Download PDF
CC BY 4.0 · Rev Bras Ortop (Sao Paulo) 2024; 59(03): e337-e348
DOI: 10.1055/s-0044-1786351
Artigo de Atualização
Joelho

Updates in the Treatment of Knee Osteoarthritis

Article in several languages: português | English
Diego Pontes de Carvalho Pires 
1   Instituto de Coluna e Ortopedia Especializada (InCore), Recife, PE, Brasil
,
Felipe Alves do Monte 
2   Departamento de Ortopedia e Traumatologia, Hospital da Restauração Governador Paulo Guerra, Recife, PE, Brasil
,
Leonardo Freire Monteiro 
3   Ortoclínica, Recife, PE, Brasil
,
Francisco Rafael do Couto Soares 
4   Serviço de Traumatologia e Ortopedia, Hospital Metropolitano Norte Miguel Arraes (HMA), Recife, PE, Brasil
5   Serviço de Traumatologia e Ortopedia, Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, PE, Brasil
,
José Leonardo Rocha de Faria 
6   Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, Brasil
› Author Affiliations Financial Support The authors declare that they did not receive funding from agencies in the public, private, or not-for-profit sectors for the conduction of the present study.
› Further Information
   Permissions and Reprints

Abstract

Knee osteoarthritis (OA) is an inflammatory and degenerative condition resulting in articular cartilage destruction and functional loss. Its prevalence has grown considerably due to increased life expectancy and obesity, and its diagnosis relies on evaluation, medical examination, and confirmation by supplementary radiographic images. Knee OA is multifactorial and influenced by several local, systemic, and external aspects. In addition, its progress and therapeutic responses highly depend on the characteristics of each subject. The initial recommendation is drug treatment and alternative therapies to improve quality of life. However, if these treatments are unsuccessful, one must consider surgical treatment. Surgical options include arthroscopies, osteotomies, and partial and total arthroplasties, while non-surgical treatments include medications and alternative therapies such as infiltrations, acupuncture, and physical exercise. It is worth highlighting that biomarkers can be a significant strategy for early disease detection, assessment of disease activity, prediction of prognosis, and monitoring a better response to therapy. Nevertheless, this topic must be the focus of further research to confirm its findings.

Keywords

arthroscopy - articular cartilage - biomarkers - physical exercise - intra-articular infiltrations - knee - osteoarthritis - physical exercise

Work developed at the Instituto de Coluna e Ortopedia Especializada (InCore), Recife, Pernambuco, Brazil.




Publication History

Received: 22 September 2022

Accepted: 21 July 2023

Article published online:
22 June 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • Referências

  • 1 Tan BY, Thach T, Munro YL. et al. Complex lifestyle and psychological intervention in knee osteoarthritis: Scoping review of randomized controlled trials. Int J Environ Res Public Health 2021; 18 (23) 12757
    CrossrefPubMedGoogle Scholar
  • 2 Hunter DJ, Bierma-Zeinstra S. Osteoarthritis. Lancet 2019; 393 (10182): 1745-1759
    CrossrefPubMedGoogle Scholar
  • 3 Salehi-abari I. 2016 ACR Revised criteria for early diagnosis of knee osteoarthritis. Autoimmune Dis Ther Approaches 2016; 3 (01) 1-5
    Google Scholar
  • 4 Mobasheri A, Batt M. An update on the pathophysiology of osteoarthritis. Ann Phys Rehabil Med 2016; 59 (5-6) 333-339
    CrossrefPubMedGoogle Scholar
  • 5 Mora JC, Przkora R, Cruz-Almeida Y. Knee osteoarthritis: pathophysiology and current treatment modalities. J Pain Res 2018; 11: 2189-2196
    CrossrefPubMedGoogle Scholar
  • 6 Teixeira J, Santos MJ, Matos LC, Machado JP. Evaluation of the effectiveness of acupuncture in the treatment of knee osteoarthritis: a case study. Medicines (Basel) 2018; 5 (01) 18
    CrossrefPubMedGoogle Scholar
  • 7 Tu JF, Yang JW, Shi GX. et al. Efficacy of intensive acupuncture versus sham acupuncture in knee osteoarthritis: a randomized controlled trial. Arthritis Rheumatol 2021; 73 (03) 448-458
    CrossrefPubMedGoogle Scholar
  • 8 da Costa SR, da Mota E Albuquerque RF, Helito CP, Camanho GL. The role of viscosupplementation in patellar chondropathy. Ther Adv Musculoskelet Dis 2021; 13: X211015005
    CrossrefPubMedGoogle Scholar
  • 9 Hart JM, Kuenze C, Norte G. et al. Prospective, randomized, double-blind evaluation of the efficacy of a single-dose hyaluronic acid for the treatment of patellofemoral chondromalacia. Orthop J Sports Med 2019; 7 (06) 2325967119854192
    CrossrefPubMedGoogle Scholar
  • 10 Acharya K, Si V, Madi S. Improvement in condition specific and generic quality of life outcomes in patients with knee osteoarthritis following single intraarticular viscosupplementation injection. J Clin Orthop Trauma 2022; 27: 101828
    CrossrefPubMedGoogle Scholar
  • 11 Silverwood V, Blagojevic-Bucknall M, Jinks C, Jordan JL, Protheroe J, Jordan KP. Current evidence on risk factors for knee osteoarthritis in older adults: a systematic review and meta-analysis. Osteoarthritis Cartilage 2015; 23 (04) 507-515
    CrossrefPubMedGoogle Scholar
  • 12 Koiri SP, Yang Y, Kui H. Hyaluronic acid in the treatment of knee osteoarthritis. . review Yangtze Med 2018; 2: 62-72
    CrossrefGoogle Scholar
  • 13 Heidari B. Knee osteoarthritis prevalence, risk factors, pathogenesis and features: Part I. Caspian J Intern Med 2011; 2 (02) 205-212
    CrossrefPubMedGoogle Scholar
  • 14 de Rezende MU, Gobbi RG. Drug therapy in knee osteoarthrosis. Rev Bras Ortop 2015; 44 (01) 14-19
    Google Scholar
  • 15 Primorac D, Molnar V, Rod E. et al. Knee osteoarthritis: a review of pathogenesis and state-of-art non-operative therapeutic considerations. Genes (Basel) 2020; 11 (08) 1-35
    CrossrefPubMedGoogle Scholar
  • 16 Boegård T, Jonsson K. [Hip and knee osteoarthritis. Conventional X-ray best and cheapest diagnostic method]. Lakartidningen 2002; 99 (44) 4358-4360
    PubMedGoogle Scholar
  • 17 Cho H, Stuart JM, Magid R. et al. Theranostic immunoliposomes for osteoarthritis. Nanomedicine Nanotechnology. Biol Med (Aligarh) 2014; 10: 619-627
    Google Scholar
  • 18 Pires D, Astur D, Cohen M. Classificações e fluxogramas em cirurgia do joelho. Manole. Baueri - São Paulo: E-book; 2021
    Google Scholar
  • 19 Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis 1957; 16 (04) 494-502
    CrossrefPubMedGoogle Scholar
  • 20 Finan PH, Buenaver LF, Bounds SC. et al. Discordance between pain and radiographic severity in knee osteoarthritis: findings from quantitative sensory testing of central sensitization. Arthritis Rheum 2013; 65 (02) 363-372
    CrossrefPubMedGoogle Scholar
  • 21 Kraus VB, Collins JE, Hargrove D. et al; OA Biomarkers Consortium. Predictive validity of biochemical biomarkers in knee osteoarthritis: data from the FNIH OA Biomarkers Consortium. Ann Rheum Dis 2017; 76 (01) 186-195
    CrossrefPubMedGoogle Scholar
  • 22 Tanishi N, Yamagiwa H, Hayami T. et al. Relationship between radiological knee osteoarthritis and biochemical markers of cartilage and bone degradation (urine CTX-II and NTX-I): the Matsudai Knee Osteoarthritis Survey. J Bone Miner Metab 2009; 27 (05) 605-612
    CrossrefPubMedGoogle Scholar
  • 23 Hao HQ, Zhang JF, He QQ, Wang Z. Cartilage oligomeric matrix protein, C-terminal cross-linking telopeptide of type II collagen, and matrix metalloproteinase-3 as biomarkers for knee and hip osteoarthritis (OA) diagnosis: a systematic review and meta-analysis. Osteoarthritis Cartilage 2019; 27 (05) 726-736
    CrossrefPubMedGoogle Scholar
  • 24 Felson DT. Arthroscopy as a treatment for knee osteoarthritis. Best Pract Res Clin Rheumatol 2010; 24 (01) 47-50
    CrossrefPubMedGoogle Scholar
  • 25 Losina E, Weinstein AM, Reichmann WM. et al. Lifetime risk and age at diagnosis of symptomatic knee osteoarthritis in the US. Arthritis Care Res (Hoboken) 2013; 65 (05) 703-711
    CrossrefPubMedGoogle Scholar
  • 26 Su X, Li C, Liao W. et al. Comparison of arthroscopic and conservative treatments for knee osteoarthritis: a 5-year retrospective comparative study. Arthroscopy 2018; 34 (03) 652-659
    CrossrefPubMedGoogle Scholar
  • 27 Zhao J. Arthroscopic arthroplasty for knee osteoarthritis: denervation of subchondral bone and comprehensive synovectomy. Arthrosc Tech 2021; 10 (12) e2651-e2657
    CrossrefPubMedGoogle Scholar
  • 28 Giuffrida A, Di Bari A, Falzone E. et al. Conservative vs. surgical approach for degenerative meniscal injuries: a systematic review of clinical evidence. Eur Rev Med Pharmacol Sci 2020; 24 (06) 2874-2885
    PubMedGoogle Scholar
  • 29 Navarro RA, Adams AL, Lin CC. et al. Does Knee Arthroscopy for Treatment of Meniscal Damage with Osteoarthritis Delay Knee Replacement Compared to Physical Therapy Alone?. Clin Orthop Surg 2020; 12 (03) 304-311
    CrossrefPubMedGoogle Scholar
  • 30 Kang KS, Tien TN, Lee MC, Lee KY, Kim B, Lim D. Suitability of Metal Block Augmentation for Large Uncontained Bone Defect in Revision Total Knee Arthroplasty (TKA). J Clin Med 2019; 8 (03) 1-14
    CrossrefPubMedGoogle Scholar
  • 31 Jang S, Lee K, Ju JH. Recent Updates of Diagnosis, Pathophysiology, and Treatment on Osteoarthritis of the Knee. Int J Mol Sci 2021; 22 (05) 2619
    CrossrefPubMedGoogle Scholar
  • 32 Peng H, Ou A, Huang X. et al. Osteotomy around the knee: the surgical treatment of osteoarthritis. Orthop Surg 2021; 13 (05) 1465-1473
    CrossrefPubMedGoogle Scholar
  • 33 Brouwer RW, Huizinga MR, Duivenvoorden T. et al. Osteotomy for treating knee osteoarthritis. Cochrane Database Syst Rev 2014; 2014 (12) CD004019
    PubMedGoogle Scholar
  • 34 He M, Zhong X, Li Z, Shen K, Zeng W. Progress in the treatment of knee osteoarthritis with high tibial osteotomy: a systematic review. Syst Rev 2021; 10 (01) 56
    CrossrefPubMedGoogle Scholar
  • 35 Paley D, Tetsworth K. Mechanical axis deviation of the lower limbs. Preoperative planning of uniapical angular deformities of the tibia or femur. Clin Orthop Relat Res 1992; (280) 48-64
    PubMedGoogle Scholar
  • 36 Khakha RS, Bin Abd Razak HR, Kley K, van Heerwaarden R, Wilson AJ. Role of high tibial osteotomy in medial compartment osteoarthritis of the knee: Indications, surgical technique and outcomes. J Clin Orthop Trauma 2021; 23: 101618
    CrossrefPubMedGoogle Scholar
  • 37 Valeiy Evgenievich B, Sergey Anatolievich M, Liudmila Ivanovna A. et al. High tibial osteotomy in patients with stages 2 and 3 of knee osteoarthritis. Short-term result and factors affecting the outcome. MOJ Orthop Rheumatol 2018; 10 (02) 122-128
    CrossrefGoogle Scholar
  • 38 Kan HS, Chan PK, Chiu KY. et al. Non-surgical treatment of knee osteoarthritis. Hong Kong Med J 2019; 25 (02) 127-133
    PubMedGoogle Scholar
  • 39 Nguyen C, Rannou F. The safety of intra-articular injections for the treatment of knee osteoarthritis: a critical narrative review. Expert Opin Drug Saf 2017; 16 (08) 897-902
    CrossrefPubMedGoogle Scholar
  • 40 Jones IA, Togashi R, Wilson ML, Heckmann N, Vangsness Jr CT. Intra-articular treatment options for knee osteoarthritis. Nat Rev Rheumatol 2019; 15 (02) 77-90
    CrossrefPubMedGoogle Scholar
  • 41 Russu OM, Pop TS, Feier AM. et al. Treatment efficacy with a novel hyaluronic acid-based hydrogel for osteoarthritis of the knee. J Pers Med 2021; 11 (04) 303
    CrossrefPubMedGoogle Scholar
  • 42 Karasavvidis T, Totlis T, Gilat R, Cole BJ. Platelet-rich plasma combined with hyaluronic acid improves pain and function compared with hyaluronic acid alone in knee osteoarthritis: a systematic review and meta-analysis. Arthroscopy 2021; 37 (04) 1277-1287.e1
    CrossrefPubMedGoogle Scholar
  • 43 Pintan GF, de Oliveira Jr AS, Lenza M, Antonioli E, Ferretti M. Update on biological therapies for knee injuries: osteoarthritis. Curr Rev Musculoskelet Med 2014; 7 (03) 263-269
    CrossrefPubMedGoogle Scholar
  • 44 Saita Y, Kobayashi Y, Nishio H. et al. Predictors of effectiveness of platelet-rich plasma therapy for knee osteoarthritis: A retrospective cohort study. J Clin Med 2021; 10 (19) 4514
    CrossrefPubMedGoogle Scholar
  • 45 Bansal H, Leon J, Pont JL. et al. Platelet-rich plasma (PRP) in osteoarthritis (OA) knee: Correct dose critical for long term clinical efficacy. Sci Rep 2021; 11 (01) 3971
    CrossrefPubMedGoogle Scholar
  • 46 Knop E, de Paula LE, Fuller R. Plasma rico em plaquetas no tratamento da osteoartrite. Rev Bras Reumatol 2016; 56 (02) 152-164
    CrossrefGoogle Scholar
  • 47 Xiang XN, Zhu SY, He HC, Yu X, Xu Y, He CQ. Mesenchymal stromal cell-based therapy for cartilage regeneration in knee osteoarthritis. Stem Cell Res Ther 2022; 13 (01) 14
    CrossrefPubMedGoogle Scholar
  • 48 Shariatzadeh M, Song J, Wilson SL. The efficacy of different sources of mesenchymal stem cells for the treatment of knee osteoarthritis. Cell Tissue Res 2019; 378 (03) 399-410
    CrossrefPubMedGoogle Scholar
  • 49 Spasovski D, Spasovski V, Baščarević Z. et al. Intra-articular injection of autologous adipose-derived mesenchymal stem cells in the treatment of knee osteoarthritis. J Gene Med 2018; 20 (01) e-3002
    CrossrefPubMedGoogle Scholar
  • 50 Chen CF, Hu CC, Wu CTE. et al. Treatment of knee osteoarthritis with intra-articular injection of allogeneic adipose-derived stem cells (ADSCs) ELIXCYTE®: a phase I/II, randomized, active-control, single-blind, multiple-center clinical trial. Stem Cell Res Ther 2021; 12 (01) 562
    CrossrefPubMedGoogle Scholar
  • 51 Arias-Vázquez PI, Tovilla-Zárate CA, Legorreta-Ramírez BG. et al. Prolotherapy for knee osteoarthritis using hypertonic dextrose vs other interventional treatments: systematic review of clinical trials. Adv Rheumatol 2019; 59 (01) 39
    CrossrefPubMedGoogle Scholar
  • 52 Lebleu J, Fonkoue L, Bandolo E. et al. Lower limb kinematics improvement after genicular nerve blockade in patients with knee osteoarthritis: a milestone study using inertial sensors. BMC Musculoskelet Disord 2020; 21 (01) 822
    CrossrefPubMedGoogle Scholar
  • 53 Pavão DM, Rocha Faria JL, Mandarino M. et al. Pulsed radiofrequency rhizotomy of the genicular nerves of the knee guided by radioscopy and ultrasonography: step-by-step technique. Arthrosc Tech 2022; 11 (03) e391-e396
    CrossrefPubMedGoogle Scholar
  • 54 Rodrigues TA, de Oliveira EJSG, Garcia JBS. Pain management in patients with knee osteoarthritis by ultrasound-guided genicular nerve block. Case reports. Br J Pain 2020; 3 (03) 288-291
    Google Scholar
  • 55 Lauretti GR, Santos DLR, Oliveira CS, Trintade C. The Antinociceptive Effect of Genicular Nerves Block Compared to Intra-Articular Dexamethasone in Grade III or IV Knee Osteoarthritis. J Biomed Sci Eng 2019; 12 (10) 451-457
    CrossrefGoogle Scholar
  • 56 Liu CY, Tu JF, Lee MS. et al. Is acupuncture effective for knee osteoarthritis? A protocol for a systematic review and meta-analysis. BMJ Open 2022; 12 (01) e052270
    CrossrefPubMedGoogle Scholar
  • 57 Li J, Li YX, Luo LJ. et al. The effectiveness and safety of acupuncture for knee osteoarthritis: An overview of systematic reviews. Medicine (Baltimore) 2019; 98 (28) e16301
    CrossrefPubMedGoogle Scholar
  • 58 Bannuru RR, Osani MC, Vaysbrot EE. et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage 2019; 27 (11) 1578-1589
    CrossrefPubMedGoogle Scholar
  • 59 Fransen M, McConnell S, Harmer AR, Van der Esch M, Simic M, Bennell KL. Exercise for osteoarthritis of the knee: a Cochrane systematic review. Br J Sports Med 2015; 49 (24) 1554-1557
    CrossrefPubMedGoogle Scholar
  • 60 Dantas LO, Salvini TF, McAlindon TE. Knee osteoarthritis: key treatments and implications for physical therapy. Braz J Phys Ther 2021; 25 (02) 135-146
    CrossrefPubMedGoogle Scholar
  • 61 Reichenbach S, Felson DT, Hincapié CA. et al. Effect of Biomechanical Footwear on Knee Pain in People With Knee Osteoarthritis: The BIOTOK Randomized Clinical Trial. JAMA 2020; 323 (18) 1802-1812
    CrossrefPubMedGoogle Scholar