The global burden of hip and knee osteoarthritis: estimates from the global burden of disease 2010 study

How does hip osteoarthritis differ from knee osteoarthritis?

Hip and knee osteoarthritis (OA) are leading causes of global disability. Most research to date has focused on the knee, with results often extrapolated to the hip, and this extends to treatment recommendations in clinical guidelines. Extrapolating results from research on knee OA may limit our understanding of disease characteristics specific to hip OA, thereby constraining development and implementation of effective treatments. This review highlights differences between hip and knee OA with respect to prevalence, prognosis, epigenetics, pathophysiology, anatomical and biomechanical factors, clinical presentation, pain and non-surgical treatment recommendations and management.

Preferred Strategies for Delivering Health Information to Patients With Musculoskeletal Disorders: A Qualitative Study

BACKGROUND

Patients' information needs may differ from what their care providers may perceive to be the patients' needs. This discordance needs to be recognized and addressed.

OBJECTIVE

We conducted a qualitative study to explore the perceptions of patients with selected musculoskeletal disorders and those of rheumatologists, on their preferred strategies for delivery of disease management information.

METHODS

Fifty-two patients diagnosed with either rheumatoid arthritis, knee osteoarthritis, or osteoporosis took part in 6 focus groups and 18 individual semistructured interviews. In addition, 11 rheumatologists participated in 2 focus groups and 4 semistructured individual interviews. Data were explored by thematic content analysis. Perceived preferences were identified and compared between patients and rheumatologists regarding (a) media, (b) setting, (c) messengers, and (d) key message content.

RESULTS

Patients' preferred media for disease management information were electronic (television and videos delivered as digital optical discs or the Internet), group instruction, and printed material. Patients preferred the information to be delivered in the setting of their homes, doctor's offices, or clinic waiting areas by the rheumatologists and patients with disease experience, addressing healthy lifestyle changes, medication adherence, and consequences of noncompliance. For rheumatologists, the perceived preference for information delivery was through printed material (brochures, booklets, and pamphlets) delivered in waiting areas by nurses and physicians, addressing nature of the disease, complications, and treatment adverse effects.

CONCLUSIONS

Provider perspectives on strategies for education may differ from those of patients. Our findings highlight the need for considering different stakeholder perspectives in designing educational tools and decision support materials for patients with chronic diseases.

TAKEHOME MESSAGE

Rheumatologists' preferences on strategies for education (mode of delivery, delivery setting, messengers, and topics) differ from those of patients. For example, patients want to learn about lifestyle changes and consequences of compliance versus noncompliance, whereas rheumatologists considered more important for patients to understand their disease, treatment adverse effects, and consequences of noncompliance.

Exploring the translational potential of clusterin as a biomarker of early osteoarthritis

BACKGROUND

Clusterin (CLU; also known as apolipoprotein J) is an ATP-independent holdase chaperone that prevents proteotoxicity as a consequence of protein aggregation. It is a ∼60 kDa disulfide-linked heterodimeric protein involved in the clearance of cellular debris and the regulation of apoptosis. CLU has been proposed to protect cells from cytolysis by complement components and has been implicated in Alzheimer's disease due to its ability to bind amyloid-β peptides and prevent aggregate formation in the brain. Recent studies suggest that CLU performs moonlighting functions. CLU exists in two major forms: an intracellular form and a secreted extracellular form. The intracellular form of CLU may suppress stress-induced apoptosis by forming complexes with misfolded proteins and facilitates their degradation. The secreted form of CLU functions as an extracellular chaperone that prevents protein aggregation.

METHODS

In this review, we discuss the published literature on the biology of CLU in cartilage, chondrocytes, and other synovial joint tissues. We also review clinical studies that have examined the potential for using this protein as a biomarker in synovial and systemic fluids of patients with rheumatoid arthritis (RA) or osteoarthritis (OA).

RESULTS

Since CLU functions as an extracellular chaperone, we propose that it may be involved in cytoprotective functions in osteoarticular tissues. The secreted form of CLU can be measured in synovial and systemic fluids and may have translational potential as a biomarker of early repair responses in OA.

CONCLUSION

There is significant potential for investigating synovial and systemic CLU as biomarkers of OA. Future translational and clinical orthopaedic studies should carefully consider the diverse roles of this protein and its involvement in other comorbidities. Therefore, future biomarker studies should not correlate circulating CLU levels exclusively to the process of OA pathogenesis and progression. Special attention should be paid to CLU levels in synovial fluid.

THE TRANSLATIONAL POTENTIAL OF THIS ARTICLE

There is significant potential for investigating synovial and systemic CLU as a predictive biomarker of osteoarthritis (OA) progression and response to novel treatments and interventions. Given that CLU plays diverse roles in other comorbidities such as rheumatoid arthritis (RA) and obesity, future translational and clinical orthopaedic biomarker studies should not directly correlate circulating CLU levels to the process of OA pathogenesis and progression. However, special attention should be paid to CLU levels in synovial fluid. The cytoprotective properties of CLU may support the implementation of regenerative strategies and new approaches for developing targeted therapeutics for OA.

Patient Perception of Depressive Symptoms in Rheumatic Diseases: A Cross-sectional Survey

OBJECTIVES

The presented study aimed to explore the presence and the self-identification of depressive symptoms among patients with rheumatic musculoskeletal diseases (RMDs) through the use of the Patient Health Questionnaire (PHQ-9).

METHODS

Between June and October 2019, patients from the regional association for people with RMDs in Lombardy, Italy (ALOMAR), were invited to participate in a cross-sectional online survey. Participants completed PHQ-9 along with a survey about their perception of depressive symptoms. Patients were stratified according to PHQ-9 score as follows: not depressed (<4), subclinical or mild depression (5-9), moderate depression (10-14), moderately severe depression (10-14), and severe depression (20-27). Descriptive statistics and analyses of variance were used to explore data.

RESULTS

Of the 192 RMD patients who completed PHQ-9, 35 (18.2%) were not depressed, 68 (35.4%) had subclinical or mild depression, 42 (21.9%) had moderate depression, 30 (15.6%) had moderately severe depression, and 17 (8.9%) had severe depression. Contrary to the above findings, only 16 respondents (8.3%) reported that they experienced depressive symptoms, and only 7 of the 16 were being followed by a psychiatrist. Respondents with higher PHQ-9 scores tended to have concomitant fibromyalgia, to be younger, and to be overweight.

CONCLUSIONS

The current results indicate the overall burden of depressive symptoms in RMD patients. While clinical depression (PHQ-9 >10) was detected in 41.2% of respondents, only 8.3% reported that they experience depressive symptoms. Routine screening of RMD patients for depression is therefore critical.

Osteoarthritis in osteogenesis imperfecta: A nationwide register-based cohort study

BACKGROUND

Osteogenesis Imperfecta (OI) is a genetic disease characterized by skeletal fragility. Collagen type 1 is found in many tissues and collagen abnormalities may result in organ specific symptomatology. Musculoskeletal pain is a known issue for patients with OI, osteoarthritis (OA) can be a likely cause. Only few studies have investigated the relationship between OI and OA but demonstrated a greater propensity in OI patients to develop rapidly progressing OA. Therefore, we wanted to investigate if OA is more frequent in patients with OI compared to the general population.

OBJECTIVE

To evaluate the risk of osteoarthritis in patients with OI.

DESIGN

A Danish nationwide, population-based and register-based longitudinal open cohort study.

PARTICIPANTS

From 1977 to 2019, all patients registered with an OI diagnosis and a reference population matched on age and sex 5:1.

MEASUREMENTS

Sub-hazard ratios for any, hip, and knee osteoarthritis comparing the OI cohort to the reference population.

RESULTS

We identified 907 patients with OI (493 women) and included 4535 patients in the reference population (2465 women). The Sub Hazard Ratio was 2.20 [95% CI 1.73-2.79] for any osteoarthritis with 11.4% of the OI population and 5.4% of the reference population being registered. We found lower incidences of upper extremity joint OA compared to lower joint OA, but upper extremity joint OA was significantly more frequent in the OI population 2.1% vs 0.6%, SHR 3.19 [95% CI 1.78-5.70].

CONCLUSION

Patients with OI have a higher risk of OA than the reference population.

MINIABSTRACT

Osteogenesis Imperfecta (OI) is a hereditary connective tissue disorder with skeletal fragility and extraskeletal manifestations. Osteoarthritis is a frequent joint disease and the incidence increases with age. In a population-register-based study, the risk of osteoarthritis was higher in patients with OI at an earlier age compared to a reference population.

Raman spectroscopy-based water measurements identify the origin of MRI T2 signal in human articular cartilage zones and predict histopathologic score

We investigated for the first time zonal-dependent water distribution in articular cartilage by Raman spectroscopy (RS). We further investigated the association of histopathologic score with RS- and magnetic resonance imaging (MRI)-based water measurements. Cadaveric human cartilage plugs (N = 16) with different osteoarthritis (OA) severity were used. Water content distribution in cartilage zones was probed using RS- and MRI-based techniques. Histopathologic scoring was performed by two independent observers blindly. Moderate associations existed between RS- and MRI-based water measurements across all cartilage zones. RS-based analysis of different water compartments helped assign the origin of the T2 signal collected from the various cartilage zones. RS-based water parameters significantly correlated with OA-severity score, whereas MRI-based water measurements did not. RS can probe different water compartments in cartilage zones and predict up to 66% of the variation observed in the histopathologic score. RS-based water measurement could be developed further to assess cartilage quality in the clinic.

Imaging Study on Acupuncture Inhibiting Inflammation and Bone Destruction in Knee Osteoarthritis Induced by Monosodium Iodoacetate in Rat Model

Objective

We aim to explore whether acupuncture inhibits inflammation and bone destruction in rat model monosodium iodoacetate (MIA)-induced knee osteoarthritis (KOA) by 18F-fluorodeoxyglucose (18F-FDG) small-animal positron emission tomography (PET) and micro-computed tomography (CT) imaging.

Methods

KOA was induced in rats by intra-articular injection MIA (2 mg/50 μL) through the right knee of the rats. Forty male Sprague Dawley rats weighing 280 to 340 g (12 weeks old) were randomly divided into four groups including Control group, KOA group, KOA plus manual acupuncture group (KOA+MA), KOA plus sham acupuncture group (KOA+SA). The acupuncture treatment lasted for three weeks (one-day rest after six days of treatment). Paw withdrawal threshold test and open-field test were used to assess mechanical allodynia and locomotor activity respectively for once a week. Hematoxylin and eosin (H&E) staining was used to assess the damage of the cartilage, synovium and infrapatellar fat pad (IFP). 18F-FDG PET was performed to quantify joint inflammation. The influence on the subchondral bone in these rats was confirmed by micro-CT.

Results

Mechanical hyperalgesia, joint inflammation, and obvious bone destruction were observed in the KOA group. H&E staining of the knee joint found that manual acupuncture played a protective effect in cartilage, synovium and IFP destruction. However, compared with KOA group, the results in sham acupuncture had no significant difference. After manual acupuncture treatment in KOA rats, inflammation was significantly suppressed shown by 18F-FDG PET imaging. Micro-CT analysis of the knee joint revealed that manual acupuncture protected bone by inhibiting osteophyte development and subchondral bone remodeling.

Conclusion

The results of 18F-FDG PET and micro-CT showed that manual acupuncture inhibited inflammation and bone destruction, which provides reliable evidence for the effectiveness of acupuncture in hindering development of KOA, and provides reliable evidence for clinical application of acupuncture.

Alterations in the Functional Knee Alignment Are Not an Effective Strategy to Modify the Mediolateral Distribution of Knee Forces During Closed Kinetic Chain Exercises

Pain felt while performing rehabilitation exercises could be a reason for the low adherence of knee osteoarthritis patients to physical rehabilitation. Reducing compressive forces on the most affected knee regions may help to mitigate the pain. Knee frontal plane positioning with respect to pelvis and foot (functional knee alignment) has been shown to modify the mediolateral distribution of the tibiofemoral joint contact force in walking. Hence, different functional knee alignments could be potentially used to modify joint loading during rehabilitation exercises. The aim was to understand whether utilizing different alignments is an effective strategy to unload specific knee areas while performing rehabilitation exercises. Eight healthy volunteers performed 5 exercises with neutral, medial, and lateral knee alignment. A musculoskeletal model was modified for improved prediction of tibiofemoral contact forces and used to evaluate knee joint kinematics, moments, and contact forces. Functional knee alignment had only a small and inconsistent effect on the mediolateral distribution joint contact force. Moreover, the magnitude of tibiofemoral and patellofemoral contact forces, knee moments, and measured muscle activities was not significantly affected by the alignment. Our results suggest that altering the functional knee alignment is not an effective strategy to unload specific knee regions in physical rehabilitation.

Physiotherapists' experiences of osteoarthritis guidelines in primary health care - an interview study

BACKGROUND

Osteoarthritis is a common joint disease, globally. Guidelines recommend information, exercise and, if needed, weight reduction as core treatment. There is a gap between evidence-based recommended care for osteoarthritis and clinical practice. To increase compliance to guidelines, implementation was conducted. The aim of the study was to explore physiotherapists' experiences of osteoarthritis guidelines and their experiences of implementation of the guidelines in primary health care in a region in southern Sweden.

METHODS

Eighteen individual, semi-structured interviews with physiotherapists in primary health care were analysed with inductive qualitative content analysis.

RESULTS

The analysis resulted in two categories and four subcategories. The physiotherapists were confident in their role as primary assessors for patients with osteoarthritis and the guidelines were aligned with their professional beliefs. The Supported Osteoarthritis Self-Management Programme, that is part of the guidelines, was found to be efficient for the patients. Even though the physiotherapists followed the guidelines they saw room for improvement since all patients with hip and/or knee osteoarthritis did not receive treatment according to the guidelines. Furthermore, the physiotherapists emphasised the need for management's support and that guidelines should be easy to follow.

CONCLUSION

The physiotherapists believed in the guidelines and were confident in providing first line treatment to patients with osteoarthritis. However, information about the guidelines probably needs to be repeated to all health care providers and management. Data from a national quality register on osteoarthritis could be used to a greater extent in daily clinical work in primary health care to improve quality of care for patients with osteoarthritis.

Implantation of Various Cell-Free Matrixes Does Not Contribute to the Restoration of Hyaline Cartilage within Full-Thickness Focal Defects

Articular cartilage is a highly organized tissue that has a limited ability to heal. Tissue engineering is actively exploited for joint tissue reconstruction in numerous cases of articular cartilage degeneration associated with trauma, arthrosis, rheumatoid arthritis, and osteoarthritis. However, the optimal scaffolds for cartilage repair are not yet identified. Here we have directly compared five various scaffolds, namely collagen-I membrane, collagen-II membrane, decellularized cartilage, a cellulose-based implant, and commercially available Chondro-Gide® (Geistlich Pharma AG, Wolhusen, Switzerland) collagen membrane. The scaffolds were implanted in osteochondral full-thickness defects, formed on adult Wistar rats using a hand-held cutter with a diameter of 2.0 mm and a depth of up to the subchondral bone. The congruence of the articular surface was almost fully restored by decellularized cartilage and collagen type II-based scaffold. The most vivid restoration was observed 4 months after the implantation. The formation of hyaline cartilage was not detected in any of the groups. Despite cellular infiltration into scaffolds being observed in each group except cellulose, neither chondrocytes nor chondro-progenitors were detected. We concluded that for restoration of hyaline cartilage, scaffolds have to be combined either with cellular therapy or morphogens promoting chondrogenic differentiation.

BoNT/A alleviates neuropathic pain in osteoarthritis by down-regulating the expression of P2X4R in spinal microglia

Neuropathic pain in osteoarthritis is one of the reasons why the pain is difficult to treat, and P2X4R plays an important role in neuropathic pain. In addition, BoNT/A has been proven to have analgesic effects on both neuropathic pain and osteoarthritis, but its exact mechanism is still unknown. This study aims to investigate the relationship between the analgesic effect of BoNT/A on osteoarthritis and the expression of P2X4R in spinal cord microglia. The analgesic effect was compared between BoNT/A and compound betamethasone. Western blot analysis was used to examine the expression of P2X4R and BDNF proteins in the spinal cord. Immunohistochemistry was used to determine the cellular location of P2X4R. Mechanical allodynia and weight asymmetry were identified using the hind paw withdrawal threshold and weight bearing test. The results showed that intra-articular injection of MIA induced persistent mechanical allodynia and weight asymmetry in rats. Both BoNT/A and betamethasone could relieve pain behavior in rats, but BoNT/A had a more obvious effect and lasted longer. Furthermore, BoNT/A could reverse the MIA-induced overexpression of BDNF and P2X4R in the spinal dorsal horn. To sum up, BoNT/A is more effective than betamethasone in relieving MIA-induced osteoarthritis pain in rats, and its analgesic effect may be related to the regulation of P2X4R-mediated BDNF release in spinal microglia and the relief of neuropathic pain in osteoarthritis.

A case report of ultrasound-guided knee nerve pulse radiofrequency combined with platelet-rich plasma in the treatment of knee osteoarthritis

RATIONABLE

Knee osteoarthritis (KOA) is a disease characterized by noninflammatory degenerative changes of articular cartilage. The main clinical manifestations are joint pain and stiffness. Pulsed radiofrequency (PRF) is thought to treat pain by destroying nerve tissue and changing the physical characteristics of nerve tissue membrane.

PATIENT CONCERNS

The patients presents with joint pain and tenderness. Touching around the knee joint will induce pain and joint stiffness when the hand is pressed hard.

INTERVENTIONS

Four patients with knee osteoarthritis underwent pulsed radiofrequency thermocoagulation in the knee joint cavity under ultrasound guidance and injected 2 mL of 10 mg/mL platelet-rich plasma into the joint cavity once a week for a total of 4 times. Record the patient's Visual Analogue Scale (VAS) score and the degree of knee movement limitation before treatment, 1, 3, and 6 months after treatment.

DIAGNOSES

Four patients with knee osteoarthritis.

OUTCOMES

After treatment, the patient's VAS score improved, and the knee joint mobility function recovered well. Ultrasound-guided knee nerve pulse radiofrequency combined with intra-articular injection of platelet-rich plasma can effectively improve the knee joint function and reduce the pain of the patient. The clinical effect is significant, and it is worthy of clinical application.

Relationship between Classification of Fabellae and the Severity of Knee Osteoarthritis: A Relevant Study in the Chinese Population

Objective

To classify the fabellae and discuss the relationship between the classification of fabellae and the severity of knee osteoarthritis (KOA) in Chinese.

Methods

From February 2019 to February 2020, 136 patients were measured and classified using three‐dimensional computed tomography (CT) reconstruction. According to the CT imaging characteristics, the fabellae were divided into five types: type I, a fabella on the lateral femoral condyle; type II, a fabella on the medial femoral condyle; type III, a fabella on the lateral femoral condyle and a fabella on the medial femoral condyle; type IV, two fabellae on the medial femoral condyle; and type V, two fabellae on the lateral femoral condyle. The severity of KOA was assessed on the Recht grade by magnetic resonance imaging (MRI). The data were analyzed with SPSS 24.0.

Results

The classification of fabellae were correlated with KOA grades (χ² = 35.026, P < 0.05). In terms of KOA grades, grade I and grade II were occupied most by fabellar type II (32, 72.8%); type II and other types showed significant statistical difference (P < 0.05). Grade I and grade II were also mainly fabellar type IV (four, 100%). Fabellar type V's biggest component was grade III and grade IV (six, 75%). Type IV and type V showed significant statistical difference (P < 0.05).

Conclusion

The classification of fabellae were correlated with KOA grades. The type II may mean the lower KOA grades while type V may mean the higher KOA grades.

Use of rating of perceived exertion during anterior cruciate ligament reconstruction and knee osteoarthritis rehabilitation: a scoping review protocol

INTRODUCTION

Anterior cruciate ligament (ACL) tear and knee osteoarthritis (KOA) are the most prevalent musculoskeletal disorders of the knee. Rehabilitation with progressive resistance training is recommended for both disorders. Rating of perceived exertion (RPE) is widely used to prescribe, monitor, and control exercise load. However, the lack of detailed methodological description and variability in the use of RPE may hinder its validity. This scoping review summarises methodological aspects of the use of RPE in resistance exercises during ACL reconstruction and KOA rehabilitation. We also aim to identify possible methodological issues related to the use of RPE and provide recommendations for future studies.

METHODS AND ANALYSIS

This scoping review protocol was developed following the Joanna Briggs Institute and Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement extension for Scoping Reviews. The search will be conducted in Medline/PubMed, Embase, CINAHL, PEDro, Central and SPORTDiscus databases. The terms "anterior cruciate ligament rehabilitation", "knee osteoarthritis" and "resistance exercise" and their synonymous will be used isolated and combined (boolean operators AND/OR/NOT). Two reviewers will independently conduct title and abstract screening and evaluate full texts of potentially eligible articles. Data related to study design, sample, intervention characteristics and RPE outcomes will be extracted, summarised and qualitatively analysed.

ETHICS AND DISSEMINATION

The proposed scoping review does not require ethical approval since it will synthesise information from publicly available studies. Regarding dissemination activities, results will be submitted for publication in a scientific journal and presented at conferences in the field.

Injectable Erythrocyte Gel Loaded with Bulleyaconitine A for the Treatment of Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a systemic autoimmune disease with clinical manifestations including joint cartilage, synovitis, and bone damage. Here we developed an injectable erythrocyte gel loaded with Bulleyaconitine A (BLA) for the treatment of RA and demonstrated its anti-inflammatory effects in vivo and in vitro. In vitro experiments showed that BLA could effectively down-regulate the expression of pro-inflammatory factor in activated macrophages through the nuclear factor-κB (NF-κB) pathway. In vivo experiments have shown that the injection of BLA@RBCs in the inflammatory joints of CIA mice increases the local concentration of BLA in a long time. Improved therapeutic outcomes and reduced toxicity of BLA are demonstrated in our work. Together, the developed BLA@RBCs drug delivery system provides an alternative strategy to treat RA joints and shows high potential in clinical RA treatment.

Long-Term Pain Management and Health Care Resource Use Among an Employed Population in Japan with Knee Osteoarthritis Combined with Low Back Pain

OBJECTIVE

Assess long-term comorbidity burden and pain management patterns among working-age patients with knee osteoarthritis (KOA) only without low back pain (LBP) (KOA-noLBP) and patients with KOA plus LBP (KOA+LBP) in Japan.

METHODS

Retrospective claims data analyses were conducted on data from the Japan Medical Data Center (JMDC) database. Adult patients (≥40 years) with a diagnosis of knee osteoarthritis (KOA) (January 1, 2011-December 31, 2012) and 5 years of follow-up were evaluated. The first claim with a KOA diagnosis defined the index date. Longitudinal pain management patterns were assessed in both cohorts.

RESULTS

Overall, 1,828 patients met study criteria (717 with KOA-noLBP; 1,111 with KOA+LBP). The mean age of patients with KOA-noLBP was 52.1 years, and that of patients with KOA+LBP was 53.1 years, with more females in the KOA+LBP cohort (49.4% vs. 55.0%). Regardless of cohort, >90% of patients received pharmacological intervention during the 5-year follow-up period. The most common regimen first received was either topical or oral nonsteroidal anti-inflammatory drugs. A higher mean number of pharmaceutical treatments were received by patients in the KOA+LBP cohort (3.6) than by patients in the KOA-noLBP cohort (2.7) during the follow-up period. Regardless of cohort, most of the direct medical cost was derived from medication.

CONCLUSION

This study demonstrates that a greater proportion of the JMDC population of working individuals with KOA were comorbid with LBP and received pain-related treatment in the long-term perspective relative to patients with KOA without LBP. Appropriate pain management for both KOA and LBP would be key for effective resource utilization in an aging society facing socioeconomic burdens.

A Review of Aceclofenac: Analgesic and Anti-Inflammatory Effects on Musculoskeletal Disorders

Aceclofenac is an oral non-steroidal anti-inflammatory drug (NSAID) with anti-inflammatory and analgesic properties. Although there are some differences in the authorized indications between countries, aceclofenac is mainly recommended for the treatment of inflammatory and painful processes, such as low back pain (LBP), scapulohumeral periarthritis, extraarticular rheumatism, odontalgia, and osteoarthritis (OA), rheumatoid arthritis (RA), and ankylosing spondylitis (AS). The analgesic properties and tolerability profile of aceclofenac in musculoskeletal disorders are reviewed, focusing on relevant and recent studies. The efficacy and safety comparison of aceclofenac with other analgesics and anti-inflammatory agents in OA, AS, RA, and LBP is described. Relevant studies were identified following a literature search of PubMed using the terms "aceclofenac" and "clinical trials" published from 1 Jan 1992 to 1 Jan 2020. Aceclofenac is at least as effective as other NSAIDs in reducing pain and/or improving functional capacity in chronic pain conditions (OA, AS, RA, and LBP). It is generally well tolerated and appears to have a more favorable GI profile than other NSAIDs. Thus, current evidence indicates that aceclofenac is a useful option for the management of pain and inflammation across a wide range of painful conditions.

Complex Lifestyle and Psychological Intervention in Knee Osteoarthritis: Scoping Review of Randomized Controlled Trials

Knee osteoarthritis (OA) causes pain, disability and poor quality of life in the elderly. The primary aim was to identify and map out the current evidence for randomised controlled trials (RCTs) on complex lifestyle and psychosocial interventions for knee OA. The secondary aim was to outline different components of complex lifestyle and psychosocial interventions. Our scoping review searched five databases from 2000 to 2021 where complex lifestyle or psychosocial interventions for patients with knee OA were compared to other interventions. Screening and data extraction were performed by two review authors independently and discrepancies resolved through consensus and in parallel with a third reviewer. A total of 38 articles were selected: 9 studied the effectiveness of psychological interventions; 11 were on self-management and lifestyle interventions; 18 looked at multifaceted interventions. This review highlights the substantial variation in knee OA interventions and the overall lack of quality in the current literature. Potential areas of future research, including identifying prognostic social factors, stratified care models, transdisciplinary care delivery and technology augmented interventions, have been identified. Further high-quality RCTs utilizing process evaluations and economic evaluation in accordance with the MRC guidelines are critical for the development of evidence-based knee OA programs globally.

Increased trunk flexion may underlie elevated knee flexor activity in people with knee osteoarthritis

BACKGROUND

Previous research has demonstrated elevated activation of the knee flexor muscles in people with knee osteoarthritis. People with this condition have also been observed to walk with increased trunk flexion; this may alter biomechanical loading patterns and change muscle activation profiles. Therefore, the aim of this study was to understand the biomechanical effect of increasing trunk flexion during walking.

METHODS

Kinetic and EMG data were collected from a sample of 20 people with knee osteoarthritis and a sample of 20 healthy matched controls during normal walking. Using a biofeedback protocol, participants were subsequently instructed to walk with a 5° increase in trunk flexion. Sagittal moments, muscle activations and co-contractions were then compared across a window in early stance with a two-way ANOVA test.

RESULTS

When trunk flexion was increased, there was a corresponding increase in activity of the medial and lateral hamstrings and gastrocnemius muscles as well as a rise in medial co-contraction. This effect was consistent across the two groups. The most pronounced effect was observed for semitendinosus, which showed a dramatic change in activation profile in the healthy group and a 127% increase in activation during early stance.

CONCLUSIONS

This is the first study to demonstrate that increased trunk flexion in people with knee osteoarthritis may explain, to some degree, the elevated knee flexor activity and medial co-contraction which is associated with this disease. These findings motivate further work to understand the therapeutic potential of interventions designed to improve postural alignment.

Reliability, validity and responsiveness of the Step Up and Down (StUD) test for individuals with symptomatic knee osteoarthritis

BACKGROUND

Stair climbing test (SCT) has been suggested as the first task affected in individuals with symptomatic knee osteoarthritis (KOA). However, there are environmental barriers for the execution of the 9- to 12-step SCT. Thus, we developed a feasible one-step SCT that could be completed in 15s.

OBJECTIVE

To check the clinimetric properties of the 15s Step Up and Down (StUD) test in individuals with KOA.

DESIGN

Prospective validity study.

METHOD

Eighty-two individuals with KOA participated in this study. The test-retest reliability of the StUD test was measured with a 1-week interval. The construct validity and responsiveness were assessed by testing predefined hypotheses. For this, the 30s Chair Stand Test (30CS), Timed Up and Go Test (TUG), quadriceps strength, Knee Injury and Osteoarthritis Outcome Score (KOOS), and Lequesne Algofunctional Index were used as comparator instruments.

RESULTS

The StUD test presented good test-retest reliability (ICC = 0.87; 95% CI = 0.79-0.91) and showed a moderate to good correlation with the 30CS (r = 0.65), TUG (r = -0.56), and quadriceps strength (r = 0.41). We found a higher correlation between the StUD test and the performance-based tests than the patient-reported outcome measures. The StUD test was responsive, with five out of the six (83.3%) hypotheses confirmed.

CONCLUSION

StUD test showed good reliability, adequate validity and responsiveness. Our findings suggest that StUD is a useful performance-based test for individuals with KOA.

Fatty Acid-Binding Protein 4 (FABP4) Is Associated with Cartilage Thickness in End-Stage Knee Osteoarthritis

BACKGROUND

There is no single blood biomarker for the staging of knee osteoarthritis (KOA). The purpose of this study was to assess the relationship of obesity, serum biomarkers, the hip-knee-ankle angle (HKAA) with sonographic cartilage thickness.

METHODS

We conducted a cross-sectional study of n = 33 patients undergoing knee arthroplasty. Body mass index (BMI) was recorded, and patients were grouped based on BMI. Serum blood samples were collected, and the following biomarkers were measured using the ELISA technique (subgroup of n = 23): oxidized low-density lipoprotein (oxLDL), soluble receptor for advanced glycation end-products (sRAGE), fatty acid-binding protein 4 (FABP4), membrane-bound phospholipase A2 (PLA2G2A). The HKAA was analyzed on full-length limb standing x-ray images. Cartilage thickness was assessed on ultrasound images. Multivariable regression analysis was performed to account for confounding.

RESULTS

After adjusting for age, gender, and HKAA, obese patients had thicker medial femoral cartilage (β = 0.165, P = 0.041). Furthermore, lateral cartilage thickness was negatively correlated with FABP4 level after adjusting for of age, gender, BMI, and HKAA (β = -0.006, P = 0.001). Confirming previous studies, after adjustment, FABP4 level was associated with a higher BMI group (β = 42.99, P < 0.001). None of the other markers (oxLDL, PLA2G2A, and sRAGE) was associated with BMI or cartilage thickness.

DISCUSSION

Our results indicate that BMI has a weak, positive association with cartilage thickness in end-stage KOA patients. FABP4 levels were negatively associated with cartilage thickness. While our study is limited by a small sample size, these results further highlight the role of FABP4 as promising biomarkers of burden of disease in KOA.

Enhanced Extracellular Matrix Breakdown Characterizes the Early Distraction Phase of Canine Knee Joint Distraction

OBJECTIVE

Joint distraction triggers intrinsic cartilage repair in animal models of osteoarthritis (OA), corroborating observations in human OA patients treated with joint distraction. The present study explores the still largely elusive mechanism initiating this repair process.

DESIGN

Unilateral OA was induced in the knee joint of 8 dogs using the groove model; the contralateral joint served as a control. After 10 weeks, 4 animals received joint distraction, the other 4 serving as OA controls. Halfway the distraction period (after 4 weeks of a standard 8-week distraction treatment), all animals were euthanized, and joint tissues were collected. A targeted quantitative reverse transcription polymerase chain reaction (qRT-PCR) analysis was performed of commonly involved processes including matrix catabolism/anabolism, inflammation, and known signaling pathways in OA. In addition, cartilage changes were determined on tissue sections using the canine OARSI (Osteoarthritis Research Society International) histopathology score and collagen type II (COL2A1) immunostaining.

RESULTS

Midway distraction, the distracted OA joint showed an upregulation of proteolytic genes, for example, ADAMTS5, MMP9, MMP13, compared to OA alone and the healthy joints, which correlated with an increased OARSI score. Additionally, genes of the transforming growth factor (TGF)-β and Notch pathway, and markers associated with progenitor cells were increased.

CONCLUSIONS

Joint distraction initiates both catabolic and anabolic transcriptional responses. The enhanced turnover, and thereby renewal of the matrix, could be the key to the cartilage repair observed in the months after joint distraction.

Infrared Thermography for the Evaluation of Inflammatory and Degenerative Joint Diseases: A Systematic Review

OBJECTIVE

Inflammation plays a central role in the pathophysiology of rheumatic diseases as well as in osteoarthritis. Temperature, which can be quantified using infrared thermography, provides information about the inflammatory component of joint diseases. This systematic review aims at assessing infrared thermography potential and limitations in these pathologies.

DESIGN

A systematic review was performed on 3 major databases: PubMed, Cochrane library, and Web of Science, on clinical reports of any level of evidence in English language, published from 1990 to May 2021, with infrared thermography used for diagnosis of osteoarthritis and rheumatic diseases, monitoring disease progression, or response to treatment. Relevant data were extracted, collected in a database, and analyzed for the purpose of this systematic review.

RESULTS

Of 718 screened articles 32 were found to be eligible for inclusion, for a total of 2094 patients. Nine studies reported the application to osteoarthritis, 21 to rheumatic diseases, 2 on both. The publication trend showed an increasing interest in the last decade. Seven studies investigated the correlation of temperature changes with osteoarthritis, 16 with rheumatic diseases, and 2 with both, whereas 2 focused on the pre-post evaluation to investigate treatment results in patients with osteoarthritis and 5 in patients with rheumatic diseases. A correlation was shown between thermal findings and disease presence and stage, as well as the clinical assessment of disease activity and response to treatment, supporting infrared thermography role in the study and management of rheumatic diseases and osteoarthritis.

CONCLUSIONS

The systematic literature review showed an increasing interest in this technology, with several applications in different joints affected by inflammatory and degenerative pathologies. Infrared thermography proved to be a simple, accurate, noninvasive, and radiation-free method, which could be used in addition to the currently available tools for screening, diagnosis, monitoring of disease progression, and response to medical treatment.

Pain and Functional Scores in Patients Affected by Knee OA after Treatment with Pulsed Electromagnetic and Magnetic Fields: A Meta-Analysis

OBJECTIVE

The purpose of this systematic review and meta-analysis was to evaluate the effect of electromagnetic field treatment on the symptoms of knee osteoarthritis (OA). In addition, the influence of the type of control group and other covariates have been investigated to identify the sources of heterogeneity in the results of the available clinical trials.

METHODS

Randomized controlled trials reporting pulsed electromagnetic field-based therapies for the treatment of knee OA have been included. Main outcomes were self-reported pain and activity scores collected by Visual Analogue Scale (VAS) and/or Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) at short term after treatment.

RESULTS

Thirteen studies comprising 914 unique patients were included in the analysis. Overall reduction in pain score was observed after treatment (standardized mean difference -0.4059, P = 0.0091), while improvement in the activity score was not significant (standardized mean difference -0.4452, P = 0.0859). Type of control (i.e., placebo or alternative therapies) and time of follow-up resulted as the two major elements influencing the outcomes. Indeed, the restriction of the analysis to placebo-controlled trials demonstrated higher standardized mean differences between treatment and control groups, with lower P value for pain, while statistical significance became evident also for the activity score. On the contrary, no differences were observed pooling only studies comparing pulsed electromagnetic or magnetic fields to alternative treatments. In addition, longer follow-up correlated with lower differences between treated and control patients.

CONCLUSIONS

Pulsed electromagnetic field therapy effectively relieves knee OA symptoms at short term, but it is not superior to other conservative therapies such as physiotherapy.

Return to Sport following Isolated Lateral Opening Wedge Distal Femoral Osteotomy

Purpose. The aims of this study were to (1) examine the timeline of return to sport (RTS) following isolated lateral opening wedge distal femoral osteotomy (DFO), (2) evaluate the degree of participation on RTS, and (3) identify risk factors for failure to RTS. Methods. Nineteen consecutive patients undergoing isolated lateral opening wedge DFO were reviewed retrospectively at a minimum of 2 years postoperatively. Patients completed a sports questionnaire, visual analogue scale for pain (VAS-Pain), Single Assessment Numerical Evaluation (SANE), and a satisfaction questionnaire. Results. Seventeen patents (89.5%; age 32.1 ± 10.1 years; gender 9 males, 52.9%) were contacted at 7.3 ± 4.4 years (range 2.0-13.8 years). Twelve patients (70.6%) resumed playing ≥1 sport at an average time of 9.5 ± 3.3 months (range 3-12 months). Of these 12 patients, 6 returned to a lower level of participation (50.0%). Seven patients (41.2%) had returned to the operating room for further surgery, which included removal of hardware (5.9%) and total knee arthroplasty (5.9%). The average VAS-Pain, SANE, and Marx scores were 3.4 ± 2.6 (range 0-8), 56.2 ± 18.7 (range 20-85), and 5.0 ± 5.3 (range 0-16), respectively. Fourteen patients (82.4%) were at least somewhat satisfied with their procedure. Conclusion. In patients with isolated lateral compartment osteoarthritis and valgus deformity, lateral opening wedge DFO allows 70.6% of patients to RTS by 9.5 ± 3.3 months. However, most patients may be unable to return to their presymptomatic level of function. Patient expectations regarding RTS can be appropriately managed with adequate preoperative patient education. Level of Evidence. IV, case series.

Synovial Adiponectin Was More Associated with Clinical Severity than Synovial Leptin in Women with Knee Osteoarthritis

OBJECTIVE

Different adipokines have been reported to play a role in the development, progression, and severity of knee osteoarthritis, but this association may be mediated by obesity. The aim of this study was to evaluate separately the associations of leptin and adiponectin with clinical severity and inflammatory markers in nonobese and obese women with knee osteoarthritis.

DESIGN

Cross-sectional study with systematic inclusion of 115 women with symptomatic primary knee osteoarthritis. Age, physical exercise, symptoms duration, and body mass index were collected. Radiographic severity was evaluated according to Kellgren-Lawrence scale. Pain and disability were assessed by WOMAC-total, -pain, -function subscales. Two adipokines (leptin and adiponectin) and 3 inflammatory markers (TNF-α, hsCRP, and IL-6) were measured by ELISA in synovial fluid and serum.

RESULTS

Synovial fluid adiponectin was associated with WOMAC pain, function, and total and with synovial fluid IL-6 in nonobese female knee osteoarthritis after controlling by confounders (partial correlation coefficient [PCC] = 0.395, 0.387, 0.427, and 0.649, respectively). Synovial fluid and serum leptin were significantly associated with IL-6 (PCC = 0.354) after controlling by confounders but associations with clinical severity and the rest of inflammatory markers were mitigated after control.

CONCLUSIONS

Adiponectin in synovial fluid was associated with clinical severity and local inflammatory markers in knee osteoarthritis women, while leptin relation was attenuated when controlled by confounders.

Gender, age, disease severity, body mass index and diabetes may not affect response to subcutaneous tanezumab in patients with osteoarthritis after 16 weeks of treatment. A subgroup analysis of placebo-controlled trials

AIM

To assess the impact of pre-specified patient characteristics on efficacy and safety of subcutaneous tanezumab in patients with osteoarthritis (OA).

METHODS

Data were pooled from two (efficacy; N = 1545) or three (safety; N = 1754) phase 3 placebo-controlled trials. Change from baseline to week 16 in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain, WOMAC Physical Function and patient global assessment of OA (PGA-OA) scores was compared between tanezumab (2.5 and 5 mg) and placebo groups via analysis of covariance. Treatment-emergent adverse events (TEAEs) were summarised descriptively. Analyses were done in patient subgroups (men or women; age <65, ≥65, or ≥75 years; body mass index [BMI] <25, 25 to <30, 30 to <35 or ≥35 kg/m² ; diabetes or no diabetes; baseline WOMAC Pain score <7 or ≥7; and Kellgren-Lawrence [KL] grades 2, 3 or 4 in the index joint) and the overall population.

RESULTS

In all subgroups, improvements in WOMAC Pain were numerically greater and often statistically significant (P < .05) for both tanezumab groups compared with placebo. Results were similar for WOMAC Physical Function and PGA-OA. TEAE profiles were generally consistent across subgroups and similar to the overall population (ie slightly higher rates of TEAEs, serious TEAEs and severe TEAEs with tanezumab relative to placebo) with a few exceptions. Exceptions included women reporting slightly more TEAEs with tanezumab than men, and patients with diabetes reporting slightly more severe TEAEs with tanezumab than patients without diabetes. Additionally, TEAEs were more frequent with tanezumab than placebo in the age ≥65 and ≥75 years, but not the age <65 years, subgroups.

CONCLUSIONS

Efficacy and safety/tolerability of tanezumab may not be meaningfully impacted by gender, age, BMI, diabetes status, baseline pain severity or KL grade in the index joint. Conclusions are limited by low patient number in some subgroups. Clinicaltrials.gov: NCT02697773, NCT02709486, NCT01089725.

Articular cartilage and osteochondral tissue engineering techniques: Recent advances and challenges

In spite of the considerable achievements in the field of regenerative medicine in the past several decades, osteochondral defect regeneration remains a challenging issue among diseases in the musculoskeletal system because of the spatial complexity of osteochondral units in composition, structure and functions. In order to repair the hierarchical tissue involving different layers of articular cartilage, cartilage-bone interface and subchondral bone, traditional clinical treatments including palliative and reparative methods have showed certain improvement in pain relief and defect filling. It is the development of tissue engineering that has provided more promising results in regenerating neo-tissues with comparable compositional, structural and functional characteristics to the native osteochondral tissues. Here in this review, some basic knowledge of the osteochondral units including the anatomical structure and composition, the defect classification and clinical treatments will be first introduced. Then we will highlight the recent progress in osteochondral tissue engineering from perspectives of scaffold design, cell encapsulation and signaling factor incorporation including bioreactor application. Clinical products for osteochondral defect repair will be analyzed and summarized later. Moreover, we will discuss the current obstacles and future directions to regenerate the damaged osteochondral tissues.

Efficacy and cost-effectiveness of Stem Cell injections for symptomatic relief and strUctural improvement in people with Tibiofemoral knee OsteoaRthritis: protocol for a randomised placebo-controlled trial (the SCUlpTOR trial)

INTRODUCTION

Knee osteoarthritis (KOA) is a highly prevalent disabling joint disease. Intra-articular stem cell therapy is increasingly being used for treating KOA with little high-quality evidence to support its use. The aim of this study is to investigate the efficacy, safety and cost-effectiveness of allogeneic mesenchymal stem cells (Cymerus MSCs) for treating symptomatic tibiofemoral KOA and improving knee structure over 24 months.

METHODS AND ANALYSIS

The Stem Cell injections for symptomatic relief and strUctural improvement in people with Tibiofemoral knee OsteoaRthritis study is a phase III, multi-centre, parallel, superiority, randomised, double-blind, placebo-controlled trial, which will be conducted in Sydney and Hobart, Australia. 440 participants (220 per arm) aged over 40 years with painful KOA and mild to moderate structural change on X-ray (Kellgren and Lawrence grade 2 or 3) with medial minimum joint space width between 1 and 4 mm in the study knee will be recruited from the community and randomly allocated to receive either intra-articular MSCs or saline at baseline, week 3 and week 52. The coprimary outcomes will be the proportion of participants achieving patient-acceptable symptom state for knee pain at 24 months and quantitative central medial femorotibial compartment cartilage thickness change from baseline to 24 months. Main secondary outcomes include change in knee pain, Patient Global Assessment, physical function, quality of life and other structural changes. Additional data for cost-effectiveness analysis will also be recorded. Adverse events will be monitored throughout the study. The primary analysis will be conducted using modified intention-to-treat.

ETHICS AND DISSEMINATION

This protocol has been approved by The University of Sydney (USYD) Human Research Ethics Committee (HREC) #: 2020/119 and The University of Tasmania (UTAS) HREC #: H0021868. All participants will be required to provide informed consent. Dissemination will occur through conferences, social media, and scientific publications.

TRIAL REGISTRATION NUMBERS

Australian New Zealand Clinical Trials Registry (ACTRN12620000870954); U1111-1234-4897.

Reactive oxygen species (ROS)-responsive nanoprobe for bioimaging and targeting therapy of osteoarthritis

Stimulus-responsive therapy that allows precise imaging-guided therapy is limited for osteoarthritis (OA) therapy due to the selection of proper physiological markers as stimulus. Based on that the over-production of Reactive Oxygen Species (ROS) is associated with the progression in OA, we selected ROS as markers and designed a cartilage targeting and ROS-responsive theranostic nanoprobe that can be used for effective bioimaging and therapy of OA. This nanoprobe was fabricated by using PEG micelles modified with ROS-sensitive thioketal linkers (TK) and cartilage-targeting peptide, termed TKCP, which was then encapsulated with Dexamethasone (DEX) to form TKCP@DEX nanoparticles. Results showed that the nanoprobe can smartly “turn on” in response to excessive ROS and “turn off” in the normal joint. By applying different doses of ROS inducer and ROS inhibitor, this nanoprobe can emit ROS-dependent fluorescence according to the degree of OA severity, helpful to precise disease classification in clinic. Specifically targeting cartilage, TKCP@DEX could effectively respond to ROS and sustained release DEX to remarkably reduce cartilage damage in the OA joints. This smart, sensitive and endogenously activated ROS-responsive nanoprobe is promising for OA theranostics.

Disease-Modifying Adjunctive Therapy (DMAT) in Osteoarthritis-The Biological Effects of a Multi-Mineral Complex, LithoLexal® Joint-A Review

Modern advances in molecular medicine have led to the reframing of osteoarthritis as a metabolically active, inflammatory disorder with local and systemic contributing factors. According to the ‘inflammatory theory’ of osteoarthritis, immune response to an initial damage is the key trigger that leads to progressive joint destruction. Several intertwined pathways are known to induce and govern articular inflammation, cartilage matrix degradation, and subchondral bone changes. Effective treatments capable of halting or delaying the progression of osteoarthritis remain elusive. As a result, supplements such as glucosamine and chondroitin sulphate are commonly used despite the lack of scientific consensus. A novel option for adjunctive therapy of osteoarthritis is LithoLexal^® Joint, a marine-derived, mineral-rich extract, that exhibited significant efficacy in clinical trials. LithoLexal^® has a lattice microstructure containing a combination of bioactive rare minerals. Mechanistic research suggests that this novel treatment possesses various potential disease-modifying properties, such as suppression of nuclear factor kappa-B, interleukin 1β, tumor necrosis factor α, and cyclooxygenase-2. Accordingly, LithoLexal^® Joint can be considered a disease-modifying adjunctive therapy (DMAT). LithoLexal^® Joint monotherapy in patients with knee osteoarthritis has significantly improved symptoms and walking ability with higher efficacy than glucosamine. Preliminary evidence also suggests that LithoLexal^® Joint may allow clinicians to reduce the dose of nonsteroidal anti-inflammatory drugs in osteoarthritic patients by up to 50%. In conclusion, the multi-mineral complex, LithoLexal^® Joint, appears to be a promising candidate for DMAT of osteoarthritis, which may narrow the existing gap in clinical practice.

Effects of Isometric Strengthening Exercises on Pain and Disability Among Patients With Knee Osteoarthritis

Introduction

Osteoarthritis (OA) is the most common form of arthritic disease of the joint worldwide, with the knee joint being the most affected in the body. This study investigated the effects of isometric strengthening exercises on pain and disability among patients with knee osteoarthritis.

Methods

This randomized control trial research design was carried out at the Physiotherapy Departments of Nnamdi Azikiwe University Teaching Hospital, Nnewi, and Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, Amaku, Awka in Anambra State, Nigeria. A total of 40 subjects, nine (22.5%) males and 31 (75.5%) females, were randomly assigned into exercise and control groups. Prior to intervention, the weight and height of each subject were measured. Pain intensity, active range of motion (AROM) and passive range of motion (PROM), and functional ability of both groups were recorded using the Numerical Pain Rating Scale (NPRS), universal goniometer, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), respectively. All participants in the exercise group performed isometric quadriceps and straight leg raise exercises, and the control group received no intervention whatsoever. After six weeks, the pain intensity, AROM, PROM, and functional ability scores were re-measured and documented.

Results

While comparing the pre-test and post-test scores using paired t-test, the exercise group showed a significant difference in each parameter (NPRS, AROM, PROM, and WOMAC = 0.000), while the control group showed no significant difference. Independent sample t-test outcome at six weeks (exercise and control groups) showed significant reduction of pain intensity (NPRS = 0.000), increased range of motion (AROM = 0.000, PROM = 0.003), as well as improvement in function (WOMAC = 0.000) at a significant level of p ˂ 0.05.

Conclusion

At the end of the six weeks, isometric strengthening exercises showed a significant effect on pain intensity, range of motion, and functional ability among subjects with knee osteoarthritis.

A New Method to Develop the Primate Model of Knee Osteoarthritis With Focal Cartilage Defect

Objective: Osteoarthritis (OA) is a common degenerative joint disease, and animal models have proven pivotal in investigating this disease. This study aimed to develop a primate model of OA that may be more relevant to research studies on OA in humans.

Method: Twelve female rhesus macaques were randomly divided into three groups. Four animals were untreated (Control group); four were subjected to the modified Hulth method, involving cutting of the anterior and posterior cruciate ligaments, and transecting the meniscus (Hulth group); and four were subjected to the modified Hulth method combined with cartilage defect (MHCD group). Each primate was subjected to motor ability tests, and underwent arthroscopic, radiographic, morphological, and pathological observation of the knee joints at various times for up to 180 days.

Results: Motor ability on Day 180 was significantly lower in the MHCD group than in the Control (p＜0.01) and Hulth (p＜0.05) groups. Radiographic and morphological examination showed that the severity of knee joint deformity and articular cartilage injury were greater in the MHCD group than in the other groups. Pathological examination showed that cartilage thickness was significantly lower in the MHCD group than in the other groups at the same time points. The Mankin score on Day 180 was markedly higher in the MHCD group than in the Hulth (p＜0.05) and Control (p＜0.001) groups.

Conclusion: The MHCD model of OA closely resembles the pathophysiological processes of spontaneous knee OA in humans. The time required to develop knee OA is shorter using the MHCD model than using the Hulth method.

Limonin Inhibits IL-1β-Induced Inflammation and Catabolism in Chondrocytes and Ameliorates Osteoarthritis by Activating Nrf2

Osteoarthritis (OA), a degenerative disorder, is considered to be one of the most common forms of arthritis. Limonin (Lim) is extracted from lemons and other citrus fruits. Limonin has been reported to have anti-inflammatory effects, while inflammation is a major cause of OA; thus, we propose that limonin may have a therapeutic effect on OA. In this study, the therapeutic effect of limonin on OA was assessed in chondrocytes in vitro in IL-1β induced OA and in the destabilization of the medial meniscus (DMM) mice in vivo. The Nrf2/HO-1/NF-κB signaling pathway was evaluated to illustrate the working mechanism of limonin on OA in chondrocytes. In this study, it was found that limonin can reduce the level of IL-1β induced proinflammatory cytokines such as INOS, COX-2, PGE2, NO, TNF-α, and IL-6. Limonin can also diminish the biosynthesis of IL-1β-stimulated chondrogenic catabolic enzymes such as MMP13 and ADAMTS5 in chondrocytes. The research on the mechanism study demonstrated that limonin exerts its protective effect on OA through the Nrf2/HO-1/NF-κB signaling pathway. Taken together, the present study shows that limonin may activate the Nrf2/HO-1/NF-κB pathway to alleviate OA, making it a candidate therapeutic agent for OA.

Short- and Midterm Comparison of Platelet-Rich Plasma with Hyaluronic Acid versus Leucocyte and Platelet-Rich Plasma on Pain and Function to Treat Hip Osteoarthritis. A Retrospective Study

Hip osteoarthritis (HOA) leads to pain and reduced function. The use of intra-articular injections based on corticosteroids, platelet-rich plasma (PRP), or hyaluronic acid (HA) is becoming a common symptomatic therapy for HOA. For the first time, we compare the effectiveness of plasma with a high concentration of platelets and leukocytes (L-PRP) with PRP+HA in patients with mild to moderate HOA. A total of 26 patients in each group were administered with either L-PRP or PRP+HA. Outcomes were evaluated at baseline, 3 months, and 1 year after the injection. The mean visual analog scale (VAS) and Harris hip score (HHS) within and between groups among different time points were compared using repeated measures ANCOVA (age set as a covariate). Both treatments were effective in reducing VAS, but not in significantly increasing HHS. In the group treated with L-PRP, VAS showed interaction between time and treatment (in favor of L-PRP). Pairwise comparison for treatment and time point evidenced a significant difference at 1-year follow-up between L-PRP and PRP-HA. Outcomes support the idea that both treatments may be effective in reducing pain, with maximal pain reduction achieved after 3 months. L-PRP showed better results in reducing VAS over time. Both treatments are effective at reducing pain in the short to medium term. L-PRP could be the treatment of choice due to a more marked effect over time. Nevertheless, further research is needed to better describe the clinical outcome of these formulations.

Better immediate and early postoperative outcomes of unicompartmental knee replacement comparing with total knee replacement: A matched cohort of patients with medial knee osteoarthritis

Introduction: This study compared the immediate and early postoperative outcomes of medial compartment knee osteoarthritis patients receiving unicompartmental knee replacement (UKR) with a matched cohort of total knee replacement (TKR). Methods: 26 UKR patients were matched with 26 TKR patients based on age, body mass index, pre-operative radiographic severity, range of motion (ROM), Knee Society score (KSS) and Feller patella score. Immediate postoperative outcomes were reflected by postoperative pain, blood loss, length of stay and the number of physiotherapy sessions attended. Early postoperative outcomes (ROM and KSS) were measured at 3 months and 1 year post-operatively. Results: UKR patients had less hemoglobin drop (UKR: 1.2 g/dL, TKR: 1.6 g/dL, p = 0.04), shorter length of stay (UKR: 4.3 days, TKR: 6.0 days, p < 0.001) and required less physiotherapy sessions for recovery (UKR: 6.9 sessions, TKR: 9.3 sessions, p < 0.05). There were no statistically significant differences in early post-operative pain score and postoperative analgesia use ( p > 0.05) between the two groups. Patients receiving UKR had significantly higher post-operative KSS (UKR: 155.9, TKR: 142.4, p = 0.005) and ROM (UKR: 115.8o, TKR: 98.8o, p < 0.001) at 3 months. The KSS and ROM of UKR group at 3 months was better than TKR group at 1-year follow-up. Conclusion: In patients with medial knee osteoarthritis, UKR showed less postoperative analgesic use and blood loss, shorter length of stay, shorter course of rehabilitation and faster recovery with better early KSS and ROM than TKR. Follow up is necessary for comparison in long term outcome and survivorship between the two groups.

Burden, Treatment Patterns and Unmet Needs of Osteoarthritis in Dubai: a Retrospective Analysis of the Dubai Real-World Claims Database

Introduction

Osteoarthritis (OA) is a degenerative joint disease that impacts 3.3–3.6% of population globally with significant health and societal impact. The current study assessed the disease burden, treatment patterns, and healthcare resource utilisation (HCRU) and costs in patients with OA and subgroups of hip and/or knee OA, in Dubai, United Arab Emirates (UAE).

Methodology

This retrospective longitudinal case–control study collected OA-related data from January 1, 2014 to May 31, 2020 from the Dubai Real-World Claims Database (DRWD). Adults aged at least 18 years old with OA diagnosis and at least two claims and continuous enrolment during the study period were included in the study. The patients with OA were 1:1 matched with individuals without OA. The patients with OA were divided into four cohorts on the basis of an a priori algorithm: OA of the hip and/or knee (cohort 1) and (difficult-to-treat) subsets of patients with moderate-to-severe OA of the hip and/or knee (cohort 2), inadequate response or inability to tolerate at least three pain-related medications (cohort 3), and contraindications to nonsteroidal anti-inflammatory drugs (NSAIDs) (cohort 4).

Results

Disease burden of OA in Dubai and HCRU and treatment costs in patients with OA were evaluated from January 1, 2014 to May 31, 2021. Patients were compared with matched controls in 1:1 ratio. The overall cohort comprised 11,651 patients with a median age of 48 years and predominantly male population (61.6%). HCRU was calculated for each cohort and it was highest (United States dollar [USD] 11,354.39) in cohort 4 (patients with contraindication to NSAIDS); in cohort 3 (inability to respond to at least three pain-related medications), USD 495.30 and USD 765.14 were spent on medication and procedures, respectively. Highest cost burden was seen in cohort 4, USD 3120.49 on consumables and USD 228.18 on services.

Conclusion

Osteoarthritis imposes a substantial healthcare and economic burden in the UAE. The study findings elucidate the unmet need among patients with difficult-to-treat OA and inform development of new therapeutics to alleviate their burden.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40744-021-00391-z.

Association between type of anesthesia and length of hospital stay in primary unilateral total knee arthroplasty patients: a single-center retrospective study

Objective

This study explored the risk factors influencing the length of hospital stay (LOS) and establish whether the type of anesthesia is independently associated with the LOS in patients after primary unilateral total knee arthroplasty (TKA).

Methods

In this retrospective cohort study, 2309 patients undergoing unilateral TKA were recruited between January 2013 and June 2014 in a tertiary academic medical center in Singapore. Univariate and multivariate linear regression analyses were used to identify the independent risk factors associated with LOS. Besides, subgroup and interaction analyses were performed to evaluate the relationship between the type of anesthesia and LOS.

Result

In total, 2309 patients were identified. Out of these, 791 patients underwent general anesthesia, whereas 1518 patients underwent regional anesthesia. Multivariate regression analyses revealed that prolonged LOS was significantly associated with age ≥ 65 years (β = 0.48; 95% CI, 0.09–0.87; P = 0.015), diabetes mellitus (DM) (β = 0.8; 95% CI, 0.33–1.27; P = 0.001), congestive cardiac failure (CCF) (β = 4.1; 95% CI, 2.02–6.17; P < 0.001), perioperative blood transfusion (β = 5.71; 95% CI, 4.86–6.56; P < 0.001), creatinine > 2 mg/dL (β = 4.54; 95% CI, 2.46–6.62; P < 0.001), ASA status (III) (β = 1.72; 95% CI, 0.72–2.71; P = 0.001), general anesthesia (β = 0.78; 95% CI, 0.41–1.66; P < 0.001). The LOS further decreased among participants receiving regional anesthesia at advanced age (age ≥ 65 years) (β = − 1.12; 95% CI, − 1.66 to − 0.58; P < 0.001), patients with BMI ≤ 25 kg/m² (β = − 1.92; 95% CI, − 2.73 to − 1.11; P < 0.001) or ≥ 30 kg/m² (β = − 0.58; 95% CI, − 1.1 to − 0.06; P = 0.029).

Conclusion

Our findings demonstrated that age ≥ 65 years, DM, CCF, perioperative blood transfusion, creatinine > 2 mg/dL, ASA status (III), general anesthesia are associated with a prolonged LOS after primary TKA. Elderly patients (age ≥ 65 years) and patients with BMI ≤ 25 kg/m² or ≥ 30 kg/m² receiving regional anesthesia have a further reduced LOS. Therefore, when TKA is performed, priority for regional anesthesia is given to the elderly patients (age ≥ 65 years old) and those with BMI ≤ 25 kg/m² or ≥ 30 kg/m².

Supplementary Information

The online version contains supplementary material available at 10.1186/s13018-021-02817-4.

A vibration sensor approach to detect intra-articular needle tip placement in the knee joint: a proof-of-concept study

BACKGROUND

Intra-articular injection in the dry knee joint is technically challenging particularly for the beginners. The aim of this study was to investigate the possible use of the vibration sensor to detect if the needle tip was at the knee intra-articular position by characterizing the frequency component of the vibration signal during empty syringe air injection.

METHODS

Two milliliters of air were injected supero-laterally at extra- and intra-articular positions of a cadaveric knee joint, using needles of size 18, 21 and 24 gauge (G). Ultrasonography was used to confirm the positions of needle tip. A piezoelectric accelerometer was mounted medially on the knee joint to collect the vibration signals which were analyzed to characterize the frequency components of the signals during injections.

RESULTS

The vibration frequency band power in the range of 500-1500 Hz was visually observed to potentially localize the needle tip placement during air injection whether they were at the knee extra-articular or intra-articular positions, as demonstrated by the higher band power (over - 40 dB or dB) for all the needle sizes. The differences of frequency band power between extra- and intra-articular positions were 18.1 dB, 26.4 dB and 39.2 dB for the needle size 18G, 21G and 24G respectively. The largest difference in spectral power was found in the smallest needle diameter (24G).

CONCLUSIONS

A vibration sensor approach was preliminarily proved to distinguish the intra-articular from extra-articular needle placement in the knee joint. This study demonstrated a possible implementation of an alternative electronic device based on this technique to detect the intra-articular knee injection.

Jintiange Capsule May Have a Positive Effect on Pain Relief and Functional Activity in Patients with Knee Osteoarthritis: A Meta-Analysis of Randomized Trials

Background

Knee osteoarthritis (KOA) occurs frequently in the elderly and causes pain, especially when they walk. Traditional Chinese medicine treatment is effective in releasing knee osteoarthritis. Jintiange (JTG) capsule is widely used in treating knee osteoarthritis, but its clinical effects such as pain relief are still unclear. This meta-analysis aims to evaluate the clinical results systematically and negative effects of JTG capsule in patients with knee osteoarthritis.

Methods

A meta-analysis of clinical randomized controlled trials (RCTs) on JTG capsule treatment was carried out in KOA patients. The search time was from the establishment of the database to May 2021. The database included PubMed, Cochrane Library, EMBASE, Web of Science database, Chinese Biomedical database (CBM), Chinese VIP information, China National Knowledge Infrastructure (CNKI), and WanFang database. The outcome indicators were extracted from the included literature and analyzed, and the risk of bias was assessed through Cochrane Handbook 5.0.1.

Results

Twenty-two articles analyzed in this study involved 1887 patients. JTG capsule used alone or used with other interventions affects total effective rate significantly (RR: 1.19; 95% Cl: 1.11, 1.29; P=0.045), VAS score (SMD: −0.74; 95% Cl: −0.90, −0.59; P ≤ 0.001), WOMAC score (SMD: −0.77; 95% Cl: −0.96, −0.59; P ≤ 0.001), and Lequesne score (SMD: −0.82; 95% Cl: −1.02, −0.61; P=0.010).

Conclusion

Our current evidence indicated that JTG capsule may release the pain of KOA patients and improve their functional activity. However, considering the unsatisfactory quality of the included trials, more high-quality trials are needed to prove this issue.

Experiences of Wearable Technology by Persons with Knee Osteoarthritis Participating in a Physical Activity Counseling Intervention: Qualitative Study Using a Relational Ethics Lens

Background

Current evidence indicates physical activity wearables could support persons with knee osteoarthritis (OA) to be more physically active. However, recent evidence also identifies some persons with arthritis experience guilt or worry while using a wearable if they are not as active as they feel they should be. Questions remain around how persons with knee OA experience benefits or downsides using a wearable in their everyday lives. Better understanding is needed if wearables are to be incorporated in arthritis self-management in ethically aware ways.

Objective

Using an ethics lens, we aimed to describe a range of experiences from persons with knee OA who used a wearable during a physical activity counseling intervention study.

Methods

This is a secondary analysis of qualitative interviews nested within a randomized controlled trial. Guided by phenomenography, we explored the experiences of persons with knee OA following participation in a physical activity counseling intervention that involved using a Fitbit Flex and biweekly phone calls with a study physiotherapist (PT) in an 8-week period. Benefits or downsides experienced in participants’ relationships with themselves or the study PT when using the wearable were identified using a relational ethics lens.

Results

Interviews with 21 participants (12 females and 9 males) aged 40 to 82 years were analyzed. Education levels ranged from high school graduates (4/21, 19%) to bachelor’s degrees or above (11/21, 52%). We identified 3 categories of description: (1) participants experienced their wearable as a motivating or nagging influence to be more active, depending on how freely they were able to make autonomous choices about physical activity in their everyday lives; (2) some participants felt a sense of accomplishment from seeing progress in their wearable data, which fueled their motivation; (3) for some participants, sharing wearable data helped to build mutual trust in their relationship with the study PT. However, they also expressed there was potential for sharing wearable data to undermine this trust, particularly if this data was inaccurate.

Conclusions

Findings provide an early glimpse into positive and negative emotional impacts of using a wearable that can be experienced by participants with knee OA when participating in a randomized controlled trial to support physical activity. To our knowledge, this is the first qualitative study that uses a relational ethics lens to explore how persons with arthritis experienced changes in their relationship with a health professional when using a wearable during research participation.

Physical Therapy Use and Associated Factors in Adults with and without Osteoarthritis-An Analysis of the Population-Based German Health Update Study

BACKGROUND

Physical therapy (PT) is recommended as first-line management for osteoarthritis (OA). The purpose of this study was to assess the PT use among adults with OA and those without (Non-OA) and subsequently identify associated factors among these populations.

METHODS

This cross-sectional study obtained national data from the population-based German Health Update (GEDA2014/2015-EHIS) study containing 24,016 participants aged 18 years and older. Analyses were stratified by sex, age, socioeconomic status (SES), residence, smoking behavior, body mass index, pain and general health. Multivariate regression analysis was conducted to evaluate factors associated with PT use within the past 12 months.

RESULTS

PT was used more frequently in the OA population compared with the Non-OA population (35.8% vs. 18.7%). In both populations, women, participants with high SES, residence in Eastern Germany, severe pain, poor general health and non-smokers received PT more frequently. Multivariate analysis confirmed these findings, in addition to people aged 80 years and older. The influence of SES was higher among OA participants.

CONCLUSION

The underutilization of PT in OA patients (35.8%) was particularly evident among males, people with a low SES and those being older than 60 years, which aids to develop strategies increasing PT use towards guideline-oriented OA management.

Work-related factors of knee osteoarthritis in Korean farmers: a cross-sectional study

Background

Several studies have reported a high prevalence of osteoarthritis (OA) of the knee among agricultural workers. We investigated work-related factors that increase the risk of knee OA among Korean farmers.

Methods

Data were extracted from the Jeonnam Center for Farmer's Safety and Health survey, conducted between 2013 and 2015. The sample included 489 farmers (man 240, woman 249). We defined knee OA as radiographic knee OA (≥ Kellgren-Lawrence grade 2) with symptoms (≥ Western Ontario and McMaster Universities Osteoarthritis, Korean version score 29.5). We considered covariates such as cumulative squatting working time (CSWT), cumulative heavy lifting working time (CLWT), body mass index (BMI), and history of knee injury. Odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) were calculated for knee OA and adjusted for relevant covariates.

Results

The results of multivariate logistic regression analysis indicated that knee OA was correlated by factors such as sex, age, BMI, history of knee injury, CSWT, and CLWT. Particularly, CSWT > 20,000 hours (OR: 2.83; 95% CI: 1.35-5.92; reference < 10,000 hours) and CLWT > 5,000 hours (OR: 2.62; 95% CI: 1.14-6.06; reference < 2,000 hours) were associated with an increased risk of knee OA after adjustment for covariates.

Conclusions

Squatting posture and heavy lifting associated with farm work might increase the risk of knee OA among Korean farmers.

How do middle-aged and older adults with chronic hip pain view their health problem and its care? A protocol for a systematic review and qualitative evidence synthesis

INTRODUCTION

Chronic hip pain in middle-aged and older adults is common and disabling. Patient-centred care of chronic hip pain requires a comprehensive understanding of how people with chronic hip pain view their health problem and its care. This paper outlines a protocol to synthesise qualitative evidence of middle-aged and older adults' views, beliefs, expectations and preferences about their chronic hip pain and its care.

METHODS AND ANALYSIS

We will perform a qualitative evidence synthesis using a framework approach. We will conduct this study in accord with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement and the Enhancing Transparency in Reporting the synthesis of Qualitative research checklist. We will search MEDLINE, CINAHL, The Cochrane Central Register of Controlled Trials, EMBASE and PsycINFO using a comprehensive search strategy. A priori selection criteria include qualitative studies involving samples with a mean age over 45 and where 80% or more have chronic hip pain. Two or more reviewers will independently screen studies for eligibility, assess methodological strengths and limitations using the Critical Appraisal Skills Programme qualitative studies checklist, perform data extraction and synthesis and determine ratings of confidence in each review finding using the Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative research approach. Data extraction and synthesis will be guided by the Common-Sense Model of Self-Regulation. All authors will contribute to interpreting, refining and finalising review findings. This protocol is registered on PROSPERO and reported according to the PRISMA Statement for Protocols (PRISMA-P) checklist.

ETHICS AND DISSEMINATION

Ethics approval is not required for this systematic review as primary data will not be collected. The findings of the review will be disseminated through publication in an academic journal and scientific conferences.

PROSPERO REGISTRATION NUMBER

PROSPERO registration number: CRD42021246305.