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

Evaluation of an e-self-management intervention (Happy Hands app) for hand osteoarthritis: Study protocol for a multicentre randomised controlled trial

OBJECTIVE

This protocol paper describes the rationale and design of a randomised controlled trial (RCT) that aims to evaluate the (cost-)effectiveness of a 12 week e-self-management intervention (Happy Hands app) in people with hand osteoarthritis (HOA).

METHODS

In this multicentre RCT, 376 people with HOA will be recruited from all four health regions in Norway. Consenting participants will be randomly allocated to either a control group receiving usual care or an intervention group receiving the Happy Hands app in addition to usual care. Primary outcome will be measured at 3-months follow-up as the proportion of participants classified as OMERACT-OARSI responders (a composite score comprising change in pain, function, and disease activity), analysed using logistic regression. Secondary outcomes, including pain, hand function, stiffness, quality-of-care, health-related quality-of-life, grip strength, adherence and healthcare costs will be measured at 3- and 6-months follow-up.

RESULTS

Recruitment was initiated in November 2022 with a total of 386 participants recruited by August 2023, 194 in the intervention group and 192 in the control group. Data collection was completed in February 2024.

DISCUSSION

To our knowledge, this is one of the first large-scale, multicentre RCTs assessing the (cost-)effectiveness of a self-management program delivered through a smartphone app for people with HOA. The results from this trial can enhance our understanding of the role technology can play in managing HOA.

TRIAL REGISTRATION

NCT05568875 ( https://clinicaltrials.gov/study/NCT05568875 , pre-registered October 3, 2022).

Complete Blood Cell Count-Based Ratios Identify Total Joint Arthroplasty Patients Likely to Benefit from Perioperative Dexamethasone

BACKGROUND

Complete blood cell count-based ratios (CBRs), including the neutrophil-lymphocyte ratio (NLR) and monocyte-lymphocyte ratio (MLR), are inflammatory markers associated with postoperative morbidity. Given the link between the surgical stress response and complications after total joint arthroplasty (TJA), this study aimed to evaluate whether higher preoperative CBR values predict greater postoperative benefits associated with dexamethasone utilization.

METHODS

The Premier Healthcare Database was queried for adult patients who underwent primary, elective total hip or knee arthroplasty (THA or TKA). Multivariable logistic regression models using dexamethasone exposure and CBRs as independent variables assessed primary end points of 90-day postoperative complications and length of stay (LOS) of ≥3 days. The probability difference between the dexamethasone and non-dexamethasone groups for each primary end point was determined across all values of each CBR. Probability differences were compared across CBR quartiles.

RESULTS

A total of 32,849 primary, elective TJAs (12,788 THAs [38.93%], 20,061 TKAs [61.07%]) performed between 2016 and 2021 were identified, and 22,282 (67.83%) of the patients received perioperative dexamethasone. Among patients with an NLR value of >1.00, those receiving dexamethasone had a lower probability of postoperative complications (all p < 0.05). Dexamethasone was associated with lower odds of an LOS of ≥3 days among patients in the highest NLR quartile (≥4.67) compared with the lowest quartile (NLR <1.84) (p = 0.002). Among patients with an MLR value of ≥0.36, those receiving dexamethasone had significantly lower odds of postoperative complications. Dexamethasone was associated with lower odds of an LOS of ≥3 days among patients with an MLR of ≥0.33 (the 2 highest quartiles) compared with an MLR of <0.24 (the lowest quartile) (p = 0.039).

CONCLUSIONS

Higher NLR and MLR values were associated with greater marginal benefit from perioperative dexamethasone treatment, establishing a modifiable link between adverse outcomes and perioperative inflammation in TJA.

LEVEL OF EVIDENCE

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Return to work after primary total knee replacement in patients under 55 years of age: a retrospective study of 129 cases

INTRODUCTION

Primary total knee arthroplasty (TKA) has shown excellent results in the treatment of osteoarthritis, and its indications have now been extended to younger patients of working age. Few articles in the literature have studied the return to work of young subjects, and no specific studies have been conducted in France. Therefore, we carried out a retrospective study to 1) investigate the rate and delay of return to work after primary TKA in a population under 55 years of age and 2) identify factors influencing early return to work before 3 months, the period usually used as the duration of initial work stoppage (TS).

HYPOTHESIS

The hypothesis of this study was that the rate and time to return to work were similar to those of other Western studies.

MATERIALS AND METHODS

This was a single-center retrospective study including all patients under 55 years of age who underwent primary TKA between 2010 and 2019, regardless of their professional status. A questionnaire collected all socioeconomic and medical information, time to return to work, and factors influencing it. Our population consisted of 223 TKAs (201 patients), with a participation rate of 64%. Among 129 patients, with a mean age of 50.3 ± 4.6 years [29-55], 109 were working (84%).

RESULTS

Ninety-four of 109 patients (86.2%) returned to work after surgery at a mean time of 17.3 ± 10.6 weeks [12-24]. Previous hip or knee prosthetic surgery had a significant negative influence on the rate of return to work (OR 0.08; 95% CI [0.008; 0.7] [p = 0.027]). Manual workers returned to work significantly earlier (OR 8.2; 95% CI [1.6; 51.4] [p = 0.017]). A total of 56 patients (43.4%) were off work preoperatively, for a mean time of 16.7 ± 17.8 weeks [4,13-24], and 49 of these patients returned to work (87.5%) at a mean time of 18.7 ± 11 weeks [12-24] compared with patients who did not receive a preoperative work stoppage (WK) (p = 0.7).

CONCLUSION

The hypothesis was only partially confirmed. Compared with patients in other Western countries, French patients under 55 years of age who underwent primary TKA surgery appeared to return to work at the same rate but with a longer delay. Patients on WT prior to surgery were more likely to return to work after the operation, although this difference did not reach the significance threshold.

LEVEL OF EVIDENCE IV

Retrospective observational study.

Comparative assessment of a virtual performance measure with self-report and performance-based outcomes in patients with hip osteoarthritis

BACKGROUND

The purposes of this study were to examine the reliability and factorial and convergent validity of a virtual performance measure (VPM) in patients with osteoarthritis (OA) of the hip joint and to compare the known-group validity of the VPM with traditional self-report and performance-based outcomes.

METHODS

The VPM score was based on the results of 10 videos showing increasing difficulty in performing specific functional tasks. Patients were requested to choose the video that best reflected their own level of function. Clinical presentation and radiological findings were documented. Self-report measures were the lower extremity functional score (LEFS) and pain scale. The performance-based measures were the 30- second Chair Stand Test (CST) and the 40-meter fast paced walk test (40 m FPWT) test.

RESULTS

Data of 100 patients, 64 (64%) females, mean age: 67 ±10 were examined. The Cronbach's alpha coefficient that examined internal consistency of the VPM total score was 0.88. Factor analysis showed two distinct domains. Moderate correlations were observed between the VPM total score and the LEFS, pain score, and 40 m FPWT (r > 0.50). The VPM and the LEFS were able to differentiate between candidates and non-candidates for hip arthroplasty and between those with and without assistive walking devices. There was no statistically significant difference between the overall accuracy of the VPM and LEFS in the area under the curve value (0.72 vs. 0.71) with respect to candidacy for surgery.

CONCLUSIONS

This study provides substantial evidence towards the validity and reliability of the VPM outcome measure in patients with moderate to severe OA of the hip joint. Digitally based outcome measures have the potential of enhancing remote measurement of functional difficulties in specific situations.

CLINICAL TRIAL NUMBER

Not applicable.

Exploring the Analgesic Effect of Acupuncture on Knee Osteoarthritis Based on MLT/cAMP/PKA/CREB Signaling Pathway

Background

Acupuncture is an effective treatment for knee osteoarthritis (KOA), reducing pain and improving function. While melatonin (MLT) has notable pain relief benefits, the analgesic mechanism of acupuncture in KOA and its relationship with melatonin are still unknown. This study aims to explore this mechanism.

Methods

In this work, the KOA rabbit model was constructed using the traditional Hulth method, and the therapeutic effect was assessed by the Lequesne MG score and Pain assessment by hot plate test. The pathological alterations of cartilage tissue were observed using hematoxylin and eosin (H&E) staining, Safranin O-fast green and MASSON staining to observe the pathological changes in cartilage tissue, and the efficacy was evaluated according to the principles of Mankin score and Osteoarthritis Research Society International (OARSI) score. Meanwhile, MLT in serum, cyclic adenosine monophosphate (cAMP) in cartilage, and matrix metalloproteinase-3 (MMP-3) in joint fluid were detected by enzyme-linked immunosorbent assay. In addition, the expression of aromatic L-amino acid N-acetyltransferase (AANAT), melatonin receptor 1 (MT1) and 2 (MT2) mRNAs in cartilage was determined by real-time quantitative reverse transcription-polymerase chain reaction, and the levels of proteins related to PKA/CREB signaling pathway were detected by Western blotting.

Results

Based on the results of Lequesne MG score and Pain assessment by hot plate test experimental data, the treatment group presented significant improvements in knee pain and overall function relative to OA (Osteoarthritis) group. Besides, according to results of histologic staining, Mankin and OARSI scores, articular cartilage degeneration of treatment group remarkably improved. In addition, acupuncture significantly reduced the expression of the inflammatory factor MMP-3 in knee joint fluid and significantly increased the levels of MLT, AANAT, MT1, MT2, cAMP, PKA and CREB.

Conclusion

By regulating sympathetic excitability, acupuncture may activate the MLT/cAMP/PKA/CREB signaling pathway, decrease inflammatory factor expression and slow down degradation of articular cartilage, resulting in the relief of knee pain.

Neuronal guidance factor Sema3A inhibits neurite ingrowth and prevents chondrocyte hypertrophy in the degeneration of knee cartilage in mice, monkeys and humans

Osteoarthritis (OA) is a degenerative joint disease accompanied with the loss of cartilage and consequent nociceptive symptoms. Normal articular cartilage maintains at aneural state. Neuron guidance factor Semaphorin 3A (Sema3A) is a membrane-associated secreted protein with chemorepulsive properties for axons. However, the role of Sema3A in articular cartilage is still not clear. In the present studies, we investigated the functions of Sema3A in OA development in mice, non-human primates, and patients with OA. Sema3A has a protective effect on cartilage degradation, validated by the organoid culture in vitro and confirmed in chondrocyte-specific Sema3A conditional knockout mice. We demonstrated that Sema3A is a key molecule in maintaining cartilage homeostasis from chondrocyte hypertrophy via activating the PI3K pathway. The potential usage of Sema3A for OA treatment was validated in mouse and Rhesus macaque OA models through intra-articular injection of Sema3A, and also in patients by administering Sema3A containing platelet-rich plasma into the knee joints. Our studies demonstrated that Sema3A exerts a critical role in inhibiting neurite ingrowth and preventing chondrocyte hypertrophy in cartilage, and could be potentially used for OA treatment.

Evidence-based hierarchy of pain outcome measures for osteoarthritis clinical trials and meta-analyses

OBJECTIVE

To rank commonly used patient-reported outcome measures (PROMs) for assessing pain in osteoarthritis trials according to their assay sensitivity, defined as the ability of a PROM to distinguish an effective from a less effective intervention or placebo, proposing a hierarchy for PROM selection in trials and data-extraction in meta-analyses.

DESIGN

Analysis of trials with placebo, sham, or non-intervention control that included ≥100 patients per arm with knee/hip osteoarthritis, reporting treatment effects on ≥2 pain PROMs. Treatment effects from all PROMs were standardized on a 0-100 scale. Negative mean differences indicated a larger effect of the experimental treatment compared to control. We ranked PROMs by assay sensitivity using a Bayesian multi-outcome synthesis random-effects model.

RESULTS

135 trials comprising 57,141 participants were included. The ranking of PROMs from highest to lowest assay sensitivity was as follows: pain overall, pain on stairs, pain at night, pain on walking, pain at rest, WOMAC pain, WOMAC global, Lequesne index. Pain overall, the highest-ranked PROM, had a pooled mean difference of -6.96 (95%CrI -7.94, -6.02), while WOMAC pain, the most reported PROM in our study, had a pooled mean difference of -4.90 (95%CrI -5.55, -4.26). The pooled ratio of mean differences between pain overall and WOMAC pain was 1.42 (95%CrI 1.30, 1.55), representing a 42% larger effect size with pain overall.

CONCLUSIONS

Pain overall has better assay sensitivity than other pain PROMs. Investigators should consider the hierarchy proposed in this study to guide PROM selection in osteoarthritis clinical trials and data extraction in osteoarthritis meta-analyses.

A natural polyphenolic nanoparticle--knotted hydrogel scavenger for osteoarthritis therapy

Exploring highly efficient and cost-effective biomaterials for osteoarthritis (OA) treatment remains challenging, as current therapeutic strategies are difficult to eradicate the excessive reactive oxygen species (ROS) and nitric oxide (NO) at damaged sites. Tea polyphenol (TP) nanoparticles (NPs), a nature-inspired antioxidant in combination with 2-(4-Carboxyphenyl)-4,4,5,5-tetramethylimidazoline-1-oxyl-3-oxide (carboxy-PTIO), a NO scavenger, could provide maximized positive therapeutic effects on OA by eradicating both ROS and NO. Notably, this combination not only improves the half-life of the TP monomer and the drug loading efficiency of carboxy-PTIO but also prevents nitrite from being harmful to tissue. Moreover, the protonation ability of carboxy-PTIO allows smart acid-responsive release in response to environmental pH, which provides conditioned treatment strategies for OA. In in vitro experiments, TP/PTIO NPs downregulated proinflammatory cytokine release via synergistic removal of ROS and NO and suppression of ROS/NF-κB and iNOS/NO/Caspase-3 signaling. For in vivo experiments, NPs were cross-linked with 4-arm-PEG-SH to form an injectable hydrogel system. The release of TP and carboxy-PTIO from the system efficiently prevents cartilage inflammation and damage via similar signaling pathways. Overall, the proposed system provides an efficient approach for OA therapy.

S100A8/A9 drives monocytes towards M2-like macrophage differentiation and associates with M2-like macrophages in osteoarthritic synovium

OBJECTIVES

Macrophages are key orchestrators of the osteoarthritis (OA)-associated inflammatory response. Macrophage phenotype is dependent on environmental cues like the inflammatory factor S100A8/A9. Here, we investigated how S100A9 exposure during monocyte-to-macrophage differentiation affects macrophage phenotype and function.

METHODS

OA synovium cellular composition was determined using flow cytometry and multiplex immunohistochemistry. Healthy donor monocytes were differentiated towards M1- and M2-like macrophages in the presence of S100A9. Macrophage markers were measured using flow cytometry, and phagocytic activity was determined using pHrodo Red Zymosan A BioParticles. Gene expression was determined using qPCR. Protein secretion was measured using Luminex multianalyte analysis and ELISA.

RESULTS

Macrophages were the dominant leucocyte subpopulation in OA synovium. They mainly presented with an M2-like phenotype, although the majority also expressed M1-like macrophage markers. Long-term exposure to S100A9 during monocyte-to-macrophage differentiation increased M2-like macrophage markers CD163 and CD206 in M1-like and M2-like differentiated cells. In addition, M1-like macrophage markers were increased in M1-like, but decreased in M2-like differentiated macrophages. In agreement with this mixed phenotype, S100A9 stimulation modestly increased expression and secretion of pro-inflammatory markers and catabolic enzymes, but also increased expression and secretion of anti-inflammatory/anabolic markers. In accordance with the upregulation of M2-like macrophage markers, S100A9 increased phagocytic activity. Finally, we indeed observed a strong association between S100A8 and S100A9 expression and the M2-like/M1-like macrophage ratio in end-stage OA synovium.

CONCLUSION

Chronic S100A8/A9 exposure during monocyte-to-macrophage differentiation favours differentiation towards an M2-like macrophage phenotype. The properties of these cells could help explain the catabolic/anabolic dualism in established OA joints with low-grade inflammation.

The effect of incline walking on lower extremity and trunk mechanics in older adults

Older adults are at an increased risk of developing knee osteoarthritis. High internal knee abduction moment during daily activities may elevate the risk of knee osteoarthritis. Incline walking exercise has been found to decrease knee abduction moment in healthy young adults. However, it is unknown if this occurs in healthy older adults. The purpose of this study was to quantify the internal knee abduction moment at different treadmill grades to determine if incline walking could reduce the knee abduction moment in healthy older adults. Twelve healthy older adult males walked on a treadmill at five incline grades (0%, 5%, 10%, 15%, and 20%) at 1.34 ​m⋅s-1. The primary outcome variable was the internal knee abduction moment. A one-way repeated measures multivariate analysis of variance was performed to determine differences in the dependent variables among incline gradients. Peak knee abduction moment significantly decreased from level walking at all gradients in 10% increments (0%-10%, p ​< ​0.001; 5%-15%, p ​< ​0.002; and 10%-20%, p ​= ​0.04). A reduction in knee abduction moment during incline walking could result in decreased knee joint loading on the medial knee compartment. For older adults, who are looking to exercise to improve their health, incline walking may be beneficial to promote lower body strength and cardiovascular ability without inflicting further harm to the aging knee joints. However, because the frontal plane knee joint was of primary interest in this study, further research is needed to determine the effects of incline walking on other joints and in other planes of motion.

Toe-in and toe-out gait retraining interventions for individuals with knee osteoarthritis trial: A pilot randomised clinical trial

BACKGROUND

Gait retraining, through altering foot progression angle, has the potential to reduce pain and offload the medial tibiofemoral compartment in people with knee osteoarthritis. This pilot study aimed to evaluate the feasibility of toe-in and toe-out gait retraining on self-reported pain and physical function, and proxy measures of medial knee load, in individuals with medial knee osteoarthritis.

METHODS

Twenty participants with symptomatic medial knee osteoarthritis were randomly allocated to receive either toe-in or toe-out gait retraining for six-weeks, consisting of weekly clinician-supervised sessions and ≥ 30 min of daily self-practice. Feedback was guided by wearable sensors and a pressure-sensitive mat. Primary outcomes included recruitment rate, data completeness, adverse events, adherence, achievability, and intervention acceptability. Secondary outcomes were proxy measures of medial knee load, and self-reported pain and physical function. Differences in feasibility and self-reported outcomes were interpreted via sample t-test using intention-to-treat analysis. The effect of the intervention group on knee biomechanics was evaluated using linear mixed modelling.

FINDINGS

Recruitment was acceptable (n = 4/month) with excellent data completeness (93 %) and attendance (82 %). Acceptability was moderate and similar between groups. There were no differences in average knee pain and physical function between groups over time, and both groups reduced maximum knee pain following the intervention (35 % improvement, p = 0.012). There were no differences in biomechanical outcomes between groups over time.

INTERPRETATION

Toe-in and toe-out gait retraining is feasible and improves pain in people with knee osteoarthritis. A full-scale randomised clinical trial is warranted and should consider individualising the intervention.

Comparison of definitions of early knee osteoarthritis for likelihood of progression at 2-year and 5-year follow-up: the Multicenter Osteoarthritis Study

BACKGROUND

Preventing worsening osteoarthritis (OA) in persons with early OA is a major treatment goal. We evaluated if different early OA definitions yielded enough cases of worsening OA within 2-5 years to make trial testing treatments feasible.

METHODS

We assessed different definitions of early OA using data from Multicenter Osteoarthritis (MOST) Study participants who were followed up longitudinally. We defined early OA as having at least minimal knee pain (WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) pain ≥3/20) with different levels of pre-radiographic OA. For MRI, we required knee pain and used MRI definitions with combinations of cartilage damage, osteophytes, bone marrow lesions and meniscus damage. The primary outcome, worsening OA at 2 or 5 years, combined structural (Kellgren and Lawrence grade ≥2 with joint space narrowing ≥1) and symptom (WOMAC pain ≥6 with increase ≥2 from baseline) outcomes. We also examined structural and symptom outcomes separately.

RESULTS

For worsening OA at 2 years, we included 750 participants (mean age 65 years, 60% female, 90% white, mean body mass index 29.2 kg/m2). Fewer than 10% of early OA knees had the combined outcome at 2 or 5 years. At 2 years, for several early OA definitions, roughly 20% of knees had either structural or symptom worsening outcomes. Two-year trials of either, but not both, outcomes would need to recruit over 1200 patients.

CONCLUSION

Most knees with early OA are stable and do not progress. Some painful knees experience worse pain but not structural progression and vice versa. Trial testing treatments to prevent OA illness or disease will be challenging.

Intra-Articular Injection of Human Bone Marrow-Derived Mesenchymal Stem Cells in Knee Osteoarthritis: A Randomized, Double-Blind, Controlled Trial

To assess the impact of a single intra-articular (IA) injection of bone marrow-derived mesenchymal stem cells (BM-MSCs) in patients with knee osteoarthritis (OA), a randomized, double-blind, placebo-controlled study was conducted. The study included 24 patients with knee OA who were randomly assigned to receive either a single IA injection of BM-MSCs or normal saline. Changes in the visual analog scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Knee Injury and Osteoarthritis Outcome Score (KOOS) after IA injection were assessed at 3, 6, 9, and 12 months. Magnetic resonance imaging (MRI) with T2 mapping sequences was conducted for knee cartilage assessment at baseline and at 3 and 12 months. The MSC group showed between-group improvement in WOMAC (-5.0 ± 3.6 vs. -0.1 ± 5.5, P = 0.02) and KOOS (23.9 ± 18.3 vs. 7.2 ± 15.9, P = 0.028) scores at 9 months compared with the control group. The MSC group exhibited a less sharp increase in the mean T2 value of the medial compartment than the control group at 12 months, with no serious adverse events observed during follow-up. A single IA injection of allogeneic BM-MSCs provided satisfactory pain relief for patients with knee OA compared with the control group at 9 months. Quantitative T2 MRI mapping of the cartilage showed that IA BM-MSCs could have a preventive effect on OA progression for 12 months. Our findings suggest the potential of allogeneic BM-MSCs IA injection as a pain-relieving and disease-modifying treatment for patients with knee OA in the outpatient setting.

Emerging biological functions of Twist1 in cell differentiation

Twist1 is required for embryonic development and expresses after birth in mesenchymal stem cells derived from mesoderm, where it governs mesenchymal cell development. As a well-known regulator of epithelial-mesenchymal transition or embryonic organogenesis, Twist1 is important in a variety of developmental systems, including mesoderm formation, neurogenesis, myogenesis, cranial neural crest cell migration, and differentiation. In this review, we first highlight the physiological significance of Twist1 in cell differentiation, including osteogenic, chondrogenic, and myogenic differentiation, and then detail its probable molecular processes and signaling pathways. On this premise, we summarize the significance of Twist1 in distinct developmental disorders and diseases to provide a reference for studies on cell differentiation/development-related diseases.

Use of advanced topic modeling to generate domains for a preference-based index in osteoarthritis

BACKGROUND

Health-related quality of life (HRQL) is an important endpoint when evaluating the effectiveness of interventions in people living with hip and knee osteoarthritis (OA). The aim of this study was to generate domains for a new OA-specific preference-based index of HRQL in people living with hip or knee OA.

METHODS

The proposed HRQL index was based on a formative measurement model. The study included people aged 50 years and older, who reported being diagnosed with hip or knee OA. Participants reported the most important areas of their lives affected by OA. BERTopic method was used for topic modeling as part of Natural Language Processing. Hierarchical topic modeling was applied to merge similar topics together.

RESULTS

A total of 102 people participated from across Canada. The participants had a mean age of 64.3 ± 7.6 years, and they reported having either knee (48.0%) or hip (16.7%) OA, or both (35.3%). Six major topics that affect the quality of life of people with OA emerged from the BERTopic analysis. Pain, going up and down stairs, walking, standing at home or work, sleep, and playing with grandchildren were the major concerns reported by people living with OA.

CONCLUSION

This study used natural language processing to generate domains for a new OA-specific HRQL index that is based on the views of people living with hip or knee OA. Six domains important to people living with OA formed the construct of HRQL. The next steps will be to create items based on the topics generated from this analysis and elicit people's preferences for the different items.

Synovial mast cells and osteoarthritis: Current understandings and future perspectives

Osteoarthritis (OA) is a prevalent joint disease worldwide that significantly impacts the quality of life of individuals, particularly those in middle-aged and elderly populations. OA was initially considered as non-inflammatory arthritis, but recent studies have identified a substantial number of immune responses in OA, leading to the recognition of inflammation as a key factor in its pathogenesis. An increasing number of studies have found that mast cell (MC) and MC-secreted inflammatory mediators and cytokines are notably increased in the synovial fluid of OA patients, indicating a potential association between MCs and the onset and progression of synovial inflammation. The present review aims to summarize the significance and mechanism of MCs in the pathogenesis of OA. Meanwhile, we also discuss the clinical potential of using MCs as therapeutic target for OA therapy. Modulating the activities of MCs or the mediators of MCs in the synovial fluid inflammatory microenvironment will be promising new options for the treatment of OA.

Prevalence and Risk Factors of Lower Extremity Musculoskeletal Disorders Among Occupational Groups in Key Industries - China, 2018-2023

What is already known about this topic?

Lower extremity musculoskeletal diseases (LE-MSDs) have emerged as a significant contributor to the global disease economic burden and worker absenteeism, becoming a global public health concern. However, the epidemic characteristics of LE-MSDs among occupational populations in China are unknown.

What is added by this report?

This report finds that the LE-MSDs prevalence rate among key occupational groups in China is 17.7%, with the top 5 being toy manufacturing, medical personnel, automobile manufacturing, nonferrous metal smelting and rolling processing, and coal mining and washing.

What are the implications for public health practice?

This study investigated the occurrence of LE-MSDs in key industries in China and its possible risk factors to provide big data support for preventing and controlling such diseases in these industries.

XGBoost-SHAP-based interpretable diagnostic framework for knee osteoarthritis: a population-based retrospective cohort study

OBJECTIVE

To use routine demographic and clinical data to develop an interpretable individual-level machine learning (ML) model to diagnose knee osteoarthritis (KOA) and to identify highly ranked features.

METHODS

In this retrospective, population-based cohort study, anonymized questionnaire data was retrieved from the Wu Chuan KOA Study, Inner Mongolia, China. After feature selections, participants were divided in a 7:3 ratio into training and test sets. Class balancing was applied to the training set for data augmentation. Four ML classifiers were compared by cross-validation within the training set and their performance was further analyzed with an unseen test set. Classifications were evaluated using sensitivity, specificity, positive predictive value, negative predictive value, accuracy, area under the curve(AUC), G-means, and F1 scores. The best model was explained using Shapley values to extract highly ranked features.

RESULTS

A total of 1188 participants were investigated in this study, among whom 26.3% were diagnosed with KOA. Comparatively, XGBoost with Boruta exhibited the highest classification performance among the four models, with an AUC of 0.758, G-means of 0.800, and F1 scores of 0.703. The SHAP method reveals the top 17 features of KOA according to the importance ranking, and the average of the experience of joint pain was recognized as the most important features.

CONCLUSIONS

Our study highlights the usefulness of machine learning in unveiling important factors that influence the diagnosis of KOA to guide new prevention strategies. Further work is needed to validate this approach.

Comparison of the effects of high tibial osteotomy with and without a tourniquet

BACKGROUND

Tourniquets are routinely employed to achieve hemostasis in modern limb surgeries. Nevertheless, the precise role and benefits of tourniquets in high tibial osteotomy (HTO) surgeries remain understudied. The aim of this study was to assess the application of tourniquets in high-tibial osteotomy procedures.

METHODS

This was a prospective study of patients who underwent HTO surgery at an identical hospital. The participants were randomly assigned into two groups: Group A, with a tourniquet (n = 43); and Group B, without a tourniquet (n = 43). The same surgical technique and postoperative care were employed for both groups of patients. Knee range of motion (ROM) and pain were assessed by utilizing a visual analogue scale (VAS) after exercise and maximum calf circumference, and postoperative Hospital for Special Surgery (HSS) score, as well as inflammatory markers including CRP and IL-6, were adopted to compare and analyse the recovery of knee function in the two groups of patients following surgery.

RESULTS

All participants were followed up for a period exceeding three months. No cases of vascular or nerve injuries were observed during surgery in either group. Moreover, there was no statistically significant difference in total blood loss volume throughout treatment or haemoglobin or haematocrit levels (P > 0.05). furthermore, Group A underwent a shorter operation than Group B did (P < 0.05). Group B demonstrated decreased postoperative visual analog scale (VAS) pain levels, calf swelling (P < 0.05), increased early knee range of motion (P < 0.05), and diminished release of blood inflammation markers(IL-6 and CRP) (P < 0.05).

CONCLUSION

The application of tourniquets in HTO surgery reduces intraoperative blood loss and shortens the operative time yet does not substantially affect total bleeding. Nonetheless, the absence of a tourniquet resulted in reduced postoperative pain and facilitated early rehabilitation of knee function.

Enhancing knee osteoarthritis diagnosis with DMS: a novel dense multi-scale convolutional neural network approach

BACKGROUND

Osteoarthritis (OA) of the knee is a prevalent chronic degenerative joint condition that is having a growing impact on a global scale., posing a challenge in diagnosis which is often reliant on time-consuming and error-prone visual analysis by physicians. There is a critical need for an automated, efficient, and accurate diagnostic method to improve early detection and treatment.

METHODS

We developed a novel Convolutional Neural Network (CNN) module, Dense Multi-Scale (DMS), an advancement over Multi-Scale Convolution (MSC). This module utilizes dense connections in convolutions of varying sizes (1 × 1, 3 × 3, 5 × 5) and across layers, enhancing feature reuse and complexity recognition, thereby improving recognition capabilities. Dense connections also facilitate deeper network architecture and mitigate gradient vanishing problems. We compared our model with a standard baseline model and validated it using an unseen-data test set.

RESULTS

The DMS model exhibited exceptional performance in unseen-data tests, achieving 73.00% average accuracy (ACC) and 92.73% area under the curve (AUC), surpassing the baseline model's (DenseNet) 63.52% ACC and 88.76% AUC. This highlights the DMS model's superior predictive capability for knee OA.

CONCLUSION

The DMS model presents a significant advancement in predicting and grading knee OA, holding substantial clinical importance. It promises to aid radiologists in accurate diagnosis and grading, and in choosing appropriate treatments, thereby reducing misdiagnosis and patient burden.

A multi-model approach identifies ALW-II-41-27 as a promising therapy for osteoarthritis-associated inflammation and endochondral ossification

Low-grade inflammation and pathological endochondral ossification are key processes underlying the progression of osteoarthritis, the most prevalent joint disease worldwide. In this study, we employed a multi-faceted approach, integrating publicly available datasets, in silico analyses, in vitro experiments and in vivo models to identify new therapeutic candidates targeting these processes. Data mining of transcriptomic datasets identified EPHA2, a receptor tyrosine kinase associated with cancer, as being linked to both inflammation and endochondral ossification in osteoarthritis. A computational model of cellular signaling networks in chondrocytes predicted that in silico activation of EPHA2 in healthy chondrocytes increases inflammatory mediators and induces hypertrophic differentiation, a hallmark of endochondral ossification. We then evaluated the effect of EPHA2 inhibition using the tyrosine kinase inhibitor ALW-II-41-27 in cultured human chondrocytes from individuals with osteoarthritis, demonstrating significant reductions in both inflammation and hypertrophy. Additionally, systemic subcutaneous administration of ALW-II-41-27 in a mouse osteoarthritic model attenuated joint degeneration by reducing local inflammation and pathological endochondral ossification. Collectively, this study demonstrates a novel drug discovery pipeline that integrates computational, experimental, and animal models, paving the way for the development of disease-modifying treatments for osteoarthritis.

Innovative Biotherapies and Nanotechnology in Osteoarthritis: Advancements in Inflammation Control and Cartilage Regeneration

Osteoarthritis (OA) is among the most prevalent degenerative joint disorders worldwide, particularly affecting the aging population and imposing significant disability and economic burdens. The disease is characterized by progressive degradation of articular cartilage and chronic inflammation, with no effective long-term treatments currently available to address the underlying causes of its progression. Conventional therapies primarily manage symptoms such as pain and inflammation but fail to repair damaged tissues. Emerging biotherapies and regenerative medicine approaches offer promising alternatives by addressing cartilage repair and inflammation control at the molecular level. This review explores the recent advancements in biotherapeutic strategies, including mesenchymal stem cell (MSC) therapy, growth factors, and tissue engineering, which hold the potential for promoting cartilage regeneration and modulating the inflammatory microenvironment. Additionally, the integration of nanotechnology has opened new avenues for targeted drug delivery systems and the development of innovative nanomaterials that can further enhance the efficacy of biotherapies by precisely targeting inflammation and cartilage damage. This article concludes by discussing the current clinical applications, the ongoing clinical trials, and the future research directions necessary to confirm the safety and efficacy of these advanced therapies for OA management. With these advancements, biotherapies combined with nanotechnology may revolutionize the future of OA treatment by offering precise and effective solutions for long-term disease management and improved patient outcomes.

Knowledge and utilization of manual therapy in the management of knee osteoarthritis by physical therapists in Saudi Arabia: a cross-sectional study

BACKGROUND

The knowledge and utilization of manual therapy in treating knee osteoarthritis (OA) may help explain the effective utilization of manual therapy for managing knee OA. Little is known about the knowledge and utilization of manual therapy in the management of knee OA by physical therapists (PTs) in Saudi Arabia. The present study aimed to evaluate the knowledge and utilization of manual therapy by PTs in Saudi Arabia via a survey method.

METHODS

A cross-sectional study design was used. PTs working in various hospitals in Saudi Arabia participated. A 29-item questionnaire was developed based on previous studies. One hundred ninety-seven participants returned the completed questionnaire (response rate, 78.8%). Descriptive statistics were utilized to summarize and present the study participants' characteristics and responses.

RESULTS

Approximately one-third (35.2%) of the participants did not receive any formal manual therapy training, whereas the others received formal manual therapy training in undergraduate (23.8%) or postgraduate (40.9%) studies. Only approximately one-third of the participants (29.9%) were qualified as certified manual therapy practitioners. Most participants (57%) reported using manual therapy according to the patient's condition. Most of the participants cited several treatment goals for manual therapy, including pain reduction (84.8%), improved range of motion (77.2%), increased mobility (58.2%), and improved function (55.4%).

CONCLUSIONS

PTs in Saudi Arabia showed a positive attitude toward using manual therapy for treating knee OA. However, they suggested combining exercise and manual therapy as the best treatment option for knee OA.

TRIAL REGISTRATION

Not applicable.

Exploration of the Key Pathways and Genes Involved in Osteoarthritis Genesis: Evidence from Multiple Platforms and Real-World Validation

Background

Osteoarthritis (OA), a degenerative and chronic joint disease, is essential for identifying novel biomarkers for the clinical diagnosis of OA.

Methods

We collected 35 OA patients and 32 healthy controls from four clinical cohorts and 8 real-world samples from our institute. The activation status of 7530 signalling pathways was calculated via the gene set enrichment analysis (GSEA) algorithm. Ten machine learning algorithms and 101 algorithm combinations were further applied to recognize the most diagnostic genes. KDELR3 was chosen for further validation via immunohistochemical staining to determine its diagnostic value in real-world samples.

Results

Sixteen pathways, namely, the cellular respiration chain, protein transport, lysosomal and endocytosis pathways, were activated in OA patients. A total of 101 types of algorithm combinations were considered for the diagnostic model, and 58 were successfully output. The two-step model of glmBoost plus RF had the highest average AUC value of 0.95 and was composed of LY86, SORL1, KDELR3, CSK, PTGS1, and PTGS2. Preferable consistency of the diagnostic mole and real conditions was observed in all four cohorts (GSE55235: Kappa=1.000, P<0.001; GSE55457: Kappa=0.700, P<0.001; GSE82107: Kappa=0.643, P=0.004; GSE1919: Kappa=1.000, P<0.001). KDELR3 was expressed at higher levels in OA patients than were the other genes, and with the help of immunohistochemistry (IHC), we confirmed that OA patients presented high levels of KDELR3 in synovial tissues. The infiltration of immunocytes, macrophages, and natural killer T cells was high in OA patients. KDELR3 might be involved in the activation and infiltration of effector memory CD4 T cells (Rpearson = 0.58, P < 0.001) and natural killer T cells (Rpearson = 0.53, P < 0.001).

Conclusion

We constructed and validated a six-gene diagnostic model for OA patients via machine learning, and KDELR3 emerged as a novel biomarker for OA.

Posterior iliac crest vs. proximal tibia: distinct sources of anti-inflammatory and regenerative cells with comparable 6-month clinical outcomes in treatment of osteoarthritis

BACKGROUND

Human bone marrow is a source of mesenchymal stem cells (MSCs), other progenitor cells, and factors with anti-inflammatory and regenerative capacity. Though the fraction of MSCs out of the nucleated cells is very small, bone marrow aspirate (BMA) for osteoarthritis (OA) has noteworthy effects. BMA is usually collected from the posterior or anterior iliac crest, and rarely from the proximal tibia. We investigated the clinically beneficial concentration of ex vivo MSCs, derived from BM harvested from the posterior iliac crest and proximal tibia by Marrow Cellution™ Aspiration System, and their phenotypic differences, in comparison to autologous Platelet-Rich Plasma (PRP) treatment prepared with a manual, closed system.

METHODS

A single-center, parallel, randomized controlled study was designed to investigate the efficacy of BMA from the posterior iliac crest compared to BMA from the proximal tibia, against a control group treated with PRP, in knee OA. Thirty patients with knee OA grade I-IV, according to Kellgren-Lawrence (KL), were distributed into each group. Visual Analog Scale (VAS) and Western Ontario & McMaster Universities Arthritis Index (WOMAC) score were used for clinical outcome evaluation.

RESULTS

Data from an intermediate analysis of 6-months follow-up, involving 15 patients in each arm, showed that the posterior iliac crest was significantly more densely populated with mononuclear cells, than the proximal tibia (p = 0.005). Flow cytometric analysis on ex vivo BMA showed a significantly greater number of MSCs in the BM-derived from the posterior iliac crest when compared with the proximal tibia (p < 0.001), together with a significantly higher number of platelets (PLTs) (p < 0.001). Surprisingly, despite these differences in cells number, the improvement in early pain and function scores, after each treatment, were statistically significant within each of the three arms. BM from the proximal tibia showed the highest ΔWOMAC, while BM from the posterior iliac crest showed the highest ΔVAS; however, these differences were not statistically significant across the three arms (p > 0.05). A better outcome, in terms of ΔVAS, was observed in patients classified as KL I-II, when treated with BMA from crest (p < 0.001) and PRP (p = 0.004). Moreover, the effect of BMA treatment on ΔVAS depends on MSCs % only in the Tibia Arm (r = -0.59, p = 0.021), where we also found a correlation between ΔWOMAC and monocytes (r = 0.75, p = 0.016).

CONCLUSION

The results indicate that the iliac crest yields a higher concentration of MSCs compared to the proximal tibia, however both BM, independently of the MSCs concentration, show a beneficial clinical outcome in the treatment of knee OA. Furthermore, BMA is not superior to PRP treatment.

Genicular Nerve Blocks for the Management of Chronic Knee Pain Related to Osteoarthritis - A Case Series

Chronic knee pain from osteoarthritis (OA) is a leading cause of disability, with limited treatment options for patients who fail conservative management and intra-articular (IA) injections. Genicular nerve blocks (GNBs) have emerged as a promising treatment for chronic knee pain, especially in patients who are not candidates for total knee replacement (TKR). This case series discusses six patients with chronic knee pain from OA who failed conventional treatments, including IA injections, and found significant relief with GNBs.

Mediterranean diet and osteoarthritis: an update

The Mediterranean diet has gained significant attention for its potential health benefits on diverse pathological conditions including osteoarthritis (OA), a prevalent degenerative joint disease characterized by cartilage breakdown and inflammation. Numerous observational studies have suggested that adherence to the Mediterranean diet, may have protective effects against OA. The abundance of antioxidants and anti-inflammatory compounds and omega-3 fatty acids, among the Mediterranean diet components is believed to contribute to its beneficial effects on OA. Research investigating the association between the Mediterranean diet and OA has shown promising results. Several observational studies have reported that adherence to the Mediterranean diet is associated with a reduced risk of developing OA and with lower severity of OA symptoms. Additionally, intervention studies have demonstrated improvements in pain, function, and quality of life among OA patients following a Mediterranean diet intervention. Furthermore, emerging evidence suggests potential mechanisms underlying the protective effects of the Mediterranean diet against OA, including its ability to reduce inflammation, oxidative stress, and cartilage degradation. However, further well-designed randomized controlled trials and mechanistic studies are needed to elucidate the precise mechanisms and establish causality. In conclusion, the Mediterranean diet appears to be a promising dietary approach for the prevention and management of OA. Its rich array of nutrients and bioactive compounds may exert protective effects against OA development and progression, although more research is warranted to confirm these findings and elucidate underlying mechanisms.

Revision of unicompartmental knee arthroplasty: a systematic review

BACKGROUND

Unicompartmental knee arthroplasty (UKA) is a surgical procedure for managing osteoarthritis of one joint compartment, most commonly the medial side. This systematic review investigates the causes of UKA revision. The outcomes of interest were establishing the revision rate, time to revision, and the most common causes of revision in the long- and midterm follow-up.

METHODS

This study was conducted according to the 2020 PRISMA statement. In October 2024, the following databases were accessed: PubMed, Web of Science, Google Scholar, and Embase. All the clinical studies investigating the rate and causes of revision in UKA were accessed. Only studies with a minimum of 10 years of follow-up were considered.

RESULTS

Data from 56 studies (13,540 patients) were collected. Of them, 65.6% were women. The mean length of the follow-up was 13.1 ± 3.0 years. The mean age of the patients was 65.6 ± 5.6 years, and the mean BMI was 28.5 ± 2.2 kg/m2. Revisions were performed in 8.8% (2641 of 30,140) of implanted UKAs. The mean time to revision was 6.5 ± 2.6 (range, 2.5 to 13.0) years.

CONCLUSION

8.8% (2641 of 30,140) of UKAs were revised at a mean time of 6.5 ± 2.6 years.

LEVEL OF EVIDENCE

Level IV, systematic review.

Efficacy of Genicular Nerve Block in Patients with Osteoarthritis: A Comparative Study with and without Fluoroscopy Assistance

Objective  To compare the efficacy of fluoroscopy as an auxiliary method in genicular nerve block (GNB) with block guidance by anatomical parameters, without imaging aid, in reducing pain. Methods  A total of 23 patients underwent fluoroscopy-guided or anatomical parameter-based GNBs. We applied the Western Ontario and McMaster Universities' Osteoarthritis Index (WOMAC) and the Visual Analog Scale (VAS) for pain at 6 time points (preblock, and after 1 hour, 24 hours, 7 days, 28 days, and 90 days). Results  The mean age of the sample was of 64.5 ± 4.8 years, and the mean Body Mass Index (BMI), of 31.4 ± 6.1 Kg/m 2 ; 16 subjects (69.6%) were women. The WOMAC pain subscale showed a significant reduction ( p  < 0.05) in pain in both groups at all time points. This reduction was greater after 1 hour in both groups, with rates if 64.3% and 64.6% in the fluoroscopy and anatomical parameters groups respectively, with no significant difference. At the end of 90 days, the pain reduction rates were of 35.7% and 44.6% in the fluoroscopy and anatomical parameter groups respectively. The VAS also showed a significant reduction ( p  < 0.05) in pain in both groups at all times. The reduction was more significant after 1 hour: 78.0% in the fluoroscopy group and 82.2% in the anatomical parameter group, with no significant difference. At the end of 90 days, the pain reduction was of in the fluoroscopy group 36.5% and of 24.6% in the anatomical parameters group. Conclusion  The GNBs guided by fluoroscopy or by anatomical parameters alone were equally effective in terms of magnitude and duration of pain relief.

An Advanced Mechanically Active Osteoarthritis-on-Chip Model to Test Injectable Therapeutic Formulations: The SYN321 Case Study

Current treatments for osteoarthritis (OA) often fail to address the underlying pathophysiology and may have systemic side effects, particularly associated with long-term use of non-steroidal anti-inflammatory drugs (NSAIDs). Thus, researchers are currently directing their efforts toward innovative polymer-drug combinations, such as mixtures of hyaluronic acid viscoelastic hydrogels and NSAIDs like diclofenac, to ensure sustained release of the NSAID within the joint following intra-articular injection. However, the progress of novel injectable therapies for OA is hindered by the absence of preclinical models that accurately represent the pathology of the disease. The uBeat® MultiCompress platform is here presented as a novel approach for studying anti-OA injectable therapeutics on human mechanically-damaged OA cartilage microtissues, in a physiologically relevant environment. This platform can accommodate injectable therapeutic formulations and is successfully tested with SYN321, a novel diclofenac-sodium hyaluronate conjugate under development as a treatment for knee OA. Results indicate the platform's effectiveness in evaluating therapeutic potential, showing downregulation of inflammatory markers and reduction in matrix degradation in OA cartilage micro-tissues treated with SYN321. The uBeat® MultiCompress platform thus represents a valuable tool for OA research, offering a bridge between traditional in vitro studies and potential clinical applications, with implications for future drug discovery.

Efficacy of Extracts of Oleogum Resin of Boswellia in the Treatment of Knee Osteoarthritis: A Systematic Review and Meta-Analysis

Knee osteoarthritis (OA) has recently been ranked as the 11th highest contributor to global disability. More than 40% of patients use complementary and alternative medicine including supplements containing phytoextracts with anti-inflammatory properties as those from the Boswellia genus. The aim of this meta-analysis was to evaluate the efficacy of phytoextracts from the oleogum resin of the Boswellia genus as supplementation for patients affected by knee OA. Four electronic databases were used for the research and PRISMA statements were followed throughout the study. The following inclusion criteria were used: (a) the subjects of the study were humans with a diagnosis of knee OA reported by medical staff; (b) randomization and the presence of control (placebo, negative or positive control), and (c) outcomes reported with WOMAC and/or visual analog scale (VAS) score. Publication bias was assessed with a funnel plot and through the Egger test. The Jadad scale was used in order to assess the quality of the studies included. The statistical heterogeneity was assessed using I2 statistics. Results of meta-analysis and subgroup analysis were reported using a forest plot. A total of 13 studies involving 850 (WOMAC) and 1185 (VAS) patients met the inclusion criteria. The meta-analysis did not detect a significant effect of the use of Boswellia extracts between the control and the treatment groups due to the high heterogeneity of the studies (p = 0.0865 for WOMAC) and (p = 0.3966 VAS). However, the subsequent subgroup analysis demonstrated the significant beneficial effect of Boswellia extracts in the treatment of knee OA with respect to a placebo (lower WOMAC score in the treatment groups). This was also confirmed in the meta-regression applied to the WOMAC scores. This is an important finding as people exposed to NSAID-related adverse effects could benefit from the use of Boswellia extracts. However, further high-quality studies are needed to establish the clinical efficacy of extracts from the genus Boswellia.

Intraarticular gold for knee osteoarthritis: An ancillary analysis of biomarkers and outcome of a pilot study

Objective

In a previous pilot study, we have shown that intraarticular gold micro-particles can reduce knee osteoarthritis (KOA) pain at two years follow-up. Proteomic changes in serum and synovial fluid within eight weeks were associated with multiple inflammatory and immunological processes. The relation between the different biomarkers and the outcome measures is not known. We hypothesized that improvement in pain and function were associated with specific groups of biomarkers. We present the integrative analyses between proteomic biomarkers and outcomes.

Design

A cohort of 30 patients, with moderate KOA, were included. Using the patients' synovial fluid as the carrier, 20 ​mg gold microparticles were injected intraarticularly. Clinical outcome measures at inclusion, 8 weeks, and 2 years, were the PainDetect questionnaire, WOMAC pain, stiffness, and function. In addition, Quantitative Sensory Testing, Pain Pressure Threshold, Temporal Summation, Conditioned Pain Modulation, and pain diary were assessed at inclusion and after 8 weeks. Proteomic analysis was performed on SF and blood samples before and after 8 weeks of treatment.

Results

Linear combinations of serum or synovial biomarkers changed significantly alongside the effect measures and PainDetect scores following gold micro-particle treatment. Of particular interest was identifying multiple members of a molecular complex that is suggestive of neural tissue regeneration and modulation following gold micro-particle treatment.

Conclusions

Gold microparticles are a possible future option for the treatment of knee osteoarthritis. The treatment triggers putative regenerative and inflammation-modulating molecular mechanisms.

Health literacy status and its relationship with physical therapy and rehabilitation applications in patients with knee osteoarthritis

Objectives

The study aimed to determine the level of health literacy in patients with knee osteoarthritis and investigate the relationship between health literacy and exercise approaches and physical therapy use.

Patients and methods

The cross-sectional study included 203 patients (143 females, 60 males; mean age: 63.5±9.2 years) between November 2018 and September 2019. Sociodemographic data, exercise habits, the number of applications to the physical medicine and rehabilitation outpatient clinic, and physical therapy applications were recorded. The Turkish Health Literacy Scale-32 (THLS-32), was used to determine health literacy. The Western Ontario and McMaster Universities Arthritis Index (WOMAC) was used to evaluate pain and physical function. The relationship between THLS-32 and the number of admissions to the outpatient clinic, the number of physical therapy applications, exercise frequency, and WOMAC scores were investigated.

Results

The median THLS-32 of the patients was 33.8 (13-46.8). A statistically significant negative correlation was found between THLS-32 scores and the number of admissions to the physical medicine and rehabilitation outpatient clinic for knee pain in the last year, the number of physical therapies, the exercise frequency, and total WOMAC scores.

Conclusion

Increasing health literacy strengthens the capacities and participation of patients, reduces the costs of physical therapy, as well as medication costs, and consequently increases efficiency in the use of health services.

Prevalence and Factors Associated With High-Impact Chronic Pain in Knee Osteoarthritis: The Johnston County Health Study

Pain is a hallmark symptom of knee osteoarthritis (KOA), yet intensity and severity vary widely among individuals. There is a knowledge gap in understanding key characteristics of high-impact chronic pain (HICP) within the context of KOA. Therefore, our first purpose was to examine the prevalence of HICP in a cohort of individuals with radiographic evidence of KOA, and our second purpose was to assess patient-level factors associated with HICP. Data from the Johnston County Health Study were used to compare those with and without HICP. Variables included sociodemographic factors, clinical factors, health care use, and psychosocial distress. HICP status was classified with Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference and Physical Function measures. The results indicated that 15.5% (48/310) of participants were classified as having HICP when the PROMIS-Pain Interference cutoff score was used, while 21.2% (66/310) were classified as having HICP with a PROMIS-Physical Function cutoff score. Multivariable analyses indicated that HICP was consistently characterized by increased kinesiophobia and somatization, regardless of PROMIS measure used for HICP status. A secondary insight was that HICP was not consistently characterized by sociodemographic and clinical variables, as these findings were dependent on PROMIS measure used. These findings could be used to develop intervention approaches specific to individuals with KOA and to inform future investigations of sociodemographic and clinical factors associated with HICP. PERSPECTIVE: These findings provide additional information on the characterization of HICP for individuals with KOA. There was consistency in psychosocial factors associated with HICP, while sociodemographic and clinical factors varied based on how HICP status was defined.

Literature Review to Understand the Burden and Current Non-surgical Management of Moderate-Severe Pain Associated with Knee Osteoarthritis

INTRODUCTION

To conduct a literature review exploring the humanistic burden, costs, and guideline recommendations for non-surgical management of moderate-severe pain in knee osteoarthritis (KOA).

METHODS

Published studies (2018-25 April 2023) assessing the burden of moderate-severe pain in KOA were identified by searching Medline, Embase, EconLit, and Cochrane database, supplemented with grey literature hand searches and reference list snowballing. Treatment guidelines were also identified for key countries.

RESULTS

This review included 106 publications and 37 treatment guidelines. Patients with moderate-severe pain were found to experience a low quality of life (QoL) and an impaired ability to perform daily tasks. The economic burden of KOA was substantial, including cost of medical visits, non-operative treatment (physical therapy and hyaluronic acid [HA] being key drivers) and productivity losses. Non-steroidal anti-inflammatory drugs (NSAIDs) were among the most frequently used pharmacological treatments, with intra-articular (IA) injections used to varying degrees. Opioid use was also frequently reported. Guidelines universally recommended NSAIDs, albeit with limited dose and duration for oral NSAIDs. IA-corticosteroids were conditionally/moderately recommended for short-term use by most guidelines, while IA-HA and opioids were rarely recommended. Guidelines are not specific to patients with moderate-severe pain and do not distinguish between different KOA phenotypes.

CONCLUSIONS

KOA with moderate-severe pain is associated with substantial humanistic and economic burden. Real-world data suggest that some treatments are regularly used at high cost regardless of the lack of evidence-based recommendations. There remains a need for new treatment options that successfully relieve pain, improve QoL and delay the need for surgery. Graphical abstract available for this article.

Required competencies for French physiotherapists for direct access to primary care for patients with musculoskeletal disorders: consensus statement based on a Delphi survey

BACKGROUND

Physiotherapists who will practice in direct access model of care must acquire the required competencies to ensure adequate and safe patient care. There is no set of required competencies for French physiotherapists.

OBJECTIVE

To develop a consensus on a minimum set of competencies that French physiotherapists should acquire to practice in direct access to primary care with patients with musculoskeletal disorders.

METHODS

The survey was conducted by 1) definition of an initial set of competencies based on a scoping review up to September 2021, 2) implementation of a two-round Delphi survey from October 2021 to January 2022 to obtain consensus on the domains and competencies required in the French context, and 3) consultation at group meeting on February 2022 to finalize and validate the final set of competencies.

RESULTS

Five domains and 52 competencies were identified from the scoping review. Twenty health-care professionals' experts (i.e. family physicians, emergency physicians, and physiotherapists) and two health-care users took part in the Delphi survey. A consensus was reached on 27 required competencies grouped within five domains.

CONCLUSION

A consensus-based, contemporary set of competencies required for direct access practice with patients with musculoskeletal disorders has been identified that may contribute to the update of entry-level and lifelong learning curricula for French physiotherapists.

An unsupervised online Tai Chi program for people with knee osteoarthritis ("My Joint Tai Chi"): Study protocol for the RETREAT randomised controlled trial

Background

Knee osteoarthritis (OA) is a leading contributor to global disability, with exercise proven to be an effective treatment. Tai Chi is a recommended type of exercise, but it is primarily done in person which imposes an accessibility issue. This study aims to evaluate the effects of an online unsupervised program, when provided with online educational information and exercise adherence support, on changes in knee pain and physical function, when compared to online education control for people with knee OA.

Methods

A two-arm, superiority parallel-design, pragmatic randomised controlled trial will be conducted involving 178 people with a clinical diagnosis of knee OA. After completing baseline assessment, participants will be randomly assigned to either: i) "My Joint Education", an education control website containing OA information only; or ii) "My Joint Tai Chi", an intervention website containing the same information as the control, a 12-week unsupervised online Tai Chi program to be undertaken at home 3 times a week, and information about an exercise adherence support app. All participants will be reassessed at 12 weeks after randomisation. Primary outcomes are overall knee pain during walking and physical function using the Western Ontario and McMaster Universities Osteoarthritis Index subscale.

Discussion

This randomised controlled trial will provide evidence about the effectiveness of the "My Joint Tai Chi" website compared to "My Joint Education" website on self-reported knee pain and physical function for people with knee OA.

Trial registration

Prospectively registered with the Australia New Zealand Clinical Trials Registry (ID: ACTRN12623000780651) on 18th July 2023.

Sex-Based Differences and Asymmetry in Hip Kinematics During Unilateral Extension From Deep Hip Flexion

The purpose of this study was to identify side-to-side and sex-based differences in hip kinematics during a unilateral step-up from deep flexion. Twelve (eight men, four women) asymptomatic young adults performed a step ascent motion while synchronized biplane radiographs of the hip were collected at 50 images per second. Femur and pelvis position were determined using a validated volumetric model-based tracking technique that matched digitally reconstructed radiographs created from subject-specific computed tomography (CT) bone models to each pair of synchronized radiographs. Hip kinematics and side-to-side differences were calculated and a linear mixed effects model evaluated sex-based differences. Women were on average 10.2 deg more abducted and 0.2 mm more medially translated than men across the step up motion (p < 0.001). Asymmetry between hips was up to 14.1 ± 12.1 deg in internal rotation and 1.3 ± 1.4 mm in translation. This dataset demonstrates the inherent asymmetry during movements involving unilateral hip extension from deep flexion and may be used provide context for observed kinematics differences following surgery or rehabilitation. Previously reported kinematic differences between total hip arthroplasty and contralateral hips may be well within the natural side-to-side differences that exist in asymptomatic native hips.

The difference in bone mineral density between femur and tibia is related to tibia deformation in endstage knee osteoarthritis

BACKGROUND

This study investigated bone mineral density (BMD) around the knee joint to clarify the mechanism by which tibia deformation exceeds that of the femur in patients with end-stage knee osteoarthritis (KOA).

METHODS

We retrospectively analyzed 193 patients who underwent total knee arthroplasty for end-stage KOA with varus alignment. Preoperative T-score of the femur neck and femur total using dual-energy X-ray absorptiometry (DXA) and hounsfield units (HU) of the distal femur and proximal tibia using computed tomography (CT) were measured to asess the BMD. HU was measured by dividing the femur and tibia into medial, lateral, and total parts, respectively. Patients with medial proximal tibial angle (MPTA) ≥ 85° were considered 'group 1', and MPTA < 85° were 'group 2'. The HU between femur and tibia were compared in group 1. T-score, HU, and HU difference between group 1 and group 2 were compared.

RESULTS

The HU of the proximal tibia was lower than that of the distal femur (femur lateral > femur medial > tibia medial > tibia lateral). T-score (femur neck, femur total) and HU (femur lateral, femur total, tibia lateral) were lower in group 2 than in group 1. There was no difference in femur-tibia HU difference between groups.

CONCLUSION

The medial tibia collapse more than the medial femur in varus endstage KOA was associated with the lower BMD of the proximal tibia than that of the distal femur, and the MPTA collapse was affected by the absolute value of BMD rather than by the femur-tibia BMD difference.

High frequency of BCP, but less CPP crystal-mediated calcification in cartilage and synovial membrane of osteoarthritis patients

OBJECTIVE

Ectopic articular calcification is a common phenomenon of osteoarthritic joints, and closely related to disease progression. Identification of the involved calcium crystal types represents an important topic in research and clinical practice. Difficulties in accurate detection and crystal type identification have led to inconsistent data on the prevalence and spatial distribution of Basic calcium phosphate (BCP) and calcium pyrophosphate (CPP) deposition.

METHOD

Combining multiple imaging methods including conventional radiography, histology and Raman spectroscopy, this study provides a comprehensive analysis of BCP and CPP-based calcification, its frequency and distribution in cartilage and synovial membrane samples of 92 osteoarthritis patients undergoing knee replacement surgery.

RESULTS

Conventional radiography showed calcifications in 35% of patients. Von Kossa staining detected calcified deposits in 88% and 57% of cartilage and synovial samples, respectively. BCP crystals presented as brittle deposits on top of the cartilage surface or embedded in synovial tissue. CPP deposits appeared as larger granular needle-shaped clusters or dense circular pockets below the cartilage surface or within synovial tissue. Spectroscopic analysis detected BCP crystals in 75% of cartilage and 43% of synovial samples. CPP deposition was only detected in 18% of cartilage and 15% of synovial samples, often coinciding with BCP deposits.

CONCLUSION

BCP is the predominant crystal type in calcified cartilage and synovium while CPP deposition is rare, often coinciding with BCP. Distinct and qualitative information on BCP and CPP deposits in joint tissues gives rise to the speculation that different disease entities are involved that might need different treatment strategies.

Mesenchymal Stromal Cells for Aging Cartilage Regeneration: A Review

Cartilage degeneration is a key feature of aging and osteoarthritis, characterized by the progressive deterioration of joint function, pain, and limited mobility. Current treatments focus on symptom relief, not cartilage regeneration. Mesenchymal stromal cells (MSCs) offer a promising therapeutic option due to their capability to differentiate into chondrocytes, modulate inflammation, and promote tissue regeneration. This review explores the potential of MSCs for cartilage regeneration, examining their biological properties, action mechanisms, and applications in preclinical and clinical settings. MSCs derived from bone marrow, adipose tissue, and other sources can self-renew and differentiate into multiple cell types. In aging cartilage, they aid in tissue regeneration by secreting growth factors and cytokines that enhance repair and modulate immune responses. Recent preclinical studies show that MSCs can restore cartilage integrity, reduce inflammation, and improve joint function, although clinical translation remains challenging due to limitations such as cell viability, scalability, and regulatory concerns. Advancements in MSC delivery, including scaffold-based approaches and engineered exosomes, may improve therapeutic effectiveness. Potential risks, such as tumorigenicity and immune rejection, are also discussed, emphasizing the need for optimized treatment protocols and large-scale clinical trials to develop effective, minimally invasive therapies for cartilage regeneration.

Associations between folate intake and knee pain, inflammation mediators and comorbid conditions in patients with symptomatic knee osteoarthritis

BACKGROUND

To investigate the associations between folate intake and changes in knee pain, inflammation mediators and comorbid conditions over 2 years in patients with symptomatic knee osteoarthritis (OA).

METHODS

A post-hoc analysis was performed based on data from the VIDEO study, a multicenter, randomized, double-blind, placebo-controlled clinical trial aimed at assessing the impact of vitamin D supplementation on patients with knee OA who were also vitamin D deficient. The original trial's design and inclusion and exclusion criteria were integrated into this subsequent post-hoc analysis. The average daily folate intake was evaluated using the Dietary Questionnaire for Epidemiological Studies version 2 over two years. The progression of knee symptoms was monitored at the baseline and then at months 3, 6, 12, and 24, utilizing the Western Ontario and McMaster Universities Index alongside a 100-mm visual analog scale. Levels of serum inflammatory mediators were quantified using ELISA techniques. Assessments of knee joint structures, leg muscle strength, depressive symptoms, feet pain, and low back pain were treated at both baseline and follow-up intervals.

RESULTS

Folate intake was correlated with reductions in overall knee pain, dysfunction, and stiffness, as well as decreased levels of Leptin and Apelin. Additionally, it was associated with enhanced leg muscle strength and diminished feet and low back pain. However, there is no association between folate intake and alterations in serum cytokine levels or knee joint structural changes. Within the subsets of overall knee pain, a significant relationship was identified between folate intake and the reduction of pain experienced when ascending or descending stairs and standing for two years.

CONCLUSIONS

Folate intake was linked with reduced knee pain, lower levels of adipokines, and a decreased prevalence of comorbid conditions in individuals with knee OA, implying that folate consumption may be associated with an improvement in knee OA symptoms, but further research is needed to verify this association.

Large language models' performances regarding common patient questions about osteoarthritis: A comparative analysis of ChatGPT-3.5, ChatGPT-4.0, and Perplexity

BACKGROUND

Large Language Models (LLMs) have gained much attention and, in part, have replaced common search engines as a popular channel for obtaining information due to their contextually relevant responses. Osteoarthritis (OA) is a common topic in skeletal muscle disorders, and patients often seek information about it online. Our study evaluated the ability of 3 LLMs (ChatGPT-3.5, ChatGPT-4.0, and Perplexity) to accurately answer common OA-related queries.

METHODS

We defined 6 themes (pathogenesis, risk factors, clinical presentation, diagnosis, treatment and prevention, and prognosis) based on a generalization of 25 frequently asked questions about OA. Three consultant-level orthopedic specialists independently rated the LLMs' replies on a 4-point accuracy scale. The final ratings for each response were determined using a majority consensus approach. Responses classified as "satisfactory" were evaluated for comprehensiveness on a 5-point scale.

RESULTS

ChatGPT-4.0 demonstrated superior accuracy, with 64% of responses rated as "excellent", compared to 40% for ChatGPT-3.5 and 28% for Perplexity (Pearson's chi-squared test with Fisher's exact test, all p < 0.001). All 3 LLM-chatbots had high mean comprehensiveness ratings (Perplexity = 3.88; ChatGPT-4.0 = 4.56; ChatGPT-3.5 = 3.96, out of a maximum score of 5). The LLM-chatbots performed reliably across domains, except for "treatment and prevention" However, ChatGPT-4.0 still outperformed ChatGPT-3.5 and Perplexity, garnering 53.8% "excellent" ratings (Pearson's chi-squared test with Fisher's exact test, all p < 0.001).

CONCLUSION

Our findings underscore the potential of LLMs, specifically ChatGPT-4.0 and Perplexity, to deliver accurate and thorough responses to OA-related queries. Targeted correction of specific misconceptions to improve the accuracy of LLMs remains crucial.

Association of smoking with knee osteoarthritis structural defects and symptoms: an individual participant data meta-analysis

Prior meta-analyses have suggested a protective link between smoking and knee osteoarthritis (KOA), but they relied on aggregate data, potentially obscuring the true relationship. To address this limitation, we conducted an Individual Participant Data (IPD) meta-analysis using data from three large cohorts: the Osteoarthritis Initiative (OAI), the Multicenter Osteoarthritis Study (MOST), and the Cohort Hip and Cohort Knee (CHECK) study. Participants from 16 centers in the USA and Netherlands were categorized as current, former, or never smokers. We assessed six outcomes, three related to structural changes over 4-5 years of follow-up, and three related to changes in KOA symptoms over 2-2.5 years, 5 years, and 7-8 years of follow-up. First, the incidence of radiographic KOA was evaluated in 10,072 knees, defined as having a Kellgren-Lawrence grade ≥ 2 ('radiographic KOA') at follow-up but not at baseline. Second, the progression of radiographic KOA was evaluated in 5274 knees, defined as an increase in Kellgren-Lawrence grade between baseline and follow-up in knees that had radiographic KOA at baseline. Third, the incidence of symptomatic KOA was evaluated in 12,910 knees, defined as having radiographic KOA in addition to symptoms at follow-up but not at baseline. Fourth, fifth, and sixth, we investigated changes between baseline and all follow-ups in scores for the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) subscales of pain, disability, and stiffness (in 2640 knees). There were no differences between smoking groups in any of these six outcomes. Our study, leveraging data from three large cohorts and the advantages of IPD, finds no evidence that smoking offers any protection against KOA, refuting the notion that smoking may benefit joint health.

Acupotomy therapy for knee osteoarthritis: An overview of systematic reviews

BACKGROUND

This study aimed to evaluate the methodological quality, report quality, and evidence quality of a meta-analysis (MA) and systematic review (SR) of the efficacy of acupotomy in the treatment of knee osteoarthritis (KOA), and provided a reference for clinical decision-making.

METHODS

We searched 8 databases to collect systematic reviews and meta-analyses on the efficacy of acupotomy in the treatment of KOA from January 30, 2018, to January 31, 2023. The methodological quality of the studies was assessed using the assessment of multiple systematic reviews (AMSTAR) 2 scale, the quality of the literature reports was scored using the Preferred Reporting Items for Systems Reviews and Meta-Analyses 2020 Version (PRISMA 2020),and the quality of the evidence was graded using the grading of recommendations assessment, development, and evaluation (GRADE) scale.

RESULTS

Nine systematic reviews including 35 outcome indicators were included. AMSTAR 2 evaluated the methodological quality of the included studies, and 1 was of low quality, 8 were of very low quality, and the entries with poor scores were 2, 3, 4, 8, 10, 12, and 13. By PRISMA 2020, there were some reporting deficiencies, and quality problems were mainly reflected in the abstract, information sources, search strategy, synthesis methods, reporting bias assessment, certainty assessment, reporting biases, certainly of evidence, registration and protocol. The GRADE classification results showed that there were 2 medium-quality evidences, 7 low-quality evidences, and 26 very low-quality evidences. The main factors of degradation were limitations, imprecision, and publication bias.

CONCLUSION

Acupotomy had been a promising complementary treatment for KOA. However, due to the low quality of the SRs/MAs supporting these results, high-quality studies with rigorous study designs and larger samples were needed before widespread recommendations could be made.

Clinical effect and contributing factors of acupuncture for knee osteoarthritis: a systematic review and pairwise and exploratory network meta-analysis

OBJECTIVES

This study aims to evaluate (1) the effect and safety of acupuncture in patients with knee osteoarthritis (KOA) and explore (2) whether the effect of acupuncture differed according to acupuncture type, acupuncture dose and follow-up time.

DESIGN

Systematic review and pairwise and exploratory network meta-analysis.

SETTING

PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, VIP Database for Chinese Technical Periodicals and Wanfang from inception to 13 November 2023.

PARTICIPANTS

Randomised controlled trials comparing acupuncture with sham acupuncture, non-steroidal anti-inflammatory drugs (NSAIDs), usual care or waiting list groups, intra-articular (IA) injection and blank groups in patients with KOA.

INTERVENTIONS

Eligible interventions included manual acupuncture (MA) and electroacupuncture (EA).

MAIN OUTCOMES MEASURES

The primary outcome was pain intensity at the end of treatment.

RESULTS

80 trials (9933 participants) were included. Very low certainty evidence suggested that acupuncture may reduce pain intensity compared with sham acupuncture (standardised mean difference, SMD -0.74, 95% CI -1.08 to -0.39, corresponded to a difference in Visual Analogue Scale of -18.50 mm, -27.00 to -9.75), NSAIDs (SMD -0.86 -1.26 to -0.46, corresponded to -21.50 mm, -31.50 to -11.50), usual care or waiting list groups (SMD -1.01, -1.47 to -0.54, corresponded to -25.25 mm, -36.75 to -13.50) and blank groups (SMD -1.65, -1.99 to -1.32, corresponded to -41.25 mm, -49.75 to -33.00), but not IA injection. Similar results were also found in other outcomes. For most of the subgroup analyses, acupuncture type, acupuncture dose and follow-up time did not show a significant relative effect. Only when compared with NSAIDs, a higher dose of acupuncture may provide greater pain relief (interaction p<0.001). The network meta-analysis revealed that electroacupuncture (SMD -0.75, 95% CI -1.34 to -0.17) had a greater effect on pain relief in patients with KOA compared with manual acupuncture.

CONCLUSIONS

The findings suggest that acupuncture may provide clinically important effects in reducing pain and improving physical function in patients with KOA, but the certainty of evidence was very low. Electroacupuncture and higher dose of acupuncture probably are two potential contributing factors.

PROSPERO REGISTRATION NUMBER

CRD42021232177.

Causal relationship of salt intake with osteoarthritis: A Mendelian randomization analysis

Recent studies have demonstrated a correlation between salt intake (SI) and various diseases. However, it remains uncertain whether the relationship between SI (including salt added to food and sodium levels in urine) and benign osteoarthritis is causal. To investigate this, we conducted a 2-sample Mendelian randomization (MR) analysis to estimate the causal impact of SI on osteoarthritis (OA). A genome-wide association study of salt added to food and sodium in urine was used as the exposure, while hip osteoarthritis, knee osteoarthritis, and rheumatoid arthritis were defined as the outcomes. Inverse variance weighting (IVW) was used to calculate causal estimates, and sensitivity analyses were performed using methods including weighted mode, weighted median, MR-Egger, and Bayesian weighted MR. All statistical analyses were conducted using R software. Our results, primarily based on the IVW method, support the existence of a causal relationship between salt added to food and knee osteoarthritis (KOA). Specifically, salt added to food was associated with a decreased risk of KOA (OR = 1.248, P = .024, 95% CI: 1.030-1.512). This study is the first MR investigation exploring the causal relationship between salt added to food and KOA, potentially providing new insights and a theoretical basis for the prevention and treatment of KOA in the future.

Global, regional, and national burdens of osteoarthritis from 1990 to 2021: findings from the 2021 global burden of disease study

Background

Osteoarthritis (OA) is a common chronic degenerative joint disease and a major contributor to disability and elevated morbidity rates worldwide. This study assesses the epidemiological trends of OA from 1990 to 2021, analyzing data by sex, affected joint sites, and Socio-Demographic Index (SDI) across global, regional, and national levels.

Methods

Data on OA were obtained from the (Global Burden of Disease Study) 2021. The age-standardized rates (ASR) for OA were computed, and the estimated annual percentage changes (EAPC) in ASR were determined to evaluate trends in incidence and disability-adjusted life years (DALYs) over the past three decades. Pearson's correlation analysis was conducted to explore the relationship between ASR and the Socio-Demographic Index (SDI). Additionally, Joinpoint regression software and age-period-cohort (APC) analysis were applied for a comprehensive examination of the OA data.

Results

From 1990 to 2021, the global burden of OA has markedly increased. In 2021, there were approximately 466.3 million new OA cases, with an ASR of incidence (ASIR) of around 535 per 100,000 population. The prevalence of OA reached about 606.9 million cases, and DALYs rose to approximately 213 million. The burden of OA is significantly higher in women compared to men, as reflected by higher ASR of incidence, prevalence, and DALYs associated with OA. In 2021, the ASR of incidence was positively associated with the SDI regions. Globally, knee osteoarthritis (KOA) remains the most common form of OA. Among the various risk factors, high body mass index (BMI) emerged as the most critical contributor to OA.

Conclusion

From 1990 to 2021, the global burden of OA has steadily increased, leading to a significant decline in health and overall quality of life. The global prevalence of OA indicates higher incidence rates among women and in countries with a higher SDI. Governments and policy makers globally must prioritize increasing awareness of the risk factors and consequences related to OA, promote early diagnostic and therapeutic services, and implement targeted interventions to mitigate the growing burden of OA.

Prevalence and risk factors of knee osteoarthritis: a cross-sectional survey in Nanjing, China

Background

Knee osteoarthritis (KOA) presents a significant public health challenge due to its hazards and increasingly severe trends. Addressing this challenge requires targeted investigation into the prevalence and identification of risk factors for KOA across different regions, especially in populous and vast China. Therefore, a cross-sectional survey was conducted in Nanjing, China, with the aim of investigating the prevalence and risk factors of KOA among individuals aged 50 and above.

Method

A total of 1,045 subjects were selected using the stratified random sampling method and diagnosed with KOA based on the diagnostic criteria established by the Chinese Medical Association. Data on 14 potential risk factors were collected through a self-designed questionnaire and standardized on-site tests. The association between KOA and these risk factors was explored using t-tests, Chi-square tests, and logistic regression analysis.

Results

The prevalence of KOA among the subjects was 23.64%. Multiple logistic regression models indicated that the risk of KOA was significantly higher among women (OR: 5.34, 95% CI: 3.13-9.11), subjects aged 60-69 (OR: 1.83, 95% CI: 1.25-2.69) and over 70 (OR: 2.87, 95% CI: 1.80-4.59), individuals with high school education and above (OR:2.22, 95% CI: 1.37-3.60), those with flatfoot (OR: 1.74, 95% CI: 1.10-2.74), and subjects classified as overweight (OR: 1.91, 95% CI: 1.21-3.04) and obese (OR: 4.63, 95% CI: 2.18-9.85) based on their BMI status. Additionally, the models identified weight (OR: 1.04, 95% CI: 1.01-1.08), 30-s chair stand performance (OR: 0.94, 95% CI: 0.91-0.97), and single-leg stand performance (OR: 0.96, 95% CI: 0.93-0.99) as independent risk factors for KOA.

Conclusion

The prevalence of KOA is remarkable in Nanjing city. The risk factors for KOA include women, older age, higher education, flatfoot, increased weight and BMI, as well as poor performance in 30-s chair stand and single-leg stand tests.