scholarly journals Efficacy of Myofascial Trigger Point Dry Needling in the Prevention of Pain after Total Knee Arthroplasty: A Randomized, Double-Blinded, Placebo-Controlled Trial

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Orlando Mayoral ◽  
Isabel Salvat ◽  
María Teresa Martín ◽  
Stella Martín ◽  
Jesús Santiago ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Physical Therapist ◽  
Trigger Point ◽  
Controlled Trial ◽  
Trigger Points ◽  
Dry Needling ◽  
Myofascial Trigger Points ◽  
Total Knee

The aim of this study was to determine whether the dry needling of myofascial trigger points (MTrPs) is superior to placebo in the prevention of pain after total knee arthroplasty. Forty subjects were randomised to a true dry needling group (T) or to a sham group (S). All were examined for MTrPs by an experienced physical therapist 4–5 hours before surgery. Immediately following anesthesiology and before surgery started, subjects in the T group were dry needled in all previously diagnosed MTrPs, while the S group received no treatment in their MTrPs. Subjects were blinded to group allocation as well as the examiner in presurgical and follow-up examinations performed 1, 3, and 6 months after arthroplasty. Subjects in the T group had less pain after intervention, with statistically significant differences in the variation rate of the visual analogue scale (VAS) measurements 1 month after intervention and in the need for immediate postsurgery analgesics. Differences were not significant at 3- and 6-month follow-up examinations. In conclusion, a single dry needling treatment of MTrP under anaesthesia reduced pain in the first month after knee arthroplasty, when pain was the most severe. Results show a superiority of dry needling versus placebo. An interesting novel placebo methodology for dry needling, with a real blinding procedure, is presented.

scholarly journals Myofascial Pain in Patients Waitlisted for Total Knee Arthroplasty

2012 ◽  
Vol 17 (5) ◽  
pp. 321-327 ◽  
Author(s):  
Richard Henry ◽  
Catherine M Cahill ◽  
Gavin Wood ◽  
Jennifer Hroch ◽  
Rosemary Wilson ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Pain ◽  
Knee Arthroplasty ◽  
Myofascial Pain ◽  
Trigger Point ◽  
Short Form ◽  
Trigger Points ◽  
Mcgill Pain Questionnaire ◽  
Myofascial Trigger Points ◽  
Total Knee

BACKGROUND: Knee pain is one of the major sources of pain and disability in developed countries, particularly in aging populations, and is the primary indication for total knee arthroplasty (TKA) in patients with osteoarthritis (OA).OBJECTIVES: To determine the presence of myofascial pain in OA patients waitlisted for TKA and to determine whether their knee pain may be alleviated by trigger point injections.METHODS: Following ethics approval, 25 participants were recruited from the wait list for elective unilateral primary TKA at the study centre. After providing informed consent, all participants were examined for the presence of active trigger points in the muscles surrounding the knee and received trigger point injections of bupivacaine. Assessments and trigger point injections were implemented on the first visit and at subsequent visits on weeks 1, 2, 4 and 8. Outcome measures included the Timed Up and Go test, Brief Pain Inventory, Centre for Epidemiologic Studies Depression Scale, State-Trait Anxiety Inventory and Short-Form McGill Pain Questionnaire.RESULTS: Myofascial trigger points were identified in all participants. Trigger point injections significantly reduced pain intensity and pain interference, and improved mobility. All participants had trigger points identified in medial muscles, most commonly in the head of the gastrocnemius muscle. An acute reduction in pain and improved functionality was observed immediately following intervention, and persisted over the eight-week course of the investigation.CONCLUSION: All patients had trigger points in the vastus and gastrocnemius muscles, and 92% of patients experienced significant pain relief with trigger point injections at the first visit, indicating that a significant proportion of the OA knee pain was myofascial in origin. Further investigation is warranted to determine the prevalence of myofascial pain and whether treatment delays or prevents TKA.

Trigger Point Dry Needling versus Strain–counterstrain Technique for Upper Trapezius Myofascial Trigger Points: A Randomised Controlled Trial

2016 ◽  
Vol 34 (3) ◽  
pp. 171-177 ◽  
Author(s):  
E Segura-Ortí ◽  
S Prades-Vergara ◽  
L Manzaneda-Piña ◽  
R Valero-Martínez ◽  
JA Polo-Traverso
Keyword(s):  
Randomised Controlled Trial ◽  
Trigger Point ◽  
Controlled Trial ◽  
Trigger Points ◽  
Dry Needling ◽  
Significant Group ◽  
Myofascial Trigger Points ◽  
Upper Trapezius ◽  
Pain Pressure Threshold ◽  
Randomised Controlled

Background Treatment of active myofascial trigger points includes both invasive and non-invasive techniques. Objectives To compare the effects of upper trapezius trigger point dry needling (DN) and strain–counterstrain (SCS) techniques versus sham SCS. Study Design Randomised controlled trial. Method 34 study subjects with active trigger points were randomly assigned to one of three treatment groups, and received either three sessions of DN (n=12), six sessions of SCS (n=10), or sham SCS (n=12) over a 3-week period. Subjective pain response and subjects’ own ratings of perceived disability were measured. Results The analysis of variance mixed model showed a significant time effect for pain (p<0.001), elicited pain (p<0.001), pain pressure threshold (p<0.01), and neck disability index (p=0.016). Pain at rest decreased in all groups, as follows: DN 18.5 mm (95% CI 4.3 to 32.7 mm); SCS 28.3 mm (95% CI 12.4 to 44.1 mm); sham SCS 21.9 mm (95% CI 3.5 to 40.1 mm). Reductions in disability score (points) were significant in the SCS group (5.5, 95% CI 1.6 to 9.4) but not in the DN (1.4, 95% CI −4.9 to 2.1) or sham SCS (1.8, 95% CI −6.4 to 2.7) groups. There was no significant group×time interaction effect for any variables studied. Conclusions There were no differences between the sham SCS, SCS, and DN groups in any of the outcome measures. DN relieved pain after fewer sessions than SCS and sham SCS, and thus may be a more efficient technique. Future studies should include a larger sample size. Trial Registration Number NCT01290653.

scholarly journals Barbed Sutures in Total Knee Arthroplasty: Are They Really Useful? A Randomized Controlled Trial

2019 ◽  
Vol 33 (09) ◽  
pp. 927-930 ◽  
Author(s):  
Carlo Gamba ◽  
Pedro Hinarejos ◽  
Paula Serrano-Chinchilla ◽  
Joan Leal-Blanquet ◽  
Raul Torres-Claramunt ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Randomized Controlled Trial ◽  
Knee Arthroplasty ◽  
Controlled Trial ◽  
Barbed Sutures ◽  
Randomized Controlled ◽  
Closure Time ◽  
Subcutaneous Layer ◽  
Total Knee

AbstractBidirectional barbed sutures (BBSs) have recently been investigated in total knee arthroplasty (TKA). The contrasting results from the scarce literature suggest that BBSs are safe, save time and money, and give results comparable to traditional sutures. The purpose of the study is to test the real effect of BBSs on closure time in TKA and assess the functional results as well as the complications related to them. It was a randomized controlled trial. Eighty-five patients undergoing primary TKA were assigned to receive traditional closure with Vicryl (V-group) or with BBSs (Q-group). The exclusion criteria were significant coronal deformity, flexion contracture, or the need for stem and/or augmentation. The closure time for the capsule and that for the subcutaneous layer were registered separately. Intraoperative incidences were recorded. The follow-up was up to 1 month, during which the range of motion (ROM), superficial or deep infection, and wound dehiscence were assessed. There was a significant reduction in the capsule layer (27 seconds; p = 0.02) and global time closure (51 seconds; p = 0.01) in the Q-group. No differences were found in the subcutaneous layer (24 seconds; p = 0.055). There were more intraoperative suture breakages in the Q-group, mainly in the subcutaneous layer (p < 0.001). No differences in terms of dehiscence, infection, and ROM were observed at the 1-month follow-up. BBSs allow for slightly faster wound closure than Vicryl during a TKA. However, the differences observed have minimal clinical repercussions. Moreover, no differences in the infection rate (deep or superficial), dehiscence, or ROM were found.

scholarly journals Reduction in patient outcomes but implant-derived preservation of function following total knee arthroplasty: longitudinal follow-up of a randomized controlled trial

2020 ◽  
Vol 102-B (4) ◽  
pp. 434-441 ◽  
Author(s):  
David F. Hamilton ◽  
Richard Burnett ◽  
James T. Patton ◽  
Gavin J. MacPherson ◽  
A. H. R. W. Simpson ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Effect Size ◽  
Functional Outcomes ◽  
Controlled Trial ◽  
Group Differences ◽  
Large Effect Size ◽  
Randomized Controlled ◽  
Total Knee

Aims There are comparatively few randomized studies evaluating knee arthroplasty prostheses, and fewer still that report longer-term functional outcomes. The aim of this study was to evaluate mid-term outcomes of an existing implant trial cohort to document changing patient function over time following total knee arthroplasty using longitudinal analytical techniques and to determine whether implant design chosen at time of surgery influenced these outcomes. Methods A mid-term follow-up of the remaining 125 patients from a randomized cohort of total knee arthroplasty patients (initially comprising 212 recruited patients), comparing modern (Triathlon) and traditional (Kinemax) prostheses was undertaken. Functional outcomes were assessed with the Oxford Knee Score (OKS), knee range of movement, pain numerical rating scales, lower limb power output, timed functional assessment battery, and satisfaction survey. Data were linked to earlier assessment timepoints, and analyzed by repeated measures analysis of variance (ANOVA) mixed models, incorporating longitudinal change over all assessment timepoints. Results The mean follow-up of the 125 patients was 8.12 years (7.3 to 9.4). There was a reduction in all assessment parameters relative to earlier assessments. Longitudinal models highlight changes over time in all parameters and demonstrate large effect sizes. Significant between-group differences were seen in measures of knee flexion (medium-effect size), lower limb power output (large-effect size), and report of worst daily pain experienced (large-effect size) favouring the Triathlon group. No longitudinal between-group differences were observed in mean OKS, average daily pain report, or timed performance test. Satisfaction with outcome in surviving patients at eight years was 90.5% (57/63) in the Triathlon group and 82.8% (48/58) in the Kinemax group, with no statistical difference between groups (p = 0.321). Conclusion At a mean 8.12 years, this mid-term follow-up of a randomized controlled trial cohort highlights a general reduction in measures of patient function with patient age and follow-up duration, and a comparative preservation of function based on implant received at time of surgery. Cite this article: Bone Joint J 2020;102-B(4):434–441.

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