Knee Joint

In-Office Knee Injection Technique: Tips for Success

Alex Haga — Wed, 29 Jan 2025 20:27:37 +0000

Date Added:

January 29, 2025

Journal/Publication:

VuMedi

Publication Date:

April 11, 2023

URL:

In-Office Knee Injection Technique: Tips for Success

Type:

Meta-analyses, Reviews, and Guidelines, Best Local Practices

Format:

Video

Keywords

MeSH

A 12-minute videotape demonstrating the proper technique for injecting or aspirating a knee joint. James W. Mold, MD, MPH

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Dr. Skelley demonstrates a technique for performing a sterile "no touch" technique for in-office knee injections. The rationale and steps for the procedure are described in this video.

Author/s:

Nathan Skelley

Total knee replacement after high tibial osteotomy: time-to-event analysis and predictors

Devin Evans — Wed, 03 Feb 2021 06:00:00 +0000

Date Added:

February 3, 2021

Journal/Publication:

The Canadian Medical Association Journal

Publication Date:

February 1, 2021

Issue:

Volume:

193

Pages:

158-166

URL:

Total knee replacement after high tibial osteotomy: time-to-event analysis and predictors

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1503/cmaj.200934

Keywords

PMID (1):

33526542

MeSH

This study documents to beneficial effects of high tibial osteotomy for medial compartment osteoarthritis of the knee. James W. Mold, MD, MPH

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BACKGROUND: An important aim of high tibial osteotomy (HTO) is to prevent or delay the need for total knee replacement (TKR). We sought to estimate the frequency and timing of conversion from HTO to TKR and the factors associated with it.

METHODS: We prospectively evaluated patients with osteoarthritis (OA) of the knee who underwent medial opening wedge HTO from 2002 to 2014 and analyzed the cumulative incidence of TKR in July 2019. The presence or absence of TKR on the HTO limb was identified from the orthopedic surgery reports and knee radiographs contained in the electronic medical records for each patient at London Health Sciences Centre. We used cumulative incidence curves to evaluate the primary outcome of time to TKR. We used multivariable Cox proportional hazards analysis to assess potential preoperative predictors including radiographic disease severity, malalignment, correction size, pain, sex, age, body mass index (BMI) and year of surgery.

RESULTS: Among 556 patients who underwent 643 HTO procedures, the cumulative incidence of TKR was 5% (95% confidence interval [CI] 3%–7%) at 5 years and 21% (95% CI 17%–26%) at 10 years. With the Cox proportional hazards multivariable model, the following preoperative factors were significantly associated with an increased rate of conversion: radiographic OA severity (adjusted hazard ratio [HR] 1.96, 95% CI 1.12–3.45), pain (adjusted HR 0.85, 95% CI 0.75–0.96)], female sex (adjusted HR 1.67, 95% CI 1.08–2.58), age (adjusted HR 1.50 per 10 yr, 95% CI 1.17–1.93) and BMI (adjusted HR 1.31 per 5 kng/m2, 95% CI 1.12–1.53).

Author/s:

Primeau, Codie A., Birmingham, Trevor B., Leitch, Kristyn M., Willits, Kevin R., Litchfield, Robert B., Fowler, Peter J., Marsh, Jacquelyn D., Chesworth, Bert M., Dixon, Stephanie N., Bryant, Dianne M., Giffin, J. Robert

Stepped Exercise Program for Patients With Knee Osteoarthritis: A Randomized Controlled Trial

Devin Evans — Thu, 14 Jan 2021 06:00:00 +0000

Date Added:

January 14, 2021

Journal/Publication:

BMC Musculoskeletal Disorder

Publication Date:

May 28, 2019

Issue:

254

Volume:

URL:

Stepped Exercise Program for Patients With Knee Osteoarthritis: A Randomized Controlled Trial

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1186/s12891-019-2627-8

Keywords

PMID (1):

31138256

MeSH

Physical Therapy Modalities

Patient-Centered Care

exercise therapy

An interesting type of stepped intervention that could be applied to other health conditions as well. James W. Mold, MD, MPH

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Background: Physical therapy (PT) and other exercise-based interventions are core components of care for knee osteoarthritis (OA), but both are underutilized, and some patients have limited access to PT services. This clinical trial is examining a STepped Exercise Program for patients with Knee OsteoArthritis (STEP-KOA). This model of care can help to tailor exercise-based interventions to patient needs and also conserve higher resource services (such as PT) for patients who do not make clinically relevant improvements after receiving less costly interventions.

Methods / design: Step-KOA is a randomized trial of 345 patients with symptomatic knee OA from two Department of Veterans Affairs sites. Participants are randomized to STEP-KOA and Arthritis Education (AE) Control groups with a 2:1 ratio, respectively. STEP-KOA begins with 3 months of access to an internet-based exercise program (Step 1). Participants not meeting response criteria for clinically meaningful improvement in pain and function after Step 1 progress to Step 2, which involves bi-weekly physical activity coaching calls for 3 months. Participants not meeting response criteria after Step 2 progress to in-person PT visits (Step 3). Outcomes will be assessed at baseline, 3, 6 and 9 months (primary outcome time point). The primary outcome is the Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC), and secondary outcomes are objective measures of physical function. Linear mixed models will compare outcomes between the STEP-KOA and AE control groups at follow-up. We will also evaluate patient characteristics associated with treatment response and conduct a cost-effectiveness analysis of STEP-KOA.

Discussion: STEP-KOA is a novel, efficient and patient-centered approach to delivering exercise-based interventions to patients with knee OA, one of the most prevalent and disabling health conditions. This trial will provide information on the effectiveness of STEP-KOA as a novel potential model of care for treatment of OA.

Author/s:

Allen, Kelli D., Bongiorni, Dennis, Caves, Kevin, Coffman, Cynthia J., Floegel, Theresa A., Greysen, Heather M., Hall, Katherine S., Heiderscheit, Bryan, Hoenig, Helen M., Huffman, Kim M., Morey, Miriam D., Ramasunder, Shalini, Severson, Herbert, Smith, Battista, Van Houtven, Courtney, Woolson, Sandra

Physical Therapy Versus Glucocorticoid Injection for Osteoarthritis of the Knee

John Bayhi — Thu, 09 Apr 2020 15:03:49 +0000

Date Added:

April 9, 2020

Journal/Publication:

New England Journal of Medicine

Publisher:

Massachusetts Medical Society

Publication Date:

April 9, 2020

Issue:

382

Pages:

1420-1429

URL:

Physical Therapy Versus Glucocorticoid Injection for Osteoarthritis of the Knee

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1056/NEJMoa1905877

Keywords

PMID (1):

32268027

MeSH

Military Health Services

Time and Motion Studies

Physical therapy produces better outcomes at one year than corticosteroid injections in patients with osteoarthritis of the knee. James W. Mold, MD, MPH

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Background: Both physical therapy and intraarticular injections of glucocorticoids have been shown to confer clinical benefit with respect to osteoarthritis of the knee. Whether the short-term and long-term effectiveness for relieving pain and improving physical function differ between these two therapies is uncertain.

Methods: We conducted a randomized trial to compare physical therapy with glucocorticoid injection in the primary care setting in the U.S. Military Health System. Patients with osteoarthritis in one or both knees were randomly assigned in a 1:1 ratio to receive a glucocorticoid injection or to undergo physical therapy. The primary outcome was the total score on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at 1 year (scores range from 0 to 240, with higher scores indicating worse pain, function, and stiffness). The secondary outcomes were the time needed to complete the Alternate Step Test, the time needed to complete the Timed Up and Go test, and the score on the Global Rating of Change scale, all assessed at 1 year.

Results: We enrolled 156 patients with a mean age of 56 years; 78 patients were assigned to each group. Baseline characteristics, including severity of pain and level of disability, were similar in the two groups. The mean (±SD) baseline WOMAC scores were 108.8±47.1 in the glucocorticoid injection group and 107.1±42.4 in the physical therapy group. At 1 year, the mean scores were 55.8±53.8 and 37.0±30.7, respectively (mean between-group difference, 18.8 points; 95% confidence interval, 5.0 to 32.6), a finding favoring physical therapy. Changes in secondary outcomes were in the same direction as those of the primary outcome. One patient fainted while receiving a glucocorticoid injection.

Conclusions: Patients with osteoarthritis of the knee who underwent physical therapy had less pain and functional disability at 1 year than patients who received an intraarticular glucocorticoid injection. (ClinicalTrials.gov number, NCT01427153.).

Author/s:

Deyle, GD, Allen, CS, Allison, SC, Gill, NW, Hando, BR, Petersen, EJ, Dusenberry, DI, Rhon, DI