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Background/Objectives: Patient acceptable symptom state (PASS) thresholds have been used as a marker of good functional outcome following total knee arthroplasty (TKA) but have not been applied to pre-operative subjective function. This study aimed to compare the outcomes of patients above and below PASS thresholds prior to TKA. Methods: A secondary analysis of a multicenter prospective observational study was used, including 1182 patients prescribed a smartphone-based care management platform following TKA with pre-operative and 1-year KOOS JR scores available. Patient demographics, pain, satisfaction, and KOOS JR were compared between those above and below PASS pre-operatively by student t-test. Logistic regression was used to quantify the odds of decline or no improvement at 1 year. Results: In this cohort, 191 (16.2%) KOOS JR scores were above PASS thresholds prior to TKA. Those above PASS reported lower pain pre-operatively (3.7 ± 1.9 vs. 6.0 ± 1.9, p < 0.0001) and less pain reduction at 90 days (−1.4 ± 2.5 vs. −3.2 ± 2.6, p < 0.0001). Patients above PASS also demonstrated higher KSS satisfaction scores pre-operatively (20.7 ± 7.9 vs. 12.1 ± 6.7, p < 0.0001) with less improvement (9.9 ± 10.6 vs. 16.5 ± 11.2, p < 0.0001) at 90 days. In logistic regression, those above PASS pre-operatively were 5.1 times more likely to report a decline or no improvement in KOOS JR at 1 year (5.10 95% CI 2.73–9.53, p < 0.0001). Conclusions: Patients above previously defined PASS thresholds who presented for TKA appreciated less improvement in pain and satisfaction and were more likely to experience functional decline or no improvement in KOOS JR post-operatively. The application of PASS thresholds pre-operatively may be useful for patient selection or guidance of patient expectations. [ABSTRACT FROM AUTHOR]

Patients with end-stage osteoarthritis are recommended to engage in physical activity (PA) to reduce pain and improve function but may avoid PA due to joint pain. Our goal was to investigate patient-reported outcomes and objective mobility metrics (step counts) in total hip arthroplasty (THA) patients as a function of pre-operative PA levels. In total, 1647 patients enrolled in a multicenter prospective cohort study investigating a smartphone-based care management platform for self-directed rehabilitation that underwent THA and were included in analysis. The entire cohort's step count was divided into quartiles to categorize patients with low, moderate, and high baseline PA. Outcomes including pain, EQ-5D-5L, HOOS JR, and step counts were compared according to activity group by ANOVA. Pre-operative pain scores were lowest, with smallest improvements, in the high-baseline PA group. Low-PA patients demonstrated the greatest improvements in EQ-5D-5L, while changes in EQ-VAS, HOOS JR, and satisfaction were similar between groups. Low- and moderate-PA patients increased physical activity by six weeks, reaching 180% and 114% of pre-operative steps; high-PA patients did not return to full step counts until one-year post-operation. Patients who perform high levels of PA undergoing THA report lower levels of pain and higher function pre-operatively but may appreciate less improvement in PA up to one year post-operatively. These results may be helpful in appropriate counseling of patient expectations prior to surgery. [ABSTRACT FROM AUTHOR]

Physical activity (PA) is suggested to reduce osteoarthritis pain; however, it may be avoided by patients requiring arthroplasty. Our goal was to investigate objective and patient-reported outcomes as a function of pre-operative PA levels in patients undergoing total knee arthroplasty (TKA). A total of 1941 patients enrolled in a multicenter prospective cohort study investigating a smartphone-based care management platform for self-directed rehabilitation underwent TKA and were included in the analysis. Activity was categorized based on the cohort's step count quartiles into low, moderate, and high pre-operative PA. Pre-operative and post-operative pain, EQ5D5L, KOOS JR, and step counts were compared by ANOVA according to activity group. Pre-operative pain scores increased with the decreasing activity level (all, p < 0.05) and were most improved post-operatively in the low PA group. High PA patients demonstrated the smallest improvements in EQ-5D-5L and KOOS JR. Low and moderate PA patients increased physical activity by three months, reaching 176% and 104% of pre-operative steps; high PA patients did not return to full step counts by one year post-operatively. Patients undergoing TKA who present with higher levels of physical activity report lower levels of pain and higher function pre-operatively but appreciate less improvement up to one year post-operatively. These results may be helpful in appropriate counseling of patient expectations before TKA. [ABSTRACT FROM AUTHOR]

Background and Objectives: National joint registries report higher total knee arthroplasty (TKA) revision rates in posterior-stabilized (PS) systems compared to non-posterior-stabilized designs. The purpose of this study was to investigate the implant survivorship and clinical outcomes of an anatomic implant with a PS bearing. Materials and Methods: An early- to mid-term follow-up of a prospective, multi-center, non-controlled outcomes study of patients who received primary TKA between November 2014 and June 2017 was performed. A total of 800 cases using PS bearings that were implanted in 664 patients were monitored post-operatively for their implant survivorship and adverse events for up to five years. The Knee Society Knee and Function scores, patient satisfaction, the five-dimensional European Quality of Life questionnaire, and range of motion (ROM) were evaluated pre-operatively and post-operatively at six weeks, six months, one year, two years, three years, and five years. Results: The mean follow-up period was 3.7 ± 1.3 years, and the three-year implant survival rate was 99.3% (95% CI: 98.4%, 99.7%) with five revisions during the five-year follow-up. Patient satisfaction was 96.1% at six weeks and increased to 99.3% at one year. All patient-reported outcome measures significantly (p < 0.0001) increased up to the one-year follow-up and then remained stable up to the five-year follow-up. Conclusions: This study supports the excellent survivorship and patient-reported outcomes of the Persona® Knee system using cemented, fixed bearing, posterior-stabilized components with minimal complications at early- to mid-term follow-up in an international Asian population. Ongoing observations are being performed to investigate the mid- to long-term survivorship and clinical outcomes associated with this knee system. [ABSTRACT FROM AUTHOR]

Context: Capsaicinoids and capsinoids (CAP) are natural substances found primarily in chili peppers and other spicy foods that agonize the transient receptor potential vanilloid-1 in the mouth, stomach, and small intestine. Several studies have shown CAP to be a potential antiobesity agent and to exhibit an analgesic effect in both rodents and humans. However, there is no scientific consensus about the effects of CAP on physical exercise performance and its physiological mechanisms of action. Purpose: This systematic review aimed to better elucidate the effects of CAP compounds as ergogenic aids and to discuss underlying mechanisms of action by which this supplement may potentially enhance endurance performance and muscular strength. Conclusions: Among 22 studies included in the review, 14 examined the effects of capsaicinoid or capsinoid compounds on endurance and resistance exercise performance in animals, with 9 studies showing benefits on performance. In humans, 8 studies were included: 3 demonstrated significant acute endurance benefits and 2 showed acute resistance exercise performance benefits compared with a placebo condition. Therefore, while more mechanistic studies are necessary to confirm these outcomes in humans, the available scientific literature appears to suggest that these compounds could be considered an effective nutritional strategy to improve exercise performance. [ABSTRACT FROM AUTHOR]

This study aimed to compare the effects of an 8-week creatine (CR) or placebo (PL) supplementation on muscle strength, thickness, endurance, and body composition employing different training paradigms with blood flow restriction (BFR) vs. traditional resistance training (TRAD). Seventeen healthy males were randomized between the PL (n = 9) and CR (n = 8) groups. Participants were trained unilaterally utilizing a within-between subject bicep curl exercise where each arm was allocated to TRAD or BFR for 8 weeks. Muscular strength, thickness, endurance, and body composition were evaluated. Creatine supplementation promoted increases in muscle thickness in TRAD and BFR compared with their placebo counterparts, however, without a significant difference between treatments (p = 0.349). TRAD training increased maximum strength (1 repetition maximum (1RM)) compared with BFR after 8 weeks of training (p = 0.021). Repetitions to failure at 30% of 1RM were increased in the BFR-CR group compared with the TRAD-CR group (p = 0.004). Repetitions to failure at 70% 1RM were increased from weeks 0–4 (p < 0.05) and 4–8 (p < 0.05) in all groups. Creatine supplementation exerted a hypertrophic effect when utilized with TRAD and BFR paradigms and increased muscle performance at 30% 1RM when utilized in conjunction with BFR. Therefore, creatine supplementation seems to amplify muscle adaptation following a BFR program. Registered in the Brazilian Registry of Clinical Trials (ReBEC), under the registration number: RBR-3vh8zgj. [ABSTRACT FROM AUTHOR]

Conrado de Freitas, M, Ricci-Vitor, AL, de Oliveira, JVNS, Quizzini, GH, Vanderlei, LCM, Silva, BSA, Zanchi, NE, Cholewa, JM, Lira, FS, and Rossi, FE. Appetite is suppressed after full-body resistance exercise compared with split-body resistance exercise: the potential influence of lactate and autonomic modulation. J Strength Cond Res 35(9): 2532-2540, 2021-The purposes of this study were to investigate the effects of full- vs. split-body resistance training on appetite and leptin response and to verify the potential involvement of lactate and autonomic modulation during this response in trained men. Twelve recreationally resistance-trained men (age = 26.1 ± 5.5 years) performed 3 randomized trials in 3 conditions: upper body (UB), lower body (LB), and full body (FB). The subjective rating of hunger was obtained through a visual analog scale. Leptin and lactate concentration were evaluated at rest, immediately after exercise, and during recovery. Heart rate variability in the time and frequency domains was recorded at baseline and during recovery (until 60 minutes after exercise) to assess autonomic modulation. The FB condition induced lower subjective hunger ratings than the UB at Post-1 hour (p < 0.05) and a significant difference in the area under the curve between conditions (p = 0.028) with lower hunger sensation for FB in relation to UB (p = 0.041). The FB presented greater lactate concentration and induced slower heart rate variability recovery in relation to UB and LB conditions (p < 0.05), and heart rate variability remained lower until 60 minutes after exercise compared with rest only in the FB condition. There was a significant negative correlation between subjective hunger ratings and lactate concentration only for the FB condition (r = -0.72, p = 0.028). Full-body resistance exercise induced lower subjective hunger ratings after exercise in relation to UB resistance exercise. The FB also induced higher lactate production and slower recovery of autonomic modulation compared with the UB and LB conditions. Future research is necessary to investigate a mechanistic relationship between lactate concentrations and hunger suppression after resistance exercise. [ABSTRACT FROM AUTHOR]