Low-dose radiotherapy in treating knee osteoarthritis – a trial from Russia
The IORBC is pleased to share a promising 2023 trial from Russia that highlights the potential benefit of low-dose radiotherapy in treating knee osteoarthritis.
The focused 2023 trial found that the use of LDRT can reduce the risk of knee arthroplasty by two-thirds and has the potential to prevent 21% cases of knee arthroplasty in patients with knee osteoarthritis.
The Russian study, led by М. V. Makarova, М. Yu. Valkov and А. М. Grjibovski, is titled ‘Effects of low-dosage radiotherapy for knee osteoarthritis on the incidence of knee arthroplasty: Results of a randomized controlled trial with 9-year follow-up’.
It compared the incidence of knee arthroplasty in patients receiving standard treatment with non-steroidal anti-inflammatory drugs (NSAIDs) in combination with symptomatic slow acting drugs for osteoarthritis (SYSADOA), or combination of NSAIDs and SYSADOA with low-dose radiation therapy (LDRT) in patients with stage 0–2 knee osteoarthritis (OA).
The small randomised controlled study featured 292 patients with confirmed knee OA according to Altman’s criteria (1991) and Kellgren – Lawrence radiographic stages 0–2. The patients were randomised into two groups.
A control group:
Featuring 146 (50%) of the patients
This group received standard therapy of NSAIDs + SYSADOA
A study group:
Also containing 146 patients (the remaining 50%)
This group received a combination of standard therapy and LDRT up to a total dose of 4.5 Gy.
The cumulative risk of knee arthroplasty was assessed using actuarial analysis and the Kaplan – Meier method. Attributable (AF) and population attributable (PAF) fractions were calculated to assess LDRT preventive potential. The results (the total observation period was 2131.2 person-years) found that:
Knee arthroplasty was performed in 4.1 % (n = 6) of patients in the study group against 7.5% (n = 11) in the control group.
The incidence density ratio was 0.60 (95% CI: 0.18–1.88), which corresponds to a risk reduction by 67%
The differences were not statistically significant however, due to the small number of cases. Yet this small sample provides promising results that we’re keen to focus on — consider that osteoarthritis ‘is the most widespread disease of the musculoskeletal system.’
From the IORBC’s perspective, whilst this was a small study, we hope that the promising insights will prompt further, larger studies within this field and that, combined, they move us towards improved patient outcomes.
We provide a link to the trial below.
Notes:
References 15, 16, 23 and 24 may also be of interest — they repeat the secondary evaluation criteria with good results.
Read our separate blog about the LoRD-KNeA trial on LDRT for knee OA, which references a trial involving three academic hospitals in Korea.
Trial Citation:
Makarova, М & Valkov, М & Grjibovski, А. (2023). Effects of low-dosage radiotherapy for knee osteoarthritis on the incidence of knee arthroplasty: Results of a randomized controlled trial with 9-year follow-up. Acta Biomedica Scientifica. 8. 100-106. 10.29413/ABS.2023-8.5.10.