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Rougereau G, Villard A, Langlais T, Delord M, Boisrenoult P, Pujol N. Femoral condyle bone mineral density in osteoarthritis differs significantly between knees with valgus vs. varus deformity. Orthop Traumatol Surg Res 2023; 109:103584. [PMID: 36889579 DOI: 10.1016/j.otsr.2023.103584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 04/28/2022] [Accepted: 06/24/2022] [Indexed: 03/08/2023]
Abstract
BACKGROUND The objective of this study was to measure bone mineral density (BMD) of the cancellous bone in both femoral condyles and to compare the results according to the hip-knee-ankle (HKA) angle in patients with knee osteoarthritis. HYPOTHESIS BMD of cancellous bone in the medial condyle is markedly lower in valgus knees compared to that in the lateral condyle in varus knees. METHODS Consecutive patients with computed tomography (CT) of the knee and long-leg radiographs obtained in preparation for total knee arthroplasty were included. The 189 knees were divided into five groups based on whether the hip-knee-ankle angle was<170° (major varus deformity), 171°-177° (varus deformity), 178°-182° (normal alignment), 183°-189° (valgus deformity), and>190° (major valgus deformity). A protocol for CT measurement of BMD values at the femoral condyles was developed. Correlations between the HKA angle and BMD were assessed using the ratio of medial-to-lateral condyle BMD values (M/L). RESULTS M/L was lower for knees with valgus deformity than for normally aligned knees (0.7 vs. 1, p<0.001). This difference was larger in the group with major valgus deformity, with a mean M/L value of 0.5 (p<0.001). M/L was higher for knees with major varus (mean, 1.2; p=0.035). The correlation coefficients showed excellent intra-observer and inter-observer agreement for the BMD measurements. CONCLUSION The BMD values of the femoral condyles correlate with the HKA angle. BMD is lower at the medial femoral condyle of valgus knees, particularly when the deformity exceeds 10°. This finding may deserve consideration when planning total knee arthroplasty. LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
- Grégoire Rougereau
- Service de chirurgie orthopédique, centre hospitalier de Versailles, Le Chesnay, France.
| | - Alexandra Villard
- Service de chirurgie orthopédique, centre hospitalier de Versailles, Le Chesnay, France
| | - Tristan Langlais
- Service de chirurgie orthopédique pédiatrique, hôpital des enfants, Purpan, université de Toulouse, Toulouse, France
| | - Marc Delord
- Département de recherche clinique, centre hospitalier de Versailles, université Île-de-France Ouest, 177, rue de Versailles, 78150 Le Chesnay, France
| | - Philippe Boisrenoult
- Service de chirurgie orthopédique, centre hospitalier de Versailles, Le Chesnay, France
| | - Nicolas Pujol
- Service de chirurgie orthopédique, centre hospitalier de Versailles, Le Chesnay, France
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Cai G, Otahal P, Cicuttini F, Wu F, Munugoda IP, Jones G, Aitken D. The association of subchondral and systemic bone mineral density with osteoarthritis-related joint replacements in older adults. Osteoarthritis Cartilage 2020; 28:438-445. [PMID: 32119971 DOI: 10.1016/j.joca.2020.02.832] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 02/12/2020] [Accepted: 02/18/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe the association of subchondral and systemic bone mineral density (BMD) with knee and hip replacements (KR and HR, respectively) due to osteoarthritis. DESIGN 1,095 participants (mean age 63 years, 51% female) were included. At baseline, subchondral BMD of the medial and lateral tibia in three regions of interest (ROI) for the right knee, and systemic BMD of the lumbar spine, femoral neck, total hip and whole-body, were measured using dual-energy X-ray absorptiometry. Subchondral BMD of the hip was not measured. Competing risk regression models were used to estimate sub-distribution hazard ratios (SHRs) of KR/HR per one standard deviation (SD) higher in BMD measures, with adjustment of potential confounders. RESULTS Over 12.2 years, 79 (7.2%) participants underwent a KR and 56 (5.1%) an HR due to osteoarthritis. For the right side, medial subchondral BMD in ROI-3 was associated with an increased risk of KR (SHR 1.95 per SD; 95% Confidence Interval [CI], 1.57 to 2.43). In contrast, systemic BMD was not associated with the risk of KR, but higher BMD at the lumbar spine (1.42, 1.07 to 1.88) and whole-body (1.29, 1.00 to 1.66) were associated with an increased risk of HR at both sides. CONCLUSIONS Subchondral BMD is positively associated with an increased risk of KR and systemic BMD with an increased risk of HR, suggesting a role of BMD in the progression of osteoarthritis.
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Affiliation(s)
- G Cai
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
| | - P Otahal
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
| | - F Cicuttini
- Department of Epidemiology and Preventive Medicine, Monash University Medical School, Melbourne, Victoria, Australia.
| | - F Wu
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
| | - I P Munugoda
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
| | - G Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
| | - D Aitken
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
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Burnett WD, Kontulainen SA, McLennan CE, Hazel D, Talmo C, Wilson DR, Hunter DJ, Johnston JD. Knee osteoarthritis patients with more subchondral cysts have altered tibial subchondral bone mineral density. BMC Musculoskelet Disord 2019; 20:14. [PMID: 30611224 PMCID: PMC6320646 DOI: 10.1186/s12891-018-2388-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 12/19/2018] [Indexed: 11/10/2022] Open
Abstract
Background Subchondral bone cysts are a widely observed, but poorly understood, feature in patients with knee osteoarthritis (OA). Clinical quantitative computed tomography (QCT) has the potential to characterize cysts in vivo but it is unclear which specific cyst parameters (e.g., number, size) are associated with clinical signs of OA, such as disease severity or pain. The objective of this study was to use QCT-based image-processing techniques to characterize subchondral tibial cysts in patients with knee OA and to explore relationships between proximal tibial subchondral cyst parameters and subchondral bone density as well as clinical characteristics of OA (alignment, joint space narrowing (JSN), OA severity, pain) in patients with knee OA. Methods The preoperative knee of 42 knee arthroplasty patients was scanned using QCT. Patient characteristics were obtained, including OA severity, knee pain, JSN, and alignment. We used 3D image processing techniques to obtain cyst parameters including: cyst number, cyst number per proximal tibial volume, cyst volume per proximal tibial volume, as well as maximum and average cyst volume across the proximal tibia, as well as regional bone mineral density (BMD) excluding cysts. We used Spearman’s correlation coefficients to explore associations between patient characteristics and cyst parameters. Results At both the medial and lateral compartments of the proximal tibia, greater cyst number and volume were associated with higher BMD. At the lateral region, cyst number and volume were also associated with lateral OA severity, lateral JSN, alignment and sex. Pain was not associated with any cyst parameters at any region. Conclusion Cyst number and volume were associated with BMD at both the medial and lateral compartments. Lateral cyst number and volume were also associated with joint alignment, OA severity, JSN and sex. This is the first study to use clinical QCT to explore subchondral tibial cysts in patients with knee OA and provides further evidence of the relationships between subchondral cysts and clinical OA characteristics. Electronic supplementary material The online version of this article (10.1186/s12891-018-2388-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | - Diane Hazel
- New England Baptist Hospital, Boston, MA, USA
| | - Carl Talmo
- New England Baptist Hospital, Boston, MA, USA
| | | | | | - James D Johnston
- Department of Mechanical Engineering, University of Saskatchewan, 57 Campus Dr, Saskatoon, SK, S7N 1G9, Canada.
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Burnett WD, Kontulainen SA, McLennan CE, Hazel D, Talmo C, Wilson DR, Hunter DJ, Johnston JD. Proximal tibial trabecular bone mineral density is related to pain in patients with osteoarthritis. Arthritis Res Ther 2017; 19:200. [PMID: 28899428 PMCID: PMC5596910 DOI: 10.1186/s13075-017-1415-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 09/04/2017] [Indexed: 11/10/2022] Open
Abstract
Background Our objective was to examine the relationships between proximal tibial trabecular (epiphyseal and metaphyseal) bone mineral density (BMD) and osteoarthritis (OA)-related pain in patients with severe knee OA. Methods The knee was scanned preoperatively using quantitative computed tomography (QCT) in 42 patients undergoing knee arthroplasty. OA severity was classified using radiographic Kellgren-Lawrence scoring and pain was measured using the pain subsection of the Western Ontario and McMaster Universities Arthritis Index (WOMAC). We used three-dimensional image processing techniques to assess tibial epiphyseal trabecular BMD between the epiphyseal line and 7.5 mm from the subchondral surface and tibial metaphyseal trabecular BMD 10 mm distal from the epiphyseal line. Regional analysis included the total epiphyseal and metaphyseal region, and the medial and lateral epiphyseal compartments. The association between total WOMAC pain scores and BMD measurements was assessed using hierarchical multiple regression with age, sex, and body mass index (BMI) as covariates. Statistical significance was set at p < 0.05. Results Total WOMAC pain was associated with total epiphyseal BMD adjusted for age, sex, and BMI (p = 0.013) and total metaphyseal BMD (p = 0.017). Regionally, total WOMAC pain was associated with medial epiphyseal BMD adjusted for age, sex, and BMI (p = 0.006). Conclusion These findings suggest that low proximal tibial trabecular BMD may have a role in OA-related pain pathogenesis. Electronic supplementary material The online version of this article (doi:10.1186/s13075-017-1415-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wadena D Burnett
- University of Saskatchewan, 57 Campus Drive, Saskatoon, SK, S7N 5A9, Canada
| | | | | | - Diane Hazel
- New England Baptist Hospital, Boston, MA, USA
| | - Carl Talmo
- New England Baptist Hospital, Boston, MA, USA
| | | | | | - James D Johnston
- University of Saskatchewan, 57 Campus Drive, Saskatoon, SK, S7N 5A9, Canada.
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Sun Y, Scannell BP, Honeycutt PR, Mauerhan DR, H JN, Hanley EN. Cartilage Degeneration, Subchondral Mineral and Meniscal Mineral Densities in Hartley and Strain 13 Guinea Pigs. Open Rheumatol J 2015; 9:65-70. [PMID: 26401159 PMCID: PMC4578142 DOI: 10.2174/1874312901409010065] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 06/01/2015] [Accepted: 06/19/2015] [Indexed: 02/06/2023] Open
Abstract
Osteoarthritis is a joint disease involved in articular cartilage, subchondral bone, meniscus and synovial membrane. This study sought to examine cartilage degeneration, subchondral bone mineral density (BMD) and meniscal mineral density (MD) in male Hartley, female Hartley and female strain 13 guinea pigs to determine the association of cartilage degeneration with subchondral BMD and meniscal MD. Cartilage degeneration, subchondral BMD and meniscal MD in 12 months old guinea pigs were examined with histochemistry, X-ray densitometry and calcium analysis. We found that male Hartley guinea pigs had more severe cartilage degeneration, subchondral BMD and meniscal MD than female Hartley guinea pigs, but not female strain 13 guinea pigs. Female strain 13 guinea pigs had more severe cartilage degeneration and higher subchondral BMD, but not meniscal MD, than female Hartley guinea pigs. These findings indicate that higher subchondral BMD, not meniscal MD, is associated with more severe cartilage degeneration in the guinea pigs and suggest that abnormal subchondral BMD may be a therapeutic target for OA treatment. These findings also indicate that the pathogenesis of OA in the male guinea pigs and female guinea pigs are different. Female strain 13 guinea pig may be used to study female gender-specific pathogenesis of OA.
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Affiliation(s)
- Yubo Sun
- Department of Orthopedic Surgery, Cannon Research, Carolinas Medical Center, PO Box 32861, Charlotte, NC 28232, USA
| | - Brian P Scannell
- Department of Orthopedic Surgery, Cannon Research, Carolinas Medical Center, PO Box 32861, Charlotte, NC 28232, USA
| | - Patrick R Honeycutt
- Department of Orthopedic Surgery, Cannon Research, Carolinas Medical Center, PO Box 32861, Charlotte, NC 28232, USA
| | - David R Mauerhan
- Department of Orthopedic Surgery, Cannon Research, Carolinas Medical Center, PO Box 32861, Charlotte, NC 28232, USA
| | - James Norton H
- Dickson Advanced Analytics Group, Carolinas Medical Center, PO Box 32861, Charlotte, NC 28232, USA
| | - Edward N Hanley
- Department of Orthopedic Surgery, Cannon Research, Carolinas Medical Center, PO Box 32861, Charlotte, NC 28232, USA
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Burnett WD, Kontulainen SA, McLennan CE, Hazel D, Talmo C, Hunter DJ, Wilson DR, Johnston JD. Knee osteoarthritis patients with severe nocturnal pain have altered proximal tibial subchondral bone mineral density. Osteoarthritis Cartilage 2015; 23:1483-90. [PMID: 25907860 DOI: 10.1016/j.joca.2015.04.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 02/07/2015] [Accepted: 04/14/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Our objective was to investigate relationships between proximal tibial subchondral bone mineral density (BMD) and nocturnal pain in patients with knee osteoarthritis (OA). METHODS The preoperative knee of 42 patients booked for knee arthroplasty was scanned using quantitative computed tomography (QCT). Pain was measured using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and participants were categorized into three groups: 'no pain', 'moderate pain', and 'severe pain' while lying down at night. We used depth-specific image processing to assess tibial subchondral BMD at normalized depths of 0-2.5 mm, 2.5-5.0 mm and 5-10 mm relative to the subchondral surface. Regional analyses of each medial and lateral plateau included total BMD and maximum BMD within a 10 mm diameter core or 'focal spot'. The association between WOMAC pain scores and BMD measurements was assessed using Spearman's rank correlation. Regional BMD was compared pairwise between pain and no pain groups using multivariate analysis of covariance using age, sex, and BMI as covariates and Bonferroni adjustment for multiple comparisons. RESULTS Lateral focal BMD at the 2.5-5 mm depth was related to nocturnal pain (ρ = 0.388, P = 0.011). The lateral focal BMD was 33% higher in participants with 'severe pain' than participants with 'no pain' at 2.5-5 mm depth (P = 0.028) and 32% higher at 5-10 mm depth (P = 0.049). There were no BMD differences at 0-2.5 mm from the subchondral surface. CONCLUSION This study suggests that local subchondral bone density may have a role in elucidating OA-related pain pathogenesis.
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Affiliation(s)
- W D Burnett
- Division of Biomedical Engineering, University of Saskatchewan, Saskatoon, SK, Canada
| | - S A Kontulainen
- Division of Biomedical Engineering, University of Saskatchewan, Saskatoon, SK, Canada; College of Kinesiology, University of Saskatchewan, Saskatoon, SK, Canada
| | - C E McLennan
- Division of Research, New England Baptist Hospital, Boston, MA, USA
| | - D Hazel
- Division of Research, New England Baptist Hospital, Boston, MA, USA
| | - C Talmo
- Division of Research, New England Baptist Hospital, Boston, MA, USA
| | - D J Hunter
- Institute of Bone and Joint Research, University of Sydney, Sydney, NSW, Australia
| | - D R Wilson
- Department of Orthopaedics and Centre for Hip Health and Mobility, University of British Columbia and Vancouver Costal Health Research Institute, Vancouver, BC, Canada
| | - J D Johnston
- Division of Biomedical Engineering, University of Saskatchewan, Saskatoon, SK, Canada; Department of Mechanical Engineering, University of Saskatchewan, SK, Canada.
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Sepriano A, Roman-Blas JA, Little RD, Pimentel-Santos F, Arribas JM, Largo R, Branco JC, Herrero-Beaumont G. DXA in the assessment of subchondral bone mineral density in knee osteoarthritis--A semi-standardized protocol after systematic review. Semin Arthritis Rheum 2015; 45:275-83. [PMID: 26188773 DOI: 10.1016/j.semarthrit.2015.06.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 05/16/2015] [Accepted: 06/12/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Subchondral bone mineral density (sBMD) contributes to the initiation and progression of knee osteoarthritis (OA). Reliable methods to assess sBMD status may predict the response of specific OA phenotypes to targeted therapies. While dual-energy X-ray absorptiometry (DXA) of the knee can determine sBMD, no consensus exists regarding its methodology. OBJECTIVE Construct a semi-standardized protocol for knee DXA to measure sBMD in patients with OA of the knee by evaluating the varying methodologies present in existing literature. METHODS We performed a systematic review of original papers published in PubMed and Web of Science from their inception to July 2014 using the following search terms: subchondral bone, osteoarthritis, and bone mineral density. RESULTS DXA of the knee can be performed with similar reproducibility values to those proposed by the International Society for Clinical Densitometry for the hip and spine. We identified acquisition view, hip rotation, knee positioning and stabilization, ROI location and definition, and the type of analysis software as important sources of variation. A proposed knee DXA protocol was constructed taking into consideration the results of the review. CONCLUSIONS DXA of the knee can be reliably performed in patients with knee OA. Nevertheless, we found substantial methodological variation across previous studies. Methodological standardization may provide a foundation from which to establish DXA of the knee as a valid tool for identification of SB changes and as an outcome measure in clinical trials of disease modifying osteoarthritic drugs.
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Affiliation(s)
- Alexandre Sepriano
- Rheumatology Department, CHLO-Hospital Egas Moniz, Lisbon, Portugal; Chronic Diseases Study Center (CEDOC), NOVA Medical School, UNL, Lisbon, Portugal
| | - Jorge A Roman-Blas
- Bone and Joint Research Unit, IIS Fundación Jiménez Díaz, Universidad Autónoma, Av. Reyes Católicos 2, 28040 Madrid, Spain
| | - Robert D Little
- Bone and Joint Research Unit, IIS Fundación Jiménez Díaz, Universidad Autónoma, Av. Reyes Católicos 2, 28040 Madrid, Spain; Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia
| | - Fernando Pimentel-Santos
- Rheumatology Department, CHLO-Hospital Egas Moniz, Lisbon, Portugal; Chronic Diseases Study Center (CEDOC), NOVA Medical School, UNL, Lisbon, Portugal
| | - Jose María Arribas
- Bone and Joint Research Unit, IIS Fundación Jiménez Díaz, Universidad Autónoma, Av. Reyes Católicos 2, 28040 Madrid, Spain
| | - Raquel Largo
- Bone and Joint Research Unit, IIS Fundación Jiménez Díaz, Universidad Autónoma, Av. Reyes Católicos 2, 28040 Madrid, Spain
| | - Jaime C Branco
- Rheumatology Department, CHLO-Hospital Egas Moniz, Lisbon, Portugal; Chronic Diseases Study Center (CEDOC), NOVA Medical School, UNL, Lisbon, Portugal
| | - Gabriel Herrero-Beaumont
- Bone and Joint Research Unit, IIS Fundación Jiménez Díaz, Universidad Autónoma, Av. Reyes Católicos 2, 28040 Madrid, Spain.
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Boudenot A, Pallu S, Toumi H, Loiseau Peres S, Dolleans E, Lespessailles E. Tibial subchondral bone mineral density: sources of variability and reproducibility. Osteoarthritis Cartilage 2013; 21:1586-94. [PMID: 23887081 DOI: 10.1016/j.joca.2013.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 07/04/2013] [Accepted: 07/13/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVES It has been shown that subchondral bone mineral density (sBMD) measurement may be a relevant parameter of osteoarthritis (OA) progression. However, factors implicating the reproducibility and contributing to the variability of the measurement have not been fully described. Thus, the aim of this study was to explore the reproducibility of sBMD by Dual energy X-ray Absorptiometry (DXA) and to further examine its sources of variability. METHODS In this study, short-term, intra and inter-observer reproducibility of sBMD was examined on knee images obtained on DXA scans. The influence of software (lumbar spine and forearm modes), knee positioning (flexion or extension), site and size of regions of interest (ROI) and use of rice, on both lateral and medial tibial sBMD, were assessed. Root mean square coefficient of variation (RMS CV) and least significant changes (LSC) were calculated. RESULTS The short-term precision of sBMD ranged between 2.24% and 5.12% for RMS CV and between 0.053 and 0.135 g/cm(2) for LSC. Good intra-observer precision was found for knee flexion conditions whatever the software used (RMS CV ranging from 0.43 to 1.41%). The reproducibility was dependant from the ROI size (the ROI including joint space exhibiting better precision results than ROI including solely the subchondral plate). For a constant size of the ROI, the precision results were site-dependant. Inter-observer RMS CV results ranged from 0.59 to 5.01% according to ROI and software used. For the specific task of monitoring medial sBMD in the ROI including solely subchondral plate, forearm flexion condition produced the highest intra-observer and short-term precision (respectively RMS CV: 0.45% and 2.77%; LSC: 0.013 and 0.080 g/cm(2)). CONCLUSION Taking account into the excellent precision of the sBMD measurements expressed as RMS CV with the protocol proposed in the present study, clinical application of these measurements might be envisaged.
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Affiliation(s)
- A Boudenot
- EA 4708, Imagerie Multimodale, Multiéchelles et Modélisation du Tissu Osseux et articulaire (I3MTO), Université d'Orléans, Orléans, France.
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9
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Cao Y, Stannus OP, Aitken D, Cicuttini F, Antony B, Jones G, Ding C. Cross-sectional and longitudinal associations between systemic, subchondral bone mineral density and knee cartilage thickness in older adults with or without radiographic osteoarthritis. Ann Rheum Dis 2013; 73:2003-9. [PMID: 23904471 DOI: 10.1136/annrheumdis-2013-203691] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To investigate cross-sectional and longitudinal associations between systemic bone mineral density (BMD), subchondral BMD (sBMD) and knee cartilage thickness in older adults with or without radiographic osteoarthritis (ROA). METHODS A prospective cohort of 158 randomly selected subjects (mean 63 years, 48% women) including 69 non-ROA and 89 ROA subjects were studied at baseline and 2.7 years later. Knee cartilage thickness was semi-automatically determined from T1-weighted fat-suppressed MRI. Knee cartilage volume was measured from MRI. Systemic BMD and sBMD were measured by dual-energy X-ray absorptiometry (DXA). RESULTS Cross-sectionally, total body, total hip, spine BMD and/or lateral tibial sBMD were significantly and positively associated with femoral, lateral tibial and/or patellar cartilage thickness in subjects with ROA after adjustment for potential confounders. Longitudinally, a high total body BMD was associated with an increase in femoral cartilage thickness (β: 0.33 mm/g/cm(2), 95% CI 0.13 to 0.53); a high spine BMD was associated with increases in femoral and lateral tibial cartilage thickness (β: 0.25 mm/g/cm(2), 95% CI 0.10 to 0.41; and β: 0.18 mm/g/cm(2), 95% CI: 0.01 to 0.34, respectively) and a high medial tibial sBMD was associated with an increase in medial tibial cartilage thickness (β: 0.45 mm/g/cm(2), 95% CI 0.02 to 0.89) in subjects with ROA. In contrast, there were no significant associations between baseline systemic BMD, sBMD and cartilage volume loss, nor were there associations between BMD and cartilage thickness in subjects without ROA. CONCLUSIONS Both systemic and subchondral BMD are positively associated with increased cartilage thickness in subjects with ROA, suggesting BMD may play a protective role against cartilage loss in knee OA.
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Affiliation(s)
- Yuelong Cao
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia Research Institute of Orthopaedics, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Oliver P Stannus
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia
| | - Dawn Aitken
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia
| | - Flavia Cicuttini
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Benny Antony
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia
| | - Graeme Jones
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia
| | - Changhai Ding
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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10
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Lespessailles E, Jennane R. Assessment of bone mineral density and radiographic texture analysis at the tibial subchondral bone. Osteoporos Int 2012. [PMID: 23179572 DOI: 10.1007/s00198-012-2167-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Microstructural changes of subchondral bone constitute one of the figures characterising osteoarthritis on a structural level. Subchondral bone mineral density may reflect the complex relationship between bone and cartilage submitted to movement and loading. In this review, the authors discussed the interest of tibial subchondral bone mineral density assessment in the perspective of its diagnostic, etiopathogenic and prognostic value in osteoarthritis. In addition, the sources of variability linked to the measurement of tibial subchondral bone mineral density are precised. Trabecular bone structure characterisation by radiographic texture analyses may also represent a new promising tool to evaluate the microarchitectural changes that occur with initiation and progression of osteoarthritis. In this paper, the authors also highlighted the interest of different radiographic texture analyses and their clinical relevance in the field of osteoarthritis.
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Affiliation(s)
- E Lespessailles
- IPROS - EA 4708 I3MTO, University of Orleans, Orléans, France.
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Zerfass P, Lowitz T, Museyko O, Bousson V, Laouisset L, Kalender WA, Laredo JD, Engelke K. An Integrated Segmentation and Analysis Approach for QCT of the Knee to Determine Subchondral Bone Mineral Density and Texture. IEEE Trans Biomed Eng 2012; 59:2449-58. [DOI: 10.1109/tbme.2012.2202660] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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12
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McCoy SY, Falgowski KA, Srinivasan PP, Thompson WR, Selva EM, Kirn-Safran CB. Serum xylosyltransferase 1 level increases during early posttraumatic osteoarthritis in mice with high bone forming potential. Bone 2012; 51:224-31. [PMID: 22146554 PMCID: PMC3319505 DOI: 10.1016/j.bone.2011.11.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2011] [Revised: 11/06/2011] [Accepted: 11/15/2011] [Indexed: 11/28/2022]
Abstract
Increased proteoglycan (PG) synthesis is essential for the stimulation of cartilage repair processes that take place during the reversible phase of osteoarthritis (OA). In articular cartilage, xylosyltransferase 1 (Xylt1) is the key enzyme that initiates glycosaminoglycan (GAG) chain synthesis by transferring the first sugar residue to the PG core protein. Biological activity of PGs is closely linked to GAG biosynthesis since their polyanionic nature directly contributes to the proper hydration and elastic properties of the cartilage tissue present at the articular interface. The aim of this study was to investigate whether variations in the level of Xylt1 present in serum can be used to predict OA disease progression. The influence of bone forming activity on the systemic release of this enzyme was addressed by experimentally-inducing OA in mice of two different genetic backgrounds that were previously characterized for their distinct bone metabolism: C57BL/6J (B6, high bone remodelers) or C3H/HeJ (C3H, high bone formers). Serum was collected after medial meniscectomy or sham surgeries in young adult mice of these two strains over a period of 3.5months at which point knee histopathology was assessed. A significant increase in serum Xylt1 levels observed shortly after meniscectomy positively correlated with severe cartilage damage evaluated by histological assessment at later time points in mice of the C3H background. In contrast, no temporal regulation of Xylt1 level was found between meniscectomies and control surgeries in B6 mice, which developed OA at a slower rate. Additionally, longitudinal evaluation of the serum levels of other markers of cartilage/bone metabolism (C1,2C, osteocalcin) did not reveal any association with late knee damages. Our results strongly support the idea that serum Xylt1 has a clinical value for monitoring risk of OA progression in young adults with high bone forming potential. Ultimately, the understanding of posttraumatic mechanisms regulating PG synthesis and their modification by GAG will be essential so that interventions that stimulate cartilage regrowth can be undertaken prior to irreversible destruction of the joint tissue. This article is part of a Special Issue entitled "Osteoarthritis".
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Affiliation(s)
- Sarah Y. McCoy
- University of Delaware, Department of Biological Sciences, Newark, DE
| | | | | | | | - Erica M. Selva
- University of Delaware, Department of Biological Sciences, Newark, DE
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McNulty MA, Loeser RF, Davey C, Callahan MF, Ferguson CM, Carlson CS. A Comprehensive Histological Assessment of Osteoarthritis Lesions in Mice. Cartilage 2011; 2:354-63. [PMID: 26069594 PMCID: PMC4297143 DOI: 10.1177/1947603511402665] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Accurate histological assessment of osteoarthritis (OA) is critical in studies evaluating the effects of interventions on disease severity. The purpose of the present study was to develop a histological grading scheme that comprehensively and quantitatively assesses changes in multiple tissues that are associated with OA of the stifle joint in mice. DESIGN Two representative midcoronal sections from 158 stifle joints, including naturally occurring and surgically induced OA, were stained with H&E and Safranin-O stains. All slides were evaluated to characterize the changes present. A grading scheme that includes both measurements and semiquantitative scores was developed, and principal components analysis (PCA) was applied to the resulting data from the medial tibial plateaus. A subset of 30 tibial plateaus representing a wide range of severity was then evaluated by 4 observers. Reliability of the results was evaluated using intraclass correlation coefficients (ICCs) and area under the receiver operating characteristic (ROC) curve. RESULTS Five factors were retained by PCA, accounting for 74% of the total variance. Interobserver and intraobserver reproducibilities for evaluations of articular cartilage and subchondral bone were acceptable. The articular cartilage integrity and chondrocyte viability factor scores were able to distinguish severe OA from normal, minimal, mild, and moderate disease. CONCLUSION This newly developed grading scheme and resulting factors characterize a range of joint changes in mouse stifle joints that are associated with OA. Overall, the newly developed scheme is reliable and reproducible, characterizes changes in multiple tissues, and provides comprehensive information regarding a specific site in the stifle joint.
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Affiliation(s)
- Margaret A. McNulty
- Department of Veterinary Population Medicine, University of Minnesota College of Veterinary Medicine, St. Paul, MN, USA
| | - Richard F. Loeser
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Cynthia Davey
- Biostatistical Design & Analysis Center, University of Minnesota, Minneapolis, MN, USA
| | - Michael F. Callahan
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Cristin M. Ferguson
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Cathy S. Carlson
- Department of Veterinary Population Medicine, University of Minnesota College of Veterinary Medicine, St. Paul, MN, USA,Cathy S. Carlson, Department of Veterinary Population Medicine, University of Minnesota College of Veterinary Medicine, 1988 Fitch Avenue, 435H AnSci/VM, St. Paul, MN 55108
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Systematic review of the concurrent and predictive validity of MRI biomarkers in OA. Osteoarthritis Cartilage 2011; 19:557-88. [PMID: 21396463 PMCID: PMC3268360 DOI: 10.1016/j.joca.2010.10.029] [Citation(s) in RCA: 148] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Revised: 09/14/2010] [Accepted: 10/17/2010] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To summarize literature on the concurrent and predictive validity of MRI-based measures of osteoarthritis (OA) structural change. METHODS An online literature search was conducted of the OVID, EMBASE, CINAHL, PsychInfo and Cochrane databases of articles published up to the time of the search, April 2009. 1338 abstracts obtained with this search were preliminarily screened for relevance by two reviewers. Of these, 243 were selected for data extraction for this analysis on validity as well as separate reviews on discriminate validity and diagnostic performance. Of these 142 manuscripts included data pertinent to concurrent validity and 61 manuscripts for the predictive validity review. For this analysis we extracted data on criterion (concurrent and predictive) validity from both longitudinal and cross-sectional studies for all synovial joint tissues as it relates to MRI measurement in OA. RESULTS Concurrent validity of MRI in OA has been examined compared to symptoms, radiography, histology/pathology, arthroscopy, CT, and alignment. The relation of bone marrow lesions, synovitis and effusion to pain was moderate to strong. There was a weak or no relation of cartilage morphology or meniscal tears to pain. The relation of cartilage morphology to radiographic OA and radiographic joint space was inconsistent. There was a higher frequency of meniscal tears, synovitis and other features in persons with radiographic OA. The relation of cartilage to other constructs including histology and arthroscopy was stronger. Predictive validity of MRI in OA has been examined for ability to predict total knee replacement (TKR), change in symptoms, radiographic progression as well as MRI progression. Quantitative cartilage volume change and presence of cartilage defects or bone marrow lesions are potential predictors of TKR. CONCLUSION MRI has inherent strengths and unique advantages in its ability to visualize multiple individual tissue pathologies relating to pain and also predict clinical outcome. The complex disease of OA which involves an array of tissue abnormalities is best imaged using this imaging tool.
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Hunter DJ, Zhang W, Conaghan PG, Hirko K, Menashe L, Reichmann WM, Losina E. Responsiveness and reliability of MRI in knee osteoarthritis: a meta-analysis of published evidence. Osteoarthritis Cartilage 2011; 19:589-605. [PMID: 21396465 PMCID: PMC3625963 DOI: 10.1016/j.joca.2010.10.030] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Revised: 10/15/2010] [Accepted: 10/17/2010] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To summarize literature on the responsiveness and reliability of MRI-based measures of knee osteoarthritis (OA) structural change. METHODS A literature search was conducted using articles published up to the time of the search, April 2009. 1338 abstracts obtained with this search were preliminarily screened for relevance and of these, 243 were selected for data extraction. For this analysis we extracted data on reliability and responsiveness for every reported synovial joint tissue as it relates to MRI measurement in knee OA. Reliability was defined by inter- and intra-reader intra-class correlation (ICC), or coefficient of variation, or kappa statistics. Responsiveness was defined as standardized response mean (SRM) - ratio of mean of change over time divided by standard deviation of change. Random-effects models were used to pool data from multiple studies. RESULTS The reliability analysis included data from 84 manuscripts. The inter-reader and intra-reader ICC were excellent (range 0.8-0.94) and the inter-reader and intra-reader kappa values for quantitative and semi-quantitative measures were all moderate to excellent (range 0.52-0.88). The lowest value (kappa=0.52) corresponded to semi-quantitative synovial scoring intra-reader reliability and the highest value (ICC=0.94) for semi-quantitative cartilage morphology. The responsiveness analysis included data from 42 manuscripts. The pooled SRM for quantitative measures of cartilage morphometry for the medial tibiofemoral joint was -0.86 (95% confidence intervals (CI) -1.26 to -0.46). The pooled SRM for the semi-quantitative measurement of cartilage morphology for the medial tibiofemoral joint was 0.55 (95% CI 0.47-0.64). For the quantitative analysis, SRMs are negative because the quantitative value, indicating a loss of cartilage, goes down. For the semi-quantitative analysis, SRMs indicating a loss in cartilage are positive (increase in score). CONCLUSION MRI has evolved substantially over the last decade and its strengths include the ability to visualize individual tissue pathologies, which can be measured reliably and with good responsiveness using both quantitative and semi-quantitative techniques.
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Affiliation(s)
- D J Hunter
- Rheumatology Department, Royal North Shore Hospital and Northern Clinical School, University of Sydney, Sydney, NSW, Australia.
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Dore D, Martens A, Quinn S, Ding C, Winzenberg T, Zhai G, Pelletier JP, Martel-Pelletier J, Abram F, Cicuttini F, Jones G. Bone marrow lesions predict site-specific cartilage defect development and volume loss: a prospective study in older adults. Arthritis Res Ther 2010; 12:R222. [PMID: 21190554 PMCID: PMC3046535 DOI: 10.1186/ar3209] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2010] [Revised: 11/18/2010] [Accepted: 12/29/2010] [Indexed: 11/26/2022] Open
Abstract
Introduction Recent evidence suggests that bone marrow lesions (BMLs) play a pivotal role in knee osteoarthritis (OA). The aims of this study were to determine: 1) whether baseline BML presence and/or severity predict site-specific cartilage defect progression and cartilage volume loss; and 2) whether baseline cartilage defects predict site-specific BML progression. Methods A total of 405 subjects (mean age 63 years, range 52 to 79) were measured at baseline and approximately 2.7 years later. Magnetic resonance imaging (MRI) of the right knee was performed to measure knee cartilage volume, cartilage defects (0 to 4), and BMLs (0 to 3) at the medial tibial (MT), medial femoral (MF), lateral tibial (LT), and lateral femoral (LF) sites. Logistic regression and generalized estimating equations were used to examine the relationship between BMLs and cartilage defects and cartilage volume loss. Results At all four sites, baseline BML presence predicted defect progression (odds ratio (OR) 2.4 to 6.4, all P < 0.05), and cartilage volume loss (-0.9 to -2.9% difference per annum, all P < 0.05) at the same site. In multivariable analysis, there was a significant relationship between BML severity and defect progression at all four sites (OR 1.8 to 3.2, all P < 0.05) and BML severity and cartilage volume loss at the MF, LT, and LF sites (β -22.1 to -42.0, all P < 0.05). Additionally, baseline defect severity predicted BML progression at the MT and LF sites (OR 3.3 to 3.7, all P < 0.01). Lastly, there was a greater increase in cartilage volume loss at the MT and LT sites when both larger defects and BMLs were present at baseline (all P < 0.05). Conclusions Baseline BMLs predicted site-specific defect progression and cartilage volume loss in a dose-response manner suggesting BMLs may have a local effect on cartilage homeostasis. Baseline defects predicted site-specific BML progression, which may represent increased bone loading adjacent to defects. These results suggest BMLs and defects are interconnected and play key roles in knee cartilage volume loss; thus, both should be considered targets for intervention.
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Affiliation(s)
- Dawn Dore
- Menzies Research Institute Tasmania, University of Tasmania, Private Bag 23, Hobart, 7000, Australia.
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