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

Effect of locomotive syndrome on knee pain in severe knee osteoarthritis

BACKGROUND

Locomotive syndrome (LS) presents symptoms related to decreased mobility due to musculoskeletal disorders. Knee osteoarthritis (KOA) is a significant public health concern linked to age-related musculoskeletal issues and is among the conditions contributing to LS. Age-related lower extremity muscle weakness exacerbates knee pain in KOA, but the impact of LS on knee pain is not clear, prompting the present investigation.

METHODS

We conducted a cross-sectional study of 76 participants (152 knee joints) with bilateral severe KOA scheduled for total knee arthroplasty. The study investigated the association between the Knee Injury and Osteoarthritis Outcome Score (KOOS) pain subscale and LS using a multiple linear regression model, which included covariates and scaled estimated regression coefficients.

RESULTS

LS had a negative impact on KOOS pain (β: 0.35, 95 % confidence interval [CI]: 24.08; -6.05) (p < 0.05) and high self-efficacy had a positive impact (β: 0.25, 95%CI: 1.27; 16.34) (p < 0.05). Age, gender, BMI, Kellgren-Lawrence grade, and Central Sensitization did not influence KOOS pain.

CONCLUSIONS

Our findings demonstrate that LS negatively affected knee pain while self-efficacy positively affected it. LS has been attracting attention in relation to mobility, but the fact that it also affected the knee pain in severe KOA is an important clinical finding. Further research is required to focus on the relationship between the prevention and improvement of LS, and knee pain in severe KOA.

Efficacy of a computer vision-based system for exercise management in patients with knee osteoarthritis: a study protocol for a randomised controlled pilot trial

INTRODUCTION

This study aims to evaluate the efficacy of a computer vision system in guiding exercise management for patients with knee osteoarthritis (OA) by comparing functional improvement between a tele-rehabilitation versus an outpatient intervention program.

METHODS AND ANALYSIS

This is a prospective, single-blind, randomised controlled trial of 60 patients with knee OA who will be randomly assigned to exercise therapy (n=30) or control (n=30) . Both groups will receive treatment two times per week for 12 weeks. The primary outcome of the study will be assessed using the University of Western Ontario and McMaster University Osteoarthritis Index (WOMAC). The Knee Injury and Osteoarthritis Outcome Score will be assessed, as well as the visual analogue scale, quality of life score and physical fitness score. All observations will be collected at baseline and at weeks 4, 8 and 12 during the intervention period, as well as at weeks 4, 8, 12 and 24 during the follow-up visits after the end of the intervention.

ETHICS AND DISSEMINATION

This evaluator-blinded, prospective, randomised controlled study was approved by the Biomedical Ethics Review Committee of West China Hospital of Sichuan University.

TRIAL REGISTRATION NUMBER

ChiCTR2300070319.

Generative AI in orthopedics: an explainable deep few-shot image augmentation pipeline for plain knee radiographs and Kellgren-Lawrence grading

OBJECTIVES

Recently, deep learning medical image analysis in orthopedics has become highly active. However, progress has been restricted by the absence of large-scale and standardized ground-truth images. To the best of our knowledge, this study is the first to propose an innovative solution, namely a deep few-shot image augmentation pipeline, that addresses this challenge by synthetically generating knee radiographs for training downstream tasks, with a specific focus on knee osteoarthritis Kellgren-Lawrence (KL) grading.

MATERIALS AND METHODS

This study leverages a deep few-shot image augmentation pipeline to generate synthetic knee radiographs. Despite the limited availability of training samples, we demonstrate the capability of our proposed computational strategy to produce high-fidelity plain knee radiographs and use them to successfully train a KL grade classifier.

RESULTS

Our experimental results showcase the effectiveness of the proposed computational pipeline. The generated synthetic radiographs exhibit remarkable fidelity, evidenced by the achieved average Frechet Inception Distance (FID) score of 26.33 for KL grading and 22.538 for bilateral knee radiographs. For KL grading classification, the classifier achieved a test Cohen's Kappa and accuracy of 0.451 and 0.727, respectively. Our computational strategy also resulted in a publicly and freely available imaging dataset of 86 000 synthetic knee radiographs.

CONCLUSIONS

Our approach demonstrates the capability to produce top-notch synthetic knee radiographs and use them for KL grading classification, even when working with a constrained training dataset. The results obtained emphasize the effectiveness of the pipeline in augmenting datasets for knee osteoarthritis research, opening doors for broader applications in orthopedics, medical image analysis, and AI-powered diagnosis.

Tetrahedral Framework Nucleic Acid-Based Delivery of Astaxanthin Suppresses Chondrocyte Pyroptosis and Modulates Oxidative Stress for the Treatment of Osteoarthritis

Worldwide, osteoarthritis (OA) is regarded as the most widespread, distressing, and limiting chronic disease that affects degenerative joints. Currently, there is no treatment available to modify the progression of OA. The pathogenesis of OA is significantly linked with oxidative stress and pyroptosis. Astaxanthin (Ast) is a natural ketocarotenoid pigment with potent antioxidant activity and is shown to effectively alleviate cartilage damage in OA. However, its bioavailability is greatly limited due to poor water solubility, high sensitivity to light, temperature, and pH. In this study, Ast-loaded tetrahedral framework nucleic acids (tFNAs) or tFNA/Ast complexes (TAC) for Ast delivery are developed. Compared with free Ast and tFNA alone, TAC exhibits improved drug stability and cellular uptake. Most importantly, TAC effectively protects chondrocytes against oxidative stress-induced pyroptosis while promoting extracellular matrix anabolism by chondrocytes, and ultimately alleviates cartilage damage in a mouse destabilization of the medial meniscus (DMM) model. Thus, TAC holds great promise for the treatment of OA patients.

IL-23p19 in osteoarthritic pain and disease

OBJECTIVE

We have previously reported that the interleukin-23 p19 subunit (IL-23p19) is required for experimental inflammatory arthritic pain-like behavior and disease. Even though inflammation is often a characteristic feature of osteoarthritis (OA), IL-23 is not usually considered as a therapeutic target in OA. We began to explore the role of IL-23p19 in OA pain and disease utilizing mouse models of OA and patient samples.

DESIGN

The role of IL-23p19 in two mouse models of OA, namely collagenase-induced OA and monosodium iodoacetate-induced OA, was investigated using gene-deficient male mice. Pain-like behavior and arthritis were assessed by relative static weight distribution and histology, respectively. In knee synovial tissues from a small cohort of human OA patients, a correlation analysis was performed between IL-23A gene expression and Oxford knee score (OKS), a validated Patient Reported Outcome Measure.

RESULTS

We present evidence that i) IL-23p19 is required for the development of pain-like behavior and optimal disease, including cartilage damage and osteophyte formation, in two experimental OA models and ii) IL-23A gene expression in OA knee synovial tissues correlates with a lower OKS (r = -0.742, p = 0.0057).

CONCLUSIONS

The findings support the possible targeting of IL-23 as a treatment for OA pain and disease progression.

Effectiveness of Osteoarthritis Management Program (OAMP) on the Level of Knowledge and Practice Regarding Self-Management Among Elderly with Osteoarthritis

Objectives

To assess the effectiveness of osteoarthritis management program (OAMP) on the level of knowledge and practice regarding self-management among elderly with OA.

Materials and Methods

A quasi-experimental study was conducted among 60 elderly with osteoarthritis (OA) from March 1, 2021, to March 29, 2021. A community-based survey was conducted to identify the elderly with OA, and 60 persons were selected by using simple random technique. Knowledge was assessed through structured questionnaire, and non-observational checklist was used for Practice. OAMP was conducted to impart knowledge and practice skills.

Results

The study findings showed that the majority of the participants had inadequate knowledge and poor practice before the intervention, whereas, after the implementation of OAMP, the maximum number of participants had adequate knowledge and good practices. The knowledge mean score increased from 52% to 86.7% and practices from 43.8% to 88.5%. There was a significant hike in the difference between the mean pre-test and post-test scores at P < 0.001 level.

Conclusion

The present study proves that the use of OAMP is effective in increasing the level of knowledge and also in improving the practices among participants which help in self-management of OA and result in improvement in the level of physical function.

Aspirin for prophylaxis of VTE in patients with Hip/ Knee replacement: Systematic review and Meta-analysis of Non-Randomized studies

ABSTRACT

Aspirin as an agent for thromboprophylaxis in patients with total knee replacement (TKR) and total hip replacement (THR) is gaining a lot of importance owing to its efficacy and safety in preventing venous thromboembolism (VTE) complications. The current guidelines do not recommend aspirin over other anticoagulants as the data from the meta-analysis of randomized controlled trails (RCTs) lacked a significant sample to draw conclusive results. The present study was aimed to carry out a systematic review and meta-analysis of nonrandomized studies (NRSs) to determine the effect of aspirin as prophylaxis for VTE. A complete electronic search was conducted at PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar for relevant articles published till March 2021. Any postsurgical VTE event (deep vein thrombosis and/or pulmonary embolism) is considered the primary outcome and adverse events as secondary outcomes. Both efficacy and safety outcomes were reported as pooled risk estimates with 95% confidence interval (CI) with a level of significance at P < 0.05. A total of 21 studies were identified for the analysis. The overall risk of occurrence of VTE among the patients taking aspirin was not significantly different from anticoagulants (risk ratio [RR]: 0.78, 95% CI: 0.52-1.15). Patients who underwent THR had a higher risk for VTE with aspirin (RR: 1.50, 95% CI: 1.35-1.61), whereas the patients who underwent TKR showed a lower risk of VTE with aspirin (RR: 0.80, 95% CI: 0.75-0.85). Meta-analysis of NRS advocates the role of aspirin as a prophylactic agent for VTE, especially for patients who are in need for TKR. Further RCTs are required to reestablish the role of aspirin, especially in patients undergoing THR.

Drinking brick tea containing high fluoride increases the prevalence of osteoarthritis in Tibetan, China

The prevalence of osteoarthritis (OA) in Tibetans is higher than that in Han, while Tibetans have a habit of drinking brick tea with high fluoride. A cross-sectional study was conducted to explore the association between fluoride exposure in drinking brick tea and OA. All subjects were divided into four groups by the quartiles (Q) of tea fluoride (TF) and urine fluoride (UF). ROC was plotted and OR were obtained using logistic regression model. The prevalence of OA in the Q3 and Q4 group of TF were 2.2 and 2.7 times higher than in the Q1 group, and the prevalence of OA in the Q2, Q3 and Q4 group of UF were 3.2, 3.5, and 4.1 times higher than in the Q1 group. ROC analysis showed the cutoff values were 4.523 mg/day (TF) and 1.666 mg/L (UF). In conclusion, excessive fluoride in drinking brick tea could be a risk factor for developing OA.

Enhancing collagen based nanoemulgel for effective topical delivery of Aceclofenac and Citronellol oil: Formulation, optimization, in-vitro evaluation, and in-vivo osteoarthritis study with a focus on HMGB-1/RAGE/NF-κB pathway, Klotho, and miR-499a

The majority of conventional osteoarthritis (OA) treatments are based on molecular adjustment of certain signaling pathways associated with osteoarthritis (OA) pathogenesis, however there is a significant need to search for more effective and safe treatments. This study centers around formulating Aceclofenac (ACF) with high bioavailability in combination with Citronellol oil and collagen. The optimal concentrations of Citronellol oil/D-Limonene oil, Tween 80, and Transcutol HP were determined using a pseudoternary phase diagram. The formulated nanoemulsions were studied for thermophysical stability. Thermodynamically stable formula were analyzed for droplet size, zeta potential, and in-vitro permeation. Then, collagen based nanoemulsion were prepared to capitalize on its efficacy in reducing osteoarthritis side effects and characterized for nano size properties. Formulae F10 and F10C were chosen as optimum nanosize formula. Hense, they were prepared and characterized as nanoemulgel dosage form. The nanoemulgel formulae F10NEG1 and F10CNEG1 showed reasonable viscosity and spreadability, with complete drug release after 4 h. These formulae were chosen for further In vivo anti-OA study. Collagen based ACF/citronellol emugel were able to modulate HMGB-1/RAGE/NF-κB pathway, mitigating the production of inflammatory cytokine TNF-α. They were also able to modulate Klotho and miR-499, reducing serum CTXII and COMP, by reducing the cartilage destruction. Histological investigations validated the efficacy, safety, and superiority of Aceclofenac in combination with Citronellol oil and collagen (F10CNEG1) over solo the treated group (F10NEG1 and blank). Hence, the findings of the current work encourage the use of this promising combined formula in treatment of OA patients.

Association between body roundness index and osteoarthritis: a cross-sectional analysis of NHANES 2011-2018

OBJECTIVE

The objective of this study was to investigate the potential association between body roundness index (BRI) and the risk of osteoarthritis (OA) in US adults.

METHODS

A cross-sectional analysis consisting of 20,232 participants was conducted using data from the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2018. Participants (≥20 years of age) were included and divided into OA and non-OA groups. Then, the demographics and characteristics of the participants were compared between the two groups. The relationship between BRI and OA was assessed using a multivariate logistic regression model with fitted smoothed curve techniques. Additionally, subgroup analyses on the correlation between BRI and OA were performed.

RESULTS

The BRI scores in OA group were significantly higher than in the non-OA group (6.60 ± 2.62 vs. 5.46 ± 2.34, p < 0.001). Multivariate logistic analysis revealed that a significantly positive association between BRI and OA (OR = 1.12, 95% CI: 1.09-1.14, p < 0.001). In the subgroup analysis, only the race subgroup showed a significant difference between BRI and OA (p < 0.001).

CONCLUSION

Our findings highlight a significantly positive association between BRI and OA prevalence in the general US population.

Assessing the change in prevalence and characteristics of canadians utilizing chiropractic services across two time periods 2001-2010 and 2015-2018: a population-based repeated cross-sectional study

BACKGROUND

Despite increases in musculoskeletal disorders (MSD) in Canada, evidence suggests utilization of chiropractic services has remained relatively stable over time. Understanding the extent to which chiropractors are consulted and factors associated with their utilization may suggest factors related to accessing care. We assessed the change in prevalence and characteristics of Canadians seeking chiropractic care across two time periods 2001-2010 and 2015-2018.

METHODS

We used national cross-sectional data from seven cycles of the Canadian Community Health Survey between 2001 and 2018. The survey included Canadians aged 12 years and older living in private dwellings in all provinces and territories. National annual weighted prevalence and age-standardized weighted prevalence (and 95% confidence intervals) of chiropractic utilization were calculated. We calculated prevalence of chiropractic utilization stratified by demographic, socioeconomic, lifestyle and health-related variables. Crude linear trends and change in prevalence from 2001 to 2010 were assessed using linear regression models.

RESULTS

The national annual prevalence of Canadians consulting a chiropractor in the previous 12 months slightly increased from 11.0% (95% CI 10.8, 11.3) in 2001 to 11.4% (95%CI 11.1, 11.7) in 2010, and in those reporting receiving regular health care from a chiropractor from 7.5% (95%CI 7.2, 7.7) in 2015 to 7.9% (95%CI 7.7, 8.2) in 2018. Prevalence of utilization varied by province, highest in the Western provinces but lowest in Atlantic provinces. The age-specific prevalence of chiropractic utilization was highest in those aged 35-49 years and remained stable over time, except for slight increase in those aged 65-79 years. A higher percentage of Canadians identifying as white, Canadian-born, in the highest quintile of household income, overweight, physically active and in excellent health reported seeking chiropractic services. The most common reported chronic conditions measured in the survey among Canadians consulting chiropractors were chronic back problems, arthritis, fibromyalgia and headaches.

CONCLUSION

The national prevalence of utilization of chiropractic services among Canadians slightly increased over time but varied by province and respondents' socioeconomic and health characteristics. Chronic back problems were the most common reported chronic condition. This comprehensive population-based study on chiropractic utilization in Canada can be used to inform decisions concerning health human resources and access to rehabilitation care for MSD.

The association between ADAMTS14/rs4747096 gene polymorphism and some risk factors and knee osteoarthritis

Knee osteoarthritis (KOA) is an important cause of disability in the world and it denotes a public health defiance of the upcoming years.Aim To examine the connection between ADAMTS14 gene rs4747096 polymorphism and KOA and to assess risk factors associated with KOA.Methods A case control study was conducted on 158 patients with KOA and 120 controls with comparable age and sex randomly recruited from National Research Centre employees. All participants were subjected to full history taking, assessment of KOA severity using WOMAC scoring system, and thorough clinical examination. Blood sample was collected for detection of ADAMTS14/rs4747096 gene polymorphism.Results The frequency of ADAMTS14 gene rs4747096 genotypes among patients with KOA was 73.5% for AA, 25.7% for AG, and 0.7% for GG compared to controls 963%, 31.3%, and 5.6% respectively and the frequency of alleles among patients was 86.4% for A and 78.7% for G compared to controls (78.7% and 21.3% respectively, P < 0.05. The study found that the median levels of total WOMAC score and its domains were significantly higher among KOA patients than controls. The logistic regression analysis revealed that age ≥ 50 years, BMI ≥ 35, and long standing at work were predictive factors for KOA (P < 0.05). Regarding different genetic patterns, only the A recessive pattern of inheritance was found to be a predictive risk factor for KOA.Conclusion For ADAMTS14 rs4747096 genotype, the AA and AG genotypes significantly increased the risk of KOA. The recessive pattern of inheritance, older age, morbid obesity, and prolonged standing at work were the predictive risk factors for KOA. Further studies with larger sample size are encouraged to investigate the mechanism by which this genotype can affect the development of KOA.

The Mechanism by Which Cyperus rotundus Ameliorates Osteoarthritis: A Work Based on Network Pharmacology

Background

Cyperus rotundus (CR) is widely used in traditional Chinese medicine to prevent and treat a variety of diseases. However, its functions and mechanism of action in osteoarthritis (OA) has not been elucidated. Here, a comprehensive strategy combining network pharmacology, molecular docking, molecular dynamics simulation and in vitro experiments was used to address this issue.

Methods

The bioactive ingredients of CR were screened in TCMSP database, and the potential targets of these ingredients were obtained through Swiss Target Prediction database. Genes in OA pathogenesis were collected through GeneCards, OMIM and DisGeNET databases. Gene Ontology (GO) analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis were performed using DAVID database. STRING database and Cytoscape 3.10 software were used to construct "component-target-pathway" network, and predict the core targets affected by CR. The binding affinity between bioactive components and the core targets was evaluated by molecular docking and molecular dynamics simulation. The therapeutic activity of kaempferol on chondrocytes in inflammatory conditions was verified by in vitro experiments.

Results

Fifteen CR bioactive ingredients were obtained, targeting 192 OA-related genes. A series of biological processes, cell components, molecular functions and pathways were predicted to be modulated by CR components. The core targets of CR in OA treatment were AKT serine/threonine kinase 1 (AKT1), interleukin 1 beta (IL1B), SRC proto-oncogene, non-receptor tyrosine kinase (SRC), BCL2 apoptosis regulator (BCL2), signal transducer and activator of transcription 3 (STAT3), epidermal growth factor receptor (EGFR), hypoxia-inducible factor 1 subunit alpha (HIF1A), matrix metallopeptidase 9 (MMP9), estrogen receptor 1 (ESR1) and PPARG orthologs from vertebrates (PPARG), and the main bioactive ingredients of CR showed good binding affinity with these targets. In addition, kaempferol, one of the CR bioactive components, weakens the effects of IL-1β on the viability, apoptosis and inflammation of chondrocytes.

Conclusion

Theoretically, CR has great potential to ameliorate the symptoms and progression of OA, via multiple components, multiple targets, and multiple downstream pathways.

ASA VI controls osteoarthritis in mice by maintaining mitochondrial homeostasis through Sirtuin 3

OBJECTIVE

The aim of this study was to investigate whether ASA VI controls osteoarthritis (OA) by regulating mitochondrial function.

METHODS

Primary chondrocytes were isolated and cultured from rat knee joints. The chondrocytes were treated with ASA VI and interleukin-1β (IL-1β) to simulate the inflammatory environment of OA. Cell viability, apoptosis, inflammatory cytokine levels, and extracellular matrix (ECM) component levels were assessed. Mitochondrial function, including ATP levels, mitochondrial membrane potential, reactive oxygen species (ROS) levels, and mitochondrial DNA content, was evaluated. The expression of Sirtuin 3 (Sirt3), a key regulator of mitochondrial homeostasis, was examined. Additionally, a rat OA model was established by destabilizing the medial meniscus, and the effects of ASA VI on cartilage degeneration were assessed.

RESULTS

ASA VI treatment improved cell viability, reduced apoptosis, and decreased IL-6 and TNF-α levels in IL-1β-induced chondrocytes. ASA VI also upregulated Collagen II and Aggrecan expression, while downregulating ADAMTS5 and MMP-13 expression. Furthermore, ASA VI mitigated IL-1β-induced mitochondrial dysfunction by increasing ATP levels, restoring mitochondrial membrane potential, reducing ROS production, and preserving mitochondrial DNA content. These effects were accompanied by the activation of Sirt3. In the rat OA model, ASA VI treatment increased Sirt3 expression and alleviated cartilage degeneration.

CONCLUSION

ASA VI exerts chondroprotective and anti-inflammatory effects on IL-1β-induced chondrocytes by improving mitochondrial function through Sirt3 activation. ASA VI also attenuates cartilage degeneration in a rat OA model. These findings suggest that ASA VI may be a potential therapeutic agent for the treatment of osteoarthritis by targeting mitochondrial dysfunction.

Osteoarthritis with depression: mapping publication status and exploring hotspots

Depression is a common psychological complication in osteoarthritis (OA) patients, and its incidence gets more and more attention year by year worldwide. This study investigates the association between OA and depression through a bibliometric analysis of published studies. It aims to identify leading authors, institutions, and countries to highlight research hotspots and suggest potential future directions. We collected publications on OA and depression from 1994 to 2024 using the Web of Science Core Collection (WOSCC) database. Bibliographic information, including authorship, country of origin, citation frequency, and visualizations, was generated using VOSviewer, R software, and CiteSpace. A total of 2,342 articles were identified. The United States led in publications with 906 articles, Boston University was the most prolific institution with 56 publications, BMC Musculoskeletal Disorders was the top journal with 71 publications, and Stefania Maggi was the most productive author with 19 publications. The primary research hotspots identified were: "The relationship between depression and OA," "Disability and prevalence," and "Characteristics of older people suffering depression after OA." Predicted future research frontiers include: "Treating depression in OA patients with multimorbidity," "Psychometric properties of instruments for assessing depression and anxiety in OA patients," "Depression or anxiety in patients with surgical intervention," and "Other mental diseases in OA patients." This bibliometric analysis underscores the importance of understanding the link between OA and depressive disorders, potentially guiding new research directions.

Vitamin C intake and osteoarthritis: findings of NHANES 2003-2018 and Mendelian randomization study

Background

The role of vitamin C in osteoarthritis (OA) is still a subject of debate. Our aim was to combine the National Health and Nutrition Examination Survey (NHANES) and MR studies to explore the relationship between vitamin C intake and OA.

Methods

Clinical information on participants during NHANES 2003-2018 was collected and the relationship between vitamin C intake and OA risk was assessed using logistic regression modelling. In MR analyses, three methods were used to explore the causality of vitamin C intake with OA. Sensitivity analysis to verify the stability of the MR study.

Results

The cross-sectional study included a total of 31,527 participants, categorizing them into low (<30.2 mg), medium (30.2-93.0 mg) and high (>93.0 mg) level groups based on their vitamin C intake levels. Logistic regression models showed that vitamin C intake was not associated with OA risk (p > 0.05). Inverse-variance weighted (IVW) method of MR study showed no causality between vitamin C intake and OA (OR = 0.993, 95% CI: 0.901 ~ 1.095, p = 0.882). Sensitivity analysis indicated that the MR study was reliable.

Conclusion

Our cross-sectional and MR studies showed that vitamin C intake was not associated with OA risk. More researches are needed in the future to investigate the link between vitamin C and OA.

Utilization of Rehabilitation Services and Rehabilitation-Related Patient Satisfaction Following Total Knee Arthroplasty-Results of the Prospective FInGK Study

(1) Background: This study aims to examine rehabilitation service utilization among total knee arthroplasty (TKA) subjects and the influencing factors associated with rehabilitation-related satisfaction. (2) Methods: The FInGK study was a single-center prospective cohort study. Patients (≥18 years) undergoing primary or revision TKA in a German university hospital were consecutively recruited between December 2019-May 2021. The subjects filled in a questionnaire one day before surgery (t0) and at two (t1) and 12 (t2) months postoperatively. Multivariable logistic regression was conducted to determine the variables associated with the subjects' rehabilitation-related satisfaction. (3) Results: A total of 236 out of 241 (97.9%) subjects participated in t1 (59.3% female; mean age: 68.2 years). Overall, 94.7% underwent post-TKA rehabilitation measures, with inpatient rehabilitation being the predominant choice (85.4%). In total, 77.6% of those with rehabilitation were satisfied or very satisfied with their rehabilitation in general. Multivariable logistic regression showed that female sex (OR 3.42; CI 1.73-6.75) and satisfaction with the surgery in general after two months (OR 4.50; CI 1.96-10.33) were associated with the subjects' rehabilitation-related satisfaction. (4) Conclusions: We found a high utilization of rehabilitation services following TKA and a high rehabilitation-related satisfaction. In international comparison, the utilization of inpatient rehabilitation services was very high. Future research should investigate the effective components for rehabilitation-related satisfaction in both in- and outpatient TKA rehabilitation.

A randomized clinical trial testing digital mindset intervention for knee osteoarthritis pain and activity improvement

This randomized clinical trial evaluated the effectiveness of short, digital interventions in improving physical activity and pain for individuals with knee osteoarthritis. We compared a digital mindset intervention, focusing on adaptive mindsets (e.g., osteoarthritis is manageable), to a digital education intervention and a no-intervention group. 408 participants with knee osteoarthritis completed the study online in the US. The mindset intervention significantly improved mindsets compared to both other groups (P < 0.001) and increased physical activity levels more than the no-intervention group (mean = 28.6 points, P = 0.001), but pain reduction was not significant. The mindset group also showed significantly greater improvements in the perceived need for surgery, self-imposed physical limitations, fear of movement, and self-efficacy than the no-intervention and education groups. This trial demonstrates the effectiveness of brief digital interventions in educating about osteoarthritis and further highlights the additional benefits of improving mindsets to transform patients' approach to disease management. The study was prospectively registered (ClinicalTrials.gov: NCT05698368, 2023-01-26).

Investigating the shared genetic architecture of osteoarthritis and frailty: a genome-wide cross-trait analysis

Observational studies suggest a link between osteoarthritis (OA) and frailty, but the shared genetic architecture and causal relationships remain unclear. We analyzed X-ray and 18F-FDG PET/CT images in frail and non-frail individuals and conducted genetic correlation analyses using Linkage Disequilibrium Score Regression (LDSC) based on recent Genome-Wide Association Studies (GWAS) for OA and frailty. We identified pleiotropic single-nucleotide polymorphisms (SNPs) through Cross-Phenotype Association (CPASSOC) and Colocalization (COLOC) analyses and investigated genetic overlaps using Multi-marker Analysis of GenoMic Annotation (MAGMA). Transcriptome-wide association studies (TWAS) were conducted to analyze pleiotropic gene expression, and Mendelian Randomization (MR) was used to assess causal relationships between OA and frailty. Frail individuals showed more severe OA on X-ray (67% vs. 31%, P ≤ 0.01) and higher SUVmax on 18F-FDG PET/CT (4.1 vs. 3.6, P < 0.05) compared to non-frail individuals. Genetic correlation between frailty and OA was significant (rg = 0.532, P = 4.230E-88). Cross-trait analyses identified 42 genomic loci and 138 genes shared between the conditions. COLOC analysis revealed 2 pleiotropic loci, while TWAS identified 27 significant shared genetic expressions in whole blood and musculoskeletal tissue. Bidirectional MR indicated that OA increases the risk of frailty (IVW: beta: 0.13, P = 1.52E-08) and vice versa (IVW: beta: 0.73, P = 1.66E-04). Frail individuals exhibit more severe imaging features of OA. The shared genetic basis between OA and frailty suggests an intrinsic link, providing new insights into the relationship between these conditions.

Patterns of pain medication usage and self-reported pain in older Irish adults with osteoarthritis: A latent class analysis of data from the Irish Longitudinal Study on Ageing

BACKGROUND

This study aimed to identify and describe links between pain medication use and self-reported pain among people aged ≥ 50 years with osteoarthritis (OA) in an Irish population, and to examine the relationships between pain, medication usage and socioeconomic and clinical characteristics.

METHODS

Secondary data analysis of wave 1 cross-sectional data from The Irish Longitudinal Study on Ageing (TILDA) was undertaken of 1042 people with self-reported doctor-diagnosed OA. We examined use of medications typically included in OA clinical guidelines, including non-opioid analgesics (e.g. paracetamol), topical and oral non-steroidal anti-inflammatory drugs (NSAIDs), opioids and nutraceuticals. Latent Class Analysis (LCA) was used to identify underlying clinical subgroups based on medication usage patterns, and self-reported pain severity. Multinomial logistic regression was used to explore sociodemographic and clinical characteristic links to latent class membership.

RESULTS

A total of 358 (34.4%) of the 1042 people in this analysis were taking pain medications including oral NSAIDs (17.5%), analgesics (11.4%) and opioids (8.7%). Nutraceutical (glucosamine/chondroitin) use was reported by 8.6% and topical NSAID use reported by 1.4%. Three latent classes were identified: (1) Low medication use/no pain (n = 382, 37%), (2) low medication use/moderate pain (n = 523, 50%) and (3) moderate medication use/high pain (n = 137, 13%). Poorer self-rated health and greater sleep disturbance were associated with classes 2 and 3; depressive symptoms and female gender were associated with class 2, and retirement associated with class 3.

CONCLUSIONS

Whilst pain medication use varied with pain severity, different medication types reported broadly aligned with OA guidelines. The two subgroups exhibiting higher pain levels demonstrated poorer self-rated health and greater sleep disturbance.

Relationships Between Socioecological Factors and Self-Efficacy to Participate in Physical Activity for Adults With Chronic Musculoskeletal Pain: An Integrative Review

OBJECTIVE

Self-efficacy for leisure-time or health-promoting physical activity (SEPA) is a psychosocial determinant of physical activity. The socioecological model can provide a robust perspective of SEPA. The objective of this study was to synthesize the evidence on multilevel correlates of SEPA among individuals with chronic musculoskeletal pain. The second aim examined the extent to which socioecological disparities are associated with SEPA among individuals with chronic musculoskeletal pain.

METHODS

An integrative review was conducted. Included studies needed to investigate the relationship between SEPA and socioecological factors at the interpersonal, institutional, community, and/or macrosystem level among adults with chronic musculoskeletal pain (≥3 months). Searches in PubMed, EMBASE, PsycINFO, and CINAHL were performed (December 30, 2020, and October 12, 2022), yielding 4047 records after duplicates were removed. Two independent reviewers completed screening, full-text reviews, and data extraction. After title and abstract screening and full-text reviews, 17 studies were included. The constant comparison method included: data reduction, data display, data comparison, and conclusion drawing/verification. Quality of evidence was assessed using the Joanna Briggs Institute appraisal tools.

RESULTS

Five themes emerged with respect to relationships between SEPA and socioecological factors: social relations, social comparisons, patient-provider relationship, organizational resources, and accessibility to physical activity. Relationships between interpersonal factors and SEPA were most prominently studied. One study examined and addressed potential disparities in SEPA at the macrosystem level.

CONCLUSION

A spectrum of relationships from supporting to straining SEPA were found at the interpersonal level. Relationships between institutional, community, and macrosystem factors and SEPA were comparably sparse. Gaps in the literature were identified regarding how health disparities present across the socioecological model with respect to SEPA.

IMPACT

Clinicians can use this review to evaluate how SEPA can be supported or threatened by factors across the socioecological model. This may be a preliminary step towards examining and addressing health disparities in SEPA.

Effectiveness of strategies to improve adherence to physical therapy in patients with knee and hip osteoarthritis: a systematic review and meta-analysis

PURPOSE

To determine the effectiveness of current strategies oriented to increase adherence to physical therapy in subjects with knee and hip osteoarthritis (OA).

MATERIAL AND METHODS

A systematic review of electronic databases was conducted from inception until March 2023. Studies with experimental interventions using strategies to increase adherence to physical therapy programs in subjects with knee or hip OA were included. A meta-analysis compared the effects of such interventions with usual care for adherence-related measures (primary outcome), and functional and pain outcomes, using standardized mean differences (SMD) with a 95% confidence interval (CI). GRADE was used to determine the strength of the resultant evidence and the external validity of the findings.

RESULTS

Fifteen articles, assessing 1,818 participants, were included. The interventions included cognitive-behavior strategies, telephone calls, internet-based interventions, communication technologies, and booster sessions. A meta-analysis revealed that the experimental interventions increased adherence over usual care with a moderate effect size of SMD = 0.39 (95%CI = 0.08-0.71) and moderate certainty in this evidence.

CONCLUSION

Overall, this review supports that the strategies to promote adherence to physical therapy in individuals with knee and hip OA are effective. However, the positive impact on adherence rates does not always translate into improved clinical outcomes.

Mesenchymal stem cells for chronic knee pain secondary to osteoarthritis: A systematic review and meta-analysis of randomized trials

OBJECTIVE

To assess the effectiveness of mesenchymal stem cells (MSCs) for chronic knee pain secondary to osteoarthritis (OA).

METHODS

We searched MEDLINE, EMBASE, CINAHL, and Cochrane Central to September 2023 for trials that (1) enrolled patients with chronic pain associated with knee OA, and (2) randomized them to MSC therapy vs. placebo or usual care. We performed random-effects meta-analysis and used Grading of Recommendations, Assessment, Development, and Evaluation to assess the certainty of evidence.

RESULTS

We included 16 trials (807 participants). At 3-6 months, MSC therapy probably results in little to no difference in pain relief (weighted mean difference [WMD] -0.74 cm on a 10 cm visual analog scale [VAS], 95% confidence interval [95%CI] -1.16 to -0.33; minimally important difference [MID] 1.5 cm) or physical functioning (WMD 2.23 points on 100-point 36-item Short Form Survey (SF-36) physical functioning subscale, 95%CI -0.97 to 5.43; MID 10-points; both moderate certainty). At 12 months, injection of MSCs probably results in little to no difference in pain (WMD -0.73 cm on a 10 cm VAS, 95%CI -1.69 to 0.24; moderate certainty) and may improve physical functioning (WMD 19.36 points on 100-point SF-36 PF subscale, 95%CI -0.19 to 38.9; low certainty). MSC therapy may increase risk of any adverse events (risk ratio [RR] 2.67, 95%CI 1.19 to 5.99; low certainty) and pain and swelling of the knee joint (RR 1.58, 95%CI 1.04 to 2.38; low certainty).

CONCLUSIONS

Intra-articular injection of MSCs for chronic knee pain associated with OA probably provides little to no improvement in pain or physical function.

Neuroinflammation in osteoarthritis: From pain to mood disorders

Osteoarthritis (OA) is the most common form of musculoskeletal disease, and its prevalence is increasing due to the aging of the population. Chronic pain is the most burdensome symptom of OA that significantly lowers patients' quality of life, also due to its frequent association with emotional comorbidities, such as anxiety and depression. In recent years, both chronic pain and mood alterations have been linked to the development of neuroinflammation in the peripheral nervous system, spinal cord and supraspinal brain areas. Thus, mechanisms at the basis of the development of the neuroinflammatory process may indicate promising targets for novel treatment for pain and affective comorbidities that accompany OA. In order to assess the key role of neuroinflammation in the maintenance of chronic pain and its potential involvement in development of psychiatric components, the monoiodoacetate (MIA) model of OA in rodents has been used and validated. In the present commentary article, we aim to summarize up-to-date results achieved in this experimental model of OA, focusing on glia activation and cytokine production in the sciatic nerve, dorsal root ganglia (DRGs), spinal cord and brain areas. The association of a neuroinflammatory state with the development of pain and anxiety- and depression-like behaviors are discussed. Results suggest that cells and molecules involved in neuroinflammation may represent novel targets for innovative pharmacological treatments of OA pain and mood comorbidities.

Men and women undergoing total hip arthroplasty have different clinical presentations before surgery and different outcomes at 1-year follow-up

PURPOSE

The purpose of this study was to investigate the influence of sex on patients undergoing total hip arthroplasty (THA) for hip osteoarthritis (HOA), aiming to assess the clinical and functional outcomes using patient-reported outcome measures (PROMs).

METHODS

A retrospective analysis of patients undergoing THA at Ospedale Galeazzi-Sant'Ambrogio between 2016 and 2022 was conducted. Inclusion criteria encompassed Kellgren-Lawrence grade III or IV HOA, with preoperative and 12-month postoperative PROMs. Enroled patients have been selected from a larger cohort without matching design for confounders. The analyses were performed using R software v4.0.3 (R Core Team) and data distributions were assessed using the Shapiro-Wilk normality test.

RESULTS

One hundred ninety patients (72 male and 118 female) who had both preoperative and postoperative PROMs have been analysed from our institutional prosthesis registry (Datareg). Baseline and 12-month post-THA PROMs showed significant improvements overall. VAS score dropped notably from baseline to 3 months postsurgery (7.1 ± 2.1 vs. 0.9 ± 1.7). Functional and mental PROMs, including Harris Hip Score-functional (HHS-F), Harris Hip Score-total (HHS-t), SF-12PS and SF-12MS, exhibited substantial improvements post-THA. Stratifying by sex, males had lower baseline VAS, higher HHS-F, SF-12MS and hip disability and osteoarthritis outcome score-physical function short form (HOOS-PS). At 12 months, males displayed significantly better VAS, HHS-F, SF-12PS and HOOS-PS scores. Complication rates were minimal (1.5%), with stable rates across genders, mostly involving dislocation and periprosthetic fractures. Implant survival at 12 months reached an impressive 99%.

CONCLUSION

THA remains an effective treatment for severe HOA. However, females presented with worse baseline conditions and showed relatively less improvement at 1-year postsurgery compared to males. This difference could be attributed to physiological and psychosocial factors associated with sex, including hormonal changes, muscle mass decline and perception of pain. Longer follow-ups and prospective studies are necessary to validate these findings and facilitate personalised approaches in HOA treatment, emphasising the need for careful consideration of sex-related variables in clinical decision-making for THA patients.

LEVEL OF EVIDENCE

Level III.

Construct Validity and Responsiveness of Performance-based Tests in Individuals With Knee Osteoarthritis

OBJECTIVES

To assess the construct validity and responsiveness of 3 performance-based tests in individuals with knee osteoarthritis (KOA).

DESIGN

This study has a prospective cohort design.

SETTING

Assessments were administered at the Federal University of São Carlos (Brazil) by 3 different raters.

PARTICIPANTS

A total of 107 participants with KOA were aged ≥40 years (N=107).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE

This study assessed the construct validity and responsiveness of 3 performance-based tests: 40-meter fast-paced walk test (40-m FPWT), 11-step stair climb test (11-step SCT), and 30-second chair stand test (30-s CST). The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), sedentary behavior (activPAL), and numeric pain rating scale (NPRS) were used as comparator instruments. Measurements were obtained at baseline and after 6 months. The construct validity and responsiveness were calculated using Spearman correlation coefficient within predefined hypotheses based on a panel comprising 5 experts in the field of outcome measurement in KOA.

RESULTS

The three performance-based tests showed excellent (ICC>0.9) reliability (intra and inter); however, only the 40-m FPWT and 11-step SCT were considered valid and responsive because both confirmed >75% of the priori hypotheses. The 30-s CST was not considered valid or responsive because it has not confirmed ≥75% of the priori hypotheses.

CONCLUSION

The 3 performance-based tests are reliable for intra and inter assessments. The 40-m FPWT and 11-step SCT are both valid and responsive for measuring physical function in patients with KOA. The 30-s CST was not considered valid or responsive. Therefore, 40-m FPWT and 11-step SCT can detect changes over time and are indicated for functional assessment in clinical practice.

Genicular artery embolisation versus sham embolisation for symptomatic osteoarthritis of the knee: a randomised controlled trial

OBJECTIVE

To determine the efficacy of genicular artery embolisation (GAE) compared with sham GAE for pain reduction in patients with symptomatic mild-to-moderate knee osteoarthritis (KOA).

DESIGN

Double-blind randomised sham-controlled clinical trial conducted from June 2019 to December 2021. The follow-up period was 4 months.

SETTING

Single-centre study conducted at a university medical centre in Rotterdam, Netherlands.

PARTICIPANTS

58 adults with symptomatic mild-to-moderate KOA not improving with conservative treatment.

INTERVENTIONS

Participants were randomised to receive either GAE treatment or a sham GAE treatment.

MAIN OUTCOME MEASURES

The primary outcome was reduction of pain measured with the Knee Injury and Osteoarthritis Outcome Score pain subscale (0-100, with 0 representing the worst pain outcome and 100 the best) after 4 months. Outcomes were assessed at baseline and 1 and 4 months.

RESULTS

From June 2019 to December 2021, 58 patients were included. 29 patients were randomised to the GAE group and 29 to the sham group. All participants completed the study. The mean pain reduction after 4 months was 21.4 (95% CI 13.9 to 28.8) for the GAE group and 18.4 points (95% CI 11.6 to 25.1) for the sham group. The between-group difference for the mean pain reduction was 3.0 (95% CI -7.1 to 13.0) with an estimated Cohen's d effect size of d = 0.15 (95% CI -0.37 to 0.66). Group allocation was not a significant contributor to pain reduction (p = 0.31). No serious adverse events (AEs) occurred. 23 mild AEs occurred in the GAE group and 5 in the sham group.

CONCLUSION

We did not establish a clinical effect of GAE in patients with mild-to-moderate KOA as GAE produced a similar effect on pain reduction as a sham GAE procedure.

TRIAL REGISTRATION NUMBER

NCT03884049.

Efficacy and Safety of Platelet-Rich Plasma (PRP) Intra-articular Injections in Hip Osteoarthritis: A Systematic Review of Randomized Clinical Trials

Hip osteoarthritis (OA) is a prevalent condition causing significant pain and disability. Platelet-rich plasma (PRP) intra-articular injections have emerged as a potential therapeutic option, but their efficacy is still debatable and their safety profile remains under-explored compared to standard treatments. This systematic review aims to evaluate the efficacy and safety of PRP injections in patients with hip OA by analyzing data from randomized clinical trials (RCTs). A comprehensive literature search was conducted in PubMed, Scopus, and the Virtual Health Library (VHL) until October 31, 2022, adhering to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Studies were included if they were RCTs assessing PRP injections for hip OA and reporting adverse events. Data extraction and methodological quality assessment were performed using the Cochrane Risk of Bias Tool (RoB 2 tool). Out of 188 identified studies, five met the inclusion criteria. The studies varied in sample size (43-111 patients) and PRP preparation methods (closed vs. open systems). All studies demonstrated significant pain reduction and functional improvement with PRP. No major adverse events were reported, indicating a favorable safety profile. Minor side effects were transient and resolved without further intervention. Methodological quality ranged from low to high risk of bias. In conclusion, PRP injections appear to be a safe and effective treatment option for managing hip OA, with favorable outcomes compared to hyaluronic acid. Further research is necessary to standardize PRP protocols and assess long-term safety and efficacy.

Depression and Time to Knee Arthroplasty Among Adults Who Have Knee Osteoarthritis

BACKGROUND

Depression is common in osteoarthritis (OA) and is associated with poor outcomes following total knee arthroplasty (TKA). Depression can increase pain sensitivity and may be related to an increased likelihood of TKA.

METHODS

Nationally distributed electronic health record data from 2010 to 2018 were used to identify eligible patients (n = 9,466) who had knee OA and were 45 to 80 years of age. Cox proportional hazard models were computed to estimate the association between depression and incident TKA for all patients and by age group (45 to 54, 55 to 64, and 65 to 80 years of age). Confounding was controlled using entropy balancing. Sensitivity analyses determined if the association between depression and TKA differed when depression occurred in the 12 months occurring 90, 60, 30, and 0 days lag time before TKA.

RESULTS

The mean age of the sample was 63 (range, 45 to 80), 64.0% were women, 83.3% were White race, and approximately 50% resided in the Midwest. There was no association between depression and incident TKA (hazard ratio = 0.97; confidence interval = 0.81 to 1.16]). Results did not differ in age-stratified analyses. Sensitivity analyses revealed a higher percentage of TKA among depressed versus nondepressed patients (24.2 versus 21.6%; P = .028) when the patient's depression diagnosis was established in the 12 months with no lag time before TKA.

CONCLUSIONS

Patients who have knee OA and comorbid depression, compared to those who have only knee OA, do not have an increased likelihood of TKA. The multifactorial, complex decision to obtain TKA does not appear to be influenced by depression, but depression is a common comorbidity.

Deep Learning for Automatic Knee Osteoarthritis Severity Grading and Classification

Introduction

Knee osteoarthritis (OA) is a prevalent condition that significantly impacts the quality of life, often leading to the need for knee replacement surgery. Accurate and timely identification of knee degeneration is crucial for effective treatment and management. Traditional methods of diagnosing OA rely heavily on radiological assessments, which can be time-consuming and subjective. This study aims to address these challenges by developing a deep learning-based method to predict the likelihood of knee replacement and the Kellgren-Lawrence (KL) grade of knee OA from X-ray images.

Methodology

We employed the Osteoarthritis Initiative (OAI) dataset and utilized a transfer learning approach with the Inception V3 architecture to enhance the accuracy of OA detection. Our approach involved training 14 different models-Xception, VGG16, VGG19, ResNet50, ResNet101, ResNet152, ResNet50V2, ResNet101V2, ResNet152V2, Inception V3, Inception, ResNetV2, DenseNet121, DenseNet169, DenseNet201-and comparing their performance.

Results

The study incorporated pixel ratio computation and picture pre-processing, alongside a decision tree model for prediction. Our experiments revealed that the Inception V3 model achieved the highest training accuracy of 91% and testing accuracy of 67%, with notable performance in both training and validation phases. This model effectively identified the presence and severity of OA, correlating with the Kellgren-Lawrence scale and facilitating the assessment of knee replacement needs.

Conclusion

By integrating advanced deep learning techniques with radiological diagnostics, our methodology supports radiologists in making more accurate and prompt decisions regarding knee degeneration. The Inception V3 model stands out as the optimal choice for knee X-ray analysis, contributing to more efficient and timely healthcare delivery for patients with knee osteoarthritis.

The Flare-OA-16 questionnaire measuring flare in knee and hip osteoarthritis in the patient perspective: scale reduction and validation using a Rasch model

OBJECTIVES

The recent Flare-OA questionnaire measuring flare in knee and hip osteoarthritis (OA) (19 items in 5 domains, numerical rating scale) showed good psychometric properties along with classical test theory. This study aimed to determine its scaling properties by Rasch analysis and to present evidence for a refined scalable version.

STUDY DESIGN AND SETTING

The participants were 398 subjects (mean age 64 years [standard deviation = 8.1], 70.4% women) recruited from Australia, France, and the United States, with clinically and radiologically symptomatic knee or hip OA, who completed an online survey. The sample was split into derivation and validation subsamples, stratified by country and joint. Rasch analysis examined differential item functioning (DIF) for sex, age, country, and joint. A confirmatory factor analysis and an analysis of convergent validity were performed to document the psychometric properties of the short version.

RESULTS

To fit the Rasch model, we reordered thresholds of answering modalities when necessary. Two items were removed. A local dependency between 2 items was solved by combining items modalities into a super-item. A uniform DIF (expected and nonremoved) was identified for one item that was split by joint, and a nonuniform DIF for one item for age and country (removed). The person-item threshold distribution showed a well-focused scale; the confirmatory factor analysis and the analysis of convergent validity showed good fit indicators for the short version.

CONCLUSION

The Rasch analysis was helpful in guiding the decision to refine the measurement instrument. After analysis, the 16-item Flare-OA self-report questionnaire is available for use in clinical research.

Fixed-Bearing and Higher Postoperative Knee Flexion Angle as Predictors of Satisfaction in Asian Patients Undergoing Posterior-Stabilized Total Knee Arthroplasty

Background

Patient-reported satisfaction following total knee arthroplasty (TKA) can be affected by various factors. This study aimed to assess patient satisfaction rates and identify factors related to patients, surgery, and postoperative knee motion associated with satisfaction in posterior-stabilized TKA among Asian patients.

Methods

A retrospective cross-sectional study was conducted in patients with primary osteoarthritis who underwent TKA and had a follow-up period of over 2 years. Patient satisfaction was measured using a 5-point Likert scale, and the patients were divided into satisfied and dissatisfied groups. The factors potentially affecting satisfaction were collected, including demographics, comorbidities, surgical options, and knee motion. Univariate and multivariate regression analyses were performed.

Results

Of the 858 patients included, 784 (91.4%) were satisfied and 74 (8.6%) were dissatisfied. Fixed-bearing implants and higher postoperative knee flexion angles were associated with satisfaction (odds ratio [OR], 2.366; p = 0.001 and OR, 1.045; p < 0.001, respectively), whereas cerebrovascular disease was related to dissatisfaction (OR, 0.403; p = 0.005). The regression model demonstrated moderate predictability (R 2 = 0.112).

Conclusions

Fixed-bearing implants and higher postoperative knee flexion angles were associated with patient satisfaction following TKA, whereas cerebrovascular disease was associated with dissatisfaction. The identification of these factors could help improve surgical outcomes and patient satisfaction following TKA.

Efficacy of preoperative pain neuroscience education in physical therapy on clinical outcomes in patients undergoing arthroplasty: A systematic review of randomized clinical trials

OBJECTIVE

To evaluate the efficacy of preoperative pain neuroscience education (PNE) on pain intensity, kinesiophobia, catastrophizing, and disability in individuals undergoing hip or knee arthroplasty.

METHODS

A search was conducted on MEDLINE, CINAHL, Epistemonikos, Scopus, and Web of Science from their inception to March 2023. Two investigators independently assessed the risk of bias with Risk of Bias 2 (ROB2) and Risk of Bias in Non-randomized Studies - of Interventions (ROBINS-I) of the studies, as well as the certainty of the evidence with Grade of Recommendation, Assessment, Development, and Evaluation (GRADE) for pain intensity, catastrophizing, kinesiophobia and disability at one month, three months and six months of follow-up.

RESULTS

A total of 1716 papers were found and two studies on knee arthroplasty were included (n = 147). The intergroup effect sizes for pain intensity were 0.29, 0.07, and 0.25 at one-, three-, and six-months post-surgery, whereas the effect sizes for disability were 0.4, 0.46, and 0.21 (GRADE analysis, moderate certainty, respectively). Catastrophizing showed intergroup effect sizes of 0.78, 1.08, and 0.25, and kinesiophobia of 1.56, 0.92, and 0.33 at follow-up (GRADE analysis, low-moderate certainty).

CONCLUSIONS

Preoperative PNE in individuals undergoing knee arthroplasty has low to moderate certainty for improving pain intensity, catastrophizing, kinesiophobia, and disability with low to high effect sizes and discrepancy between studies. More research on the effect of a preoperative PNE intervention in people undergoing knee or hip arthroplasty is required.

Application of adhesives in the treatment of cartilage repair

From degeneration causing intervertebral disc issues to trauma‐induced meniscus tears, diverse factors can injure the different types of cartilage. This review highlights adhesives as a promising and rapidly implemented repair strategy. Compared to traditional techniques such as sutures and wires, adhesives offer several advantages. Importantly, they seamlessly connect with the injured tissue, deliver bioactive substances directly to the repair site, and potentially alleviate secondary problems like inflammation or degeneration. This review delves into the cutting‐edge advancements in adhesive technology, specifically focusing on their effectiveness in cartilage injury treatment and their underlying mechanisms. We begin by exploring the material characteristics of adhesives used in cartilage tissue, focusing on essential aspects like adhesion, biocompatibility, and degradability. Subsequently, we investigate the various types of adhesives currently employed in this context. Our discussion then moves to the unique role adhesives play in addressing different cartilage injuries. Finally, we acknowledge the challenges currently faced by this promising technology.

Effectiveness of Internet-Based Telehealth Programs in Patients With Hip or Knee Osteoarthritis: Systematic Review and Meta-Analysis

BACKGROUND

Osteoarthritis (OA) is a chronic musculoskeletal disease that causes pain, functional disability, and an economic burden. Nonpharmacological treatments are at the core of OA management. However, limited access to these services due to uneven regional local availability has been highlighted. Internet-based telehealth (IBTH) programs, providing digital access to abundant health care resources, offer advantages, such as convenience and cost-effectiveness. These characteristics make them promising strategies for the management of patients with OA.

OBJECTIVE

This study aimed to evaluate the effectiveness of IBTH programs in the management of patients with hip or knee OA.

METHODS

We systematically searched 6 electronic databases to identify trials comparing IBTH programs with conventional interventions for hip and knee OA. Studies were selected based on inclusion and exclusion criteria, focusing on outcomes related to function, pain, and self-efficacy. Standardized mean differences (SMDs) with 95% CIs were calculated to compare outcome measures. Heterogeneity was assessed using I² and χ² tests. The methodological quality of the selected studies and the quality of evidence were also evaluated.

RESULTS

A total of 21 studies with low-to-high risk of bias were included in this meta-analysis. The pooled results showed that IBTH has a superior effect on increasing function (SMD 0.30, 95% CI 0.23-0.37, P<.001), relieving pain (SMD -0.27, 95% CI -0.34 to -0.19, P<.001), and improving self-efficacy for pain (SMD 0.21, 95% CI 0.08-0.34, P<.001) compared to the conventional intervention group. Subgroup analysis revealed that IBTH with exercise can significantly alleviate pain and improve function and self-efficacy, but IBTH with cognitive-behavioral therapy only had the effect of reducing pain.

CONCLUSIONS

The meta-analysis provides moderate-quality evidence that IBTH programs have a beneficial effect on improving function, relieving pain, and improving self-efficacy compared to conventional interventions in patients with hip or knee OA. Limited evidence suggests that the inclusion of exercise regimens in IBTH programs is recommended.

TRIAL REGISTRATION

PROSPERO CRD42024541111; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=541111.

Prevalence and Associated Factors of Musculoskeletal Disorders among Older Patients Treated at Walailak University Physical Therapy Clinic in Thailand: A Retrospective Study

The prevalence of musculoskeletal disorders (MSDs) is high among older adults worldwide, significantly affecting their quality of life and overall health. Understanding the prevalence of MSDs and their associated factors is crucial to developing effective preventive and management strategies in Thailand. In this study, we aimed to investigate the prevalence of MSDs and their associated factors among older patients at Walailak University Physical Therapy Clinic. In this retrospective study, we analyzed the medical records of 396 older patients. Data on demographics, underlying diseases, career types, and treatments were collected and analyzed using descriptive statistics chi-squared tests, and logistic regression analysis to determine their associations with MSD prevalence. The overall prevalence of MSDs was 89.90%. MSD prevalence was higher among female patients than among male patients (p < 0.001). The most commonly affected body regions were the lower back, shoulders, and knees. Career type (p < 0.001) had the highest impact on the presence of MSDs after controlling for sex, age, and underlying diseases as covariates in a logistic regression model. Manual labor and heavy industry workers as well as pensioners showed an increased risk of MSDs. While older age was associated with a higher MSD prevalence using chi-squared statistics, it was removed from the logistic regression models. Pensioners were the most likely to receive treatment, indicating the need for targeted interventions for individuals with physically demanding occupations. These findings underscore the importance of targeted interventions and further research on socioeconomic factors, lifestyle behaviors, and comorbidities to manage MSDs among older adults in Thailand.

Multivariable model for gait pattern differentiation in elderly patients with hip and knee osteoarthritis: A wearable sensor approach

Background

Hip and knee osteoarthritis (OA) patients demonstrate distinct gait patterns, yet detecting subtle abnormalities with wearable sensors remains uncertain. This study aimed to assess a predictive model's efficacy in distinguishing between hip and knee OA gait patterns using accelerometer data.

Method

Participants with hip or knee OA underwent overground walking assessments, recording lower limb accelerations for subsequent time and frequency domain analyses. Logistic regression with regularization identified associations between frequency domain features of acceleration signals and OA, and k-nearest neighbor classification distinguished knee and hip OA based on selected acceleration signal features.

Findings

We included 57 knee OA patients (30 females, median age 68 [range 49-89], median BMI 29.7 [range 21.0-45.9]) and 42 hip OA patients (19 females, median age 70 [range 47-89], median BMI 28.3 [range 20.4-37.2]). No significant difference could be found in the time domain's averaged shape of acceleration signals. However, in the frequency domain, five selected features showed a diagnostic ability to differentiate between knee and hip OA. Using these features, a model achieved a 77 % accuracy in classifying gait cycles into hip or knee OA groups, with average precision, recall, and F1 score of 77 %, 76 %, and 78 %, respectively.

Interpretation

The study demonstrates the effectiveness of wearable sensors in differentiating gait patterns between individuals with hip and knee OA, specifically in the frequency domain. The results highlights the promising potential of wearable sensors and advanced signal processing techniques for objective assessment of OA in clinical settings.

Osteochondral Tissue-On-a-Chip: A Novel Model for Osteoarthritis Research

The existing in vitro and in vivo models for studying osteoarthritis have significant limitations in replicating the complexity of joint tissues. This research aims to validate a Tissue-On-a-Chip system for osteoarthritis research. Osteochondral tissues obtained from knee replacement surgeries of patients with osteoarthritis were cultured in an Organ-On-a-Chip system. This system was designed to supply oxygen and glucose to the cartilage from the bone. The distribution of oxygen and glucose was evaluated by fluorescence using Image-iT Green Hypoxia and 2-NBDG, respectively. Cytotoxicity was measured using lactate dehydrogenase (LDH) levels in chip cultures compared to plate cultures (12 tissues per method). Glycosaminoglycans (GAGs), alkaline phosphatase (ALP), Coll2-1, and procollagen type II N-terminal propeptide (PIINP) were measured in the perfused medium of the Tissue-On-a-Chip over a period of 70 days. Fluorescence of Image-iT Green Hypoxia was observed only in the cartilage area, while 2-NBDG was distributed throughout the tissue. An increase in LDH levels was noted in the plate cultures on day 24 and in the Tissue-On-a-Chip cultures on day 63. Compared to the start of the culture, GAG content increased on day 52, while ALP showed variations. A notable increase in GAG, ALP, and Coll2-1 levels was observed on day 59. PIINP levels remained stable throughout the experiment. The validated osteochondral Tissue-On-a-Chip system can replicate the joint microenvironment, with hypoxic conditions in cartilage and normoxic conditions in bone. Tissue survival and component stability were maintained for approximately two months. This platform is a useful tool for evaluating new drugs and represents a viable alternative to animal models.

A single intraarticular injection of a tranexamic acid-modified hyaluronic acid (HA/TXA) alleviates pain and reduces OA development in a murine model of monosodium iodoacetate-induced osteoarthritis

Rationale

Tranexamic acid (TXA) is a strong and specific plasminogen activator inhibitor with inhibitory effects on the matrix metalloproteases involved in the pathophysiology of osteoarthritis (OA) through targeting of the fibrinolysis pathway. In this study, we evaluated the analgesic and chondroprotective effects of a HA-tranexamic acid (HA/TXA) conjugate, compared to HA alone and placebo, in an animal model of knee OA.

Methods

Knee OA was induced in 15 C57 b l/6J mice by IA injection of 0.75 mg of Monosodium IodoAcetate (MIA). At day 28, the mice received 1 IA injection of 10 µL of saline (control-group), or of HA or of HA/TXA. Tactile sensitivity was assessed using von Frey filaments. Stimulations started at 1 g and increased until a response was obtained (up to 4 g). A response to the stimulus was counted if the animal withdrew its paw. If the animal responded to the 1 g stimulation, stimulation was reduced until the lack of response was observed (up to 0.2 g). At day 56, mice were euthanized for knee histological assessment. Cartilage degradation was assessed using the OARSI score. Statistical analysis was performed on GraphPad Prism 8.0.2 software. Kruskal-Wallis or Mann-Whitney tests were performed as appropriate.

Results

Just before treatment administration, no intergroup difference in paw withdrawal threshold was observed. Throughout the experiment animals given saline and HA had a lower paw withdrawal threshold than those treated with HA/TXA (p < 0.01). In the control group OARSI score was 5.5 ± 0.6. In HA and HA + TXA treated mice the OARSI score was 3.2 ± 0.8 and 3.1 ± 0.5 (p < 0.01) showing that both treatments were able to reduce OA progression.

Conclusion

In this animal model of MIA induced KOA, a single IA injection of a HA/TXA conjugate resulted in a greater efficacy on pain than both saline and HA. HA and HA/TXA exhibited chondroprotective effects compared to placebo.

Does Knee Arthroplasty Have a Beneficial Effect on Return to Work in Patients with Knee Osteoarthritis who Receive Long-Term Disability Benefits in the Netherlands?

PURPOSE

Optimal timing of knee arthroplasty (KA) is complex: operating at a younger age increases life time risk of revision, while delay results in an increased risk of job loss. This study evaluates whether disability benefits recipients due to knee osteoarthritis have an increased odds of returning to work (RTW) following KA.

METHODS

A retrospective cohort study was performed among long-term disability benefits recipients due to knee osteoarthritis using data of the Dutch Employee Insurance Agency. Logistic regression assessed whether recipients with KA had a higher odds of RTW in 10 years following start of disability benefits, compared to those without KA.

RESULTS

A total of 159 participants were included. During 10-year follow up, 42% had received KA and 37% had returned to work. No association was observed between KA and RTW (OR 1.39, 95% CI 0.62-3.12). Prognostic factors for RTW were being the main breadwinner (OR 7.93, 95% CI 2.95-21.32) and classification as 100% work disability (OR 0.20, 95% CI 0.09-0.45).

CONCLUSIONS

KA has no beneficial effect on RTW among patients with knee osteoarthritis granted long-term disability in the Netherlands. For RTW, KA is probably best performed within the two years of paid sick leave before long-term disability is assessed in the Netherlands.

Efficacy of the mHealth-Based Exercise Intervention re.flex for Patients With Knee Osteoarthritis: Pilot Randomized Controlled Trial

BACKGROUND

Exercise therapy is recommended by international guidelines as a core treatment for patients with knee osteoarthritis. However, there is a significant gap between recommendations and practice in health care. Digital exercise apps are promising to help solve this undersupply.

OBJECTIVE

This study aims to evaluate the efficacy of a 12-week fully automated app-based exercise intervention with and without a supporting knee brace on health-related outcomes, performance measures, and adherence in patients with knee osteoarthritis.

METHODS

This closed user group trial included participants with moderate to severe unicondylar painful knee osteoarthritis. Randomization was 1:1:2 into an intervention group (IG) with 2 subgroups (app-based training [IG A] and app-based training and a supportive knee brace [IG AB]) and a control group (CG). The intervention included a 12-week home exercise program with 3 sessions per week. Instructions for the exercises were given via the app and monitored using 2 accelerometers placed below and above the affected knee joint. Participants in the CG did not receive any study intervention but were allowed to make use of usual care. Osteoarthritis-specific pain (Knee Injury and Osteoarthritis Outcome Score) was defined as the primary outcome, and secondary outcomes included all other Knee Injury and Osteoarthritis Outcome Score subscales, general health-related quality of life (Veterans RAND 12-item Health Survey), psychological measures (eg, exercise self-efficacy), performance measures (strength and postural control), and the monitoring of adherence and safety. Outcomes were assessed at baseline and after 12 weeks. Intervention effects were calculated using baseline-adjusted analysis of covariance for the joint comparison of IG A and IG AB versus the CG using a per-protocol approach. Subgroup analyses were conducted for each IG separately.

RESULTS

A total of 61 participants were included (IG: n=30, 49%; CG: n=31, 51%; male: n=31, 51%; female: n=30, 49%; mean age 62.9, SD 8.5 years; mean BMI 27.7, SD 4.5 kg/m2). Analysis revealed statistically significant effects in favor of the IG for pain reduction (P<.001; effect size [ES]=0.76), improvements in physical function (P<.001; ES=0.64), improvements in symptoms (P=.01; ES=0.53), improvements in sport and recreation activities (P=.02; ES=0.47), improvements in knee-related quality of life (P<.001; ES=0.76), and improvements in the physical component of general health-related quality of life (P<.001; ES=0.74). Mean differences ranged from 6.0 to 13.2 points (scale range 0-100). ESs indicated small to medium effects. No effects were found for psychological and performance measures. Participants adhered to 92.5% (899/972) of all scheduled exercise sessions.

CONCLUSIONS

Individuals with knee osteoarthritis undergoing a 12-week sensor-assisted app-based exercise intervention with or without an additional knee brace experienced clinically meaningful treatment effects regarding pain relief and improvements in physical function as well as other osteoarthritis-specific concerns compared to controls.

TRIAL REGISTRATION

German Clinical Trials Register (DRKS) DRKS00023269; https://drks.de/search/de/trial/DRKS00023269.

Association between intra-articular hyaluronic acid injections in delaying total knee arthroplasty and safety evaluation in primary knee osteoarthritis: analysis based on Health Insurance Review and Assessment Service (HIRA) claim database in Republic of Korea

BACKGROUND

The prevalence of knee osteoarthritis (KOA), a progressive degenerative disease, is gradually increasing, and it is a progressive degenerative disease. In patients with mild-to-moderate KOA, intra-articular hyaluronic acid (IA-HA) has been shown to be an effective non-operative treatment option that can provide significant pain relief and symptom improvement by increasing intra-articular viscoelasticity. This study aimed to evaluate the efficacy of IA-HA injections in delaying total knee arthroplasty (TKA) and the safety of IA-HA according to IA-HA type and combination with intra-articular corticosteroid (IA-CS) using a large health insurance claim database.

METHODS

For this retrospective cohort study, the study population included patients aged ≥ 50 years with a first diagnosis of KOA between 2009 and 2014, who underwent TKA by 2020, using the Health Insurance Review and Assessment Service claim database in Republic of Korea. IA-HA injections were categorized as single or multiple injection regimen agents. Cox proportional hazard models estimated hazard ratios (HR) for TKA risk, adjusted for covariates. Logistic regression assessed the occurrence of adverse events after IA-HA administration.

RESULTS

In all, 36,983 patients were included. Patients who received IA-HA injections had a significantly longer time to TKA compared to those who did not (mean delay of approximately 1 year). The IA-HA group had a significantly lower risk of TKA (HR: 0.61, 95% CI: 0.60-0.62) than non-IA-HA group after adjusting for covariates, which included age, sex, medical history, number of hospital beds, and CS injection. Single injection IA-HA regimen agents showed the longest time to TKA and lowest risk (HR: 0.56, 95% CI: 0.53-0.59). TKA risk decreased with the number of IA-HA cycles. Adverse events occurred in 6.7% of IA-HA cases without CS, with very low incidence of infection. Multiple injection regimen agents (multiple injection regimen 7.0% vs. single injection regimen 3.6%) and concurrent IA-CS use (concurrent IA-CS use 13.9% vs. IA-HA only 6.7%) were associated with higher infection risk.

CONCLUSION

IA-HA injections were associated with a significant delay in TKA among patients with KOA. Single-injection regimen agents had the lowest TKA risk. Infection risk increased with multiple injections and concurrent IA-CS use. These findings could suggest the use of IA-HA as an effective non-operative intervention option for managing KOA and delaying TKA. Careful selection of IA-HA type and consideration of concurrent IA-CS use could play a role in delaying the time to TKA and reducing complications.

Reliability of pre-resection ligament tension assessment in imageless robotic assisted total knee replacement

BACKGROUND

Ligament tension balance is a major determinant for the success of total knee replacement (TKR). The present study aimed at determining the inter-rater and intra-rater reliability in performing ligament tension assessment using an imageless robotic-assisted TKR.

METHODS

Twenty-four knees in 21 patients who received robotic-assisted TKR for end-stage varus osteoarthritis were examined. Three orthopedic specialists and six orthopedic trainees participated in the operations. Data from the ligament tension assessment were collected during the operations.

RESULTS

For the inter-rater reliability, "extension medial" and "flexion medial" had excellent reliability whilst "extension lateral" and "flexion lateral" had good-to-excellent reliability. For the intra-rater reliability, "extension medial" showed excellent reliability, "extension lateral" and "flexion medial" showed good-to-excellent reliability, and "flexion lateral" showed moderate-to-excellent reliability.

CONCLUSIONS

Robotic-assisted technology provides a reliable solution to improve ligament tension assessment. All ligament tension assessments with the use of the technology could demonstrate at least good-to-excellent reliability except for the intra-rater reliability of "flexion lateral".

The effect of intra-articular autologous protein solution on knee osteoarthritis symptoms

Aims

Knee osteoarthritis (OA) is characterized by a chronic inflammatory process involving multiple cytokine pathways, leading to articular cartilage degeneration. Intra-articular therapies using pharmaceutical or autologous anti-inflammatory factors offer potential non-surgical treatment options. Autologous protein solution (APS) is one such product that uses the patient's blood to produce a concentrate of cells and anti-inflammatory cytokines. This study evaluated the effect of a specific APS intra-articular injection (nSTRIDE) on patient-reported outcome measures compared to saline in moderate knee OA.

Methods

A parallel, double-blinded, placebo-controlled randomized controlled trial was conducted, where patients with unilateral moderate knee OA (Kellgren-Lawrence grade 2 or 3) received either nSTRIDE or saline (placebo) injection to their symptomatic knee. The primary outcome was the difference in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score at 12 months post-intervention. Secondary outcomes included WOMAC component scores, Knee injury and Osteoarthritis Outcome Score (KOOS), and visual analogue scale (VAS) scores at all follow-up timepoints (three, six, and 12 months).

Results

A total of 40 patients were analyzed (21 nSTRIDE; 19 saline) in the study. No significant difference was found between nSTRIDE and saline groups for WOMAC total score at 12 months (mean difference -10.4 (95% CI -24.4 to 3.6; p = 0.141). There were no significant differences in WOMAC or KOOS scores across all timepoints. VAS scores favoured the saline group for both rest and worst pain scales at 12 months post-injection (mean difference (worst) 12 months 21.5 (95% CI 6.2 to 36.8; p = 0.008); mean difference (rest) 12 months 17.8 (95% CI 2.2 to 33.4; p = 0.026)). There were no adverse events recorded in either study group.

Conclusion

Our study demonstrates no significant differences between nSTRIDE and saline groups in KOOS and WOMAC scores over time. Notably, APS injection resulted in significantly worse pain symptoms at 12 months compared to saline injection.

Effectiveness of a Single Intra-articular Injection of High-Molecular-Weight Hyaluronic Acid Versus NSAIDs on the Visual Analog Pain Scale and Western Ontario and McMaster Universities Osteoarthritis Index Scores in Patients With Knee Osteoarthritis

OBJECTIVE

This study aimed to determine the effectiveness of a single intra-articular injection of high-molecular-weight (HMW) hyaluronic acid (HA) at a dose of 4 mL/60 mg to reduce pain in people with knee osteoarthritis (OA) over 12 months.

METHODOLOGY

This retrospective study was conducted after obtaining ethical approval from Dhaka Medical College and Hospital, Bangladesh. From July 2020 to June 2021, a medical professional conducted the investigation. The investigation encompassed patients aged 40 to 70 hospitalized at our facility and diagnosed with Grade 2 or Grade 3 knee OA according to the Kellgren-Lawrence grading method. We divided the patients into two categories based on the treatments they received. Patients in Group A received a single injection of HMW HA (60 mg/4 mL) into the joint, along with instructions on activities of daily living, exercise, and painkillers. Group B patients received conservative therapy, which involved the use of nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, therapeutic exercises, and a knee brace during physical activity.

RESULTS

This study compared the efficacy of a single injection of HMW HA in the joint versus NSAIDs for managing OA-related symptoms over 12 weeks. The HA group initially scored similarly to the comparison group. By week three, however, the group receiving HA had considerably higher Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores (p=0.019). This pattern continued through weeks 6 (p=0.044), 9 (p=0.016), and 12 (p<0.001). Similarly, by week 3 (p=0.029), the visual analog scale (VAS) scores, which were initially identical (p=0.120), demonstrated a significant preference for HA, and this preference persisted through weeks 6, 9, and 12 (all p<0.001). The results show that by the third week, HA is more effective than NSAIDs at relieving pain and improving symptoms.

CONCLUSION

The study's results indicated that over 12 weeks, the use of HMW HA led to statistically significant reductions in pain intensity, as measured by the VAS. Furthermore, HMW HA demonstrated a more significant improvement in WOMAC ratings, which assess physical function, stiffness, and pain, compared to NSAIDs. The findings suggest that administering HMW HA injections can significantly reduce symptoms and improve functionality in individuals with knee OA.

Saccharomyces boulardii improves clinical and paraclinical indices in overweight/obese knee osteoarthritis patients: a randomized triple-blind placebo-controlled trial

PURPOSE

This study aimed to determine the effect of the probiotic Saccharomyces boulardii (S. boulardii) in patients with knee osteoarthritis (KOA).

METHODS

In this study, 70 patients with KOA were recruited via outpatient clinics between 2020 and 2021 and randomly assigned to receive probiotics or placebo supplements for 12 weeks. The primary outcome was a change in pain intensity according to the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score.

RESULTS

Sixty-three patients completed the trial. A linear mixed analysis of covariance (ANCOVA) model analysis showed that probiotic was better than placebo in decreasing the pain intensity measured by visual analogue scale (VAS) [-2.11 (-2.59, -1.62) in probiotic group and -0.90 (-1.32, -0.48) in placebo group, p = 0.002] and WOMAC pain score [-3.57 (-4.66, -2.49) in probiotic group and -1.43 (-2.33, -0.53) in placebo group, p < 0.001]. The daily intake of acetaminophen for pain management significantly decreased in the probiotic group [-267.18 (-400.47, -133.89) mg, p < 0.001] that was significantly better than placebo (p = 0.006). Probiotic significantly decreased the serum levels of high-sensitivity C-reactive protein (hs-CRP) inflammatory index [-2.72 (-3.24, -2.20) µg/ml] and malondialdehyde (MDA) oxidative stress index [-1.61 (-2.11, -1.11) nmol/ml] compared to the placebo (p = 0.002 and p < 0.001, respectively). Probiotic was better than placebo in increasing the scores of role disorder due to physical health (p = 0.023), pain (p = 0.048) and physical health (p = 0.031).

CONCLUSION

Probiotic S. boulardii supplementation in patients with KOA significantly improved pain intensity, some dimensions of QoL, and inflammatory and oxidative stress biomarkers with no severe side effects.

TRIAL REGISTRY

Registered on the Iranian clinical trial website ( http://www.irct.ir : IRCT20161022030424N4) on 2019-09-02.

Experiences of Working with Lower Limb Osteoarthritis: A Qualitative Study

PURPOSE

Pain and disability associated with lower limb osteoarthritis (OA) may contribute to difficulties at work. This study aimed to understand the perspectives of workers with lower limb OA on difficulties, concerns, and coping strategies used at work.

METHODS

Twenty-two individuals with lower limb OA who were working in paid employment participated in semi-structured interviews. Data were qualitatively analyzed using an inductive thematic approach. Codes were identified and refined through review of interview transcripts and discussion with the research team.

RESULTS

Six themes were identified in relation to experiences working with lower limb OA. Themes were as follows: weight-bearing physical demands are challenging; lower limb OA can affect work performance; emotional consequences of pain; concerns about work in the future; positive experiences of supportive colleagues and managers; and minimal effects on sedentary work. Three themes were identified relating to strategies to manage at work: adjustments at work help manage pain and avoid exacerbations; regular strategies to manage pain; and healthcare professionals are consulted, but usually not specifically for work.

CONCLUSIONS

Workers with lower limb OA experience physical and emotional difficulties at work that can impact work performance. Workers are concerned about longevity and job security and use a range of strategies to manage symptoms and remain at work. Employers, employees, and healthcare professionals may need to work together to create workplace accommodations to help workers with lower limb OA confidently remain in work.

Hypothyroidism Impacts Clinical and Healthcare Utilization Outcomes After Primary Total Hip Arthroplasty

BACKGROUND

Our objective was to assess the association of hypothyroidism with outcomes of primary total hip arthroplasty (THA) overall and stratified by underlying diagnosis.

METHODS

We identified patients undergoing primary THA in a national database from 2016 to 2020. We stratified them based on primary diagnoses into hip osteoarthritis (OA; N = 1,761,960), osteonecrosis (ON; N = 78,275), traumatic fracture (N = 532,910), inflammatory arthritis (IA; N = 3,520), and "other" (N = 90,550). We identified hypothyroidism and complications using secondary diagnoses. Among 2,467,215 patients undergoing primary THA, mean age was 68 years (range, 18 to 90), and 58.3% were women. Complications codes only included initial encounters. We performed time-trends analyses and multivariable-adjusted regression analyses adjusted for demographics, expected primary payer, a comorbidity score, elective versus non-elective admission, and hospital characteristic information, with clinical and healthcare utilization outcome as endpoints.

RESULTS

Overall, hypothyroidism was significantly associated with increased LOS, total charges, non-routine discharges, blood transfusions, and prosthetic fractures. In the OA cohort, hypothyroidism was associated with increased LOS, total charges, and non-routine discharges (P < .001 for each), and blood transfusions (P = .02). Hypothyroidism was associated with increased total charges (P = .001) in the ON cohort and with increased LOS, non-routine discharge, and blood transfusion (P < .05 each) in the traumatic fracture cohort.

CONCLUSIONS

Hypothyroidism was associated with blood transfusions, prosthetic fractures, and utilization outcomes in THA patients. Tailored intervention strategies for hypothyroidism should be tested for their efficacy to improve THA peri-operative outcomes.

People with painful knee osteoarthritis hold negative implicit attitudes towards activity

ABSTRACT

Negative attitudes/beliefs surrounding osteoarthritis, pain, and activity contribute to reduced physical activity in people with knee osteoarthritis (KOA). These attitudes/beliefs are assessed using self-report questionnaires, relying on information one is consciously aware of and willing to disclose. Automatic (ie, implicit) assessment of attitudes does not rely on conscious reflection and may identify features unique from self-report. We developed an implicit association test that explored associations between images of a person moving/twisting their knee (activity) or sitting/standing (rest), and perceived threat (safe vs dangerous). We hypothesised that people with KOA would have greater implicit threat-activity associations (vs pain-free and non-knee pain controls), with implicit attitudes only weakly correlating with self-reported measures (pain knowledge, osteoarthritis/pain/activity beliefs, fear of movement). Participants (n = 558) completed an online survey: 223 had painful KOA (n = 157 female, 64.5 ± 8.9 years); 207 were pain free (n = 157 female, 49.3 ± 15.3 years); and 99 had non-KOA lower limb pain (n = 74 female, 47.5 ± 15.04 years). An implicit association between "danger" and "activity" was present in those with and without limb pain (KOA: 0.36, 95% CI 0.28-0.44; pain free: 0.13, 95% CI 0.04-0.22; non-KOA lower limb pain 0.11, 95% CI -0.03 to 0.24) but was significantly greater in the KOA group than in the pain free ( P < 0.001) and non-KOA lower limb pain ( P = 0.004) groups. Correlations between implicit and self-reported measures were nonsignificant or weak (rho = -0.29 to 0.19, P < 0.001 to P = 0.767). People with painful KOA hold heightened implicit threat-activity associations, capturing information unique to that from self-report questionnaires. Evaluating links between implicit threat-activity associations and real-world behaviour, including physical activity levels, is warranted.