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Al-Abbad H, Reznik JE, Biros E, Paulik B, Will R, Gane S, Moss P, Wright A. Evaluation of treatment parameters for focused-extracorporeal shock wave therapy in knee osteoarthritis patients with bone marrow lesions: a pilot study. J Rehabil Med 2024; 56:jrm13207. [PMID: 38470167 PMCID: PMC10949080 DOI: 10.2340/jrm.v56.13207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 01/25/2024] [Indexed: 03/13/2024] Open
Abstract
OBJECTIVES To evaluate the effect of different dosage parameters of focused-extracorporeal shock wave therapy on pain and physical function in knee osteoarthritis patients with bone marrow lesions. In addition, to investigate pathophysiological changes based on imaging and biomarker measures. METHODS Using a single-case experimental design, a total of 12 participants were randomly allocated in 4 equal groups of 3 to receive different dosages of focused-extracorporeal shock wave therapy. Each group received either 4 or 6 sessions of 1500 or 3000 shocks over 4 or 6 weekly sessions. Participants underwent repeated measurements during the baseline, intervention, and post-intervention phases for Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, aggregated locomotor function score and pressure pain threshold. Imaging and inflammatory biomarker outcomes were measured at baseline and 3 months following the intervention. RESULTS The group receiving the highest dosage of focused-extracorporeal shock wave therapy showed clinical improvements superior to those of participants in the other 3 groups. Statistically significant changes during the follow-up phase in contrast to baseline measurements for the WOMAC score (Tau-U= -0.88, p < 0.001), aggregated locomotor function score (Tau-U= -0.77, p = 0.002), and pressure pain threshold (Tau-U= 0.54, p = 0.03) were observed. Bone marrow lesion and inflammatory cytokines demonstrated no change. CONCLUSION A dose-dependent effect for focused-extracorporeal shock wave therapy on osteoarthritis-related symptoms was suggested. However, these improvements were not associated with changes in the underlying pathophysiological mechanisms.
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Affiliation(s)
- Hani Al-Abbad
- Physical Therapy department, Rehabilitation hospital, King Fahad Medical City. Riyadh, Saudi Arabia; College of Healthcare Science and Division of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia
| | - Jacqueline E Reznik
- College of Healthcare Science and Division of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia
| | - Erik Biros
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Bruce Paulik
- Hollywood Functional Rehabilitation Clinic, Nedlands, Perth, WA, Australia
| | - Rob Will
- School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia
| | | | - Penny Moss
- School of Allied Health, Curtin University, Perth, WA, Australia
| | - Anthony Wright
- School of Allied Health, Curtin University, Perth, WA, Australia.
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Heiss R, Laredo JD, Wirth W, Jansen MP, Marijnissen ACA, Lafeber F, Lalande A, Weinans HH, Blanco FJ, Berenbaum F, Kloppenburg M, Haugen IK, Engelke K, Roemer FW. Quantitative CT of the knee in the IMI-APPROACH osteoarthritis cohort: Association of bone mineral density with radiographic disease severity, meniscal coverage and meniscal extrusion. Bone 2023; 168:116673. [PMID: 36623756 DOI: 10.1016/j.bone.2023.116673] [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: 10/19/2022] [Revised: 12/16/2022] [Accepted: 01/04/2023] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Osteoarthritis (OA) is a highly prevalent chronic condition. The subchondral bone plays an important role in onset and progression of OA making it a potential treatment target for disease-modifying therapeutic approaches. However, little is known about changes of periarticular bone mineral density (BMD) in OA and its relation to meniscal coverage and meniscal extrusion at the knee. Thus, the aim of this study was to describe periarticular BMD in the Applied Public-Private Research enabling OsteoArthritis Clinical Headway (APPROACH) cohort at the knee and to analyze the association with structural disease severity, meniscal coverage and meniscal extrusion. DESIGN Quantitative CT (QCT), MRI and radiographic examinations were acquired in 275 patients with knee osteoarthritis (OA). QCT was used to assess BMD at the femur and tibia, at the cortical bone plate (Cort) and at the epiphysis at three locations: subchondral (Sub), mid-epiphysis (Mid) and adjacent to the physis (Juxta). BMD was evaluated for the medial and lateral compartment separately and for subregions covered and not covered by the meniscus. Radiographs were used to determine the femorotibial angle and were evaluated according to the Kellgren and Lawrence (KL) system. Meniscal extrusion was assessed from 0 to 3. RESULTS Mean BMD differed significantly between each anatomic location at both the femur and tibia (p < 0.001) in patients with KL0. Tibial regions assumed to be covered with meniscus in patients with KL0 showed lower BMD at Sub (p < 0.001), equivalent BMD at Mid (p = 0.07) and higher BMD at Juxta (p < 0.001) subregions compared to regions not covered with meniscus. Knees with KL2-4 showed lower Sub (p = 0.03), Mid (p = 0.01) and Juxta (p < 0.05) BMD at the medial femur compared to KL0/1. Meniscal extrusion grade 2 and 3 was associated with greater BMD at the tibial Cort (p < 0.001, p = 0.007). Varus malalignment is associated with significant greater BMD at the medial femur and at the medial tibia at all anatomic locations. CONCLUSION BMD within the epiphyses of the tibia and femur decreases with increasing distance from the articular surface. Knees with structural OA (KL2-4) exhibit greater cortical BMD values at the tibia and lower BMD at the femur at the subchondral level and levels beneath compared to KL0/1. BMD at the tibial cortical bone plate is greater in patients with meniscal extrusion grade 2/3.
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Affiliation(s)
- Rafael Heiss
- Department of Radiology, Universitätsklinikum Erlangen & Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Maximiliansplatz 3, 91054 Erlangen, Germany.
| | - Jean-Denis Laredo
- Service de Radiologie, Institut Mutualiste Montsouris, 42 Bd Jourdan, 75014 Paris, France; Bioimagerie Ostéo-articulaires (B3OA), UMR, CNRS, 7052 INSERM U1271,10 Avenue de Verdun, 75010 Paris, France
| | - Wolfgang Wirth
- Department of Imaging & Functional Musculoskeletal Research, Institute of Anatomy & Cell Biology, Paracelsus Medical University Salzburg & Nuremberg, Strubergasse 21, 5020 Salzburg, Austria; Ludwig Boltzmann Inst. for Arthritis and Rehabilitation, Paracelsus Medical University Salzburg & Nuremberg, Strubergasse 21, 5020 Salzburg, Austria; Chondrometrics GmbH, Ludwig-Zeller-Straße 12, 83395 Freilassing, Germany
| | - Mylène P Jansen
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands
| | - Anne C A Marijnissen
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands
| | - Floris Lafeber
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands
| | - Agnes Lalande
- Servier, 50 rue Carnot, 92284 Suresnes cedex, France
| | - Harrie H Weinans
- Department of Orthopaedics, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Francisco J Blanco
- Grupo de Investigación de Reumatología (GIR), INIBIC - Complejo Hospitalario Universitario de A Coruña, SERGAS, Centro de Investigación CICA, Departamento de Fisioterapia y Medicina, Universidad de A Coruña, A Coruña, Spain; Servicio de Reumatologia, INIBIC- Universidade de A Coruña, As Xubias 84, 15006 A Coruña, Spain
| | - Francis Berenbaum
- Sorbonne University, Inserm, APHP Hôpital Saint-Antoine, 75571 Paris cedex 12, France
| | - Margreet Kloppenburg
- Departments of Rheumatology, Clinical Epidemiology, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, Netherlands
| | - Ida K Haugen
- Diakonhjemmet Hospital, Diakonveien 12, 0370 Oslo, Norway
| | - Klaus Engelke
- Department of Immunology and Rheumatology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Ulmenweg 18, Erlangen, Germany; Institute of Medical Physics, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Henkestr. 91, 91052 Erlangen, Germany
| | - Frank W Roemer
- Department of Radiology, Universitätsklinikum Erlangen & Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Maximiliansplatz 3, 91054 Erlangen, Germany; Boston University School of Medicine, 72 E Concord St, Boston, MA, 02118, MA, USA
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An SH, Kwack KS, Park S, Yun JS, Park B, Kim JS. Correlation Analysis between Fat Fraction and Bone Mineral Density Using the DIXON Method for Fat Dominant Tissue in Knee Joint MRI: A Preliminary Study. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:427-440. [PMID: 37051387 PMCID: PMC10083622 DOI: 10.3348/jksr.2022.0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 07/15/2022] [Accepted: 08/18/2022] [Indexed: 01/21/2023]
Abstract
Purpose This study aimed to investigate the correlation between the fat signal fraction (FF) of the fat-dominant bone tissue of the knee joint, measured using the MRI Dixon method (DIXON) technique, and bone mineral density (BMD). Materials and Methods Among the patients who underwent knee DIXON imaging at our institute, we retrospectively analyzed 93 patients who also underwent dual energy X-ray absorptiometry within 1 year. The FFs of the distal femur metaphyseal (Fm) and proximal tibia metaphyseal (Tm) were calculated from the DIXON images, and the correlation between FF and BMD was analyzed. Patients were grouped based on BMD of lumbar spine (L), femoral neck (FN), and common femur (FT) respectively, and the Kruskal-Wallis H test was performed for FF. Results We identified a significant negative correlation between TmFF and FN-BMD in the entire patient group (r = -0.26, p < 0.05). In female patients, TmFF showed a negative correlation with FN-BMD, FT-BMD, and L-BMD (r = -0.38, 0.28 and -0.27, p < 0.05). In male patients, FmFF was negatively correlated with only FN-BMD and FT-BMD (r = -0.58 and -0.42, p < 0.05). There was a significant difference in the TmFF between female patients grouped by BMD (p < 0.05). In male patients, there was a significant difference in FmFF (p < 0.05). Conclusion Overall, we found that FF and BMD around the knee joints showed a negative correlation. This suggests the potential of FF measurement using DIXON for BMD screening.
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Affiliation(s)
- Sung Hyun An
- Department of Radiology, Ajou University Medical Center, Suwon, Korea
- Musculoskeletal Imaging Laboratory, Ajou University Medical Center, Suwon, Korea
| | - Kyu-Sung Kwack
- Department of Radiology, Ajou University Medical Center, Suwon, Korea
- Musculoskeletal Imaging Laboratory, Ajou University Medical Center, Suwon, Korea
| | - Sunghoon Park
- Department of Radiology, Ajou University Medical Center, Suwon, Korea
- Musculoskeletal Imaging Laboratory, Ajou University Medical Center, Suwon, Korea
| | - Jae Sung Yun
- Department of Radiology, Ajou University Medical Center, Suwon, Korea
- Musculoskeletal Imaging Laboratory, Ajou University Medical Center, Suwon, Korea
| | - Bumhee Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
- Office of Biostatistics, Medical Research Collaborating Center, Ajou Research Institute for innovative Medicine, Ajou University Medical Center, Suwon, Korea
| | - Ji Su Kim
- Office of Biostatistics, Medical Research Collaborating Center, Ajou Research Institute for innovative Medicine, Ajou University Medical Center, Suwon, Korea
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Pedersen JR, Skou ST, Roos EM, Shakoor N, Thorlund JB. Changes in medial-to-lateral knee joint loading patterns assessed by Dual-Energy X-ray Absorptiometry following supervised neuromuscular exercise therapy and patient education in patients with knee osteoarthritis: an exploratory cohort study. Physiother Theory Pract 2022; 39:1205-1214. [PMID: 35139736 DOI: 10.1080/09593985.2022.2036885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The mechanisms underlying pain reductions following exercise therapy in patients with knee osteoarthritis (OA) are poorly understood. One mechanism could be changes in mechanical knee joint loading. OBJECTIVE To investigate if a neuromuscular exercise therapy and patient education intervention could alter knee joint loading assessed by Dual-Energy X-ray Absorptiometry (DXA) in people with knee OA. METHODS Participants with symptomatic knee OA were evaluated before and 26 weeks after an 8-week supervised neuromuscular exercise therapy and patient education intervention (Good Life with OsteoArthritis in Denmark). DXA scans were used to estimate the medial-to-lateral tibial plateau bone mineral density (BMD) ratio. The Knee Injury and Osteoarthritis Outcome Score was used to assess improvements in knee pain, symptoms, physical function, and knee-related quality of life. Changes in physical function were assessed with the 30-second chair stand test and the 40-meter fast paced walk test. RESULTS Of 42 participants recruited, 30 (21 females, mean age 64 ± 7.9 years) had full data available. Medial-to-lateral tibial BMD ratio increased non-significantly by 0.02 (95% CI -0.01 to 0.06) (indicating higher medial load) from baseline to 26-weeks follow-up. Participants had statistically significant improvements of 21% in pain, 17% in symptoms, 14% in ADL, 17% in knee-related quality of life, 13% in chair stand ability, and 6% in walking speed. CONCLUSIONS In this exploratory cohort study, following an 8-weeks supervised exercise therapy and patient education intervention, the medial-to-lateral tibial BMD ratio did not seem to change.
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Affiliation(s)
- Julie Rønne Pedersen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Søren T Skou
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Ewa M Roos
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Najia Shakoor
- Department of Internal Medicine, Division of Rheumatology Rush University Medical Center, Chicago, IL, USA
| | - Jonas Bloch Thorlund
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Chu L, He Z, Qu X, Liu X, Zhang W, Zhang S, Han X, Yan M, Xu Q, Zhang S, Shang X, Yu Z. Different subchondral trabecular bone microstructure and biomechanical properties between developmental dysplasia of the hip and primary osteoarthritis. J Orthop Translat 2019; 22:50-57. [PMID: 32440499 PMCID: PMC7231963 DOI: 10.1016/j.jot.2019.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 08/29/2019] [Accepted: 09/03/2019] [Indexed: 01/21/2023] Open
Abstract
Objective Developmental dysplasia of the hip (DDH) is recognized as a frequent cause of secondary osteoarthritis (OA). The purpose in this study was to compare structural and biomechanical properties of subchondral trabecular bone and its relationship with cartilage damage between patients with DDH and patients with primary hip OA. Methods Forty-three femoral head specimens obtained from patients who underwent total hip arthroplasty [DDH, n = 17; primary OA, n = 16; and normal control (NC), n = 10] were scanned by microcomputed tomography and analyzed by individual trabecula segmentation to obtain the microstructural types of subchondral trabecular bone. The biomechanical properties were analyzed by micro-finite element analysis, and cartilage damage was evaluated by histology. The linear regression analysis was used to indicate the association between microstructures, biomechanical property, and articular cartilage. Results The DDH group showed the lowest total bone volume fractions (BV/TV) and plate BV/TV in the three groups (p < 0.05). There were also different discrepancies between the three groups in plate/rod trabecular number, plate/rod trabecular thickness, trabecular plate surface area/trabecular rod length, and junction density with different modes (plate-plate, rod-rod, and plate-rod junction density). The micro-finite element analysis, histology, and linear regression revealed that the subchondral trabecular bone in the DDH group had inferior biomechanical properties and cartilage damage of patients with DDH was more serious with different subchondral trabecular bone microstructures. Conclusion Our findings detected deteriorating subchondral trabecular bone microstructures in patients with DDH. The mass and type of subchondral trabecular bone play a key role in mechanical properties in DDH, which might be related to cartilage damage. The translational potential of this article Our findings suggested that changes of subchondral trabecular bone play a critical role in DDH progression and that the improvement on subchondral trabecular bone may be a sensitive and promising way in treatment of DDH.
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Affiliation(s)
- Linyang Chu
- Shanghai Key Laboratory of Orthopedic Implants, Department of Orthopedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Zihao He
- Shanghai Key Laboratory of Orthopedic Implants, Department of Orthopedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Xinhua Qu
- Department of Bone and Joint Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200011, PR China
| | - Xuqiang Liu
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, The Artificial Joint Engineering and Technology Research Center of Jiangxi Province, Nanchang, PR China
| | - Weituo Zhang
- Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, PR China
| | - Shuo Zhang
- Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, PR China
| | - Xuequan Han
- Shanghai Key Laboratory of Orthopedic Implants, Department of Orthopedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Mengning Yan
- Shanghai Key Laboratory of Orthopedic Implants, Department of Orthopedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Qi Xu
- Shanghai Key Laboratory of Orthopedic Implants, Department of Orthopedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Shuhong Zhang
- Shanghai Key Laboratory of Orthopedic Implants, Department of Orthopedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Xifu Shang
- Department of Orthopedics, The Affiliated Provincial Hospital of China Science and Technology University, Hefei, 230001, Anhui Province, PR China
| | - Zhifeng Yu
- Shanghai Key Laboratory of Orthopedic Implants, Department of Orthopedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
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Prince JM, Bernatz JT, Binkley N, Abdel MP, Anderson PA. Changes in femoral bone mineral density after total knee arthroplasty: a systematic review and meta-analysis. Arch Osteoporos 2019; 14:23. [PMID: 30798359 DOI: 10.1007/s11657-019-0572-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 01/27/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Bone loss after total knee arthroplasty (TKA) may lead to periprosthetic fractures that are associated with significant costs (morbidity, economic, etc.) and pose a challenge to operative fixation. This meta-analysis quantifies the change in bone mineral density (BMD) of the distal femur after primary TKA. METHODS A systematic review of six databases was performed by two independent reviewers. Studies that reported bone density after knee arthroplasty were identified and inclusion/exclusion criteria was applied. Data were extracted and analyzed using the Comprehensive Meta-Analysis Software. RESULTS Fourteen studies were included in the analysis. The average decrease in BMD was 0.09 [0.05, 0.13], 0.14 [0.08, 0.20], 0.16 [0.10, 0.23], and 0.16 [0.12, 0.20] g/cm2 at 3, 6, 12, and 24 months, respectively, corresponding to a 9.3%, 13.2%, 15.8%, and 15.4% BMD loss. A high degree of heterogeneity existed between the studies (I2 > 90% at most time points). CONCLUSION In summary, there is a rapid and significant 15% decrease in BMD in the first 6 months after TKA that is sustained to 24 months. Better understanding regarding how perioperative optimization of bone health may affect BMD loss and the incidence of periprosthetic fracture is essential. LEVEL OF EVIDENCE Therapeutic Level II.
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Affiliation(s)
- Joel M Prince
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, UWMF Centennial Building, 1685 Highland Avenue, 6th Floor, Madison, WI, 53705, USA
| | - James T Bernatz
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, UWMF Centennial Building, 1685 Highland Avenue, 6th Floor, Madison, WI, 53705, USA
| | - Neil Binkley
- University of Wisconsin Osteoporosis Clinical Research Program, Madison, WI, 53705, USA
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 65905-53705, USA
| | - Paul A Anderson
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, UWMF Centennial Building, 1685 Highland Avenue, 6th Floor, Madison, WI, 53705, USA.
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van der Wal RJP, Attia D, Waarsing EH, Thomassen BJW, van Arkel ERA. Two-year follow-up of bone mineral density changes in the knee after meniscal allograft transplantation: Results of an explorative study. Knee 2018; 25:1091-1099. [PMID: 29933933 DOI: 10.1016/j.knee.2018.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 04/18/2018] [Accepted: 06/04/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The potential chondroprotective effect of meniscal allograft transplantation (MAT) is unclear. Subchondral bone mineral density (BMD) and subchondral bone remodeling play important roles in osteoarthritis development. Evaluation of subchondral BMD after MAT might give more insight into the potential chondroprotective effect. The purpose of this study was to determine early BMD changes in the knee after MAT. METHODS Twenty-six consecutive patients underwent MAT during 2010-2013. The BMD was measured using dual-energy x-ray absorptiometry (DXA) scan preoperatively, and six months, one and two years postoperatively. Bone mineral density was measured in six regions of interest (ROIs) in the tibia and femur (medial, central, lateral) in both treated and healthy contralateral knees. RESULTS The BMD levels of MAT knees did not significantly change during two years of follow-up in almost all ROIs. Bone mineral density was significant higher in nearly all ROIs in MAT knees at almost all follow-ups compared to healthy contralateral knees. In the healthy contralateral knees, BMD slightly, but not statistically, decreased in the first postoperative year, where it normalized to baseline values at two-year follow-up. The BMD levels in all ROIs did not significantly differ between the patients with or without chondropathy at baseline and two-year follow-up. CONCLUSION Based on the findings, MAT did not show a significant influence on BMD in the first two postoperative years. Longer follow-up is necessary to prove the potential chondroprotective effect of MAT using BMD measurements.
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Affiliation(s)
- Robert J P van der Wal
- Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the Netherlands.
| | - David Attia
- Department of Orthopaedic Surgery and Traumatology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Erwin H Waarsing
- Department of Orthopaedic Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Bregje J W Thomassen
- Department of Orthopaedic Surgery and Traumatology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Ewoud R A van Arkel
- Department of Orthopaedic Surgery and Traumatology, Haaglanden Medical Center, The Hague, the Netherlands
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Lo GH, Schneider E, Driban JB, Price LL, Hunter DJ, Eaton CB, Hochberg MC, Jackson RD, Kwoh CK, Nevitt MC, Lynch JA, McAlindon TE. Periarticular bone predicts knee osteoarthritis progression: Data from the Osteoarthritis Initiative. Semin Arthritis Rheum 2018; 48:155-161. [PMID: 29449014 DOI: 10.1016/j.semarthrit.2018.01.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 12/22/2017] [Accepted: 01/10/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Osteoarthritis (OA) is a disease with a substantial public health burden. Quantitative assessments of periarticular bone may be a biomarker capable of monitoring early disease progression. The purpose of this study was to evaluate whether measures of periarticular bone associate with longitudinal structural progression. METHODS We conducted a 12-18 months longitudinal study using the Osteoarthritis Initiative (OAI). Participants received knee dual-energy x-ray absorptiometry (DXA), trabecular magnetic resonance (MR) imaging, and x-rays. Knee DXAs generated proximal tibial medial:lateral periarticular bone mineral density (paBMD) measures. Proximal tibial trabecular MR images were assessed for trabecular morphometry: apparent bone volume fraction (BVF), trabecular number, thickness, and spacing. Weight-bearing x-rays were assessed for medial tibiofemoral joint space narrowing (JSN). Chi-squared analyses assessed whether periarticular bone measures were predictive of worsening medial tibiofemoral JSN, adjusted for age, sex, and BMI. RESULTS In all, 444 participants, mean age 64.2 ± 9.2 years, BMI 29.5 ± 4.6kg/m2, and 52% male at baseline. Medial JSN (radiographic progression) occurred in 40 participants (9%). Higher baseline medial:lateral paBMD, apparent BVF, trabecular number and thickness, and lower baseline and decreased trabecular spacing were all associated with more progression of JSN in the medial compartment. From lowest to highest baseline medial:lateral paBMD quartile groups, 2%, 5%, 11%, and 18% had medial JSN progression, respectively, between the 36- and 48-month visits, p-values = 0.001 and 0.002 unadjusted and adjusted. The rate of change in medial:lateral paBMD, apparent BVF, and spacing were associated with more medial JSN. For rate of medial:lateral paBMD change from lowest to highest quartile, the proportion of each group that experienced medial JSN progression were 5%, 5%, 11%, and 18%, with an unadjusted and adjusted p-value of 0.005. CONCLUSION Baseline and most rates of periarticular bone change associate with knee OA structural progression, highlighting the close relationship between subchondral bone and JSN. Future studies should focus on developing these measures as predictive and pathophysiological biomarkers, and evaluating their deployment in clinical trials testing bone-targeted therapeutics.
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Affiliation(s)
- Grace H Lo
- Department of Medicine, Baylor College of Medicine, Houston, TX; Medical Care Line and Research Care Line, Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Medical Center, Houston, TX.
| | - Erika Schneider
- Imaging Institute, Cleveland Clinic Foundation, Cleveland, OH; SciTrials, LCC, Rocky River, OH
| | | | - Lori Lyn Price
- The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA; Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA
| | - David J Hunter
- Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Australia
| | - Charles B Eaton
- Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, RI; Department of Epidemiology, School of Public Health of Brown University, Providence, RI
| | | | - Rebecca D Jackson
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - C Kent Kwoh
- University of Pittsburgh School of Medicine, Pittsburgh, PA; University of Arizona Arthritis Center, Tucson, AZ
| | | | - John A Lynch
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
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Lo GH, Merchant MG, Driban JB, Duryea J, Price LL, Eaton CB, McAlindon TE. Knee Alignment Is Quantitatively Related to Periarticular Bone Morphometry and Density, Especially in Patients With Osteoarthritis. Arthritis Rheumatol 2018; 70:212-221. [PMID: 28940779 DOI: 10.1002/art.40325] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 09/13/2017] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Static alignment influences knee loading and predicts osteoarthritis (OA) progression. Periarticular bone is important in dispersing forces across the knee, and there is substantial evidence for molecular crosstalk between cartilage and subchondral bone. The aim of this study was to evaluate the relationship between periarticular trabecular bone morphology and bone mineral density (BMD) and knee alignment in OA. METHODS This was a cross-sectional analysis of participants in the Osteoarthritis Initiative Bone Ancillary Study. Dual x-ray absorptiometry (DXA) was performed to measure tibial periarticular bone mineral density (paBMD). Magnetic resonance imaging of knee trabecular bone was performed to calculate the apparent bone volume fraction (aBVF), apparent trabecular number (aTbN), apparent trabecular spacing (aTbSp), and apparent trabecular thickness (aTbTh). Static alignment was assessed by measuring the hip-knee-ankle (HKA) angle on long-limb films. RESULTS The study group comprised 436 participants (mean ± SD age 65.4 ± 9.2 years, 46% female, mean ± SD body mass index 29.6 ± 4.6 kg/m2 ), 71% of whom had OA. Correlations between the HKA angle and medial:lateral paBMD, medial paBMD, aBVF, aTbN, aTbTh, and aTbSp were -0.63, -0.34, -0.29, -0.32, -0.22, and 0.30, respectively. More varus alignment was associated with higher medial:lateral paBMD, medial paBMD, aBVF, aTbN, aTbTh, and lower aTbSp. In OA knees, the results were more pronounced. In non-OA knees, the most consistent association was with medial:lateral paBMD. CONCLUSION Static alignment was associated with medial:lateral paBMD in all knees and with medial paBMD and trabecular morphometry in OA knees only. Aberrant knee loading may lead to increased relative subchondral bone density, which is partly related to a higher aBVF and a greater number of thicker trabeculae with smaller intertrabecular spacing. Knee DXA may be a useful early biomarker of knee OA.
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Affiliation(s)
- Grace H Lo
- Baylor College of Medicine and Houston VA Health Services Research & Development Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Medical Center, Houston, Texas
| | - Mehveen G Merchant
- Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | | | - Lori Lyn Price
- Tufts Medical Center and Tufts University, Boston, Massachusetts
| | - Charles B Eaton
- Memorial Hospital of Rhode Island and Alpert Medical School of Brown University, Pawtucket, Rhode Island
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MacKay JW, Murray PJ, Low SBL, Kasmai B, Johnson G, Donell ST, Toms AP. Quantitative analysis of tibial subchondral bone: Texture analysis outperforms conventional trabecular microarchitecture analysis. J Magn Reson Imaging 2015; 43:1159-70. [PMID: 26606692 DOI: 10.1002/jmri.25088] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 10/26/2015] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The aim of this study was to compare two different methods of quantitative assessment of tibial subchondral bone in osteoarthritis (OA): statistical texture analysis (sTA) and trabecular microarchitecture analysis (tMA). METHODS Asymptomatic controls aged 20-30 (n = 10), patients aged 40-50 with chronic knee pain but without established OA (n = 10) and patients aged 55-85 with advanced OA scheduled for knee replacement (n = 10) underwent knee MR imaging at 3 Tesla with a three-dimensional gradient echo sequence to allow sTA and tMA. tMA and sTA features were calculated using region of interest creation in the medial (MT) and lateral (LT) tibial subchondral bone. Features were compared between groups using one-way analysis of variance. The two most discriminating tMA and sTA features were used to construct exploratory discriminant functions to assess the ability of the two methods to classify participants. RESULTS No tMA features were significantly different between groups at either MT or LT. 17/20 and 11/20 sTA features were significantly different between groups at the MT/LT, respectively (P < 0.001). Discriminant functions created using tMA features classified 12/30 participants correctly (40% accuracy; 95% confidence interval [CI], 22-58%) based on MT data and 9/30 correctly (30%,; 95% CI, 14-46) based on LT data. Discriminant functions using sTA features classified 16/30 participants correctly (53%; 95% CI, 35-71) based on MT data and 14/30 correctly (47%; 95% CI, 29-65) based on LT data. CONCLUSION sTA features showed more significant differences between the three study groups and improved classification accuracy compared with tMA features.
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Affiliation(s)
- James W MacKay
- Department of Radiology, Norfolk & Norwich University Hospital, Norwich, United Kingdom
| | - Philip J Murray
- Department of Radiology, Norfolk & Norwich University Hospital, Norwich, United Kingdom
| | - Samantha B L Low
- Department of Radiology, Norfolk & Norwich University Hospital, Norwich, United Kingdom
| | - Bahman Kasmai
- Department of Radiology, Norfolk & Norwich University Hospital, Norwich, United Kingdom
| | - Glyn Johnson
- Department of Radiology, Norfolk & Norwich University Hospital, Norwich, United Kingdom
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Simon T Donell
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
- Department of Trauma & Orthopaedics, Norfolk & Norwich University Hospital, Norwich, United Kingdom
| | - Andoni P Toms
- Department of Radiology, Norfolk & Norwich University Hospital, Norwich, United Kingdom
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
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