and surgery group (P>0.05). After handling, plasma hs-CRP in the conservative grouping steadily decreased in a time-dependent mode (P<0.05). Even so, the post-operative levels of plasma hs-CRP in the surgery group reached the highest value at solar day 4 (P<0.05 vs. the conservative group). Afterward, plasma hs-CRP levels in the surgery group decreased and were significantly lower than those in the conservative group at two and four weeks afterwards treatment (P<0.05; Fig. 1).
Plasma levels of hs-CRP. *P<0.05 vs. the conservative group; #P<0.05 vs. iv days later surgery. hs-CRP, high-sensitivity C-reactive protein.
A similar trend was observed for the ESR in the conservative grouping and surgery group. Prior to treatment, no significant difference in the ESR was seen between the bourgeois group and surgery group (P>0.05). At ii and 4 weeks, the post-operative ESR in the surgery group was lower than the ESR in the conservative grouping post-treatment (all P<0.05), while at 4 days after surgery, the ESR reached a maximum value in the surgery group, which was significantly higher than that in the conservative group at 4 days after treatment (P<0.05; Fig. ii). The results demonstrated that arthroscopic loose trunk removal may exist an constructive treatment of KOA.
ESR assay in the bourgeois and surgery groups. *P<0.05 vs. the bourgeois group; #P<0.05 vs. 4 days after surgery. ESR, erythrocyte sedimentation rate.
Synovial concentration of IL-i and IL-6 in KOA patients
Adjacent, the levels of synovial inflammatory factors IL-1 and IL-half-dozen were detected to evaluate the local inflammatory reaction in the joints in the two groups. Prior to treatment, no significant differences in synovial IL-1 were observed between the conservative group and surgery group (P>0.05). At iv days after surgery, the IL-1 concentration in the conservative group and surgery grouping was increased to reach a maximum value (P<0.05). Subsequently, the IL-one levels decreased in each group and remained significantly lower in the surgery group than in the conservative group at 2 and 4 weeks after treatment (all P<0.05; Fig. 3). Similarly, compared with the levels in the conservative group, the postal service-operative IL-6 concentration in the surgery group was significantly lower at 2 and 4 weeks (all P<0.05), despite a higher superlative value at 4 days (Fig. 4). Post-obit surgery, inflammatory factors inititally demonstrated a higher increment in the surgery grouping, but later a greater decrease compared with those in the conservative handling group. This indicates that surgery initially caused more inflammation, just that the efficacy of surgery at 2 and 4 weeks was college. These results likewise revealed that the local inflammatory reaction in the joints of patients with KOA is less astringent after arthroscopic loose body removal than that after conservative therapy.
Synovial fluid concentration of IL-ane in the surgery and bourgeois groups. *P<0.05 vs. the conservative group; #P<0.05 vs. iv days afterward surgery. IL, interleukin.
Synovial concentration of IL-6 in the surgery and conservative groups. *P<0.05 vs. the conservative group; #P<0.05 vs. 4 days after surgery. IL, interleukin.
Comparison of cure rates for different treatments
Ultimately, the cure charge per unit of patients in the 2 groups was analyzed. All patients were followed up for two years to estimate the cure rate. A tendency towards a higher cure rate was seen in each group with increasing follow-upward time, and more importantly, the cure rate for KOA in the surgery grouping was significantly college than that in the conservative grouping at 1, ane.5 and 2 years of follow-up (P<0.05; Fig. 5).
Cure rate in the surgical and bourgeois groups over a 2 yr period. A tendency towards a college cure rate was observed in each group with increasing time, however, the cure rate was significantly higher in the surgery group compared with the bourgeois group at 1, ane.v and two years of follow-up. *P<0.05 vs. the bourgeois group.
Discussion
KOA is considered to be a not-inflammatory joint disease; even so, inflammatory cytokines have a major office in the pathogenesis and evolution of osteoarthritis due to their shut clan with the dysfunctions of synovium, articular cartilage and subchondral bone (20). The therapeutic goals of KOA treatment are to reduce or eliminate pain, correct deformities, improve or restore joint function and improve quality of life. The main treatment arroyo for this disease is combination therapy including drugs, non-pharmaceutical treatments and surgical treatment if necessary.
Arthroscopy is performed for the diagnosis and treatment of joint disorders using an endoscope with diameter of 5 mm (21). Arthroscopic surgery is a minimally invasive surgery blazon and was commencement used in the genu joint (22). The results of the present study demonstrated that immediately after surgery, a tendency towards lower hs-CRP levels and ESR was seen in patients receiving conservative therapy. All the same, the post-operative levels of hs-CRP and ESR in patients with arthroscopic loose body removal reached the highest value at day 4, which may have been triggered by surgical stimulation. Afterward, the levels of hs-CRP and ESR decreased and those in the surgery group were significantly lower than those in patients with bourgeois therapy at two and four weeks after surgery. Nearly importantly, the cure rate in patients with arthroscopic loose body removal was significantly higher than that in patients who received conservative therapy. These findings indicated that, compared with bourgeois handling, arthroscopic loose trunk removal is more effective for KOA with a less astringent inflammatory reaction once the patients recovered from surgery.
Previous studies have indicated that IL-ane and IL-6 have critical roles in the pathological procedure of osteoarthritis via promoting cartilage matrix degradation and damaging articular cartilage (23,24). It has been demonstrated that IL-i and IL-half-dozen stimulate a diverseness of mesenchymal cells to release proteolytic enzymes, co-stimulate antigen-presenting cells and activate T cells, promote B cell proliferation besides as antibody secretion and later regulate the metabolism of cartilage cells, fibroblasts and bone cells (25–27). Synovial lesions in OA are due to decomposition of synovial tissue by prostaglandins and collagenase secreted by stromal cells after IL-1 stimulation in joint capsules (28). Previous studies revealed that the expression levels of IL-1β in the synovial fluid of patients with KOA was increased and positively correlated with articular cartilage damage (29,xxx). IL-i also induces the degeneration of cartilage and inhibition of chondrocyte proliferation though agonizing the mechanism of collagen I–Iv in patients with KOA (31). In the present study, the synovial fluid levels of IL-fifty and IL-6 in patients immediately after arthroscopic loose body removal and bourgeois therapy were college than those prior to treatment, which was consequent with the findings of Marks and Donaldson (29). Furthermore, at four days after surgery, the IL-1 and IL-vi concentration in patients with arthroscopic loose body removal and those with conservative therapy was increased to reach a maximum value. Afterward, the levels of these inflammatory cytokines decreased and remained lower in patients with arthroscopic loose body removal than that in patients with conservative therapy at 2 and 4 weeks later surgery. One reasonable speculation regarding the transient peak value of IL-1 and IL-6 is that it may be induced past surgical stress.
In determination, arthroscopic loose body removal for treating KOA, which likewise has the advantage of minimal surgical incision, less scarring and fewer complications (32), is a more effective treatment for KOA.
Acknowledgements
The authors wish to thank Professor Xin Liu (Section of Orthopedics, Linyi People's Hospital, Linyi, Communist china) for his technical support.
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Should Loose Bodies In Knee Be Removed,
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