Background: Psychosocial interventions for patients with osteoarthritis (OA) of the knee to reduce pain and improve physical and psychological functioning are still lacking in Malaysia. Methods: A parallel-group unblinded randomized controlled trial involving 300 patients was conducted in two hospital orthopedics clinics in Malaysia. Patients were randomly assigned to receive cognitive behavioral-based group therapy (n = 150) or no further intervention (n = 150). The primary outcome was the change from baseline in knee pain as determined by the Knee injury and Osteoarthritis Outcome Score (KOOS) at 6 months. The data collected were analyzed by covariate-adjusted mixed design repeated measures analysis of variance. All analyses were performed under the terms of intention-to-treat. Results: At 6 months, mean change from baseline in the KOOS knee pain score was 0.6 points (95% CI −1.73 to 2.94) in the control group and 8.9 points (95% CI 6.62 to 11.23) (denoting less knee pain intensity) in the intervention group (significant treatment effect p < 0.0001). Patients treated with such an approach also experienced significant improvement in functional ability when performing activities of daily living and had improved ability to cope with depression, anxiety and pain catastrophizing. Conclusion: The intervention module delivered by healthcare professionals had a sustained effect on knee OA pain and functionality over 6 months, thereby leading to an overall improvement in psychological well-being, thus benefitting most of the Malaysian knee OA patients.

Objective: Chronic tophaceous gout can lead to significant complications beyond joint damage, including compression neuropathies. Gouty tophi involving the flexor tendons are a rare but notable cause of median nerve entrapment. This report aims to highlight the clinical presentation, diagnostic process, and surgical management required for effective treatment. Case: We present the case of a male patient in his 60s with chronic tophaceous gout, who developed median nerve entrapment due to intratendinous gouty tophi compressing the nerve. The patient reported numbness in the right hand, specifically over the median nerve distribution, accompanied by thenar muscle atrophy and a palpable mass over the volar wrist. Magnetic resonance imaging (MRI) confirmed the presence of gouty tophi within the flexor tendons causing median nerve compression. The surgical intervention included an extended open carpal tunnel release, debulking of the tophi, removal of adhesions, and excision of inflamed tendon sheaths. Six months post-surgery, the patient showed significant improvement in hand numbness and grip strength, with no wound complications noted. Conclusion: This case underscores the importance of considering tophaceous gout as a differential diagnosis in cases of atypical median nerve entrapment. Routine carpal tunnel release alone may be insufficient. Comprehensive management, including the debulking of tophi, adhesiolysis, and tenosynovectomy, is essential to relieve nerve compression and enhance tendon mobility.

A luxação congênita do joelho (LCJ) é uma malformação rara caracterizada por deformidade de hiperextensão do joelho com deslocamento anterior da tíbia, presente ao nascimento. Raramente relatada, a LCJ pode ocorrer como uma deformidade isolada ou comumente associada a anormalidades musculoesqueléticas, sendo as mais comuns a displasia do desenvolvimento do quadril (DDQ) e o pé torto congênito (PTC). A etiologia é desconhecida, mas a LCJ foi associada a certos fatores intrínsecos e extrínsecos. O tratamento com métodos conservadores em um estágio inicial tem maior probabilidade de produzir resultados bem-sucedidos. Relatamos aqui um caso raro de redução espontânea bem-sucedida de LCJ em um bebê nas suas primeiras 24 horas de vida. ^* Trabalho desenvolvido junto à Ortopedia do Departamento de Cirurgia Ortopédica da Universidade Putra Malaysia, Serdang, Selangor, Malásia. Received: 29 March 2020 Accepted: 06 July 2020 Publication Date: 22 December 2020 (online) © 2020. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/) Thieme Revinter Publicações Ltda. Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil