• Knee surgery & related research
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• v.30 no.4
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• pp.293-302
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• 2018

Purpose: High tibial valgus osteotomy (HTO) is a well-established surgical procedure for patients with medial compartment osteoarthritis (OA) of the knee. The hybrid closed-wedge HTO (CWHTO) procedure permits extensive correction in patients with severe deformities or patellofemoral joint OA. The aim of this study was to report the short-term results in a consecutive series of patients treated with hybrid CWHTO. Materials and Methods: We retrospectively evaluated the clinical outcomes and radiographic parameters in 29 consecutive knees that underwent hybrid CWTHO to correct medial compartment OA at an average follow-up of 52.6 months. Clinical outcomes were assessed using the Lysholm score and knee scoring system of the Japanese Orthopedic Association (JOA). The Kellgren-Lawrence grading system and pre- and postoperative mechanical axis (MA), femorotibial angle (FTA), posterior tibial slope, and patella height were assessed. Results: The FTA and MA significantly changed from $180.7^{\circ}$ to $170.4^{\circ}$ and from $22.0^{\circ}$ to $60.2^{\circ}$, respectively. No significant differences were observed between the mean pre- and postoperative posterior tibial slope, Insall-Salvati ratio, or Caton-Deschamps index. The postoperative JOA and Lysholm scores significantly improved from 76.7 to 95.8 and from 58.8 to 90.2, respectively. Conclusions: Satisfactory outcomes can be achieved with hybrid CWHTO in patients with medial OA.

• Journal of Korean Medicine Rehabilitation
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• v.23 no.1
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• pp.25-49
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• 2013

Objectives : This study was carried out to know the anti-osteroarthritic effects of Bangkibokryeong-tang(Fanjifuling-tang(BBT)) on the papain-induced osteoarthritis C57BL/10 mouse. Methods : Osteoarthritis was induced by injection of papain(6 ${\mu}l$) into knee joint of mouse. Osteoarthritic mice were divided into 4 groups(normal, control, joins(R), BBT). The injection did not fit the normal group. A week later, after the injection of papain, control group was taken normal saline 200 ${\mu}l$, positive control group was taken joins(R)(100 mg/kg), treated group was taken extract of Bangkibokryeong-tang(Fanjifuling-tang(BBT))(400 mg/kg). After then, we examined hepatotoxicity, nephrotoxicity, inflammation cytokines, expression of inflammation factor mRNA, hemotology, histology through the micro CT-arthrography, and etc. Results : 1. Hepatotoxicity and nephrotoxicity have not expressed. 2. The levels of IL-$1{\beta}$, TNF-${\alpha}$, IL-6, MCP-1, Thromboxane B2, Leukotriene B4, Prostaglandin E2 in serum were significantly decreased. 3. In hematology, the levels of neutrophils and monocytes were significantly decreased. 4. The expression of inflammation factor mRNA like TNF-${\alpha}$ and IL-6, COX-2, iNOS-II were significantly inhibited. 5. In micro CT-arthrography, cartilage volume was less decreased. 6. The degree of osteoarthritis induced damage of joint of BBT group is low in histopathologic observation(hematoxylin&eosin(H&E), Safranin-O). Conclusions : According to this study, BBT has effect of anti-osteoarthritis. Further clinical research for the cartilage protective effect is necessary.

• The Korean Journal of Physiology and Pharmacology
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• v.20 no.1
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• pp.129-136
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• 2016

This study was performed to investigate whether an intra-articular injection of transient receptor potential vanilloid 1 (TRPV1) receptor agonist, resiniferatoxin (RTX) would alleviate behavioral signs of arthritic pain in a rat model of osteoarthritis (OA). We also sought to determine the effect of RTX treatment on calcitonin gene-related peptide (CGRP) expression in the spinal cord. Knee joint inflammation was induced by intra-articular injection of monosodium iodoacetate (MIA, $8mg/50{\mu}l$) and weight bearing percentage on right and left hindpaws during walking, paw withdrawal threshold to mechanical stimulation, and paw withdrawal latency to heat were measured to evaluate pain behavior. Intra-articular administration of RTX (0.03, 0.003 and 0.0003%) at 2 weeks after the induction of knee joint inflammation significantly improved reduction of weight bearing on the ipsilateral hindlimb and increased paw withdrawal sensitivity to mechanical and heat stimuli. The reduction of pain behavior persisted for 3~10 days according to each behavioral test. The MIA-induced increase in CGRP immunoreactivity in the spinal cord was decreased by RTX treatment in a dose-dependent manner. The present study demonstrated that a single intra-articular administration of RTX reduced pain behaviors for a relatively long time in an experimental model of OA and could normalize OA-associated changes in peptide expression in the spinal cord.

• Knee surgery & related research
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• v.30 no.4
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• pp.303-310
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• 2018

Purpose: The purpose of this study was to investigate whether surgical experience could improve surgical competency in medial open wedge high tibial osteotomy (MOWHTO). Materials and Methods: One hundred consecutive cases of MOWHTO were performed with preoperative planning using the Miniaci method. Surgical errors were defined as under- or overcorrection, excessive posterior slope change, or the presence of a lateral hinge fracture. Each of these treatment failures was separately evaluated using the cumulative summation test for learning curve (LC-CUSUM). Results: The LC-CUSUM showed competency in prevention of undercorrection, excessive posterior slope change, and lateral hinge fracture after 27, 47, and 42 procedures, respectively. However, the LC-CUSUM did not signal achievement of competency in prevention of overcorrection after 100 procedures. Furthermore, the failure rate for overcorrection showed an increasing tendency as surgical experience increased. Conclusions: Surgical experience may improve the surgeon's competency in prevention of undercorrection, excessive posterior slope change, and lateral hinge fracture. However, it may not help reduce the incidence of overcorrection even after performance of 100 cases of MOWHTO over a period of 6 years.

• Journal of Korean Medicine Rehabilitation
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• v.21 no.1
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• pp.57-77
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• 2011

Objectives : This study was to investigate the suppression effects of Sopunghwalhyeol-tang(Shufenghuoxie-tang) on the monosodium iodoacetate-induced osteoarthritis in rats. Methods : Arthritis was induced by injection of monosodium iodoacetate(0.5 mg) into the both knee joints of rats. Arthritic rats were divided into control(n=8) and treated(n=8) group. Control group was taken distilled water for 20 days. Treated group was taken extracts of Sopunghwalhyeol-tang(Shufenghuoxie-tang) by oraly for same duration. Normal group(n=8) was injected with normal saline and was taken distilled water for 20 days. Macroscopic examination and histopathological study on articular cartilage of knee joint were operated at 20 days after injection. Proteoglycan(PG) content of articular cartilages of knee joint was represented by safranine O staining, was measured at 20 days after injection. Tumor necrosis $factor-{\alpha}(TNF-{\alpha})$, $interleukin-1{\beta}(IL-1{\beta})$, in synovial fluid were measured with enzyme-linked immuno sorbent assay(ELISA) kit at 20 days after injection. Immunohistochemical staining of cyclo-oxygenase-2(COX-2), inducible nitric oxide synthase(iNOS) in knee joints were observed at 20 days after injection. Results : 1. Lymphocytes in peripheral blood the treated group was significantly decreased compared with the control group. 2. PG content in articular cartilage of the treated group was significantly increased compared with the control group. 3. Histopathologically, osteoarthritic scores of the treated group was significantly decreased compared with the control group. 4. $TNF-{\alpha}$ content in synovial fluid of the treated group was significantly decreased compared with the control group. 5. COX-2 revelation index in chondrocytes and synovial membrane of the treated group was significantly decreased compared with the control group. 6. Matrix metalloproteinase-3(MMP-3) revelation index in chondrocytes and synovial membrane of the treated group was significantly decreased compared with the control group. Conclusions : On the basis of these results, we concluded that Sopunghwalhyeol-tang(Shufenghuoxie-tang) has inhibiting effects on the $TNF-{\alpha}$, COX-2 and MMP-3 secretion of chondrocytes and synovial membrane in Monosodium Iodoacetate-induced osteoarthritis model of rats.

• Journal of Korean Medicine Rehabilitation
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• v.26 no.3
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• pp.17-30
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• 2016

Objectives The purpose of this study was to find out the effects of ChondroT on arthralgia of the Collagenase-induced osteoarthritis in rats. Methods Osteoarthritis was induced into rat by injecting Collagenase in its knee joint. Rats are divided into a total of 8 groups (n=6). Normal group was not induced for osteoarthritis whereas control groups were induced for osteoarthritis by Collagenase. Positive-A (Indomethacin) was injected with Collagenase and after 8 days, 2 mg/kg of Indomethacin was medicated. Positive-B (JOINS TAB) was injected with Collagenase and after 8 days, 20 mg/kg of JOINS TAB was medicated. Experimental groups (Chondro T) at three dose levels (50, 100 and 200 mg/kg) were injected with Collagenase and after 8days they were medicated with 10 ml/kg. Indomethacin, JOINS TAB and ChondroT were medicated each substances once a day for 10 days. Thereafter, the changes in plantar withdrawal response of osteoarthritis rats by dynamic plantar aesthesiometer were observed and then RT-PCR analysis was done to investigate the expression of related proteins. Results 1. ChondroT significantly decreased withdrawal response of mechanical allodynia compared with control group in all of the experimental groups (ChondroT-A, ChondroT-B, ChondroT-C). 2. ChondroT significantly reduced Bax/Bcl-2 ratio in all of the experimental groups (ChondroT-A, ChondroT-B, ChondroT-C). 3. ChondroT significantly reduced the expression of INF-${\gamma}$ compared with control group in group ChondroT-B, ChondroT-C. Conclusions This results suggest that ChondroT may be meaningful for suppressing the pain of osteoarthritis. Further study is needed to conduct a rigorous clinical research.

• Journal of Korean Foot and Ankle Society
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• v.15 no.1
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• pp.27-31
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• 2011

Purpose: This study evaluated the efficacy of an intra-articular injection of sodium hyaluronate in the treatment of early stage osteoarthritis of the ankle. Materials and Methods: Early stage ankle osteoarthritis (Takakura stage I and II) patients who received hyaluronic acid injection therapy were retrospectively reviewed. Patients underwent intra-articular injections of 2 mL of sodium hyaluronate for 3 consecutive weeks. Clinical evaluation and Visual Analogue Scale (VAS) scoring were performed at every three months after treatment. Results: Total 27 patients were involved and mean age was 55 year old (range 33 to 77 years). There were 13 male and 14 female patients. Mean follow up duration was 13 month and. Pre-intra-articular VAS score was $8.9{\pm}0.7$ and three month follow up score was $3.8{\pm}2.8$. VAS score of last follow up was $3.2{\pm}3.4$. The effect of hyaluronic acid continued about one year when analyzed the VAS score change of the patients followed for more than one year. Patients' satisfaction was "very satisfied" in nine, "satisfied" in 12, "fair" in one, and "not satisfied" in five patients. Overall satisfaction rate was 82%. There were no ankle osteoarthritis stage changes in serial follow up radiograph. Conclusion: Symptomatic relief of signs and symptoms of osteoarthritis of the ankle was achieved by injection of an intra-articular hyaluronate injection. Efficacy of Hyaluronate acid injection persisted more than 1 year in our study. Intra-articular hyaluronate injection to ankle osteoarthritis is safe and effective as knee joint and should be considered as a valid conservative treatment for ankle osteoarthritis.

• Journal of Acupuncture Research
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• v.26 no.6
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• pp.121-132
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• 2009

Objectives : To evaluate the current status of East-West combination treatment in joint disorders. Methods : The medical records of patients who visited the Joints & Rheumatism Center at the Kyung Hee East-West Neo Medical Center from April 2006 to June 2009 were evaluated. The general characteristics of patients who underwent combination treatment, trend in number of cross-system referrals, and disorders and involved body regions of patients referred to the Eastern medical hospital from the Western medical hospital were initially assessed. 6 major disorders were found from the initial scanning. The trend in number of cross-hospital referrals, number of visits to the Eastern medical hospital, current status of combination treatment, treatment modality, and reason for cross-system referral was evaluated. Results : 1. 1510 patients were referred from the Eastern medical hospital to the Western medical hospital, and 1065 patients were referred from the Western medical hospital to the Eastern medical hospital. First visit patients reached a peak at the second quarter of 2007 and fourth quarter of 2006 respectively, and have steadily decreased from then on. Referrals of female patients were twice as common as male patient referrals. Patients in their sixth or seventh decade of life were most commonly referred, and more outpatients were referred compared to inpatients. 2. Patients with knee joint disorders were most commonly referred from the Western medical hospital to the Eastern medical hospital, followed by hip, shoulder, ankle, wrist, and elbow joint disorders. The most common disorders for each of the above regions in referred patients were knee osteoarthritis, avascular necrosis of the hip, adhesive capsulitis, and ankle strain and sprain. The generalized disorders rheumatoid arthritis and ankylosing spondylitis followed. 3. Patients referred to the Eastern hospital received approximately 3 to 10 Eastern medical treatment sessions. 45 percent remained on constant combination treatment, and 98 percent of referred patients received acupuncture treatment. Conclusions : In regard to the number of patients and duration of combination treatment, combination treatment was successfully performed for knee osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis, while it was not so for avascular necrosis of the hip, adhesive capsulitis, and ankle strain and sprain. Further research on this subject is required.

• Journal of Korean Medicine Rehabilitation
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• v.28 no.1
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• pp.19-31
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• 2018

Objectives The object of this study was to investigate the antioxidative and antiinflammatory effects of Jinmu-tang extract (JMT) on the Monosodium iodoacetate (MIA)-induced rat osteoarthritis. Methods To investigate the antioxidant capacities of JMT, we measured the total polyphenol and flavonoid, and 2,2-diphenyl-1-picrylhydrazyl (DPPH) and 2,2'-Azino-bis(3-ethyl-benzothiazoline-6-sulfonic acid) (ABTS) radical scavenging activity. To evaluate the antioxidative and antiinflammatory effects of JMT, the rats were divided into 5 groups (n=8). Normal group was not induced by MIA and treated at all (N), control group was induced by MIA and not treated at all (Con), positive control group was induced by MIA and orally administered indomethacin 5 mg/kg (Indo) and experimental groups were induced by MIA and orally administered JMT 100 mg/kg (JMT100) and JMT 200 mg/kg (JMT200) for 4 weeks. The changes of anti-type II collagen antibody in serum, heme oxygenase-1 (HO-1), phosphorylated inhibitor of ${\kappa}B{\alpha}$ ($p-I{\kappa}B{\alpha}$), cyclooxygenase-2 (COX-2), inducible nitric oxide synthase (iNOS) and tumor necrosis factor alpha ($TNF-{\alpha}$) in knee joint tissue and histopathological observation (Hematoxylin & Eosin and Safranin-O stain) were measured. Results Total polyphenol and flavonoid levels of JMT were $26.90{\pm}0.33mg/g$ and $6.02{\pm}0.34mg/g$. $IC_{50}$ of L-ascorbic acid and JMT of DPPH radical scavenging activity were $1.35{\pm}0.07{\mu}g/ml$ and $52.95{\pm}0.97{\mu}g/ml$. $IC_{50}$ of L-ascorbic acid and JMT of ABTS radical scavenging activity were $3.18{\pm}0.02{\mu}g/ml$ and $91.49{\pm}1.74{\mu}g/ml$. In serum, the anti-type II collagen antibody levels of JMT100 and JMT200 groups were decreased significantly. In knee joint tissue, the HO-1 level of JMT200 was increased significantly. The $p-I{\kappa}B{\alpha}$ and $TNF-{\alpha}$ levels of JMT200 were decreased significantly. The COX-2 and iNOS levels of JMT groups were decreased significantly. In histopathological observation, in comparison with Con, synovial tissue, cartilage and proteoglycan of JMT100 and JMT200 were well preserved. Conclusions According to the results, It is considered that JMT has antioxidant and antiinflammatory effects for MIA-induced rat osteoarthritis, so it could be applied to osteoarthritis treatment.

• Biomolecules & Therapeutics
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• v.22 no.3
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• pp.260-266
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• 2014

This study evaluated the pharmacokinetic profile and therapeutic efficacy of piroxicam (PX), a long acting non-steroidal anti-inflammatory drug for the treatment of arthritis, following intra-articular (IA) injection in comparison to the pharmacokinetic profile and therapeutic efficacy of PX after intramuscular (IM) injection. In the pharmacokinetic study in rats, systemic exposure and pharmacokinetic parameters of PX after a single IA dose were compared with systemic exposure and pharmacokinetic parameters of PX after administration of the same dose IM (0.6 mg/kg). The anti-inflammatory and analgesic effects of IA PX were evaluated simultaneously in a monoiodoacetate-induced osteoarthritis rat model. The plasma PX concentration rapidly rose following IA injection, and it was comparable to the plasma PX concentration following IM injection, suggesting the rapid efflux of the drug molecule from the joint cavity. However, in the efficacy study, the IA PX administration significantly reduced the knee swelling by reducing the level of prostaglandin $E_2$ in the joint, compared to that following administration of IA vehicle and after administration of the IM PX dose. In addition, we found that the anti-inflammatory and anti-nociceptive efficacies of IA PX were synergistically increased upon co-treatment with hyaluronic acid (HA), a potent agent for the treatment of osteoarthritis, at the weight ratio of 1:1 or 1:2, and these effects were more pronounced than those following administration of HA or PX alone. In conclusion, this study demonstrated the efficacy of the IA use of PX alone and/or in combination with HA in osteoarthritis.