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

Patellar alignment compared between kinematic and mechanical unicompartmental knee arthroplasties

Background

Surgical treatment of unicompartmental knee arthritis is typically treated by unicompartmental knee arthroplasty (UKA). UKA may be performed by more traditional mechanical alignment, or alternatively, kinematic alignment. The purpose of this study is to compare pre- and post-operative patellar tendon alignment between mechanical and kinematic UKA.

Methods

A retrospective study at Medstar Washington Hospital Center from 2015 to 2022 identified 156 cases of partial knee arthroplasties. Of these, 95 had mechanical alignments and 61 had kinematic alignments. Patients were evaluated pre and post-surgically for Insall-Salvati and Blackburne-Peel ratios. Analysis of joint imaging x-ray imaging was performed by a blinded MSK-trained radiologist.

Results

Pre-and-post-operative Insall-Salvati and Blackburne-Peel ratios were calculated for kinematic and mechanical knee replacement patients. The ratio differences for the kinematically aligned cohort demonstrated an average for Blackburne-Peele operative ratio difference of 0.089 ( ± 0.30) and an average Insall-Salvati ratio difference of 0.18 ( ± 0.34), whereas for mechanically aligned patients, the Blackburne-Peele ratio difference was 0.054 ( ± 0.47) and the Insall-Salvati ratio difference was 0.41 ( ± 0.31). There was a statistically significant difference in operative Insall-Salvati ratios between kinematic and mechanical patients. Additionally, a two-sample t-test found a significant difference between the postoperative Blackburne-Peel and Insall-Salvati ratios for the kinematically aligned knees with a p-value of 2.33 × 10-16 below the significance level of 0.05. A two-sample f-test found a significant difference in the standard deviation of the difference between mechanical and kinematically aligned knees with respect to the Blackburne-Peel ratio, with a p-value of 0.00183.

Conclusion

This study demonstrates that sagittal patella-femoral knee alignment when comparing Blackburne-Peel and Insall-Salvati ratios are more accurately reproduced with kinematically aligned knees, and a greater variability among the kinematically aligned knees.

Implementation of best-evidence rehabilitation for hip, knee and hand osteoarthritis in Africa: A cause for concern

Importance

Evidence-based practice recommendations and guidelines highlight the benefits of exercise, physical activity, weight management, and education for self-management, which are effective in the management of osteoarthritis (OA). However, the uptake among African health professionals remain poor. The objective of this commentary is to highlight the disparity between current best-evidence rehabilitation practices and African health professionals' practices amidst the high prevalence of OA.

Observations

The World Health Organization emphasizes the importance of physical activity in light of the rising OA prevalence in the ageing population, with the burden of comorbid disease negatively impacting the ageing population's quality of life. The concern is that even though the physical activity directive from the World Health Organisation clearly outlines the physical activity targets and best-evidence recommendations and guidelines for managing patients with OA, African health professionals' uptake remain low, potentially to the disadvantage of patients.

Conclusions and relevance

Increasing OA prevalence with subpar rehabilitation may result in lower quality of life and function for individuals diagnosed with hip, knee, hand and other joint OA, leading to a substantial financial burden on the individual, family, community, stakeholders and governmental levels. Development of African context-specific evidence-based rehabilitation guidelines and improved training on current guidelines by universities and professional societies are needed. Policy makers prioritizing OA as a pertinent burden of disease is lacking in Africa. A multidisciplinary team approach is needed where early referral to physiotherapists is emphasized.

Imaging-based measures of synovitis in knee osteoarthritis: A scoping review and narrative synthesis

Background

Synovitis has emerged as a tissue target of importance in OA research and is commonly evaluated with medical imaging.

Objectives

The purpose of this scoping review was to identify and describe the medical imaging techniques and definitions used by knee OA researchers to assess synovitis, summarize their advantages and disadvantages, and identify opportunities for future work.

Eligibility criteria

We included full-text peer-reviewed English publications including adults diagnosed with knee OA. Studies were included if one or more medical imaging modalities were used to assess synovitis in the knee.Studies of inflammatory arthritis, joint replacement, and synovial joints other than the knee were excluded. Animal studies and literature syntheses were also excluded.

Sources

MEDLINE, SCOPUS, and Google scholar databases were systematically searched for publications (2000-2023) using the following medical subject headings (MeSH): "osteoarthritis, knee", "magnetic resonance imaging", "ultrasonography", "synovitis".

Results

1154 articles were identified from searching medical databases. After removal of duplicates, abstract screening, and full text reading, 251 articles were included in the final review. MRI is the most common modality employed to assess knee synovitis, followed by US imaging. Varied imaging techniques used in the assessment of joint synovitis may be targeting divergent constructs of synovial remodeling and inflammation, which complicates interpretation of results.

Conclusions

There is no consensus on the best method for imaging of knee synovitis in OA. Future work may benefit from the evaluation of synovitis separate from joint effusion, and their associations with histologic findings to discriminate between features of synovial inflammation and remodeling.

A retrospective comparison of Coronal Plane Alignment of the Knee

Background

Unicompartmental arthritic degeneration is treated by unicompartmental knee arthroplasties (UKA). The two current standards are mechanical alignment, where knee placement is perpendicular to the leg's mechanical axis and kinematic alignment, that consists of aligning the knee with the angles specific to the patient's innate bone structure. The purpose of this study was to compare knee alignment between mechanical and kinematic UKA.

Methods

A retrospective study at Medstar Washington Hospital Center from 2015 to 2022 identified 156 cases of knee arthroplasties. Of these, 95 had mechanical alignments and 61 had kinematic alignments. Patients were evaluated post-surgically for Coronal Plane Alignment of the Knee (CPAK). Analysis of post-operative joint x-ray imaging was performed, and the mechanical medial proximal tibial angle (MPTA) and lateral distal femoral angle (LDFA) were measured. The arithmetic hip knee ankle angle (aHKA) and joint line obliquity (JLO) were calculated.

Results

The CPAK results for mechanically aligned group demonstrated an average MPTA of 87.12 (±3), LDFA average of 86.04 (±3), aHKA average of 0.62 (±4) and JLO average of 172.57 (±4). The CPAK results for the kinematically aligned group demonstrated an average MPTA of 86.96 (±3), LDFA average of 84.67 (±3), aHKA average of 2.09 (±4), and JLO average of 171.1 (±4). A two-sample t-test on this data demonstrates statistically significant p-values of 0.004 for LDFA, 0.03 for aHKA, and 0.02 for JLO all below the 0.05 significance level. Both cohorts only contained CPAKs alignment types I and III.

Conclusion

This study demonstrated that there is a statistically significant difference in knee alignment when comparing mechanically versus kinematically aligned knees which suggests that there is an advantage for patients that undergo kinematically aligned knee replacements.

Pantothenic acid alleviates osteoarthritis progression by inhibiting inflammatory response and ferroptosis through the SIRT1/Nrf2 signaling pathway

Osteoarthritis (OA) is a degenerative joint disease that is a major cause of deformity, swelling, pain and even loss of function in the knee joints of the elderly. Pantothenic acid (PA) plays a protective role in many organs due to its antioxidant and anti-inflammatory properties. Herein, we aimed to assess the protective role of PA on osteoarthritis and investigate the underlying molecular mechanism. The levels of inflammatory factors (IL-1β and TNF-α) in knee tissues were measured by ELISA. The Safranin O-Fast Green staining was used to assess the severity of OA and the H&E staining was used to assess the degree of synovitis. In vitro, the levels of iron, MDA, GSH were measured by the detection kits. Western blotting was used to assess the levels of signaling-related proteins. Our results showed that PA significantly attenuated the degree of cartilage degeneration in the MIA-induced osteoarthritis model. PA also reduced the expression of IL-1β, TNF-α, MMP1 and MMP3. In vitro, PA effectively reduced the concentrations of MMP1 and MMP3 in IL-1β-stimulated chondrocytes. PA decreased the levels of Fe2+ and MDA, while increasing GSH production and GPX4 and SLC7A11 expression in IL-1β-induced chondrocytes. Meanwhile, we found that PA was able to inhibit the phosphorylation level of p65, IκB protein in chondrocytes, which effectively blocked the NF-κB signaling pathway. Furthermore, PA also increased the level of SIRT1, Nrf2, and HO-1 protein expression. In addition, the inhibition of PA on IL-1β-induced MMPs production and ferroptosis were inhibited by the SIRT1 inhibitor EX-527. In conclusion, PA inhibited chondrocyte ferroptosis and cartilage destruction in osteoarthritis. The mechanism was through activating SIRT1/Nrf2 signaling pathway.

Biomechanical insights to mitigate lateral hinge fracture risk in opening-wedge high tibial osteotomy

Lateral hinge fractures (LHFs) are serious complications of high tibial osteotomy (HTO). We aimed to establish the relationship between osteotomy parameters and LHF risk factors using finite element simulation. The parameters analyzed included cutting position, hinge position, and correction angle. Optimizing the hinge position in HTO reduced stress and strain concentrations. An osteotomy with a 40 mm cutting position and an AL hinge effectively minimized force moments and stress while ensuring that strain remained below the cortical bone's yield limit. These findings highlight the importance of optimizing osteotomy parameters to reduce LHF risk and improve surgical outcomes in HTO.

Acceptability of self-administered acupressure for knee osteoarthritis in middle-aged and older adults: A mixed-method secondary analysis

OBJECTIVES

To evaluate the acceptability of self-administered acupressure for Knee osteoarthritis (KOA) among middle-aged and older adults.

METHODS

This is a mixed-method acceptability evaluation was embedded in a randomized controlled trial on self-administered acupressure for KOA. Participants received two 2-h training sessions on self-administered acupressure and were instructed to practice twice daily for 12 weeks. Quantitative data were collected using an acceptability questionnaire (n = 153) and acupressure logbooks (n = 157). Qualitative data were obtained through semi-structured interviews, including post-training (n = 13) and post-intervention focus groups (n = 13), and individual interviews with participants who dropped out (n = 5). Data were analysed using descriptive statistics and framework analysis based on the Theoretical Framework of Acceptability.

RESULTS

The intervention had 91.7 % completion rate. Participants rated willingness to attend future sessions at 9.5/10 (SD=0.85). 57.8 % found technique education "very helpful" and 81.5 % followed the prescribed routine. Participants reported high overall acceptability of the self-administered acupressure training program, citing its practicality and potential benefits on knee pain, thigh strength, inflammation, and swelling. The minimal time and financial investment required were also appreciated. However, challenges related to personal efforts, time management, pressure from research monitoring, possible adverse events, and uncertainties with acupressure techniques were noted, leading to adherence issues. Participants expressed a need for continuous professional guidance.

CONCLUSION

Self-administered acupressure is highly acceptable to middle-aged and older adults with KOA due to its potential benefits and merits of minimal time and cost. Future research should focus on optimizing intervention implementation by providing professional support and efficient monitoring to address identified challenges.

Platelet-rich plasma treatment for large joint osteoarthritis: retrospective study highlighting a possible treatment protocol with long-lasting stimulation of the joint with an adequate dose of platelets

Platelet-rich plasma (PRP) therapy has emerged as a potential treatment option for osteoarthritis (OA) due to its ability to promote tissue healing and anti-inflammatory effects. More evidences are needed to establish the optimal therapy protocol. We present here a retrospective analysis of 252 patients treated with PRP for big joints OA between 2020 and 2022. We aimed to evaluate the benefits of PRP combined with rehabilitation on pain and function as well as the potential prognosis factors. We observed clinically significant improvements in pain (VAS improvement 49% at 6 months, 45% at 12 months) and function (Single Assessment Numeric Evaluation i.e. SANE score improvement 44% at 6 months, 39% at 12 months). Multiple PRP shoots and high sports activity, especially competition level, were found as favorable prognosis factors. The authors would suggest offering systematically PRP therapy for competition sports practitioners. Moreover, authors suggest that multiple PRP shoots, spaced from 3 to 4 weeks, could be a viable treatment option for OA.

Correlation between severity of knee joint osteoarthritis and alignment of patellofemoral and patellar height on radiographs

BACKGROUND

The correlation between the morphological structure of the patellofemoral joint (PFJ) and the severity of knee joint osteoarthritis (KOA) remains uncertain. This study aims to investigate the correlation between the severity of knee joint osteoarthritis and the alignment of patellofemoral and patellar height on radiographs.

METHODS

This multi-center, retrospective study analyzed the magnetic resonance imaging (MRI) scans and anteroposterior radiographs of 534 adult outpatients with KOA. To evaluate the radiographic severity of KOA, anteroposterior radiographs of the knee and the Kellgren-Lawrence (K-L) grade were used. Knee MRI scans were used to measure the patellar length ratio (PLR), sulcus angle (SA), lateral patellar tilt angle (LPTA), and the distance between tibial tuberosity and trochlear groove (TT-TG). We examined the association between the configuration of the PFJ, arrangement, and harshness of the KOA. Information on participants' demographics, such as age, sex, side, height, and weight, was collected. A chi-squared test was used for the correlation of radiographic severity of KOA with sex and the affected side. Spearman correlation was used for patellofemoral alignment or morphology and the radiographic severity of lateral KOA. Multiple linear regression models were used for the association between LPTA, SA, TT-TG, and severity of KOA after accounting for demographic variables.

RESULTS

The study comprised of 534 patients; of these, 339 (63%) were female. A total of 586 knees were evaluated in this study. Age showed a strong positive correlation with KOA severity ( r  = 0.516, P <0.01), whereas LPTA showed a strong negative correlation ( r  = -0.662, P <0.01). Additionally, SA ( r  = 0.616, P <0.05), and TT-TG showed a strong positive correlation ( r  = 0.770, P <0.01) with tibiofemoral osteoarthritis (TFOA) severity. Multiple linear regression analysis indicated that knee osteoarthritis severity (β = -2.946, P <0.001) and side (β = -0.839, P  = 0.001) was associated with LPTA; knee osteoarthritis severity (β = 5.032, P <0.001) and age (β = -0.095, P <0.001) was associated with SA; knee osteoarthritis severity (β = 2.445, P <0.001), sex (β = -0.326, P  = 0.041), body mass index (β = -0.061, P  = 0.017) and age (β = -0.025, P <0.001) was associated with TT-TG.

CONCLUSION

Radiographic severity of KOA was positively associated with age, SA, and TT-TG but negatively associated with LPTA.

The relation of walking forces to structural damage in the knee: The Multicenter Osteoarthritis Study

OBJECTIVE

Mechanical loading is an important, modifiable risk factor for knee osteoarthritis. Identifying walking loads associated with disease worsening presents intervention opportunities. Our purpose was to evaluate the longitudinal relation of the baseline vertical ground reaction force (GRF) during walking to worsening bone marrow lesions (BMLs) and cartilage damage using cohort data from the Multicenter Osteoarthritis Study (MOST).

METHODS

MOST participants with GRF data at baseline and magnetic resonance imaging examinations at baseline and 2-year follow-up were included. Peak impact force (PIF) and average loading rate (ALR) from the vertical GRF were analyzed with respect to four joint regions (i.e., the medial and lateral portions of the tibiofemoral and patellofemoral joints). Analyses used logistic regression with generalized estimating equations and adjusted for relevant covariates.

RESULTS

Higher PIF was associated with increased odds of worsening BMLs in the lateral patellofemoral joint (odds ratio (95% confidence interval [CI]): 1.33 (1.11, 1.60)) and worsening cartilage damage in the lateral patellofemoral joint (1.48 (1.24, 1.77)), lateral tibiofemoral joint (1.24 (1.03, 1.50)), and medial tibiofemoral joint (1.25 (1.06, 1.48)). Higher ALR was associated with reduced odds of BML worsening in the lateral tibiofemoral joint (0.60 (0.41,0.87)).

CONCLUSIONS

Higher peak forces when walking were associated with worsening BMLs in the lateral patellofemoral joint and with worsening cartilage damage in regions of the knee associated with higher contact forces during walking. Higher ALRs were not associated with increased odds of structural worsening (BMLs or cartilage).

Vertical whole body vibration for treatment of knee osteoarthritis: a pilote monocentric prospective, randomized trial

INTRODUCTION

Osteoarthritis of the knee (KOA) is a leading cause of disability in the aging population. The treatment of choice in most stages is a conservative multimodal approach. Previous studies were able to prove the efficiency of physical therapy for improvement. Therefore physical therapy, besides pain medication, is one of the most common used forms of therapy for KOA. This study aims to evaluate the possible efficiency of whole-body vibration (WBV) compared to physical therapy. This might benefit patients to whom physical therapy is not accessible.

MATERIALS AND METHODS

Patients with primary Gonarthrosis grade II or III were recruited. Included patients were randomly allocated to two groups. One group was treated by physical therapy and the other one with WBV. Treatment duration was six weeks. An Intention-to-Treat analysis was performed. Effectiveness was evaluated by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Outcome Measures in Rheumatology Committee (OMERACT) and Short-Form-Health-Survey 12 (SF-12) at seven, twelve and 26 weeks.

RESULTS

Of 51 patients recruited, 39 patients were finally included. Overall, both treatments were able to show improvements. The SF-12 Score was improved in both groups without significant difference (p = 0.487). The conventional group showed insignificant vaster pain reduction (p = 0.926). Whereas WBV resulted in insignificant improved function (p = 0.144), reduced stiffness (p = 0.931) and improved total score (p = 0.295). Response to therapy reduced over time in both groups. Although more patients of the WBV group reported improvement of their general health status, average improvement was better at the conventional group.

CONCLUSIONS

This study was able to show that, for the conservative treatment of knee osteoarthritis grade II and III, WBV is a non-inferior therapy compared to conventional physiotherapy. Both were able to improve the status of the patients and may be used based on the accessibility and preferences of affected patients.

Effects of Blood Flow Restriction Training on Strength and Functionality in People With Knee Arthropathies: A Systematic Review and Dose-Response Meta-Analysis of Randomized Controlled Trials

Background: Previous meta-analyses show contrasting findings regarding the effects of blood flow restriction training (BFRT) in different knee conditions. Furthermore, no previous dose-response analysis has been conducted to determine the dose of BFRT required for maximal strength and functionality adaptations. Objective: To analyze the evidence on the effects of BFRT on strength and functionality in patients with knee osteoarthritis or rheumatoid arthritis through a systematic review with dose-response meta-analysis. Methods: Included studies met the following criteria: participants with knee osteoarthritis or rheumatoid arthritis; low-load resistance BFRT as intervention; control group with traditional moderate or high intensity resistance training (MIRT and HIRT); include muscle strength and functionality as primary and secondary outcome measures, respectively; and only randomized controlled trials. A random-effects and a dose-response model estimated strength and functionality using estimates of the total repetitions performed. Results: We included five studies with a sample of 205 participants. No statistically significant differences were found between BFRT and MIRT or HIRT for strength (SMD = -0.06; 95% CI = -0.78-0.67; and p > 0.05) and functionality (SMD = 0.07; 95% CI = -0.23-0.37; and p > 0.05). We found an inverted U-shaped association between the increase in total repetitions and strength gain and between the increase in total repetitions and functional improvement. Conclusions: People with knee osteoarthritis or rheumatoid arthritis can use low-load BFRT for strength and functionality as a similarly effective alternative to MIRT and HIRT. A total of 2000 repetitions per BFRT program are necessary to maximize strength gains in these patients, while functional improvement requires 1800 total repetitions.

Effect of intra-articular corticosteroid injections for knee osteoarthritis on the rates of subsequent knee replacement and post-operative outcomes: a national cohort study of England

BACKGROUND

Intra-articular corticosteroid injection (IACI) is an established treatment option for uncontrolled pain in osteoarthritis. There is a lack of longer-term follow-up in most studies of the effects of IACI, meaning there is scarcity of data on the impact of IACI on the subsequent need for joint replacement. Our aim was to assess the effect of IACI for knee osteoarthritis on the subsequent incidence of knee replacement surgery and on associated post-operative outcomes.

METHODS

We conducted a cohort study of knee osteoarthritis patients registered in the Clinical Practice Research Datalink (CPRD) GOLD database with an incident diagnosis between 2005 and 2019. Exposure was single or repeated IACI use, analysed separately. The primary outcome was knee replacement during 1-year and 5-year follow-ups. Secondary outcomes included post-operative patient-reported outcome measures and adverse events. Primary analyses used general practitioner practice preference for IACI as an instrumental variable given this methodology can account for strong and unmeasured confounding. Secondary analyses used propensity score matching, accounting for measured covariates only.

RESULTS

During 1-year follow-up, 1628/33,357 (4.9%) knee osteoarthritis patients underwent knee replacement, for which single IACI was associated with lower risk, which persisted to 5-year follow-up (incidence rate ratio: 0.52 [0.36, 0.77]). Conversely, in secondary propensity score analyses no association was found between IACI use and knee replacement rate at 1-year follow-up, and an estimated increased rate of knee replacement at 5-year follow-up. Use of IACI pre-joint replacement was not associated with any adverse post-operative outcomes, for example, 1-year complication rates (per 100 person-years) following knee replacement were 4.6 (3.8, 5.8), 4.0 (2.7, 6.0) and 5.0 (3.1, 8.1) among patients with no, single and repeat pre-joint replacement IACI use, respectively.

CONCLUSIONS

Findings from our main analysis suggest that short-term pain reduction following IACI for knee osteoarthritis may translate to lower rates of knee replacement over 5 years follow-up, although contradictory associations were observed in secondary analyses which likely reflected residual confounding by indication. Reassuringly, IACI use before knee replacement was not associated with post-operative adverse outcomes.

Automated determination of hip arthrosis on the Kellgren-Lawrence scale in pelvic digital radiographs scans using machine learning

BACKGROUND AND OBJECTIVE

Automated analysis of digital radiographs of the pelvis to determine the hip arthrosis state in concordance with the Kellgren-Lawrence scale could facilitate and standardize radiogram descriptions.

METHODS

This research evaluates and compares the applicability of the traditional machine-learning approach based on the textural features fed to the classifier and the deep-learning networks of various architectures.

RESULTS

The investigation performed for the binary problem, where the healthy and the most severe state of hip arthrosis were considered, proved that the distinction of these classes is possible for both considered approaches. However, the outcomes recorded for deep-learning methods overcome significantly other approaches, resulting in a correct classification ratio equal to 0.98. When all five classes are considered, the results drop, primarily due to the underrepresentation of such cases.

CONCLUSIONS

The influence of data pre-processing was investigated, showing that it is insignificant for deep-learning models and that the statistical dominance analysis approach dominates for traditional models. The evaluation also indicates that the deep-learning models must be trained on the selected region of interest. Otherwise, they lack precision and have problems determining the significant changes depicting the arthrosis.

Safety of Anti-osteoarthritis Medications: A Systematic Literature Review of Post-marketing Surveillance Studies

BACKGROUND

Several meta-analyses of phase 3 randomized controlled trials (RCTs) were published in 2019, reassessing the safety of most anti-osteoarthritis (OA) medications, mainly on the basis of data from full safety reports. The current systematic review (SR) intends to provide complementary insights into the safety of anti-OA medications, using evidence from post-marketing safety surveillance studies.

METHODS

The review protocol was registered with PROSPERO database (registration no. CRD42021227872). We followed the Cochrane methodology for SRs of interventions and comprehensively searched the Medline, CENTRAL, Scopus and TOXLINE databases from inception to November 2023, to include all post-marketing safety surveillance studies on any anti-OA medications. The outcomes of this SR were any adverse events (AEs) reported in the included studies.

RESULTS

The literature search yielded 16,990 studies, of which 59 articles were ultimately included in the review. Most studies investigated non-steroidal anti-inflammatory drugs (NSAIDs, 27 studies, 28 reports) and intra-articular hyaluronic acid (IAHA, 16 studies). Symptomatic slow-acting drugs for osteoarthritis (SYSADOAs) were assessed in seven studies (one of which also assessed NSAIDs), and corticosteroid injections in four studies, while opioids and "herbal mixtures and other compounds" each were investigated respectively in three and two studies. Most of the studies were cohort studies (n = 44), others were case reports or case series (n = 12), RCTs (n = 2 reports of the same trial), or a case-control study (n = 1). The most commonly reported AEs with NSAIDs from cohort (sample sizes varied between 129 and 22,938 patients), RCT (21,645 patients with OA), and case-control (174 cases and 926 control patients with OA) studies were gastrointestinal (GI) and/or cardiovascular (CV) AEs, with specific AEs varying with individual NSAIDs. Where comparisons between NSAIDs were made, the overall literature shows a better or similar safety profile for celecoxib (at a daily dose of 200 mg, where dosage was reported) compared with other NSAIDs in regards to GI, CV and renal events. Other anti-OA medications with most common AEs reported from cohort studies were: IAHA (injection site pain); diacerein (GI AEs and reddish urine); avocado-soybean unsaponifiables (GI AEs); non-pharmaceutical-grade glucosamine and chondroitin (allergic reactions, GI disorders); opioids (hip fracture associated with long-term tramadol use among older adults; GI and nervous system disorders with hydrocodone); corticosteroid injections (increased risk of OA progression); herbal mixtures and other compounds (GI AEs). There were case reports or case series of specific AEs with various anti-OA medications that require further investigations in well-designed cohort studies before any definitive conclusions can be reached.

CONCLUSIONS

This SR confirms previous evidence on the safety of anti-OA medications from meta-analyses of phase 3 RCTs. Beyond the evidence here reported, the limitations of this research highlight the urgent need of a reporting guideline for post-marketing safety surveillance studies. Importantly, real-life safety surveillance of anti-OA medications should be strengthened with large cohort studies with control groups, and results should be disaggregated by disease populations for drugs common to several conditions.

Clinical and economic impact analysis of viscosupplementation with hylan G-F 20 versus hyaluronic acids and no viscosupplementation for the treatment of knee osteoarthritis in Colombia

BACKGROUND

Viscosupplementation is a viable alternative for managing knee osteoarthritis, showing potential to delay the need for total joint replacement in affected patients.

METHODS

We constructed an economic model that compared viscosupplementation with hylan G-F 20, with available hyaluronic acids, and no viscosupplementation over a 5-year period, from the perspective of the Colombian general health system. Time until total knee replacement, sourced from published literature, informed the model. Costs, including acquisition, administration, and knee replacement surgery, were sourced from the local drug prices database and the Ministry of Health's integral information system and expressed in USD.

RESULTS

Over 5 years, hylan G-F 20 demonstrated a total cost of USD$45,188,523 compared to hyaluronic acids (USD$50,247,826) and no viscosupplementation (USD$27,345,736). Hylan G-F 20 yielded 39,400 total knee replacement-free years, exceeding hyaluronic acid (30,741) and no viscosupplementation (4,280). Cumulative costs per surgery-free patient showed substantial savings, ranging from USD$1,158 to $6,847 for hylan G-F 20, compared to $1,164 to $74,662 for hyaluronic acid and $5,426 to $6,389 for no viscosupplementation.

CONCLUSIONS

Hylan G-F 20 showed reduced cost per surgery-free patient compared to hyaluronic acids and no viscosupplementation, enhancing knee replacement-free years.

Pharmacotherapy for Venous Thromboprophylaxis following Total Hip or Knee Arthroplasty: A Systematic Review and Network Meta-analysis

The optimal pharmacological prophylaxis for venous thromboembolism (VTE) after hip or knee arthroplasty is uncertain. We conducted a systematic review and network meta-analysis to compare the efficacy and safety of various medications. We searched multiple databases for randomized clinical trials (RCTs) comparing medications (including factor Xa inhibitors, factor IIa inhibitor, warfarin, unfractionated heparin [UFH], low-molecular-weight heparin [LMWH], aspirin, pentasaccharide) for VTE prophylaxis post-arthroplasty. Outcomes included any postoperative VTE identified with screening, major bleeding, and death. We used LMWH as the main comparator for analysis and performed trial sequential analysis (TSA) for each pairwise comparison. Certainty of evidence was assessed using GRADE (Grading of Recommendations, Assessments, Developments and Evaluations). We analyzed 70 RCTs (55,841 participants). Factor Xa inhibitors decreased postoperative VTE significantly compared with LMWH (odds ratio [OR]: 0.55, 95% confidence interval [CI]: 0.44-0.68, high certainty). Pentasaccharides probably reduce VTE (OR: 0.61, 95% CI: 0.36-1.02, moderate certainty), while the factor IIa inhibitor dabigatran may reduce VTE (OR: 0.75, 95% CI: 0.40-1.42, low certainty). UFH probably increases VTE compared with LMWH (OR: 1.31, 95% CI: 0.91-1.89, moderate certainty), and other agents like warfarin, aspirin, placebo, and usual care without thromboprophylaxis increase VTE (high certainty). Factor Xa inhibitors may not significantly affect major bleeding compared with LMWH (OR: 1.06, 95% CI: 0.81-1.39, low certainty). No medications had a notable effect on mortality compared with LMWH (very low certainty). TSA suggests sufficient evidence for the benefit of factor Xa inhibitors over LMWH for VTE prevention. Compared with LMWH and aspirin, factor Xa inhibitors are associated with reduced VTE after hip or knee arthroplasty, without an increase in bleeding and likely no impact on mortality.

Impact of self-management training on quality of life, medication adherence, and self-efficacy among rheumatoid arthritis patients

INTRODUCTION

Rheumatoid Arthritis(RA) can result in significant joint destruction and work disability which needs physical and psychosocial adjustment to deal with pain, and fatigue.

METHODS

True experimental parallel arm design with a pre-test post-test wait-listed control group was used to assess the impact of self-management training on Quality of life, medication adherence and self-efficacy among patients with RA. Participants were randomly allocated to the study(70) or control(70)group by simple randomization by the researcher. The study group underwent a self-management training consisting of six sessions over a 12-week period, while the control group received routine care. Importantly, the research assistant responsible for outcome assessment remained blinded to the treatment allocation at 1st, 3rd and 5th month post intervention using Short form- 36, Compliance Questionnaire, Rheumatology and Arthritis self efficacy scale.

RESULTS

The SMT led to significant improvements in QoL-physical components including Pain (p = 0.001, partial eta squared(η²) = 0.372) and General Health (p = 0.001, η² = 0.320). Significant between-group differences were observed for Pain (p = 0.007), while other measures showed no differences. Mental health components also improved significantly in the study group, particularly in Energy (p = 0.001, η² = 0.344). Medication adherence improved initially but stabilized over time. The study group showed significant improvements in self-efficacy for pain, function, and other symptoms (p < 0.009), with large effect sizes and sustained progress.

CONCLUSION

By empowering patients with knowledge, skills, and confidence to effectively manage their condition, such health educations can contribute significantly improve overall health outcomes.

The global burden of osteoarthritis knee: a secondary data analysis of a population-based study

BACKGROUND

Osteoarthritis knee poses a substantial and pervasive global health challenge.

METHODS

The data was extracted from the Global Burden of Disease 2021 Study database. First, numbers and age-standardized rates (ASRs) of incidence, prevalence, and disability-adjusted life years (DALYs) of osteoarthritis knee were assessed globally and by sub-types in 2021. Subsequently, we employed a linear regression model to analyze the temporal trends from 1990 to 2021. To predict the future burden, we utilized the age-period-cohort model and the Bayesian age-period-cohort model. Furthermore, we conducted a sensitivity analysis using the Autoregressive Integrated Moving Average model and the Exponential Smoothing model.

RESULTS

In 2021, osteoarthritis knee accounted for 30.85 million incidence cases, 374.74 million prevalence cases, and 12.02 million DALYs cases globally, with ASRs of 353.67, 4294.27, and 137.59, respectively. Females and individuals over 50 years old were identified as high-risk populations, while higher socio-demographic index regions emerged as high-risk areas. From 1990 to 2021, incidence cases rose from 14.13 million to 30.85 million, prevalence cases from 159.80 million to 374.74 million, and DALYs cases from 5.15 million to 12.02 million, accompanied by increases in their respective ASRs. Projections using the APC model predict a continued increase in incidence, prevalence, and DALYs cases for both genders until 2046. Specifically, male incidence cases are projected to increase to 18.45 million and female incidence to 25.60 million. Similarly, male prevalence cases are projected to rise to 235.41 million and female prevalence to 365.97 million. Male DALYs cases are expected to increase to 7.52 million and female DALYs to 11.55 million. The BAPC models also indicate an upward trend in number of cases.

CONCLUSION

In conclusion, osteoarthritis knee represents a formidable threat to global public health, necessitating the development of proactive and tailored strategic interventions that account for global-specific contexts. Key Points • Females and individuals over 50 years old were identified as high-risk populations. • Higher socio-demographic index regions were identified as high-risk areas. • The disease burden attributable to osteoarthritis knee increased from 1990 to 2019. • The number of deaths and DALYs cases would still increase in the next 25 years.

Projections and Epidemiology of Total Ankle and Revision Total Ankle Arthroplasty in the United States to 2030

Background: Total ankle arthroplasty (TAA) utilization is increasing in the United States. As the incidence of this procedure grows, it is important for providers to understand the future projections for ankle arthroplasty and more importantly revision total ankle arthroplasty (rTAA). Methods: The National Inpatient Sample (USA) was queried from 2005 to 2017 for all TAA and rTAA. Poisson and linear regression analysis was performed to project annual incidence of TAA and rTAA to 2030, with subgroup analyses on septic rTAA. Results: There were 5315 TAAs performed in 2017, a 564% (P < .001) increase when compared with the TAAs performed in 2005. From 2017 to 2030, the incidence of TAAs is projected to increase from 110% to 796% (P < .001). There were 1170 rTAAs performed in 2017, a 155% (P < .001) increase when compared with rTAAs performed in 2005. There was a 256% increase in the incidence of septic rTAAs from 2005 to 2017 with a projected increase between 22% and 120% by 2030. Conclusions: The incidence of both TAAs and rTAAs is projected to significantly increase over the next decade. Given the known risk factors of TAA and rTAA, these findings reinforce the need for thoughtful consideration when selecting patients for TAA.

Deciphering chondrocyte diversity in diabetic osteoarthritis through single-cell transcriptomics

The pathophysiological distinctions between osteoarthritis (OA) and diabetic osteoarthritis (DOA) are critical yet not well delineated. In this study, we employed single-cell RNA sequencing to clarify the unique cellular and molecular mechanisms underpinning the progression of both conditions. We identified a novel subpopulation of chondrocytes in DOA, termed 'Heat Shock' chondrocytes, marked by the expression of distinct molecular markers including HSPA1A, HSPA1B, HSPB1, and HSPA8. Our comprehensive gene expression analysis revealed a pronounced upregulation of inflammatory pathways associated with oxidative stress-namely the MAPK, NF-κB, and PI3K signaling pathways-in the effector and proliferating chondrocyte subpopulations, with a predominance in DOA. Further, our investigation into cell-cell communication demonstrated a significant diminution of intercellular signaling in DOA compared to OA. These insights not only elucidate distinct cellular heterogeneities and potential pathogenic mechanisms differentiating OA from DOA but also enhance our understanding of their molecular pathophysiology, offering novel avenues for targeted therapeutic strategies.

High-resolution microCT analysis of sclerotic subchondral bone beneath bone-on-bone wear grooves in severe osteoarthritis

Osteoarthritis (OA) is associated with sclerosis, a thickening of the subchondral bone plate, yet little is known about bone adaptations around full-thickness cartilage defects in severe knee OA, particularly beneath bone-on-bone wear grooves. This high-resolution micro-computed tomography (microCT) study aimed to quantify subchondral bone microstructure relative to cartilage defect location, distance from the joint space, and groove depth. Ten tibial plateaus with full-thickness cartilage defects were microCT-scanned to determine defect location and size. Wear groove depth was estimated as the thickness from its deepest point to a surface interpolated from the defect edges. Two 5 × 5 mm specimens were sampled from three regions (defect, edge, and cartilage-covered areas) and two from the contralateral condyle, then scanned at higher resolution. Bone density profiles were analyzed as a function of distance from the joint space to identify cortical and trabecular regions of interest and and compute their respective bone density and microstructure. Cortical bone beneath defects was four times thicker under wear grooves than beneath cartilage. Bone density profiles significantly differed between the three specimen types at depths up to 5 mm. Below defects, cortical porosity was 85 % higher, and trabecular density 14 % higher, than in cartilage-covered specimens. Some trabecular spaces were filled with woven bone-like tissue, forming a new cortical layer. These changes were confined to the defect region and ceased abruptly at the defect edge. No correlation was found between bone microstructural indices and the estimated groove depth. Our findings suggest an ongoing migration of the cortical layer during formation of the groove from its original position into the underlying trabecular bone, a process we termed "trabecular corticalization." Under deeper wear grooves, the new cortical layer exhibited large pores connecting bone marrow to the joint space, suggesting physiological limits to corticalization. These results highlight specific bone adaptations beneath cartilage defects in severe OA and provide insights into the progression of subchondral bone changes under bone-on-bone contact areas.

Improved performance of cementless total knee arthroplasty (TKA)across international registries: a comparative review

BACKGROUND

Cementless fixation in total knee arthroplasty (TKA) has been associated with higher revision rates in the past. However, due to advancements in design, as well as surgical techniques, cementless TKA performance has significantly improved. The advantages of cementless fixation include reduced cement-related complications, shorter operating times, and the potential benefits of osseointegration. We aim to assess the improvement in revision rates for cementless TKA over the last 9 years based on international registry reports.

METHODS

A comprehensive retrospective review was conducted of six major English-speaking knee arthroplasty registries across the world including the National Joint Registry of England and Wales, Northern Islan Isle of Man and Guernsey (herby referred to as British), Swedish, Canadian, American, Australian, and New Zealand National Joint Registry. Data was collected from the year 2014 along with the most recent annual report published: 2022 or 2023. Data points collected included usage rates of cemented and cementless prostheses for primary TKA, their respective revision rates, and indications for revision.

RESULTS

Across four databases, there was an average 8.3% increase in the utilization of cementless fixation for primary TKA over the past decade. Three registries reported a reduction in revision rates for cementless fixation. Lower revision rates for cementless compared to cemented TKA were observed in the most recent American (3.2% cemented vs. 2.8% cementless) and New Zealand annual reports (11.8% cemented vs. 4.5% cementless). In 2022, the British registry reported lower rates of revision for infection with cementless fixation (0.56 vs. 0.89).

CONCLUSION

International registries demonstrate increased utilization of cementless TKA. Cementless TKA was reported to have lower revision rates in the most recent US and New Zealand annual reports when compared to cemented TKA.

Defining Clinically Meaningful Thresholds for 12-Month Patient-Reported Outcomes in Total Hip Arthroplasty; Toward Improving Threshold Accuracy

Background

Clinically meaningful thresholds for patient-reported outcomes are relevant to define and predict success of total hip arthroplasties (THAs). Defining and offering thresholds must consider preoperative symptom severity.

Methods

In this retrospective study of 40,213 primary total hip replacements registered in the Dutch Arthroplasty Register (2016-2018), receiver operating curve analysis was used to define minimal clinically important changes and patient-acceptable symptom states with the anchor transition in function. Subgroups were identified for which independent thresholds should be defined. Patient-reported outcome measures were symptoms (pain, Oxford Hip Score [OHS], Hip disability and Osteoarthritis Outcome Score) and quality of life (European Quality of Life 5 Dimensions 3L questionnaire).

Results

94.6% completed the anchor questions, of whom 80.1% reporting "much improved function" 1 year after surgery. Discriminative abilities of thresholds were not good (area under the curve < 0.8). Tercile-specific determination of thresholds improved discrimination and reliability (+10%). Minimal clinically important change values were higher for all outcomes (eg, change in OHS ≥ 24.5 vs ≥ 10.5) in patients with more severe preoperative symptoms. Patient-acceptable symptom state scores for European Quality of Life 5 Dimensions index (≥ 0.809) and OHS (≥ 40.5) showed good discrimination (area under the curve > 0.8). Patients with less symptoms required lower postoperative scores for reporting "much improved function" (postoperative OHS ≥ 38.5 vs 42.5). Tercile-specific thresholds did not improve accuracy of thresholds (Cohens kappa 42%).

Conclusions

The present study demonstrates that patients with more severe preoperative symptoms require greater change scores to achieve clinically relevant improvements than patients with less severe preoperative symptoms. This study suggests that current one-size-fits-all thresholds for success of THA should be replaced with more nuanced thresholds.

Level of evidence

Level III, Therapeutic Study.

Risk factors for the development of knee osteoarthritis across the lifespan: a systematic review and meta-analysis

OBJECTIVE

To identify and quantify risk factors for incident knee osteoarthritis (KOA) across the lifespan.

METHODS

This systematic review and meta-analysis identified eligible studies from seven electronic databases and three registries. Longitudinal cohort studies or randomised controlled trials evaluating participants who developed incident symptomatic and/or radiographic KOA were included. Two independent reviewers completed data screening and extraction. Estimates were pooled using a random effects model and reported as odds ratio (OR), hazard ratio (HR), or risk ratio (RR) and corresponding 95% confidence intervals (95% CI). Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used to determine the certainty of evidence. Population attributable fractions (PAFs) were calculated, including risk factors significantly associated with radiographic KOA based on the pooled meta-analysis and where we could determine communality scores using existing clinical datasets.

RESULTS

We identified 132 studies evaluating >150 risk factors. Higher body mass index (BMI), previous knee injury, older age and high bone mineral density were associated with an increased risk of incident radiographic KOA based on the pooled analysis [OR (95% CI): 1.56 (1.25, 1.95), 3.02 (1.93, 4.71), 1.15 (1.00, 1.33) and 1.82 (1.12, 2.94), respectively], with moderate-to-high certainty. Two risk factors (overweight/obesity and previous knee injury) accounted for 14% of incident radiographic KOA. Other modifiable risk factors including occupational physical activity also contribute to radiographic or symptomatic KOA.

CONCLUSION

Novel strategies addressing known modifiable risk factors including overweight/obesity, knee injuries and occupational physical activity are needed to reduce overall burden of KOA.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO ID: CRD42023391187 FUNDING: Sydney Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney.

Synovial Fibroblast Extracellular Vesicles Induce Inflammation via Delivering miR-21-5p in Osteoarthritis

Small extracellular vesicles (sEVs) derived from different osteoarthritic (OA) tissues regulate OA-related biological processes through transporting their content (proteins, miRNAs, etc.) to recipient cells. This study aimed to characterize the miRNA profile of synovial fibroblasts-derived small EVs (FS_OA_sEVs) and investigate their role in inflammation in chondrocytes. Chondrocytes were isolated from macroscopically preserved and lesioned OA cartilage (C_OAmin and C_OAmax) and synovial fibroblasts from OA synovium. Synovial fibroblasts-derived small EVs (FS_OA_sEVs) were characterized according to ISEV guidelines and used for miRNA profiling and bioinformatics analysis. miR-21-5p was identified as one of the most abundant, and its target genes, such as KLF6, were enriched in OA-related processes including inflammation. Treatment of C_OAmin chondrocytes with FS_OA_sEVs resulted in decreased expression of COL2A1 and ACAN and an increase in catabolic markers MMP-3 and MMP-13. Moreover, C-OAmin receiving FS_OA_sEVs exhibited increased levels of inflammatory markers and miR-21-5p expression, resembling chondrocytes' phenotype from lesioned OA cartilage, whereas miR-21-5p inhibition reversed their expression of inflammatory markers and miR-21-5p. Compared to C_OA min, C_OAmax chondrocytes exhibited increased miR-21-5p and inflammatory markers expression and decreased KLF6 expression. miR-21-5p inhibition in C_OAmax led to KLF6 upregulation and suppression of inflammatory mediators, whereas co-treatment with siRNA against KLF6 negated this effect, confirming a potential direct regulatory relationship between miR-21-5p and KLF6. Our results provide novel insights into the FS_OA_sEV-mediated inflammation axis, highlighting FS_OA_sEV-derived miR-21-5p as a driver of OA progression via regulating inflammation in chondrocytes.

Assessing the quality of care for knee osteoarthritis in Singapore: a cross-sectional study

INTRODUCTION

The aim of this study was to assess the self-reported quality of care for people with knee osteoarthritis in Singapore and to investigate the associations between participant characteristics and functional outcomes at 1 year in relation to the reported quality of care.

METHODS

Patients with knee osteoarthritis completed the osteoarthritis quality indicator (OA-QI) questionnaire, a validated patient-reported measure that assesses the clinician's adherence to evidence-based guidelines for non-surgical knee osteoarthritis education and patient education. The OA-QI includes 17 indicators, with "achievement" defined as a 'Yes' response for each. We calculated individual per-item, overall per-item mean, and per-person achievement rates (%) and examined associations between participant characteristics, achievement rates, and function at 1 year.

RESULTS

A total of 314 participants completed the OA-QI. Referral for physical activity (87.5%) and referral for daily activity aid assessment (15.7%) had the highest and lowest per-item achievement rates, respectively. The overall mean per-item and per-person achievement rates were both 62.2%. Participants educated about steroid injections (adjusted coefficient [95% CI]: 7.23 [1.42-13.04]; p = 0.015) or surgery (adjusted coefficient [95% CI]: 12.65 [5.89-19.40]; p < 0.001) had worse functional outcomes at one year than those who were eligible but not informed. Those not assessed for walking aids and indicating walking issues had poorer outcomes one year later (adjusted coefficient [95% CI]: -9.89 (-19.63, -0.15); p = 0.0470). However, no significant associations were found between per-person achievement rates and 1-year functional outcomes.

CONCLUSIONS

The quality of care in Singapore for people with knee osteoarthritis is suboptimal, especially for those needing walking aids and weight loss assistance. However, the quality of care alone does not fully account for long-term outcomes, suggesting that other factors need to be considered.

Impact of low-load blood flow restriction training on knee osteoarthritis pain and muscle strength: a systematic review and meta-analysis of randomized controlled trials

Objectives

The effectiveness of low-load blood flow restriction training (LL-BFRT) in alleviating symptoms in patients with knee osteoarthritis (KOA) remains inconclusive. This systematic review and meta-analysis aim to comprehensively assess the effects of LL-BFRT compared to conventional resistance training on pain, muscle strength, and functional capacity in individuals with KOA.

Data sources

PubMed, Embase, Web of Science, EBSCO, Scopus, and Cochrane trails were searched.

Study selection

We included randomized controlled trials involving patients with KOA, in which the intervention group underwent LL-BFRT.

Data extraction

Literature quality and risk of bias were assessed using the Physiotherapy Evidence Database (PEDro) scale and the Cochrane Risk-of-Bias Tool (ROB 2). Data were extracted using a predefined table, including outcomes such as pain, quadriceps muscle strength, 30-s sit-to-stand test (30STS) and Timed Up and Go test (TUG).

Result

Ten studies were included in the meta-analysis. The pooled results indicated that, compared to conventional resistance training, LL-BFRT significantly improved knee joint pain [SMD = 0.25, 95%CI (0.02, 0.48), P = 0.03], increased quadriceps muscle strength [SMD = 0.46, 95%CI (0.04, 0.88), P = 0.03], and enhanced performance on the 30s sit-to-stand test (30STS) [WMD = 1.71, 95%CI (0.30, 3.11), P = 0.02]. However, no significant difference was observed in the improvement of the Timed Up and Go test (TUG) [WMD = -0.13, 95%CI (-0.51, 0.24), P = 0.49]. Subgroup analysis revealed that interventions with an occlusion pressure >100 mmHg and a duration ≤6 weeks had a significant impact on pain relief, quadriceps muscle strength, and the 30STS performance. For patients with KOA aged >65 years, LL-BFRT was more effective in alleviating pain, while for patients aged ≤65 years, it demonstrated more significant improvements in quadriceps strength and 30STS performance.

Conclusion

Limited evidence suggests that LL-BFRT may be more effective than conventional resistance training in improving pain, quadriceps muscle strength, and 30STS performance in patients with KOA, while exhibiting a comparable effect on TUG test.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/#myprospero, identifier CRD42024603542.

Gait Characteristics of Fallers and Nonfallers in Female Patients with Unilateral End-Stage Hip Osteoarthritis

BACKGROUND/OBJECTIVES

Osteoarthritis of the hip (hip OA) may increase the risk of falls. To decrease fall risk, it is important to assess the gait characteristics of patients with hip OA in detail. This study aimed to investigate the gait characteristics of patients with hip OA caused by falls by simultaneously assessing foot and waist trajectories via an inertial measurement unit (IMU).

METHODS

The subjects were 77 patients with hip OA, 17 of whom had fallen in the past year. The physical function, gait parameters, and waist trajectories of the fall and nonfall groups were compared.

RESULTS

Compared with the nonfall group, the fall group was older and had higher fall scores and lower Japan Orthopaedic Association (JOA) hip scores. With respect to gait characteristics, the stride length on the nonaffected side was significantly shorter in the fall group than in the nonfall group. Stride velocity gait asymmetry was also significantly lower in the fall group than in the nonfall group. The amount of lifting of the waist on the affected and nonaffected sides was significantly lower in the falling group than in the nonfalling group.

CONCLUSIONS

It was suggested that the fall group might be adapting to stabilization and adjusting to a stable and safe gait pattern because of the effects of falls; new gait characteristics regarding falls in patients with hip OA were found.

Microbiological Differences Among Age Groups in Patients Diagnosed With Periprosthetic Joint Infection: A Database Analysis of 2,392 Patients

INTRODUCTION

Periprosthetic joint infection (PJI) after total joint arthroplasty (TJA) poses substantial economic and quality-of-life challenges. With the rising incidence of hip and knee arthritis globally, understanding the changing profile of PJIs across different age groups becomes crucial. While various studies have explored risk factors, the influence of age on PJI remains debated, with potential bimodal relationships. This study aims to investigate the causative organisms of PJIs in patients of different age groups undergoing TJA.

METHODS

Conducted as a retrospective cohort study at a high-volume PJI referral center, the study adhered to Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Data spanned from January 1, 2001, to December 31, 2022, including patients with documented PJI undergoing revision TJA. Patients were categorized into age quintiles, and outcomes analyzed included causative organisms, difficult-to-treat infections, antimicrobial resistance, and Gram stain characteristics. Statistical analyses used descriptive statistics, chi-square tests, and sensitivity analyses for hip and knee patients separately.

RESULTS

The study comprised 2,392 patients, with 60.7% undergoing hip arthroplasty and 39.3% undergoing knee arthroplasty. 1,080 women (45.2%) and 1,312 men (54.8%) were included. Older patients were markedly more likely to have gram-negative infections and atypical infections. Patients in the youngest age group had the lowest rates of methicillin-resistant Staphylococcus aureus infection. Results were similar between hip and knee PJIs.

CONCLUSIONS

The study reveals age-related variations in the characteristics of PJIs after TJA, emphasizing higher risks of atypical and resistant infections in older patients. These findings underscore the importance of tailored preventive measures and potential considerations for adjunctive or prolonged antibiotic therapies, especially in the elderly population. Recognizing the unique infection patterns in older patients may inform better prevention and treatment strategies, with implications for enhanced patient care and outcomes. Future directions should focus on patient-specific strategies for preventing and treating PJIs, particularly in high-risk populations.

Comparison of hyaluronic acid and platelet-rich plasma in knee osteoarthritis: a systematic review

BACKGROUND

Knee osteoarthritis (KOA) is a common joint disorder, and intra-articular injections of hyaluronic acid (HA) or platelet-rich plasma (PRP) are frequently employed therapeutic interventions. However, there remains controversy regarding their efficacy. This systematic review aims to compare the effectiveness and safety of HA and PRP through a meta-analysis, with the objective of identifying the optimal treatment protocol for KOA and enhancing its management.

METHODS

Randomized controlled trials evaluating the clinical outcomes of patients receiving intra-articular injections of either HA or PRP were included as eligible studies. Two independent investigators assessed the selected studies and evaluated their risk of bias. Primary outcome measures included the Visual Analog Scale (VAS) score, the Western Ontario and McMaster Universities Arthritis Index (WOMAC) score, and other relevant assessment indices. Dichotomous variables were analyzed using risk ratios (RR) with 95% confidence intervals (CI). Data analysis was conducted using RevMan software (version 5.3).

RESULTS

A total of forty-two randomized controlled trials were included in this meta-analysis. No significant differences were observed between the patient populations in the two groups. The analysis demonstrated that PRP resulted in lower VAS and WOMAC scores compared to HA. Additionally, PRP exhibited superior performance across other evaluation indices. Notably, the incidence of adverse events was higher in the PRP group; however, all reported complications were mild.

CONCLUSIONS

Based on the current evidence, intra-articular injection of PRP appears to be more effective than HA for the treatment of KOA, as indicated by the analysis of VAS, WOMAC scores, and other evaluation indices.

TRIAL REGISTRATION

Retrospectively registered.

Effects of intra-articular applied rat BMSCs expressing alpha-calcitonin gene-related peptide or substance P on osteoarthritis pathogenesis in a murine surgical osteoarthritis model

BACKGROUND

About 655 million persons worldwide are affected by osteoarthritis (OA). As no therapy modifies disease progression long-term, there is an immense clinical need for novel therapies. The joints are innervated by alpha calcitonin gene-related peptide (αCGRP)- and substance P (SP)-positive sensory nerve fibers. Both neuropeptides have trophic effects on target cells within the joints. The aim of this study was to examine the effects of SP- and αCGRP-expressing intra-articular (i.a.) applied rat(r)BMSC on cartilage and subchondral bone structural changes after OA induction.

METHODS

Mice were subjected to destabilization of the medial meniscus (DMM) surgery, followed by i.a. injections with rBMSC, transduced with lacZ, SP or αCGRP. 2, 8 and 16 weeks after DMM/Sham surgery, motion analysis and serum marker analysis were performed. Cartilage and subchondral bone properties were assessed by OA scoring, atomic force microscopy and nano-CT analysis.

RESULTS

OARSI scores of the medial cartilage compartments indicated induction and progression of OA after DMM surgery in all groups. Differences between the treatment groups were mostly restricted to the lateral cartilage compartments, where αCGRP caused a decrease of structural changes. DMM-rBMSC-αCGRP or -SP mice displayed decreased cartilage stiffness in the cartilage middle zone. DMM-rBMSC-αCGRP mice revealed improved mobility, whereas Sham-rBMSC-SP mice revealed reduced mobility compared to rBMSC-lacZ. With respect to condyle length, subarticular bone and ephiphyseal bone morphology, DMM-rBMSC-SP mice had more alterations indicating either a more progressed OA stage or a more severe OA pathology compared to controls. In addition, DMM-rBMSC-SP mice developed osteophytes already 8 weeks after surgery. Adiponectin serum level was increased in DMM-rBMSC-αCGRP mice, and MIP1b level in DMM-rBMSC-SP mice. Notably, pain and inflammation markers increased over time in rBMSC-SP mice while rBMSC-αCGRP mice revealed a bell-shaped curve with a peak at 8 weeks.

CONCLUSIONS

We conclude that i.a. injection of rBMSC in general have a beneficial effect on cartilage matrix structure, subchondral bone microarchitecture and inflammation. rBMSC-αCGRP have anabolic and possible analgesic properties and may attenuate the progression or severity of OA. In contrast, rBMSC-SP exert a more catabolic influence on knee joints of both, Sham and DMM mice, making it a potential candidate for inhibition studies.

Research Progress and Hot Topics in Telerehabilitation for Hip or Knee Arthroplasty

OBJECTIVE

Many publications on telerehabilitation for hip or knee arthroplasty have been published in recent years. However, no specific studies have attempted to characterize research hotspots, global research collaborations, or trends related to telerehabilitation after hip or knee arthroplasty. Therefore, the aim of this bibliometric analysis was to provide an overview of the current status of research and map the research landscape on telerehabilitation for joint replacement to understand current trends, identify research gaps, and guide future research directions.

METHODS

The Web of Science Core Collection and PubMed were comprehensively searched to identify all relevant English-language documents published from 2003 to June 7, 2024. Data from these published studies were then cleaned and structured. CiteSpace and VOSviewer were used to conduct the bibliometric visualization and comparative analysis of countries, institutions, journals, authors, references, and keywords. Then, the map illustrating the research hotspots and knowledge structure was plotted based on the analysis results.

RESULTS

A total of 229 records were obtained, and the number of articles published has increased steadily over the investigated period. The largest increase was observed in 2022. With the highest number of publications and centrality, the United States was the most influential country. The University of Sherbrooke was the most productive institution. Author Boissy P. ranked first in terms of the number of publications, while Tousignant M. ranked highest in cited authors, with 7 publications and 65 citations. The Journal of Arthroplasty published the greatest number of articles, with 29 publications. The most popular keywords from 2018 to 2023 were "home telerehabilitation," "older adults," and "physical therapy". In terms of the strongest citation burst, the top five keywords were associated with "total knee arthroplasty," "in home tele rehabilitation," "physical activity," "motion," and "range." The frontier keywords were "patient satisfaction," "mobile application," "self-efficacy," "fear avoidance model," "home assessment tool," and "cost benefit analysis."

CONCLUSIONS

The current status and trends in telerehabilitation for hip or knee arthroplasty are presented. A major concern at present is physical therapy for home telerehabilitation in the elderly. In the future, mobile app-based telerehabilitation programs for arthroplasty will continue to be encouraged, and some outcomes, such as "patient satisfaction," "self-efficacy," and "cost benefit analysis," are expected to receive more attention. Our work will serve as a valuable resource, providing fundamental references and a directional guide for future research.

Instant gait classification for hip osteoarthritis patients: a non-wearable sensor approach utilizing Pearson correlation, SMAPE, and GMM

This study aims to establish a methodology for classifying gait patterns in patients with hip osteoarthritis without the use of wearable sensors. Although patients with the same pathological condition may exhibit significantly different gait patterns, an accurate and efficient classification system is needed: one that reduces the effort and preparation time for both patients and clinicians, allowing gait analysis and classification without the need for cumbersome sensors like EMG or camera-based systems. The proposed methodology follows three key steps. First, ground reaction forces are measured in three directions-anterior-posterior, medial-lateral, and vertical-using a force plate during gait analysis. These force data are then evaluated through two approaches: trend similarity is assessed using the Pearson correlation coefficient, while scale similarity is measured with the Symmetric Mean Absolute Percentage Error (SMAPE), comparing results with healthy controls. Finally, Gaussian Mixture Models (GMM) are applied to cluster both healthy controls and patients, grouping the patients into distinct categories based on six quantified metrics derived from the correlation and SMAPE. Using the proposed methodology, 16 patients with hip osteoarthritis were successfully categorized into two distinct gait groups (Group 1 and Group 2). The gait patterns of these groups were further analyzed by comparing joint moments and angles in the lower limbs among healthy individuals and the classified patient groups. This study demonstrates that gait pattern classification can be reliably achieved using only force-plate data, offering a practical tool for personalized rehabilitation in hip osteoarthritis patients. By incorporating quantitative variables that capture both gait trends and scale, the methodology efficiently classifies patients with just 2-3 ms of natural walking. This minimizes the burden on patients while delivering a more accurate and realistic assessment. The proposed approach maintains a level of accuracy comparable to more complex methods, while being easier to implement and more accessible in clinical settings.

Association of walking cadence to changes in knee pain and physical function: The multicenter osteoarthritis study

Objective

Determine the association of walking cadence to incident and worsening knee pain and physical function over 2 years in adults with or at risk for knee OA.

Design

Participants from the Multicenter Osteoarthritis study were included.Cadence was measured using a GAITRite walkway. Incident and worsening knee symptoms, pain with walking, and functional limitations were assessed at baseline and 2 years later. The association of cadence to each outcome was analyzed using log binomial regression. Cadence was assessed continuously as a 10-unit change and categorically using quartiles. Analyses were adjusted for age, sex, race, BMI, presence of tibiofemoral OA, depression, and history of knee injury. Sensitivity analyses were conducted for all outcomes adjusted for gait speed and stratified by sex.

Results

Among 1600 participants (60.3 ​% female, age 67.1 ​± ​7.7 years), lower cadence was not significantly associated with incident or worsening knee symptoms, pain with walking, or functional limitations. For every 10-step/min decrease in cadence, the risk of incident knee symptoms increased by 10 ​% (RR ​= ​1.10, 95%CI [0.97, 1.25]), though this was not statistically significant and was attenuated after adjusting for gait speed (RR ​= ​0.95, 95%CI [0.80, 1.12]). No significant associations were observed for incident or worsening pain with walking or functional limitations. Sex-stratified analyses revealed inconsistent findings, including an increased risk for incident functional limitations in females (RR ​= ​1.45, 95%CI [1.02, 2.08]), which was attenuated after adjusting for gait speed.

Conclusion

Lower cadence was not significantly associated with pain and function, suggesting that the interplay between cadence, gait speed, and clinical outcomes warrants further investigation.

Everyday living with osteoarthritis in the global South: A qualitative focus group inquiry in Nigeria

Objective

Africa contributes significantly to the increasing global prevalence (>37 ​%), unmet need and treatment burden for people with osteoarthritis. Despite this, little research has examined the expressed needs of patients with osteoarthritis (OA) and joint pain in West-Africa. This study aimed to explore lived experiences, expressed needs and current care gaps for people living with osteoarthritis in low-health resource contexts using Nigeria as a case study.

Design

Qualitative study using Focus Groups. People aged 45 years and over living with osteoarthritis and joint pain were recruited at local health services or via wide advertisements in the community. Discussions were recorded and transcribed verbatim. Data were analyzed using thematic analysis (inductive approach).

Results

Three focus groups were conducted with people living with osteoarthritis (n ​= ​30, age range 45-90 years) across socio-demographic strata. Participants described their experiences of living with osteoarthritis as emotionally, physically, and socio-economically challenging. Four main themes (and 14 sub-themes) were identified. Participants expressed the need for an information and health education campaign and access to appropriate health professionals (especially physiotherapists) for providing support, guidance, and assistance with self-management.

Conclusions

The provision of an accessible, and contextually appropriate patient education package, in line with evidence-based recommendations is a critical need for people living with osteoarthritis in Nigeria. This will promote evidence-based care for OA in low-resource settings, empowering patients to self-manage and reducing confusion related to inconsistent advice and mixed messages about cause, healthcare access and OA care.

Thigh muscle features in female patients with severe knee osteoarthritis: a cross-sectional study

BACKGROUND

Muscle function deterioration in female patients with severe knee osteoarthritis (KOA) is linked to alterations in muscle morphology, composition, and mechanical properties. This study evaluates thigh muscle features in female patients with severe KOA and explores correlations with knee joint function.

METHODS

Ultrasound and shear wave elastography measured physiological cross-sectional area (PCSA), echo intensity (EI), and shear modulus (G) in the rectus femoris (RF), vastus lateralis (VL), vastus medialis (VM), biceps femoris long head (BFL), and semitendinosus (ST) of 24 KOA patients and 24 controls. EI indicates intramuscular fat, while G reflects stiffness. Muscle characteristics were compared between groups, and correlations with knee function scores (WOMAC, KSS, HSS) were analyzed.

RESULTS

In patients, the symptomatic side displayed reduced PCSA for RF, VL, VM, BFL, and ST (15.85[Formula: see text], 28.18[Formula: see text], 21.53[Formula: see text], 11.67[Formula: see text], 6.59[Formula: see text] respectively) vs. controls (19[Formula: see text], 36.32[Formula: see text], 23.37[Formula: see text], 14.15[Formula: see text], 7.12[Formula: see text] respectively). EI was elevated (128.95, 121.12, 105.72, 90.52, 93.15) vs. controls (100.39, 93.97, 88.14, 77.69, 78.73), and G values (9.48 kPa, 7.88 kPa, 6.9 kPa, 7.2 kPa, 9.03 kPa) was higher than controls (8.85 kPa, 5.28 kPa, 5.98 kPa, 6.58 kPa, 6.73 kPa). BFL`s G, ST`s G, and VM`s EI, negatively correlated with knee function, whereas BFL`s PCSA positively correlated. The variable importance of BFL's PCSA and G ranked at the top in all scores.

CONCLUSIONS

Compared to controls, PCSAs in muscles on both sides of KOA patients were lowered by up to 22%, indicative of muscle loss and diminished strength. The G value is 20.65% higher, suggesting poor flexibility and elevated passive tension. EI in muscles on both sides of KOA patients was greater, reaching up to 23.88%, possibly reducing contractile components and muscle force. G, PCSA, and EI are closely correlated with function scores, and PCSA and G of BFL are the most significant predictors of knee function. These results may help explain muscle dysfunction in KOA patients.

CLINICAL TRIAL NUMBER

Not applicable.

EMMATKA trial: the effects of mobilization with movement following total knee arthroplasty in women: a single-blind randomized controlled trial

BACKGROUND

Mobilization with Movement (MWM) is an examination and management approach for correcting the intra-articular translational and rotational movements to facilitate the active physiological movement. The study aimed to determine the effects of MWM on Total Knee Arthroplasty (TKA) using a randomized controlled trial (RCT) design.

METHODS

The trial is registered (ISRCTN ref: 13,028,992). A blinded examiner assessed patients at pre-surgical (before TKA), post-surgical (at 3-weeks post-TKA), 6-weeks and 6-months post-TKA. Participants were randomly assigned to receive MWM (six sessions, between 3 and 6 weeks post-TKA) plus standard rehabilitation (intervention group) or standard rehabilitation alone (control group) of outpatient rehabilitation including range of motion and strengthening exercises, cycling, gait and stair training. Outcome measures were range of motion (goniometer), pain (visual analogue scales), physical function (Timed Up and Go (TUG)), a 15-m walk test, and health status (Western Ontario and McMaster (WOMAC) Osteoarthritis Index). Change in outcome measures from post-surgical to 6 weeks and 6 months post-TKA were compared between groups. The primary outcome was change in knee flexion range of motion at 6 weeks.

RESULTS

84 women scheduled for TKA were randomly allocated to intervention (n = 42) or control (n = 42); mean ± (SD) age 65.1 ± 7.4 and 66.8 ± 8.9 years, respectively. The intervention group demonstrated significantly greater increase in knee flexion at both 6 weeks (median (IQR) + 10.000 (20.000) compared with + 2.500 (6.250) in the control group) and 6 months (+ 12.500 (15.000) and + 5.000 (10.000) respectively) (both p < 0.05). There were no differences between groups in secondary outcomes.

CONCLUSION

Introducing MWM for TKA rehabilitation has greater benefits for women post-TKA in increasing knee joint flexion range of motion than the standard rehabilitation programs in the short and medium-term. This evidence-based approach offers a promising adjunctive intervention for optimizing recovery and rehabilitation process following TKA in women. Clinicians should consider including MWM approach in post-TKA rehabilitation programs.

LEVEL OF EVIDENCE

I.

Gender-differences in imaging phenotypes of osteoarthritis in the osteoarthritis initiative

In osteoarthritis (OA) research it is increasingly recognized that stratification according to disease phenotypes is essential for optimizing treatment regimens. Gender-specific differences in clinical OA manifestations have been identified, and this analysis aimed to assess whether these differences extend to imaging phenotypes.From the Osteoarthritis Initiative database 2523 participants (1409 women and 1114 men) with completed 3T MRI and whole-organ magnetic resonance imaging scores (WORMS) of the right knee at baseline were included. Imaging phenotypes were assigned based on modified Rapid OsteoArthritis MRI Eligibility Score: the inflammatory, meniscus-cartilage, and bone phenotype. Logistic regression was performed to investigate the effect of gender on phenotype, independent of BMI, race, Kellgren & Lawrence (KL) grade and level of physical activity. Female gender was independently associated with lower odds for the meniscus-cartilage (OR 0.61, 95%CI 0.47-0.80, p < 0.001) but not for the inflammatory (OR 1.04, 95%CI 0.89-1.24, p = 0.697) or the subchondral bone phenotype (OR 1.13, 95%CI 0.95-1.36, p = 0.166). This difference highlights an opportunity for future refinements to better accommodate gender/sex differences in disease trajectories while investigating different treatment regimes in knee OA.

Analgesic effects of intraarterial injection of imipenem/cilastatin sodium in a rat model of knee osteoarthritis

Angiogenesis plays a role in the mechanism underlying musculoskeletal pain; thus, embolization of blood vessels may exert an analgesic effect. Recent clinical studies have reported promising therapeutic outcomes for arterial embolization in knee osteoarthritis (OA). However, the placebo effect in human studies cannot be ignored, underscoring the need for objective evidence to validate the analgesic effects. However, basic research data supporting this role are limited. Thus, we investigated the analgesic effect of intraarterial administration of imipenem/cilastatin sodium (IPM/CS) in a model of knee OA induced by monosodium iodoacetate (MIA) using Sprague-Dawley rats. First, we infused IPM/CS in the right femoral artery and investigated the knee joint mechanical pressure threshold using pressure application measurement (PAM). Next, the nociceptive signals originating from the knee were analyzed via the spontaneous excitatory postsynaptic current (sEPSC) recording within the neural cells in the dorsal spinal horn using the in vivo patch-clamp recording. In the model of knee OA, the mechanical thresholds at the damaged knee were decreased compared with those of the contralateral knee, whereas these thresholds remained stable in the sham group (p < 0.05). The pressure threshold of the model of knee OA was significantly increased following intraarterial infusion of IPM/CS but not saline (p < 0.05). A notable decrease in the average sEPSC frequency in the model of knee OA following intraarterial infusion of IPM/CS but not saline (p < 0.05). These results indicated that intraarterial infusion of IPM/CS attenuated nociception caused by knee OA.

Clinical efficacy of cell-free fat extract and its effects on bone marrow edema in patients with early to mid-stage knee osteoarthritis: a clinical trial in comparison with hyaluronic acid

BACKGROUND

Previous studies have shown that hyaluronic acid can delay the progression of knee osteoarthritis. Existing research has extracted a bright red fluid called cell-free fat extract from human adipose tissue, which may play an important role in delaying the progression of osteoarthritis. By comparing with intra-articular injection of hyaluronic acid, this study aimed to evaluate the effects of intra-articular injection of CEFFE on both clinical efficacy and the reduction of bone marrow edema in patients with early to mid-stage knee osteoarthritis.

METHODS

A total of 48 patients with KOA (Kellgren-Lawrence grade II-III) symptoms were randomly divided into CEFFE group (24 cases) and HA group (24 cases). The patients in the CEFFE group received five injections of CEFFE (2 ml, 1 time/week), and the patients in the HA group received five injections of HA (2 ml, 1 ml/10 mg, 1 time/week). All the patients underwent clinical assessments using rating scales, including VAS, WOMAC and Lysholm Knee Score. These assessments were conducted at pre-treatment and at 3-week, 6-week, 3-month, and 6-month follow-up timepoints post-treatment. The clinical efficacy was evaluated at the 6-month follow-up after the treatment. The changes in subchondral bone marrow edema before and 6 months after treatment were assessed by grading BME on MRI of the affected knees.

RESULTS

A total of 52 knees from 46 patients were included in the final analysis. Comparison of VAS score, WOMAC score, and Lysholm score between the two groups revealed that the differences between pre-treatment and 3 weeks post-treatment were not statistically significant (P > 0.05). For the VAS score and WOMAC score at 6 weeks, 3 months, and 6 months post-treatment, the CEFFE group was lower than the HA group (P < 0.05). For the Lysholm score, the CEFFE group was higher than the HA group (P < 0.05). Compared with pre-treatment, VAS scores and WOMAC scores were lower and Lysholm scores were higher at all post-treatment time points (P < 0.05). At 6 months post-treatment, the clinical efficacy of the CEFFE group was significantly better than that of the HA group (P < 0.05). At 6 months post-treatment, MRI grading showed that subchondral BME was reduced to different degrees in both groups, with the reduction being more pronounced in the CEFFE group (P < 0.05).

CONCLUSION

This study demonstrated that intra-articular injection of CEFFE into the knee joint could enhance the durability of tissue-specific cells (especially chondrocytes) and improve cellular metabolic processes, preventing the continued progression of osteoarthritis. Both CEFFE and HA were found to improve clinical symptoms and reduced subchondral bone marrow edema in the treatment of early to mid-stage knee osteoarthritis. However, CEFFE was more effective than HA in achieving these outcomes.

Effects of X-ray-based diagnosis and explanation of knee osteoarthritis on patient beliefs about osteoarthritis management: A randomised clinical trial

BACKGROUND

Although X-rays are not recommended for routine diagnosis of osteoarthritis (OA), clinicians and patients often use or expect X-rays. We evaluated whether: (i) a radiographic diagnosis and explanation of knee OA influences patient beliefs about management, compared to a clinical diagnosis and explanation that does not involve X-rays; and (ii) showing the patient their X-ray images when explaining radiographic report findings influences beliefs, compared to not showing X-ray images.

METHODS AND FINDINGS

This was a 3-arm randomised controlled trial conducted between May 23, 2024 and May 28, 2024 as a single exposure (no follow-up) online survey. A total of 617 people aged ≥45 years, with and without chronic knee pain, were recruited from the Australian-wide community. Participants were presented with a hypothetical scenario where their knee was painful for 6 months and they had made an appointment with a general practitioner (primary care physician). Participants were randomly allocated to one of 3 groups where they watched a 2-min video of the general practitioner providing them with either: (i) clinical explanation of knee OA (no X-rays); (ii) radiographic explanation (not showing X-ray images); or (iii) radiographic explanation (showing X-ray images). Primary comparisons were: (i) clinical explanation (no X-rays) versus radiographic explanation (showing X-ray images); and (ii) radiographic explanation (not showing X-ray images) versus radiographic explanation (showing X-ray images). Primary outcomes were perceived (i) necessity of joint replacement surgery; and (ii) helpfulness of exercise and physical activity, both measured on 11-point numeric rating scales (NRS) ranging 0 to 10. Compared to clinical explanation (no X-rays), those who received radiographic explanation (showing X-ray images) believed surgery was more necessary (mean 3.3 [standard deviation: 2.7] versus 4.5 [2.7], respectively; mean difference 1.1 [Bonferroni-adjusted 95% confidence interval: 0.5, 1.8]), but there were no differences in beliefs about the helpfulness of exercise and physical activity (mean 7.9 [standard deviation: 1.9] versus 7.5 [2.2], respectively; mean difference -0.4 [Bonferroni-adjusted 95% confidence interval: -0.9, 0.1]). There were no differences in beliefs between radiographic explanation with and without showing X-ray images (for beliefs about necessity of surgery: mean 4.5 [standard deviation: 2.7] versus 3.9 [2.6], respectively; mean difference 0.5 [Bonferroni-adjusted 95% confidence interval: -0.1, 1.2]; for beliefs about helpfulness of exercise and physical activity: mean 7.5 [standard deviation: 2.2] versus 7.7 [2.0], respectively; mean difference -0.2 [Bonferroni-adjusted 95% confidence interval: -0.7, 0.3]). Limitations of our study included the fact that participants were responding to a hypothetical scenario, and so findings may not necessarily translate to real-world clinical situations, and that it is unclear whether effects would impact subsequent OA management behaviours.

CONCLUSIONS

An X-ray-based diagnosis and explanation of knee OA may have potentially undesirable effects on people's beliefs about management.

TRIAL REGISTRATION

ACTRN12624000622505.

Simultaneous vs Staged Procedures for Bilateral Total Knee Arthroplasty: Reduced Infection, Cost, and Readmission Rates Associated With Simultaneous Procedures

Background

Many patients require total knee arthroplasty (TKA) bilaterally; however, there is limited data on bilateral procedures. This study aims to compare medical and surgical complications and hospital-related outcomes between simultaneous and staged bilateral TKA. We hypothesize that staged procedures will have superior outcomes.

Methods

This retrospective cohort study queried the National Readmissions Database, years 2016-2020, for patients undergoing bilateral TKA via ICD-10 codes. For patients undergoing staged procedures, outcomes were compared in aggregate for comparison to simultaneous operations. Multivariate regression was performed to assess complications. Negative binomial regression was utilized for 30-day readmission, reoperation, and discharge disposition. Quasi-Poisson regression was performed to assess total charges. Demographics and comorbidities, measured via Elixhauser Comorbidity Index, were controlled for in our analysis.

Results

A total of 210,682 patients, 89,568 (42.51%) undergoing simultaneous bilateral and 121,115 (57.49%) undergoing staged bilateral TKA, were included. The staged cohort had higher odds of medical complications (odds ratio (OR), 1.14; P < .001), reduced surgical complications (OR, 0.51; P < .001), and increased odds of routine discharges (OR, 1.39; P < .001). They also had increased odds of readmission (OR, 1.25; P < .001), reoperation (OR, 1.56; P < .001), and greater total charges (OR, 1.18; P < .001).

Conclusions

Our results demonstrate that, for some patients, simultaneous procedures may be a viable option. While staged operations were associated with reduced surgical complications and resulted in better discharge dispositions, they were also associated with greater medical complications, readmissions, reoperations, and total cost. Surgeons should consider individual patient risks and preferences when planning bilateral TKA.

An Innovative Anoikis Signature With Inflammatory Infiltrates in Osteoarthritis

AIM

To explore the relationship between an innovative anoikis-related gene signature and inflammatory infiltrates in patients with osteoarthritis.

METHODS

Gene expression profiles (GSM1248759 and GSE200843) were curated from the Gene Expression Omnibus database, followed by the construction of a protein-protein interaction network. Functional and genomic enrichment analyses were conducted using Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) databases. The CIBERSORT method was employed to investigate immune cell infiltration differences between osteoarthritic and control tissues. Additionally, the ConsensusClusterPlus package in R software was utilized to identify distinct anoikis patterns (Cluster C1 and Cluster C2) and conduct molecular biological investigations.

RESULTS

Analysis revealed two distinct anoikis patterns (Cluster C1 and Cluster C2), with Cluster C2 patients exhibiting varying immune cell levels compared to Cluster C1 patients. Molecular investigations identified 84 DEGs enriched in specific pathways such as adipocytokine signaling, cytokine-cytokine receptor interaction, ECM-receptor interaction, and the PPAR signaling pathway. qPCR experiments confirmed the elevated expression levels of specific genes, including SOD2, MAPK14, CEACM3, LAMB3, COL13A1, TLR3, NOTCH3, and KLF12, in the IL-1β-induced group compared with the osteoarthritis group.

CONCLUSION

This study highlights the role of anoikis-related genes and immune infiltration differences in osteoarthritis, enhancing our understanding of its development.

The potential molecular markers of inflammatory response in KOA with AD based on single-cell transcriptome sequencing analysis and identification of ligands by virtual screening

Alzheimer's disease (AD) and osteoarthritis (OA) are both senile degenerative diseases. Clinical studies have found that OA patients have a significantly increased risk of AD in their later life. This study hypothesized that chronic aseptic inflammation might lead to AD in KOA patients. However, current research has not yet clarified the potential mechanism between AD and KOA. Therefore, this study intends to use KOA transcriptional profiling and single-cell sequencing analysis technology to explore the molecular mechanism of KOA affecting AD development, and screen potential molecular biomarkers and drugs for the prediction, diagnosis, and prognosis of AD in KOA patients. It was found that the higher the expression of TXNIP, MMP3, and MMP13, the higher the risk coefficient of AD was. In addition, the AUC of TXNIP, MMP3, and MMP13 were all greater than 0.70, which had good diagnostic significance for AD. Finally, through the virtual screening of core proteins in FDA drugs and molecular dynamics simulation, it was found that compound Cobicistat could be targeted to TXNIP, Itc could be targeted to MMP3, and Isavuconazonium could be targeted to MMP13. To sum up, TXNIP, MMP3, and MMP13 are prospective molecular markers in KOA with AD, which could be used to predict, diagnose, and prognosis.

Effectiveness of mHealth Interventions to Improve Pain Intensity and Functional Disability in Individuals With Hip or Knee Osteoarthritis: A Systematic Review and Meta-analysis

OBJECTIVE

This review aimed to investigate the effectiveness of mHealth-supported active exercise interventions to reduce pain intensity and disability level in persons with hip or knee osteoarthritis (OA).

DATA SOURCES

Three databases (PubMed, Cochrane Library, and Web of Science) were systematically searched for randomized controlled trials (RCTs) published between January 1, 2012 and July 31, 2023. PROSPERO registration number of this review was CRD42023394119.

STUDY SELECTION

We included only RCTs that were identified and screened by 2 independent reviewers (J.M. and G.N.). In addition, the reference lists of the identified studies were manually checked for further inclusion. Included studies had to provide mHealth-supported active exercises for persons with hip or knee OA, and evaluate pain intensity and disability using both questionnaires and performance tests.

DATA EXTRACTION

From the included studies, the 2 independent authors extracted data using a predetermined Excel form. Characteristics of the interventions were described and a meta-analysis was performed.

DATA SYNTHESIS

Twelve RCTs were included, representing 1541 patients with a mean age of 58.7±5 years, and a body mass index of 28.8±3.1 kg/m2; women being more predominant than men with a total female to male ratio of 2.2. The methodological quality of the included studies was moderate in 75% of the studies. There was no statistically significant difference between mHealth-supported active exercises compared with the interventions without mHealth in terms of pain reduction (standard mean differences [SMD]=-0.42; 95% CI, -0.91 to 0.07; P=.08) and disability mitigation (SMD=-0.36; 95% CI, -0.81 to 0.09; P=.10). However, a statistically significant difference was found between patient education combined with mHealth-supported active exercises compared with patient education alone in terms of pain (SMD= -0.42; 95% CI, -0.61 to -0.22; P<.01) and disability (SMD=-0.27; 95% CI, -0.46 to -0.08; P<.01) reduction.

CONCLUSIONS

mHealth-supported exercises were found to be effective, especially when combined with patient education, in reducing pain and mitigating disability in patients with hip or knee OA.

Evaluation of Safety and Efficacy of a Single Lorecivivint Injection in Patients with Knee Osteoarthritis: A Multicenter, Observational Extension Trial

INTRODUCTION

Lorecivivint (LOR), a CDC-like kinase/dual-specificity tyrosine kinase (CLK/DYRK) inhibitor thought to modulate inflammatory and Wnt pathways, is being developed as a potential intra-articular knee osteoarthritis (OA) treatment. The objective of this trial was to evaluate long-term safety of LOR within an observational extension of two phase 2 trials.

METHODS

This 60-month, observational extension study (NCT02951026) of a 12-month phase 2a trial (NCT02536833) and 6-month phase 2b trial (NCT03122860) was administratively closed after 36 months as data inferences became limited. Participants received a single intra-articular LOR or placebo (PBO) injection at their parent-trial baseline. The primary outcome was the comparative incidence of serious adverse events (SAEs), with AEs and similar safety measures comprising secondary outcomes. A post hoc baseline-adjusted analysis of covariance (ANCOVA) compared changes from baseline in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain and Function subscores and medial joint space width (JSW) between LOR 0.07 mg and PBO groups in a subpopulation of participants with unilateral knee pain and widespread pain low enough to allow participants to differentiate their target knee pain.

RESULTS

The safety analysis set for the extension study included 495 LOR-treated and 208 control participants, with 409 (82.6%) and 175 (84.1%) remaining at study close, respectively. There were 68 SAEs reported in 38 (5.4%) patients; none were considered treatment-related by investigators. The incidence of AEs was similar between groups. In the post hoc subgroup efficacy analyses, LOR 0.07 mg demonstrated greater mean improvements from baseline compared with PBO in WOMAC pain and function scores out to 12 months post-injection. No between-group differences in medial JSW were observed out to 18 months.

CONCLUSIONS

LOR appeared generally safe and well tolerated. Efficacy analyses on the subset of completer patients demonstrated durable symptom improvements in WOMAC pain and function for at least 12 months compared to PBO after a single injection of LOR.

CLINICAL TRIAL REGISTRATION NUMBER

NCT02951026.

Mendelian randomization analysis of female reproductive factors on osteoarthritis

Epidemiology shows women have a higher incidence of osteoarthritis (OA) than men. However, there is not enough evidence to suggest a direct correlation between female reproductive factors and OA. Therefore, this study will employ Mendelian randomization (MR) analysis to investigate whether there is a causal relationship between the 2. This study used a 2-sample MR analysis with single nucleotide polymorphisms significantly associated with female reproductive factors as instrumental variables (IV). We used inverse variance weighted (IVW), MR-Egger regression, weighted median method to infer a causal relationship between female reproductive factors and OA, Cochran Q heterogeneity test by IVW and MR-Egger method, MR PRESSO method and IVW-radial method to detect outliers, MR_pleiotropy_test function and MR PRESSO method for multivariate validity test, and calculation of F-value was used to assess the presence of weak IVs. Finally, the stability of the findings was assessed using the leave-one-out method. Our research shows that there is no reliable causal relationship between an increase in Age at menarche (years) (AAM) and Age at menopause (years) (AM) and OA, that an increase in Age first had sexual intercourse (years) (AFS) is associated with a decreased risk of knee OA and/or hip OA and hand OA, that an increase in Age at first live birth (years) (AFB) is associated with a decreased risk of knee OA and/or hip OA and knee OA, and that an increase in Number of live births (NOB) is associated with an increased risk of knee OA and/or hip OA. This study provides genetic support for an increase in AFS as a reduced knee OA and/or hip OA and hand OA risk factor, an increase in AFB as a reduced knee OA and/or hip OA and knee OA risk factor, and an increase in NOB as an increased knee OA and/or hip OA risk factor. Further studies are needed to elucidate the potential mechanisms underlying the causal associations between AFS, AFB, and NOB and site-specific OA.

Shining light on knee osteoarthritis: an overview of vitamin D supplementation studies

Background

The impact of knee osteoarthritis on individuals' daily functioning is significant. In recent years, Vitamin D supplements cure osteoarthritis has garnered attention from medical professionals and patients due to its simplicity and portability. Several systematic reviews (SRs) and meta-analyses (MAs) have examined the efficacy of vitamin D supplementation for knee osteoarthritis, yet there is variability in their methodology and quality.

Objective

To search, gather, and analyze data on the characteristics and quantitative results of SR/MA in patients with KOA treated with Vitamin D supplementation, and objectively evaluate the efficacy of supplements. Then, provides clinical evidence and recommendations the clinical use of vitamin D supplementation.

Methods

Two individuals reviewed and collected data from four databases until October 2023. AMSTAR-2, ROBIS, PRISMA 2020, and GRADE tools were used to evaluate the methodological quality, bias risk, reporting quality, and evidence strength of all SR/MA. Additionally, we applied the corrected covered area (CCA) method to measure overlap in randomized controlled trials (RCTs) cited among the SR/MA.

Results

3 SRs and 6 MAs were included in the analysis: 3 studies were low quality by AMSTAR-2, and 6 studies were very low quality. According to ROBIS, 6 studies were high-risk and 3 were low-risk. In PRISMA 2020 reporting quality, most studies showed deficiencies in comprehensive literature search strategy, reasons for literature exclusion, data preprocessing for meta-analysis, exploration of reasons for heterogeneity, sensitivity analysis, publication bias, and disclosure of funding and conflicts of interest. Grading the quality of evidence in GRADE consisted of 5 items of moderate quality, 14 items of low quality, and 10 items of very low quality. Bias risk and imprecision were the main factors for downgrading. The calculation of RCT overlap between SR/MA using CCA showed a high degree of overlap.

Conclusion

Vitamin D supplementation may show potential efficacy in ameliorating symptoms of KOA. The evidence indicates that Vitamin D supplements for knee osteoarthritis can improve patients' Total WOMAC scores and synovial fluid volume in the joints. Nevertheless, due to the generally low quality of current studies, future research should prioritize improving the quality of primary studies to establish the efficacy of vitamin D supplementation for KOA with more robust scientific evidence.

Systematic review registration

The protocol of this overview was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (https://www.crd.york.ac.uk/PROSPERO/) with the registration number CRD42024535841.