Net Guide: Chronic Knee and Joint Pain

Pain Management, November 2010, Volume 3, Issue 7

A collection of links and resources from across the web focused on one specific condition. These resource range from useful websites to clinical trials.

//The Educated Patient

Knee Pain Overview

This site is dedicated to all things knee pain. Whether the knee pain is a result of osteoarthritis of the knee, runner’s knee, water on the knee, or more, patients can learn about the common symptoms related to these conditions and treatments exercises that can help. Clicking on one of the conditions on the left provides an in-depth, detailed look at what is happening in the knee. For example, clicking on Osgood-Schlatter Disease, describes it as “a common overuse condition causing inflammation of the tibial tuberosity” in teenagers. It goes on to explain that the condition occurs when the “front thigh muscle pulls on the patellar tendon, which pulls on the tibial tuberosity,” usually after activities that include running and jumping. This section discusses the diagnosis, symptoms, treatment, and long-term consequences.

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Common Adolescent Problems - Knee Pain

Parents of patients can check out this site to learn more about the specific knee injuries that are common to adolescents and children and ways to treat these conditions. The article “Common Adolescent Problems — Knee Pain” highlights knee conditions such as Parapatellar knee pain syndrome, Osteochondritis dissecans, Patellar dislocation, Collateral ligament injury, Meniscal injuries, and more. Other related articles highlight treatments for these conditions and common injuries that trigger the issues. The site also features a number of articles on pediatric conditions, parenting advice, and more.

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Total Knee Replacement

For patients that might have to undergo total knee replacement, this site is a good resource on what to expect and offers detailed information on which patients are candidates for the surgery and why. The article offers diagrams on knee anatomy, describes the benefits of TKR surgery, and describes who the common patients are: patients age 60 to 80, with strong levels of pain and disability. It goes on to explain what transpires during an orthopedic evaluation, including the physical examination, X-rays, and some blood tests or MRI. In the “Realistic Expectations About Knee Replacement Surgery” section of the page, the site advises what recovery time may look like and which activities should be avoided. The preparing for surgery section of the page offers tips on what may be expected such as the need to prepare the skin and leg, disclosure of medications, urinary evaluations, dental evaluations, and the need for home or social planning, etc. Additionally, there is info on what a stay at the hospital will entail and what to expect when returning home.


Chronic Knee Pain Relief

This segment of the TV show, “The Doctor’s,” discusses a procedure that may help certain chronic knee pain sufferers. The video can be shared with patients as an additional visual aid. The clip highlights the story of a relatively young chronic knee-sufferer who seeks medical advice on treatments that will help her return to completing common tasks like walking up the stairs, and others that require bending or twisting the knees. The doctors bring in a sports medicine specialist to provide the patient with a series of hyalouronic acid injections after first taking X-rays and an MRI to rule out certain injuries.

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//Online CME

Osteoarthritis: A Case Study of Knee OA



Expires:June 30, 2011


This activity will discuss “a conservative approach to treatment” in older adults, emphasizing “individualized care” and considering “the various aspects of their condition in order to achieve functional improvement.”

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Platelet-rich plasma intra-articular knee injections for the treatment of degenerative cartilage lesions and osteoarthritis

Journal:Knee surgery, sports traumatology, arthroscopy: Official Journal of the ESSKA (August, 26, 2010)

Authors:Filardo G, Kon E, Buda R, et al

Purpose:The study was designed to “investigate the persistence of the beneficial effects observed,” in a previous analysis of a 12-month follow-up study that demonstrated positive results in treating patients with knee degeneration with PRP intra-articular injections.

Results:The study evaluated 90 of the 91 patients from the previous study for a two-year follow-up. The patients all presented with a “chronic knee degenerative condition and were treated with three intra-articular PRP injections.” The team took IKDC and EQ-Vas scores. Also recorded were: complications, adverse events, and patient satisfaction. “All of the evaluated parameters worsened at the 24-month follow-up.” Better results were shown in younger patients and “lower degrees of cartilage degeneration.” The researchers concluded that “treatment with PRP injections can reduce pain and improve knee function and quality of life with short-term efficacy.”

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Infiltration of Plasma Rich in Growth Factors for Osteoarthritis of the Knee Short-term Effects on Function and Quality of Life

Journal:Archives of Orthopaedic and Trauma Surgery (August, 17, 2010)

Authors: Wang-Saegusa A, Cugat R, Ares O, et al

Purpose:The researchers sought to evaluate alternative and co-adjuvant therapies to improve the quality of life and physical function of affected patients.

Results:The team treated 808 patients with knee pathology with plasma rich in growth factors (PRGF). Of the total patients, 312 had osteoarthritis of the knee and symptoms that lasted for more than three months. “Three intra-articular injections of autologous PRGF were administered at two-week intervals in outpatient surgery.” The results indicate that at six months “following intra-articular infiltration of PRGF in patients with OA of the knee” experienced “improvements in function and quality of life.”

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Manual for Guided Home Exercises for Osteoarthritis of the Knee

Journal:Clinics (June 2010)

Authors:Carvalho N, Bittar S, Pinto F, et al

Purpose:The researchers sought to “assess the efficiency of a guidance manual for patients with osteoarthritis of the knee in relation to pain, range of movement, muscle strength and function, active goniometry, manual strength test, and function.”

Results:The team studies 38 adults with osteoarthritis of the knee (ages 45 and up). The patients “received guidance for the practice of specific physical exercises and a manual with instructions on how to perform the exercises at home.” The results determined that “the program was effective for improving muscle strength, controlling pain, maintaining range of movement of the knee joint, and reducing functional incapacity.”

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Knee Osteoarthritis, Knee Joint Pain and Aging in Relation to Increasing Serum Hyaluronan Level in the Japanese Population

Journal: Osteoarthritis Cartilage (October 30, 2010)

Authors: Inoue R, Ishibashi Y, Tsuda E, et al

Purpose: The researchers sought to “investigate the relationship between serum hyaluronan (HA) level and the presence and severity of radiographic knee osteoarthritis (OA) as well as the degree of knee pain in Japanese population.”

Results: The study included 616 volunteers. The participants were placed into three groups based on their score on the Kellgren-Lawrence (K-L) grade: normal, moderate and severe. The found that, “Serum HA level has the potential to be useful for the diagnosis of the presence and severity of knee OA.”

//Clinical Trials

Intra-articularInjection of Botulinum Toxin Type

Study Type: Interventional

Age/Gender Requirements: 18 years (male/female)

Sponsor: Minneapolis Veterans Affairs Medical Center

Purpose: The study is designed to “determine whether intra-articular injection of botulinum toxin is effective in the treatment of chronic knee pain due to arthritis.”

Chronic Knee Pain Study (JRPIT)

Study Type: Observational

Age/Gender Requirements: 50 years (male/female)

Sponsor: University of Pittsburgh

Purpose: There are four main goals: “To examine differences between AA and white patients with knee OA in willingness to consider knee joint replacement;” “to examine the relationship between socio-cultural factors and patient willingness to consider joint replacement;” “To examine how demographic, socio-cultural, and clinical factors mediate the relationship between race and patient willingness;” and “To examine the relationship between patient willingness and referral to orthopedic care for knee OA (secondary aim).”

Study of TG-C in Patients with Grade 3 Degenerative Joint Disease of the Knee

Study Type: Interventional

Age/Gender Requirements: 18-70 years (male/female)

Sponsor: TissueGene, Inc.

Purpose: The researchers seek to examine whether or not they “can safely regenerate cartilage without invasive surgery using a biologic product called TissueGene-C.”

Pharma Focus

Vimovo (naproxen and esomeprazole magnesium)

The Educated Patient

Vimovo Official Site

Send your patients to the main Vimovo site to learn more about how the drug works, how to take the medicine, and safety information. Additionally, there is information on the different types of arthritis, facts about arthritis, treatment option information, and pain relief options.

Clinical Trials

Phase I Study to Evaluate Bioavailability of Naproxen as PN400 Compared to Naproxen as Naprosyn E

Study type: Interventional

Age/gender Requirements: 18-55 years (male/female)

Sponsor: AstraZeneca

Purpose: The researchers seek to “investigate the uptake in the body of naproxen; one of the two active substances in PN400.” Additionally, the team would like to “ to show that the body's uptake of naproxen given as PN400 is comparable to that of currently marketed naproxen tablets.”