Knee symptom but not radiographic knee osteoarthritis increases the risk of falls and fractures: results from the Osteoarthritis Initiative

A Comparative Study of Risk Factors for Falls in Total Hip and Knee Arthroplasty Patients and Community-Dwelling Older Adults

OBJECTIVES

Falls in older adults are a public health concern, yet little is known about falls in adults with hip or knee total joint arthroplasty (TJA) who may be at a higher risk than the general population. The study objectives were to compare the number of fallers and fear of falling in TJA patients to age and sex matched community controls, and determine whether the type of risk factors for falls reported in TJA differed from the community group.

METHODS

A cross sectional comparative study was conducted with patients waiting or recovering from TJA and age and sex matched comparison group of older adults residing in the community. Reported falls and risk factors for falling were compared to age and sex matched controls from the community. Fear of falling was measured using the Activities-specific Balance Confidence (ABC) Scale. Logistic regression was used to determine risk factors associated with falls in TJA and community participants.

RESULTS

Of the 198 TJA participants, 29% (n = 57) reported falls within the past 12 months compared to 24% (n = 24) of 100 participants in the control group (p = 0.36). Of those who fell, 25 (44%) were recurrent fallers in the TJA cohort compared with 6 (25%) in the community cohort. Eleven participants reported falls after TJA surgery. Fear of falling was greater in the TJA group (ABC score, mean ± SD: 67.1 ± 24.4) than in the community group (88.1 ± 14.9) (p < 0.001).

CONCLUSION

Although the number of participants who reported falls was comparable in both groups, the TJA group had more recurrent falls, different risk factors for falls, and more fear of falling. Fall prevention programs should be embedded in pre-operative programs for patients undergoing surgery for TJA.

Associations of osteoarthritis with risk of future fracture events: prospective study in UK Biobank

BACKGROUND

Researchers have long been interested in the potential relationship between osteoarthritis (OA), falls, and fractures; however, the evidence supporting this relationship has been conflicting. This study aimed to investigate the association between osteoarthritis and future fracture events.

MATERIALS AND METHODS

This study was designed as a prospective cohort study. We recruited a total of 440 476 individuals from the UK Biobank to investigate the impact of OA on the incidence of fracture. Among the total population, there were 54 581 participants diagnosed with OA. Cox proportional hazard models were used to calculate hazard ratios (HRs) and 95% confidence intervals (95% CIs).

RESULTS

A total of 26 083 fracture events were documented over a median follow-up period of 13.5 years. After multivariable adjustment, participants with osteoarthritis had an HR (95% CI) of 1.11 (1.08, 1.15) for future fracture events compared to participants without osteoarthritis ( P  < 0.0001). Falls explained 16.34% of the association between osteoarthritis and fracture events and 14.15% of the association between knee osteoarthritis and fracture events. The association was not substantially altered across the series of sensitivity analyses.

CONCLUSION

Osteoarthritis was associated with a greater risk of future fracture events. This finding highlights the importance of preventing future fracture events in people with osteoarthritis.

Association of physical activity trajectories over 8 years and risk of knee replacement: data from the osteoarthritis initiative

BACKGROUND

To identify physical activity (PA) trajectories in adults with or at risk of knee osteoarthritis and to evaluate the association of PA trajectories with incident knee replacement (KR).

METHODS

This study used data from the Osteoarthritis Initiative. The Physical Activity Scale for the Elderly and the KR were assessed annually from baseline to 9 years. Individuals were included if they did not undergo KR surgery at baseline and had data on PA at ≥ 1 visit before KR. Latent class growth mixture Modeling was used to identify the optimal trajectories of PA before KR. Log-binomial regression models were used to assess the association between PA trajectories and the risk of KR. Data analyses were conducted in all individuals and those with radiographic osteoarthritis (ROA) and significant knee pain (Western Ontario and McMaster Osteoarthritis Index pain score of ≥ 5 on a 0-20 scale) at baseline, respectively.

RESULTS

Of 4731 participants (mean age 61.1 years, 58.5% female), four distinct and slightly declined PA trajectories were identified. Compared to individuals with a "Low" PA trajectory, those with "Medium-low", "Medium-high", or "High" PA trajectories were not significantly associated with the risk of KR (risk ratios: 0.97-1.19, all p > 0.05). Similar PA trajectories and associations with the risk of KR were observed in the subgroups of individuals with radiographic osteoarthritis and those with significant knee pain at baseline, respectively.

CONCLUSION

In participants with or at risk of knee osteoarthritis, PA slightly declines over time and may play no role in the risk of KR.

Automated system for classifying uni-bicompartmental knee osteoarthritis by using redefined residual learning with convolutional neural network

Knee Osteoarthritis (OA) is one of the most common joint diseases that may cause physical disability associated with a significant personal and socioeconomic burden. X-ray imaging is the cheapest and most common method to detect Knee (OA). Accurate classification of knee OA can help physicians manage treatment efficiently and slow knee OA progression. This study aims to classify knee OA X-ray images according to anatomical types, such as uni or bicompartmental. The study proposes a deep learning model for classifying uni or bicompartmental knee OA based on redefined residual learning with CNN. The proposed model was trained, validated, and tested on a dataset containing 733 knee X-ray images (331 normal Knee images, 205 unicompartmental, and 197 bicompartmental knee images). The results show 61.81 % and 68.33 % for accuracy and specificity, respectively. Then, the performance of the proposed model was compared with different pre-trained CNNs. The proposed model achieved better results than all pre-trained CNNs.

Radiographic knee osteoarthritis severity has no impact on fall risk: the locomotive syndrome and health outcomes in the aizu cohort study (LOHAS): a cross-sectional study

BACKGROUND

To investigate factors that have an impact on the risk of falls and determine whether radiographic knee osteoarthritis (KOA) is a factor involved in falls independent of knee pain, psychological factors, and physical function.

METHODS

A cross-sectional analysis was conducted on 1083 subjects for the 2009 Locomotive Syndrome and Health Outcomes in the Aizu Cohort Study (LOHAS). A logistic regression analysis was performed to examine the relationship between radiographic KOA and fall history.

RESULTS

Fall history was significantly associated with the severity of knee pain. Compared to subjects with no knee pain, the odds ratio (OR) was 1.53 times higher in the subjects with mild knee pain (95% confidence interval [CI]: 1.04-2.25), 1.69 times higher in those with moderate knee pain (95%CI: 1.03-2.79), and 2.98 times higher in those with severe knee pain (95%CI: 1.67-5.30). In subjects with depression, the OR was 1.91 (95%CI: 1.25-2.92), and in those with decreased mobility, the OR was 1.70 (95%CI: 1.08-2.69). Age, gender, knee crepitus, BMI, OLST, and sleeping pill use were not significantly associated with fall risk. In a multivariate analysis, radiographic KOA severity was not significantly associated with fall risk (OR 0.81, 95%CI 0.44-1.50 in mild OA; OR 1.10, 95%CI 0.57-2.14 in severe OA).

CONCLUSION

Knee pain, decreased mobility, and depression, but not the radiographic KOA severity, were significantly associated with a fall risk. Regardless of the individual's radiographic KOA severity, the risk of falls may be reduced by treating his/her knee pain, mobility problems, and/or psychological factors.

Cross-Sectional and Longitudinal Associations of Comorbidities with Knee Symptoms and Radiographic Abnormalities of Osteoarthritis

INTRODUCTION

This study aimed to investigate the associations of comorbidities with knee symptoms and radiographic abnormalities of osteoarthritis (OA).

METHODS

Participants were from the Osteoarthritis Initiative. Comorbidities were identified at baseline using the modified Charlson Comorbidity Index. For both knees, symptoms were assessed annually from baseline to 48 months using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function scores (rescaled range 0-100), and radiographic abnormalities using the Kellgren-Lawrence (KL, 0-4) grades. The presence of significant pain and functional disability was defined as a WOMAC score of ≥ 25 and ≥ 22, respectively, and radiographic OA (ROA) as KL ≥ 2. An increase of ≥ 9 in WOMAC scores and ≥ 1 in KL grades were defined as symptomatic and radiographic progression, respectively.

RESULTS

Of 3337 participants, 28% and 9% had one and ≥ 2 comorbidities, respectively. The number of comorbidities was associated with the presence of significant functional disability (odds ratios [ORs] 1.15; 1.46) and predicted the progression of both knee pain and functional disability (ORs 1.11; 1.51). For the type of comorbidities, non-OA musculoskeletal diseases were associated with the presence of ROA and significant functional disability (ORs 1.63; 1.82) and showed a trend to predict incident ROA (OR 1.84, 95% confidence interval 1.00-3.38 p = 0.051). Diabetes and kidney diseases were associated with symptomatic progression of OA (ORs 1.38; 2.72).

CONCLUSIONS

Having more comorbidities, especially diabetes and kidney diseases, is associated with symptomatic progression of knee OA. Moreover, non-OA musculoskeletal diseases may be associated with the presence and onset of ROA.

Frailty predicts knee pain trajectory over 9 years: results from the Osteoarthritis Initiative

OBJECTIVE

Frailty is a multisystem syndrome and its relationship with symptomatic osteoarthritis has been reported. We aimed to identify trajectories of knee pain in a large prospective cohort and to describe the effect of frailty status at baseline on the pain trajectories over 9 years.

METHODS

We included 4419 participants (mean age 61.3 years, 58% female) from the Osteoarthritis Initiative cohort. Participants were classified as "no frailty," "pre-frailty," or "frailty" at baseline, based on 5 characteristics (ie, unintentional weight loss, exhaustion, weak energy, slow gait speed, and low physical activity). Knee pain was evaluated annually using the Western Ontario and McMaster Universities Osteoarthritis Index pain subscale (0-20) from baseline to 9 years.

RESULTS

Of the participants included, 38.4%, 55.4%, and 6.3% were classified as "no frailty," "pre-frailty," and "frailty," respectively. Five pain trajectories were identified: "No pain" (n = 1010, 22.8%), "Mild pain" (n = 1656, 37.3%), "Moderate pain" (n = 1149, 26.0%), "Severe pain" (n = 477, 10.9%), and "Very Severe pain" (n = 127, 3.0%). Compared to participants with no frailty, those with pre-frailty and frailty were more likely to have more severe pain trajectories (pre-frailty: odds ratios [ORs] 1.5 to 2.1; frailty: ORs 1.5 to 5.0), after adjusting for potential confounders. Further analyses indicated that the associations between frailty and pain were mainly driven by exhaustion, slow gait speed, and weak energy.

CONCLUSIONS

Approximately two-thirds of middle-aged and older adults were frail or pre-frail. The role of frailty in predicting pain trajectories suggests that frailty may be an important treatment target for knee pain.

Patients with knee osteoarthritis have altered gait and gaze patterns compared to age-matched controls: A pilot study

PURPOSE

Although knee Osteoarthritis (KOA) sufferers are at an increased risk of falls, possibly due to impaired gait function, the associated gaze behaviour in patients with KOA are largely unknown. Thus, we compared gait and gaze behaviours characteristics between KOA patients and asymptomatic age-matched controls.

RESULTS

For Timed Up and Go (TUG) and stair climb tasks, the KOA group demonstrated longer periods of gaze fixations with less frequency of fixations compared to the control group. Conversely, for the Timed up and Go Agility (TUGA) test shorter fixation and frequency patterns were observed. The KOA group presented a shorter final stride length prior to the initiation of the first step in the Stair climb assessment. In addition, for the 30m walk and dual task assessments, the average step length was significantly shorter in the KOA group compared to controls.

CONCLUSION

Overall, we found altered gait and gaze behaviours are evident in KOA patients which could relate to their increased falls risk.

Association of Sleep Disturbance With Catastrophizing and Knee Pain: Data From the Osteoarthritis Initiative

OBJECTIVE

To investigate the relationship between sleep disturbance, catastrophizing, and knee pain in middle-aged and older individuals.

METHODS

Data from the Osteoarthritis Initiative cohort from months 48 to 96 were used, where month 48 was treated as baseline. Knee pain (Western Ontario and McMaster Universities Osteoarthritis Index pain scale score ≥5 [range 0-20]), catastrophizing (extracted from Coping Strategies Questionnaire score ≥3 [range 0-6]), and sleep quality (extracted from Center for Epidemiologic Studies Depression Scale [range 1-4]) were assessed annually. We described the association of sleep disturbance with the presence and risk of knee pain and catastrophizing. The mediation effect of knee pain and catastrophizing on the sleep-catastrophizing and sleep-pain association was evaluated, respectively.

RESULTS

Catastrophizing and knee pain were reported in 346 (10%) and 917 (24%) of the 3,813 participants (mean 64.9 years, 58% female) at baseline. Participants with worse sleep disturbance were more likely to have knee pain (prevalence ratio [PR] 1.4-2.0, P for trend <0.001) and catastrophizing (PR 1.4-3.1, P for trend <0.001). Sleep disturbance at baseline predicted the risk of knee pain (risk ratio [RR] 1.1, P for trend <0.001) and catastrophizing (RR 1.2-1.7, P for trend <0.001) during follow-up. No statistically significant interactions between sleep disturbance and knee pain or catastrophizing were observed. Knee pain and catastrophizing mediated the sleep-catastrophizing and sleep-pain association, respectively, at baseline, and knee pain negatively mediated the sleep-catastrophizing association longitudinally.

CONCLUSION

Sleep disturbance was associated with the presence and risk of catastrophizing and knee pain. Sleep interventions may have a universal and independent effect in preventing incident knee pain.

Association of knee and hip osteoarthritis with the risk of falls and fractures: a systematic review and meta-analysis

OBJECTIVE

Studies evaluating the association of knee and hip osteoarthritis (OA) with falls and fractures have inconsistent findings. We aimed to investigate associations of symptomatic and radiographic knee and hip OA with risk of falls, recurrent falls, and fractures.

METHODS

We conducted an electronic search of databases from inception to February 2023. Two authors independently screened studies, extracted data, and assessed the risk of bias using the Newcastle-Ottawa Scale tool in eligible studies. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random-effects models.

RESULTS

Of 17 studies included (n = 862849), 2 had a high risk of bias. Among studies that evaluated falls or fractures as outcomes, 7/8 (87.5%) and 5/11 (45.5%) were self-reported, respectively. Both symptomatic knee and hip OA were associated with increased risk of recurrent falls (knee: OR = 1.55, 95% CI 1.10 to 2.18; hip: OR = 1.50, 95% CI 1.28 to 1.75) but not falls or fractures. Radiographic knee OA increased risk of falls (OR = 1.28, 95% CI 1.03 to 1.59) and did not significantly increase risk of recurrent falls (OR = 1.39, 95% CI 0.97 to 1.97) or fractures (OR = 1.22, 95% CI 0.99 to 1.52). Radiographic hip OA decreased the risk of recurrent falls (OR = 0.70, 95% CI 0.51 to 0.96) but had no statistically significant association with fractures (OR = 1.16, 95% CI 0.79 to 1.71).

CONCLUSION

Symptomatic knee and hip OA were both associated with an increased risk of recurrent falls, and radiographic knee OA was associated with an increased risk of falls. No statistically significant associations of radiographic and symptomatic knee or hip OA with fractures were found.

Does a relationship between type of hip fracture and osteoarthritis exist?

Background/Aim: Many factors have been associated with the etiology of falls and hip fractures in the elderly. However, only a few studies have examined the relationship between osteoarthritis and hip fractures, which are common in this age group. The aim of this study was to determine the relationship between the knee and hip osteoarthritis (OA) and the type of hip fracture. Methods: Patients who underwent surgery in the Orthopedics and Traumatology Department between January 2017 and December 2021 were eligible to participate in this retrospective cohort study. Patients who were 60 years and older with a hip fracture and adequate medical records and radiographs of bilateral hip and knee joints met the inclusion criteria. Data concerning patient co-morbidities, type of hip fracture, whether they had OA in their hip and knee joints, and the severity of their OA were assessed. The severity of the osteoarthritis presence was categorized with using the Kellgren–Lawrence (KL) classification. To categorize the patients, three groups were identified: (1) femoral neck, (2) trochanteric, and (3) subtrochanteric fracture groups. The presence and severity status of OA in the hip and knee joints and co-morbidity data were compared between the groups. Results: Three-hundred forty-one patients with a M/F ratio of 148/193 are included in this study. Femoral neck fractures occurred in 142 (41.6%), trochanteric fractures in 147 (43.1%), and subtrochanteric fractures in 52 (15.2%) patients. The mean age of the cohort was 76.72 (10.165); The mean age of the patients in the trochanteric group was higher than in the subtrochanteric group (P = 0.001). No effect of any existing co-morbidities on fracture type was observed. The overall prevalence of OA in the cohort that was observed in the hip joint was 34.3% with 33.7% in males and 35.3% in females. These rates were 66.6%, 53.4%, and 76.7% in the knee joint, respectively. No difference could be observed between hip OA presence and any type of hip fracture group (P = 0.833 for right hip, P = 0.865 for left hip). Similar rates of moderate and severe hip OA were found in the femoral neck and trochanteric fracture groups. However, the frequency of moderate hip OA was lower and the frequency of severe hip OA was higher in subtrochanteric fracture group compared to other groups (P = 0.164 for right hip, P = 0.241 for left hip. Knee OA was observed to be more common in the trochanteric fracture group (P = 0.003 for the right knee, P = 0.002 for left knee) and also, the rate of severe OA was higher in the trochanteric fracture group compared to other groups (P = 0.013 for right knee, P = 0.006 for the left knee). Conclusion: In contrast to OA presence in the hip, knee OA presence and severity can be significant risk factors for occurrence of trochanteric type fractures in the elderly.