Search Results (437)

Background and Objectives: Spinopelvic alignment may affect the outcomes of total hip arthroplasty (THA), with pelvic version influencing the risk of mechanical complications occurring after surgery. On the other hand, THA surgery itself may contribute to the modification of pelvis version. The sacro-femoro-pubic (SFP) angle is measured on anteroposterior (AP) radiographs of the pelvis in a supine position, and is used to estimate pelvic tilt (PT), representative of pelvic version, which requires lateral views of the sacrum for its calculation; however, these X rays are not routinely performed in the preoperative setting of hip surgery. This study aims to analyze how THA determines changes in the pelvic version of operated patients; the SFP angle will be used to assess pelvic version on standard AP radiographs. Materials and Methods: This retrospective study included 182 consecutive patients undergoing THA for unilateral primary degenerative hip osteoarthritis (HOA-study group, n = 104) or femoral neck fracture (FNF-control group, n = 78) at the author’s institution. The SFP angle was measured on AP pelvic radiographs of the non-replaced hip preoperatively, postoperatively, and at the last follow-up. PT values were derived from SFP angles. Pre- and postoperative PT and its variations ΔPT were assessed. Study groups were compared in terms of native and postoperative variations of pelvic version. Results: The average absolute value of ΔPT was 2.99° ± 3.07° in the HOA group and 3.57° ± 2.92° in FNF group. There was no significant overall difference in preoperative or postoperative PT values between groups. In both groups, THA surgery led to a certain improvement, still not significant, in pelvic orientation, with FNF patients presenting a greater tendency toward retroversion. No significant differences in complication rates were found comparing patients with different pelvic orientations. Conclusions: THA can lead to a “normalization” of pelvic version in a certain number of patients with preoperative anteversion or retroversion. Although statistically non-significant, this observation may have clinical implications for spinopelvic balance and could support prioritizing THA in patients with concurrent spinal disease. Further research is needed to confirm these findings and to evaluate the long-term impact of THA on spinopelvic alignment. Full article

Background: Residual deficits after early treatment of developmental dysplasia of the hip (DDH) using osteotomy often led to asymmetrical gait deviations with increased repetitive rates of ground reaction force (GRF) in both hips, resulting in a higher risk of early osteoarthritis. This study investigated lower limb inter-joint coordination and swing foot control during level walking in adolescents with early-treated unilateral DDH. Methods: Eleven female adolescents treated early for DDH using Pemberton osteotomy were compared with 11 age-matched healthy controls. The joint angles and angular velocities of the hip, knee, and ankle were measured, and the corresponding phase angles and continuous relative phase (CRP) for hip–knee and knee–ankle coordination were obtained. The variability of inter-joint coordination was quantified using the deviation phase values obtained as the time-averaged standard deviations of the CRP curves over multiple trials. Results: The DDH group exhibited a flexed posture with increased variability in knee–ankle coordination of the affected limb throughout the gait cycle compared to the control group. In contrast, the unaffected limb compensated for the kinematic alterations of the affected limb with reduced peak angular velocities but increased knee–ankle CRP over double-limb support and trajectory variability over the swing phase. Conclusions: The identified changes in inter-joint coordination in adolescents with early treated DDH provide a plausible explanation for the previously reported increased GRF loading rates in the unaffected limb, a risk factor of premature OA. Full article

Background/Objectives: Degenerative processes of the hip joint increasingly affect not only the articular cartilage but also periarticular structures such as the joint capsule and acetabular labrum. This study aimed to investigate the structural and molecular changes occurring in these tissues during advanced hip osteoarthritis. Methods: A combined analysis using immunohistochemistry (IHC), scanning electron microscopy (SEM), and micro-computed tomography (microCT) was conducted on tissue samples from patients undergoing total hip arthroplasty and from controls with morphologically normal joints. Markers associated with proliferation (Ki67), inflammation (CD68), angiogenesis (CD31, ERG), chondrogenesis (SOX9), and lubrication (Lubricin) were evaluated. Results: The pathological group showed increased expression of Ki67, CD68, CD31, ERG, and SOX9, with a notable decrease in Lubricin. SEM analysis revealed ultrastructural disorganization, collagen fragmentation, and neovascular remodeling in degenerative samples. A significant correlation between structural damage and molecular expression was identified. Conclusions: These results suggest that joint capsule and acetabular labrum degeneration are interconnected and reflect a broader pathophysiological continuum, supporting the use of integrated IHC and SEM profiling for early detection and targeted intervention in hip joint disease. Full article

Lipoma arborescens (LA) is a rare, non-neoplastic, intra-articular, mass-like lesion with villous lipomatous proliferation that replaces and distends the synovium, particularly in the knee joint. A few cases have been sporadically reported to affect the shoulder, elbow, wrist, hip, and ankle. The authors would like to present a rare and unique case of LA in the elbow joint with significant osteoarthritis in a 24-year-old young man, which suggests that a longstanding pre-existing LA can give rise to severe degenerative arthritis even in young patients unless diagnosed early and adequately treated. Full article

Introduction/Objectives: Osteoarthritis (OA) is a chronic systemic disease that affects the entire array of joint structures. It is one of the most common chronic, socially significant diseases, associated with a decline in the quality of life of patients and constantly increasing the cost of treatment. Clinical trial outcomes are largely inconclusive, and OA remains one of the few musculoskeletal diseases without an established disease-modifying therapy. One potential explanation is the use of ineffective tools for OA classification, patient stratification, and the assessment of disease progression. There is growing interest in musculoskeletal ultrasonography (MSK US), as it enables the dynamic visualization of the examined structures and gives information about both inflammatory and structural changes that have occurred. Determining the leading ultrasound phenotype, which depends on the most damaged tissue at a given time (bone, cartilage, synovial membrane, joint capsule, ligaments, tendons, menisci, etc.), can rationalize therapy use by selecting patients more suitable for specific treatments. This article aims to evaluate and summarize the potential of MSK US in the process of determining the clinical phenotype of OA and to emphasize the importance of this imaging modality in evaluating further therapeutic strategies. Method: A single-center prospective study conducted in the period of September 2023–June 2024 enrolled 259 consecutive patients with proven OA. The statistical program Minitab version 22.2.1 (2025) was used to analyze the data. The predominant and secondary phenotypes were tabulated for each OA localization and were presented numerically and as relative proportions (%). The rate of the most frequently occurring phenotypes was compared against that of the less frequent ones through paired z-tests. The initially acceptable type I error was set at 5%; it was further adjusted for the number of comparisons (Bonferroni). Results: The most frequent and predominant US phenotype for patients with knee OA was intra-articular effusion (n = 47, 37.90%). It was significantly higher compared to the rest of the US phenotypes: synovial proliferation (n = 22, 17.70%; p < 0.001), cartilage destruction (n = 26, 21%; p = 0.001), altered subchondral bone (n = 8, 6.50%; p < 0.001), extra-articular soft tissue changes (n = 12, 9.70%; p < 0.001), crystal deposits (n = 6, 4.8%; p < 0.001), and post-traumatic (n = 3, 2.40%; p < 0.001). The most common US phenotype for hip OA was altered subchondral bone (n = 32, 47.1%), with significant differences from intra-articular effusion (n = 12, 17.60%; p = 0.001), synovial proliferation (n = 5, 7.40; p = 0.001), cartilage destruction (n = 12, 17.60%; p = 0.001), extra-articular soft tissue changes (n = 3, 4.40%; p = 0.001), crystal deposits (n = 3, 4.40%; p = 0.001), and post-traumatic (n = 0). Altered subchondral bone was also the leading US phenotype for hand OA (n = 31, 55.40%), with significant differences compared to intra-articular effusion (n = 1, 1.80%; p < 0.001), synovial proliferation (n = 7, 12.50%; p < 0.001), cartilage destruction (n = 11, 19.60%; p < 0.001), extra-articular soft tissue changes (n = 2, 3.60%; p < 0.001), crystal deposits (n = 3, 5.40%; p < 0.001), and post-traumatic (n = 1, 1.80%, p < 0.001). For shoulder OA, extra-articular soft tissue changes were the most frequent (n = 8, 46.20%), followed by post-traumatic (n = 4, 30.70%), as the rate of both phenotypes was significantly higher compared to that of intra-articular effusion (n = 0), synovial proliferation (n = 0), cartilage destruction (n = 1, 7.70%; p = 0.003), and crystal deposits (n = 0). Conclusions: The therapeutic approach for OA is a dynamic and intricate process, for which the type of affected joint and the underlying pathogenetic mechanism at a specific stage of the disease’s evolution is essential. MSK US is one of the options for the clinical phenotyping of OA. Some of the suggested ultrasound subtypes may serve as the rationale for selecting a particular treatment. Full article

Background: Ginger contains gingerols, shagaols, paradols, gingerdiones, and terpenes, which have been shown to display anti-inflammatory properties and inhibit pain receptors. For this reason, ginger has been marketed as a natural analgesic. This study examined whether a specialized ginger extract obtained through supercritical CO₂ extraction and subsequent fermentation affects pain perception, functional capacity, and markers of inflammation. Methods: Thirty men and women (56.0 ± 9.0 years, 164.4 ± 14 cm, 86.5 ± 20.9 kg, 31.0 ± 7.5 kg/m²) with a history of mild to severe joint and muscle pain as well as inflammation participated in a placebo-controlled, randomized, parallel-arm study. Participants donated fasting blood, completed questionnaires, rated pain in the thighs to standardized pressure, and then completed squats/deep knee bends, while holding 30% of body mass, for 3 sets of 10 repetitions on days 0, 30, and 56 of supplementation. Participants repeated tests after 2 days of recovery following each testing session. Participants were matched by demographics and randomized to ingest 125 mg/d of a placebo or ginger (standardized to contain 10% total gingerols and no more than 3% total shogaols) for 58 days. Data were analyzed by a general linear model (GLM) analysis of variance with repeated measures, mean changes from the baseline with 95% confidence intervals, and chi-squared analysis. Results: There was evidence that ginger supplementation attenuated perceptions of muscle pain in the vastus medialis; improved ratings of pain, stiffness, and functional capacity; and affected several inflammatory markers (e.g., IL-6, INF-ϒ, TNF-α, and C-Reactive Protein concentrations), particularly following two days of recovery from resistance exercise. There was also evidence that ginger supplementation increased eosinophils and was associated with less frequent but not significantly different use of over-the-counter analgesics. Conclusions: Ginger supplementation (125 mg/d, providing 12.5 mg/d of gingerols) appears to have some favorable effects on perceptions of pain, functional capacity, and inflammatory markers in men and women experiencing mild to moderate muscle and joint pain. Registered clinical trial #ISRCTN74292348. Full article

Osteoarthritis (OA) is a leading cause of disability worldwide and is characterized by the gradual degradation of articular cartilage in weight-bearing joints, notably the knees and hips. However, the primary morphological and anatomical determinants of the disease onset and progression remain unclear. This narrative overview examines how variations in cartilage thickness—traditionally viewed as a biomechanical protective feature—can paradoxically compromise metabolic homeostasis during prolonged sedentary behavior. Intriguingly, compelling evidence suggests that despite its superior load-bearing capacity, thicker cartilage faces greater challenges in solute transport, a limitation further exacerbated by the formation of diffusion-resistant boundary layers at the cartilage–fluid interface during immobilization. This phenomenon restricts nutrient influx and impedes waste clearance, leading to the accumulation of catabolic byproducts in deep cartilage zones and accelerated extracellular matrix breakdown, potentially influencing OA pathogenesis. By critically synthesizing current debates on mechanical loading with emerging data on metabolic dysregulation, particularly nutrient diffusion limitations, this analysis underscores the urgent need for targeted investigation of synovial–cartilage interface dynamics and chondrocyte metabolism under low-motion conditions. This study further advocates for strategic research focusing on often-overlooked, silent metabolic imbalances among sedentary populations and recommends early-intervention strategies, such as periodic joint mobilization, ergonomic adaptations, and public-health campaigns, to reduce prolonged sitting, preserve joint function, and guide more effective prevention and management approaches for non-traumatic OA in contemporary contexts. Full article

Open reduction and internal fixation (ORIF) is widely regarded as the primary treatment for acetabular fractures, but limitations arise in complex cases, leading to non-anatomical reductions and increased risk of post-traumatic osteoarthritis. Given the high incidence of secondary arthritis (12–57%) following ORIF, total hip arthroplasty (THA) is often necessitated, particularly in scenarios unsuitable for ORIF, such as extensive comminution or combined femoral head and neck fractures. The surgical landscape has shifted from a traditional “fix or replace” to a more integrated “fix and replace” approach, especially beneficial in managing elderly patients with osteoporotic bones. THA is applied across various timelines, including acute (0–3 weeks), delayed (3 weeks to 3 months), and late (beyond 3 months), each presenting distinct challenges and requiring specific strategies to optimize outcomes. The importance of precise bone defect classifications and the role of dual mobility cups in reducing dislocation risks are highlighted, alongside the use of modern surgical and fixation techniques to improve stability and patient outcomes. Enhanced recovery protocols and meticulous postoperative management are critical to addressing complications, such as infections and hardware interference, tailoring treatment approaches to each patient’s needs, and advancing care for complex acetabular fractures. Full article

Background: Osteoarthritis (OA) of the hip and knee is a common age-related degenerative disease characterized by joint pain, stiffness, and gait disturbances. This study investigated the influence of genetic polymorphisms in the OPRM1 (rs1799971) and COMT (rs4633, rs4680, rs4818, and rs6269) genes on the postoperative analgesic requirements in 195 diabetic and non-diabetic patients undergoing total hip or knee arthroplasty. Methods: The prospective study included all patients who were admitted between January and September 2020 and agreed to participate. Postoperative pain management was assessed based on acetaminophen, ketoprofen, and morphine consumption on the first and second postoperative day. Results: Multilevel regression analyses revealed a significant three-way interaction between diabetes, type of analgesic, and OPRM1rs1799971 polymorphism, indicating different analgesic dosing patterns in diabetic and non-diabetic patients. Two-way interactions between diabetes and COMT polymorphisms rs4633, rs4680, and rs6269 further influenced the analgesic requirements. No significant associations were found for COMT rs4818. The results show that diabetes and genetic factors significantly influence opioid requirements and pain perception. Conclusions: Given the complexity of pain management in diabetic patients, personalized analgesic strategies tailored to genetic and metabolic profiles could be useful in postoperative pain management and reducing opioid consumption. Full article

Osteoarthritis (OA) is a prevalent and debilitating joint disease in older adults with a complex etiology. We investigated the role of SUMOylation, a post-translational modification, in OA pathogenesis, focusing on the mitochondrial chaperone Prohibitin (PHB1) and the cartilage homeostasis transcription factor PITX1. We hypothesized that oxidative stress-induced SUMOylation promotes PHB1 nuclear accumulation, leading to PITX1 downregulation and contributing to OA development. Analysis of cartilage specimens from 27 OA patients and 4 healthy controls revealed an increased nuclear accumulation of PHB1 in OA chondrocytes, accompanied by elevated levels of SUMO-1 and SUMO-2/3. Mechanistically, nuclear PHB1 interacted indirectly with SUMO-1 through a SUMO-interacting motif (SIM), and the deletion of this SIM prevented PHB1 nuclear trapping in OA cells. Furthermore, the SUMO-conjugating enzyme E2 (UBC9) encoded by the UBE2I gene was upregulated in knee OA cartilage, and its overexpression in vitro enhanced PHB1 nuclear accumulation. Consistently, transgenic mice overexpressing the Ube2i gene exhibited increased UBC9 in their knee cartilage, resulting in Pitx1 downregulation and the emergence of an early OA-like phenotype in articular chondrocytes. Our findings uncover a novel role for UBC9-mediated SUMOylation in primary knee and hip OA. This pathway enhances PHB1 nuclear accumulation, contributing to PITX1 repression and subsequent OA development. These results underscore the importance of SUMOylation in OA pathogenesis and suggest potential molecular targets for early diagnosis and therapeutic intervention. Full article

Background/Objectives: Rapidly progressive osteoarthritis of the hip (RPOH) has unique diagnostic and surgical challenges due to rapid joint degeneration and acetabular structural alterations. This study aimed to investigate correlations between preoperative spinopelvic geometry and anterior acetabular wall bone stock deficiency in RPOH patients and introduce an advanced imaging measurement techniques for cases with amputated femoral heads. Methods: A prospective observational study was conducted that enrolled 85 patients, comprising 40 with unilateral RPOH (Zazgyva Grade II or III) and 45 controls with primary osteoarthritis (OA). Preoperative spino-pelvic parameters (pelvic tilt—PT, sacral slope—SS, lumbar lordosis—LL, and T1 pelvic angle) and acetabular anterior wall characteristics (anterior center edge angle—ACEA, anterior wall index—AWI, and anterior acetabular surface area—AASA) were measured using standardized radiographic and CT imaging protocols, including a new methodology for acetabular center estimation in femoral head-amputated cases. Results: Significant differences were identified between RPOH and primary OA patients in the PT (22.5° vs. 18.9°, p = 0.032), SS (37.8° vs. 41.1°, p = 0.041), T1 pelvic angle (14.3° vs. 11.8°, p = 0.018), and anterior center edge angle (25.3° vs. 29.7°, p = 0.035). RPOH patients exhibited pronounced spinopelvic misalignment and anterior acetabular deficiencies. Conclusions: RPOH is associated with spinopelvic misalignment and anterior acetabular wall deficiency. Accurate preoperative diagnosis imaging and personalized surgical approaches specifically addressing acetabular bone stock deficiencies are mandatory in these cases. Full article

Background: Musculoskeletal injuries have a substantial impact on athletes, affecting sports performance and increasing the risk of future musculoskeletal disorders (e.g., osteoarthritis). Injury prevention programs are essential to reduce the risk of sport-related injuries and meta-analyses can provide a large amount of information in a single article. Objective: To summarize the pooled effects of injury prevention programs focused on any form of physical exercise in the incidence and risk of musculoskeletal injuries and reinjuries by sports and musculoskeletal body regions. Methods: The CINAHL (via EBSCOhost), Embase (via Elsevier), Epistemonikos, PubMed, Scopus, SPORTDiscus (via EBSCOhost), and the Cochrane Library e-databases were searched from inception to 7 October 2024. Systematic reviews with meta-analyses of randomized clinical trials were considered. The methodological quality of systematic reviews was assessed with AMSTAR 2. The degree of overlap between meta-analyses of interest was calculated. Results: Fourteen systematic reviews were included. Thirteen of these reviews were focused on soccer. Overall, meta-analyses including a specific injury prevention program (FIFA 11+ and FIFA 11+ kids) found that these programs may reduce the risk of musculoskeletal injuries among soccer players. Concretely, FIFA 11+ may reduce the risk of ankle, knee, hip/groin, and hamstring injuries, whereas FIFA 11+ kids may decrease the risk of ankle and knee injuries. Conclusions: FIFA 11+ and FIFA 11+ kids may reduce the risk of sports musculoskeletal injuries, mainly in the lower limbs. However, many clinical and methodological issues (e.g., the lack of meta-analyses in many types of sports) were discussed and highlighted the difficulty of making robust clinical recommendations with the current data. Full article

Background: Patients awaiting total hip arthroplasty (THA), particularly those with hip osteoarthritis (OA), face an elevated risk of osteoporosis due to age and gender-related factors. Osteoporosis, indicated by low bone mineral density (BMD), can affect implant osteointegration, long-term stability, and increase the likelihood of periprosthetic fractures. Despite these risks, osteoporosis is often underdiagnosed and undertreated in THA candidates. While several studies have addressed this issue in Northern populations, data on Southern European cohorts, particularly Italian patients, remain limited. This study aims to evaluate the prevalence of osteoporosis and vitamin D deficiency, as well as the rates of related treatments, in patients with hip osteoarthritis scheduled for THA. Methods: This single-center, retrospective study was conducted at Policlinico Universitario di TorVergata, Italy, involving 66 hip OA patients (35 men, 31 women; mean age 67.5 years). BMD was assessed at the femoral neck, total femur, and lumbar spine via DEXA, alongside vitamin D and PTH levels. Demographic data, ongoing anti-osteoporotic therapies, Harris Hip Score (HHS), and handgrip strength were recorded. Statistical analysis included t-tests and Pearson’s correlation. Osteoporosis was defined per WHO criteria, with significance set at p < 0.05. Results: In this study of 66 patients with hip osteoarthritis (35 men, 31 women; mean age 67.5 years), women exhibited significantly lower bone mineral density (BMD) at the total femur (−0.98 ± 1.42 vs. −0.08 ± 1.04; p < 0.05) and lumbar spine (−0.66 ± 1.74 vs. 0.67 ± 1.59; p < 0.05) compared to men. Handgrip strength was also significantly reduced in females (17.1 ± 8.2 kg) versus males (27.3 ± 10.3 kg; p < 0.05). Vitamin D levels were below 30 ng/mL in 89.4% of patients, and 63.6% had levels below 20 ng/mL; PTH levels were elevated (>65 pg/mL) in 54.5% of cases, indicating frequent secondary hyperparathyroidism. Only 9 patients were receiving vitamin D supplementation and none were on anti-osteoporotic treatment. Conclusions: These findings highlight the frequent coexistence of low BMD, vitamin D deficiency, and reduced muscle strength in THA candidates, suggesting a pattern of musculoskeletal vulnerability that warrants clinical attention. Full article

Background and Objectives: Osteoarthritis, the most common degenerative joint disease, causes pain, decreased mobility, and functional disability, having a significant impact on patients’ quality of life. This study aimed to evaluate the impact of hip osteoarthritis (HOA) and knee osteoarthritis (KOA) on physical functioning and quality of life, and to explore how these outcomes vary according to sex, disease stage, and common comorbidities. Materials and Methods: A cross-sectional study was conducted between 1 October and 30 December 2024, at the Medical Rehabilitation Department of Avram Iancu Clinical Hospital in Oradea, Romania. A total of 133 adult patients diagnosed with HOA or KOA, based on clinical and radiographic criteria, were included. Functional status was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), while quality of life was evaluated using the World Health Organization quality of life questionnaire-BREF version (WHOQOL-BREF). The main outcomes were the total scores of these instruments, analyzed in relation to demographic and clinical variables. Results: Based on the clinical staging criteria applied in the study, 23 patients (17.3%) were classified as being in the early stage, 98 (73.7%) in the progressive stage, and 12 (9.0%) in the advanced or end stage of the disease. The mean WOMAC total score was 52.0 ± 7.9 (scale: 0–96), indicating moderate to severe functional impairment. The mean WHOQOL-BREF score was 67.9 ± 13.1 (scale: 0–100), reflecting a moderately reduced quality of life. A moderate, statistically significant inverse correlation was observed between WOMAC and WHOQOL-BREF scores (Spearman’s rho = −0.565, p < 0.001). Patients with knee osteoarthritis reported significantly lower quality of life compared to those without this condition (66.48 ± 12.73 vs. 71.76 ± 13.31, p = 0.006). No statistically significant differences were found in functional, or quality-of-life scores based on sex. Conclusions: Knee osteoarthritis, particularly when combined with hip involvement, is associated with a substantial decline in quality of life and functional capacity. The severity and location of joint involvement appear to be the primary determinants of disability in this patient population, while systemic comorbidities have a less pronounced influence in the rehabilitation setting. Full article

Background and Objectives: Osteoarthritis (OA) of the knee and hip is a major cause of pain and functional impairment. This study evaluated the effects of non-immersive virtual reality (NIVR) combined with conventional physical therapy (CPT) on pain intensity, mechanical hyperalgesia, and perceived recovery in older adults with OA. Materials and Methods: Sixty older adults with mild-to-moderate knee or hip OA were randomly assigned to a NIVR group (NIVR-G; n = 30) or a CPT group (CPT-G; n = 30). Both groups completed 30 sessions over 10 weeks (3 sessions/week). The NIVR-G performed 20 minutes of exergames integrated into CPT. Pain intensity was assessed using the Visual Analog Scale (VAS), and mechanical hyperalgesia was evaluated through pressure pain thresholds (PPTs). Secondary outcomes included the Global Rating of Change (GRoC) and the minimal clinically important difference (MCID) for the VAS. This study is a secondary analysis of a randomized controlled trial registered at ClinicalTrials.gov (ID: NCT05839262). Results: The NIVR-G demonstrated significant reductions in pain intensity after 30 sessions (p < 0.05, d = 1.50), with greater improvements compared to the CPT-G (p < 0.05, d = 1.17). The MCID for the VAS was established at 9.2 mm, with a higher proportion of responders in the NIVR-G (p < 0.05). The NIVR-G also reported superior recovery perception on the GRoC scale (p < 0.05). No significant changes in PPTs were observed in either group. However, the improvements in the NIVR-G diminished four weeks post-intervention. Conclusions: NIVR exergames combined with CPT significantly reduced pain intensity, improved perceived recovery, and resulted in a higher proportion of responders compared to CPT alone. These findings support the use of NIVR as an effective adjunct to CPT in older adults with OA; however, further research is needed to optimize its long-term benefits. Full article