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Appropriate animal models of osteoarthritis (OA) are essential to develop new treatment modalities for OA. A combination of surgical and chemical induction could be appropriate for OA models.Rabbit knee OA models developed by surgical induction (anterior cruciate ligament transection [ACLT]), chemical induction (monosodium iodoacetate [MIA] injection), and a combination of both were compared to assess compositional and structural destruction of the knee joint. Twenty-one New Zealand white rabbits were randomly divided into 3 groups to induce OA (group 1: ACLT, n = 3; group 2: MIA [3, 6, 9 mg] injection, n = 9; group 3: ACLT + MIA [3, 6, 9 mg] injection, n = 9).In all groups, the Modified Mankin score was significantly higher in the osteoarthritis-induced knee than in the control. Modified Mankin scores were compared by category. The ACLT group was observed to score high in cartilage structure. In the MIA group, chondrocytes and matrix staining showed higher scores, and the ACLT+MIA group scored higher in all categories for cartilage structure, chondrocytes, matrix staining, and tidemark integrity. The ACLT + 3 mg MIA showed definite OA characteristics such as cartilage surface destruction and degeneration of cartilage layers, and the ACLT + 6 mg MIA and ACLT + 9 mg MIA showed more prominent OA characteristics such as cartilage surface destruction, matrix disorganization, and osteophyte formation.The combination of MIA injection and ACLT could be an appropriate method for OA induction in rabbit models.

This retrospective study compares tibial component rotations and radiological and functional outcomes in patients who underwent Oxford medial unicompartmental knee arthroplasty (UKA), using the antero-posterior (AP) tibia axis or anterior superior iliac spine (ASIS) as the landmarks for the direction of the vertical cut.A total of 86 patients, who underwent Oxford medial UKA were divided into 2 groups, each consisting of 43 patients, according to the use of AP axis (group I) or ASIS (group II) as landmarks for the rotation of vertical tibial cut and compared for the radiological and functional outcomes. Tibial component rotations (α-angle), involvement of the posterior cruciate ligament (PCL) fossa, and instant bearing position (IBP) were measured on computed tomography (CT) images. Functional outcomes were evaluated using Oxford knee score (OKS) and Knee Society score (KSS).The median α‑angle was significantly smaller in group I than group II (2.5°, range -4-5.5° vs. -6°, range -13-0.5°, p 0.001). The rates of PCL fossa involvements were 14 (32.6%) and 17 (39.5%, p = 0.7). The median flexion angle of the femoral component (7° vs. 10.5°) and posterior tibial slope (6° vs. 8°) were significantly lower in group I than group II (p = 0.001). All other radiological parameters, preoperative and final OKS and KSS were statistically similar in both groups.Taking the AP tibial axis as a landmark for vertical tibial cut rotation provides more neutral tibial component rotation in Oxford medial UKA compared to ASIS; however, this difference may not influence the clinical outcomes.HINTERGRUND: Diese retrospektive Studie vergleicht die Rotation der Tibiakomponente sowie die radiologischen und funktionellen Ergebnisse bei Patienten, die eine mediale unikondyläre Knieendoprothese (Oxford-Schlittenprothese) am Kniegelenk erhalten hatten, wobei die anteroposteriore Tibiaachse oder die Spina iliaca anterior superior (SIAS) als Orientierungspunkt für die Richtung des vertikalen Schnitts verwendet wurde.Insgesamt 86 Patienten, die eine mediale unikondyläre Schlittenprothese erhalten hatten, wurden in 2 Gruppen mit jeweils 43 Patienten unterteilt, je nachdem, ob die a.-p.-Achse (Gruppe I) oder die SIAS (Gruppe II) als Orientierungspunkt für die Rotation des vertikalen Tibiaschnitts verwendet wurde, und hinsichtlich der radiologischen und funktionellen Ergebnisse verglichen. Die Rotation der Tibiakomponente (α-Winkel), die Beteiligung der Fossa des hinteren Kreuzbands (HKB) und die sofortige Lagerposition („instant bearing position“ [IBP]) wurden auf CT-Bildern gemessen. Die funktionellen Ergebnisse wurden mit dem Oxford Knie Score (OKS) und dem Knee Society Score (KSS) bewertet.Der mediane α‑Winkel war in Gruppe I signifikant kleiner als in Gruppe II (2,5°, Range: −4 bis 5,5° vs. −6°, Range: −13 bis 0,5°; p 0,001). Die Raten der HKB-Fossa-Beteiligung betrugen 14 (32,6 %) und 17 (39,5 %; p = 0,7). Der mediane Flexionswinkel der femoralen Komponente (7 vs. 10,5) und die posteriore tibiale Neigung (6 vs. 8) waren in Gruppe I signifikant geringer als in Gruppe II (p = 0,001). Alle anderen radiologischen Parameter sowie der präoperative und endgültige OKS und KSS waren in beiden Gruppen statistisch ähnlich.Bei der medialen unikondylären Oxford-Schlittenprothese führt die Verwendung der a.-p.-Tibiaachse als Orientierungspunkt für die vertikale Rotation des Tibiaschnitts zu einer neutraleren Rotation der Tibiakomponente im Vergleich zur SIAS; dieser Unterschied hat jedoch möglicherweise keinen Einfluss auf das klinische Outcome.

Apolipoprotein D (ApoD) is a 25-30 kDa glycoprotein, as a distinct component of the human plasma lipoprotein system. Its known biological functions are mainly related to lipid metabolism. The purpose of this study was to explore the potential role of ApoD concentration in knee osteoarthritis (KOA).This study was performed in a population of 113 KOA subjects and 97 healthy controls. Serum ApoD was detected using the commercial ELISA kit (Cusabio, Wu Han, China, Cat No. CSB-EL001935HU). Radiographic progression was evaluated using Kellgren-Lawrence (KL) classification. The clinical severity of KOA was assessed by visual analog score (VAS), Hospital for special surgery (HSS) knee score disease duration and TNF-α. Receiver-operating characteristic (ROC) curve was performed to test the potential diagnostic value of ApoD in radiographic progression.The serum ApoD level of patients with KOA was significantly lower than that of healthy controls. The serum ApoD level was negatively correlated with KL grades, VAS score, disease duration, TNF-α concentrations. On the contrary, it was positively correlated with HSS score. However, there was no correlation between this serological indicator and which side was affected. ROC curve analysis indicated that attenuated serum ApoD could serve as an appropriate biomarker concerning the diagnosis of KOA.Serum ApoD concentration was correlated with the presence and severity of KOA.

To present the preliminary results of a cohort of 13 patients with hip osteoarthritis (OA) and great trochanteric pain syndrome (GTPS) refractory to conservative management or physical therapy and no indication for surgery treated with embolization of the lateral femoral circumflex artery.This is a single-center prospective cohort from July 2019 to September 2020. Visual analogue scale (VAS) and Western Ontario and MacMaster Universities (WOMAC) were used to compare the symptoms before and after 6-month follow-up. Technical success was considered when at least one artery responsible for the hyperemic synovium was embolized. Complications and adverse events were noted.In total, 13 patients were included; mean age was 62.4 (± 11.0) years. 10 (76.9%) patients were treated for GTPS and 3 (23.1%) for hip OA. Nine patients were treated with imipenem/cilastatin (I/C) alone. Microsphere 100-300 μm and I/C were combined in 4 patients. The WOMAC Index had a statistically significant decrease in the total from 77 to 27 points (p = 0.001). Pain, rigidity and physical activity have also significantly reduced (19 to 5, p = 0.001; 6 to 2, p = 0.002 and 53 to 22, p = 0.001, respectively). VAS score had a significant decrease (10 to 2, p = 0.002). Two patients present posterior tight numbness, spontaneously improved within 30 days.In this cohort, lateral femoral circumflex artery embolization was a safe and effective treatment for patients with hip pain due to OA and GTPS.

Purpose To assess the relationship between pre-operative psychological state, postoperative pain and function one year after total shoulder, hip or knee arthroplasty. Methods Patients undergoing shoulder, hip or knee arthroplasty between March 2014 and November 2015 were included. Pain catastrophizing score (PCS) was determined preoperatively, at six months and at one year follow-up. Joint pain at rest was quantified using a Visual Analogue Scale (0‒100). Depressive symptoms were measured using the Beck Depression Inventory or Geriatric Depression Score, situational anxiety and dispositional anxiety were measured using the State-Trait Inventory and joint function was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index for the hip and knee and Oxford Shoulder Score for the shoulder. Results A total of 266 patients were included (65% female; mean (± SD) age: 71.8 ± 10.3 years; mean body mass index: 27.5 ± 5.0 kg/m2). Pre-operative PCS was significantly correlated with pain > 30/100 at one year and with functional scores, for all joints. Multivariate analysis identified the following variables as risk factors for pain intensity > 30/100 at one year: pre-operative PCS > 20/52 (OR = 3.5 ± 1.1 [95% CI: 1.9‒6.6]; p = 0.0001), trait-anxiety score ≥ 46 (OR = 2.4 ± 0.9 [95% CI: 1.1‒5.2]; p = 0.03), pre-operative pain ≥ 60/100 (OR = 3.2 ± 1 [95% CI: 1.8‒6.1]; p = 0.0001) and pain for at least 3 years (OR = 1.8 ± 0.6 [95% CI: 1‒3.4]; p = 0.04). Conclusion Pre-operative pain catastrophizing and trait-anxiety are risk factors for post-operative pain after shoulder, hip and knee arthroplasty. Trial registration number www.clinicaltrials.gov NCT02361359.

We sought to identify and characterize distinct responder profiles among osteoarthritis (OA) subjects treated with tanezumab, nonsteroidal anti-inflammatory drugs (NSAIDs), or placebo.Subject-level data were derived from three randomized, double-blind, placebo- or NSAID-controlled trials of tanezumab in subjects with moderate-to-severe OA. Subjects received subcutaneous tanezumab (2.5 mg, n = 1527; 5 mg, n = 1279) every 8 weeks, oral NSAIDs (n = 994) daily, or placebo (n = 513). Group-based trajectory modeling (GBTM, an application of finite mixture statistical modeling that uses response trajectory to identify and summarize complex patterns in longitudinal data) was used to identify subgroups of subjects following similar patterns of response in each treatment arm, based on daily pain intensity scores from baseline through Week 16. We then examined whether subject-related variables were associated with any of the subgroups using multinomial logistic regression.A three-subgroup/four-inflection point trajectory model was selected based on clinical and statistical considerations. The subgroups were high responders (substantial pain improvement and a large majority of members achieved ≥ 30% improvement before Week 16), medium responders (gradual pain improvement and a majority of members achieved ≥ 30% improvement by Week 16), and non-responders (little to no pain improvement over 16 weeks). Across all treatments, fluctuation in pain intensity in the week prior to treatment was consistently associated with treatment response. Other variables were positively (age, body mass index, days of rescue medication use) or negatively (severity of disease based on Kellgren-Lawrence grading) associated with response but effects were small and/or varied across treatments.Across all treatments, GBTM identified three subgroups of subjects that were characterized by extent of treatment response (high, medium, and non-responders). Similar analyses (e.g., grouping of subjects based on response trajectory and identification of subgroup-related variables) in other studies of OA could inform clinical trial design and/or treatment approaches. (NCT02697773; NCT02709486; NCT02528188).

To investigate the effect of lateral wedge insole (LWI) on medial meniscus extrusion (MME) observed during dynamic evaluation with ultrasound and its correlation with the alteration in knee pain in patients with knee osteoarthritis (OA).This cohort study included 25 participants with knee OA. The medial meniscus was imaged during walking in video mode using ultrasonography. The degree of increase in MME (ΔMME) was calculated as the difference in the value of the maximum and minimum MME. The intensity of knee pain was evaluated immediately after the walking trial using the visual analogue scale (VAS). These measurements were performed with and without the LWI. The participants were categorised into the responder group, which was identified by the constant reduction in the VAS, and the non-responder group.MME, ΔMME, and knee pain during walking were significantly lower with the LWI than without the LWI (p 0.01). The reduction in ΔMME with the LWI in the responder group was significantly higher than that in the non-responder group (p 0.01).Our findings showed that MME and knee pain during walking decreased with LWI use, especially in patients whose reduction in knee pain was characterised by inhibition in the increase in MME observed during dynamic evaluation with ultrasound.

Purpose To explore in vivo kinematical behavior of the same total knee arthroplasty (TKA) cruciate-retaining (CR) femoral design with either medial-congruent (MC) or ultra-congruent (UC) inlay using model-based dynamic radiostereometric analysis (RSA). The hypothesis was that there would be comparable kinematics between the two groups. Methods A cohort of 16 randomly selected patients (8 MC Persona Zimmer, 8 UC Persona Zimmer) was evaluated through dynamic radiostereometric analysis (RSA) at a minimum of 9 months after TKA, during the execution of a sit-to-stand. The antero-posterior (AP) translation of the femoral component and the AP translation of the low point of medial and lateral femoral compartments were compared through Student’s t test (p Results Both groups showed a medial pivot behavior, with a significantly greater anterior translation of the Low Point of the lateral compartment with respect to the medial compartment (MC medial range: 2.4 ± 2.4 mm; MC lateral range: 7.7 ± 3.0 mm; p p p = 0.003). Conclusion The present study did not show difference in the medial pivot behavior between ultra-congruent and medial-congruent total knee arthroplasty when implanted with mechanical alignment; however, the MC group demonstrated a greater degree of flexion. The MC design examined is a valid alternative to the UC design, allowing to achieve a screw-home movement restoration combined with a high flexion. Level of evidence IV.

The aim of this study was to analyze local and systematic inflammatory status in knee osteoarthritis (KOA), focusing on intra-articular and remote adipose tissue depots, and to explore its potential association with metabolic syndrome (MetS).Patients (n = 27) with end-stage KOA were enrolled in the study and samples from infrapatellar fat pad (IFP), synovium, subcutaneous adipose tissue (SAT), synovial fluid (SF), and serum were collected. In homogenates from the tissues, mRNA expression of developmental endothelial locus-1 (DEL-1) was determined. Interleukin 6 (IL-6) and interleukin 8 (IL-8) were measured in tissues and SF and serum samples by enzyme-linked immunosorbent assay.Fifteen patients fulfilled MetS criteria (w-MetS group) and 12 did not (non-MetS). In the entire population, IL-6 levels were significantly higher in IFP compared to synovium (median (interquartile range), 26.05 (26.16) vs. 15.75 (14.8) pg/mg of total protein, p = 0.043), but not to SAT (17.89 (17.9) pg/mg); IL-8 levels were significantly higher in IFP (17.3 (19.3) pg/mg) and SAT (24.2 (26) pg/mg) when compared to synovium (8.45 (6.17) pg/mg) (p = 0.029 and 0.001, respectively). Significantly higher IL-6 concentrations in SF were detected in w-MetS patients compared to non-MetS (194.8 (299) vs. 64.1 (86.9) pg/ml, p = 0.027). Finally, DEL-1 mRNA expression was higher in IFP compared to synovium (eightfold, p = 0.019).Our findings support the critical role of IFP in knee joint homeostasis and progression of KOA. Furthermore, in KOA patients w-MetS, SAT is thought to play an important role in intra-knee inflammation via secretion of soluble inflammatory mediators, such as IL-6.

To verify tibial tubercle-Roman arch (TT-RA) distance is superior to tibial tubercle-trochlear groove (TT-TG) distance in preoperative assessment of patellofemoral joints in patients with knee osteoarthritis.Patients with knee osteoarthritis from 2016 to 2020 were considered eligible for inclusion in this study. We divided the patients into valgus group and varus group and did 1:1 matching for the two groups. We measured the TT-TG distance, TT-RA distance, patellar height, patella tilt, hip-knee-ankle (HKA) angle, and Iwano's classification of patellofemoral osteoarthritis (PFOA) by computed tomography images or radiographs. The intraclass correlation coefficient (ICC) of each measurement, the correlations and differences among the parameters, and binary logistic regression analysis were conducted.Each group in this study included 75 knees. The inter-observer and intra-observer reliability of the TT-TG distance decreased with the increasing degree of PFOA (ICC0.75). The reliability of the TT-RA distance showed excellent agreement in different stages of Iwano's classification. The HKA angle was poorly correlated with the TT-TG distance (r = 0.34, p = 0.003) and the TT-RA distance (r = 0.39, p = 0.001) in valgus knees. As the HKA angle increased by 1 degree, the TT-TG and TT-RA distance increased by nearly 0.45 mm and 0.61 mm, respectively. Valgus malalignment and severe PFOA revealed significant ORs of 3.26 (95% CI [1.06-10.03], p = 0.036) and 3.10 (95% CI [1.01-9.54], p = 0.048) with regard to pathological TT-RA distance, respectively.The TT-RA distance was more reliable than the TT-TG distance in patients with knee osteoarthritis. Valgus malalignment and severe PFOA were risk factors for pathological TT-RA distance.• The TT-RA distance is a reliable and repeatable alternative to the TT-TG distance in evaluating coronal malalignment, especially in patients with severe PFOA. • We validated the significant relationships between TT-TG distance or TT-RA distance and HKA angle in valgus knees, while the correlations among such parameters were not significant in varus knees. • Pathological lateralization of the tibial tubercle was prone to be traced in patients with valgus malalignment or severe PFOA, which could contribute to the patellofemoral malalignment.

To compare bone union after medial closing wedge distal femoral osteotomy (MCWDFO) with that after lateral closing wedge distal femoral osteotomy (LCWDFO) using a novel scoring system.The data of 30 patients who received biplanar MCWDFO for valgus knees (MCWDFO group) were retrospectively examined and compared to that of 22 patients (25 knees) who underwent biplanar LCWDFO via a double-level osteotomy (DLO) for varus knees (LCWDFO group). The progression of bone union of the transverse osteotomy plane in the femur was assessed using a newly developed scoring system using radiographs taken immediately after surgery and 3 and 6 months postoperatively. The scoring system is based on a scale of zero to six points with higher scores indicating better bone union. The incidence of hinge fractures was assessed using CT images, and the rates of reoperation were evaluated using medical record data.The mean bone union score was significantly lower in the MCWDFO group than in the LCWDFO group 3 months (2.1 ± 1.9 vs. 3.7 ± 1.7, P 0.01) and 6 months (3.8 ± 2.1 vs 4.9 ± 1.5, P 0.05) postoperatively. The incidence ratio of hinge fractures was significantly higher in the MCWDFO group than in the LCWDFO group (70.0% vs. 32.0%, P 0.01). Two patients in the MCWDFO group underwent reoperation for delayed bone union or non-union.Bone union progression was slower and hinge fractures were more frequently observed after MCWDFO than after LCWDFO via DLO. MCWDFO is technically challenging, and patients must be monitored closely during and after surgery.

This study aims to (1) measure the kinematics of lower extremity alignment and the bony position relative to the ground during walking, focusing on the coronal plane, and (2) determine the correlation between the kinematics and coronal inclination of the medial tibial plateau (coronal inclination) for healthy and varus knee osteoarthritis (OA).In this study, 43 women (non-OA, 9 knees; early OA, 13 knees; advanced OA, 21 knees; mean age 58 ± 17 years) were examined. The knee phenotypes in varus knee OA were varied. Three-dimensional (3D) knee kinematics were calculated in gait analysis by combining the motion capture system and the 3D lower extremity alignment assessment system via biplanar long-leg X-rays, applying the 3D-2D registration technique. The main parameters were the kinematics of the bony axes relative to the ground in the coronal plane during the stance phase of the gait. The differences in overall kinematics were assessed using repeated measures ANOVA with Tukey's post hoc test. The association between kinematic parameters and coronal inclination was evaluated by multiple linear regression after univariate analysis.The tibia tilted laterally during the loading response, and a plateau area subsequently appeared until the terminal stance phase, whereas the femur slowly tilted laterally until the terminal stance phase. The dynamic alignment showed a relatively large varus angular change during the loading response in all groups. The trend of motion was similar among all groups (p = n.s.), although to varying degrees. The coronal inclination was the more dominant factor than the Kellgren-Lawrence (K-L) grades (β = - 0.423, p = 0.005) when the change in dynamic alignment was determined.The TAA plateau area after the loading response implies that the tibial articular surface may become horizontal. The femur slowly tilted laterally until the terminal stance phase in response to the tibial motion. Consequently, the dynamic alignment showed a varus angular change, in which coronal MCT was more involved than K-L grades.

Purpose An observation was made by the senior author of this paper that patients reported changes in their hip function after a medial opening wedge high tibial osteotomy (MOHTO) for varus pattern osteoarthritis. Alignment changes at the hip after MOHTO have not been previously documented. This study assesses coronal alignment changes at the hip after MOHTO. Methods We retrospectively analysed pre- and post-operative lower limb alignment radiographs of patients who underwent MOHTO. The medial proximal tibial angle (MPTA) and mechanical axis deviation (MAD) were measured to assess the alignment changes created by the MOHTO. The coronal alignment changes at the hip were evaluated using the mechanical greater trochanter angle (MGTA). Results 29 osteotomies in 27 patients were included in this study. Results showed MOHTO created alignment changes at the hip. A positive correlation was found between the size of the correction at the knee and the subsequent changes at the hip. The change in the MGTA had a stronger correlation with the MAD than with the change in MPTA (r = 0.684 vs. 0.585). It was found that age, weight, height and BMI had no significant influence on these correlations. Conclusions Increased correction by the MOHTO lead to increased change in the coronal alignment of the hip. These changes are likely to result in an alteration in the weight bearing portion of the femoral head and the function of the abductors and we recommend assessing the hip joint as part of pre-operative planning. Level of evidence Prognostic level IV.

Early detection of knee osteoarthritis (KOA) can improve treatment outcomes and prevent its progression. The aim of this systematic review was to identify the functional changes in early KOA. Electronic journal databases and platforms, including PubMed, the Physiotherapy Evidence Database, the Cochrane Central Register of Controlled Trials, and Scopus were searched. The inclusion criteria were as follows: (1) studies comparing patients with early KOA with an age-matched control group and (2) studies with objectively measured functional changes as outcomes. Studies that included individuals with Kellgren and Lawrence (K/L) grades 2- were excluded. A random-effects model was constructed to calculate pooled standardized mean differences (SMDs). A total of nine articles were included in this systematic review. Seven studies used classification criteria to define early KOA, including knee pain; a K/L grade of 0, 1, or 2- (osteophytes only) for the medial compartment; and the presence of two out of four MRI criteria. The remaining two studies included K/L grade 1 confirmed by radiography. Early KOA participants had a significantly longer timed up-and-go test (TUG) time (pooled SMD: 0.57; 95% confidence interval: 0.15, 0.98). The two groups had similar knee extension muscle strength at 90° knee flexion. The quality of evidence for each measured outcome was "very low." In this review, longer TUG was identified as a functional manifestation of early KOA. Further studies involving functional assessments are needed to develop a screening method to detect early KOA. Key Points • There is a need for diagnostic criteria that include functional changes in patients with early knee osteoarthritis, since radiographic facilities are not available everywhere. • In this review, a long timed up-and-go test time was identified as a functional manifestation of early knee osteoarthritis. • If the findings of this study can be replicated, measurement of TUG may allow for earlier detection of knee osteoarthritis outside the hospital and in routine clinical practice without the use of MRI or X-rays.

Knee osteoarthritis pain is a chronic form of pain for which conventional non-steroidal anti-inflammatory drugs may provide insufficient analgesia. Twice-daily tramadol hydrochloride (65% sustained-release/35% immediate-release) bilayer tablets are a novel formulation of tramadol developed for managing chronic pain. The objectives of this study were to examine the effectiveness and safety of this formulation in patients with chronic knee osteoarthritis pain.This was a multicenter, randomized, placebo-controlled, double-blind, parallel-group, treatment-withdrawal study. Patients with a reduction in Numeric Rating Scale (NRS) for pain of ≥2 points during a 1-3-week, open-label, tramadol dose-escalation period (100-300 mg/day) were randomized to continue tramadol or switched to placebo for 4 weeks (double-blind period). Patients with inadequate efficacy (increase in NRS ≥2 points/patient request) were withdrawn. Outcomes included the time to inadequate analgesic efficacy from randomization (primary endpoint), the cumulative retention rate, and safety.Overall, 249 and 160 patients entered the dose-escalation and double-blind periods, respectively (tramadol 79; placebo 81). Kaplan-Meier analysis revealed superiority of tramadol (log-rank p = 0.042), and a hazard ratio of 0.50 (95% confidence interval [CI] 0.25-0.99). Documentation of an inadequate analgesic effect was less frequent in the tramadol group (15.4%, 95% CI 8.2-25.3% vs. 30.9%, 95% CI 21.1-42.1%). The cumulative retention rate was greater in the tramadol group (83.7% vs. 69.0%). Adverse events occurred in 80.6% (200/248) of patients in the open-label period, and in 38.5% (30/78) and 13.6% (11/81) of patients in the tramadol and placebo groups, respectively, in the double-blind period. Opioid-associated adverse events, such as nausea, vomiting, constipation, somnolence, and dizziness, were the most frequent events.This study demonstrated the analgesic efficacy and safety of sustained-release tramadol tablets with an immediate-release component for chronic knee osteoarthritis pain.JapicCTI-132103 (Japan Pharmaceutical Information Center; registration date February 25, 2015).

Objective To study the prevalence of suprapatellar fat pad (SPFP) MR alterations in asymptomatic subjects, in relation to a wide range of clinical/imaging parameters, including muscle performance tests and physical activity data. Materials and methods We prospectively included 110 asymptomatic subjects as part of a cohort study. Inclusion criteria were no knee pain in the last year. Exclusion criteria were any medical/surgical history of a knee disorder. Subjects underwent knee and low-dose posture radiographs [EOS®], 3 T MRI, clinical examination including muscle performance tests, and physical activity monitoring. The presence/absence of SPFP alterations (hyperintensity and mass effect) were assessed through consensus reading on fluid-sensitive sequences. Differences between groups of knees with SPFP alterations and controls were tested for a total of 55 categorical/continuous clinical/imaging parameters, including SPFP relative-T2-signal, trochlear/patellar/lower-limb morphologic measurements. Wilcoxon-rank-sum and chi-square tests were used to compare groups of patients. The histological correlation was obtained in a cadaveric specimen. Results SPFP alterations were common in asymptomatic subjects: hyperintensity 57% (63/110) and mass effect 37% (41/110), with 27% (30/110) showing both. Among the 55 imaging, clinical, or activity parameters tested, only increased patellar tilt angle (p = 0.02) and TT-TG distance (p = 0.03) were statistically different between groups of SPFP alterations and controls. The histological correlation showed more abundant connective tissue in SPFP compared to the prefemoral fat pad. Conclusions SPFP hyperintensity and mass effect are common MRI findings in asymptomatic knees, and they are not related to most imaging, clinical, and activity parameters. Care should be taken not to overcall them pathological findings as they most likely represent normal variants.

This study aimed to establish and validate a novel evaluation method using digital tomosynthesis to quantify bone formation in the gap after opening wedge high tibial osteotomy (OW-HTO). We retrospectively analyzed bone formation in the gap in 22 patients who underwent OW-HTO using digital tomosynthesis at 1, 2, 3, 6, 9, and 12 months postoperatively. Bone formation was semi-quantitatively assessed using the modified van Hemert's score and density measurements on digital tomosynthesis images. The gap filling value (GFV) was calculated as the ratio of the intensities of the opening gap and the tibial shaft. In addition, the relationship between the modified van Hemert's score and GFV was evaluated. The reproducibility of GFV had an interclass correlation coefficient (ICC [1,2]) of 0.958 for intraobserver reliability and an ICC (2,1) of 0.975 for interobserver reliability. The GFV increased in a time-dependent manner and was moderately correlated with the modified van Hemert's score (r = 0.630, p lt; 0.001). The GFV plateaued at 6 months postoperatively. In addition, the GFV was higher in patients with a modified van Hemert's score of 2 than in patients with a modified van Hemert's score of 3 (p = 0.008). The GFVs obtained using digital tomosynthesis can be used to assess postoperative bone formation in the opening gap after OW-HTO with high accuracy and reproducibility.

A varus deformity (VD) of the lower limbs results in greater loading of the medial compartment of the knee joint (KJ), leading to its degenerative changes and, eventually, to progressive osteoarthritis (OA) of the joint. The aim of the study was to investigate the mid-term changes in gait biomechanics and clinical symptoms in patients with VD of KJ and OA before and six months after surgical correction.The study enrolled 25 patients with medial OA of grade 2-3 according to Kellgren-Lawrence and a VD of 3°, who underwent arthroscopic lavage and debridement of the knee joint followed by corrective osteotomy. The control group included 20 healthy adults. Clinical and biomechanical assessments were done twice: immediately prior to and six months after the surgical treatment. Biomechanical parameters of gait were recorded using an inertial sensor system.According to our findings, there was a statistically significant post-operative increase in the knee extension amplitude by 1.4° in female patients and an insignificant extension increase in male patients. The mean postoperative KOOS score was 66.7 points (46 to 91) in the patient group, 67.1 points (54 to 91) in males, and 59.5 points (46 to 64) in females. As early as six months after a valgus osteotomy, we already observed improved biomechanics of the KJ motions compared to pre-operative data. By that time, the swing flexion amplitude of the affected KJ had increased and became symmetrical, which had not been the case before surgery. We observed a total of three changes in the KJ kinematics after surgery: increased swing flexion amplitudes in both KJs, a decreased extension amplitude in the affected KJ, and increased first flexion amplitudes in both KJs.According to our study, the midterm outcomes after a valgus osteotomy showed clinical improvements based on the VAS and KOOS scores, which were however less pronounced than in similar studies with a longer assessment term after surgery. We also found a significant increase in the amplitude of joint extension, but only in females. As the function of the operated joint is concerned, valgus osteotomy restored the kinematics of walking movements to a nearly normal gait with increased first and second flexion amplitudes. The function of KJ becomes symmetric though the non-operative side. Thus, the healthy and functionally more capable side is copying the movement pattern of the affected side. Hence, the non-operative leg is functioning less efficiently than it is required by the walking pace.

Purpose An investigation of arthroscopic surgery combined with coverage of the microfractured wound surface with platelet-rich plasma (PRP) and fibrin gels (FG) to treat knee cartilage defects. Methods Between February 2017 and February 2020, 145 patients with knee cartilage defects were treated. Only isolated full-thickness cartilage defects were included, and 28 patients (12 men and 16 women) were included in this study. They were all treated with arthroscopic surgery on subchondral bones, filled with PRP and thrombin, and sealed with FG. The knee pain visual analogue scale (VAS) scores were measured after the patients climbed ten stairs up and down, and the Western Ontario and McMaster Universities osteoarthritis index and the area of cartilage defects were measured through the pre-operative and post-operative follow-up. The complication incidences were also observed. Results All patients were followed up for ten to 15 months (median 12 months). The knee pain VAS scores decreased from 6.57 ± 1.07 pre-operatively to 2.09 ± 1.35 at the last follow-up. The WOMAC osteoarthritis index decreased from 44.32 ± 3.95 (mean ± sd) pre-operatively to 16.57 ± 2.20 by the last follow-up. The cartilage defect decreased from 2.93 ± 0.65 cm2 pre-operatively to 1.09 ± 0.69 cm2 at the last follow-up. All scores showed statistically significant improvements after surgery (p Conclusion The combination therapy of arthroscopic surgery and covering the microfractured wound surface with PRP and FG can repair knee cartilage defects, relieve pain, and improve function, and is a safe and effective treatment.

The purpose of this study was to determine the effect of obesity on patient outcome, procedure failure rate and osteoarthritis (OA) progression in the tibiofemoral compartments in a series of isolated patellofemoral arthroplasty (PFA) performed with a third-generation implant.The study population was patients who had undergone third-generation PFA at a specialized orthopedic center between 2007 and 2017. Patients were categorized by body-mass index (BMI) as obese (O, BMI 30 kg/mA total of 120 PFAs with a mean follow-up of 6.9 ± 2.5 years were included: 25 in the O group and 95 in the NO group. Significant improvement was noted in in knee range of motion (P 0.001), clinical and functional KSS (P 0.001), UCLA Activity Score (P 0.001), Tegner score (P 0.001) and VAS pain (P 0.001) without inter-groups differences. Worsening of the medial Kellgren-Lawrence (KL) grade (but not the lateral KL grade) was more frequent in the O than the NO group during the follow-up period (P = 0.014). Failure occurred in 4.2% of NO and in 20% of O group patients; the difference was solely due to failure because of OA progression in the tibiofemoral compartment (16% in the O group). There were no between group differences in the failure rate for any cause other than OA progression (4.2% in the NO group, 4.0% in the O group).An equal improvement in function after PFA was noted in both obese and nonobese patients; however, the high failure rate due to OA progression in the medial tibiofemoral compartment warrants caution when considering PFA in obese patients.

The purpose of this study was to investigate the therapeutic and the chemical effects of balneological treatment (peloidotherapy + hydrotherapy), and its effects on serum levels of interleukin-1beta (IL-1β), tumor necrosis factor-alpha (TNF-α), and insulin-like growth factor-1 (IGF-1) in patients with knee osteoarthritis (OA). Sixty-four (64) knee OA patients were randomly divided into study and control groups. Balneological treatment, consisting of hydrotherapy, and peloidotherapy were given to both groups. Unlike the study group, in the control group, the peloid was applied over a stretch film cover, preventing any contact between the skin and peloid. Clinical outcome measures of the study were pain degree, patient's and investigator's global assessment on visual analog scale (VAS-pain, VAS-PGA, VAS-IGA), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) (pain, stiffness, and physical function). Patients were evaluated at baseline, post-treatment (after 10th session), and 3 and 6 months after treatment. Blood samples were taken at baseline, post- treatment, and 6 months after treatment for analysis of IL-1β, TNF-α, and IGF-1 serum levels. When compared with the baseline, VAS measurements decreased significantly in almost all evaluation periods in both groups, and no difference was observed between the groups. In the study group, WOMAC scores showed significant improvement in all assessments. In the control group, pain and physical function subscores of WOMAC significantly decreased at post-treatment and 3 months after treatment. In group comparison, pain and stiffness subscores showed a significant difference in favor of the study group at 6 months after treatment. No clinically significant improvement was seen in levels of IL-1β and IGF-1 in both groups during the whole assessment period. Because of TNF-α kit failure, we could not evaluate the measurements. In conclusion, balneological treatment is an effective treatment option to improve the pain and functional capacity of patients with knee OA. The application of peloid by contact with the skin is superior in the long-term period, which means that in addition to the thermal effect, the chemical content of peloid can also contribute to the therapeutic effect.

Genicular artery embolization (GAE) has emerged as a treatment option to improve quality of life in patients suffering from moderate-to-severe pain refractory to conservative treatment of knee osteoarthritis, with encouraging results. This paper describes the study protocol of a single-center, double-blind, randomized controlled trial designed to evaluate and compare the safety and efficacy of GAE using imipenem/cilastatin vs. microspheres for the treatment of moderate-to-severe pain associated with knee osteoarthritis. We hypothesized that there will be no difference in safety and efficacy outcomes. The study received ethics approval of the institutional review board with number 4.364.391 / CAAE: 37590820.3.0000.5342 and is registered onto the Registro Brasileiro de Ensaios Clinicos (ReBEC), with number RBR-2h5rwgb. Technical success was defined as embolization of at least 1 feeding artery supplying the hyperemic synovium of the knee joint. Primary outcome: clinical success was defined as improvement in symptoms, 50% reduction in Western Ontario and McMaster Universities Osteoarthritis Index pain scores or an increase of at least 10 points in the Knee Injury and Osteoarthritis Outcome Score from baseline to 3 months of follow-up. Secondary outcome: radiological success was defined as significant improvement in the Whole-Organ Magnetic Resonance Imaging Score for knee synovitis considering the embolized areas at 12 months of follow-up after GAE and a reduction in the analgesia or other conservative therapies for knee pain used by the patient at 3 and 12 months of follow-up. Clinical assessments will be performed before GAE, during GAE and at hospital discharge (for Visual Analog Scale of pain), and at 30 days, 3 months, and 12 months after GAE.

To systematically review and critically appraise the literature on double-level osteotomy (DLO) of the knee, and determine the indications, contraindications, targets and outcomes.A systematic literature search was performed on PubMed, Embase®, and Cochrane for studies that reported on DLO by any technique or approach, including indications, contraindications, and targets for DLO, as well as patient-reported outcome measures (pROMS) and radiographic angles.Twelve eligible studies were found: 9 case series and 3 studies that compared DLO to high-tibial osteotomy (HTO). In all studies, DLO was performed by medial opening-wedge tibial osteotomy and lateral closing-wedge femoral osteotomy. Seven specified that DLO was performed if simple HTO would exceed thresholds of postoperative medial proximal tibial angle (MPTA), lateral distal femoral angle (LDFA), and/or predicted wedge size. The targets were 88°-95° for MPTA, 84°-89° for LDFA, and 0°-4° for hip-knee-ankle (HKA) angle. The 3 comparative studies reported lower MPTA after DLO (89.6°-92.5°) than after HTO (91.5°-98.3°). All 3 reported similar postoperative HKA after DLO (0.2°-4.4°) as HTO (0.4°-4.8°); only 2 compared postoperative LDFA, which was lower after DLO (85.4° and 84.9°) than HTO (88.7° and 88.8°). Two comparative studies reported postoperative overall KOOS which was slightly lower after DLO (351-403) than HTO (368-410); only 1 study reported separate items of the KOOS.There was relative consistency between studies on the indications, targets and techniques for DLO. Furthermore, while the comparative studies reported similar preoperative MPTA, LDFA and HKA, the postoperative MPTA and LDFA were lower after DLO than after HTO, though both treatments achieved equivalent postoperative HKA.IV, systematic review.

We aimed to validate a 2D radial T2* mapping method and its ability to reveal subtle alterations in the menisci of patients with knee osteoarthritis (OA).Of 40 enrolled participants, 20 were diagnosed with OA, and 20 were age- and sex-matched asymptomatic controls. Data from the right knee of each participant were collected using a 1.5-T MRI equipped with a single-channel knee coil. T2* values were acquired using a conventional T2* mapping protocol and a radial T2* mapping method. Mean T2* values in the meniscal white zones, meniscal red zones, and total menisci were calculated. Numerical simulation was performed for validation.Both simulation and clinical data confirmed that 2D radial T2* mapping provided better discrimination than the conventional method. Compared to controls, the OA group showed significantly greater mean (standard deviation) T2* values in the white zones (9.33 [2.29] ms vs. 6.04 [1.05] ms), red zones (9.18 [2.03] ms vs. 6.81 [1.28] ms), and total menisci (9.26 [2.06] ms vs. 6.34 [1.14] ms). Correlations were found between the Lequesne index and the meniscal T2* values in all three regions (r = 0.528, p = 0.017; r = 0.635, p = 0.003; and r = 0.556, p = 0.011, respectively).These findings indicate that in early OA, radial T2* mapping is an alternative means of assessing meniscal degeneration and can be used to monitor its progression.• Radial T2* mapping outperforms Cartesian T2* mapping. • Radial T2* measurements are useful in assessing meniscal degeneration. • Meniscal T2* values correlate well with disease severity.

The purpose of this study was to compare the early functional outcomes between robotic-arm assisted total knee arthroplasty (RATKA) and conventional manual total knee arthroplasty (TKA).This prospective cohort study included 52 patients (26 RATKA and 26 TKA). All procedures were performed by a single experienced surgeon using identical approach and implant designs. Post-operative evaluation consisted of the risks of inflammatory and blood loss, the accuracy of mechanical alignment, post-operative pain, peri-operative and post-operative functional outcomes, and complications for 30 days after index surgery.There was no statistical difference in baseline characteristics of patients between two groups (p 0.05). There was a trend that the operative time of RATKA was prolonged compared with manual TKA (p 0.0001). However, the risks of infection and blood loss did not increase accordingly (p 0.05). No statistical difference was found in the correction of mechanical alignment between two groups (p 0.05). The RATKA was associated with reduced pain post-operatively in day 1 (p 0.05). Afterwards, there was no systematic difference in VAS score from day two to three post-operatively (p 0.05). There was no significant difference in functional recovery (p 0.05). No complication occurred in both groups.Although the operative time was prolonged in RATKA, it did not increase the risks of infection and blood loss. There was no significant difference in radiological or functional outcomes between RATKA and conventional manual TKA. RATKA might be related to reduced pain after surgery.

The purpose of this study was to report Knee Society Scores (KSS) at 12-month follow-up in a series of 266 knees that received custom TKA. The hypothesis was that custom TKA combined with personalised alignment would yield improvements greater than substantial clinical benefits (SCB) of KSS Knee and Function.From a consecutive series of 905 patients (918 knees) that received primary TKAs, 261 (29%) patients (266 knees) received computed tomography (CT)-based posterior-stabilised cemented custom TKA. Knees were aligned aiming to preserve or restore constitutional alignment within predetermined limits of 85°-95° for femoral mechanical angle (FMA) and tibial mechanical angle (TMA), and 175°-183° for hip knee ankle (HKA) angle. The KSS Knee and Function were collected preoperatively and 12 months postoperatively, to determine if patients achieved SCB. Uni- and multivariable analyses were performed to determine associations between KSS scores (Knee and Function) and patient demographics as well as pre- and postoperative radiographic alignments.Of the initial cohort of 261 patients, 4 (1.8%) were reoperated for patellar resurfacing, 1 (0.4%) for lavage to treat infection, and 1 (0.4%) had arthroscopy to treat a stiff knee with 90° range of motion. Complete clinical records were available for 227 patients (232 knees, 87%) that comprised 102 men (5 bilateral) and 125 women. At 12-month follow-up, mean improvements in KSS Knee and Function scores were, respectively, 61.0 ± 13.0 and 42.7 ± 16.7, which exceeded the SCB of KSS. Comparison of knees inside versus outside the target zone revealed no differences in KSS Knee (94.1 ± 9.1 versus 94.3 ± 9.0, n.s.) and Function (96.1 ± 9.2 versus 96.3 ± 8.9, n.s.). Multivariable analysis revealed worse KSS Knee in knees with preoperative FMA 95° (β = - 6.21; p = 0.023), but no association between KSS Function and patient demographics or pre- and postoperative radiographic alignments.Custom TKA combined with personalised alignment yielded improvements that exceeded substantial clinical benefits of KSS Knee and Function scores. These findings demonstrate the feasibility of custom TKA with 'personalised alignment' and encourage further investigations using comparative studies at longer follow-up.IV, case series.

To compare the effectiveness of ultrasound-guided genicular nerve block (GNB) and physical therapy (PT) in patients with chronic knee osteoarthritis. A prospective randomised study with 102 patients (45–70 years) was performed wherein the patients received ultrasound-guided GNB (n = 51) and PT (n = 51) along with a standard home exercise programme. Scores for pain on a Visual Analogue Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and 6-min walking test (6MWT) were assessed pre-treatment and at 2- and 12-weeks post-treatment. Both groups were comparable for sociodemographic characteristics. VAS scores (in mm) in the ultrasound-guided GNB group at 0, 2 and 12 weeks were 7.01 ± 1.36; 3.71 ± 2.18; 5.08 ± 2.22 (p < 0.001) and 6.64 ± 1.99; 4.35 ± 1.09; 5.25 ± 1.33, (p < 0.001) in the PT group. While the increase in the 6MWT test in the 2nd week was similar for both groups (p = 0.073), the increase in walking distance was greater in the ultrasound-guided GNB group at 12 weeks (p = 0.046). As compared to PT, ultrasound-guided GNB is beneficial in reducing pain and increasing functional and physical capacity, with greater retention of effects on the physical capacity seen at 12 weeks. Trial registration number: ClinicalTrials.gov (NCT04782401).

To investigate the efficacy of fat fraction (FF) and T2* relaxation based on DIXON in the assessment of infrapatellar fat pad (IFP) for knee osteoarthritis (KOA) progression in older adults.Ninety volunteers (age range 51-70 years, 65 females) were enrolled in this study. Participants were grouped based on the Kellgren-Lawrence grading (KLG). The FF and T2* values were measured based on the 3D-modified DXION technique. Cartilage defects, bone marrow lesions, and synovitis were assessed based on a modified version of whole-organ magnetic resonance imaging score (WORMS). Knee pain was assessed by self-administered Western Ontario and McMaster Osteoarthritis Index (WOMAC) questionnaire. The differences of FF and T2* measurement and the correlation with WORMS and WOMAC assessments were analyzed. Diagnostic efficiency was analyzed by using receiver operating characteristic (ROC) curves.A total of 60 knees were finally included (n = 20 in each group). The values were 82.6 ± 3.7%, 74.7 ± 5.4%, and 60.5 ± 14.1% for FF is the no OA, mild OA, and advanced OA groups, and were 50.7 ± 6.6 ms, 44.1 ± 6.6 ms, and 39.1 ± 4.2 ms for T2*, respectively (all p values0.001). The WORMS assessment and WOMAC pain assessment showed negative correlation with FF and T2* values. The ROC showed the area under the curve (AUC), sensitivity, and specificity for diagnosing OA were 0.93, 77.5%, and 100% using FF, and were 0.86, 75.0%, and 90.0% using T2*, respectively.FF and T2* alternations in IFP are associated with knee structural abnormalities and clinical symptoms cross-sectionally and may have the potential to predict the severity of KOA.• Fat fraction (FF) and T2* relaxation based on DIXON imaging are novel methods to quantitatively assess the infrapatellar fat pad for knee osteoarthritis (KOA) progression in older adults. • The alterations of FF and T2* using mDIXON technique in IFP were associated with knee structural abnormalities and clinical symptoms. • FF and T2* alternations in IFP can serve as the new imaging biomarkers for fast, simple, and noninvasive assessment in KOA.

To investigate the benefits of vancomycin-soaked femoral head allograft versus allogenic bone chips as an osteotomy gap filler in reducing infection rates and perioperative pain control after medial opening wedge high tibial osteotomy (MOW-HTO).Retrospective analysis of 114 knees that underwent MOW-HTO between 2013 and 2020. Osteotomy gaps were filled with vancomycin-soaked femoral head allograft (Study Group) or allogenic bone chips (Control Group). Both groups received systemic antibiotics. Perioperative parameters studied included pain, blood loss, length of stay, postoperative day (POD1) pain scores at rest, with activity as well as ambulatory distance. Patients in the Study Group were also followed up prospectively and clinical outcome scores, namely Knee Society Score, Oxford knee score (OKS) and Physical and Mental Component of the Short-Form 36 Questionnaire (PCS and MCS, respectively). Statistical analyses using Student's T-test were performed between the groups.Patients of the study group had significantly better POD1 visual analogue scale (VAS) at rest (0.9 ± 1.6 vs 2.9 ± 1.2, p 0.001) as well as when active (3.0 ± 1.9 vs 5.8 ± 1.5, p 0.001). A greater proportion of patients in the study group ambulated on POD 1, (90.6% vs 26.0%, p 0.001). Of those who ambulated on POD1, study group patients managed to cover a greater ambulatory distance (13.9 ± 7.4 m vs 8.4 ± 9.3 m, p 0.05). The proportion of study group patients requiring patient-controlled analgesia (PCA) was also significantly less compared to the control group (32.8% vs 58.0%, p 0.05). Of those requiring PCA, the amount of morphine requirement was also significantly reduced in the group with vancomycin-soaked allograft (8.7 ± 8.1 mg vs 23.9 ± 33.0 mg, p 0.05). The study group also had a reduced length of stay (3.5 ± 2.0 days vs 5.5 ± 2.6 days, p 0.001). Patients in the study group demonstrated significant improvement in Knee Society Knee Score (KSKS), OKS, PCS and MCS at 12 months postoperatively. The study group had a significantly reduced incidence of superficial wound infections compared to the control group (3.1% vs 18.0%, p 0.05).Vancomycin-soaked femoral head allograft reduced superficial and deep wound infections in MOW-HTO. It was also effective in reducing postoperative pain, thereby enabling early ambulation and shorter hospital stays.Retrospective comparative study, III.

Genetic variations in a disintegrin and metalloprotease 12 (ADAM12) gene may contribute to develop Osteoarthritis (OA) that is characterized by cartilage matrix degradation and osteophytes formation. Therefore, the aim of present study was to analyze the association between the ADAM12 gene variants and knee OA predisposition. Tetra-primers ARMS-PCR was employed, to genotype the ADAM12 gene polymorphisms (rs1044122 and rs1871054) in 400 knee OA patients and equal number of age-matched controls. The association between ADAM12 gene variants and OA susceptibility was estimated using the Chi-square, logistic regression, haplotypes and linkage analyses. A significant association of rs1044122 (genotype: χ

The purpose of this study was to compare ligament balance and laxity profiles achieved throughout flexion in restricted kinematic alignment (rKA) and gap balancing (GB). rKA and GB both aim to improve soft tissue balance and reduce ligament releases in total knee arthroplasty (TKA).One surgeon performed 68 rKA, another performed 73 GB TKAs using the same CR implant and robotic system. rKA limited femoral valgus and tibial varus to 6°, with tibial recuts performed to achieve balance. GB limited tibial varus and femoral valgus to 2°, with femoral resections adjusted to achieve mediolateral balance throughout flexion using predictive-gap planning software. Final joint laxity was measured using a robotic ligament tensioner. Statistical analyses were performed to compare differences in mediolateral balance and joint laxity throughout flexion. Further analyses compared alignment, joint line elevation and orientation (JLO), and frequency of ligament releases and bone recuts.Both techniques reported greater lateral laxity throughout flexion, with GB reporting improved mediolateral balance from 10° to 45° flexion. GB resected 1.7 mm more distal femur (p ≤ 0.001) and had greater overall laxity than rKA throughout flexion (p ≤ 0.01). rKA increased JLO by 2.5° and 3° on the femur and tibia (p ≤ 0.001). Pre-operative and post-operative coronal alignment were similar across both techniques. rKA had a higher tibial recut rate: 26.5% vs 1.4%, p 0.001.rKA and GB both report lateral laxity but with different JLO and elevation. Use of a predictive-gap GB workflow resulted in greater mediolateral gap symmetry with fewer recuts.III, retrospective cohort study.

Glenohumeral osteoarthritis (GH-OA) is a common cause of shoulder pain and is characterized by articular cartilage thinning, glenoid bone loss and deformity, osteophytosis, and other associated changes. The prevalence is estimated to be between 85 and 94% in men and women over the age of 80 years. A diagnosis of GH-OA is established based on clinical history, physical examination, and radiographic assessments. Non-pharmacological treatment options may serve as adjuvants to other therapies and should be incorporated for a more holistic approach to management. Pharmacological treatments include oral agents such as acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), opioids, corticosteroids and antidepressants. The National Institute for Health and Care Excellence (NICE) UK guidelines recommend NSAIDS as the first-line drugs for OA; topical forms of some of these agents can also be used. However, clinical evidence is largely lacking for its use in GH-OA, although patients with other types of OA, especially the knee and hip, are using these products in efforts to relieve joint pain. Intra-articular injections such as platelet-rich plasma, cortisone, and hyaluronic acid are usually used to control symptoms in moderate to advanced arthritis or in non-surgical candidates. Other non-surgical treatment options include suprascapular nerve block and radiofrequency ablation, and these options have been studied on different levels of evidence. Furthermore, all these treatments have their own indications, contraindications, and adverse effects profiles. Surgical treatment of GH-OA is reserved for patients who do not respond to conservative management or who suffer from debilitating symptoms that severely impair their quality of life.Level of Evidence IV, review article.

Hip involvement in juvenile idiopathic arthritis (JIA) is one of most important causes of pain and disability. Total hip arthroplasty (THA) is considered the standard when medical approaches fail to relieve pain. However, THA is problematic for many reasons. As current literature lacks studies valuating medical management of osteoarthritis (OA) secondary to JIA, we assessed the long-term pain relief effect of US-guided intra-articular viscosupplementation in hip osteoarthritis secondary to JIA versus primary OA under different etiological conditions.Patients in both groups received intra-articular Hylan G-F 20 2 ml once a month for 3 consecutive months and every 6 months for 2 years as maintenance. Effectiveness (VAS and WOMAC), NSAID/analgesic consumption, tolerability, withdrawals and reason for discontinuation were collected at each time point. An inverse probability weighting was used to balance the two groups.We retrospectively retrieved data of 14 JIA patients and 26 primary OA. Weighting successfully accounted for differences between the disease groups supporting the results. Viscosupplementation led to an early and significant improvement of pain and function and concomitant decrease in NSAIDs consumption, while the response diverged over 1 year with loss of benefits in JIA. The worst outcome was observed in active JIA.Duration of symptom relief after intra-articular injection of hyaluronic acid depends on the nature of arthritis. Multiple courses of viscosupplementation are required to maintain low-dose NSAIDs consumption in patients responsive to treatment while shortening the time between consecutive injections might provide persistent positive results in patients suffering from JIA.

Knee and hip osteoarthritis (KHOA) are a source of functional impairment. With aging, the management of osteoarthritis (OA) is a major issue in the search for improved quality of life. Spa treatment provides short- and mid-term symptom relief without serious side effects. This study aimed to identify characteristics of patients with KHOA associated with use of spa treatment. The prospective KHOALA cohort included 878 adults aged 40 to 75 years with symptomatic KHOA. We separately analyzed knee and hip OA data and compared patients who never had spa treatment with those who had at least one or multiple treatments during 5 years of follow-up in terms of socio-demographic characteristics, clinical data, quality of life (OAKHQOL, SF-36), physical activity (MAQ), functional impairment (WOMAC), and health care consumption (pharmacological and non-pharmacological treatments). Factors associated with at least one or multiple spa treatments were evaluated with regression logistic models. In all, 607 (69.1%) patients had knee OA (KOA), 222 (25.3%) hip OA (HOA) and 49 (5.6%) both, 91 (13.9%) with KOA, and 33 (12.2%) with HOA had at least one spa treatment. In the KOA cohort, the probability of at least one, two, or three spa treatments was increased with older age (odds ratio = 1.6 [95% confidence interval 1.2-2.2], 1.8 [1.2-2.8], 2.4 [1.4-4.2], respectively), greater use of physiotherapy (OR = 3.9 [2.1-7.1], 2.7 [1.3-5.6], 2.5 [1.1-5.9]), having a prosthesis (OR = 2.1 [1.2-3.8], 2.2 [1.1-4.3], 2.5 [1.1-5.5]), and low MAQ score (OR = 0.7 [0.6-0.9], 0.7 [0.5-1.0], 0.7 [0.5-1.0]). In the HOA cohort, female sex was associated with at least one (OR = 3.0 [1.1-8.0]) or two (OR = 5.1 [1.2-22.5]) spa treatments. In this cohort of KHOA, repeated spa treatment over 5 years was strongly associated with older age, greater use of physiotherapy and presence of a prothesis with KOA and female sex with HOA. This study may help to better understand spa treatment determinants in OA.

Total knee arthroplasty (TKA) is an important treatment for knee osteoarthritis, but the result of whole-body vibration (WBV) in knee function rehabilitation and bone loss with osteopenia was unknown. Therefore, the purpose of this study is to study whether low-frequency, low-amplitude WBV can improve the clinical outcome of knee osteoarthritis.This study was randomized and included 67 osteopenic patients (55-90 years, 85% women) for TKA surgery (control group N = 32, WBV group N = 35). All selected patients after TKA surgery tested clinical results, such as knee function and bone mass in baseline, 3 months after surgery, and 6 months after surgery.Compared to the control group, the WBV group improved pain scores, thigh circumference, lower limb muscle strength, joint activity, and joint function in 6 months after surgery. WBV intervention also improves bone density in the spine, the microstructure of the radius and tibia, and the bone turnover marker. At 3 months after TKA surgery, the WBV group had no significant effect on knee function and bone loss.Whole-body vibration for osteopenic patients with knee arthroplasty showed good therapeutic results in 6 months after TKA surgery, but the long-term therapeutic effect still needs to be further observed.

To describe the association between body weight change and the risk of knee replacement and hip replacement.Time-to-event survival analysis from a population-based cohort of participants who had or were at risk of clinically significant knee osteoarthritis at baseline.Data from the Osteoarthritis Initiative (OAI), which collected data from four clinical centres in the United States.A total of 8069 knees from 4081 participants, and 8076 hips from 4064 participants (59.3% female) aged 45-79 years, with mean ± SD body mass index (BMI) of 28.7 ± 4.8 kg/mBody weight change from baseline as a percentage of baseline at repeated follow-up visits over 8 years.Incidence of primary knee or hip replacement during 8-year follow-up.Body weight change had a small, positive, linear association with the risk of knee replacement (adjusted hazard ratio [HR] 1.02; 95% confidence interval [CI] 1.00-1.04). Body weight change was also positively and linearly associated with the risk of hip replacement in hips that were persistently painful at baseline (adjusted HR 1.03; 95% CI 1.01-1.05), but not in hips that were not persistently painful at baseline. There were no significant interactions between body weight change and baseline BMI in the association with knee or hip replacement.In people with or at risk of clinically significant knee osteoarthritis, every 1% weight loss was associated with a 2% reduced risk of knee replacement and - in those people who also had one or more persistently painful hips - a 3% reduced risk of hip replacement, regardless of baseline BMI. Public health strategies that incorporate weight loss interventions have the potential to reduce the burden of knee and hip replacement surgery.

The load on the lead knee joint during a golf swing is greater than that observed during gait. However, current evidence regarding golf swing biomechanics for risks associated with knee osteoarthritis (OA) is limited. Therefore, this study investigated golf swing styles associated with knee adduction and abduction moments, which are considered to be crucial loading regions of the medial and lateral compartments of knee OA, respectively. Thirteen professional male golfers performed five shots using a 5-iron club, and their swings were recorded using a motion capture system with two force platforms for the feet. A regression analysis was performed to calculate the correlation coefficients between the peak knee adduction and abduction moments of the lead leg and varus/valgus angle, toe-out angle, stance width, weight transfer, and shoulder sway. Swinging with a narrower stance width at address (r = − 0.62, p = 0.02) with more weight shift (r = 0.66, p = 0.014) and shoulder sway (r = 0.79, p = 0.001) towards the target during the downswing were associated with a higher peak knee adduction of the lead leg, whereas a greater valgus angle at address (r = 0.60, p = 0.03) was associated with a higher peak knee abduction of the lead leg. Based on these findings, we anticipate future research to support postural changes, particularly a wider stance width and restricted shoulder sway for golfers who are classified to be at high risk of developing medial compartment knee OA, as well as a lower valgus (tibial medial tilt) angle at address for those classified to be at high risk of developing lateral compartment knee OA.

Background Soft tissue has an important role in stabilizing the hinge point of medial closed wedge distal femoral osteotomy (MCWDFO). However, there are conflicting data on the soft tissue anatomy around the hinge point of MCWDFO and, therefore, further anatomical data are needed. The purposes of the study were to: 1) anatomically analyze the soft tissue around the hinge point of MCWDFO; 2) radiologically define the appropriate hinge point to prevent an unstable hinge fracture based on the result of the anatomical analysis; and 3) histologically analyze the soft tissue based on the result of the anatomical analysis. Methods In 20 cadaveric knees, the capsule attachment of the distal lateral side of the femur was marked with a radiopaque ball bearing. A digital planning tool was used to calculate the area of the marked capsule attachment around the ideal hinge point of MCWDFO on radiographs. The soft tissue around the hinge point was histologically examined and the periosteal thickness was measured and visualized graphically. The graph and radiograph were overlayed using image editing software, and the appropriate hinge position was determined based on the periosteal thickness. Results As a result, the periosteal thickness of the distal lateral femur tended to rapidly decrease from the metaphyseal region toward the diaphyseal region. The overlayed graph and radiograph revealed that the periosteal thickness changed in the region corresponding to the apex of the turning point of the femoral metaphysis in all cases. Conclusions In conclusion, the periosteum might support the hinge of MCWDFO within the area surrounded by the apex of the turning point of the femoral metaphysis and the upper border of the posterior part of the lateral femoral condyle.

Background For knee osteoarthritis, the commonly used radiology severity criteria Kellgren–Lawrence lead to variability among surgeons. Most existing diagnosis models require preprocessed radiographs and specific equipment. Methods All enrolled patients diagnosed with KOA who met the criteria were obtained from **** Hospital. This study included 2579 images shot from posterior–anterior X-rays of 2,378 patients. We used RefineDet to train and validate this deep learning-based diagnostic model. After developing the model, 823 images of 697 patients were enrolled as the test set. The whole test set was assessed by up to 5 surgeons and this diagnostic model. To evaluate the model’s performance we compared the results of the model with the KOA severity diagnoses of surgeons based on K-L scales. Results Compared to the diagnoses of surgeons, the model achieved an overall accuracy of 0.977. Its sensitivity (recall) for K-L 0 to 4 was 1.0, 0.972, 0.979, 0.983 and 0.989, respectively; for these diagnoses, the specificity of this model was 0.992, 0.997, 0.994, 0.991 and 0.995. The precision and F1-score were 0.5 and 0.667 for K-L 0, 0.914 and 0.930 for K-L 1, 0.978 and 0.971 for K-L 2, 0.981 and 0.974 for K-L 3, and 0.988 and 0.985 for K-L 4, respectively. All K-L scales perform AUC > 0.90. The quadratic weighted Kappa coefficient between the diagnostic model and surgeons was 0.815 (P Conclusion The deep learning-based diagnostic model can be used to assess the severity of KOA in portable devices according to the Kellgren–Lawrence scale. On the premise of improving diagnostic efficiency, the results are highly reliable and reproducible.

Background Patellofemoral pain is highly prevalent across the lifespan, and a significant proportion of people report unfavourable outcomes years after diagnosis. Previous research has implicated patellofemoral joint loading during gait in patellofemoral pain and its sequelae, patellofemoral osteoarthritis. Biomechanical foot-based interventions (e.g., footwear, insoles, orthotics, taping or bracing) can alter patellofemoral joint loads by reducing motions at the foot that increase compression between the patella and underlying femur via coupling mechanisms, making them a promising treatment option. This systematic review will summarise the evidence about the effect of biomechanical foot-based interventions on patellofemoral joint loads during gait in adults with and without patellofemoral pain and osteoarthritis. Methods MEDLINE (Ovid), the Cumulative Index to Nursing and Allied Health Literature CINAHL, The Cochrane Central Register of Controlled Trials (CENTRAL), SPORTdiscus (EBSCO) and Embase (Ovid) will be searched. Our search strategy will include terms related to ‘patellofemoral joint’, ‘loads’ and ‘biomechanical foot-based interventions’. We will include studies published in the English language that assess the effect of biomechanical foot-based interventions on patellofemoral joint loads, quantified by patellofemoral joint pressure, patellofemoral joint reaction force and/or knee flexion moment. Two reviewers will independently screen titles and abstracts, complete full-text reviews, and extract data from included studies. Two reviewers will assess study quality using the Revised Cochrane Risk of Bias (RoB 2) tool or the Cochrane Risk Of Bias In Non-Randomized Studies – of Interventions (ROBINS-I) tool. We will provide a synthesis of the included studies’ characteristics and results. If three or more studies are sufficiently similar in population and intervention, we will pool the data to conduct a meta-analysis and report findings as standardised mean differences with 95% confidence intervals. If a meta-analysis cannot be performed, we will conduct a narrative synthesis of the results and produce forest plots for individual studies. Discussion This protocol outlines the methods of a systematic review that will determine the effect of biomechanical foot-based interventions on patellofemoral joint loads. Our findings will inform clinical practice by identifying biomechanical foot-based interventions that reduce or increase patellofemoral joint loads, which may aid the treatment of adults with patellofemoral pain and osteoarthritis. Trial registration Registered with PROSPERO on the 4th of May 2022 (CRD42022315207).

Background Fall is a major cause of mortality and cause a significant burden on the healthcare system and economic system. Weak grip strength signifies impaired function. Older people with weak grip strength are at a higher risk of death. China has the largest ageing population in the world today. This study aims to analyze the factors contributing to weak grip strength and fall among Chinese. Methods This study analyzed data from the 2011 baseline and 2015 follow-up survey of the China Health and Retirement Longitudinal Study (CHARLS). To identify the risk factors of fall and weak grip strength, we used a stepwise multivariable logistic regression model and a least absolute shrinkage and selection operator (LASSO) regression model. Results In the LASSO regression model, all the risk factors were not shrunken. In the stepwise logistic regression model, adjusted for gender, age, grip strength, depression, and chronic disease, we found that female (aOR = 1.376, 95% CI = 1.243–1.523; P P = 0.001), depression (aOR = 1.559, 95% CI = 1.396–1.742; P P = 0.001), older age (aOR = 1.227, 95% CI = 1.163–1.294; P P P = 0.001) were factors associated with fall significantly. After further adjusting, we found the risk factors of weak grip strength included symptomatic knee osteoarthritis (aOR = 1.755, 95% CI 1.158–2.661; P = 0.008), living in rural area (aOR = 2.056, 95% CI 1.290–3.277; P = 0.002), depression (aOR = 1.523, 95% CI 1.116–2.078; P = 0.008), older age (aOR = 2.116, 95% CI 1.801–2.486; P Conclusion From the study, we found that older age and depression were risk factors of weak grip strength and fall. Weak grip strength was a risk factor of fall. Female, ischemic stroke, kidney disease, rheumatoid arthritis were risk factors of fall; living in rural area and symptomatic knee osteoarthritis were risk factors of weak grip strength.

Purpose It is not shown whether anatomical variations exist in valgus arthritic limbs as to support individualized component and limb alignment. The null hypothesis was that there was no phenotypic variation of coronal femoro-tibial morphology in valgus knees. The aim was to determine whether distinct phenotypes of valgus knees could be identified to help surgical planning and classifying valgus knees for outcome studies. Methods Full-leg weight-bearing radiographs of 233 knees (182 preoperative; 51 of contralateral arthritic knee) were measured for HKA (hip-knee-ankle angle), VCA (valgus correction angle), mLDFA (lateral mechanical distal femoral angle), aLDFA (lateral anatomical distal femoral angle), MPTA (medial proximal tibial angle), MNSA (medial neck shaft angle), TAMA (angle between tibial mechanical and anatomical axes), and TBA (tibial bowing angle). Results Nine phenotypes were identified encompassing all 233 knees which could be clubbed into 4 broad types. Type 1 Neutral knees (12.5%) had almost normal values (mean VCA 5.3°, mLDFA 86.9°, aLDFA 81.1°). Type 2 'Intra-articular valgus' (22.7%) showed lateral compartment bone loss (mean mLDFA 83.9°; MPTA 90.2°). Type 3 'Extra-articular valgus' (35.2%) had extra-articular deformity: 3a showed valgus femoral bowing (mean VCA 2.7°); 3b valgus tibial bowing; 3c showed valgus tibial bowing with lateral femoral condyle wear (mean mLDFA 84.3°). Type 4 'Varus' type (29.6%) had features of varus knees: 4a had varus femoral bowing (VCA 8.3°); distal femur in 4b was akin to varus knees (mean mLDFA 89.3°) with lateral tibial bone loss (mean MPTA 91.2°). 4c had varus tibial bowing and deficient lateral femoral condyle (mLDFA 83.7°). 4d had varus tibial bowing and lateral tibial bone loss (mean MPTA 89.8°). Conclusions The study identified four broad groups of valgus arthritic knees with nine phenotypes based on coronal plane variations in femoro-tibial morphology. This study may be of value in planning and performing corrective osteotomies, and planning the optimal position of femoral and tibial components in unicompartmental and total knee arthroplasty. The classification presented in this study may aid in categorizing valgus knees for outcome studies. Level of evidence IV.

Two-surgeon, simultaneous bilateral total knee arthroplasty (TKA) is considered as an unpredictable, complex procedure in terms of its radiographic and functional outcomes because of different surgeons and teams, and too many instruments and hands in a narrow space. We compared radiological and functional results of simultaneous bilateral TKA and single-surgeon sequential bilateral TKA.The 136 participants with a minimum of 24 months follow-up were prospectively randomized into 2 groups: two-surgeon bilateral TKA and single-surgeon bilateral TKA. We prespecified primary outcome of the study as between-group differences in terms of component alignment in the coronal and sagittal planes. Short-term functional outcomes were evaluated prospectively using the Oxford Knee Score (OKS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).Each group consisted of 136 knees of 68 patients. The mean tibial medial angles (TMA) were 89° ± 3 ° and 88° ± 5° in two-surgeons and single surgeon groups, respectively (p = 0.24). Radiological outcomes showed that the mean femoral lateral angles (FLA) were 87.9 ± 3.5° and 85.84 ± 3.7° (p = 0.12), posterior tibial slope angles (PTSA) were 8.2 ± 16.9° and 7.6 ± 17.8° (p = 0.84), and femoral flexion angles (FFA)were 86.8 ± 3.8° and 86.3 ± 3.5° (p = 0.41), anterior femoral offset ratios (AFOR) (%) were 29.5 ± 11.1 and 27.7 ± 7.9 (p = 0.31), and posterior femoral offset ratio (PFOR) (%) were 108.41 ± 31.3 and 108.45 ± 25.7 (p = 0.98), respectively.Two-team simultaneous bilateral TKA is as safe as single stage one-surgeon sequential bilateral TKA in terms of short-term component radiological and the functional outcomes.ZWECK: Die simultane bilaterale Knietotalendoprothese (TKA) mit zwei Chirurgen gilt als ein schwer einschätzbares, komplexes Verfahren in Bezug auf die radiologischen und funktionellen Ergebnisse, da verschiedene Chirurgen und Teams sowie zu viele Instrumente und Hände auf engem Raum zum Einsatz kommen. Wir haben die radiologischen und funktionellen Ergebnisse der simultanen bilateralen TKA mit denen der sequenziellen bilateralen TKA mit nur einem Chirurgen verglichen.Die 136 Teilnehmer mit einer Nachbeobachtungszeit von mindestens 24 Monaten wurden prospektiv in 2 Gruppen randomisiert: bilaterale TKA mit zwei Chirurgen und bilaterale TKA mit einem Chirurgen. Als primäres Ergebnis der Studie wurden die Unterschiede zwischen den Gruppen in Bezug auf die Ausrichtung der Komponenten in der koronalen und sagittalen Ebene spezifiziert. Die kurzfristigen funktionellen Ergebnisse wurden prospektiv mit dem Oxford Knee Score (OKS) und dem Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) bewertet.Jede Gruppe bestand aus 136 Knien von 68 Patienten. Die mittleren medialen Tibiawinkel (TMA) betrugen 89° ± 3° bzw. 88° ± 5° in den Gruppen mit zwei Chirurgen und in den Gruppen mit einem Chirurgen (p = 0,24). Die radiologischen Ergebnisse zeigten, dass die mittleren femoralen lateralen Winkel (FLA) 87,9 ± 3,5° und 85,84 ± 3,7° (p = 0,12), die posterioren tibialen Slope-Winkel (PTSA) 8,2 ± 16,9° und 7,6 ± 17,8° (p = 0,84) und die femoralen Flexionswinkel (FFA) 86,8 ± 3,8° und 86,3 ± 3,5° (p = 0,41) betrugen. Das anteriore femorale Offset-Verhältnis (AFOR) betrug 29,5 ± 11,1 und 27,7 ± 7,9 (p = 0,31) und das posteriore femorale Offset-Verhältnis (PFOR) 108,41 ± 31,3 bzw. 108,45 ± 25,7 (p = 0,98).Die simultane bilaterale TKA mit zwei Teams ist in Bezug auf die radiologischen und funktionellen Kurzzeitergebnisse genauso sicher wie die sequenzielle bilaterale TKA mit einem Chirurgen.

Purpose Randomized comparison of the effect of radiotherapy on painful osteoarthritis (OA) applying a standard-dose vs. a very-low-dose regime Patients and methods Patients with OA of the hand and knee joints were included. Further inclusion criteria: symptoms for more than 3 months, favorable general health status, age above 40 years. Patients with prior local radiotherapy, trauma, rheumatoid arthritis, or vascular diseases were excluded. After randomization (every joint was randomized separately), the following protocols were applied: standard arm: total dose 3.0 Gy, single fractions of 0.5 Gy twice weekly; experimental arm: total dose 0.3 Gy, single fractions of 0.05 Gy twice weekly. The dosage was not known to the patients. The patients were examined 3 and 12 months after radiotherapy. Scores like VAS (visual analogue scale), KOOS-SF (the knee injugy and osteoarthritis outcome score), SF-SACRAH (short form score for the assessment and quantification of chronic rheumatic affections of the hands), and SF-12 (short form 12) were used. Results A total of 64 knees and 172 hands were randomized. 3.0 Gy was applied to 87 hands and 34 knees, 0.3 Gy was given to 85 hands and 30 knees. After 3 months, we observed good pain relief after 3 Gy and after 0.3 Gy, there was no statistically significant difference. Side effects were not recorded. The trial was closed prematurely due to slow recruitment. Conclusion We found favorable pain relief and a limited response in the functional and quality of life scores in both arms. The effect of low doses such as 0.3 Gy on pain is widely unknown. Further trials are necessary to compare a conventional dose to placebo and to further explore the effect of low doses on inflammatory disorders.

The aim of this meta-analysis was to to determine the influence of obesity on patient outcome and implant survivorship after primary unicompartmental knee arthroplasty (UKA). A PRISMA systematic review was conducted by searching the Medline (PubMed), EMBASE, and Cochrane electronic databases to identify clinical studies investigating the effect of obesity on outcomes after UKA. Data were collected on aspecifically designed extraction form. Methodological quality was assessed using the Methodological Index for Nonrandomized Studies score. Quantitative meta-analysis was carried out using RevMan 5.4 software. A total of 17 studies were included; 43,845 primary UKA patients were classified by their BMI: on-obese (BMI 25 to 35 kg/m2). Pooled analysis showed no statistically significant difference in Knee Society Score (KSS) pain in the obese (n.s.) and the severely obese (n.s.) group compared to the non-obese group, while the KSS function score was lower in the severely obese (P = 0.0002) compared to the obese (P = 0.06) and the non-obese group. Postoperative Oxford Knee Score (OKS) was lower in the obese group (P = 0.01) but not in the severely obese group (P = 0.16). Postoperative Range of Motion (ROM) was comparable in the obese and non-obese group (P = 0.16). Implant survival at 10 years follow-up was significantly lower in the obese (82.5–95.3%; P

INTRODUCTION The purpose of this study was to evaluate balance function before and after total knee arthroplasty (TKA) using Berg balance scale (BBS). The study also aimed to identify factors associated with balance impairment. MATERIALS AND METHODS Ninety-three knees in 90 patients were prospectively evaluated using their BBS scores, passive knee extension/flexion angles, Visual analogue scale for pain scores, hip-knee-ankle angles, and knee extensor/flexor muscle strengths before and after TKA. A total BBS score of less than 45 indicates an enhanced risk of multiple falls. Multivariate logistic regression models were performed to elucidate factors associated with post-operative BBS score. RESULTS A significant difference in mean pre- and post-operative BBS scores were noted (49.3 ± 6.4 vs. 52.2 ± 4.7) (p

The primary purposes of this study were to prove the efficacy of PRP injection therapy on knee pain and functions by comparing patients with mild to moderate OA with a placebo control group, and also to understand the effectiveness of multiple doses compared to a single dose. It was hypothesized that PRP would lead to more favorable results than the placebo at 1, 3, 6, 12 and 24 months after treatment. 237 patients diagnosed with OA were randomly separated into 4 groups, who were administered the following: single dose of PRP (n: 62), single dose of sodium saline (NS) (n: 59), three doses of PRP (n: 63), and three doses of NS (n: 53). Clinical evaluations were made pre-treatment and at 1, 3, 6, 12 and 24 months post-treatment, using the Knee Injury and Osteoarthritis Result Score (KOOS), Kujala Patellofemoral Score, knee joint range of motion (ROM), measurements of knee circumference (KC), and mechanical axis angle (MAA) and a Visual Analog Scale (VAS) for the evaluation of pain. The better score values in the groups were recorded at 3 and 6 months. Patients treated with PRP maintained better scores at 3, 6 and 12 months compared to the NS groups (p

Introduction Continuous passive motion (CPM) is a frequently used method in the early post-operative rehabilitation of patients after knee surgery. In this study, the effectiveness of the CPM method was evaluated after primary total knee arthroplasty during an early recovery period. Methods Eighty patients undergoing total knee arthroplasty were assigned into two groups. The experimental group received CPM and active exercises, while the control group active exercises only. All subjects were evaluated once before the surgery and at a discharge, in terms of mean active range of motion (AROM), mean Knee Society Score (KSS), and Western Ontario and MacMaster Universities Osteoarthritis Index (WOMAC). Results The mean AROM for the experimental group was 82.3° ± 14.3° and 76.1° ± 22.2° for the control. The mean KSS score was 136.4 ± 19.3 points for the experimental group, and 135.7 ± 15.1 for the control. There were no statistical differences between the two groups. The KSS functional score was 66.4 ± 8.1 points for the experimental group compared to 62.2 ± 7.3 points for the control, but there was a statistically significant difference between the groups at discharge from the hospital (p = 0.009). A subjective estimation of the pain level, joint stiffness and function also showed a statistically significant difference between the two groups (38.6 ± 14.3 points for the CPM group and 21.2 ± 15.7 for the control). Conclusion These findings show that there is no significant effect of CPM in terms of improving clinical measurements. However, there was a significant beneficial effect on the subjective assessment of pain level, joint stiffness, and functional ability.

Biomarkers of bone and cartilage metabolism were proposed as early diagnosis indicators for knee osteoarthritis (OA), however, which were influenced by disease stage, age, and menopause state. Accurate diagnosis indicators are eagerly awaited. The current study aims to investigate associations of joint metabolism biomarkers and bone mineral density (BMD) with early knee OA in males and premenopausal females before age 50 years.A total of 189 patients aged before 50 years with early knee OA and 152 healthy participants were enrolled. Levels of bone biomarkers (PINP, OC, and CTX-I) and cartilage biomarkers (PIIANP, COMP, CTX-II, and MMP-3) were assessed. BMD was measured at the lumbar, femoral neck, and hip. Multivariate regression analyses were performed to evaluate the relationship between biomarkers, BMD, and early knee OA.Serum COMP, urine CTX-II and BMD at femoral neck and hip were increased in premenopausal patients as compared to control; with serum PINP and OC reduced. Meanwhile, serum COMP, urine CTX-II, and BMD at femoral neck and hip showed positive associations with premenopausal early knee OA, while serum PINP had negative association. However, in male patients, only serum COMP was higher than control, and no association of biomarkers or BMD was found with early knee OA.The joint metabolism biomarkers and BMD showed multiple associations with early knee OA in premenopausal females, but not in males aged before 50 years. It was suggested that sex differences should be taken into account when evaluating cartilage and bone metabolism in early knee OA. Key Points • The joint metabolism biomarkers and BMD are associated with early knee OA in premenopausal females, but not in males aged before 50 years. • Sex differences should be taken into account when evaluating cartilage and bone metabolism in early knee OA.

Objective To explore whether and which quantitative 3D measures of medial and/or lateral meniscus position and size are associated with subsequent medial femorotibial structural progression of knee osteoarthritis and to determine the correlation between central slice and total meniscus measures. Materials and Methods Knees with radiographic osteoarthritis from Osteoarthritis Initiative participants with longitudinal medial MRI-based cartilage thickness and radiographic joint space width (JSW) loss over 12 months were selected. These 37 structural progressor knees (64.7 ± 8.0y, 30.2 ± 4.6 kg/m2, 35% men) were matched 1:1 to 37 non-progressor knees (64.6 ± 9.8y, 30.2 ± 4.4 kg/m2, 35% men) without cartilage thickness or JSW loss. Quantitative measures of meniscus position and size were computed from manual segmentations of coronal baseline MRIs. Cohen’s D was used as measure of effect size. Results Maximum extrusion distance of the total medial meniscus and mean extrusion in the central 5 and in the central slice were greater for progressor than non-progressor knees (Cohen’s D 0.58–0.66). No significant differences were observed for medial tibial coverage or mean extrusion (entire meniscus). Among medial meniscus morphology measures, only mean height differed between progressor vs non-progressor knees (Cohen’s D 0.40). Among lateral meniscus measures, height and volume were greater in progressor vs. non-progressor knees (Cohen’s D 0.46–0.83). Mean extrusion measures were highly correlated between the entire meniscus and the central (r = 0.88) or the central 5 (r = 0.93) slices. Conclusions 3D maximum and central medial meniscus extrusion may serve as predictors for subsequent structural progression. Central meniscus extrusion measures could substitute 3D extrusion measurement across the entire meniscus.