Epidemiology of osteoarthritis

Sensorimotor or Balance Training to Increase Knee-Extensor and Knee-Flexor Maximal Strength in Patients With Knee Osteoarthritis: A Critically Appraised Topic

CLINICAL SCENARIO

Knee osteoarthritis (KOA) is a complex progressive synovial joint disease that results in impaired muscle function, including a considerable loss of maximal strength and power. Exercise therapies, such as sensorimotor or balance training and resistance training, are frequently used to improve muscle function, mobility, and quality of life, but their impact on maximal muscle strength in patients with KOA is not well understood.

FOCUSED CLINICAL QUESTION

Does sensorimotor or balance training improve knee-extensor and knee-flexor maximal muscle strength compared with strength training or no intervention in patients with KOA?

SUMMARY OF KEY FINDINGS

Results from 4 fair- to good-quality randomized controlled/clinical trials (level 1b) revealed inconsistent grade B evidence regarding the effect of sensorimotor or balance training to improve knee-extensor and knee-flexor maximal muscle strength in patients with KOA. Two studies, one good-quality study and one fair-quality study, showed significant strength improvements, and 2 good-quality studies demonstrated no significant strength enhancements.

CLINICAL BOTTOM LINE

Sensorimotor or balance training may be useful to improve maximal strength of quadriceps and hamstring muscle groups in patients with KOA; however, it seems that this depends on a training duration of at least 8 weeks and the use of unstable devices to induce destabilization of patients' balance, initiating neuromuscular adaptations.

STRENGTH OF RECOMMENDATION

Due to inconsistent evidence (grade B), the true effect of sensorimotor or balance training to improve knee-extensor and knee-flexor maximal muscle strength in patients with KOA remains unclear and needs to be further investigated.

Ultrasound Evaluation of Knee Osteoarthritis

While radiographs and magnetic resonance imaging (MRI) have long been used in the assessment of osteoarthritis (OA), ultrasound imaging has been rapidly accepted by musculoskeletal providers in both the assessment and treatment of OA. A limiting factor in the use of ultrasound is the proper training required by the user for results to be reliable and reproducible. A standardized ultrasound protocol can potentially address this limiting factor. The critical information to consider in a standardized protocol include proper patient positioning, probe alignment, probe orientation, and identification of the appropriate anatomic landmarks. The outlined protocol considers these factors with the purpose of providing a step-by-step method to assess and monitor knee OA.

Risk Assessment of Osteoarthritis Among Geriatric Population in Perambalur District Using the Western Ontario and McMaster Universities Arthritis Index and Katz Index of Independence in Activities of Daily Living: A Cross-Sectional Study

BACKGROUND

Osteoarthritis (OA) is a degenerative joint disease that occurs resulting from tear and progressive loss of articular cartilage. It is one of the leading causes of disability in elderly people. This study aims to assess the risk of OA and the ability to perform activities of daily living (ADL) independently among the geriatric population using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) scale and Katz Index of Independence in Activities of Daily Living (Katz ADL) scale, respectively.

METHODS

This cross-sectional study was conducted among the geriatric population in Perambalur district, Tamil Nadu from November 2022 to January 2023. Around 415 geriatric populations above 60 years of age were included by using a simple random sampling method. A semi-structured questionnaire was used to collect sociodemographic profiles, personal and medical details, OA risk (WOMAC), and ADL (Katz ADL scale). Descriptive statistics and the chi-square test were used to investigate the relationship between sociodemographic characteristics and the Katz ADL scale and the WOMAC index score for assessing OA risk.

RESULTS

The mean age of participants was 69.62 ± 6.86 years. The mean ± SD score for the WOMAC scale and the Katz ADL scale among the geriatric population was 20.997 ± 14.69 and 4.821 ± 2.37, respectively. The OA risk among the geriatric population using the WOMAC scale was low in 98 (23.6%), moderate in 216 (52%), and high risk in 101 (24.3%) participants. Using the Katz ADL scale, 332 (80%) participants were found to be independent and 83 (20%) were dependent. The high-risk factors for developing OA were age ≥ 70 years, female sex, living in a rural area, employment status, Muslim religion, the habit of betel nut chewing, diabetes mellitus, hypertension, thyroid diseases, family history of knee OA, history of previous surgery, and ADL, significantly associated with WOMAC (p < 0.05).

CONCLUSION

As per the WOMAC scale, approximately 24.3% of the geriatric population is at high risk of developing OA and 20% of them are dependent on performing ADL as assessed using the Katz ADL scale. The WOMAC and Katz ADL scales are simple questionnaire-based screening tools used to detect high-risk individuals for OA at an early stage in the geriatric population.

Hospital Admission Profile Due to Osteoarthritis: An Ecological Study

Background Osteoarthritis (OA) is also known as degenerative joint disease and is considered the major cause of joint pain and disability. Furthermore, OA is the most common, costly, and disabling form of joint diseases. The objective of this study is to explore the hospital admission profile due to OA between the period 1999 and 2019 in England and Wales. Method This is an ecological study that used health care data in the United Kingdom. Patients who were hospitalized for OA in England and Wales between 1999 and 2019 formed the study population. The Hospital Episode Statistics in England and the Patient Episode Database for Wales databases were used in this study. The difference in the admission rate during the study period was estimated using the chi-squared test. Results The admission rate during the study period increased by 112.1% for all hospital admission related to OA. The most common type of admission was related to gonarthrosis, which accounted for 46.7% of the total number of admissions for OA. The increase in admission rate across different types of admissions related to OA was not consistent. The highest increase in the admission rate was observed for polyarthrosis (604.6%). Admission rates related to OA were observed to be directly related to age. The highest increase in the admission rate during the study period was for the age group of 15-59 years (102.1%). Admission rate due to OA was higher among females compared to males. Conclusion The increase in admission rates for the various OA-related admissions was not consistent. This study found that the age range of 15 to 59 years experienced the greatest increase in admission rates. Female gender is a high risk factor for OA, especially in women around menopause.

Marine collagen-chitosan-fucoidan/chondroitin sulfate cryo-biomaterials loaded with primary human cells envisaging cartilage tissue engineering

Cartilage repair after a trauma or a degenerative disease like osteoarthritis (OA) continues to be a big challenge in current medicine due to the limited self-regenerative capacity of the articular cartilage tissues. To overcome the current limitations, tissue engineering and regenerative medicine (TERM) and adjacent areas have focused their efforts on new therapeutical procedures and materials capable of restoring normal tissue functionalities through polymeric scaffolding and stem cell engineering approaches. For this, the sustainable exploration of marine origin materials has emerged in the last years as a natural alternative to mammal sources, benefiting from their biological properties (e.g., biocompatibility, biodegradability, no toxicity, among others) for the development of several types of scaffolds. In this study, marine collagen(jCOL)-chitosan(sCHT)-fucoidan(aFUC)/chondroitin sulfate(aCS) were cryo-processed (-20 °C, -80 °C, and -196 °C) and a chemical-free crosslinking approach was explored to establish cohesive and stable cryogel materials. The cryogels were intensively characterized to assess their oscillatory behavior, thermal structural stability, thixotropic properties (around 45 % for the best formulations), injectability, and surface structural organization. Additionally, the cryogels demonstrate an interesting microenvironment in in vitro studies using human adipose-derived stem cells (hASCs), supporting their viability and proliferation. In both physic-chemical and in vitro studies, the systems that contain fucoidan in their formulations, i.e., C₁ (jCOL, sCHT, aFUC) and C₃ (jCOL, sCHT, aFUC, aCS), submitted at -80 °C, are those that demonstrated most promising results for future application in articular cartilage tissues.

A case series of total knee arthroplasty with a non-constrained implant in 2nd and 3rd degree valgus deformity in knee osteoarthritis and medial collateral ligament insufficiency

INTRODUCTION

Osteoarthritis is one of the leading causes of disability and the most common degenerative disease of the knee that causes enormous pain. As many as 10-15 % of patients requiring total knee arthroplasty (TKA) present with valgus knee deformity. When fully constrained TKA is not possible, the surgeon must use a different method to achieve a good result.

CASE DESCRIPTION

A 56-year-old female with 3rd degree (48-degree) and a 62-year-old male with 2nd degree valgus knee (13-degree) with painful osteoarthritis were examined. Both have valgus thrust gait and medial collateral ligament (MCL) laxity and underwent TKA using non-constrained implants. During surgical exposure, MCL insufficiency was found in both patients, and MCL augmentation was performed. Post-operative assessment and 4-month follow-up were done through clinical and radiological parameters using the knee scoring system.

DISCUSSION

A good outcome could still be achieved with a primary TKA implant in severe and moderate valgus knees with MCL insufficiency using MCL augmentation. The primary TKA implant proved to improve clinical and radiological parameters after 4 months of follow-up. Clinically, both patients no longer felt pain in their knees and were able to walk with better stability. Radiologically, there was a much-reduced valgus degree. The results were the first case went from 48-degree to 2-degree and the second case went from 13-degree to 6-degree.

CONCLUSION

Knee osteoarthritis with valgus deformity and MCL insufficiency present surgical challenges during TKA. It is still possible to use in severe or moderate valgus with MCL insufficiency, which was proven by satisfactory clinical and radiological findings. Although a non-constrained option is not ideal, it is still the first choice in certain cases.

Clinical efficacy of Yiqi Yangxue formula on knee osteoarthritis and unraveling therapeutic mechanism through plasma metabolites in rats

Objective: To observe the clinical efficacy and safety of Yiqi Yangxue formula (YQYXF) on knee osteoarthritis (KOA), and to explore the underlying therapeutic mechanism of YQYXF through endogenous differential metabolites and their related metabolic pathways.

Methods: A total of 61 KOA patients were recruited and divided into the treatment group (YQYXF, 30 cases) and the control group (celecoxib, Cxb, 31 cases). Effects of these two drugs on joint pain, swelling, erythrocyte sedimentation rate (ESR) and c-reactive protein (CRP) were observed, and their safety and adverse reactions were investigated. In animal experiments, 63 SD rats were randomly divided into normal control (NC) group, sham operation (sham) group, model (KOA) group, Cxb group, as well as low-dose (YL), medium-dose (YM), and high-dose groups of YQYXF (YH). The KOA rat model was established using a modified Hulth method. Ultra-high-performance liquid chromatography/Q Exactive HF-X Hybrid Quadrupole-Orbitrap Mass (UHPLC-QE-MS)-based metabolomics technology was used to analyze the changes of metabolites in plasma samples of rats. Comprehensive (VIP) &gt;1 and t-test p &lt; 0.05 conditions were used to screen the disease biomarkers of KOA, and the underlying mechanisms of YQYXF were explored through metabolic pathway enrichment analysis. The related markers of YQYXF were further verified by ELISA (enzyme-linked immunosorbent assay).

Results: YQYXF can improve joint pain, swelling, range of motion, joint function, Michel Lequesen index of severity for osteoarthritis (ISOA) score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, ESR, and CRP. No apparent adverse reactions were reported. In addition, YQYXF can improve cartilage damage in KOA rats, reverse the abnormal changes of 16 different metabolites, and exert an anti-KOA effect mainly through five metabolic pathways. The levels of reactive oxygen species (ROS) and glutathione (GSH) were significantly decreased after the treatment of YQYXF.

Conclusion: YQYXF can significantly improve the clinical symptoms of KOA patients without obvious adverse reactions. It mainly improved KOA through modulating lipid metabolism-related biomarkers, reducing lipid peroxidation and oxidative stress.

A Decade's Perspective on the Orthopedic Workforce in Saudi Arabia

Background The orthopedic surgery workforce constitutes a vital role in the healthcare system, with data being scarce. Therefore, through this study, we share an overview of the orthopedic workforce distribution, demographic trends, and changes over the past decade in Saudi Arabia. Methods All practicing orthopedic surgeons in Saudi Arabia from January 1, 2010, to December 31, 2021, were included in the study. Data regarding orthopedic surgeons' demographics and numbers were obtained from the Saudi Commission for Health Specialties (SCFHS), whereas the data related to the geographical distribution of orthopedic surgeons was obtained from the Ministry of Health Statistical Yearbook of 2020. Results The ratio of orthopedic surgeons per 100,000 people was 5.42 in 2010, which grew subsequently to 12.29 in 2021. The number of Saudi orthopedic surgeons has been noticeably rising through the years, while a slowly growing pattern can be seen among non-Saudi orthopedic surgeons. In addition, the highest ratios of orthopedic surgeons per 100,000 were in Makkah (1.72), Riyadh (1.26), and the Eastern Region (1.06). Conclusion In this study, we demonstrate the progress of the orthopedic workforce in Saudi Arabia over a period of 12 years. The number of orthopedic surgeons per 100,000 people showed a significant rise due to several factors, one of which is road traffic accidents. Also, although the number of female orthopedic surgeons has been rising lately, they are still much fewer than males in this field. In addition, Saudi Arabia has been developing a new healthcare system via the privatization of some of the governmental hospitals, which will lead to changes in the future workforce and its accommodations.

Inflammaging and Osteoarthritis

Osteoarthritis is a highly prevalent disease particularly in subjects over 65 years of age worldwide. While in the past it was considered a mere consequence of cartilage degradation leading to anatomical and functional joint impairment, in recent decades, there has been a more dynamic view with the synovium, the cartilage, and the subchondral bone producing inflammatory mediators which ultimately lead to cartilage damage. Inflammaging is defined as a chronic, sterile, low-grade inflammation state driven by endogenous signals in the absence of infections, occurring with aging. This chronic status is linked to the production of reactive oxygen species and molecules involved in the development of age-related disease such as cancer, diabetes, and cardiovascular and neurodegenerative diseases. Inflammaging contributes to osteoarthritis development where both the innate and the adaptive immune response are involved. Elevated systemic and local inflammatory cytokines and senescent molecules promote cartilage degradation, and antigens derived from damaged joints further trigger inflammation through inflammasome activation. B and T lymphocyte populations also change with inflammaging and OA, with reduced regulatory functions, thus implicating self-reactivity as an additional mechanism of joint damage. The discovery of the underlying pathogenic pathways may help to identify potential therapeutic targets for the management or the prevention of osteoarthritis. We will provide a comprehensive evaluation of the current literature on the role of inflammaging in osteoarthritis and discuss the emerging therapeutic strategies.

Effect of Adding Perineural Methylprednisolone to Peripheral Nerve Blocks Combined With Intravenous Dexamethasone for Prolonged Postdischarge Analgesia After Fast-track Total Knee Arthroplasty: A Randomized Controlled Trial

OBJECTIVES

Patients undergoing total knee arthroplasty (TKA) may experience moderate-to-severe subacute pain after hospital discharge that may be undermanaged. We aimed to evaluate the effect of methylprednisolone added to ultrasound-guided peripheral nerve blocks (PNBs) combined with multimodal analgesia including intravenous dexamethasone for prolonged analgesia after early discharge.

MATERIALS AND METHODS

We randomized 80 patients who underwent fast-track TKA into 2 groups. All patients received a periarticular injection, PNBs, and multiple doses of intravenous dexamethasone. The methylprednisolone group received 140 mg methylprednisolone in PNBs, while the nonmethylprednisolone group did not. The primary outcome was the incidence of moderate-to-severe pain (Numerical Rating Scale ≥4) during the first 12 postdischarge days. The secondary outcomes included pain scores until 3 postoperative months, incidence of rebound pain, functional performances, patient satisfaction, and adverse events.

RESULTS

No significant between-group differences were noted in the incidence of moderate-to-severe pain during the first 12 postdischarge days (nonmethylprednisolone vs. methylprednisolone groups: 70% vs. 69.2%, P=0.941). However, this incidence was significantly higher in the methylprednisolone group between 2 weeks and 1 month (P=0.015) and between 1 and 3 months (P=0.004) postoperatively. No between-group differences in the Numerical Rating Scale scores at the postdischarge time points, incidence of rebound pain, and functional performance results were noted.

DISCUSSION

Adding perineural methylprednisolone to ultrasound-guided PNBs for multimodal analgesia with intravenous dexamethasone did not prolong analgesia and improved the functional ability after fast-track TKA within 12 postdischarge days. However, the incidence moderate-to-severe pain may increase between the 2-week and 3-month follow-up.

Uncovering the "riddle of femininity" in osteoarthritis: a systematic review and meta-analysis of menopausal animal models and mathematical modeling of estrogen treatment

OBJECTIVE

Post-menopausal women are disproportionately affected by osteoarthritis (OA). As such, the purpose of this study was to (1) summarize the state-of-the-science aimed at understanding the effects of menopause on OA in animal models and (2) investigate how dosage and timing of initiation of estrogen treatment affect cartilage degeneration.

DESIGN

A systematic review identified articles studying menopausal effects on cartilage in preclinical models. A meta-analysis was performed using overlapping cartilage outcomes in conjunction with a rigor and reproducibility analysis. Ordinary differential equation models were used to determine if a relationship exists between cartilage degeneration and the timing of initiation or dosage of estrogen treatment.

RESULTS

Thirty-eight manuscripts were eligible for inclusion. The most common menopause model used was ovariectomy (92%), and most animals were young at the time of menopause induction (86%). Most studies did not report inclusion criteria, animal monitoring, protocol registration, or data accessibility. Cartilage outcomes were worse in post-menopausal animals compared to age-matched, non-menopausal animals, as evidenced by cartilage histological scoring [0.75, 1.72], cartilage thickness [-4.96, -0.96], type II collagen [-4.87, -0.56], and c-terminal cross-linked telopeptide of type II collagen (CTX-II) [2.43, 5.79] (95% CI of Effect Size (+greater in menopause, -greater in non-menopause)). Moreover, modeling suggests that cartilage health may be improved with early initiation and higher doses of estrogen treatment.

CONCLUSIONS

To improve translatability, animal models that consider aging and natural menopause should be utilized, and more attention to rigor and reproducibility is needed. Timing of initiation and dosage may be important factors modulating therapeutic effects of estrogen on cartilage.

Intra-Articular Hyaluronic Acid in Osteoarthritis and Tendinopathies: Molecular and Clinical Approaches

Musculoskeletal diseases continue to rise on a global scale, causing significant socioeconomic impact and decreased quality of life. The most common disorders affecting musculoskeletal structures are osteoarthritis and tendinopathies, complicated orthopedic conditions responsible for major pain and debilitation. Intra-articular hyaluronic acid (HA) has been a safe, effective, and minimally invasive therapeutic tool for treating these diseases. Several studies from bedside to clinical practice reveal the multiple benefits of HA such as lubrication, anti-inflammation, and stimulation of cellular activity associated with proliferation, differentiation, migration, and secretion of additional molecules. Collectively, these effects have demonstrated positive outcomes that assist in the regeneration of chondral and tendinous tissues which are otherwise destroyed by the predominant catabolic and inflammatory conditions seen in tissue injury. The literature describes the physicochemical, mechanical, and biological properties of HA, their commercial product types, and clinical applications individually, while their interfaces are seldom reported. Our review addresses the frontiers of basic sciences, products, and clinical approaches. It provides physicians with a better understanding of the boundaries between the processes that lead to diseases, the molecular mechanisms that contribute to tissue repair, and the benefits of the HA types for a conscientious choice. In addition, it points out the current needs for the treatments.

The Relationship between Nutritional Risk and the Most Common Chronic Diseases in Hospitalized Geriatric Population from Central Poland

The aim of this study was to assess the relationship between Nutrition Risk Screening 2002 (NRS-2002) and the prevalence of concomitant chronic diseases among hospitalized older adults. This study included 2122 consecutively hospitalized older participants with an average age of 82 years. The criteria to participate were the ability to communicate and give consent. In multivariate design, the prevalence of nutritional risk with at least 3 points in the NRS-2002 score was associated with the presence of stroke, atrial fibrillation, dementia and pressure ulcers. Patients with arterial hypertension, lipid disorders, osteoarthritis and urine incontinence had a significantly lower (better) NRS-2002 score. The explanation of the inverse relationship between some disorders and nutritional risk may be their occurrence in relatively earlier age and the relationship with body mass index. In conclusion, the study revealed which medical conditions coexist with the increased nutritional risk in a “real-world” hospitalized geriatric population. The hospital admission of an older subject with stroke, atrial fibrillation, dementia or pressure ulcers should primarily draw attention to the nutritional risk of the patient.

Screening for or diagnosing medial meniscal root injury using peripheral medial joint space width ratio in plain radiographs

To evaluate the sensitivity and specificity for screening and diagnosis of medial meniscal root injury using the distance ratio of medial joint space width between affected and unaffected knees in patients with potential medial meniscal root injury (MMRI) using plain radiographs, the study enrolled 49 patients with suspected MMRI who were then evaluated for MMRI using plain radiographs of both knees in the anteroposterior view and magnetic resonance imaging (MRI) findings. The ratios of peripheral medial joint space width between the affected and unaffected sides were calculated. The cut point value, sensitivity and specificity were calculated according to a receiver operating characteristic (ROC) curve. In the study, 18 and 31 patients were diagnosed with and without MMRI, respectively. The mean peripheral medial joint space width ratios comparing the affected side to the unaffected side in the standing position of the anteroposterior view of both knees in the MMRI and non-MMRI groups were 0.83 ± 0.11 and 1.04 ± 0.16, respectively, which was a significant difference (p-value < 0.001). The cut point value of the peripheral medial joint space width ratio between the affected and unaffected sides for suspected MMRI was 0.985, with sensitivity and specificity of 0.83 and 0.81, respectively, and for diagnosis was 0.78, with sensitivity and specificity of 0.39 and 1.00, respectively. The area under the ROC curve was 0.881. Patients with a possible MMRI had peripheral medial joint space width ratios less than patients with non-MMRI. This test can be used for reliably screening for or diagnosing medial meniscal root injury in primary or secondary care settings.

The Role of Ferroptosis in the Pathogenesis of Osteoarthritis

Osteoarthritis (OA) is the most common type of arthritis. Its high prevalence, especially in the elderly, and its negative impact on physical function make it a leading cause of disability in the elderly. Joint pain as well joint stiffness are the common classic signs of OA. Chondrocyte death together with loss of articular cartilage integrity are the main pathologic changes in OA. Non-steroidal anti-inflammatory drugs (NSAIDs) and glucocorticoids are commonly used for the management of OA; still, their effectiveness is limited, and no therapeutic strategy is able to fully stop OA progression. Ferroptosis is a kind of cell death, distinct from apoptosis and necroptosis, caused by iron-dependent peroxidation of membrane phospholipids that terminates cell life by disintegrating all plasma membranes. It has been suggested that ferroptosis has a critical role in decreased viability of chondrocytes in OA, and here, we review recent findings regarding the pathologic pathways that lead to chondrocyte ferroptosis, and discuss the possible therapeutic utility of ferroptosis inhibition in OA.

(Cost-)effectiveness of a personalized multidisciplinary eHealth intervention for knee arthroplasty patients to enhance return to activities of daily life, work and sports - rationale and protocol of the multicentre ACTIVE randomized controlled trial

BACKGROUND

With the worldwide rising obesity epidemic and the aging population, it is essential to deliver (cost-)effective care that results in enhanced societal participation among knee arthroplasty patients. The purpose of this study is to describe the development, content, and protocol of our (cost-)effectiveness study that assesses a perioperative integrated care program, including a personalized eHealth app, for knee arthroplasty patients aimed to enhance societal participation post-surgery compared to care as usual.

METHODS

The intervention will be tested in a multicentre randomized controlled trial with eleven participating Dutch medical centers (i.e., hospitals and clinics). Working patients on the waiting-list for a total- or unicompartmental knee arthroplasty with the intention to return to work after surgery will be included. After pre-stratification on medical centre with or without eHealth as usual care, operation procedure (total- or unicompartmental knee arthroplasty) and recovery expectations regarding return to work, randomization will take place at the patient-level. A minimum of 138 patients will be included in both the intervention and control group, 276 in total. The control group will receive usual care. On top of care as usual, patients in the intervention group will receive an intervention consisting of three components: 1) a personalized eHealth intervention called ikHerstel ('I Recover') including an activity tracker, 2) goal setting using goal attainment scaling to improve rehabilitation and 3) a referral to a case-manager. Our main outcome is quality of life, based on patient-reported physical functioning (using PROMIS-PF). (Cost-)effectiveness will be assessed from a healthcare and societal perspective. Data collection has been started in 2020 and is expected to finish in 2024.

DISCUSSION

Improving societal participation for knee arthroplasty is relevant for patients, health care providers, employers and society. This multicentre randomized controlled trial will evaluate the (cost-)effectiveness of a personalized integrated care program for knee arthroplasty patients, consisting of effective intervention components based on previous studies, compared to care as usual.

TRIAL REGISTRATION

Trialsearch.who.int; reference no. NL8525, reference date version 1: 14-04-2020.

A Brief Overview: Sex Differences in Prevalent Chronic Musculoskeletal Conditions

Musculoskeletal (MSK) pain disorders are some of the most prevalent and disabling chronic pain conditions worldwide. These chronic conditions have a considerable impact on the quality of life of individuals, families, communities, and healthcare systems. Unfortunately, the burden of MSK pain disorders does not fall equally across the sexes. Females consistently demonstrate more prevalent and severe clinical presentations of MSK disorders, and this disparity increases in magnitude with age. The aim of the present article is to review recent studies that have examined sex differences between males and females in four of the most common MSK pain disorders: neck pain, low back pain, osteoarthritis, and rheumatoid arthritis.

Prevalence of Symptomatic Knee Osteoarthritis in Saudi Arabia and Associated Modifiable and Non-Modifiable Risk Factors: A Population-Based Cross-Sectional Study

OBJECTIVE

This study aimed to determine the prevalence of knee osteoarthritis (OA) in Saudi Arabia and the association between knee OA and modifiable and non-modifiable risk factors.

METHODS

A self-reported, population-based, cross-sectional survey between January 2021 and October 2021 was conducted. A large, population-representative sample (n = 2254) of adult subjects aged 18 years and over from all regions of Saudi Arabia was collected electronically using convenience sampling. The American College of Rheumatology (ACR) clinical criteria were used to diagnose OA of the knee. The knee injury and osteoarthritis outcome score (KOOS) was used to investigate the severity of knee OA. This study focused on modifiable risk factors (body mass index, education, employment status, marital status, smoking status, type of work, previous history of knee injury, and physical activity level) and non-modifiable risk factors (age, gender, family history of OA, and presence of flatfoot).

RESULTS

The overall prevalence of knee OA was 18.9% (n = 425), and women suffered more compared to their male counterparts (20.3% vs. 13.1%, p = 0.001). The logistic regression analysis model showed age (OR: 1.06 [95% CI: 1.05-1.07]; p < 0.01), sex (OR: 2.14 [95% CI: 1.48-3.11]; p < 0.01), previous injury (OR: 3.95 [95% CI: 2.81-5.56]; p < 0.01), and obesity (OR: 1.07 [95% CI: 1.04-1.09]; p < 0.01) to be associated with knee OA.

CONCLUSIONS

A high prevalence of knee OA underlines the need for health promotion and prevention programmes that focus on modifiable risk factors to decrease the burden of the problem and the cost of treatment in Saudi Arabia.

Knowledge and Awareness Regarding Osteoarthritis and Its Factors in Hail Region, Saudi Arabia

Objectives Osteoarthritis (OA) is a common chronic degenerative joint disease linked to age, joint overuse abnormalities, and previous trauma. This research aims to assess the awareness levels, as well as the knowledge gap and misconceptions, about OA and its risk factors among the general population in Hail, Saudi Arabia. Methods The research adopted an observational cross-sectional method. Participants from Hail, Saudi Arabia, were recruited and then interviewed between 1 April and 15 July 2022. Adult males and females aged 18 or more were recruited via an online questionnaire using a Google Form link, inviting them to take part in a study concerning their knowledge of OA. The questionnaire was split into three sections. The first section covered demographic data, the second section contained general knowledge regarding OA, and the third section was made up of a 20-item quiz. The collected data was reviewed and then analyzed using the Statistical Package for Social Sciences (SPSS) Version 21 (IBM Corp., Armonk, NY, USA). The statistical methods employed were all two-tailed, with an alpha level of 0.05 considered significant if the P value was less than, or equal to, 0.05. Results Nine hundred six (906) eligible respondents completed the questionnaire. Participants ranged from 18 to 65 in age. More than 66% were female, while 77.5% had a university level of education or above. 13.6% had been diagnosed with OA. Overall, 40.9% of the study participants demonstrated a good knowledge level regarding OA, while 59.1% showed a poor knowledge level. Conclusion The study revealed that the awareness and knowledge levels of the general population in Hail about OA are unsatisfactory. Efforts are recommended to increase the awareness and knowledge of the population through public education, which in turn can lead to a reduction in risk factors and improved early detection of the disease.

Prediction of progression rate and fate of osteoarthritis: Comparison of machine learning algorithms

Appropriate prediction models can assist healthcare systems in delaying or reversing osteoarthritis (OA) progression. We aimed to identify a reliable algorithm for predicting the progression rate and fate of OA based on patient-specific information. From May 2003 to 2019, 83,280 knees were collected. Age, sex, body mass index, bone mineral density, physical demands for occupation, comorbidities, and initial Kellgren-Lawrence (K-L) grade were used as variables for the prediction models. The prediction targets were divided into dichotomous groups for even distribution. We compared the performances of logistic regression (LR), random forest (RF), and extreme gradient boost (XGB) algorithms. Each algorithm had the best precision when the model used all variables. XGB showed the best results in accuracy, recall, F1 score, specificity, and error rates (progression rate/fate of OA: 0.710/0.877, 0.542/0.637, 0.637/0.758, 0.859/0.981, and 0.290/0.123, respectively). The feature importance of RF and XGB had the same order up to the top six for each prediction target. Age and initial K-L grade had the highest feature importance in RF and XGB for the progression rate and fate of OA, respectively. The XGB and RF machine learning algorithms showed better performance than conventional LR in predicting the progression rate and fate of OA. The best performance was obtained when all variables were combined using the XGB algorithm. For each algorithm, the initial K-L grade and physical demand for occupation were the greatest contributors with superior feature importance compared with the others.

Gender differences in the associations between knee pain and urinary incontinence in older adults: Cross-sectional analysis from the Malaysian Elders Longitudinal Research Study (MELoR)

INTRODUCTION

The common assumption that urinary incontinence occurs in osteoarthritis (OA) due to poor mobility is supported by limited evidence. The influence of gender in such associations is also yet to be elucidated.

OBJECTIVE

This study, therefore, identified any potential associations between knee OA symptoms and urinary incontinence and further explore sex differences in the associations.

DESIGN

Cross-sectional study.

SETTING

University Hospital.

PARTICIPANTS

This was a cross-sectional study from a longitudinal research study comprising 1221 community-dwelling older persons (57% women), mean age (SD) 68.95 (7.49) years.

MAIN OUTCOME MEASURE(S)

Presence of urinary incontinence: mixed, stress and urge symptoms. Physical performance and C-reactive protein levels were also assessed.

RESULTS

Two hundred and seventy-seven (22.83%) individuals reported the presence of urinary incontinence: mixed (41.5%), stress (30%), and urge (28.5%) symptoms. In an unadjusted analysis, stratified by gender, the association between knee pain and urinary incontinence was only present in women with mixed symptoms. After further adjustment of demographics differences and body mass index, the association between knee pain with any urinary incontinence and mixed symptoms remained significant with the odds ratios (95% confidence interval): 1.48 (1.02-2.15) and 1.73 (1.06-2.83), respectively. This relationship was attenuated after further adjustment for waist circumference and impaired lower limb mobility.

CONCLUSION

Our study refutes previous assumptions that urinary incontinence in individuals with OA is attributed to impaired mobility alone, but introduces the role of abdominal obesity in this relationship, particularly in women. Future studies should assess the temporal relationship between body fat distribution and OA with urinary incontinence.

Effects of Running on the Development of Knee Osteoarthritis: An Updated Systematic Review at Short-Term Follow-up

Background

Some studies have suggested that running increases the risk of knee osteoarthritis (OA), while others believe it serves a protective function.

Purpose

To perform an updated systematic review of the literature to determine the effects of running on the development of knee OA.

Study Design

Systematic review; Level of evidence, 4.

Methods

A systematic review was performed by searching the PubMed, Cochrane Library, and Embase databases to identify studies evaluating the effect of cumulative running on the development of knee OA or chondral damage based on imaging and/or patient-reported outcomes (PROs). The search terms used were "knee AND osteoarthritis AND (run OR running OR runner)." Patients were evaluated based on plain radiographs, magnetic resonance imaging (MRI), and PROs (presence of knee pain, Health Assessment Questionnaire-Disability Index, and the Knee injury and Osteoarthritis Outcome Score).

Results

Seventeen studies (6 level 2 studies, 9 level 3 studies, and 2 level 4 studies), with 7194 runners and 6947 nonrunners, met the inclusion criteria. The mean follow-up time was 55.8 months in the runner group and 99.7 months in the nonrunner group. The mean age was 56.2 years in the runner group and 61.6 years in the nonrunner group. The overall percentage of men was 58.5%. There was a significantly higher prevalence of knee pain in the nonrunner group (P < .0001). Although 1 study found a significantly higher prevalence of osteophytes in the tibiofemoral (TF) and patellofemoral (PF) joints within the runner group, multiple studies found no significant differences in the prevalence of radiographic knee OA (based on TF/PF joint-space narrowing or Kellgren-Lawrence grade) or cartilage thickness on MRI between runners and nonrunners (P > .05). One study found a significantly higher risk of knee OA progressing to total knee replacement among nonrunners (4.6% vs 2.6%; P = .014).

Conclusion

In the short term, running is not associated with worsening PROs or radiological signs of knee OA and may be protective against generalized knee pain.

Influence of Scan Parameters of Single and Dual-Energy CT Protocols in Combination with Metal Artifact Suppression Algorithms for THA: An ex Vivo Study

BACKGROUND

Metal artifacts caused by hip arthroplasty stems limit the diagnostic value of computed tomography (CT) in the evaluation of periprosthetic fractures or implant loosening. The aim of this ex vivo study was to evaluate the influence of different scan parameters and metal artifact algorithms on image quality in the presence of hip stems.

METHODS

Nine femoral stems, 6 uncemented and 3 cemented, that had been implanted in subjects during their lifetimes were exarticulated and investigated after death and anatomical body donation. Twelve CT protocols consisting of single-energy (SE) and single-source consecutive dual-energy (DE) scans with and without an iterative metal artifact reduction algorithm (iMAR; Siemens Healthineers) and/or monoenergetic reconstructions were compared. Streak and blooming artifacts as well as subjective image quality were evaluated for each protocol.

RESULTS

Metal artifact reduction with iMAR significantly reduced the streak artifacts in all investigated protocols (p = 0.001 to 0.01). The best subjective image quality was observed for the SE protocol with a tin filter and iMAR. The least streak artifacts were observed for monoenergetic reconstructions of 110, 160, and 190 keV with iMAR (standard deviation of the Hounsfield units: 151.1, 143.7, 144.4) as well as the SE protocol with a tin filter and iMAR (163.5). The smallest virtual growth was seen for the SE with a tin filter and without iMAR (4.40 mm) and the monoenergetic reconstruction of 190 keV without iMAR (4.67 mm).

CONCLUSIONS

This study strongly suggests that metal artifact reduction algorithms (e.g., iMAR) should be used in clinical practice for imaging of the bone-implant interface of prostheses with either an uncemented or cemented femoral stem. Among the iMAR protocols, the SE protocol with 140 kV and a tin filter produced the best subjective image quality. Furthermore, this protocol and DE monoenergetic reconstructions of 160 and 190 keV with iMAR achieved the lowest levels of streak and blooming artifacts.

LEVEL OF EVIDENCE

Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

The Public’s Knowledge of Osteoarthritis and Its Related Risk Factors in Makkah, Saudi Arabia

Background Osteoarthritis (OA) is a chronic progressive disease that leads to the destruction of the articular cartilage inside the joint. OA is a common everyday musculoskeletal disorder worldwide, and it is believed that OA is triggered by genetics and environmental factors, including age, which is the most significant risk factor. This study aimed to investigate the general population's knowledge of OA and its related risk factors in Makkah, Saudi Arabia. Methodology This cross-sectional study was performed between December 2022 and January 2023 among the general population of Makkah, Saudi Arabia using an online survey using Google Forms. An appropriate statistical analysis was then conducted on the collected data. Results A total of 1,087 participants enrolled in this study. According to the multivariate logistic regression analysis, 48% (n = 789) of the participants reported that OA occurs due to joint cartilage age and use. In total, 69.7% of the participants knew that OA is a chronic problem, 84.4% knew it is a common disease, and 39.3% thought that all types of joints can suffer from OA. Over half (53.1%) of the participants knew that joint stiffness is a sign of OA, and 63.4% thought that OA may lead to the loss of joint motion. Over four-fifths (82.5%) thought that advancing age is a risk factor for OA, and 27.5% incorrectly thought that the incidence of OA is equal between men and women. Overall, 62.9% of the participants knew about clinical examinations and X-rays. Moreover, 78% thought that physiotherapy can improve the symptoms of OA, and 65.3% thought that some types of exercise can help. Finally, 35.8% of the participants had an overall awareness of OA, while 64.2% had poor awareness. Conclusions The general public of Makkah showed low knowledge of OA and its associated risk factors. Many misunderstandings about the causes, risk factors, and treatment of OA were acknowledged. Awareness campaigns with brochures and flyers can be used to raise the population's knowledge.

Vitamin D3 Metabolism and Its Role in Temporomandibular Joint Osteoarthritis and Autoimmune Thyroid Diseases

The aim of this review was to present the metabolism of vitamin D₃, as well as to discuss the role of vitamin D₃ in bone metabolism, temporomandibular joint osteoarthritis (TMJ OA), and autoimmune thyroid diseases (AITD) on the basis of the literature. Vitamin D₃ plays a significant role in human health, as it affects the calcium-phosphate balance and regulates the bone metabolism. Calcitriol impresses the pleiotropic effect on human biology and metabolism. Its modulative function upon the immune system is based on the reduction of Th1 cell activity and increased immunotolerance. Vitamin D₃ deficiency may lead to an imbalance in the relationship between Th1/Th17 and Th2, Th17/Th reg, and is considered by some authors as one of the possible backgrounds of autoimmune thyroid diseases (AITD), e.g., Hashimoto's thyroiditis or Graves' disease. Moreover, vitamin D₃, through its direct and indirect influence on bones and joints, may also play an important role in the development and progression of degenerative joint diseases, including temporomandibular joint osteoarthritis. Further randomized, double blind studies are needed to unequivocally confirm the relationship between vitamin D₃ and abovementioned diseases and to answer the question concerning whether vitamin D₃ supplementation may be used in the prevention and/or treatment of either AITD or OA diseases.

The Impact of Living Arrangements on the Prevalence of Falls after Total Joint Arthroplasty: A Comparison between Institutionalized and General Geriatric Population

Due to population aging, there is an increasing need for orthopedic surgery, especially total knee arthroplasty (TKA) and total hip arthroplasty (THA). In geriatric patients, postoperative falls are common events which can compromise the success of these expensive procedures. The aim of our study was to assess the influence of living arrangements on the prevalence of postoperative falls following joint replacement. We included 441 patients after TKA or THA, living in nursing homes, alone or with family. The prevalence of falls in the first 2 years (15.2%) was significantly influenced by living arrangements: patients with TKA or THA living alone had three times higher odds of falling compared to those living with family, and institutionalized patients with THA had four times higher odds of falling compared to those living with family. Of 67 patients who fell, 6 (8.9%) needed reintervention. For TKA patients, the fall rates were not significantly different between institutions and family, indicating the interest of nursing homes in offering proper care. However, for the THA group, the results were poorer, emphasizing the need for improvement in postoperative rehabilitation. Further multi-centric studies are required for generalizing the impact of living arrangements on fall prevalence after joint replacement.

The Effects of Gout Following total Knee Arthroplasty: A Retrospective Analysis

BACKGROUND

The prevalence of gout is increasing along with the number of total knee arthroplasties (TKA) performed annually. The purpose of this study was to evaluate the incidence of gout following TKA in patients who had a previous history of gout and to determine if it is associated with an increased rate of postoperative joint complications.

METHODS

Patients who did and did not have a preoperative diagnosis of gout and underwent a primary TKA were identified from a national database. The gout patients were matched 1:1 to patients who did not have gout and rates of postoperative gout diagnoses within 2 years of surgery were compared. Complication rates at mean 1 and 2 years were then compared for both patient cohorts using multivariable logistic regressions. A total of 17,463 patients with a prior diagnosis of gout were matched with 17,463 controls.

RESULTS

There were 53.8% of patients who had previous gout and had a recurrence of gout within 2 years versus 3.6% of controls (Odds Ratios [OR]: 30.86). At mean 1-year, patients who had gout were significantly more likely to experience prosthetic joint infections (PJIs) and revision procedures. At mean 2 years, gout patients were at increased risk of prosthetic loosening, PJI, revision, and incision and debridement procedures.

CONCLUSION

This study suggests that patients who had a prior diagnosis of gout are significantly more likely to experience recurrent episodes of gout after TKA. Gout attacks after TKA are associated with an increase in the rate of joint complications.

LEVEL OF EVIDENCE

Level III.

Effects of Venous Insufficiency in Patients Undergoing Primary Total Knee Arthroplasty: An Analysis of 1.2 Million Patients

Chronic venous insufficiency (CVI) is extraordinarily prevalent in our aging population with over 30 million people in the United States suffering from the disease. There is a paucity of data analyzing the effects of CVI on outcomes following total knee arthroplasty (TKA). The purpose of this study was to utilize a nationwide administrative claims database to determine whether patients with CVI undergoing TKA have higher rates of: (1) in-hospital lengths of stay (LOS); (2) readmission rates; (3) medical complications; (4) implant-related complications; and (5) costs of care compared to controls. Using a nationwide database, we matched patients with CVI undergoing TKA to controls without CVI undergoing TKA in a 1:5 ratio by age, sex, and medical comorbidities associated with CVI. Primary outcomes analyzed within the study included LOS, 90-day readmission rates, 90-day medical complications, 2-year implant-related complications, in addition to 90-day total global episode of care costs. The query yielded 1,265,534 patients with (n = 210,926) and without (n = 1,054,608) CVI undergoing primary TKA. Patients with CVI had significantly longer LOS (4 vs. 3 days, p < 0.0001), higher 90-day readmission rates (20.96 vs. 15.34%; odds ratio [OR]: 1.46, 95% confidence interval [CI]: 1.44-1.48, p < 0.0001), and higher odds of medical complications (2.27 vs. 1.30%; OR: 1.76, 95% CI: 1.70-1.83, p < 0.0001) compared to matched controls. Patients with CVI also had higher odds of periprosthetic joint infections (2.23 vs. 1.03%; OR: 2.18, p < 0.0001) and implant-related complications in general (4.27 vs. 2.17%; OR: 2.01, 95% CI: 1.96-2.06, p < 0.0001). Additionally, patients with CVI had higher total global 90-day episode of care costs ($15,583.07 vs. $14,286.95, p < 0.0001). Patients with CVI undergoing TKA have increased LOS, higher odds of medical and implant complications, and increased costs of care compared to those without CVI. The study can be utilized by orthopaedic surgeons to counsel patients on the potential complications following this procedure. This is a level III, retrospective cohort study.

Understanding sex-related differences in healthcare utilisation among patients with inflammatory arthritis: a population-based study

OBJECTIVES

Our aim was to compare patterns of musculoskeletal-related healthcare utilisation between male and female patients before and after the diagnosis of inflammatory arthritis (IA).

METHODS

We used Ontario administrative health data to create three inception cohorts of adult patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) diagnosed between April 2010 and March 2017. Healthcare utilisation indicators including visits to physicians, and use of musculoskeletal imaging and laboratory tests were assessed in each year for 3 years before and after diagnosis and compared between male and female patients using regression models adjusting for sociodemographic factors and comorbidities. Results were reported as ORs with 95% CIs for female patients compared with male patients.

RESULTS

A total of 41 277 patients with RA (69% female), 8150 patients with AS (51% female) and 6446 patients with PsA (54% female) were analysed.Similar trends of sex-related differences were observed in all three cohorts. Before diagnosis, female patients were more likely to visit rheumatologists (OR 1.32-2.28) and family physicians (OR 1.03-1.15) for musculoskeletal reasons, whereas male patients were more likely to visit the emergency for musculoskeletal reasons (OR 0.76-0.87). A similar female predominance was observed regarding musculoskeletal imaging and laboratory tests before diagnosis. After diagnosis, female patients were more likely to remain in rheumatology care (OR 1.12-1.24).

CONCLUSION

Female patients with IA have higher healthcare utilisation than male patients which may indicate biological differences in disease course or sociocultural differences in healthcare-seeking behaviour.

The effects of dietary patterns and food groups on symptomatic osteoarthritis: A systematic review

AIM

To systematically review current literature to determine the association between symptomatic osteoarthritis and dietary patterns, diet quality and food groups in adults aged ≥45 years.

METHODS

The review was registered on PROSPERO (CRD42021270891). Cochrane Central Library, Cumulative Index of Nursing and Allied Health Literature, Embase, Medline and Web of Science databases were searched. A total of 3816 records were identified. Eligible articles involved populations aged ≥45 years with symptomatic osteoarthritis, assessing dietary patterns, diet quality or food groups, with pain in joints as outcomes. The Joanna Briggs Institute Critical Appraisal Checklists were used for quality assessment. Grading of Recommendations, Assessment, Development and Evaluation was used to assess the certainty of evidence.

RESULTS

Six cohort studies were included. The Prudent dietary pattern and the Mediterranean dietary pattern reduced the progression of osteoarthritis symptoms. The Western dietary pattern increased symptomatic osteoarthritis progression. Increased total fibre consumption reduced symptomatic osteoarthritis progression and pain worsening, but the effects of fibre from each food group were inconclusive. Diet with high inflammatory potential increased risk of new onset symptomatic osteoarthritis, but the effects of overall diet quality were inconclusive.

CONCLUSIONS

The Prudent dietary pattern showed the highest protection on symptomatic osteoarthritis in adults aged 45 years and over. The body of evidence is limited, suggesting that further research is needed to corroborate the estimated effect at a high certainty of evidence, and to incorporate previously unstudied dietary patterns and food groups. Identifying the most beneficial dietary pattern may inform future guidelines for reducing symptomatic osteoarthritis in middle aged and older adults.

Does a Uni "Feel Better" than a Total Knee? Not Necessarily, When Using Modern Implant Designs

Background: When comparing functional outcomes of patients with unicompartmental knee arthroplasty (UKA) versus total knee arthroplasty (TKA), studies often report the UKA as the preferred procedure; however, recent improvements in the design of modern TKA implants have aimed at narrowing this gap. Purpose: We sought to compare the "feel" of modern TKA implants to that of UKA, using the Forgotten Joint Score (FJS), a validated patient-reported outcome measure. Methods: We performed a retrospective review of patients who underwent TKA and UKA at 2 institutions between 2014 and 2017. All UKA procedures were robotic arm-assisted with a single implant, "traditional TKAs" were performed using traditional posterior-stabilized implants, and "modern TKAs" were performed using posterior-stabilized implants with a modern design. Differences in FJS were assessed using 1-way analysis of variance and independent 2-sample t tests. Results: A total of 600 patients were included in our study, with 200 patients in each surgical subcategory. Mean age was 62.8 ± 10.2 years and mean body mass index was 29.9 ± 4.9. Modern TKA and UKA had similar FJS at 1 year. While modern TKA had a significantly higher FJS than traditional TKA, UKA did not have a significantly higher FJS than traditional TKA. Conclusion: Our retrospective analysis found no significant differences in the FJS of patients who underwent UKA and TKA with a modern design; however, both had superior scores than traditional TKA designs. This finding suggests that modern TKA designs may have the potential to achieve the natural feeling that is typically associated with joint-conserving surgeries such as UKA, although longer follow-up is necessary.

Diffusion-weighted MRI of total hip arthroplasty for classification of synovial reactions: A pilot study

BACKGROUND

Conventional quantitative diffusion-weighted imaging (DWI) is sensitive to changes in tissue microstructure, but its application to evaluating patients with orthopaedic hardware has generally been limited due to metallic susceptibility artifacts. The apparent diffusion coefficient (ADC) and T2-values from a multi-spectral imaging (MSI) DWI combined with 2D multi-spectral imaging with a 2D periodically rotated overlapping parallel lines with enhanced reconstruction (2D-MSI PROPELLER DWI) based sequence and a MAVRIC based T2 mapping sequence, respectively, may mitigate the artifact and provide additional quantitative information on synovial reactions in individuals with total hip arthroplasty (THA). The aim of this pilot study is to utilize a 2D-MSI PROPELLER DWI and a MAVRIC-based T2 mapping to evaluate ADC and T2-values of synovial reactions in patients with THA.

METHODS

Coronal morphologic MRIs from THA patients underwent evaluation of the synovium and were assigned a synovial classification of 'normal', or 'grouped abnormal' (consisting of sub-groups 'infection', 'polymeric', 'metallosis', 'adverse local tissue reaction' [ALTR], or 'non-specific') and type of synovial reaction present (fluid-like, solid-like, or mixed). Regions of interest (ROIs) were placed in synovial reactions for measurement of ADC and T2-values, obtained from the 2D-MSI PROPELLER DWI and T2-MAVRIC sequences, respectively. A one-way analysis of variance (ANOVA) and Kruskal-Wallis rank sum tests were used to compare the differences in ADC and T2-values across the different synovial reaction classifications. A Kruskal-Wallis test was used to compare the ROI areas for the ADC and T2-values. A principal component analysis (PCA) was performed to evaluate the possible effects of ADC values, size of the ADC ROI, T2-values, and size of the T2 ROI with respect to synovial reaction classification.

RESULTS

Differences of ADC and T2 among the individual synovial reactions were not found. A difference of ADC between 'normal' and 'grouped abnormal' synovial reactions was also not detected even as the ADC area of 'grouped abnormal' synovial reactions were significantly larger (p = 0.02). The 'grouped abnormal' synovial reactions had significantly shorter T2-values than 'normal' synovial reactions (p = 0.02), and that the T2 area of 'grouped abnormal' synovial reactions were significantly larger (p = 0.01). A larger ROI area on the T2-maps was observed in the mixed synovial reaction type as compared to the fluid-like reaction type area (p = 0.01). Heterogeneity was noted in calculated ADC and T2 maps. PCA analysis revealed obvious clustering by the 'normal' and 'grouped abnormal' classifications.

CONCLUSIONS

2D-MSI PROPELLER DWI and MAVRIC-T2 generate quantitative images of periprosthetic tissues within clinically feasible scan times. The combination of derived ADC and T2-values with area of synovial reaction may aid in differentiating normal from abnormal synovial reactions between types of synovial reactions in patients with THA.

An automated, web-based triage tool may optimise referral pathways in elective orthopaedic surgery: A proof-of-concept study

Introduction

Knee pain is caused by various pathologies, making evaluation in primary-care challenging. Subsequently, an over-reliance on imaging, such as radiographs and MRI exists. Electronic-triage tools represent an innovative solution to this problem. The aims of this study were to establish the magnitude of unnecessary knee imaging prior to orthopaedic surgeon referral, and ascertain whether an e-triage tool outperforms existing clinical pathways to recommend correct imaging.

Methods

Patients ≥18 years presenting with knee pain treated with arthroscopy or arthroplasty at a single academic hospital between 2015 and 2020 were retrospectively identified. The timing and appropriateness of imaging were assessed according to national guidelines, and classified as 'necessary', 'unnecessary' or 'required MRI'. Based on an eDelphi consensus study, a symptom-based e-triage tool was developed and piloted to preliminarily diagnose five common knee pathologies and suggest appropriate imaging.

Results

1462 patients were identified. 17.2% (n = 132) of arthroplasty patients received an 'unnecessary MRI', 27.6% (n = 192) of arthroscopy patients did not have a 'necessary MRI', requiring follow-up. Forty-one patients trialled the e-triage pilot (mean age: 58.4 years, 58.5% female). Preliminary diagnoses were available for 33 patients. The e-triage tool correctly identified three of the four knee pathologies (one pathology did not present). 79.2% (n = 19) of participants would use the tool again.

Conclusion

A substantial number of knee pain patients receive incorrect imaging, incurring delays and unnecessary costs. A symptom-based e-triage tool was developed, with promising performance and user feedback. With refinement using larger datasets, this tool has the potential to improve wait-times, referral quality and reduce cost.

Making the current non-surgical treatments for knee osteoarthritis more effective: Solutions from a diverse patient group

OBJECTIVE

To examine patient perceived solutions to barriers to effective non-surgical knee osteoarthritis (OA) treatments in a diverse racial/ethnic group.

METHODS

Nominal groups were conducted with consecutive patients with knee OA at a medical center clinic, oversampling for African Americans with knee OA. Participants discussed potential solutions and rank-ordered their concerns.

RESULTS

Thirteen nominal groups with 46 knee OA patients were conducted with mean age, 60.8 years (standard deviation [sd], 10.0) and knee OA duration, 8.1 years (sd, 5.4); 22% were men, and 56% were African American. The following solutions were in the top three ranked solutions in 13 NGTs: (A) more research, effective and/or safer new medications/treatments, and joint cartilage restoration (8 groups; 15% votes [43/276]); (B) early diagnosis (2 groups; 7% votes [20/276]); (C) better and more effective communication (5 groups; 10% votes [29/276]); (D) public and patient education (4 groups; 8% votes [22/276]); (E) motivation and behavioral modification (4 groups; 9% votes [26/276]); (F) team approach (1 group; 1% votes [2/276]); (G) personalized medicine (6 groups; 8% votes [24/276]); (H) cheaper and more affordable medications and treatments (3 groups; 5% votes [15/276]).

CONCLUSIONS

A diverse group of participants with knee OA identified several solutions to barriers to the effectiveness of current knee OA treatments. This new knowledge can inform the development and implementation of future interventions to improve the outcomes of people with knee OA.

Efficacy of self-management program associated with a spa therapy for knee osteoarthritis patients (GETT 2): a research protocol for a randomized trial

INTRODUCTION

Osteoarthritis is a chronic pathology that involves multidisciplinary management. Self-management for patients is an essential element, present in all international guidelines. During the time of the spa therapy, the patient is receptive to take the advantage of self-management workshops. The aim of this study is to assess the effects of 18 days spa therapy associated with a self-management intervention in patients with knee osteoarthritis in comparison with spa therapy alone on a priority objective, personalized and determined with the patient, chosen in the list of 5 objectives determined during the self-management initial assessment.

METHODS AND ANALYSIS

Two hundred fifty participants with knee osteoarthritis will participate to this multicenter, prospective, randomized, controlled study. All patients will benefit 18 days of spa therapy and patients randomized in the intervention group will participate to 6 self-management workshops. Randomization will be centralized. The allocation ratio will be 1:1. Data analysts and assessor will be blinded. The primary outcome is the effectiveness of the educational workshops associated with spa therapy in comparison with spa therapy alone on a priority objective, measured by Goal Attainment Scaling (GAS). The secondary outcomes are disability, health-related quality of life, and pain intensity.

ETHICS AND DISSEMINATION

Ethics were approved by the CPP Sud-Méditerranée II. The results will be disseminated in a peer-reviewed journal and disseminated at PRM, rheumatology, and orthopedics conferences. The results will also be disseminated to patients.

TRIAL REGISTRATION

Trial registration number NCT03550547. Registered 8 June 2018. Date and version identifier of the protocol. Version N°6 of March 12, 2018.

Effects of Obesity on Medial Tibiofemoral Cartilage Mechanics in Females-An Exploration Using Musculoskeletal Simulation and Probabilistic Cartilage Failure Modelling

This study examined the effects of obesity on cartilage mechanics and longitudinal failure probability at the medial tibiofemoral compartment, using combined musculoskeletal simulation and probabilistic failure modelling approaches. The current investigation examined twenty obese females (BMI > 30.0 kg/m²) and 20 healthy weight (BMI < 25.0 kg/m²) females. Walking kinematics were obtained via an 8-camera optoelectric system, and a force plate was used to collect ground reaction forces. Musculoskeletal simulation and probabilistic failure modelling were utilized to explore medial tibiofemoral forces and cartilage probability. Comparisons between groups were undertaken using linear mixed-effects models. Net peak cartilage forces, stress and strain were significantly larger in the obese group (force = 2013.92 N, stress = 3.03 MPa & strain = 0.25), compared to health weight (force = 1493.21 N, stress 2.26 MPa & strain = 0.19). In addition, medial tibiofemoral cartilage failure probability was also significantly larger in the obese group (42.98%) compared to healthy weight (11.63%). The findings from the current investigation show that obesity has a profoundly negative influence on longitudinal medial knee cartilage health and strongly advocates for the implementation of effective weight management programs into long-term musculoskeletal management strategies.

Osteoarthritis, an old wine in a new bottle!

Osteoarthritis (OA) is the most common form of arthritis that has a major impact on patient morbidity and health care services. Despite its prevalence and impact, we do not have any effective management strategy to prevent or control their manifestations. Several decades of pharmacological development have failed to deliver a disease-modifying solution to OA. This editorial article outlines the lacunae in the research efforts of the past, the challenges that we are facing at present, and the exciting opportunities we have in the future for the management of OA. OA research has to be made more personalized concerning the phenotypic and endotypic disease variants. To begin with, robust disease classification criteria need to be defined for early OA, and biomarkers to detect such early diseases to aid in patient stratification. We also need to refine our clinical research design to make them more objective to meet the demands of the patient and the regulatory agencies. Embracing the current technologies such as artificial intelligence along with the use of genomic profiling from the omics platforms, the future of OA is more promising in developing appropriate management of OA.

Improving Self-Confidence of Military Medical Providers With Joint Procedure Simulation: A Pilot Study

INTRODUCTION

Military medical providers are a unique population that encounter different environments across the world. From hospital clinics to war zones, these providers must perform procedures and rely on their training and skill to help their patients. This pilot study aimed to assess the self-confidence of military medical providers performing joint aspiration and injection before and after a simulation workshop in both clinical and austere settings.

METHODS

In 2016, 25 military physicians from various military facilities participated in a 1-hour knee arthrocentesis and injection and shoulder injection workshop. Education was provided on the knee and shoulder anatomy and various approaches to performing the procedures before the hands-on portion of the workshop. Surveys assessing self-reported confidence levels by performing the procedures in the clinic and austere settings were completed before and after simulation training.

RESULTS

The results were analyzed and grouped based on the provider experience level, simulation environment, and specific procedure performed. There was a statistical significance seen in the shoulder arthrocentesis group, which included all participating providers, with a P-value of <.01 in the clinic setting and a P-value of <.001 in the austere setting. In the knee aspiration simulation, there were also improvements in the provider confidence, but it was not statistically significant with P-values of .36 and .14 in the clinical and austere settings, respectively.

CONCLUSION

Simulation training can lead to increased medical provider self-confidence in performing musculoskeletal joint aspirations and injections in both clinic and austere settings. The military medicine demographics have had little research in joint injections and provider confidence to date. This pilot study was one of the first to evaluate this unique population. The methods used in this study, and the positive data collected on provider confidence, can be used in larger studies, encompassing other medical providers to increase the confidence of providers throughout various fields of medicine.

Knee osteoarthritis accelerates amyloid beta deposition and neurodegeneration in a mouse model of Alzheimer's disease

Knee osteoarthritis (OA) is characterized by knee cartilage degeneration and secondary bone hyperplasia, resulting in pain, stiffness, and gait disturbance. The relationship between knee OA and neurodegenerative diseases is still unclear. This study used an Alzheimer's disease (AD) mouse model to observe whether osteoarthritis accelerates dementia progression by analyzing brain histology and neuroinflammation. Knee OA was induced by destabilizing the medial meniscus (DMM) in control (WT) and AD (5xFAD) mice before pathological symptoms. Mouse knee joints were scanned with a micro-CT scanner. A sham operation was used as control. Motor and cognitive abilities were tested after OA induction. Neurodegeneration, β-amyloid plaque formation, and neuroinflammation were analyzed by immunostaining, Western blotting, and RT-PCR in brain tissues. Compared with sham controls, OA in AD mice increased inflammatory cytokine levels in brain tissues. Furthermore, OA significantly increased β-amyloid deposition and neuronal loss in AD mice compared to sham controls. In conclusion, knee OA accelerated amyloid plaque deposition and neurodegeneration in AD-OA mice, suggesting that OA is a risk factor for AD.

Research on the Influence of MUVON PLUS Treatment Upon the Biomechanical Behavior of the Human Osteoarthritic Knee

BACKGROUND

This study aimed to investigate the effects of MUVON PLUS, a dietary supplement containing hydrolized collagen, chondroitin sulfate, and vitamin C, on the biomechanical behavior of the knee joint in patients with second-degree osteoarthritis (OA).

MATERIAL AND METHOD

The study included 15 participants who underwent biomechanical testing before and after 3 and 6 months of supplement administration. Biometrics and SimiMotion software were used to process and analyze the data. Results showed significant improvements in biomechanical parameters such as joint range of motion, joint torque, and joint stiffness for all patients during the treatment. Improvements were observed across various tests, including horizontal walking, stairs climbing and descending, sitting/standing up from a chair, and knee squats. This improvement in biomechanical performance was also reflected in the patients' reported quality of life. For the stairs climbing test, the maximum flexion-extension angle increased by approximately 7% after 3 months and 12% after 6 months. In the stairs descending test, the maximum flexion-extension angle increased by approximately 8% after 3 months and 19% after 6 months. These results highlight an improvement in mobility for the study participants.

CONCLUSIONS

Significant improvements of the biomechanical parameters of the knee joint were found in all patients during the treatment with the MUVON PLUS in all tests, which indicates the clear clinical benefit, revealed by improving the quality of life reported by patients. Overall, the study demonstrated the effectiveness of MUVON PLUS in enhancing the biomechanical behavior of the knee joint in patients with OA, providing valuable insights for future research and treatment.

Therapeutic effect of induced pluripotent stem cell -derived extracellular vesicles in an in vitro and in vivo osteoarthritis model

Background/Objective

Osteoarthritis (OA) is a multifactorial joint disease associated with the deterioration of chondrocytes and inflammation. Treatment of OA is only aimed at reducing pain and improving joint function. Recently, extracellular vesicles (EVs) secreted from stem cells have emerged as a cell regenerative tool in several degenerative diseases, including OA. We hypothesised that induced pluripotent stem cell (iPSC)-derived EVs would be beneficial for regenerating chondrocytes and OA therapy. Therefore, we aimed to investigate iPSC-EVs' effects on chondrocyte behaviour in an interleukin 1 beta (IL-1β)-induced in vitro OA model and anterior cruciate ligament transection (ACLT)-induced in vivo OA model of rabbit articular cartilage.

Methods

The iPSC-EVs were isolated by sequential ultracentrifugation from a 48-h-incubated conditional medium of iPSC. The isolated iPSC-EVs were characterised by transmission electron microscopy, western blot analyses, and dynamic light scatter. The effects of iPSC-EVs on the viability of human primary chondrocytes and cell senescence were analysed. Premature senescence of cells was induced by long-term incubation with low doses of hydrogen peroxide. To investigate the therapeutic effect of iPSC-EVs on OA chondrocytes in vitro, IL-1β was used to induce chondrocyte damage. Inflammatory macrophages were activated from THP-1 monocytes to observe the impact of iPSC-EV on macrophage polarisation. The phenotypes of the macrophages exposed to iPSC-EVs were evaluated by ELISA and western blot analyses. The primary chondrocytes were co-cultured with different phenotypes of macrophages to observe the expression of collagen II and catabolic enzymes in chondrocytes. iPSC-EVs were injected intraarticularly into the rabbit with an ACLT-induced OA model. The progression of lesions was assessed through macroscopic and histopathological studies.

Results

We showed that iPSC-EVs significantly stimulated the proliferation of primary human chondrocytes and suppressed cell senescence by regulating the expression of p21 and collagen II. iPSC-EVs reduced matrix degradation enzymes and IL-6 expression and attenuated IL-1β-mediated cell death of chondrocytes. Furthermore, iPSC-EVs modulated macrophage polarisation, resulting in the rescue of damaged chondrocytes in an inflammatory microenvironment. In the rabbit ACLT model, the OA-like lesions, including inflammation, subchondral bone protrusion, and articular cartilage destruction, were ameliorated by iPSC-EV. A histopathological study consistently revealed that iPSC-EVs attenuated ACLT-mediated alteration of MMP13 and ADAMTS5 and collagen II expression.

Conclusion

iPSC-EVs protected chondrocytes by enhancing cell proliferation, suppressing premature senescence, and maintaining homeostasis of collagen II synthesis and matrix degradation enzymes such as matrix metalloproteinases (MMPs) and ADAMTS5. iPSC-EVs also reduced cell death in IL-1β-mediated chondrocyte cell damage. In the rabbit ACLT-induced OA model, iPSC-EV injection reduced cartilage destruction, as indicated by the upregulation of collagen II and down-regulation of MMP13 and ADAMTS5. Overall, our results suggest that iPSC-EVs possess therapeutic potential and may be used as an OA treatment option.

The translational potential of this article

This study highlights the potential of iPSC-EVs as a therapeutic option for chondrocyte regeneration and OA treatment.

Association between Elevated Magnesium Intake and Reduced Risk of Recurrent Falls and Frailty in Osteoarthritis: Data from the Osteoarthritis Initiative

OBJECTIVES

The objective of this 8-year follow-up study was to investigate the relationship between magnesium intake and frailty, as well as recurrent falls, in individuals diagnosed with Osteoarthritis (OA) or those at a heightened risk for developing the condition.

METHODS

This study utilized data from the Osteoarthritis Initiative (OAI) database and conducted a prospective cohort study with a 8-year follow-up period. Total magnesium intake from both food sources and supplements was assessed using a food frequency questionnaire (FFQ), while frailty and recurrent falls were evaluated through established criteria and self-report, respectively. To account for potential confounding factors, various covariates were considered, and statistical analyses, including generalized additive mixed models (GAMMs), were employed to examine the associations.

RESULTS

Among the 4,667 participants with OA, those with lower total magnesium intake were characterized by younger age, a higher proportion of African American individuals, higher body mass index (BMI), and lower dietary fiber intake (P<0.001). Notably, this group exhibited higher odds of experiencing recurrent falls and frailty (P = 0.034 and 0.006, respectively). Controlling for various factors, the GAMMs consistently revealed negative correlations between magnesium intake and the likelihood of frailty and recurrent falls, with each 1 mg/1000 kcal increase in magnesium intake associated with a 0.5% reduced frailty risk (p < 0.001) and a 0.2% decreased risk of recurrent falls (p = 0.001). Subgroup analyses suggested that increased total magnesium intake from both food sources and supplements may exert a more pronounced preventive effect on recurrent falls and frailty in men, older adults, individuals with normal BMI, and those with higher dietary fiber intake.

CONCLUSIONS

Elevated total magnesium intake from both food sources and supplements was found to be associated with a decreased risk of recurrent falls and frailty in individuals diagnosed with OA or those at risk of developing the condition. These findings imply that increased total magnesium intake might be beneficial in managing the risk of these outcomes, particularly within specific subgroups, including men, older adults, those with a normal BMI, and those with higher dietary fiber intake.

Mid-vastus total knee arthroplasty for medial osteoarthritis recovers gait balance control better than lateral parapatellar approach three months post-surgery

Total knee arthroplasty (TKA) approaches affect recovery outcomes, with different levels of residual loss of muscle strength and functional deficits. The current study compared the gait balance control in older individuals 3 months after TKA via the lateral parapatellar approach (LPPA) and mid-vastus approach (MVA) in terms of the inclination angle (IA) of the center of pressure (COP) to the body's center of mass (COM) vector, and the rate of change of IA (RCIA). In a gait laboratory, 12 patients with severe medial knee osteoarthritis who had undergone bilateral TKA via LPPA and 12 via MVA were evaluated and compared against 12 healthy controls for their balance control during gait 3 months after surgery. The participants' kinematic data and ground reaction forces were measured synchronously using an 8-camera motion capture system and three forceplates, respectively, from which the COM, COP, IA and RCIA were calculated using a 13-body-segment model. The LPPA group showed significantly greater sagittal IA during DLS (p < 0.01) but less sagittal and frontal RCIA throughout the gait cycle (p < 0.04) compared to controls. The MVA showed better recovery in the balance control with most IA and RCIA variables similar to those of the healthy controls throughout the gait cycle. The patients with LPPA walked with a compromised balance control throughout the gait cycle while the MVA group showed close-to-normal balance control with a slight decrease in sagittal RCIA during SLS. The current between-approach findings were likely related to the differences in the muscles involved during surgery, suggesting that MVA may be a better choice than LPPA when taking short-term gait balance control into consideration.

Use of bone marrow derived mesenchymal stem cells for the treatment of osteoarthritis: A retrospective long-term follow-up study

Background

Available studies suggest that bone marrow concentrate, highly enriched in mesenchymal stem cells, is a potentially encouraging treatment for knee osteoarthritis. The aim of this retrospective study was to evaluate the clinical outcome in patients affected by this condition after treatment with autologous bone marrow aspirate concentrate (BMAC).

Methods

55 patients who had undergone a single intra-articular injection of BMAC were administered two questionnaires to clinically evaluate their condition based on patient-reported outcome measures before treatment and at follow-up.

Results

Analysis of the data collected indicates that patients experienced improvements in Tegner, VAS and WOMAC scores and that all outcomes at the follow-up improved in a statistically significant manner compared to outcomes at baseline.

Conclusions

The changes observed in the different scores examined suggest that a single BMAC injection seems to be a beneficial and safe treatment for knee osteoarthritis.

Applications of artificial intelligence in orthopaedic surgery

The practice of medicine is rapidly transforming as a result of technological breakthroughs. Artificial intelligence (AI) systems are becoming more and more relevant in medicine and orthopaedic surgery as a result of the nearly exponential growth in computer processing power, cloud based computing, and development, and refining of medical-task specific software algorithms. Because of the extensive role of technologies such as medical imaging that bring high sensitivity, specificity, and positive/negative prognostic value to management of orthopaedic disorders, the field is particularly ripe for the application of machine-based integration of imaging studies, among other applications. Through this review, we seek to promote awareness in the orthopaedics community of the current accomplishments and projected uses of AI and ML as described in the literature. We summarize the current state of the art in the use of ML and AI in five key orthopaedic disciplines: joint reconstruction, spine, orthopaedic oncology, trauma, and sports medicine.

Opioid Legislation Decreases Opioid Prescribing in Total Knee Arthroplasty

The purpose of this study was to evaluate the impact of opioid-limiting legislation on perioperative opioid prescriptions in total knee arthroplasty. The hypothesis was that opioid legislation has reduced opioid prescription filling above levels anticipated by national trends. This study retrospectively evaluated opioid prescription filling for all patients undergoing total knee arthroplasty in a commercially available insurance database between 2010 and 2018 (n=1,068,764). Initial discharge and 90-day cumulative oxycodone 5-mg equivalents filled were tabulated. Opioid prescription filling was evaluated over time and between states with and without opioid-limiting legislation using analysis of variance and multivariable linear and logistic regression. States with and without opioid legislation had significant reductions in initial and cumulative opioid prescription filling volume (all P<.001). However, the magnitude of this reduction was larger in states with opioid legislation. Legislation targeting duration and volume had the largest impact on initial post-act opioid prescription filling volume compared with states without legislation in an estimated "pre-act" time frame. Legislation targeting duration and volume and no specific target had the largest impact on cumulative post-act opioid prescription filling volume. States without legislation still had large, significant reductions in filling volume, but the magnitude was not as great as in states with opioid legislation. States with and without opioid legislation had significant decreases in initial and cumulative opioid prescription filling volume. However, the magnitude of reduction was larger in states that enacted legislation. Younger age, pre-operative opioid use, and higher comorbidity burden were associated with greater opioid use postoperatively. [Orthopedics. 202x;4x(x):xx-xx.].

Comparison of the clinical effectiveness of activated and non-activated platelet-rich plasma in the treatment of knee osteoarthritis: a systematic review and meta-analysis

INTRODUCTION/OBJECTIVES

Platelet-rich plasma (PRP) has shown to be clinically effective in the treatment of knee osteoarthritis (OA). Notwithstanding, some inconsistences remain due to methodological differences in PRP preparation such as the use (or not) of activation strategies. We aimed to evaluate whether the use of non-activated PRP would be as effective as activated PRP in patients with knee OA.

METHOD

All randomized, placebo-controlled trials were identified through a search in MEDLINE, EMBASE, Scopus, and Web of Science up to June 2022. Pre- and post-injection pain and function scores were collected. The meta-analysis was conducted with a random-effects model and generic inverse variance method. Effect sizes were estimated using standardized mean differences (SMD).

RESULTS

Fourteen clinical trials involving 1292 subjects were included for meta-analysis. Exogenous activation of PRP revealed a significant pain relief (SMD, - 1.05 [95% CI - 1.58 to - 0.52]; p = 0.0001) and a significant functional improvement (SMD, - 1.21 [95% CI - 1.75 to - 0.67]; p < 0.0001) unlike studies describing the use of a non-activated PRP. The sensitivity analysis indicated that the effect size for both outcomes was not influenced by a single study.

CONCLUSIONS

The results of this systematic review suggest that the use of an exogenously activated PRP is more effective in improving both pain and functional scores in patients with knee OA. Key Points • Results from meta-analysis suggest that exogenously activated PRP is clinically more effective than non-activated PRP. • The use of an activated PRP was more frequently reported by the included studies. • The most frequent method for activation was the use of calcium chloride (CaCl₂).

Channa striatus in inflammatory conditions: A systematic review

Channa striatus (CS), or snakehead murrel, is an obligate air-breathing freshwater fish. Besides its wound healing properties, CS has also been reported to exhibit anti-inflammatory effects in multiple studies. While there are anti-inflammatory medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), their long-term use is associated with an increased risk of peptic ulcers, acute renal failure, stroke, and myocardial infarction. Thus, it is essential to look at natural methods such as CS extract. While there is an abundant number of investigative studies on the inflammatory properties of CS, the quality of these studies has not been evaluated effectively. Thus, this review aims to summarise, evaluate, and critically appraise currently available literature regarding the anti-inflammatory properties of CS extract. This is done by performing a search using four databases, namely Google Scholar, Embase via Elsevier, Scopus, and Web of Science, with the following terms: Channa striatus AND inflammation. From our review, CS has been experimentally shown to positively affect inflammatory conditions such as gastric ulcers, dermatitis, osteoarthritis, and allergic rhinitis. Beneficial effects were also found on inflammation in the presence of tuberculosis and in situations that involve inflammation, such as wound healing. While CS clearly has potential for treating inflammatory conditions, much work needs to be done on identifying and isolating the active constituents before exact mechanisms of action can be worked out to develop future anti-inflammatory medications.