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Rizkalla JM, Gladnick BP, Bhimani AA, Wood DS, Kitziger KJ, Peters PC. Triaging Total Hip Arthroplasty During the COVID-19 Pandemic. Curr Rev Musculoskelet Med 2020; 13:416-424. [PMID: 32444993 PMCID: PMC7242608 DOI: 10.1007/s12178-020-09642-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review was to evaluate the available literature to determine what may be considered urgent indications for total hip arthroplasty, in the unprecedented setting of the worldwide COVID-19 pandemic. RECENT FINDINGS SARS-CoV-2 is a novel coronavirus currently presenting in the form of a global pandemic, referred to as COVID-19. In this setting, multiple states have issued executive orders prohibiting "elective" surgery, including arthroplasty, in order to preserve healthcare resources. However, during this unprecedented reduction in elective surgery, there is likely to be some controversy as to what constitutes a purely "elective" procedure, versus an "urgent" procedure, particularly regarding hip arthroplasty. We reviewed the available literature for articles discussing the most commonly encountered indications for primary, conversion, and revision hip arthroplasty. Based upon the indications discussed in these articles, we further stratified these indications into "elective" versus "urgent" categories. In patients presenting with hip arthroplasty indications, the decision to proceed urgently with surgery should be based upon (a) the potential harm incurred by the patient if the surgery was delayed and (b) the potential risk incurred by the patient in the context of COVID-19 if surgery was performed. The authors present a decision-making algorithm for determining surgical urgency in three patients who underwent surgery in this context. Urgent total hip arthroplasty in the setting of the COVID-19 pandemic is a complex decision-making process, involving clinical and epidemiological factors. These decisions are best made in coordination with a multidisciplinary committee of one's peers. Region-specific issues such as hospital resources and availability of PPE may also inform the decision-making process.
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Affiliation(s)
- James M. Rizkalla
- Department of Orthopaedic Surgery, Baylor University Medical Center, 3500 Gaston Ave., Dallas, TX 75246 USA
| | - Brian P. Gladnick
- Adult Hip and Knee Reconstruction, W.B. Carrell Memorial Clinic, 9301 N. Central Expressway, Suite 500, Dallas, TX 75231 USA
| | - Aamir A. Bhimani
- Department of Orthopaedic Surgery, Baylor University Medical Center, 3500 Gaston Ave., Dallas, TX 75246 USA
| | - Dorian S. Wood
- Department of Orthopaedic Surgery, Baylor University Medical Center, 3500 Gaston Ave., Dallas, TX 75246 USA
| | - Kurt J. Kitziger
- Adult Hip and Knee Reconstruction, W.B. Carrell Memorial Clinic, 9301 N. Central Expressway, Suite 500, Dallas, TX 75231 USA
| | - Paul C. Peters
- Adult Hip and Knee Reconstruction, W.B. Carrell Memorial Clinic, 9301 N. Central Expressway, Suite 500, Dallas, TX 75231 USA
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102
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Progressive Osteoarthritis of the Hip. Orthop Nurs 2020; 39:270-272. [PMID: 32701787 DOI: 10.1097/nor.0000000000000687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Diamond LE, Hoang HX, Barrett RS, Loureiro A, Constantinou M, Lloyd DG, Pizzolato C. Individuals with mild-to-moderate hip osteoarthritis walk with lower hip joint contact forces despite higher levels of muscle co-contraction compared to healthy individuals. Osteoarthritis Cartilage 2020; 28:924-931. [PMID: 32360739 DOI: 10.1016/j.joca.2020.04.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 04/06/2020] [Accepted: 04/20/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare hip joint contact forces (HJCF), hip muscle forces, and hip muscle co-contraction levels between individuals with mild-to-moderate hip osteoarthritis (OA) and healthy controls during walking. DESIGN Eighteen participants with mild-to-moderate hip OA and 23 healthy controls walked at a self-selected speed while motion capture and electromyographic data were synchronously collected. HJCF were computed using a calibrated electromyography-informed neuromusculoskeletal model. Hip joint contact forces, muscle forces, and co-contraction indices for flexor/extensor and adductor/abductor muscle groups were compared between groups using independent sample t-tests (P < 0.05). RESULTS There was no between-group difference in self-selected walking speed. On average, participants with hip OA walked with 11% lower first peak (mean difference 235 [95% confidence interval (CI) 57-413] N) and 22% lower second peak (mean difference 574 [95%CI 304-844] N) HJCF compared to controls. Hip muscle forces were also significantly lower in the hip OA compared to control group at first (mean difference 224 [95%CI 66-382] N) and second (mean difference 782 [95%CI 399-1164] N) peak HJCF. Participants with hip OA exhibited higher levels of hip muscle co-contraction in both flexor/extensor and adductor/abductor muscle groups. Consistent with existing literature, hip joint angles (extension, adduction) and external moments (flexion, extension, adduction) were lower in hip OA compared to controls. CONCLUSION Lower HJCF were detected in mild-to-moderate hip OA, primarily due to lower hip muscle force production, and despite higher levels of hip muscle co-contraction. Findings suggest that lower loading of the hip joint during walking is a feature of mild-to-moderate hip OA, which could have implications for the pathogenesis of hip OA and/or disease progression.
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Affiliation(s)
- L E Diamond
- School of Allied Health Sciences, Griffith University, Gold Coast, Australia; Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia; Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health & Rehabilitation Sciences, The University of Queensland, Queensland, Australia.
| | - H X Hoang
- Department of Movement Sciences, KU Leuven, Leuven, Belgium.
| | - R S Barrett
- School of Allied Health Sciences, Griffith University, Gold Coast, Australia; Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.
| | - A Loureiro
- Faculty of Physical Education and Sports, UNISINOS, São Leopoldo, Brazil.
| | - M Constantinou
- School of Physiotherapy, Australian Catholic University, Brisbane, Australia.
| | - D G Lloyd
- School of Allied Health Sciences, Griffith University, Gold Coast, Australia; Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.
| | - C Pizzolato
- School of Allied Health Sciences, Griffith University, Gold Coast, Australia; Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.
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104
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Degerstedt Å, Alinaghizadeh H, Thorstensson CA, Olsson CB. High self-efficacy - a predictor of reduced pain and higher levels of physical activity among patients with osteoarthritis: an observational study. BMC Musculoskelet Disord 2020; 21:380. [PMID: 32534579 PMCID: PMC7293780 DOI: 10.1186/s12891-020-03407-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 06/05/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Self-efficacy is considered a core component in self-management. However, there is a lack of knowledge about the association between self-efficacy and health-related outcomes in osteoarthritis. The aim of this study was to investigate whether self-efficacy at baseline was associated with change over time in pain and physical activity after a supported osteoarthritis self-management programme. METHODS A total of 3266 patients with hip or knee osteoarthritis attended this observational, register-based study. Self-efficacy was assessed using the Arthritis Self-Efficacy Scale. Pain was estimated on a visual analogue scale and physical activity by self-reporting number of days per week the patients were physically active ≥30 min. Data were self-reported at baseline and at follow-ups after 3 and 12 months. Analyses were performed using a mixed linear model analysis and are presented with an unadjusted and an adjusted model. RESULTS High vs low self-efficacy for pain management at baseline resulted in reduced pain and increased physical activity at the follow-ups; least squares means and standard error were 37.43 ± 0.40 vs 44.26 ± 0.40, for pain, and 5.05 ± 0.07 vs 4.90 ± 0.08 for physical activity. High self-efficacy for management of other symptoms resulted in lower pain and higher physical activity at follow-up: 35.78 ± 0.71 vs 41.76 ± 0.71 for pain, and 5.08 ± 0.05 vs 4.72 ± 0.05 for physical activity. Patients with obesity reported lower activity levels at the follow-ups. CONCLUSION Self-efficacy at baseline was associated with change over time in pain and physical activity at 3 and 12 months after the supported osteoarthritis self-management programme. High self-efficacy had a positive effect on pain and physical activity, indicating the need for exploring and strengthening patients' self-efficacy. Patients with obesity may need further interventions and support during a self-management programme to achieve an increase in physical activity.
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Affiliation(s)
- Åsa Degerstedt
- Team Aktiv Primärvårdsrehab, Stockholm, Hässelby, Sweden
| | | | - Carina A Thorstensson
- Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Department of Medicine, Karolinska Institutet, Stockholm, Solna, Sweden
| | - Christina B Olsson
- Academic Primary Healthcare Centre, Stockholm, Region Stockholm, Sweden. .,Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden. .,Danderyds akademiska vårdcentral, Golfvägen 8, 182 31, Danderyd, Sweden.
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105
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Ren L, Meng L, Yan H, Sun W, Yao D. Preoperative meloxicam versus postoperative meloxicam for pain control, patients' satisfaction and function recovery in hip osteoarthritis patients who receive total hip arthroplasty: a randomized, controlled study. Inflammopharmacology 2020; 28:831-838. [PMID: 32506275 PMCID: PMC7363719 DOI: 10.1007/s10787-020-00718-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 04/29/2020] [Indexed: 01/01/2023]
Abstract
This study aimed to compare the analgesic effect, patients’ satisfaction, tolerance and hip-joint function recovery by preoperative meloxicam versus postoperative meloxicam in treating hip osteoarthritis (OA) patients receiving total hip arthroplasty (THA). 132 hip OA patients who underwent THA surgery were allocated into postoperative analgesia (POST) and preoperative analgesia (PRE) groups at a 1:1 ratio. In the PRE group, patients took meloxicam 15 mg at 24 h pre-operation, 7.5 mg at 4 h, 24 h, 48 h and 72 h post-operation; in the POST group, patients received meloxicam 15 mg at 4 h post-operation, then 7.5 mg at 24 h, 48 h and 72 h post-operation. Furthermore, postoperative pain, consumption of patient-controlled analgesia (PCA), overall satisfaction and adverse events were evaluated within 96 h post-operation; meanwhile, Harris hip score was assessed within 6 months post-operation. Pain VAS at rest at 6 h, 12 h, 24 h, and pain VAS at passive movement at 6 h, 12 h were decreased in PRE group compared to POST group. In addition, additional consumption of PCA and the total consumption of PCA were both reduced in PRE group compared to POST group. Additionally, overall satisfaction in PRE group was higher at 24 h, 48 h and 72 h compared to POST group. While Harris hip score was of no difference between POST group and PRE group at M3 or M6. Besides, no difference in adverse events incidence was found between the two groups. In conclusion, preoperative meloxicam achieves better efficacy and similar tolerance compared to postoperative meloxicam in hip OA patients post THA.
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Affiliation(s)
- Lingyun Ren
- Department of Anesthesiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No. 26, Shengli Street, Wuhan, 430014, People's Republic of China
| | - Li Meng
- Department of Anesthesiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No. 26, Shengli Street, Wuhan, 430014, People's Republic of China
| | - Hong Yan
- Department of Anesthesiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No. 26, Shengli Street, Wuhan, 430014, People's Republic of China.
| | - Wei Sun
- Department of Anesthesiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No. 26, Shengli Street, Wuhan, 430014, People's Republic of China
| | - Dan Yao
- Department of Anesthesiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No. 26, Shengli Street, Wuhan, 430014, People's Republic of China
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106
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Stasi S, Stamou M, Papathanasiou G, Frantzeskaki P, Kanavas E, Evaggelou-Sossidis G, Gouskos A, Palantzas A, Poursanidis K, Macheras GA. International Hip Outcome Tool (12-items) as health-related quality-of-life measure in osteoarthritis: validation of Greek version. J Patient Rep Outcomes 2020; 4:41. [PMID: 32462334 PMCID: PMC7253559 DOI: 10.1186/s41687-020-00207-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 05/12/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The 12-item International Hip Outcome Tool (iHOT12) is a patient-reported outcome (PRO) designed to evaluate quality of life. We assessed the psychometric properties of the Greek version (iHOT12-Gr) in hip osteoarthritic patients. METHODS Data from 124 patients aged > 50 years were used for factor analysis. Reliability evaluation included internal consistency, test-retest reliability, and interpretability. Content validity was examined by calculating the item-level content validity indices (I-CVI) and the scale-level content validity indices (S-CVI), using two methods: S-CVI Average (S-CVI/Ave), and the S-CVI Universal Agreement among experts (S-CVI/UA). Construct validity was tested against Greek versions of the Lower Extremity Functional Scale (LEFS-Greek), Modified Harris Hip Score (MHHS-Gr), and the 30 s chair-to-stand, Timed Up & Go (TUG), and 9-stairs-ascend/descend (9S-A/D) tests. Known-groups validity was examined using LEFS-Greek (cut-off = 53 points) as estimate variable. Responsiveness was examined pre and post total hip arthroplasty (4 and 8 weeks). RESULTS Factor analysis revealed a two-factor model. Factor-1 (items 1-9) reflects "Symptoms and functionality", while Factor-2 (items 10-12) reflects "Hip disorder-related concerns". Reliability: Internal consistency and test-retest reliability of iHOT12-Gr-total were excellent: Cronbach's alpha > 0.92 and ICC(95% CI) > 0.976(0.96-0.99)(p < 0.001). Interpretability: There was no floor or ceiling effect; measurement error: 3.72 (Factor-1), 3.64 (Factor-2), and 3.22 (iHOT12-Gr-total); minimal detectable change: 10.3 (Factor-1), 10.1 (Factor-2), and 8.92 (iHOT12-Gr-total). VALIDITY Content validity: The I-CVI value of the 12 items ranged from 1.00 to 0.83, the S-CVI/Ave was 0.97 and the S-CVI/UA was 0.83. Construct validity: iHOT12-Gr correlated strongly with both LEFS-Greek and MHHS-Gr, and weakly but significantly with 30s chair-to-stand, TUG and 9S-A/D (p < 0.001). Known-groups validity showed that iHOT12-Gr well discriminated subgroups of patients (p < 0.001). ROC analysis cut-off points were 51.9 (Factor-1), 25 (Factor-2) and 45.2 (iHOT12-Gr-total) (p < 0.001). Responsiveness: Four and 8 weeks postoperatively, standardized response means of Factor-1, Factor-2, and iHOT12-Gr-total were > 0.8. CONCLUSION iHOT12-Gr showed excellent reliability properties. The content validity was excellent and significant weak-to-strong correlations were found regarding construct validity. The known-group validity was also significant, while the responsiveness was excellent. iHOT12-Gr could be a reliable and valid PRO for assessing quality of life in patients with hip osteoarthritis.
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Affiliation(s)
- Sophia Stasi
- Laboratory of Neuromuscular and Cardiovascular Study of Motion, Physiotherapy Department, Faculty of Health and Care Sciences, University of West Attica, Campus 1, 28 Agiou Spyridonos St., 12243, Egaleo, Attica, Greece.
| | - Magdalini Stamou
- Laboratory of Neuromuscular and Cardiovascular Study of Motion, Physiotherapy Department, Faculty of Health and Care Sciences, University of West Attica, Campus 1, 28 Agiou Spyridonos St., 12243, Egaleo, Attica, Greece
| | - George Papathanasiou
- Laboratory of Neuromuscular and Cardiovascular Study of Motion, Physiotherapy Department, Faculty of Health and Care Sciences, University of West Attica, Campus 1, 28 Agiou Spyridonos St., 12243, Egaleo, Attica, Greece
| | - Paraskevi Frantzeskaki
- Laboratory of Neuromuscular and Cardiovascular Study of Motion, Physiotherapy Department, Faculty of Health and Care Sciences, University of West Attica, Campus 1, 28 Agiou Spyridonos St., 12243, Egaleo, Attica, Greece
| | - Emmanouil Kanavas
- Laboratory of Neuromuscular and Cardiovascular Study of Motion, Physiotherapy Department, Faculty of Health and Care Sciences, University of West Attica, Campus 1, 28 Agiou Spyridonos St., 12243, Egaleo, Attica, Greece
| | - George Evaggelou-Sossidis
- Laboratory of Neuromuscular and Cardiovascular Study of Motion, Physiotherapy Department, Faculty of Health and Care Sciences, University of West Attica, Campus 1, 28 Agiou Spyridonos St., 12243, Egaleo, Attica, Greece
| | - Adamantios Gouskos
- Laboratory of Neuromuscular and Cardiovascular Study of Motion, Physiotherapy Department, Faculty of Health and Care Sciences, University of West Attica, Campus 1, 28 Agiou Spyridonos St., 12243, Egaleo, Attica, Greece
| | - Andreas Palantzas
- Laboratory of Neuromuscular and Cardiovascular Study of Motion, Physiotherapy Department, Faculty of Health and Care Sciences, University of West Attica, Campus 1, 28 Agiou Spyridonos St., 12243, Egaleo, Attica, Greece
| | - Kyriakos Poursanidis
- Laboratory of Neuromuscular and Cardiovascular Study of Motion, Physiotherapy Department, Faculty of Health and Care Sciences, University of West Attica, Campus 1, 28 Agiou Spyridonos St., 12243, Egaleo, Attica, Greece
| | - George A Macheras
- Laboratory of Neuromuscular and Cardiovascular Study of Motion, Physiotherapy Department, Faculty of Health and Care Sciences, University of West Attica, Campus 1, 28 Agiou Spyridonos St., 12243, Egaleo, Attica, Greece
- 4th Department of Orthopaedics, "KAT" General Hospital of Attica, 2 Nikis St., Kifissia, 14561, Athens, Greece
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107
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Aguilera-Bohórquez B, Brugiatti M, Coaquira R, Cardozo O, Cantor E. Functional Outcomes of Arthroscopic Treatment in Femoroacetabular Impingement in Patients over 60 Years Old Compared with Patients Aged 40 Years or Younger. Rev Bras Ortop 2020; 55:715-721. [PMID: 33364649 PMCID: PMC7748922 DOI: 10.1055/s-0040-1708515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 12/20/2019] [Indexed: 11/18/2022] Open
Abstract
Objective
To evaluate the functional outcomes of patients diagnosed with femoroacetabular impingement (FAI) older than 60 years, compared with those of patients of age 40 years or younger.
Methods
This was a retrospective review of patients with FAI who underwent hip arthroscopy between 2010 and 2015. The patients were adults aged over 60 years with Tönnis ≤ 1 matched in a 1:1 ratio with adults aged 40 years or younger, according to the type of deformity (cam, pincer, or mixed), sex, and the date when the surgery was performed.
Results
Thirty-four patients were included in each group. The mean age was 30.6 ± 6.9 years and 65.6 ± 4.6 years in the control and case groups, respectively. There were no significant differences between the groups at 1-year follow-up (
p
> 0.05). In the group with older patients (case group), we observed a change in the total Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score from 46.3 to 22.0 in the 1
st
postoperative year, while the control cases improved in the WOMAC score from 38.1 to 7.2 in relation to the preoperative stage.
Conclusion
In the group of patients ≤ 40 years old, a considerable change was observed in the WOMAC score without a statistical significance compared with the > 60 years group. This observation suggests that hip arthroscopy is beneficial when there is an appropriate selection of patients with FAI, regardless the age of the patient.
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Affiliation(s)
- Bernardo Aguilera-Bohórquez
- Unidade de Preservação do Quadril, Instituto de Doenças Osteoarticulares, Centro Médico Imbanaco, Cali, Colômbia
| | - Miguel Brugiatti
- Centro Médico Imbanaco, Pontificia Universidad Javeriana de Cali, Cali, Colômbia
| | - Ruddy Coaquira
- Centro Médico Imbanaco, Pontificia Universidad Javeriana de Cali, Cali, Colômbia
| | - Orlando Cardozo
- Centro Médico Imbanaco, Pontificia Universidad Javeriana de Cali, Cali, Colômbia
| | - Erika Cantor
- Centro Médico Imbanaco, Research Institute, Cali, Colômbia
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Abbasifard M, Kamiab Z, Bagheri-Hosseinabadi Z, Sadeghi I. The role and function of long non-coding RNAs in osteoarthritis. Exp Mol Pathol 2020; 114:104407. [PMID: 32088191 DOI: 10.1016/j.yexmp.2020.104407] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 01/03/2020] [Accepted: 02/19/2020] [Indexed: 12/20/2022]
Abstract
Osteoarthiritis (OA) is the most prevalent disease of articulating joints in human that frequently results in joint pain, movement limitations, inflammation, and progressive degradation of articular cartilage. The etiology of OA is not completely clear and there is no full treatment for this disease. Molecular investigations have revealed the involvement of non-coding RNAs such as Long non-coding RNAs (lncRNAs) in OA pathogenesis. LncRNAs play roles in multiple cellular and biological processes. Moreover, numerous lncRNAs are differentially expressed in human OA cartilage. In this review, we underlie the increasing evidence for the critical role of lncRNAs in OA pathogenesis reviewing the latest researches.
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Affiliation(s)
- Mitra Abbasifard
- Department of Internal Medicine, Ali-Ibn Abi-Talib Hospital, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Zahra Kamiab
- Department of Family Medicine, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran; Clinical Research Development Unit, Ali Ibn Abi Talib Hospital, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Zahra Bagheri-Hosseinabadi
- Department of Clinical Biochemistry, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
| | - Iman Sadeghi
- Centre for Genomic Regulation (CRG), The Barcelona Institute for Science and Technology, Dr. Aiguader 88, Barcelona, E-08003 Catalonia, Spain; CEINGE-biotecnologie avanzate, Naples, Italy.
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109
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Frysz M, Gregory JS, Aspden RM, Paternoster L, Tobias JH. The effect of pubertal timing, as reflected by height tempo, on proximal femur shape: Findings from a population-based study in adolescents. Bone 2020; 131:115179. [PMID: 31794847 PMCID: PMC6961111 DOI: 10.1016/j.bone.2019.115179] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 11/05/2019] [Accepted: 11/27/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To examine the relationship between pubertal timing (using measures of height tempo) and proximal femur shape in a large adolescent cohort. METHODS Hip DXA scans were obtained in offspring from the Avon Longitudinal Study of Parents and Children. To quantify hip morphology, the images were analyzed using Shape software based on a 53-point statistical shape model and independent modes of variation (hip shape mode (HSM) scores) for each image were generated. Height tempo (which corresponds to age at peak height velocity (aPHV)) was estimated from serial height measurements collected between age 5-20 years. Multivariable linear regression was used to examine cross-sectional associations between height tempo and the top ten HSMs at age 14 and 18, adjusting for sex and fat mass index (FMI). RESULTS Complete outcome and covariate data were available from 3827 and 3507 participants at age 14 and 18 years, respectively. Mean aPHV was 13.5 and 11.8 years for males and females, respectively. At age 14, height tempo was associated with a majority of modes, except for HSM4 and there was strong evidence of interaction by sex. In males, all modes showed evidence of an association with tempo, independent of FMI, with the strongest observed for HSM8 (adjusted β 0.38 (0.33, 0.43) p = 4.1 × 10-50). Compared with males, the associations were generally weaker in females, with the strongest effect observed for HSM8 (adjusted β 0.10 (0.05, 0.14) p = 1.6 × 10-5). The overall effect of later pubertal timing on proximal femur shape in males was a narrower femoral neck and larger superolateral head, whereas in females these changes were hard to discern. When assessed at age 18, there was little relationship between tempo and proximal femur shape in either sex. CONCLUSION Our results indicate that significant changes in hip shape occur during puberty, including aspects of shape which may be related to future risk of hip OA and/or fracture. However, puberty timing per se does not appear to exert long lasting effects on proximal femur shape.
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Affiliation(s)
- Monika Frysz
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Medical Research Council Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Jennifer S Gregory
- Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Richard M Aspden
- Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Lavinia Paternoster
- Medical Research Council Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, UK; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jonathan H Tobias
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Medical Research Council Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, UK
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110
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Gielis WP, Weinans H, Welsing PMJ, van Spil WE, Agricola R, Cootes TF, de Jong PA, Lindner C. An automated workflow based on hip shape improves personalized risk prediction for hip osteoarthritis in the CHECK study. Osteoarthritis Cartilage 2020; 28:62-70. [PMID: 31604136 DOI: 10.1016/j.joca.2019.09.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 09/07/2019] [Accepted: 09/22/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To design an automated workflow for hip radiographs focused on joint shape and tests its prognostic value for future hip osteoarthritis. DESIGN We used baseline and 8-year follow-up data from 1,002 participants of the CHECK-study. The primary outcome was definite radiographic hip osteoarthritis (rHOA) (Kellgren-Lawrence grade ≥2 or joint replacement) at 8-year follow-up. We designed a method to automatically segment the hip joint from radiographs. Subsequently, we applied machine learning algorithms (elastic net with automated parameter optimization) to provide the Shape-Score, a single value describing the risk for future rHOA based solely on joint shape. We built and internally validated prediction models using baseline demographics, physical examination, and radiologists scores and tested the added prognostic value of the Shape-Score using Area-Under-the-Curve (AUC). Missing data was imputed by multiple imputation by chained equations. Only hips with pain in the corresponding leg were included. RESULTS 84% were female, mean age was 56 (±5.1) years, mean BMI 26.3 (±4.2). Of 1,044 hips with pain at baseline and complete follow-up, 143 showed radiographic osteoarthritis and 42 were replaced. 91.5% of the hips had follow-up data available. The Shape-Score was a significant predictor of rHOA (odds ratio per decimal increase 5.21, 95%-CI (3.74-7.24)). The prediction model using demographics, physical examination, and radiologists scores demonstrated an AUC of 0.795, 95%-CI (0.757-0.834). After addition of the Shape-Score the AUC rose to 0.864, 95%-CI (0.833-0.895). CONCLUSIONS Our Shape-Score, automatically derived from radiographs using a novel machine learning workflow, may strongly improve risk prediction in hip osteoarthritis.
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Affiliation(s)
- W P Gielis
- UMC Utrecht, Department of Orthopedics and Department of Radiology, Utrecht, the Netherlands.
| | - H Weinans
- UMC Utrecht, Department of Orthopedics and Department of Rheumatology & Clinical Immunology, Utrecht, the Netherlands; TU Delft, Department of Biomechanical Engineering, Delft, the Netherlands.
| | - P M J Welsing
- UMC Utrecht, Department of Rheumatology & Clinical Immunology, Utrecht, the Netherlands.
| | - W E van Spil
- UMC Utrecht, Department of Rheumatology & Clinical Immunology, Utrecht, the Netherlands.
| | - R Agricola
- Erasmus MC, Department of Orthopedics, Rotterdam, the Netherlands.
| | - T F Cootes
- University of Manchester, Division of Informatics, Imaging & Data Sciences, Manchester, United Kingdom.
| | - P A de Jong
- UMC Utrecht, Department of Radiology, Utrecht, the Netherlands.
| | - C Lindner
- University of Manchester, Division of Informatics, Imaging & Data Sciences, Manchester, United Kingdom.
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Ellegaard M, Bieler T, Beyer N, Kjaer M, Jørgensen NR. The effect of 4 months exercise training on systemic biomarkers of cartilage and bone turnover in hip osteoarthritis patients. TRANSLATIONAL SPORTS MEDICINE 2020. [DOI: 10.1002/tsm2.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Maria Ellegaard
- Department of Clinical Biochemistry Rigshospitalet Copenhagen Denmark
| | - Theresa Bieler
- Department of Physical & Occupational Therapy Bispebjerg and Frederiksberg Hospital, University of Copenhagen Copenhagen Denmark
| | - Nina Beyer
- Institute for Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Michael Kjaer
- Institute of Sports Medicine Copenhagen Bispebjerg and Frederiksberg Hospital, University of Copenhagen Copenhagen Denmark
- Center for Healthy Aging, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Niklas R. Jørgensen
- Department of Clinical Biochemistry Rigshospitalet Copenhagen Denmark
- University of Southern Denmark Odense Denmark
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Zeng ZP, Liu YB, Fang J, Liu Y, Luo J, Yang M. Effects of Baduanjin exercise for knee osteoarthritis: A systematic review and meta-analysis. Complement Ther Med 2019; 48:102279. [PMID: 31987253 DOI: 10.1016/j.ctim.2019.102279] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 10/30/2019] [Accepted: 12/11/2019] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES Baduanjin is a Chinese form of low-intensity aerobic exercise that consists of eight movements. It is one of the most common forms of Chinese Qigong exercise, which originated during the Song dynasty and has a history of more than 1000 years. The aim of this research was to assess the efficacy of Baduanjin exercise for knee osteoarthritis (KOA). METHODS A literature search was conducted of 10 databases (Web of Science, AMED, Scopus, CINAHL, MEDLINE, EMBASE, KoreaMed Synapse, Oriental Medicine Advanced Searching Integrated System, Chinese Wan Fang and China National Knowledge Infrastructure) from their inception to June 2019. We included eligible randomised controlled trials (RCTs) in which Baduanjin was employed either alone or as an adjuvant treatment for baseline interventions in patients with KOA. The Western Ontario and McMaster Universities Arthritis Index (WOMAC), Visual Analogue Scale (VAS) and response rate were used as important outcomes in this research. Risk of bias was assessed using the Cochrane Collaboration tool. Two reviewers independently selected studies, extracted data and assessed risk of bias. Meta-analysis was applied to quantitative data. RESULTS Seven RCTs totalling 424 participants were included. Overall, only three studies (43 %) reported adequate random sequence generation, allocation concealment, blinding of outcome assessment and accounting for incomplete outcome data. The results showed a statistically significant mean difference (MD) between Baduanjin exercise and waiting list control on three domains of WOMAC scores [MD=-4.40 (95 % CI: -7.16, -1.64), p < 0.01 in pain; MD=-1.34 (95 % CI: -1.64, -1.04), p < 0.01 in stiffness; MD=-2.44 (95 % CI: -4.33,-0.55), p < 0.01 in physical function] and the response rate [RR = 1.18 (95 % CI: 1.01, 1.37), p = 0.04]. Moreover, when used alone, Baduanjin exercise demonstrated a statistically significant improvement on three domains of WOMAC scores [MD=-1.69 (95 % CI: -2.03, -1.35), p < 0.01 in pain; MD=-0.86 (95 % CI: -1.13, -0.58), p < 0.01 in stiffness; MD=-2.23 (95 % CI: -3.65,-0.82), p < 0.01 in physical function] compared to health education. Furthermore, Baduanjin exercise plus NSAID therapies significantly improved total WOMAC score [MD=-10.26 (95 % CI: -13.41, -7.11), p < 0.01] and reduced VAS [MD=-1.65 (95 % CI: -1.83,-1.48), p < 0.01] compared to NSAID therapies alone. CONCLUSION The existing weak evidence suggests that Baduanjin exercise may have favourable effects for KOA patients. However, further rigorously designed RCTs are warranted before it can be recommended.
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Affiliation(s)
- Zhi-Peng Zeng
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Ya-Bin Liu
- 2nd Department of Limb Orthopedic and Reconstructive Surgery, Tianjin Hospital, Tianjin, 300211 China
| | - Jinju Fang
- Department of Dermatology, The Third Affiliated Hospital of Guangxi Medical University, 13 Dancun Road, Nanning, 530031, Guangxi, China
| | - Yue Liu
- School of Health and Biomedical Sciences, Royal Melbourne Institute of Technology University, WHO Collaborating Centre for Traditional Medicine, Bundoora, Vic., Australia
| | - Jun Luo
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China.
| | - Meng Yang
- Department of Dermatology, The Third Affiliated Hospital of Guangxi Medical University, 13 Dancun Road, Nanning, 530031, Guangxi, China; Department of Dermatology, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, Yunnan, China.
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Hajewski C, Anthony CA, Rojas EO, Westermann R, Willey M. Detailing postoperative pain and opioid utilization after periacetabular osteotomy with automated mobile messaging. J Hip Preserv Surg 2019; 6:370-376. [PMID: 33354334 PMCID: PMC7742655 DOI: 10.1093/jhps/hnz049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/19/2019] [Accepted: 10/03/2019] [Indexed: 12/18/2022] Open
Abstract
In the setting of periacetabular osteotomy (PAO), this investigation sought to (i) describe patient-reported pain scores and opioid utilization in the first 6 weeks following surgery and (ii) evaluate the effectiveness of postoperative communication using a robotic mobile messaging platform. Subjects indicated for PAO were enrolled from a young adult hip clinic. For the first 2 weeks after surgery, subjects received daily mobile messages inquiring about pain level on a 0–10 scale and the number of opioid pain medication tablets they consumed in the previous 24 h. Messaging frequency decreased to 3 per week in Weeks 3–6. Pain scores, opioid utilization and response rates with our mobile messaging platform were quantified for the 6-week postoperative period. Twenty-nine subjects underwent PAO. Twenty-one had concurrent hip arthroscopy. Average daily pain scores decreased over the first four postoperative days. Average pain scores reported were 5.9 ± 1.9, 4.1 ± 3.3 and 3.0 ± 3.5 on Day 1, Day 14 and Week 6, respectively. Reported opioid tablet utilization was 5.0 ± 3.2, 2.2 ± 2.0 and 0.0 ± 0.0 on Days 1 and 14 and at 6 weeks. Response rate for participants completing the 6-week messaging protocol was 84.1%. Patient-reported pain scores decreased over the first two postoperative weeks following PAO before plateauing in weeks 3–6. Opioid pain medication utilization increased in the first postoperative week before gradually declining to no tabs consumed at 6 weeks after PAO. Automated mobile messaging is an effective method of perioperative communication for the collection of pain scores and opioid utilization in patients undergoing PAO.
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Affiliation(s)
- Christina Hajewski
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA 52242, USA
| | - Chris A Anthony
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA 52242, USA
| | - Edward O Rojas
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA 52242, USA
| | - Robert Westermann
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA 52242, USA
| | - Michael Willey
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA 52242, USA
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Abstract
Hip pathology is common amongst athletes and the general population. The mechanics of cycling have the potential to exacerbate symptomatic hip pathology and progress articular pathology in patients with morphologic risk factors such as femoroacetabular impingement. A professional fit of the bicycle to the individual which aims to optimize hip joint function can allow patients with hip pathology to exercise in comfort when alternative high impact exercise such as running may not be possible. Conversely improper fit of the bicycle can lead to hip symptoms in otherwise healthy individuals who present with risk factors for hip pain. Accordingly a bike fit can form part of the overall management strategy in a cyclist with hip symptoms. The purpose of this clinical commentary is to discuss hip pathomechanics with respect to cycling, bicycle fitting methodology and the options available to a physical therapist to optimize hip mechanics during the pedaling action.
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Translation, Cross-Cultural Adaptation, and Psychometric Properties of the Polish Version of the Hip Disability and Osteoarthritis Outcome Score (HOOS). ACTA ACUST UNITED AC 2019; 55:medicina55100614. [PMID: 31547119 PMCID: PMC6843159 DOI: 10.3390/medicina55100614] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 09/11/2019] [Accepted: 09/16/2019] [Indexed: 11/16/2022]
Abstract
Background and Objectives: This study aimed to translate the Hip disability and Osteoarthritis Outcome Score (HOOS) into the Polish language, to determine its validity and reliability, and to assess its main psychometric properties. Materials and Methods: A total of 332 hip osteoarthritis (OA) subjects were recruited to the study group and 90 healthy subjects to the control group. The study consisted of the HOOS translation and the assessment of the discriminative power, internal consistency, and the potential floor and ceiling effects followed by the determination of the construct validity and test-retest reliability. The analysis was performed using Western Ontario and McMaster Universities osteoarthritis index (WOMAC) and SF-36 questionnaires. Results: The translation process consisted of forward translation, reconciliation, backward translation, review, harmonization, and proofreading. The hip OA patients reported a reduced HOOS score when compared to the control subjects. The discriminant validity of the questionnaire was confirmed. A Cronbach’s alpha of 0.97 was found, indicating a high internal consistency. The HOOS showed a significant correlation with the SF-36 and WOMAC, which ranged from r = −0.93, p-value < 0.05 for WOMAC total score to r = 0.92, and p-value < 0.05 for WOMAC daily living. No floor or ceiling effects were found. A very high intraclass correlation coefficient (ICC) was found (0.93–0.97) for the total score and the individual domains of the HOOS. Conclusions: The Polish HOOS is valid and reliable for evaluating the outcomes of hip OA patients in Poland. This questionnaire may be used with confidence for clinical and research purposes.
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Liao YY, Lin T, Zhu HX, Shi MM, Yan SG. Intra-Articular Viscosupplementation for Patients with Hip Osteoarthritis: A Meta-Analysis and Systematic Review. Med Sci Monit 2019; 25:6436-6445. [PMID: 31454342 PMCID: PMC6724564 DOI: 10.12659/msm.916955] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 07/31/2019] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The aim of this study was to review the efficacy and safety of intra-articular (IA) viscosupplementation (VS) for hip osteoarthritis (OA). MATERIAL AND METHODS We searched Medline, Clinical Trial Register Center, EMBASE, and Cochrane databases for randomized controlled trials (RCTs) comparing VS with placebo injection for hip OA. We included suitable studies, assessed the quality of studies, and extracted data on pain reduction, function improvement at different time points, and safety profiles. The comparisons of pain and function outcome were performed by meta-analysis. RESULTS Five high-quality randomized controlled studies trials (RCTs) with 591 patients with hip OA were identified. Although several trials demonstrated a significant decline in pain in VS groups during follow-up compared to baseline, without severe adverse events, the pooled analysis did not show VS was superior to placebo at any time windows [7-14 days: standardized mean difference (SMD): -0.18; 95% CI, -0.47 to 0.10, p=0.21; 28-30 days: 0.02 (-0.15, 0.19), p=0.82; or at final visit: -0.14 (-0.46, 0.18), p=0.38]. Similar results were also observed in the combined data of functional results. CONCLUSIONS IA VS does not reduce pain or improve function significantly better than placebo in a short-term follow-up. The benefits and safety of VS should be further assessed by sufficiently-sized, methodologically sound studies with validated assessment of more clinically relevant end-points.
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Affiliation(s)
- Ying-Yang Liao
- Department of Musculoskeletal Oncology, Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P.R. China
- Department of Orthopedic Surgery, Hui-Ya Hospital of The First Affiliated Hospital, Sun Yat-sen University, Huizhou, Guangdong, P.R. China
| | - Tiao Lin
- Department of Musculoskeletal Oncology, Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P.R. China
| | - Han-Xiao Zhu
- Department of Orthopedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, P.R. China
| | - Ming-Min Shi
- Department of Orthopedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, P.R. China
| | - Shi-Gui Yan
- Department of Orthopedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, P.R. China
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Kuijpers MFL, Hannink G, Vehmeijer SBW, van Steenbergen LN, Schreurs BW. The risk of revision after total hip arthroplasty in young patients depends on surgical approach, femoral head size and bearing type; an analysis of 19,682 operations in the Dutch arthroplasty register. BMC Musculoskelet Disord 2019; 20:385. [PMID: 31438921 PMCID: PMC6706879 DOI: 10.1186/s12891-019-2765-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 08/15/2019] [Indexed: 01/09/2023] Open
Abstract
Background Total hip arthroplasty (THA) is used increasingly in younger patients. There is little knowledge about the effect of THA characteristics on risk of revision, especially in young patients. Therefore, we studied the influence of both patient-related and surgical factors on the risk of revision using data from the Dutch Arthroplasty Registry (LROI). Methods All patients younger than 55 years with a primary THA implanted in the Netherlands between 2007 and 2017 were selected (n = 19,682). The covariates age, sex, primary diagnosis, ASA-classification, surgical approach, fixation method, bearing type, head size and year of surgery were entered into Cox proportional hazards models to calculate hazard ratios for the risk of revision. Results The overall 5-year survival of primary THA was 95.3% (95% CI, 94.9–95.6). Use of the anterior approach resulted in a lower risk of revision than the use of the posterolateral approach (HR: 0.66, 95% CI: 0.47–0.92). THAs with a head diameter ≥ 38 mm had a higher risk of revision (HR: 1.90, 95% CI: 1.33–2.72) than THAs with 32 mm heads. Use of MoM bearings resulted in an increased risk when compared to C-PE (HR: 1.76, 95% CI: 1.27–2.43). Conclusion The risk of revision in patients younger than 55 years depends on surgical approach, head size and bearing type. The anterior approach resulted in a decreased risk of revision, whereas use of ≥38 mm heads and MoM bearings resulted in an increased risk of revision for any reason.
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Affiliation(s)
- M F L Kuijpers
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Orthopaedics, Nijmegen, The Netherlands.
| | - G Hannink
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Operating Rooms, Nijmegen, The Netherlands
| | - S B W Vehmeijer
- Department of Orthopaedic Surgery, Reinier de Graaf Hospital, Delft, the Netherlands
| | - L N van Steenbergen
- Dutch Arthroplasty Register (Landelijke Registratie Orthopedische Implantaten), 's-Hertogenbosch, the Netherlands
| | - B W Schreurs
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Orthopaedics, Nijmegen, The Netherlands
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118
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Kaufman J, Caric D, Vukojevic K. Expression pattern of Syndecan-1 and HSP-70 in hip tissue of patients with osteoarthritis. J Orthop 2019; 17:134-138. [PMID: 31879492 DOI: 10.1016/j.jor.2019.08.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 08/12/2019] [Indexed: 10/26/2022] Open
Abstract
Objectives We investigated the expression of Syndecan-1 and HSP-70 in synovial, chondral and subchondral tissue in the hips of patients with osteoarthritis (OA). Methods Total hip arthroplasty was performed on 6 patients and 3 controls. Patients were divided into two groups according to disease severity. The tissues were immunohistochemically analyzed. Results Cartilage and subchondral tissue in patients with severe OA contained abundant positive cells with a mean positive percentage of 94,51 ± 5% and 78,95 ± 14% for Syndecan-1 and 94,42 ± 5% and 75,67 ± 17% for HSP-70, respectively. Conclusion In conclusion, HSP-70 and Syndecan-1 might play a role in the onset and regulation of OA in the hip.
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Affiliation(s)
- Julian Kaufman
- Department of Anatomy, Histology and Embryology. School of Medicine, University of Split, Soltanska 2, 21000, Split, Croatia
| | - Davor Caric
- Department of Orthopedic Surgery and Traumatology, KBC Split - Krizine, Soltanska 1, 21000, Split, Croatia
| | - Katarina Vukojevic
- Department of Anatomy, Histology and Embryology. School of Medicine, University of Split, Soltanska 2, 21000, Split, Croatia
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Loureiro A, Constantinou M, Beck B, Barrett RS, Diamond LE. A 12-month prospective exploratory study of muscle and fat characteristics in individuals with mild-to-moderate hip osteoarthritis. BMC Musculoskelet Disord 2019; 20:283. [PMID: 31200691 PMCID: PMC6570923 DOI: 10.1186/s12891-019-2668-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 06/05/2019] [Indexed: 11/29/2022] Open
Abstract
Background Reductions in lower extremity muscle strength, size and quality and increased fat content have been reported in advanced hip osteoarthritis (OA). Whether these differences are also evident at earlier stages of the disease and the extent to which they might develop over time is unclear. The main purpose of this 12-month exploratory prospective study was to compare changes in muscle and fat characteristics in individuals with mild-to-moderate hip OA and healthy controls. Methods Fourteen individuals with mild-to-moderate symptomatic and radiographic hip OA (n = 9 unilateral; n = 5 bilateral), and 15 healthy controls similar in age and sex without symptoms or radiographic hip OA were assessed at baseline and at 12-month follow-up. Maximal voluntary isometric strength of the hip and knee muscle groups was assessed using an isokinetic dynamometer. Lower extremity lean and fat mass were assessed using dual-energy x-ray absorptiometry, and thigh muscle and fat areas and thigh muscle density were assessed using peripheral quantitative computed tomography. Results Knee extension (p = 0.01), hip extension (p < 0.01), hip flexion (p = 0.03), and hip abduction (p < 0.01) strength, lower extremity lean mass (p < 0.01), thigh muscle area (p = 0.03), and thigh muscle density (p < 0.01) were significantly lower in hip OA compared to controls. Hip extension (p < 0.05), hip flexion (p = 0.03), and hip abduction (p = 0.03) strength significantly declined over the follow-up period in the hip OA group. Conclusions Pre-existing deficits in hip muscle strength in individuals with mild-to-moderate hip OA were accentuated over 12-months, though no changes in symptoms or joint structure were observed. A longer follow-up period is required to establish whether strength deficits drive clinical and structural decline in these patients. Interventions to prevent or slow declines in strength may be relevant in the management of mild-to-moderate hip OA. Electronic supplementary material The online version of this article (10.1186/s12891-019-2668-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Aderson Loureiro
- School of Allied Health Sciences, Griffith University, Gold Coast, Australia.,Pontifical Catholic University (PUCRS), Porto Alegre, Brazil.,Faculty of Physical Education and Sports, University of Rio dos Sinos (UNISINOS), São Leopoldo, Brazil
| | - Maria Constantinou
- School of Allied Health Sciences, Griffith University, Gold Coast, Australia.,School of Physiotherapy, Australian Catholic University, Brisbane, Australia
| | - Belinda Beck
- School of Allied Health Sciences, Griffith University, Gold Coast, Australia
| | - Rod S Barrett
- School of Allied Health Sciences, Griffith University, Gold Coast, Australia.,Gold Coast Orthopaedics Research Engineering & Education Alliance (GCORE), Griffith University, Menzies Health Institute Queensland, Gold Coast, Australia
| | - Laura E Diamond
- School of Allied Health Sciences, Griffith University, Gold Coast, Australia. .,Gold Coast Orthopaedics Research Engineering & Education Alliance (GCORE), Griffith University, Menzies Health Institute Queensland, Gold Coast, Australia. .,Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health & Rehabilitation Sciences The University of Queensland, Brisbane, Australia.
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Vascular cell adhesion molecule 1 in patients with severe osteoarthritis of the hip : A prospective cross-sectional study. Wien Klin Wochenschr 2019; 131:369-373. [PMID: 31037360 PMCID: PMC6702185 DOI: 10.1007/s00508-019-1497-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 04/03/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Osteoarthritis (OA) of the hip is a frequent and debilitating joint disease. Only few clinical risk factors for hip OA are established and clinically applicable biomarkers to identify patients at risk are still lacking. The glycoprotein vascular cell adhesion molecule 1 (VCAM-1) is expressed by chondrocytes and synovial tissue and was a predictive marker for development of severe large joint OA in a previous study. OBJECTIVE It was tested whether increased serum levels of VCAM-1 are prevalent in patients with severe OA of the hips. METHODS In this prospective, multicenter, cross-sectional study, risk factors of severe hip OA were investigated in patients scheduled for hip joint arthroplasty and 100 patients were randomly selected for validation of VCAM-1 as a potential biomarker for hip OA. Serum samples were analyzed by an enzyme-linked immunosorbent assay and compared with a sex and age-matched control cohort. RESULTS The groups were similar in age, gender ratio and prevalence of diabetes. Serum concentrations of VCAM-1 were 8% higher in OA patients compared to controls, without reaching statistical significance (818 ng ml-1, 95% confidence interval, CI 746-891 ng ml-1 versus 759 ng m-1, 95% CI 711-807 ng ml-1; P = 0.4839). CONCLUSION The results of this study show that serum concentrations of VCAM-1 cannot distinguish patients with severe hip OA from age and sex-matched controls.
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121
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A pragmatic approach to prevent post-traumatic osteoarthritis after sport or exercise-related joint injury. Best Pract Res Clin Rheumatol 2019; 33:158-171. [PMID: 31431269 DOI: 10.1016/j.berh.2019.02.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Lower extremity musculoskeletal injuries are common in sport and exercise, and associated with increased risk of obesity and post-traumatic osteoarthritis (PTOA). Unlike other forms of osteoarthritis, PTOA is common at a younger age and associated with more rapid progression, which may impact career choices, long-term general health and reduce quality of life. Individuals who suffer an activity-related joint injury and present with abnormal joint morphology, elevated adiposity, weak musculature, or become physically inactive are at increased risk of PTOA. Insufficient exercise therapy or incomplete rehabilitation, premature return-to-sport and re-injury, unrealistic expectations, or poor nutrition may further elevate this risk. Delay in surgical interventions in lieu of exercise therapy to optimize muscle strength and neuromuscular control while addressing fear of movement to guarantee resumption of physical activity, completeness of rehabilitation before return-to-sport, education that promotes realistic expectations and self-management, and nutritional counseling are the best approaches for delaying or preventing PTOA.
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Chinzei N, Rai MF, Hashimoto S, Schmidt EJ, Takebe K, Cheverud JM, Sandell LJ. Evidence for Genetic Contribution to Variation in Posttraumatic Osteoarthritis in Mice. Arthritis Rheumatol 2019; 71:370-381. [PMID: 30225954 DOI: 10.1002/art.40730] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 09/13/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Recombinant inbred mouse strains generated from an LG/J and SM/J intercross offer a unique resource to study complex genetic traits such as osteoarthritis (OA). We undertook this study to determine the susceptibility of 14 strains to various phenotypes characteristic of posttraumatic OA. We hypothesized that phenotypic variability is associated with genetic variability. METHODS Ten-week-old male mice underwent surgical destabilization of the medial meniscus (DMM) to induce posttraumatic OA. Mice were killed 8 weeks after surgery, and knee joints were processed for histology to score cartilage degeneration and synovitis. Micro-computed tomography was used to analyze trabecular bone parameters including subchondral bone plate thickness and synovial ectopic calcifications. Gene expression in the knees was assessed using a QuantiGene Plex assay. RESULTS Broad-sense heritability ranged from 0.18 to 0.58, which suggested that the responses to surgery were moderately heritable. The LGXSM-33, LGXSM-5, LGXSM-46, and SM/J strains were highly susceptible to OA, while the LGXSM-131b, LGXSM-163, LGXSM-35, LGXSM-128a, LGXSM-6, and LG/J strains were relatively OA resistant. This study was the first to accomplish measurement of genetic correlations of phenotypes that are characteristic of posttraumatic OA. Cartilage degeneration was significantly positively associated with synovitis (r = 0.83-0.92), and subchondral bone plate thickness was negatively correlated with ectopic calcifications (r = -0.59). Moreover, we showed that 40 of the 78 genes tested were significantly correlated with various OA phenotypes. However, unlike the OA phenotypes, there was no evidence for genetic variation in differences in gene expression levels between DMM-operated and sham-operated knees. CONCLUSION For these mouse strains, various characteristics of posttraumatic OA varied with genetic composition, which demonstrated a genetic basis for susceptibility to posttraumatic OA. The heritability of posttraumatic OA was established. Phenotypes exhibited various degrees of correlations; cartilage degeneration was positively correlated with synovitis, but not with the formation of ectopic calcifications. Further investigation of the genome regions that contain genes implicated in OA, as well as further investigation of gene expression data, will be useful for studying mechanisms of OA and identifying therapeutic targets.
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Affiliation(s)
| | | | | | | | - Ken Takebe
- Konan Kakogawa Hospital, Kakogawa, Japan
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Dall'Oca C, Breda S, Elena N, Valentini R, Samaila EM, Magnan B. Mesenchymal Stem Cells injection in hip osteoarthritis: preliminary results. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:75-80. [PMID: 30715002 PMCID: PMC6503401 DOI: 10.23750/abm.v90i1-s.8084] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 01/10/2019] [Indexed: 12/18/2022]
Abstract
Background and aim of the work: Osteoarthritis will become even more common in the near future since the average life span is steadily growing. Pain and loss of function are the main complaints reported by patients, inevitably leading towards a worsened daily life performance. New modern techniques have been developed with advanced cell based therapies. Mesenchymal stem cells (MSC) have the inner ability to mature into different types of cells depending on the stimuli they undergo. This technique has already been proven successful in the knee and, with this retrospective study, we would like to assess its feasibility in the hip joint. Methods:6 consecutive patients affected by hip osteoarthritis were treated by intra-articular injection of autologous adipose-derived MSC between June 2017 and June 2018. Our study included only patients with constant hip pain resistant conservative treatment and OA graded 0-2 on the Tonnis grading scale. All 6 patients were evaluated in the preoperative setting and at the 6 months post-operative mark. Results: The HHS showed an improvement from the pre-operative baseline mean value of 67.2±3.4 to the 84.6±6.3 post-operative value. Moreover, the WOMAC score dropped from a baseline score of 36.3±4.7 to 19.8±3.4 at 6 months’ post-op follow up visit. Conclusions: MSC Lipogems is a fairly easy technique. No adverse effects were recorded in our experience. Preliminary results showed a positive outcome according to all the grading systems used in this study even though a longer follow up is needed to validate this technique. (www.actabiomedica.it)
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Affiliation(s)
- Carlo Dall'Oca
- Azienda Ospedaliera Universitaria Integrata Verona, Ortopedia e Traumatologia B, Verona, Italy.
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Machado ES, Leite R, dos Santos CC, Artuso GL, Gluszczak F, de Jesus LG, Caldas JMP, Bredemeier M. Turn down - turn up: a simple and low-cost protocol for preparing platelet-rich plasma. Clinics (Sao Paulo) 2019; 74:e1132. [PMID: 31433042 PMCID: PMC6691835 DOI: 10.6061/clinics/2019/e1132] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 05/10/2019] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To describe and analyze a new protocol for the extraction of platelet-rich plasma (PRP) for use in clinical practice and compare this technique with methods that have been previously described in the medical literature. METHODS We extracted PRP from 20 volunteers using four different protocols (single spin at 1600 ×g, single spin at 600 ×g, double spin at 300 and 700 ×g, and double spin at 600 and 900 ×g). In another group of 12 individuals, we extracted PRP with our new technique (named 'turn down-turn up') consisting of a double spin (200 ×g and 1600 ×g) closed system using standard laboratory equipment (including an ordinary benchtop centrifuge), where the blood remained in the same tube during all processes, reducing the risk of contamination. Platelet counts adjusted to baseline values were compared using analysis of covariance (ANCOVA). RESULTS Using the four previously described protocols (mentioned above), we obtained concentrations of platelets that were 1.15-, 2.07-, 2.18-, and 3.19-fold greater than the baseline concentration, respectively. With the turn down-turn up technique, we obtained a platelet count that was 4.17-fold (95% confidence interval (CI): 3.09 to 5.25) greater than the baseline platelet count (p=0.063 compared with the double spin at 600 and 900 ×g method). The total cost of the disposable materials used in the extraction process was less than US$10.00 per individual. CONCLUSION In the present study, we described a simple and safe method for obtaining PRP using low-cost devices.
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Affiliation(s)
- Edilson Silva Machado
- Servico de Dor e Cuidados Paliativos, Grupo Hospitalar Conceicao, Hospital Nossa Senhora da Conceicao, Porto Alegre, RS, BR
- Centro de Pesquisa e Gerenciamento da Dor, Clinica Univida, Canoas, RS, BR
- *Corresponding author. E-mail:
| | - Renata Leite
- Laboratorio de Analises Clinicas, Grupo Hospitalar Conceicao, Hospital Nossa Senhora da Conceicao, Porto Alegre, RS, BR
| | - Cintia Cichowski dos Santos
- Laboratorio de Analises Clinicas, Grupo Hospitalar Conceicao, Hospital Nossa Senhora da Conceicao, Porto Alegre, RS, BR
| | - Georgia Lazzari Artuso
- Laboratorio de Analises Clinicas, Grupo Hospitalar Conceicao, Hospital Nossa Senhora da Conceicao, Porto Alegre, RS, BR
| | - Fernando Gluszczak
- Centro de Pesquisa e Gerenciamento da Dor, Clinica Univida, Canoas, RS, BR
| | - Leonardo Giovani de Jesus
- Servico de Dor e Cuidados Paliativos, Grupo Hospitalar Conceicao, Hospital Nossa Senhora da Conceicao, Porto Alegre, RS, BR
| | | | - Markus Bredemeier
- Servico de Reumatologia, Grupo Hospitalar Conceicao, Hospital Nossa Senhora da Conceicao, Porto Alegre, RS, BR
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A calibrated EMG-informed neuromusculoskeletal model can appropriately account for muscle co-contraction in the estimation of hip joint contact forces in people with hip osteoarthritis. J Biomech 2019; 83:134-142. [DOI: 10.1016/j.jbiomech.2018.11.042] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 11/13/2018] [Accepted: 11/23/2018] [Indexed: 11/20/2022]
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Lespasio MJ, Sultan AA, Piuzzi NS, Khlopas A, Husni ME, Muschler GF, Mont MA. Hip Osteoarthritis: A Primer. Perm J 2018; 22:17-084. [PMID: 29309269 DOI: 10.7812/tpp/17-084] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The objective of this article is to deliver a concise up-to-date review on hip osteoarthritis. We describe the epidemiology (disease distribution), etiologies (associated risk factors), symptoms, diagnosis and classification, and treatment options for hip osteoarthritis. A quiz serves to assist readers in their understanding of the presented material.
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Affiliation(s)
- Michelle J Lespasio
- Assistant Professor and Adult Nurse Practitioner in Orthopedic Surgery at the Boston Medical Center in MA.
| | - Assem A Sultan
- Clinical Orthopedic Surgery Fellow at the Cleveland Clinic in OH.
| | - Nicolas S Piuzzi
- Orthopedic Regenerative Medicine and Cellular Therapy Fellow at the Cleveland Clinic in OH.
| | - Anton Khlopas
- Research Fellow in Orthopedic Surgery at the Cleveland Clinic in OH.
| | - M Elaine Husni
- Rheumatologist and Immunologist and Director of the Arthritis & Musculoskeletal Treatment Center in the Department of Rheumatologic and Immunologic Disease at the Cleveland Clinic in OH.
| | - George F Muschler
- Professor of Orthopedic Surgery, Director of the Regenerative Medicine Laboratory, and Attending Physician at the Cleveland Clinic in OH.
| | - Michael A Mont
- Chairman of Orthopedic Surgery at the Cleveland Clinic in OH.
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Onset and Progression of Human Osteoarthritis-Can Growth Factors, Inflammatory Cytokines, or Differential miRNA Expression Concomitantly Induce Proliferation, ECM Degradation, and Inflammation in Articular Cartilage? Int J Mol Sci 2018; 19:ijms19082282. [PMID: 30081513 PMCID: PMC6121276 DOI: 10.3390/ijms19082282] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 07/22/2018] [Accepted: 08/01/2018] [Indexed: 12/30/2022] Open
Abstract
Osteoarthritis (OA) is a degenerative whole joint disease, for which no preventative or therapeutic biological interventions are available. This is likely due to the fact that OA pathogenesis includes several signaling pathways, whose interactions remain unclear, especially at disease onset. Early OA is characterized by three key events: a rarely considered early phase of proliferation of cartilage-resident cells, in contrast to well-established increased synthesis, and degradation of extracellular matrix components and inflammation, associated with OA progression. We focused on the question, which of these key events are regulated by growth factors, inflammatory cytokines, and/or miRNA abundance. Collectively, we elucidated a specific sequence of the OA key events that are described best as a very early phase of proliferation of human articular cartilage (AC) cells and concomitant anabolic/catabolic effects that are accompanied by incipient pro-inflammatory effects. Many of the reviewed factors appeared able to induce one or two key events. Only one factor, fibroblast growth factor 2 (FGF2), is capable of concomitantly inducing all key events. Moreover, AC cell proliferation cannot be induced and, in fact, is suppressed by inflammatory signaling, suggesting that inflammatory signaling cannot be the sole inductor of all early OA key events, especially at disease onset.
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Bolia IK, Briggs KK, Locks R, Chahla J, Utsunomiya H, Philippon MJ. Prevalence of High-Grade Cartilage Defects in Patients With Borderline Dysplasia With Femoroacetabular Impingement: A Comparative Cohort Study. Arthroscopy 2018; 34:2347-2352. [PMID: 29730219 DOI: 10.1016/j.arthro.2018.03.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 02/23/2018] [Accepted: 03/01/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the prevalence, size, and location of Outerbridge grade III and IV cartilage defects on the femoral head and acetabulum between patients with borderline acetabular dysplasia and patients with non-borderline dysplasia who underwent hip arthroscopy for femoroacetabular impingement (FAI). METHODS Patients aged 18 years or older who underwent primary hip arthroscopy for correction of FAI and labral repair from November 2005 to April 2016 were included. We excluded patients with previous hip surgery, a radiographic hip joint space of 2 mm or less, and/or a lateral center-edge angle (LCEA) of less than 20° or greater than 40°. The study patients were divided into 2 groups based on the LCEA on the anteroposterior pelvic radiograph: Patients with an LCEA between 20° and 25° were included in the borderline group, and patients with an LCEA between 25° and 40° were included in the non-borderline group. The prevalence, size, and location of Outerbridge grade III and IV chondral lesions on the femoral head and acetabulum were recorded intraoperatively. Comparisons between groups were performed with the Mann-Whitney U test for nonparametric testing and the t test for data that were normally distributed. Data were analyzed to calculate odds ratios associated with the various factors. RESULTS In total, 2,429 patients (1,114 women and 1,315 men) met the inclusion criteria. The borderline group consisted of 305 patients (150 men and 155 women), whereas the non-borderline dysplasia group comprised 2,124 patients (1,165 men and 959 women). Outerbridge grade III and IV chondral lesions were found on the femoral head in 118 patients with borderline dysplasia (39%) and 127 patients with non-borderline dysplasia (6%) and on the acetabulum in 132 patients with borderline dysplasia (43%) and 874 patients with non-borderline dysplasia (41%). Patients with borderline dysplasia were 10 times more likely (95% confidence interval, 7.3-13.4; P < .001) to have a grade III or IV cartilage defect on the weight-bearing surface of the femoral head (P < .001) than patients with non-borderline dysplasia. On the acetabular side, no difference in the prevalence of severe cartilage damage was detected between the 2 groups (P = .588). The size of chondral damage was significantly greater in patients with borderline dysplasia on the acetabulum (P = .039) compared with the non-borderline dysplasia group. CONCLUSIONS Patients with FAI and borderline dysplasia are at higher risk of having Outerbridge grade III and IV chondral damage on the femoral head than patients with non-borderline dysplastic hips. Borderline dysplastic hips also presented with significantly larger chondral defects on the acetabular surface. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Ioanna K Bolia
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Karen K Briggs
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A..
| | - Renato Locks
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A.; The Steadman Clinic, Vail, Colorado, U.S.A
| | - Jorge Chahla
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | | | - Marc J Philippon
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A.; The Steadman Clinic, Vail, Colorado, U.S.A
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Wang YL, An CM, Song S, Lei FL, Wang Y. Cupping Therapy for Knee Osteoarthritis: A Synthesis of Evidence. Complement Med Res 2018; 25:249-255. [PMID: 30007978 DOI: 10.1159/000488707] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND This systematic review was aimed to evaluate the efficacy and safety of cupping therapy for treating patients with knee osteoarthritis (KOA). METHODS The following databases were searched from their inception until June 2017: the Cochrane Central Register of Controlled Trials, PubMed, EMBASE, and 4 Chinese databases (Wan Fang Data, Chinese Biomedical Literature Database (CBM), VeiPu, and China National Knowledge Infrastructure (CNKI)). Randomized controlled trials (RCTs) assessing the effects of cupping therapy on KOA were included in this systematic review. A quantitative synthesis of the RCTs was conducted using RevMan 5.3 software. Study selection and data extraction and validation were performed independently by 2 reviewers. Cochrane criteria for risk of bias were used to assess the methodological quality of the trials. RESULTS A total of 5 studies met our inclusion criteria. We analyzed the data from these 5 RCTs involving 535 participants. All included studies were judged to be at high risk for bias. Dry cupping therapy plus Western medicine therapy was more effective than Western therapy alone in reducing the pain scores (mean difference (MD) = -1.79, 95% confidence interval (CI) -2.40 to -1.18; p < 0.01). In addition, the study participants in the dry cupping therapy plus Western medicine therapy group showed significantly greater improvements in the pain (MD = -0.73, 95% CI -1.61 to -0.41; p < 0.01), stiffness (MD = -0.94, 95% CI -1.30 to -0.58; p < 0.01), and physical function (MD = -10.07, 95% CI -13.45 to -6.69; p < 0.01) domains of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) compared to participants in the Western medicine therapy group. Moreover, when compared with Western medicine therapy alone, a meta-analysis of 4 RCTs suggested statistically significant favorable effects of wet cupping therapy plus Western medicine on the Lequesne Algofunctional Index (LAI) (MD = -3.44, 95% CI -4.21 to -2.68; p < 0.01). CONCLUSION There is weak evidence to support the hypothesis that cupping therapy has beneficial effects on reducing the pain intensity and improving the physical function in patients with KOA.
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Hussain SM, Ackerman IN, Wang Y, Zomer E, Cicuttini FM. Could low birth weight and preterm birth be associated with significant burden of hip osteoarthritis? A systematic review. Arthritis Res Ther 2018; 20:121. [PMID: 29884206 PMCID: PMC5994049 DOI: 10.1186/s13075-018-1627-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Approaches for the prevention and treatment of hip osteoarthritis (OA) remain limited. There are recent data suggesting that low birth weight (LBW) and preterm birth may be risk factors for hip osteoarthritis. This has the potential to change the current paradigm of hip osteoarthritis prevention by targeting early life factors. The aim of this review was to examine the available evidence for an association of LBW and preterm birth with hip OA. The potential cost implications associated with total hip arthroplasty were also evaluated. METHODS Ovid Medline, EMBASE, and Cinahl were searched up until August 2017 using MeSH terms and key words. Methodological quality was evaluated using the National Heart Lung and Blood Institute (NHLBI) quality assessment tool. Qualitative evidence synthesis was performed to summarise the results. Bradford Hill's criteria for causation including the temporal relationship, consistency, strength of the association, specificity, dose-response relationship, and analogy were used to assess the evidence for causation. Economic modelling was used to calculate the potential economic burden associated with LBW or preterm birth related total hip arthroplasty using Australian data from 2012 to 2015. RESULTS Five studies, ranging from high to low quality, were included. Hip bone shape abnormalities examined included developmental hip dysplasia and immature hip, and hip osteoarthritis included osteophytes and total hip arthroplasty. A causal link between low birth weight or preterm birth and hip osteoarthritis was found. Of the 30,477 total hip arthroplasties performed for hip osteoarthritis in Australia in 2015, 5791 were estimated to be born preterm and 5273 with low birth weight. This equated to a potential total hip arthroplasty cost of AU$145,136,082 and AU$132,150,222 for these subgroups, respectively. CONCLUSION Available data suggest that low birth weight and preterm birth are associated with hip bone shape abnormalities and hip osteoarthritis requiring total hip arthroplasty, with a substantial associated financial burden. Given the current lack of effective treatment and prevention strategies for hip osteoarthritis, this offers a new avenue for reducing the future burden of hip osteoarthritis.
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Affiliation(s)
- Sultana Monira Hussain
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia.
| | - Ilana N Ackerman
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Yuanyuan Wang
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Ella Zomer
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Flavia M Cicuttini
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
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Saberi Hosnijeh F, Kavousi M, Boer CG, Uitterlinden AG, Hofman A, Reijman M, Oei EHG, Bierma-Zeinstra SM, van Meurs JBJ. Development of a prediction model for future risk of radiographic hip osteoarthritis. Osteoarthritis Cartilage 2018; 26:540-546. [PMID: 29382605 DOI: 10.1016/j.joca.2018.01.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 12/27/2017] [Accepted: 01/18/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To develop and validate a prognostic model for incident radiologic hip osteoarthritis (HOA) and determine the value of previously identified predictive factors. DESIGN We first validated previously reported predictive factors for HOA by performing univariate and multivariate analyses for all predictors in three large prospective cohorts (total sample size of 4548 with 653 incident cases). The prognostic model was developed in 2327 individuals followed for 10 years from the Rotterdam Study-I (RS-I) cohort. External validation of the model was tested on discrimination in two other cohorts: RS-II (n = 1435) and the Cohort Hip and Cohort Knee (CHECK) study (n = 786). RESULTS From the total number of 28 previously reported predictive factors, we were able to replicate 13 factors, while 15 factors were not significantly predictive in a meta-analysis of the three cohorts. The basic model including the demographic, questionnaire, and clinical examination variables (area under the receiver-operating characteristic curve (AUC) = 0.67) or genetic markers (AUC = 0.55) or urinary C-terminal cross-linked telopeptide of type II collagen (uCTX-II) levels (AUC = 0.67) alone were poor predictors of HOA in all cohorts. Imaging factors showed the highest predictive value for the development of HOA (AUC = 0.74). Addition of imaging variables to the basic model led to substantial improvement in the discriminative ability of the model (AUC = 0.78) compared with uCTX-II (AUC = 0.74) or genetic markers (AUC = 0.68). Applying external validation, similar results were observed in the RS-II and the CHECK cohort. CONCLUSIONS The developed prediction model included demographic, a limited number of questionnaire, and imaging risk factors seems promising for prediction of HOA.
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Affiliation(s)
- F Saberi Hosnijeh
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - M Kavousi
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - C G Boer
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - A G Uitterlinden
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - A Hofman
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - M Reijman
- Department of Orthopedics, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - E H G Oei
- Department of Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - S M Bierma-Zeinstra
- Department of General Practice, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - J B J van Meurs
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
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Leite VF, Daud Amadera JE, Buehler AM. Viscosupplementation for Hip Osteoarthritis: A Systematic Review and Meta-Analysis of the Efficacy on Pain and Disability, and the Occurrence of Adverse Events. Arch Phys Med Rehabil 2018; 99:574-583.e1. [DOI: 10.1016/j.apmr.2017.07.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 07/15/2017] [Accepted: 07/17/2017] [Indexed: 01/12/2023]
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Odonkor CA, Chen Y, Adekoya P, Marascalchi BJ, Chaudhry-Richter H, Tang T, Abruzzese C, Cohen BK, Cohen SP. Inciting Events Associated With Lumbar Facet Joint Pain. Anesth Analg 2018; 126:280-288. [DOI: 10.1213/ane.0000000000002242] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Schwarz S, Mrosewski I, Silawal S, Schulze-Tanzil G. The interrelation of osteoarthritis and diabetes mellitus: considering the potential role of interleukin-10 and in vitro models for further analysis. Inflamm Res 2017; 67:285-300. [PMID: 29196771 DOI: 10.1007/s00011-017-1121-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 11/12/2017] [Accepted: 11/24/2017] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Today, not only the existence of an interrelation between obesity/adipositas and osteoarthritis (OA) but also the association of OA and diabetes mellitus (DM) are widely recognized. Nevertheless, shared influence factors facilitating OA development in DM patients still remain speculative up until now. To supplement the analysis of clinical data, appropriate in vitro models could help to identify shared pathogenetic pathways. Informative in vitro studies could later be complemented by in vivo data obtained from suitable animal models. MATERIALS AND METHODS Therefore, this detailed review of available literature was undertaken to discuss and compare the results of currently published in vitro studies focusing on the interrelation between OA, the metabolic syndrome and DM and to propose models to further study the molecular pathways. RESULTS The survey of literature presented here supports the hypothesis that the pathogenesis of OA in DM is based on imbalanced molecular pathways with a putative crucial role of antiinflammatory cytokines such as IL-10. CONCLUSION Future development of versatile micro-scaled in vitro models such as combining DM and OA on chip could allow the identification of common pathogenetic pathways and might help to develop novel therapeutic strategies.
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Affiliation(s)
- Silke Schwarz
- Department of Anatomy, Paracelsus Medical University, Prof. Ernst Nathan Str. 1, 90419, Nuremberg, Germany.,Institute of Anatomy, Paracelsus Medical University, Salzburg, Austria
| | - Ingo Mrosewski
- MVZ Limbach Laboratories, Aroser Allee 84, 13407, Berlin, Germany
| | - Sandeep Silawal
- Department of Anatomy, Paracelsus Medical University, Prof. Ernst Nathan Str. 1, 90419, Nuremberg, Germany.,Institute of Anatomy, Paracelsus Medical University, Salzburg, Austria
| | - Gundula Schulze-Tanzil
- Department of Anatomy, Paracelsus Medical University, Prof. Ernst Nathan Str. 1, 90419, Nuremberg, Germany. .,Institute of Anatomy, Paracelsus Medical University, Salzburg, Austria.
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van Heerden JA, Burger JR, Gerber JJ, Vlahović-Palčevski V. Prevalence of potentially serious drug-drug interactions among South African elderly private health sector patients using the Mimica Matanović/Vlahović-Palčevski protocol. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2017; 26:156-164. [PMID: 28665037 DOI: 10.1111/ijpp.12383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 05/15/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the prevalence of potentially serious drug-drug interactions (DDIs) and their relationship with gender and age, among elderly in South Africa. METHODS A cross-sectional study was conducted using pharmaceutical claims data for 2013, for a total of 103 420 medical scheme beneficiaries' ≥65 years. All medications dispensed within one calendar month where the days' supply of medication dispensed overlapped, were grouped as one prescription. DDIs per prescription were then identified using the Mimica Matanović/Vlahović-Palčevski DDI protocol. Results were interpreted using effect sizes, that is Cramér's V, Cohen's d and Cohen's ƒ2 . KEY FINDINGS A total of 331 659 DDIs were identified on 235 870 (25.8%, N = 912 713) prescriptions (mean 0.36 (SD 0.7) (95% CI, 0.36 to 0.37)). Women encountered 63.5% of all DDIs. Effect sizes for the association between DDIs and age group (Cramér's V = 0.06), and gender (Cramér's V = 0.05) was negligible. There was no difference between men and women regarding the mean number of DDIs identified per prescription (Cohen's d = 0.10). The number of medicine per prescription (ƒ2 = 0.51) was the biggest predictor of the DDIs. The most frequent interacting drug combinations were between central nervous system medicines (30.6%). CONCLUSION Our study is the first to report the prevalence of potentially serious DDIs among an elderly population in the South African private health sector utilising the Mimica Matanović/Vlahović-Palčevski DDI protocol. Overall, we identified DDIs in approximately 26% of the prescriptions in our study. Age and gender were not found to be predictors of potentially serious DDIs.
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Affiliation(s)
- Julandi A van Heerden
- Medicine Usage in South Africa (MUSA), North-West University (Potchefstroom Campus), Potchefstroom, South Africa
| | - Johanita R Burger
- Medicine Usage in South Africa (MUSA), North-West University (Potchefstroom Campus), Potchefstroom, South Africa
| | - Jan J Gerber
- Medicine Usage in South Africa (MUSA), North-West University (Potchefstroom Campus), Potchefstroom, South Africa
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Li JQ, Guo W, Sun ZG, Huang QS, Lee EY, Wang Y, Yao XD. Cupping therapy for treating knee osteoarthritis: The evidence from systematic review and meta-analysis. Complement Ther Clin Pract 2017; 28:152-160. [PMID: 28779923 DOI: 10.1016/j.ctcp.2017.06.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 06/06/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Cupping therapy is widely used in East Asia, the Middle East, or Central and North Europe to manage the symptom of knee osteoarthritis (KOA). The purpose of this systematic review was to evaluate the available evidence from randomized controlled trials (RCTs) of cupping therapy for treating patients with KOA. METHODS The following databases were searched from their inception until January 2017: PubMed, Embase, the Cochrane Central Register of Controlled Trials and four Chinese databases [WanFang Med Database, Chinese BioMedical Database, Chinese WeiPu Database, and China National Knowledge Infrastructure (CNKI)]. Only the RCTs related to the effects of cupping therapy on KOA were included in this systematic review. A quantitative synthesis of RCTs will be conducted using RevMan 5.3 software. Study selection, data extraction, and validation was performed independently by two reviewers. Cochrane criteria for risk-of-bias were used to assess the methodological quality of the trials. RESULTS Seven RCTs met the inclusion criteria, and most were of low methodological quality. Study participants in the dry cupping therapy plus the Western medicine therapy group showed significantly greater improvements in the pain [MD = -1.01, 95%CI (-1.61, -0.41), p < 0.01], stiffness [MD = -0.81, 95%CI (-1.14, -0.48), p < 0.01] and physical function [MD = -5.53, 95%CI (-8.58, -2.47), p < 0.01] domains of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) compared to participants in the Western medicine therapy group, with low heterogeneity (Chi2 = 0.00 p = 1.00, I2 = 0% in pain; Chi2 = 0.45 p = 0.50, I2 = 0% in stiffness; Chi2 = 1.09 p = 0.30, I2 = 9% in physical function). However, it failed to do so on a Visual Analog Scale (VAS) [MD = -0.32, 95%CI (-0.70, 0.05), p = 0.09]. In addition, when compared with Western medicine therapy alone, meta-analysis of four RCTs suggested favorable statistically significant effects of wet cupping therapy plus western medicine on response rate [MD = 1.06, 95%CI (1.01, 1.12), p = 0.03; heterogeneity: Chi2 = 1.13, p = 0.77, I2 = 0%] and Lequesne Algofunctional Index (LAI) [MD = -2.74, 95%CI (-3.41, -2.07), p < 0.01; heterogeneity: Chi2 = 2.03, p = 0.57, I2 = 0% ]. CONCLUSION Only weak evidence can support the hypothesis that cupping therapy can effectively improve the treatment efficacy and physical function in patients with KOA.
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Affiliation(s)
- Jin-Quan Li
- Department of Orthopedics, Fuzhou General Hospital of Nanjing Command, PLA, FuZhou 350025, China
| | - Wen Guo
- Department of Endocrinology, Fuzhou General Hospital of Nanjing Command, PLA, FuZhou 350025, China
| | - Ze-Gan Sun
- Department of Orthopedics, Fuzhou General Hospital of Nanjing Command, PLA, FuZhou 350025, China
| | - Qing-Song Huang
- Department of Orthopedics, Fuzhou General Hospital of Nanjing Command, PLA, FuZhou 350025, China
| | - En Yeong Lee
- School of Health and Biomedical Sciences, Royal Melbourne Institute of Technology University, Bundoora, Victoria, Australia
| | - Ying Wang
- Department of First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province 210023, China
| | - Xiao-Dong Yao
- Department of Orthopedics, Fuzhou General Hospital of Nanjing Command, PLA, FuZhou 350025, China.
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Cupping therapy for Treating Knee Osteoarthritis: A protocol for systematic review and meta-analysis of randomized controlled trials. Eur J Integr Med 2017. [DOI: 10.1016/j.eujim.2017.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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139
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Patient-specific chondrolabral contact mechanics in patients with acetabular dysplasia following treatment with peri-acetabular osteotomy. Osteoarthritis Cartilage 2017; 25:676-684. [PMID: 27923602 PMCID: PMC6565367 DOI: 10.1016/j.joca.2016.11.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 11/21/2016] [Accepted: 11/28/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Using a validated, patient-specific finite element (FE) modeling protocol, we evaluated cartilage and labrum (i.e., chondrolabral) mechanics before and after peri-acetabular osteotomy (PAO) to provide insight into the ability of this procedure to improve mechanics in dysplastic hips. DESIGN Five patients with acetabular dysplasia were recruited in this case-controlled, prospective study. Models, which included anatomy for bone, cartilage, and labrum, were generated from computed tomography (CT) arthrography scans acquired before and after PAO. Cartilage and labrum contact stress and contact area were quantified overall and regionally. Load supported by the labrum, expressed as a percentage of the total hip force, was analyzed. RESULTS Percent cartilage contact area increased post-operatively overall, medially, and superiorly. Peak acetabular contact stress decreased overall, laterally, anteriorly, and superiorly. Average contact stress decreased overall, laterally, anteriorly, and posteriorly. Only average contact stress on the superior labrum and peak labrum stress overall decreased. Load supported by the labrum did not change significantly. CONCLUSIONS PAO was efficacious at medializing cartilage contact and reducing cartilage contact stresses, and therefore may minimize deleterious loading to focal cartilage lesions, subchondral cysts, and cartilage delaminations often observed in the lateral acetabulum of dysplastic hips. However, the excessively prominent, hypertrophied labrum of dysplastic hips remains in contact with the femoral head, which continues to load the labrum following PAO. The clinical ramifications of continued labral loading following PAO are not known. However, it is plausible that failure to reduce the load experienced by the labrum could result in end-stage hip OA following PAO.
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140
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Phytomedicine in Joint Disorders. Nutrients 2017; 9:nu9010070. [PMID: 28275210 PMCID: PMC5295114 DOI: 10.3390/nu9010070] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 01/11/2017] [Accepted: 01/12/2017] [Indexed: 01/24/2023] Open
Abstract
Chronic joint inflammatory disorders such as osteoarthritis and rheumatoid arthritis have in common an upsurge of inflammation, and oxidative stress, resulting in progressive histological alterations and disabling symptoms. Currently used conventional medication (ranging from pain-killers to biological agents) is potent, but frequently associated with serious, even life-threatening side effects. Used for millennia in traditional herbalism, medicinal plants are a promising alternative, with lower rate of adverse events and efficiency frequently comparable with that of conventional drugs. Nevertheless, their mechanism of action is in many cases elusive and/or uncertain. Even though many of them have been proven effective in studies done in vitro or on animal models, there is a scarcity of human clinical evidence. The purpose of this review is to summarize the available scientific information on the following joint-friendly medicinal plants, which have been tested in human studies: Arnica montana, Boswellia spp., Curcuma spp., Equisetum arvense, Harpagophytum procumbens, Salix spp., Sesamum indicum, Symphytum officinalis, Zingiber officinalis, Panax notoginseng, and Whitania somnifera.
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