1
|
Arnold KM, Weaver SR, Zars EL, Tschumperlin DJ, Westendorf JJ. Inhibition of Phlpp1 preserves the mechanical integrity of articular cartilage in a murine model of post-traumatic osteoarthritis. Osteoarthritis Cartilage 2024; 32:680-689. [PMID: 38432607 PMCID: PMC11127785 DOI: 10.1016/j.joca.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 12/21/2023] [Accepted: 01/17/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE Phlpp1 inhibition is a potential therapeutic strategy for cartilage regeneration and prevention of post-traumatic osteoarthritis (PTOA). To understand how Phlpp1 loss affects cartilage structure, cartilage elastic modulus was measured with atomic force microscopy (AFM) in male and female mice after injury. METHODS Osteoarthritis was induced in male and female Wildtype (WT) and Phlpp1-/- mice by destabilization of the medial meniscus (DMM). At various timepoints post-injury, activity was measured, and knee joints examined with AFM and histology. In another cohort of WT mice, the PHLPP inhibitor NSC117079 was intra-articularly injected 4 weeks after injury. RESULTS Male WT mice showed decreased activity and histological signs of cartilage damage at 12 but not 6-weeks post-DMM. Female mice showed a less severe response to DMM by comparison, with no histological changes seen at any time point. In both sexes the elastic modulus of medial condylar cartilage was decreased in WT mice but not Phlpp1-/- mice after DMM as measured by AFM. By 6-weeks, cartilage modulus had decreased from 2 MPa to 1 MPa in WT mice. Phlpp1-/- mice showed no change in modulus at 6-weeks and only a 25% decrease at 12-weeks. The PHLPP inhibitor NSC117079 protected cartilage structure and prevented signs of OA 6-weeks post-injury. CONCLUSIONS AFM is a sensitive method for detecting early changes in articular cartilage post-injury. Phlpp1 suppression, either through genetic deletion or pharmacological inhibition, protects cartilage degradation in a model of PTOA, validating Phlpp1 as a therapeutic target for PTOA.
Collapse
Affiliation(s)
- Katherine M Arnold
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN, USA; Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA; Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
| | | | - Elizabeth L Zars
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Daniel J Tschumperlin
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Jennifer J Westendorf
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN, USA.
| |
Collapse
|
2
|
Olsen AA, Junge JM, Booth G, Abraham VM, Balazs GC, Goldman AH. A Lack of Generalizability-Total Knee Demographics in the Active Duty Population. Mil Med 2024; 189:e1161-e1165. [PMID: 37966515 DOI: 10.1093/milmed/usad437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/09/2023] [Accepted: 10/27/2023] [Indexed: 11/16/2023] Open
Abstract
INTRODUCTION Age and sex are known demographic risk factors for requiring revision surgery following primary total knee arthroplasty (TKA). Military service members are a unique population with barriers to long-term follow up after surgery. This study aims to compare demographic data between active duty military personnel and a nationwide sample to identify differences that may impact clinical and economic outcomes. METHODS A retrospective observational analysis was performed using the Military Health System Data Repository (MDR) and the National Surgical Quality Improvement Program (NSQIP). Databases were queried for patients undergoing primary TKA between January 1, 2015 and December 31, 2020. The MDR was queried for demographic data including age, sex, duty status, facility type, geographic region, history of prior military deployment, history of deployment-related health condition, branch of military service, and military rank. National Surgical Quality Improvement Program was queried for age and sex. Median age between populations was compared with the Mann-Whitney U test, and gender was compared with a chi-squared test. RESULTS During the study period, 2,094 primary TKA patients were identified from the MDR, and 357,865 TKA patients were identified from the NSQIP database. Military TKA patients were 79.4% male with a median age of 49.0, and NSQIP TKA patients were 38.9% were male, with a median age of 67. Military TKA patients were significantly more likely to be male (P < .001) and younger (P < .001). CONCLUSION Patients undergoing TKA in the military are younger and more likely to be male compared to national trends. Current evidence suggests these factors may place them at a significant revision risk in the future. The application of quality metrics based on nationwide demographics may not be applicable to military members within the Military Health System.
Collapse
Affiliation(s)
- Aaron A Olsen
- Department of Orthopaedic Surgery, Bone and Joint Sports Medicine Institute, Portsmouth, VA 23708, USA
| | - Joshua M Junge
- Department of Anesthesia, Naval Medical Center, Portsmouth, VA 23708, USA
| | - Greg Booth
- Department of Anesthesia, Naval Medical Center, Portsmouth, VA 23708, USA
| | - Vivek M Abraham
- Department of Orthopaedic Surgery, Bone and Joint Sports Medicine Institute, Portsmouth, VA 23708, USA
| | - George C Balazs
- Department of Orthopaedic Surgery, Bone and Joint Sports Medicine Institute, Portsmouth, VA 23708, USA
| | - Ashton H Goldman
- Department of Orthopaedic Surgery, Bone and Joint Sports Medicine Institute, Portsmouth, VA 23708, USA
| |
Collapse
|
3
|
Wheeler TA, Antoinette AY, Bhatia E, Kim MJ, Ijomanta CN, Zhao A, van der Meulen MCH, Singh A. Mechanical loading of joint modulates T cells in lymph nodes to regulate osteoarthritis. Osteoarthritis Cartilage 2024; 32:287-298. [PMID: 38072172 PMCID: PMC10955501 DOI: 10.1016/j.joca.2023.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/09/2023] [Accepted: 11/20/2023] [Indexed: 12/18/2023]
Abstract
OBJECTIVE The crosstalk of joint pathology with local lymph nodes in osteoarthritis (OA) is poorly understood. We characterized the change in T cells in lymph nodes following load-induced OA and established the association of the presence and migration of T cells to the onset and progression of OA. METHODS We used an in vivo model of OA to induce mechanical load-induced joint damage. After cyclic tibial compression of mice, we analyzed lymph nodes for T cells using flow cytometry and joint pathology using histology and microcomputed tomography. The role of T-cell migration and the presence of T-cell type was examined using T-cell receptor (TCR)α-/- mice and an immunomodulatory drug, Sphingosine-1-phosphate (S1P) receptor inhibitor-treated mice, respectively. RESULTS We demonstrated a significant increase in T-cell populations in local lymph nodes in response to joint injury in 10, 16, and 26-week-old mice, and as a function of load duration, 1, 2, and 6 weeks. T-cell expression of inflammatory cytokine markers increased in the local lymph nodes and was associated with load-induced OA progression in the mouse knee. Joint loading in TCRα-/- mice reduced both cartilage degeneration (Osteoarthritis Research Society International (OARSI) scores: TCRα 0.568, 0.981-0.329 confidence interval (CI); wild type (WT) 1.328, 2.353-0.749 CI) and osteophyte formation. Inhibition of T-cell egress from lymph nodes attenuated load-induced cartilage degradation (OARSI scores: Fingolimod: 0.509, 1.821-0.142 CI; Saline 1.210, 1.932-0.758 CI) and decreased localization of T cells in the synovium. CONCLUSIONS These results establish the association of lymph node-resident T cells in joint damage and suggest that the S1P receptor modulators and T-cell immunotherapies could be used to treat OA.
Collapse
Affiliation(s)
- Tibra A Wheeler
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, USA
| | - Adrien Y Antoinette
- Sibley School of Mechanical & Aerospace Engineering, Cornell University, Ithaca, NY, USA
| | - Eshant Bhatia
- Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, USA; Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University School of Medicine, Atlanta, GA, USA
| | - Matthew J Kim
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, USA
| | | | - Ann Zhao
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, USA
| | - Marjolein C H van der Meulen
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, USA; Sibley School of Mechanical & Aerospace Engineering, Cornell University, Ithaca, NY, USA; Research Division, Hospital for Special Surgery, New York, NY, USA.
| | - Ankur Singh
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, USA; Sibley School of Mechanical & Aerospace Engineering, Cornell University, Ithaca, NY, USA; Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, USA; Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University School of Medicine, Atlanta, GA, USA; Petit Institute for Bioengineering and Biosciences, Georgia Institute of Technology, Atlanta, GA, USA.
| |
Collapse
|
4
|
Wilczyński M, Bieniek M, Krakowski P, Karpiński R. Cemented vs. Cementless Fixation in Primary Knee Replacement: A Narrative Review. MATERIALS (BASEL, SWITZERLAND) 2024; 17:1136. [PMID: 38473607 DOI: 10.3390/ma17051136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 02/13/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024]
Abstract
Knee osteoarthritis (OA) is one of the leading causes of disability around the globe. Osteoarthritis is mainly considered a disease affecting the elderly. However, more and more studies show that sports overuse, obesity, or congenital disorders can initiate a pathologic cascade that leads to OA changes in the younger population. Nevertheless, OA mostly affects the elderly, and with increasing life expectancy, the disease will develop in more and more individuals. To date, the golden standard in the treatment of the end-stage of the disease is total joint replacement (TJR), which restores painless knee motion and function. One of the weakest elements in TJR is its bonding with the bone, which can be achieved by bonding material, such as poly methyl-methacrylate (PMMA), or by cementless fixation supported by bone ingrowth onto the endoprosthesis surface. Each technique has its advantages; however, the most important factor is the revision rate and survivor time. In the past, numerous articles were published regarding TJR revision rate, but no consensus has been established yet. In this review, we focused on a comparison of cemented and cementless total knee replacement surgeries. We introduced PICO rules, including population, intervention, comparison and outcomes of TJR in a PubMed search. We identified 783 articles published between 2010 and 2023, out of which we included 14 in our review. Our review reveals that there is no universally prescribed approach to fixate knee prostheses. The determination of the most suitable method necessitates an individualized decision-making process involving the active participation and informed consent of each patient.
Collapse
Affiliation(s)
- Mikołaj Wilczyński
- Orthopaedic and Sports Traumatology Department, Carolina Medical Center, Pory 78, 02-757 Warsaw, Poland
| | - Michał Bieniek
- Orthopaedic and Sports Traumatology Department, Carolina Medical Center, Pory 78, 02-757 Warsaw, Poland
| | - Przemysław Krakowski
- Orthopaedic and Sports Traumatology Department, Carolina Medical Center, Pory 78, 02-757 Warsaw, Poland
- Department of Trauma Surgery and Emergency Medicine, Medical University of Lublin, Staszica 11, 20-081 Lublin, Poland
| | - Robert Karpiński
- Department of Machine Design and Mechatronics, Faculty of Mechanical Engineering, Lublin University of Technology, Nadbystrzycka 36, 20-618 Lublin, Poland
| |
Collapse
|
5
|
Tropf JG, Dickens JF, LeClere LE. Surgical Treatment of Focal Chondral Lesions of the Knee in the Military Population: Current and Future Therapies. Mil Med 2024; 189:e541-e550. [PMID: 37428507 DOI: 10.1093/milmed/usad250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 06/09/2023] [Accepted: 06/27/2023] [Indexed: 07/11/2023] Open
Abstract
INTRODUCTION Chondral and osteochondral defects of the knee are common injuries in the military population that have a significant impact on readiness. Definitive treatment of these injuries is challenging since cartilage has a limited capacity for self-repair and regeneration. Management is particularly challenging in military patients who maintain a higher level of activity similar to athletes. Existing surgical techniques have variable results and often long recovery times, sparking the development of several new innovative technologies to return service members back to duty more quickly and effectively after cartilage injury. The purpose of this article is to review the current and future surgical treatments for chondral and osteochondral knee lesions and their relevance in managing these injuries in the military. METHODS In this review article, we describe the current treatments for chondral and osteochondral defects of the knee, reporting on outcomes in military populations. We explore emerging treatment modalities for cartilage defects, reporting innovations, stage of research, and current data. Published results of each treatment option in military populations are reviewed throughout the article. RESULTS This review includes 12 treatments for chondral lesions. Of these therapies, four are considered synthetic and the remaining are considered regenerative solutions. Regenerative therapies tend to perform better in younger, healthier populations with robust healing capacity. Success of treatment depends on lesions and patient characteristics. Nearly all modalities currently available in the USA were successful in improving patients from presurgical function in the short (<6 months) term, but the long-term efficacy is still challenged. Upcoming technologies show promising results in clinical and animal studies that may provide alternative options desirable for the military population. CONCLUSIONS The current treatment options for cartilage lesions are not entirely satisfactory, usually with long recovery times and mixed results. An ideal therapy would be a single procedure that possesses the ability to enable a quick return to activity and duty, alleviate pain, provide long-term durability, and disrupt the progression of osteoarthritis. Evolving technologies for cartilage lesions are expanding beyond currently available techniques that may revolutionize the future of cartilage repair.
Collapse
Affiliation(s)
- Jordan G Tropf
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Department of Orthopaedic Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Jonathan F Dickens
- Department of Orthopaedic Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Lance E LeClere
- Department of Orthopaedic Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| |
Collapse
|
6
|
Fisher TF, Rider DE, Waterman BR, Belmont PJ. Occupational and Functional Outcomes following Patellofemoral Arthroplasty in U.S. Military Servicemembers. J Knee Surg 2024; 37:175-182. [PMID: 36720244 DOI: 10.1055/s-0043-1761201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The functional outcomes in patients undergoing patellofemoral arthroplasty (PFA) with high occupational demands have not been fully examined. This study assessed return to work and conversion to TKA rates following PFA in a young, military cohort. Patient demographics, pain scores, and surgical information were retrospectively collected for all active-duty military members who underwent PFA over a 4-year period. The data were then analyzed to calculate return to work, conversion to TKA, and perioperative complications rates. A total of 48 servicemembers with 60 total PFAs (36 unilateral, 12 bilateral) were included, with a mean follow up of 2.2 years. At the final follow-up, 83% of servicemembers returned to military service or completed their service obligation after PFA. Conversion to TKA occurred in three (6.2%) patients at an average of 2.4 years after PFA, resulting in a PFA annual revision rate of 2.3%. The mean numeric rating scale for pain improved from 4.9 ± 2.6 at baseline to 2.5 ± 2.0 postoperatively (p < 0.001). Servicemembers with at least one prior ipsilateral knee procedure had a significantly decreased odds ratio (OR) for both occupational outcome failure (OR, 0.03; 95% confidence interval [CI], 0-0.29) and overall failure (OR, 0.13; 95% CI, 0.02-0.78). At an average of 2 years following PFA, 83% of military members returned to duty, with a low rate of revision to TKA. Prior ipsilateral knee procedure decreased the probability of medical separation. LEVEL OF EVIDENCE: IV.
Collapse
Affiliation(s)
- Tuesday F Fisher
- Orthopedic Surgery and Rehabilitation, Evans Army Community Hospital, Fort Carson, Colorado
| | - Danielle E Rider
- Orthopedic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Brian R Waterman
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Philip J Belmont
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| |
Collapse
|
7
|
Formby PM, Rodkey DL. Most Military Arthroplasty Surgeons Have a Low Volume Practice in the Military Health System. Arthroplast Today 2024; 25:101295. [PMID: 38380159 PMCID: PMC10877328 DOI: 10.1016/j.artd.2023.101295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 10/20/2023] [Accepted: 11/05/2023] [Indexed: 02/22/2024] Open
Abstract
Background The purpose of this study is to investigate hospital and surgeon joint arthroplasty volume in the Military Health System (MHS). A secondary aim is to look at interruption in physician practice during the study period. Methods Review of all patients undergoing hip or knee arthroplasty in the MHS over >5-year period to examine hospital and surgeon volume for total joint arthroplasty (TJA). We stratified hospital and surgeon volume into low, medium, and high volumes. Results Fifty surgeons performed at least 50 hip and/or knee arthroplasties during this period. These surgeons accounted for 75% of TJA in the MHS. When stratified by cases per year, the median primary total hip arthroplasty (THA) per year was 31.4 and primary total knee arthroplasty (TKA) was 47.3 per year. Regarding the volume threshold for primary and revision TJA, all hospitals were classified as having low volumes for both THA and unicompartmental knee arthroplasty/TKA. There were 0 high volume, 7 (21.9%) medium volume, and 25 (78.1%) low volume THA surgeons; there was 1 high volume TKA surgeon, 17 (34.7%) medium volume, and 31 (63.3%) low volume TKA surgeons. The average duration of clinical activity for fellowship-trained surgeons over the study period was 4.0 years, and the average duration of clinical inactivity was 263.7 days (17.9% of practice period). Conclusions The highest-volume military arthroplasty surgeons have low volume when compared to their civilian colleagues. There are also long periods of clinical practice interruption. These findings stress the need to establish civilian-DOD or DOD-VA working relationships so that MHS patients experience the best possible care by high-volume surgeons in high-volume surgical centers.
Collapse
Affiliation(s)
- Peter M. Formby
- Department of Orthopaedic Surgery, Womack Army Medical Center, Fort Liberty, NC, USA
| | - Daniel L. Rodkey
- Department of Orthopaedic Surgery, Madigan Army Medical Center, Joint Base Lewis-McChord, WA, USA
| |
Collapse
|
8
|
de Geofroy B, Chateau L, Barbier O, Demoures T, Coste S, Mathieu L, de L'Escalopier N, Choufani C. Return to Sport and Duty in French Military Personnel after Medial Opening Wedge High Tibial Osteotomy. Mil Med 2024:usae005. [PMID: 38294141 DOI: 10.1093/milmed/usae005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/10/2023] [Accepted: 01/03/2024] [Indexed: 02/01/2024] Open
Abstract
INTRODUCTION Medial opening wedge high tibial osteotomy (MOWHTO) is a surgical option for medial femorotibial osteoarthritis, which preserves articular cartilage by correcting the extra-articular deformities of the lower limbs that cause osteoarthritis. This is an increasingly popular treatment in a population with high functional demand, such as the French military population. The aim of this study was to evaluate the rate of return to work and military activities at 6 months postsurgery and at last follow-up in this military population following MOWHTO.The hypothesis of this study was that MOWHTO enabled a majority of service members to return to the same level of activity within 6 months of surgery. MATERIALS AND METHODS This was a retrospective, multicenter study including all French military personnel operated on for MOWHTO alone for osteoarthritis of medial compartment between 2008 and 2018 in different Military Teaching Hospitals. We excluded civilian patients. For each patient, a questionnaire was used to collect epidemiological, professional, sports, and functional data. The primary endpoint was the rate of return to work at 6 months postsurgery. We also studied the recovery of sports activities and functional results at a 6.6-year follow-up by standardized questionnaires (Tegner activity scale, Lysholm, IKDC subjective (International Knee Documentation Commitee)). RESULTS Twenty-four MOWHTOs were performed during this period in a cohort of 22 French military personnel. Return to work at 6 months was possible in 20/24 cases (83.3%). Of the four patients who did not return to work at 6 months, two changed their activities, while the other two returned to their jobs after 6 months. The rate of resumption of sporting activities at an equal or higher level was 50% (11/22). There was no difference between pre- and postoperative Tegner Activity Scale scores at the longest follow-up (P = .08). The mean postoperative Lysholm scores were 73.5 (standard deviation 17.8) and IKDC 59 (standard deviation 8.7). No intraoperative complications were found, and one case of postoperative infection was found. CONCLUSIONS A total of 83% of the operated soldiers were able to return to their professional activities in less than 6 months. We observed a functional improvement at the last follow-up. Comparing these results with data from civilian populations, the rate of occupational recovery is comparable. However, the return to sport is much better in the series of nonmilitary patients with approximately 90% return to work and sport in the year following surgery. MOWHTO improves the functional results of the knee, enabling a return to work and sport in most cases in young, active populations such as the French military.
Collapse
Affiliation(s)
- Bernard de Geofroy
- Department of Orthopaedic and Trauma Surgery, Laveran Military Hospital, Marseille 13013, France
- Department of Orthopaedic Surgery and Traumatology Sainte Anne Military Hospital, Toulon Mediterranean Orthopaedic and Trauma, TMOST, Toulon 83000, France
| | - Lucas Chateau
- Department of Orthopaedic surgery and traumatology, Begin Military Hospital, Saint-Mandé 94160, France
| | - Olivier Barbier
- Department of Orthopaedic Surgery and Traumatology Sainte Anne Military Hospital, Toulon Mediterranean Orthopaedic and Trauma, TMOST, Toulon 83000, France
- Department of Orthopaedic Surgery and Traumatology, Edouard Herriot Hospital, Lyon 69003, France
| | - Thomas Demoures
- Department of Orthopaedic surgery and traumatology, Begin Military Hospital, Saint-Mandé 94160, France
| | - Sébastien Coste
- Department of Orthopaedic surgery and traumatology, Begin Military Hospital, Saint-Mandé 94160, France
| | - Laurent Mathieu
- Department of Orthopaedic Surgery and Traumatology, Edouard Herriot Hospital, Lyon 69003, France
| | - Nicolas de L'Escalopier
- Department of Orthopaedic Surgery and Traumatology, Percy Military Hospital, Clamart 92140, France
| | - Camille Choufani
- Department of Orthopaedic Surgery and Traumatology Sainte Anne Military Hospital, Toulon Mediterranean Orthopaedic and Trauma, TMOST, Toulon 83000, France
- Department of Orthopaedic Surgery and Traumatology, Edouard Herriot Hospital, Lyon 69003, France
| |
Collapse
|
9
|
Marquina V, Sánchez C, Mariscal G, Espí F, Crespo D, Hernández L. Return to full duty after anterior cruciate ligament reconstruction surgery in military personnel: A meta-analysis. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:64-72. [PMID: 37406733 DOI: 10.1016/j.recot.2023.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 06/26/2023] [Accepted: 06/29/2023] [Indexed: 07/07/2023] Open
Abstract
OBJECTIVE A meta-analysis was carried out to evaluate the clinical-functional results of anterior cruciate ligament surgery in military population, as well as the complications associated with it. MATERIAL AND METHOD Three major database sources up to December 2022 (PubMed, Google Scholar, and ScienceDirect) were searched for outcomes after anterior cruciate ligament surgery in military personnel. The systematic review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses -PRISMA- standards, and the inclusion criteria following the PICO strategy. Data from included studies were analyzed using Review Manager 5.4 software. RESULTS A total of 7 retrospective studies were selected. The general rate of return to full duty in military personnel was 62.3% (61.5% for the non-officer group vs. 68.3% for the officer group) without this difference being significant (p=0.92). The general rate of meniscal injury in the military was 58.8%, without this difference being significant (p=0.88). The homogeneity in both cases was good (I2=0%, p=0.99). CONCLUSION Return to full military duty can be used in the military population as a marker of success after anterior cruciate ligament reconstruction. It should be noted that a large number of military personnel experience permanent activity limitations that prevent full return to service.
Collapse
Affiliation(s)
- V Marquina
- Servicio de Cirugía Ortopédica y Traumatología, Consorcio Hospital General Universitario de Valencia, Valencia, España.
| | - C Sánchez
- Servicio de Cirugía Ortopédica y Traumatología, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - G Mariscal
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari i Politècnic La Fe, Valencia, España
| | - F Espí
- Servicio de Cirugía Ortopédica y Traumatología, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - D Crespo
- Servicio de Cirugía Ortopédica y Traumatología, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - L Hernández
- Servicio de Cirugía Ortopédica y Traumatología, Consorcio Hospital General Universitario de Valencia, Valencia, España
| |
Collapse
|
10
|
Marquina V, Sánchez C, Mariscal G, Espí F, Crespo D, Hernández L. [Translated article] Return to full duty after anterior cruciate ligament reconstruction surgery in military personnel: A meta-analysis. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:T64-T72. [PMID: 37995820 DOI: 10.1016/j.recot.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 06/29/2023] [Indexed: 11/25/2023] Open
Abstract
OBJECTIVE A meta-analysis was carried out to evaluate the clinical-functional results of anterior cruciate ligament surgery in military population, as well as the complications associated with it. MATERIAL AND METHOD Three major database sources up to December 2022 (PubMed, Google Scholar, and ScienceDirect) were searched for outcomes after anterior cruciate ligament surgery in military personnel. The systematic review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses -PRISMA- standards, and the inclusion criteria following the PICO strategy. Data from included studies were analysed using Review Manager 5.4 software. RESULTS A total of seven retrospective studies were selected. The general rate of return to full duty in military personnel was 62.3% (61.5% for the non-officer group versus 68.3% for the officer group) without this difference being significant (p=0.92). The general rate of meniscal injury in the military was 58.8%, without this difference being significant (p=0.88). The homogeneity in both cases was good (I2=0%, p=0.99). CONCLUSION Return to full military duty can be used in the military population as a marker of success after anterior cruciate ligament reconstruction. It should be noted that a large number of military personnel experience permanent activity limitations that prevent full return to service.
Collapse
Affiliation(s)
- V Marquina
- Servicio de Cirugía Ortopédica y Traumatología, Consorcio Hospital General Universitario de Valencia, Valencia, Spain.
| | - C Sánchez
- Servicio de Cirugía Ortopédica y Traumatología, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - G Mariscal
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - F Espí
- Servicio de Cirugía Ortopédica y Traumatología, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - D Crespo
- Servicio de Cirugía Ortopédica y Traumatología, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - L Hernández
- Servicio de Cirugía Ortopédica y Traumatología, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| |
Collapse
|
11
|
Farrokhi S, Gunterstockman BM, Hendershot BD, Russell Esposito E, McCabe CT, Watrous JR. Post-Traumatic Osteoarthritis, Psychological Health, and Quality of Life After Lower Limb Injury in U.S. Service Members. Mil Med 2023:usad475. [PMID: 38109721 DOI: 10.1093/milmed/usad475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/06/2023] [Accepted: 11/29/2023] [Indexed: 12/20/2023] Open
Abstract
INTRODUCTION The aims of this project were to assess (1) the prevalence and timing of post-traumatic osteoarthritis (PTOA) after a traumatic lower limb injury, (2) the risk of PTOA based on injury type, and (3) the association of PTOA with psychological health and quality of life (QoL). MATERIALS AND METHODS The Wounded Warrior Recovery Project (WWRP) database and the Expeditionary Medical Encounters Dataset were queried to identify service members injured during deployment. The Military Health System Data Repository was utilized to extract medical record data to identify individuals with PTOA. Data on PTSD, depression symptoms, and QoL were extracted from the WWRP. RESULTS Of the 2,061 WWRP participants with lower limb injuries, 124 (6%) were diagnosed with PTOA, with first PTOA diagnosis occurring 3.8 ± 3.1 years after injury. Of the injury categories identified, only fractures were associated with high odds of lower limb PTOA (adjusted odds ratio [OR] = 3.92, 95% confidence interval [CI]: 2.38, 6.44). Individuals with PTOA diagnoses reported lower QoL scores relative to those without PTOA (F(1,2057) = 14.21, B = -0.05, P < .05). Additionally, rates of PTSD and depression symptoms were high but not different between those with or without PTOA. CONCLUSIONS Despite a low prevalence of lower limb PTOA in our study, fractures increased the risk of PTOA after deployment-related injuries. Additionally, those with PTOA reported lower QoL scores relative to those without PTOA. The findings of this study highlight the personalized needs of patients with trauma beyond just the repair of the immediate injury.
Collapse
Affiliation(s)
- Shawn Farrokhi
- Department of Physical Therapy, Chapman University, Rinker Health Science Campus, Irvine, CA 92618, USA
| | - Brittney Mazzone Gunterstockman
- Doctor of Physical Therapy Program, Lincoln Memorial University, Debusk College of Osteopathic Medicine, Knoxville, TN 37932, USA
| | - Brad D Hendershot
- Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, Falls Church, VA 22042, USA
- Department of Rehabilitation Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Department of Rehabilitation, Research and Development Section, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
| | - Elizabeth Russell Esposito
- Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, Falls Church, VA 22042, USA
- Department of Rehabilitation Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Center for Limb Loss & MoBility (CLiMB), VA Puget Sound Health Care System, Seattle, WA 98108, USA
| | | | | |
Collapse
|
12
|
Jones BW, Willson JD, DeVita P, Wedge RD. Tibiofemoral Load Magnitude and Distribution During Load Carriage. J Appl Biomech 2023; 39:432-439. [PMID: 37739402 DOI: 10.1123/jab.2022-0257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 07/26/2023] [Accepted: 08/02/2023] [Indexed: 09/24/2023]
Abstract
Chronic exposure to high tibiofemoral joint (TFJ) contact forces can be detrimental to knee joint health. Load carriage increases TFJ contact forces, but it is unclear whether medial and lateral tibiofemoral compartments respond similarly to incremental load carriage. The purpose of our study was to compare TFJ contact forces when walking with 15% and 30% added body weight. Young healthy adults (n = 24) walked for 5 minutes with no load, 15% load, and 30% load on an instrumented treadmill. Total, medial, and lateral TFJ contact peak forces and impulses were calculated via an inverse dynamics informed musculoskeletal model. Results of 1-way repeated measures analyses of variance (α = .05) demonstrated total, medial, and lateral TFJ first peak contact forces and impulses increased significantly with increasing load. Orthogonal polynomial trends demonstrated that the 30% loading condition led to a curvilinear increase in total and lateral TFJ impulses, whereas medial first peak TFJ contact forces and impulses responded linearly to increasing load. The total and lateral compartment impulse increased disproportionally with load carriage, while the medial did not. The medial and lateral compartments responded differently to increasing load during walking, warranting further investigation because it may relate to risk of osteoarthritis.
Collapse
Affiliation(s)
- Blake W Jones
- Department of Kinesiology, East Carolina University, Greenville, NC,USA
- Department of Physical Therapy, East Carolina University, Greenville, NC,USA
| | - John D Willson
- Department of Physical Therapy, East Carolina University, Greenville, NC,USA
| | - Paul DeVita
- Department of Kinesiology, East Carolina University, Greenville, NC,USA
| | - Ryan D Wedge
- Department of Physical Therapy, East Carolina University, Greenville, NC,USA
| |
Collapse
|
13
|
Wasser JG, Hendershot BD, Acasio JC, Dodd LD, Krupenevich RL, Pruziner AL, Miller RH, Goldman SM, Valerio MS, Senchak LT, Murphey MD, Heltzel DA, Fazio MG, Dearth CL, Hager NA. Exploring relationships among multi-disciplinary assessments for knee joint health in service members with traumatic unilateral lower limb loss: a two-year longitudinal investigation. Sci Rep 2023; 13:21177. [PMID: 38040780 PMCID: PMC10692131 DOI: 10.1038/s41598-023-48662-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 11/29/2023] [Indexed: 12/03/2023] Open
Abstract
Motivated by the complex and multifactorial etiologies of osteoarthritis, here we use a comprehensive approach evaluating knee joint health after unilateral lower limb loss. Thirty-eight male Service members with traumatic, unilateral lower limb loss (mean age = 38 yr) participated in a prospective, two-year longitudinal study comprehensively evaluating contralateral knee joint health (i.e., clinical imaging, gait biomechanics, physiological biomarkers, and patient-reported outcomes); seventeen subsequently returned for a two-year follow-up visit. For this subset with baseline and follow-up data, outcomes were compared between timepoints, and associations evaluated between values at baseline with two-year changes in tri-compartmental joint space. Upon follow-up, knee joint health worsened, particularly among seven Service members who presented at baseline with no joint degeneration (KL = 0) but returned with evidence of degeneration (KL ≥ 1). Joint space narrowing was associated with greater patellar tilt (r[12] = 0.71, p = 0.01), external knee adduction moment (r[13] = 0.64, p = 0.02), knee adduction moment impulse (r[13] = 0.61, p = 0.03), and CTX-1 concentration (r[11] = 0.83, p = 0.001), as well as lesser KOOSSport and VR-36General Health (r[16] = - 0.69, p = 0.01 and r[16] = - 0.69, p = 0.01, respectively). This longitudinal, multi-disciplinary investigation highlights the importance of a comprehensive approach to evaluate the fast-progressing onset of knee osteoarthritis, particularly among relatively young Service members with lower limb loss.
Collapse
Affiliation(s)
- Joseph G Wasser
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Brad D Hendershot
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, USA.
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
- Research and Surveillance Section, Extremity Trauma and Amputation Center of Excellence, Research and Engineering Directorate, Defense Health Agency, Falls Church, VA, USA.
| | - Julian C Acasio
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Research and Surveillance Section, Extremity Trauma and Amputation Center of Excellence, Research and Engineering Directorate, Defense Health Agency, Falls Church, VA, USA
| | - Lauren D Dodd
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Rebecca L Krupenevich
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Alison L Pruziner
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Research and Surveillance Section, Extremity Trauma and Amputation Center of Excellence, Research and Engineering Directorate, Defense Health Agency, Falls Church, VA, USA
| | - Ross H Miller
- Department of Kinesiology, University of Maryland, College Park, MD, USA
| | - Stephen M Goldman
- Research and Surveillance Section, Extremity Trauma and Amputation Center of Excellence, Research and Engineering Directorate, Defense Health Agency, Falls Church, VA, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Michael S Valerio
- Research and Surveillance Section, Extremity Trauma and Amputation Center of Excellence, Research and Engineering Directorate, Defense Health Agency, Falls Church, VA, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Lien T Senchak
- Department of Diagnostic Radiology, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Mark D Murphey
- Department of Diagnostic Radiology, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - David A Heltzel
- Department of Diagnostic Radiology, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Michael G Fazio
- Department of Diagnostic Radiology, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Christopher L Dearth
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Research and Surveillance Section, Extremity Trauma and Amputation Center of Excellence, Research and Engineering Directorate, Defense Health Agency, Falls Church, VA, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Nelson A Hager
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| |
Collapse
|
14
|
Abd-Eltawab AE, Elbandrawy AM, Ghanem HB, Ebrahim HA, El-Sherbiny M, Ibrahim AM, Eladl MA, Elsherbini DMA. Whole-Body Vibration Impacts on the Degree of Toe Angle and Its Correlation to the Knee Osteoarthritis Index during Level Walking among Female University Students: A Randomized Controlled Trial. J Clin Med 2023; 12:5735. [PMID: 37685802 PMCID: PMC10488986 DOI: 10.3390/jcm12175735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 08/19/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
Whole-body vibration (WBV) training is used for ankle rehabilitation as it stimulates muscle spindles to excite tonic vibration reflexes, and improves muscle strength, power, joint proprioception, balance, and flexibility. Thus, this study aims to determine the impact of whole-body vibration on the degree of the toe angle and the correlation between the toe angle and knee osteoarthritis index during level walking among female university students. A randomized controlled trial was conducted with 42 participants divided into two groups. The control group performed only home-based exercise (HBE) after education, and the study group received WBV with HBE. The functional status of participants to predict osteoarthritis was evaluated using the Western Ontario and McMaster osteoarthritis index (WOMAC), where the toe angle degree and WOMAC index were assessed before and six weeks after training. The results showed a significant improvement in the toe-in angle of HBE + WBV compared to the HBE group (p = 0.02), and in HBE + WBV, an improvement of the toe angle showed a 43% decrease in the WOMAC index (p = 0.001). In conclusion, WBV for the ankle and foot training program positively affected the degree of the toe angle, that directly affected the subtalar and ankle joint mechanics. Trial registration in the Pan African Clinical Trial Registry PACTR202304816093190 (registered retrospectively, date of registration: 18 April 2023).
Collapse
Affiliation(s)
- Amany E. Abd-Eltawab
- Physical Therapy and Health Rehabilitation Department, Faculty of Applied Medical Sciences, Jouf University, Sakaka P.O. Box 2014, Saudi Arabia;
- Biomechanics Department, Faculty of Physical Therapy, Cairo University, Giza P.O. Box 12612, Egypt
| | - Asmaa M. Elbandrawy
- Department of Physical Therapy for Women’s Health, Faculty of Physical Therapy, Cairo University, Giza P.O. Box 12612, Egypt;
- Department of Physical Therapy for Women’s Health, Faculty of Physical Therapy, Al-Salam University, Tanta P.O. Box 31527, Egypt
| | - Heba B. Ghanem
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Jouf University, Sakaka P.O. Box 2014, Saudi Arabia;
- Medical Biochemistry Department, Faculty of Medicine, Tanta University, Tanta P.O. Box 31511, Egypt
| | - Hasnaa A. Ebrahim
- Department of Basic Medical Sciences, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh P.O. Box 84428, Saudi Arabia;
| | - Mohamed El-Sherbiny
- Department of Basic Medical Sciences, College of Medicine, AlMaarefa University, Riyadh P.O. Box 71666, Saudi Arabia;
- Department of Anatomy, Faculty of Medicine, Mansoura University, Mansoura P.O. Box 35516, Egypt
| | - Ateya Megahed Ibrahim
- Department of Nursing, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj P.O. Box 11942, Saudi Arabia;
- Department of Family and Community Health Nursing, Faculty of Nursing, Port Said University, Port Said P.O. Box 42526, Egypt
| | - Mohamed Ahmed Eladl
- Department of Basic Medical Sciences, College of Medicine, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates;
| | - Dalia Mahmoud Abdelmonem Elsherbini
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Jouf University, Sakaka P.O. Box 2014, Saudi Arabia;
- Department of Anatomy, Faculty of Medicine, Mansoura University, Mansoura P.O. Box 35516, Egypt
| |
Collapse
|
15
|
Yerke Hansen P, Macknofsky B, Busheme CE, Fomunung CK, Lavin AC, Fernandez CA, Sabesan V. Access to Total Knee Arthroplasty for Military Insured Patients. Arthroplast Today 2023; 21:101143. [PMID: 37521086 PMCID: PMC10382688 DOI: 10.1016/j.artd.2023.101143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 03/13/2023] [Accepted: 03/25/2023] [Indexed: 08/01/2023] Open
Abstract
Background Rigorous training may lead to increased rates of knee osteoarthritis and arthroplasties in military service members. Given the large numbers of arthritis and the increasing need for total joint replacements, access to appropriate care can be difficult for this population based on insurance restrictions. The aim of this study was to evaluate access to total knee arthroplasty for TRICARE patients in contracted civilian medical facilities. Methods Orthopedic surgeons contracted to perform total knee replacements in the state of Florida were identified via TRICARE's website. Investigators used a secret shopper methodology with a standardized script to request an appointment for their family member for a total knee arthroplasty using either TRICARE Select or BlueCross preferred provider organization. The appointment acceptance rates, wait times, call duration, and accuracy of the physician listing were collected. Results A total of 228 offices that perform total knee arthroplasties in Florida were successfully contacted. Overall, 43.1% of the clinics had an inaccurate online listing, and 207 (91%) were able to schedule an appointment with TRICARE, compared to 93% for BlueCross Blue Shield (P = .06). The average wait for TRICARE patients was 24 days and 18 days for BlueCross (P < .01). Call times for TRICARE patients averaged 7.2 minutes, compared to 5.2 minutes for BlueCross (P < .01). Conclusions TRICARE patients encountered longer waiting periods and inaccurate provider listings when accessing orthopedic care. Our results suggest a disparity in healthcare access for patients using TRICARE, which may result in negative health outcomes from receiving delayed care.
Collapse
Affiliation(s)
- Payton Yerke Hansen
- Charles E. Schmidt College of Medicine Florida Atlantic University, Boca Raton, FL, USA
| | - Brandon Macknofsky
- Charles E. Schmidt College of Medicine Florida Atlantic University, Boca Raton, FL, USA
| | - Cara E. Busheme
- Charles E. Schmidt College of Medicine Florida Atlantic University, Boca Raton, FL, USA
| | - Clyde K. Fomunung
- Department of Orthopaedics, JFK/University of Miami, Palm Beach, FL, USA
- Palm Beach Shoulder Service at Atlantis Orthopaedics, Lake Worth, FL, USA
| | - Alessia C. Lavin
- Department of Orthopaedics, JFK/University of Miami, Palm Beach, FL, USA
- Palm Beach Shoulder Service at Atlantis Orthopaedics, Lake Worth, FL, USA
| | - Carlos A. Fernandez
- Department of Orthopaedics, JFK/University of Miami, Palm Beach, FL, USA
- Palm Beach Shoulder Service at Atlantis Orthopaedics, Lake Worth, FL, USA
| | - Vani Sabesan
- Department of Orthopaedics, JFK/University of Miami, Palm Beach, FL, USA
- Palm Beach Shoulder Service at Atlantis Orthopaedics, Lake Worth, FL, USA
| |
Collapse
|
16
|
Lloyd DG, Saxby DJ, Pizzolato C, Worsey M, Diamond LE, Palipana D, Bourne M, de Sousa AC, Mannan MMN, Nasseri A, Perevoshchikova N, Maharaj J, Crossley C, Quinn A, Mulholland K, Collings T, Xia Z, Cornish B, Devaprakash D, Lenton G, Barrett RS. Maintaining soldier musculoskeletal health using personalised digital humans, wearables and/or computer vision. J Sci Med Sport 2023:S1440-2440(23)00070-1. [PMID: 37149408 DOI: 10.1016/j.jsams.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 03/27/2023] [Accepted: 04/05/2023] [Indexed: 05/08/2023]
Abstract
OBJECTIVES The physical demands of military service place soldiers at risk of musculoskeletal injuries and are major concerns for military capability. This paper outlines the development new training technologies to prevent and manage these injuries. DESIGN Narrative review. METHODS Technologies suitable for integration into next-generation training devices were examined. We considered the capability of technologies to target tissue level mechanics, provide appropriate real-time feedback, and their useability in-the-field. RESULTS Musculoskeletal tissues' health depends on their functional mechanical environment experienced in military activities, training and rehabilitation. These environments result from the interactions between tissue motion, loading, biology, and morphology. Maintaining health of and/or repairing joint tissues requires targeting the "ideal" in vivo tissue mechanics (i.e., loading and strain), which may be enabled by real-time biofeedback. Recent research has shown that these biofeedback technologies are possible by integrating a patient's personalised digital twin and wireless wearable devices. Personalised digital twins are personalised neuromusculoskeletal rigid body and finite element models that work in real-time by code optimisation and artificial intelligence. Model personalisation is crucial in obtaining physically and physiologically valid predictions. CONCLUSIONS Recent work has shown that laboratory-quality biomechanical measurements and modelling can be performed outside the laboratory with a small number of wearable sensors or computer vision methods. The next stage is to combine these technologies into well-designed easy to use products.
Collapse
Affiliation(s)
- David G Lloyd
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland and Advanced Design and Prototyping Technologies Institute, Australia; School of Health Sciences and Social Work, Griffith University, Australia.
| | - David J Saxby
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland and Advanced Design and Prototyping Technologies Institute, Australia; School of Health Sciences and Social Work, Griffith University, Australia
| | - Claudio Pizzolato
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland and Advanced Design and Prototyping Technologies Institute, Australia; School of Health Sciences and Social Work, Griffith University, Australia
| | - Matthew Worsey
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland and Advanced Design and Prototyping Technologies Institute, Australia
| | - Laura E Diamond
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland and Advanced Design and Prototyping Technologies Institute, Australia; School of Health Sciences and Social Work, Griffith University, Australia
| | - Dinesh Palipana
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland and Advanced Design and Prototyping Technologies Institute, Australia; School of Medicine, Dentistry and Health, Griffith University, Australia
| | - Matthew Bourne
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland and Advanced Design and Prototyping Technologies Institute, Australia; School of Health Sciences and Social Work, Griffith University, Australia
| | - Ana Cardoso de Sousa
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland and Advanced Design and Prototyping Technologies Institute, Australia
| | - Malik Muhammad Naeem Mannan
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland and Advanced Design and Prototyping Technologies Institute, Australia
| | - Azadeh Nasseri
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland and Advanced Design and Prototyping Technologies Institute, Australia
| | - Nataliya Perevoshchikova
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland and Advanced Design and Prototyping Technologies Institute, Australia
| | - Jayishni Maharaj
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland and Advanced Design and Prototyping Technologies Institute, Australia; School of Health Sciences and Social Work, Griffith University, Australia
| | - Claire Crossley
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland and Advanced Design and Prototyping Technologies Institute, Australia; School of Health Sciences and Social Work, Griffith University, Australia
| | - Alastair Quinn
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland and Advanced Design and Prototyping Technologies Institute, Australia; School of Health Sciences and Social Work, Griffith University, Australia
| | - Kyle Mulholland
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland and Advanced Design and Prototyping Technologies Institute, Australia
| | - Tyler Collings
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland and Advanced Design and Prototyping Technologies Institute, Australia; School of Health Sciences and Social Work, Griffith University, Australia
| | - Zhengliang Xia
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland and Advanced Design and Prototyping Technologies Institute, Australia
| | - Bradley Cornish
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland and Advanced Design and Prototyping Technologies Institute, Australia; School of Health Sciences and Social Work, Griffith University, Australia
| | - Daniel Devaprakash
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland and Advanced Design and Prototyping Technologies Institute, Australia; VALD Performance, Australia
| | | | - Rodney S Barrett
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland and Advanced Design and Prototyping Technologies Institute, Australia; School of Health Sciences and Social Work, Griffith University, Australia
| |
Collapse
|
17
|
Beaudette-Zlatanova B, Lew RA, Otis JD, Branch-Elliman W, Bacorro E, Dubreuil M, Eyvazzadeh C, Kaur M, Lazzari AA, Libbey C, Monach PA. Pilot Study of Low-Dose Naltrexone for the Treatment of Chronic Pain Due to Arthritis: A Randomized, Double-blind, Placebo-Controlled, Crossover Clinical Trial. Clin Ther 2023:S0149-2918(23)00113-3. [PMID: 37045708 DOI: 10.1016/j.clinthera.2023.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 04/14/2023]
Abstract
PURPOSE Low-dose naltrexone (LDN) is commonly used to control pain and other symptoms, especially in patients with autoimmune diseases, but with limited evidence. This study tests the efficacy of LDN in reducing chronic pain in patients with osteoarthritis (OA) and inflammatory arthritis (IA), where existing approaches often fail to adequately control pain. METHODS In this randomized, double-blind, placebo-controlled, crossover clinical trial, each patient received 4.5 mg LDN for 8 weeks and placebo for 8 weeks. Outcome measures were patient reported, using validated questionnaires. The primary outcome was differences in pain interference during the LDN and placebo periods, using the Brief Pain Inventory (scale, 0-70). Secondary outcomes included changes in mean pain severity, fatigue, depression, and multiple domains of health-related quality of life. The painDETECT questionnaire classified pain as nociceptive, neuropathic, or mixed. Data were analyzed using mixed-effects models. FINDINGS Seventeen patients with OA and 6 with IA completed the pilot study. Most patients described their pain as nociceptive (n = 9) or mixed (n = 8) rather than neuropathic (n = 3). There was no difference in change in pain interference after treatment with LDN (mean [SD], -23 [19.4]) versus placebo (mean [SD], -22 [19.2]; P = 0.90). No significant differences were seen in pain severity, fatigue, depression, or health-related quality of life. IMPLICATIONS In this small pilot study, findings do not support LDN being efficacious in reducing nociceptive pain due to arthritis. Too few patients were enrolled to rule out modest benefit or to assess inflammatory or neuropathic pain. CLINICALTRIALS gov identifier: NCT03008590.
Collapse
Affiliation(s)
- Britte Beaudette-Zlatanova
- Rheumatology Section, VA Boston Healthcare System, Boston, Massachusetts; VA Cooperative Studies Program, VA Boston Healthcare System, Boston, Massachusetts
| | - Robert A Lew
- VA Cooperative Studies Program, VA Boston Healthcare System, Boston, Massachusetts
| | - John D Otis
- Research Service, VA Boston Healthcare System, Boston, Massachusetts
| | - Westyn Branch-Elliman
- VA Cooperative Studies Program, VA Boston Healthcare System, Boston, Massachusetts; Infectious Diseases Section, VA Boston Healthcare System, Boston, Massachusetts
| | - Eugene Bacorro
- Rheumatology Section, VA Boston Healthcare System, Boston, Massachusetts
| | - Maureen Dubreuil
- Rheumatology Section, VA Boston Healthcare System, Boston, Massachusetts
| | | | - Maneet Kaur
- Rheumatology Section, VA Boston Healthcare System, Boston, Massachusetts
| | - Antonio A Lazzari
- Rheumatology Section, VA Boston Healthcare System, Boston, Massachusetts
| | - Caryn Libbey
- Rheumatology Section, VA Boston Healthcare System, Boston, Massachusetts
| | - Paul A Monach
- Rheumatology Section, VA Boston Healthcare System, Boston, Massachusetts; VA Cooperative Studies Program, VA Boston Healthcare System, Boston, Massachusetts.
| |
Collapse
|
18
|
Rosado SE. Osteoarthritis affects us too: an expert panel survey of factors important for younger adult wellbeing. SOCIAL WORK IN HEALTH CARE 2023; 62:73-92. [PMID: 36987586 DOI: 10.1080/00981389.2023.2191654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 02/04/2023] [Accepted: 03/10/2023] [Indexed: 06/19/2023]
Abstract
Research on quality of life (QOL) factors important for younger adults (ages 18-45 years old) with osteoarthritis (OA) is limited. This study utilizes an online survey method to conduct an expert panel review of QOL domains for this population. Health provider and young adult perspectives of living with OA were captured and compared. Results indicate that providers are underestimating the impact OA is having on a variety of QOL factors for younger adults. Overall, these results reveal critical QOL domains to consider during assessment and when considering intervention strategies aimed at improving the lives of younger adults with this chronic disease. Implications for social work are also discussed.
Collapse
|
19
|
Golightly YM, Shiue KY, Nocera M, Guermazi A, Cantrell J, Renner JB, Padua DA, Cameron KL, Svoboda SJ, Jordan JM, Loeser RF, Kraus VB, Lohmander LS, Beutler AI, Marshall SW. Association of Traumatic Knee Injury With Radiographic Evidence of Knee Osteoarthritis in Military Officers. Arthritis Care Res (Hoboken) 2022. [PMID: 36530032 DOI: 10.1002/acr.25072] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 11/03/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The association between knee injury and knee osteoarthritis (OA) is understudied relative to its importance, particularly in younger populations. This study was undertaken to examine the association of knee injury with radiographic features of knee OA in military officers, who have a physically demanding profession and high rates of knee injury. METHODS Participants were recruited in 2015-2017 from an existing program that enrolled 6,452 military officers during 2004-2009. Officers with a history of knee ligament or meniscal injuries (n = 117 via medical record review) were compared to officers with no history of knee injury (n = 143). Bilateral posteroanterior knee radiographs were obtained using a standardized fixed-flexion positioning frame. All images were read for Kellgren/Lawrence (K/L) grade, osteophyte (OST), and joint space narrowing (JSN) scores. Data were analyzed using linear-risk regression models with generalized estimating equations. RESULTS Injured and noninjured participants were similar (mean age 28 years, mean body mass index 25 kg/m2 , ~40% female). The mean time from first knee injury to imaging among injured participants was 9.2 years. Compared with noninjured knees, greater prevalence of radiographic OA (K/L grade ≥ 2), OST (grade ≥ 1), and JSN (grade ≥ 1) was observed among injured knees, with prevalence differences of +16% (95% confidence interval [95% CI] 10%, 22%), +29% (95% CI 20%, 38%), and + 17% (95% CI 10%, 24%), respectively. Approximately 1 in 6 officers with prior knee injury progressed to radiographic OA by age 30 years. CONCLUSION At the midpoint of a projected 20-year military career, officers with a history of traumatic knee injury have a markedly increased prevalence of knee radiographic OA compared to officers without injury.
Collapse
Affiliation(s)
- Yvonne M Golightly
- University of North Carolina, Chapel Hill, and University of Nebraska Medical Center, Omaha
| | | | | | - Ali Guermazi
- Boston University School of Medicine, Boston, Massachusetts
| | | | | | | | - Kenneth L Cameron
- Keller Army Hospital, West Point, New York, and Uniformed Services University, Bethesda, Maryland
| | | | | | | | | | | | - Anthony I Beutler
- Uniformed Services University, Bethesda, Maryland, and Intermountain Healthcare, Salt Lake City, Utah
| | | |
Collapse
|
20
|
Ayobami OO, Goldring SR, Goldring MB, Wright TM, van der Meulen MCH. Contribution of joint tissue properties to load-induced osteoarthritis. Bone Rep 2022; 17:101602. [PMID: 35899096 PMCID: PMC9309407 DOI: 10.1016/j.bonr.2022.101602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 06/29/2022] [Accepted: 07/11/2022] [Indexed: 11/27/2022] Open
Abstract
Objective Clinical evidence suggests that abnormal mechanical forces play a major role in the initiation and progression of osteoarthritis (OA). However, few studies have examined the mechanical environment that leads to disease. Thus, using a mouse tibial loading model, we quantified the cartilage contact stresses and examined the effects of altering tissue material properties on joint stresses during loading. Design Using a discrete element model (DEA) in conjunction with joint kinematics data from a murine knee joint compression model, the magnitude and distribution of contact stresses in the tibial cartilage during joint loading were quantified at levels ranging from 0 to 9 N in 1 N increments. In addition, a simplified finite element (FEA) contact model was developed to simulate the knee joint, and parametric analyses were conducted to investigate the effects of altering bone and cartilage material properties on joint stresses during compressive loading. Results As loading increased, the peak contact pressures were sufficient to induce fibrillations on the cartilage surfaces. The computed areas of peak contact pressures correlated with experimentally defined areas of highest cartilage damage. Only alterations in cartilage properties and geometry caused large changes in cartilage contact pressures. However, changes in both bone and cartilage material properties resulted in significant changes in stresses induced in the bone during compressive loading. Conclusions The level of mechanical stress induced by compressive tibial loading directly correlated with areas of biological change observed in the mouse knee joint. These results, taken together with the parametric analyses, are the first to demonstrate both experimentally and computationally that the tibial loading model is a useful preclinical platform with which to predict and study the effects of modulating bone and/or cartilage properties on attenuating OA progression. Given the direct correlation between computational modeling and experimental results, the effects of tissue-modifying treatments may be predicted prior to in vivo experimentation, allowing for novel therapeutics to be developed.
Collapse
Affiliation(s)
- Olufunmilayo O Ayobami
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, United States of America
| | - Steven R Goldring
- Research Division, Hospital for Special Surgery, New York, NY, United States of America
| | - Mary B Goldring
- Research Division, Hospital for Special Surgery, New York, NY, United States of America
| | - Timothy M Wright
- Research Division, Hospital for Special Surgery, New York, NY, United States of America
| | - Marjolein C H van der Meulen
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, United States of America.,Research Division, Hospital for Special Surgery, New York, NY, United States of America
| |
Collapse
|
21
|
Rodriguez M, Heida K, Rider DE, Goodman GP, Waterman BR, Belmont PJ. Occupational Outcomes and Revision Rates for Medial Unicondylar Knee Arthroplasty in U.S. Military Servicemembers. J Knee Surg 2022; 35:1393-1400. [PMID: 33607676 DOI: 10.1055/s-0041-1723968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This study evaluates return to work and revision rates for medial unicondylar knee arthroplasty (UKA) in a high-demand military cohort. Patient demographic and clinical variables were isolated from the medical records of active-duty military servicemembers with at least 2 years of postoperative follow-up and correlated with return to work, medial UKA survivorship, and perioperative complications. The medial UKA annual revision rate was calculated as the percentage of implants revised per observed component year. A total of 39 servicemembers underwent 46 primary medial UKAs (32 unilateral and 7 bilateral) with a mean follow-up of 3.9 (2.0-6.6) years. At a minimum of 2 years postoperatively, 33 (85%) servicemembers returned to military service or successfully completed their service obligation. Older servicemembers (odds ratio [OR] = 0.67; 95% confidence interval [CI]: 0.45, 0.99) had a significantly decreased OR for knee-related medical separation. Nine servicemembers (20%) had conversion to TKA at an average of 2.4 (range, 0.6-5.6) years with a medial UKA annual revision rate of 5%. When compared with Navy/Air Force, Army/Marine servicemembers had an increased TKA conversion rate (OR = 5.40; 95% CI: 1.13, 25.81). Older age decreased the likelihood of medical separation and Army/Marines service was the sole risk factor associated with conversion to TKA. The level of evidence is IV, therapeutic case series.
Collapse
Affiliation(s)
- Marina Rodriguez
- Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas
| | - Ken Heida
- Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas
| | | | - Gens P Goodman
- Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas
| | - Brian R Waterman
- Division of Sports Medicine, Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Philip J Belmont
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| |
Collapse
|
22
|
Beck EC, Rider D, Nadig N, Moreland C, Rushford P, Wolfley C, Brown S, Shaw KA, Waterman BR. Senior Military Rank Is Associated With Higher Rates of Return to Running and Unrestricted Activity Among Military Servicemembers After Surgical Repair of Patellar Tendon Rupture at 1-Year Follow-up. Arthrosc Sports Med Rehabil 2022; 4:e2019-e2024. [PMID: 36579040 PMCID: PMC9791865 DOI: 10.1016/j.asmr.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 09/02/2022] [Indexed: 11/09/2022] Open
Abstract
Purpose To evaluate 1-year outcomes in active-duty servicemembers who underwent patellar tendon rupture repair and to identify baseline variables associated with return to activity. Methods We performed a retrospective review of all active-duty servicemembers undergoing primary patellar tendon rupture repair between 2009 and 2014. All patients had a minimum 12-month follow-up. Demographic variables were recorded, as well as ability to return to impact activities and remain on active-duty status. Rates of recurrent rupture and revision surgery were identified. Univariate analysis was performed to assess relations between outcomes and baseline variables. Results A total of 123 patients met the inclusion criteria (average age, 33.5 ± 6.6 years; 99% male patients) with a mean follow-up period of 4.3 ± 2.2 years. Whereas 67.4% of patients returned to running at an average of 8.3 months from index surgery, only 42.4% of patients resumed unrestricted occupational function. Higher rates of return to running were observed among patients with senior military rank (P = .046). Senior military rank was also associated with a higher rate of return to unrestricted active-duty status (P = .006). Logistic regression analysis showed an association between postoperative pain (odds ratio [OR], 0.684; 95% confidence interval [CI], 0.56-0.84; P < .001) and return to running, between postoperative pain (OR, 0.77; 95% CI, 0.60-0.98; P = .033) and return to active duty, and between rank (OR, 2.06; 95% CI, 1.04-4.07; P = .037) and return to active duty. Patients who sustained injuries during deployment had a higher rate of recurrent rupture (26.1% vs 9.3%, P = .028). Conclusions At 1-year follow-up, approximately two-thirds of military servicemembers undergoing primary patellar tendon repair had returned to running after surgery, whereas fewer than one-half returned to full military duty. Younger age and more senior military rank were associated with higher rates of return to running. Additionally, servicemembers of higher rank, particularly officers, had statistically higher rates of return to unrestricted activity. Level of Evidence Level IV, therapeutic case series.
Collapse
Affiliation(s)
- Edward C. Beck
- Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA,Address correspondence to Edward C. Beck, M.D., M.P.H., Department of Orthopaedic Surgery, Wake Forest Baptist Health, 1 Medical Center Blvd, Winston-Salem, NC 27157, USA.
| | - Danielle Rider
- Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Nischal Nadig
- Department of Orthopaedic Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia, USA
| | - Colleen Moreland
- Department of Orthopaedics & Rehabilitation, Womack Army Medical Center, Fort Bragg, North Carolina, USA
| | - Patrick Rushford
- Department of Orthopaedic Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia, USA
| | - Cortney Wolfley
- Department of Orthopaedic Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia, USA
| | - Scott Brown
- Department of Orthopaedic Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia, USA
| | - K. Aaron Shaw
- Department of Orthopaedic Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia, USA
| | - Brian R. Waterman
- Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| |
Collapse
|
23
|
Huang Z, Cui J, Zhong M, Deng Z, Chen K, Zhu W. Risk factors of cartilage lesion after anterior cruciate ligament reconstruction. Front Cell Dev Biol 2022; 10:935795. [PMID: 36158222 PMCID: PMC9498578 DOI: 10.3389/fcell.2022.935795] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 08/22/2022] [Indexed: 11/16/2022] Open
Abstract
Anterior cruciate ligament injury is the most common sports injury in orthopaedics, which can adversely affect knee joint function and exercise of patients. Using arthroscopy to reconstruct the anterior cruciate ligament has become the first choice for treating anterior cruciate ligament rupture. However, different degrees of articular cartilage injury of the knee can be observed in patients after anterior cruciate ligament reconstruction. More importantly, the articular cartilage injury after anterior cruciate ligament reconstruction indicates that it will develop into osteoarthritis in the long term. It is of great significance to fully understand the factors that lead to the occurrence and development of cartilage injury. This article reviews the effects of surgical methods, meniscus status, different grafts, time from injury to surgical intervention, postoperative knee joint stability, postoperative rehabilitation, knee joint anatomical factors, and demographic characteristics of patients on articular cartilage degeneration after anterior cruciate ligament reconstruction. The present review provides insights into the anterior cruciate ligament reconstruction, which can be used to investigate new treatment strategies to delay and prevent the progress of osteoarthritis. At the same time, it provides a holistic understanding of the influence of multiple factors on cartilage lesions after anterior cruciate ligament reconstruction.
Collapse
Affiliation(s)
- Zirong Huang
- Department of Sports Medicine, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
- Clinical Medical College, Guangzhou Medical University, Guangzhou, China
- Guangdong Key Laboratory of Tissue Engineering, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Jiaming Cui
- Department of Sports Medicine, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
- Guangdong Key Laboratory of Tissue Engineering, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
- *Correspondence: Jiaming Cui, ; Weimin Zhu,
| | - Mingjin Zhong
- Department of Sports Medicine, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
- Guangdong Key Laboratory of Tissue Engineering, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Zhenhan Deng
- Department of Sports Medicine, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
- Guangdong Key Laboratory of Tissue Engineering, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Kang Chen
- Department of Sports Medicine, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
- Guangdong Key Laboratory of Tissue Engineering, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Weimin Zhu
- Department of Sports Medicine, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
- Clinical Medical College, Guangzhou Medical University, Guangzhou, China
- Guangdong Key Laboratory of Tissue Engineering, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
- *Correspondence: Jiaming Cui, ; Weimin Zhu,
| |
Collapse
|
24
|
Osteoarthritis Risks and Sports: An Evidence-based Systematic Review. Sports Med Arthrosc Rev 2022; 30:118-140. [PMID: 35921595 DOI: 10.1097/jsa.0000000000000351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Regular sports activities are associated with multiple physical and psychological health benefits. However, sports also may lead to injuries and the development of osteoarthritis (OA). This systematic review investigated the association between sports activity, sports type, and the risk of developing OA. METHODS A systematic review was performed by assessing studies that have investigated the risk of OA development in sports. Data extracted included general information, study design, number of participants, related body mass index, sports type, and assessment of OA. The methodological quality of the studies was assessed using the Newcastle-Ottawa Scale. RESULTS A total of 63 studies were included in this systematic review. The overall Newcastle-Ottawa Scale score was 6.46±1.44 demonstrating a good methodological quality of the articles included in the present study. A total of 628,036 participants were included, with a mean follow-up of 8.0±8.4 years. The mean age of the included athletes was 45.6±15.8, with a mean body mass index of 24.9±2.3 kg/m 2 . CONCLUSION Football and soccer players seem to be at higher risk for the development of OA, although the injury status of the joint should be considered when assessing the risk of OA. High equipment weight and increased injury risk also put military personnel at a higher risk of OA, although elite dancing leads to more hip labral tears. Femoroacetabular impingement was also often diagnosed in ice-hockey players and ballet dancers.
Collapse
|
25
|
Rivera JC, Amuan ME, Pugh MJ. Musculoskeletal Conditions and Secondary Cardiovascular Morbidity Increase Veterans’ Rehabilitation and Orthopaedic Service Utilization. Cureus 2022; 14:e27139. [PMID: 36017301 PMCID: PMC9392965 DOI: 10.7759/cureus.27139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background Musculoskeletal conditions often affect patients’ mobility and ability to participate in health behaviors such as exercise, potentially affecting their systemic health. The purpose of this research is to determine how frequently cardiac-related comorbidities present in a veteran population with musculoskeletal service-connected disability and how this affects musculoskeletal health care utilization. Methodology A retrospective cohort of Iraq and Afghanistan Veterans who received a Veterans Affairs (VA) disability determination for service-connected musculoskeletal disability were categorized according to the diagnosis of cardiac comorbidity including diabetes mellitus, hyperlipidemia, hypertension, and obesity, and atherosclerosis disease documented by ICD-9 codes in the VA administrative data. Among veterans with musculoskeletal service-connected disability, logistic regression was modeled to determine if musculoskeletal clinic utilization was associated with also having a cardiac comorbid condition. Results Veterans with musculoskeletal disability had a comorbid cardiac disorder 43% of the time. Post-traumatic arthritis was the only musculoskeletal condition positively associated with comorbid cardiac conditions. Veterans with comorbid cardiac diagnoses had 26-37% higher odds of receiving care by physical and occupational therapy, physical medicine, and orthopaedic surgery clinics compared to veterans without comorbid cardiac disease. Conclusions Veterans in this cohort with musculoskeletal service-connected disability, plus cardiac conditions had greater clinic use for musculoskeletal and rehabilitation services compared to those without cardiac conditions. These results have implications for the rehabilitation and other health service needs of a new generation of veterans.
Collapse
|
26
|
Wake JL, Chung B, Bottoni CR, Zhou L. Management Considerations for Unicompartmental Osteoarthritis in Athletic Populations: A Review of the Literature. J Knee Surg 2022. [PMID: 35798349 DOI: 10.1055/s-0042-1750750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Unicompartmental osteoarthritis in the young athlete poses a challenge for both patients and providers. Coronal plane malalignment is frequently a concomitant finding that adds to the complexity of management. Military surgeons are presented unique challenges, in that they must consider optimal joint-preservation methods while returning patients to a high-demand occupational function. Management options range from lifestyle changes to surgical interventions. We present a concise review of the available literature on this subject, with a specific focus on indications and outcomes within the military and young athletic population.
Collapse
Affiliation(s)
- Jeffrey L Wake
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Tripler AMC, Hawaii
| | - Brandon Chung
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Tripler AMC, Hawaii
| | - Craig R Bottoni
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Tripler AMC, Hawaii
| | - Liang Zhou
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Tripler AMC, Hawaii
| |
Collapse
|
27
|
Sun TY, Hsu CL, Tseng WC, Yeh TT, Huang GS, Shen PH. Risk Factors Associated with Cartilage Defects after Anterior Cruciate Ligament Rupture in Military Draftees. J Pers Med 2022; 12:jpm12071076. [PMID: 35887573 PMCID: PMC9317476 DOI: 10.3390/jpm12071076] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/26/2022] [Accepted: 06/28/2022] [Indexed: 01/21/2023] Open
Abstract
This study aimed to evaluate the different clinical results and factors associated with cartilage defects in military draftees who underwent different treatments after anterior cruciate ligament (ACL) rupture. Overall, 105 patients who had sustained ACL rupture were military draftees who underwent a conscription examination for physical status assessment from January 2012 to December 2020. Patients were divided into three groups: conservative treatment after ACL rupture, status post-anterior cruciate ligament reconstruction (ACLR), but graft rupture, and status post-ACLR with graft intact. Inter-group comparisons and statistical analyses were performed for age, body mass index (BMI), thigh circumference difference, side-to-side difference in anterior knee translation by KT-2000, meniscus tear, and cartilage defect. Multivariate logistic regression analysis was used to determine the factors associated with cartilage defects. The multivariable regression model showed that BMI (odds ratio OR: 1.303; 95% CI: 1.016–1.672; p = 0.037), thigh circumference difference (OR: 1.403; 95% CI: 1.003–1.084; p = 0.034), tear of lateral meniscus (LM) and medial meniscus (MM) (OR: 13.773; 95% CI: 1.354–140.09; p = 0.027), and graft rupture group (OR: 5.191; 95% CI: 1.388–19.419; p = 0.014) increased the risk of cartilage defects. There was no correlation between cartilage defects and age, KT-2000 difference, tear of LM or MM, or graft intact group. Progression of osteoarthritis was concerned after ACL rupture, and this study identified several factors of post-ACLR graft rupture, greater thigh circumference difference, BMI, and meniscus tear of both LM and MM affecting cartilage defects, which represent early degenerative osteoarthritis changes of the knee. The results of this study should be customized for rehabilitation and military training, especially in military draftees with ACL injuries.
Collapse
Affiliation(s)
- Ting-Yi Sun
- Department of Orthopedic Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan; (T.-Y.S.); (C.-L.H.); (T.-T.Y.)
- Division of Traumatology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Chun-Liang Hsu
- Department of Orthopedic Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan; (T.-Y.S.); (C.-L.H.); (T.-T.Y.)
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Wei-Cheng Tseng
- Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan;
| | - Tsu-Te Yeh
- Department of Orthopedic Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan; (T.-Y.S.); (C.-L.H.); (T.-T.Y.)
| | - Guo-Shu Huang
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan;
| | - Pei-Hung Shen
- Department of Orthopedic Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan; (T.-Y.S.); (C.-L.H.); (T.-T.Y.)
- Correspondence: ; Tel.: +886-2-87923311; Fax: +886-2-87927186
| |
Collapse
|
28
|
Migliorini F, Pintore A, Torsiello E, Oliva F, Spiezia F, Maffulli N. Intensive Physical Activity Increases the Risk of Knee and Hip Arthroplasty: A Systematic Review. Sports Med Arthrosc Rev 2022; 30:111-116. [PMID: 35533064 DOI: 10.1097/jsa.0000000000000340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The present study investigated the type of sport and activity level of athletes before they underwent knee and/or hip arthroplasty for osteoarthritis (OA), and compared them with a control group of subjects who did not undergo knee and hip arthroplasty. We hypothesed athletes exposed to high physical loads during sports had the highest risk of developing OA requiring arthroplasty. MATERIALS AND METHODS This systematic review was conducted according to the PRISMA guidelines. All the comparative clinical trials to August 2021 investigating the sport activity level between subjects who underwent arthroplasty versus those who did not undergo arthroplasty for OA were considered. RESULTS Data from 5 studies and 3638 patients were collected. The mean age for both groups was 47.61±15.5 years, and the mean body mass index was 24.6±2.1 kg/m2 17.6% were women. The Newcastle-Ottawa scale attested good quality of the methodology of the investigations included in the present study. CONCLUSION Intense physical exercise, implying a high cumulative number of hours of exercise which can lead to excessive joint overload, in both sexes is associated with greater likelihood of early knee and hip OA which may lead to prosthetic surgery. Moderate and recreational exposure to sport has minor degenerative effects, and is not associated with early onset OA requiring arthroplasty.
Collapse
Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany
| | - Andrea Pintore
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi
| | - Ernesto Torsiello
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi
| | - Francesco Oliva
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi
| | - Filippo Spiezia
- Department of Orthopaedics and Trauma Surgery, San Carlo Hospital, Potenza, Italy
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi
- School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Stoke on Trent
- Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, London, England
| |
Collapse
|
29
|
Karpiński R, Szabelski J, Krakowski P, Jojczuk M, Jonak J, Nogalski A. Evaluation of the Effect of Selected Physiological Fluid Contaminants on the Mechanical Properties of Selected Medium-Viscosity PMMA Bone Cements. MATERIALS 2022; 15:ma15062197. [PMID: 35329650 PMCID: PMC8951357 DOI: 10.3390/ma15062197] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/10/2022] [Accepted: 03/15/2022] [Indexed: 02/06/2023]
Abstract
Revision surgeries several years after the implantation of the prosthesis are unfavorable from the patient’s point of view as they expose him to additional discomfort, to risk of complications and are expensive. One of the factors responsible for the aseptic loosening of the prosthesis is the gradual degradation of the cement material as a result of working under considerable loads, in an aggressive environment of the human body. Contaminants present in the surgical field may significantly affect the durability of the bone cement and, consequently, of the entire bone-cement-prosthesis system. The paper presents the results of an analysis of selected mechanical properties of two medium-viscosity bone cements DePuy CMW3 Gentamicin and Heraeus Palamed, for the samples contaminated with saline and blood in the range of 1–10%. The results obtained for compressive strength and modulus of elasticity were subjected to statistical analysis, which estimated the nature of changes in these parameters depending on the amount and type of contamination and their statistical significance.
Collapse
Affiliation(s)
- Robert Karpiński
- Department of Machine Design and Mechatronics, Faculty of Mechanical Engineering, Lublin University of Technology, Nadbystrzycka 36, 20-618 Lublin, Poland;
- Correspondence: (R.K.); (J.S.)
| | - Jakub Szabelski
- Section of Biomedical Engineering, Department of Computerization and Production Robotization, Faculty of Mechanical Engineering, Lublin University of Technology, Nadbystrzycka 36, 20-618 Lublin, Poland
- Correspondence: (R.K.); (J.S.)
| | - Przemysław Krakowski
- Department of Trauma Surgery and Emergency Medicine, Medical University of Lublin, Staszica 11, 20-081 Lublin, Poland; (P.K.); (M.J.); (A.N.)
- Orthopaedic Department, Łęczna Hospital, Krasnystawska 52, 21-010 Leczna, Poland
| | - Mariusz Jojczuk
- Department of Trauma Surgery and Emergency Medicine, Medical University of Lublin, Staszica 11, 20-081 Lublin, Poland; (P.K.); (M.J.); (A.N.)
| | - Józef Jonak
- Department of Machine Design and Mechatronics, Faculty of Mechanical Engineering, Lublin University of Technology, Nadbystrzycka 36, 20-618 Lublin, Poland;
| | - Adam Nogalski
- Department of Trauma Surgery and Emergency Medicine, Medical University of Lublin, Staszica 11, 20-081 Lublin, Poland; (P.K.); (M.J.); (A.N.)
| |
Collapse
|
30
|
Karpiński R, Krakowski P, Jonak J, Machrowska A, Maciejewski M, Nogalski A. Diagnostics of Articular Cartilage Damage Based on Generated Acoustic Signals Using ANN-Part I: Femoral-Tibial Joint. SENSORS 2022; 22:s22062176. [PMID: 35336346 PMCID: PMC8950358 DOI: 10.3390/s22062176] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/02/2022] [Accepted: 03/09/2022] [Indexed: 02/01/2023]
Abstract
Osteoarthritis (OA) is a chronic, progressive disease which has over 300 million cases each year. Some of the main symptoms of OA are pain, restriction of joint motion and stiffness of the joint. Early diagnosis and treatment can prolong painless joint function. Vibroarthrography (VAG) is a cheap, reproducible, non-invasive and easy-to-use tool which can be implemented in the diagnostic route. The aim of this study was to establish diagnostic accuracy and to identify the most accurate signal processing method for the detection of OA in knee joints. In this study, we have enrolled a total of 67 patients, 34 in a study group and 33 in a control group. All patients in the study group were referred for surgical treatment due to intraarticular lesions, and the control group consisted of healthy individuals without knee symptoms. Cartilage status was assessed during surgery according to the International Cartilage Repair Society (ICRS) and vibroarthrography was performed one day prior to surgery in the study group. Vibroarthrography was performed in an open and closed kinematic chain for the involved knees in the study and control group. Signals were acquired by two sensors placed on the medial and lateral joint line. Using the neighbourhood component analysis (NCA) algorithm, the selection of optimal signal measures was performed. Classification using artificial neural networks was performed for three variants: I—open kinetic chain, II—closed kinetic chain, and III—open and closed kinetic chain. Vibroarthrography showed high diagnostic accuracy in determining healthy cartilage from cartilage lesions, and the number of repetitions during examination can be reduced only to closed kinematic chain.
Collapse
Affiliation(s)
- Robert Karpiński
- Department of Machine Design and Mechatronics, Faculty of Mechanical Engineering, Lublin University of Technology, Nadbystrzycka 36, 20-618 Lublin, Poland; (J.J.); (A.M.)
- Correspondence: (R.K.); (P.K.)
| | - Przemysław Krakowski
- Department of Trauma Surgery and Emergency Medicine, Medical University of Lublin, Staszica 11, 20-081 Lublin, Poland;
- Orthopaedic Department, Łęczna Hospital, Krasnystawska 52 str, 21-010 Łęczna, Poland
- Correspondence: (R.K.); (P.K.)
| | - Józef Jonak
- Department of Machine Design and Mechatronics, Faculty of Mechanical Engineering, Lublin University of Technology, Nadbystrzycka 36, 20-618 Lublin, Poland; (J.J.); (A.M.)
| | - Anna Machrowska
- Department of Machine Design and Mechatronics, Faculty of Mechanical Engineering, Lublin University of Technology, Nadbystrzycka 36, 20-618 Lublin, Poland; (J.J.); (A.M.)
| | - Marcin Maciejewski
- Department of Electronics and Information Technology, Faculty of Electrical Engineering and Computer Science, Lublin University of Technology, Nadbystrzycka 36, 20-618 Lublin, Poland;
| | - Adam Nogalski
- Department of Trauma Surgery and Emergency Medicine, Medical University of Lublin, Staszica 11, 20-081 Lublin, Poland;
| |
Collapse
|
31
|
Sawitzke AD, Jackson CG, Carlson K, Bizien MD, Leiner M, Reda DJ, Sindowski T, Hanrahan C, Spencer RG, Kwoh CK, Lee SJ, Hose K, Robin L, Cain DW, Taylor MD, Bangerter N, Finco M, Clegg DO. Effect of Pulsed Low-Intensity Ultrasonography on Symptom Relief and Tibiofemoral Articular Cartilage Thickness Among Veterans Affairs Enrollees With Knee Osteoarthritis: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e220632. [PMID: 35258579 PMCID: PMC8905392 DOI: 10.1001/jamanetworkopen.2022.0632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
IMPORTANCE Osteoarthritis (OA) is a major cause of disability in the US, with no approved treatments to slow progression, but animal models suggest that pulsed low-intensity ultrasonography (PLIUS) may promote cartilage growth. OBJECTIVE To evaluate the efficacy of PLIUS in providing symptom reduction and decreased loss of tibiofemoral cartilage thickness in patients with knee OA. DESIGN, SETTING, AND PARTICIPANTS A phase 2A, sham-controlled, parallel, double-blind randomized clinical trial was conducted at 2 Veterans Affairs hospitals in Salt Lake City, Utah, and San Diego, California, from May 22, 2015, to January 31, 2019. Data were analyzed from June 27, 2020, to October 20, 2020. Participants recruited through the US Department of Veterans Affairs (N = 132) with clinical and radiographic evidence of early knee OA were randomly assigned to receive PLIUS or a sham device, self-administered for 20 minutes daily over the medial compartment of the knee. All enrollees participated in a 4-week prerandomization sham run-in period, followed by a 48-week treatment period. Randomization was stratified by study site and Kellgren-Lawrence grades 1 (n = 15), 2 (n = 51), and 3 (n = 66). INTERVENTION Participants either received 48 weeks of PLIUS or sham ultrasonography. MAIN OUTCOMES AND MEASURES The trial incorporated 2 coprimary outcomes: symptomatic improvement assessed by Outcome Measures in Rheumatology Clinical Trials-Osteoarthritis Research Society International Responder Criteria (ie, met if either >50% improvement in pain and function with at least a 20% absolute improvement of at least 2 of the following 3 factors: improvement by at least 20% [pain, function, and patient global assessment] with at least a 10-mm absolute improvement), and cartilage preservation assessed as change in central medial femoral condyle cartilage thickness by magnetic resonance imaging. Intention-to-treat analysis was used. RESULTS The mean (SD) participant age was 63.6 (10.7) years and 119 were men (90.2%). The mean (SD) duration of OA symptoms was 13.4 (12.3) years. In the PLIUS group, 70.4% (95% CI, 58.2%-82.6%) of the participants experienced symptomatic improvement, compared with 67.3% (95% CI, 54.9%-79.7%) of participants in the sham group (P = .84); there was no statistically significant difference in response rates between the treatment groups, and the between-group rate difference of 3.1% (95% CI, -14.3% to 20.5%) did not meet the predefined 10% threshold for clinically significant symptomatic improvement from application of PLIUS. At 48 weeks of treatment, central medial femoral condyle cartilage thickness decreased by a mean (SD) of 73.8 (168.1) μm in the PLIUS group and by 42.2 (297.0) μm in the sham group. This 48-week mean change between the 2 groups did not reach statistical significance (P = .44), and the between-group 48-week difference of -31.7 μm (95% CI, -129.0 μm to 65.7 μm) did not meet the predefined threshold. There were 99 nonserious adverse events in the PLIUS group and 89 in the sham group during the trial. No serious adverse events were deemed related to the study device. CONCLUSIONS AND RELEVANCE PLIUS, as implemented in this study, demonstrated neither symptomatic benefit nor a decrease in loss of tibiofemoral cartilage thickness in knee OA. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02034409.
Collapse
Affiliation(s)
| | - Christopher G Jackson
- Department of Medicine, University of Utah, Salt Lake City
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah
| | - Kimberly Carlson
- Edward Hines Junior VA Hospital Cooperative Studies Program Coordinating Center, Hines, Illinois
| | - Marcel D Bizien
- VA Cooperative Studies Program, Clinical Research Pharmacy Coordinating Center, Albuquerque, New Mexico
- School of Pharmacy, University of New Mexico, Albuquerque, New Mexico
| | - Mathew Leiner
- Edward Hines Junior VA Hospital Cooperative Studies Program Coordinating Center, Hines, Illinois
| | - Domenic J Reda
- Edward Hines Junior VA Hospital Cooperative Studies Program Coordinating Center, Hines, Illinois
| | - Tom Sindowski
- Edward Hines Junior VA Hospital Cooperative Studies Program Coordinating Center, Hines, Illinois
| | - Christopher Hanrahan
- Department of Medicine, University of Utah, Salt Lake City
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah
| | - Richard G Spencer
- National Institutes of Health/National Institute on Aging, Laboratory of Clinical Investigation, Baltimore, Maryland
| | - C Kent Kwoh
- University of Arizona Arthritis Center, University of Arizona, Tucson
| | - Susan J Lee
- VA San Diego Healthcare System, San Diego, California
| | - Kalli Hose
- Department of Medicine, San Diego VA Medical Center, San Diego, California
| | - Lisa Robin
- Edward Hines Junior VA Hospital Cooperative Studies Program Coordinating Center, Hines, Illinois
| | - Donna W Cain
- VA Cooperative Studies Program, Clinical Research Pharmacy Coordinating Center, Albuquerque, New Mexico
| | - Meredith D Taylor
- Department of Electrical & Computer Engineering, Brigham Young University, Provo, Utah
| | - Neal Bangerter
- Department of Radiology, University of Utah, Salt Lake City
- Department of Orthopedics, University of Utah, Salt Lake City
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Martha Finco
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah
| | - Daniel O Clegg
- Department of Medicine, University of Utah, Salt Lake City
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah
| |
Collapse
|
32
|
Koehler L, Waterman BR, Kusnezov NA, Blair JA, Belmont PJ, Orr JD. Occupational Outcomes and Return to Running After Operative Management of Lisfranc Injuries in a High-Demand Population. Foot Ankle Spec 2022; 15:18-26. [PMID: 32517507 DOI: 10.1177/1938640020933078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Literature evaluating outcomes following operative fixation of Lisfranc injuries has demonstrated high rates of chronic disability, particularly in those returning to prior levels of physical function. The purpose of this study is to evaluate the occupational outcomes and return to running after open reduction and internal fixation (ORIF) or arthrodesis for Lisfranc fracture-dislocations in a moderate- to high-demand military cohort. Methods: All active-duty servicemembers undergoing ORIF or primary arthrodesis (Current Procedural Terminology 28615 and 28730, respectively) for confirmed Lisfranc fracture-dislocations (International Classification of Diseases, Ninth Revision codes 838.03 or 838.13) with minimum 2-year follow-up were isolated from the Military Health System. Demographic and surgical variables were recorded. Return to military function, return to running, perioperative morbidity, and rates of reoperation for complication were the outcomes of interest. Univariate analysis followed by multivariate logistic regression determined the association between patient demographics, type of fracture fixation (ie, ORIF vs arthrodesis) and functional outcomes, including medical separation. Results: Among Lisfranc injuries, 64 patients underwent ORIF while 6 underwent primary arthrodeses with a mean age of 28.1 years. At mean follow-up of 3.5 years (range, 2.0-6.3 years), 20% of servicemembers underwent medical separation due to limitations related to their injuries. body mass index (BMI) ≥30 kg/m2 (OR 17.67; 95% CI, 3.69-84.53) and Army or Marines service branch (OR 3.86; 95% CI, 1.08-13.86) were significant independent predictors for medical separation. Among servicemembers undergoing ORIF or primary arthrodeses, 69% returned to occupationally required daily running during the follow-up period. Servicemembers with a BMI <30 kg/m2 were more likely to return to running (OR 13.14, 95% CI, 2.50-69.19). Radiographic evidence of posttraumatic Lisfranc osteoarthritis occurred in 10 (16%) servicemembers who underwent internal fixation, and 82% of ORIF patients underwent implant removal. Conclusions: At mean 3.5-year follow-up, 80% of servicemembers undergoing ORIF or primary arthrodeses for Lisfranc injuries remained on active duty or successfully completed their military service, and 69% were able to resume occupationally required daily running. Surgeons should preoperatively counsel patients with these injuries on the possibility of persistent long-term disability.Levels of Evidence: Level IV: Retrospective series.
Collapse
Affiliation(s)
- Logan Koehler
- Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas
| | - Brian R Waterman
- Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas
| | - Nicholas A Kusnezov
- Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas
| | - James A Blair
- Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas
| | - Philip J Belmont
- Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas
| | - Justin D Orr
- Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas
| |
Collapse
|
33
|
Smith JD, Schroeder AN. Second-Order Peer Reviews of Clinically Relevant Articles for the Physiatrist: Physical Therapy vs. Glucocorticoid Injection for Osteoarthritis of the Knee. Am J Phys Med Rehabil 2021; 100:e147-e152. [PMID: 33587453 DOI: 10.1097/phm.0000000000001715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Jeffrey D Smith
- From the Department of Physical Medicine & Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (JDS); and Department of Physical Medicine & Rehabilitation, Mayo Clinic, Minneapolis, Minnesota (ANS)
| | | |
Collapse
|
34
|
Krishnamurthy A, Lang AE, Pangarkar S, Edison J, Cody J, Sall J. Synopsis of the 2020 US Department of Veterans Affairs/US Department of Defense Clinical Practice Guideline: The Non-Surgical Management of Hip and Knee Osteoarthritis. Mayo Clin Proc 2021; 96:2435-2447. [PMID: 34481599 DOI: 10.1016/j.mayocp.2021.03.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 02/24/2021] [Accepted: 03/16/2021] [Indexed: 12/12/2022]
Abstract
In July 2020, the US Department of Veterans Affairs (VA) and US Department of Defense (DoD) approved a new joint clinical practice guideline for the non-surgical management of hip and knee osteoarthritis. This synopsis highlights some of the recommendations. In February 2019, the VA/DoD Evidence-Based Practice Work Group convened a joint VA/DoD guideline development effort that included clinical stakeholders and conformed to the National Academy of Medicine's tenets for trustworthy clinical practice guidelines. The guideline panel developed key questions, systematically searched (ie, Cochrane Database of Systematic Reviews, EMBASE, MEDLINE PreMEDLINE, PubMed, and the Agency for Healthcare Research and Quality website) and evaluated the literature, created a simple 1-page algorithm, and advanced 19 recommendations using the Grading of Recommendations Assessment, Development, and Evaluation system. This synopsis summarizes key recommendations in all 6 topics covered in the guideline. These topics are diagnosis, self-management, physical therapy, pharmacotherapy, orthobiologics, and complementary and integrative health.
Collapse
Affiliation(s)
- Anil Krishnamurthy
- Department of Orthopedics and Plastic Surgery, Dayton Veterans Affairs Medical Center, Dayton, OH; Department of Orthopaedic Surgery, Boonshoft School of Medicine, Wright State University, Dayton, OH
| | - Adam Edward Lang
- Department of Primary Care, McDonald Army Health Center, Fort Eustis, VA.
| | - Sanjog Pangarkar
- Department of Physical Medicine and Rehabilitation, West Los Angeles Veterans Affairs Medical Center, Los Angeles, CA
| | - Jess Edison
- Department of Rheumatology ,Walter Reed National Military Medical Center, Bethesda, MD
| | - John Cody
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD
| | - James Sall
- Office of Evidence-Based Practice, Veterans Affairs Central Office, Washington, DC
| |
Collapse
|
35
|
Mehta B, Goodman S, Ho K, Parks M, Ibrahim SA. Community Deprivation Index and Discharge Destination After Elective Hip Replacement. Arthritis Care Res (Hoboken) 2021; 73:531-539. [PMID: 31961488 DOI: 10.1002/acr.24145] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 01/14/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine how the deprivation level of the community in which one lives influences discharge disposition and the odds of 90-day readmission after elective total hip arthroplasty (THA). METHODS We performed a retrospective cohort study on 84,931 patients who underwent elective THA in the Pennsylvania Health Care Cost Containment Council database from 2012 to 2016. We used adjusted binary logistic regression models to test the association between community Area Deprivation Index (ADI) level and patient discharge destination as well as 90-day readmission. We included an interaction term for community ADI level and patient race in our models to assess the simultaneous effect of both on the outcomes. RESULTS After adjusting for patient- and facility-level characteristics, we found that patients from high ADI level communities (most disadvantaged), compared to patients from low ADI level communities (least disadvantaged), were more likely to be discharged to an institution as opposed to home for postoperative care and rehabilitation (age <65 years adjusted odds ratio [ORadj ] 1.47; age ≥65 years ORadj 1.31; both P < 0.001). The interaction effect of patient race and ADI level on discharge destination was statistically significant in those patients age ≥65 years, but not in patients age <65 years. The association with ADI level on 90-day readmission was not statistically significant. CONCLUSION In this statewide sample of patients who underwent elective THA, the level of deprivation of the community in which patients reside influences their discharge disposition, but not their odds of 90-day readmission to an acute-care facility.
Collapse
Affiliation(s)
- Bella Mehta
- Hospital for Special Surgery, New York, New York
| | | | - Kaylee Ho
- Weill Cornell Medicine, New York, New York
| | | | | |
Collapse
|
36
|
Abstract
SUMMARY There is currently no consensus on the appropriate sports and occupational restrictions for military service members with a joint replacement. Data from the United States show that 14% of military patients complete an operational deployment after the index surgery. No published data are available on arthroplasty in the militaries of other North Atlantic Treaty Organization countries. Research is needed to determine the appropriate medical employment limitations for Canadian Armed Forces members with a knee or hip replacement. Service members wanting to continue military service should be carefully screened to ensure that their duties do not compromise the longevity of the implant and that the risk of mission-threatening complications is minimal.
Collapse
Affiliation(s)
- Max Talbot
- Department of Surgery, Division of Orthopaedic Surgery, McGill University, Montreal, Que. and Chief of Orthopaedic Surgery, Canadian Armed Forces
| |
Collapse
|
37
|
Anderson AB, Balazs GC, Brooks DI, Dickens JF, Potter BK. Total Joint Arthroplasty Volume in the Military Health System. Mil Med 2020; 185:e1051-e1056. [PMID: 32627835 DOI: 10.1093/milmed/usz401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION The relationship between volume and outcome of total knee arthroplasties is a concern in both the civilian and military patient populations. We sought to compare surgeons and hospital procedure volumes performed on military service members and define factors leading to increased civilian referrals. MATERIALS AND METHODS The Military Health System Data Repository (MDR) contains patient information on all healthcare beneficiary encounters, including care provided both in Military Health System (MHS) facilities and in civilian network facilities. The Military Analysis and Reporting Tool (M2) queried the MDR for all patients between 2011 and 2015 with a CPT code for hip or knee arthroplasty associated with a provider HIPAA taxonomy code for orthopedic surgery. M2 enrollee encounters were used to calculate the total number of arthroplasty procedures performed by both military and civilian orthopedic surgeons on MHS enrollees as well as the incidence rate of arthroplasty procedures. Logistic regression was used to predict which cases were more likely to have been treated at military treatment facilities using patient gender, sponsor service branch, age, and beneficiary category. RESULTS During the study period, a total of 12,627 military facility arthroplasty cases and a total of 142,637 civilian facility arthroplasty cases were performed on TRICARE enrolled patients. The total number of military surgeons performing arthroplasty on TRICARE enrolled patients was 323, while the total number of civilian surgeons performing arthroplasty was 10,245 during the same time period; the number of military surgeons performing arthroplasty on active duty patients was 176, and the total number of civilian surgeons performing arthroplasty on military patients was 1045. Overall, including retirees and activity duty service members, more procedures are performed by civilian network surgeons than military surgeons in all states. In an adjusted model, male patients were slightly more likely to receive care at an military treatment facilitie than female patients (OR = 1.47, 95% CI: 1.41-1.53). Furthermore, with respect to service, patients with Air Force (OR: 1.08, 95% CI: 1.02-1.15) and Navy sponsors (OR: 1.61, 95% CI: 1.51-1.71) were more likely to receive military care than patients with Army sponsors. CONCLUSIONS Based on our findings, we recommend the MHS focus attention to recapturing the Army active duty male patients who are more likely to receive care outside of the military healthcare network. Further analysis of the many factors including, but not limited to, referral process for total joint arthroplasty, time to procedure, and facility resources is required, in addition to assessing patient outcomes following the procedures.
Collapse
Affiliation(s)
- Ashley B Anderson
- Walter Reed National Military Medical Center, Department of Surgery Division of Orthopaedics 8901 Rockville Pike, Bethesda, MD 20889, USA.,Uniformed Services University of the Health Science 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - George C Balazs
- Naval Medical Center Portsmouth 620 John Paul Jones Cir, Portsmouth, VA 23708, USA
| | - Daniel I Brooks
- Walter Reed National Military Medical Center, Department of Surgery Division of Orthopaedics 8901 Rockville Pike, Bethesda, MD 20889, USA
| | - Jonathan F Dickens
- Walter Reed National Military Medical Center, Department of Surgery Division of Orthopaedics 8901 Rockville Pike, Bethesda, MD 20889, USA.,Uniformed Services University of the Health Science 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Benjamin K Potter
- Walter Reed National Military Medical Center, Department of Surgery Division of Orthopaedics 8901 Rockville Pike, Bethesda, MD 20889, USA.,Uniformed Services University of the Health Science 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| |
Collapse
|
38
|
Slaven SE, Richards JT, Wade SM, Saxena SK, Vanier AT, Cody JP. Low Revision Rates at 10 years for Metal on Metal Hip Implants in a Military Population. Mil Med 2020; 184:e454-e459. [PMID: 30811533 DOI: 10.1093/milmed/usz019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 01/14/2019] [Accepted: 01/17/2019] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Prior to being largely abandoned due to unacceptably high failure rates and the adverse physiologic reactions to metal ions, metal-on-metal (MoM) total hip arthroplasty (THA) and hip resurfacing (HR) were in widespread use throughout the USA, and the potential benefit of decreased volumetric wear rates made it of particular interest to those who serve a young active population, such as military surgeons. The aim of our study was to determine the revision rate of metal on metal hip implants performed at our military institution and obtain current patient reported outcomes from this cohort. MATERIALS AND METHODS We conducted a retrospective review of patients who underwent MoM total hip arthroplasty (THA) or hip resurfacing (HR) at our institution from 2006 to 2012. Revision status and component type were determined, and patients were contacted to obtain current HOOS JR scores. RESULTS We identified 103 THAs in 88 patients and 38 HRs in 33 patients, with mean follow up of 10.2 years. Average age at time of surgery was 48 years, and 85% of the patients were male. The mean HOOS JR score in the THA and HR groups were 84.9 ± 17.6 and 75.8 ± 24.9, respectively (p = 0.38), and were not significantly lower in those who were revised. Two THA revisions occurred for metallosis and one for aseptic loosening of the femoral component. One HR revision occurred for breach of the anterior femoral neck, and one occurred for heterotopicossification. CONCLUSIONS Revision rates of MoM THA and HR in this young, predominantly male population were 2.9% and 5.3%, respectively, and patients maintained generally good hip-specific outcomes.
Collapse
Affiliation(s)
- Sean E Slaven
- Department of Orthopedic Surgery, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD.,Uniformed Services University of Health Sciences, 4301 Jones Bridge Road, Bethesda MD
| | - John T Richards
- Department of Orthopedic Surgery, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD.,Uniformed Services University of Health Sciences, 4301 Jones Bridge Road, Bethesda MD
| | - Sean M Wade
- Department of Orthopedic Surgery, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD.,Uniformed Services University of Health Sciences, 4301 Jones Bridge Road, Bethesda MD
| | - Sameer K Saxena
- Department of Orthopedic Surgery, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD.,Uniformed Services University of Health Sciences, 4301 Jones Bridge Road, Bethesda MD
| | - Alan T Vanier
- Uniformed Services University of Health Sciences, 4301 Jones Bridge Road, Bethesda MD
| | - John P Cody
- Department of Orthopedic Surgery, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD.,Uniformed Services University of Health Sciences, 4301 Jones Bridge Road, Bethesda MD
| |
Collapse
|
39
|
Canetti EFD, Schram B, Orr RM, Knapik J, Pope R. Risk factors for development of lower limb osteoarthritis in physically demanding occupations: A systematic review and meta-analysis. APPLIED ERGONOMICS 2020; 86:103097. [PMID: 32342888 DOI: 10.1016/j.apergo.2020.103097] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 02/05/2020] [Accepted: 03/06/2020] [Indexed: 06/11/2023]
Abstract
This systematic review and meta-analysis identified and critically reviewed the findings of recent studies (last 15 years) examining relationships between specific physically demanding occupations or occupational tasks and development of lower limb osteoarthritis (OA). Twenty-eight studies with 266,227 cases of lower limb OA were included. Occupational tasks contributing to OA included farming, floor laying, and brick laying. Activities significantly contributing to the risk of knee OA were lifting heavy loads (>10 kg/week) (odds ratio [OR] = 1.52, 95% confidence interval [95%CI] 1.29-1.79), squatting/kneeling (OR = 1.69, 95%CI 1.15-2.49), standing (>2 h/daily) (OR = 1.22 95%CI 1.02-1.46) and walking (OR = 1.40 95%CI 1.14-1.73). Lifting contributed significantly to the risk of hip OA (OR = 1.35, 95%CI 1.16-1.57). The effects of occupational exposures appear to be magnified by previous injury and BMI >25 kg/m2. Since specific occupational activities increase OA risk, ergonomist should encourage the use of existing tools, or oversee the design of new tools that may decrease exposure to such activities.
Collapse
Affiliation(s)
- Elisa F D Canetti
- Faculty of Health Sciences and Medicine, Bond University, 14 University Drive, Robina, QLD, 4226, Australia; Tactical Research Unit, Bond University, 2 Promethean Way, Robina, QLD, 4226, Australia.
| | - Ben Schram
- Faculty of Health Sciences and Medicine, Bond University, 14 University Drive, Robina, QLD, 4226, Australia; Tactical Research Unit, Bond University, 2 Promethean Way, Robina, QLD, 4226, Australia.
| | - Robin M Orr
- Faculty of Health Sciences and Medicine, Bond University, 14 University Drive, Robina, QLD, 4226, Australia; Tactical Research Unit, Bond University, 2 Promethean Way, Robina, QLD, 4226, Australia.
| | - Joseph Knapik
- Tactical Research Unit, Bond University, 2 Promethean Way, Robina, QLD, 4226, Australia.
| | - Rodney Pope
- Tactical Research Unit, Bond University, 2 Promethean Way, Robina, QLD, 4226, Australia; School of Community Health, Charles Sturt University, Elizabeth Mitchell Dr, Thurgoona, NSW, 2640, Australia.
| |
Collapse
|
40
|
Gabriel EH, McCann RS, Hoch MC. Use of Social or Behavioral Theories in Exercise-Related Injury Prevention Program Research: A Systematic Review. Sports Med 2020; 49:1515-1528. [PMID: 31187453 DOI: 10.1007/s40279-019-01127-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The use of social or behavioral theories within exercise-related injury prevention program (ERIPP) research may lead to a better understanding of why adherence to the programs is low and inform the development of interventions to improve program adherence. There is a need to determine which theories have been used within the literature and at what level theory was used to further the field. OBJECTIVE To determine which social or behavioral science theories have been incorporated within ERIPP research and assess the level at which the theories were used. The key question guiding the search was "What social or behavioral theories have been used within ERIPP research?" METHODS A systematic review of the literature was completed with an appraisal of bias risk using a custom critical appraisal tool. An electronic search of EBSCOhost (Academic Search Complete, CINAHL, Medline, Psychology and Behavioral Sciences Collection) and PubMed was completed from inception to October 2018. Studies investigating attitudes towards ERIPP participation with the use of a social or behavioral theoretical model or framework were eligible for inclusion. RESULTS The electronic search returned 7482 results and two articles were identified though a hand search, which resulted in ten articles meeting inclusion criteria. Four different behavioral or social theoretical models or frameworks were identified including the health action process approach model, health belief model, self-determination theory, and theory of planned behavior. Six studies utilized the theory at a B level meaning a theoretical construct was measured while four utilized the theory at the C level meaning the theory was tested. The mean critical appraisal score was 78%, indicating a majority of the studies were higher quality. CONCLUSION There has been an increase in the use of theory within literature that is specific to ERIPP participation. Additionally, the use of theory has shifted from guiding program design to the measurement of theoretical constructs and testing of the theoretical models.
Collapse
Affiliation(s)
- Emily H Gabriel
- College of Health Professions, Mercer University, Macon, GA, 31207, USA.
| | - Ryan S McCann
- School of Physical Therapy and Athletic Training, Old Dominion University, Norfolk, VA, 23529, USA
| | - Matthew C Hoch
- Department of Athletic Training and Clinical Nutrition, University of Kentucky, Lexington, KY, 40536, USA
| |
Collapse
|
41
|
Adebayo OO, Holyoak DT, van der Meulen MCH. Mechanobiological Mechanisms of Load-Induced Osteoarthritis in the Mouse Knee. J Biomech Eng 2020; 141:2736041. [PMID: 31209459 DOI: 10.1115/1.4043970] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Indexed: 12/18/2022]
Abstract
Osteoarthritis (OA) is a degenerative joint disease that affects millions of people worldwide, yet its disease mechanism is not clearly understood. Animal models have been established to study disease progression by initiating OA through modified joint mechanics or altered biological activity within the joint. However, animal models often do not have the capability to directly relate the mechanical environment to joint damage. This review focuses on a novel in vivo approach based on controlled, cyclic tibial compression to induce OA in the mouse knee. First, we discuss the development of the load-induced OA model, its different loading configurations, and other techniques used by research laboratories around the world. Next, we review the lessons learned regarding the mechanobiological mechanisms of load-induced OA and relate these findings to the current understanding of the disease. Then, we discuss the role of specific genetic and cellular pathways involved in load-induced OA progression and the contribution of altered tissue properties to the joint response to mechanical loading. Finally, we propose using this approach to test the therapeutic efficacy of novel treatment strategies for OA. Ultimately, elucidating the mechanobiological mechanisms of load-induced OA will aid in developing targeted treatments for this disabling disease.
Collapse
Affiliation(s)
| | - Derek T Holyoak
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY 14853
| | - Marjolein C H van der Meulen
- Meinig School of Biomedical Engineering, Cornell University, 113 Weill Hall, Ithaca, NY 14853.,Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY 14853.,Research Division, Hospital for Special Surgery, New York, NY 10021 e-mail:
| |
Collapse
|
42
|
Abstract
Osteoarthritis (OA) is a worldwide endemic and debilitating disease. Previously thought to simply be damaged from "wear and tear," OA is now understood to be a complex interaction of local and systemic factors. This article reviews the pathology, symptoms, diagnosis, and various conservative, surgical, and novel treatments of OA.
Collapse
Affiliation(s)
- Benjamin Abramoff
- Department of PM&R, University of Pennsylvania, Penn Medicine Rittenhouse, 1800 Lombard Street, Philadelphia, PA 19146, USA
| | - Franklin E Caldera
- Department of PM&R, University of Pennsylvania, Penn Medicine Rittenhouse, 1800 Lombard Street, Philadelphia, PA 19146, USA.
| |
Collapse
|
43
|
|
44
|
Cotter EJ, Frank RM, Mandelbaum B. Management of osteoarthritis - biological approaches: current concepts. J ISAKOS 2020. [DOI: 10.1136/jisakos-2019-000377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
|
45
|
Schram B, Orr R, Pope R, Canetti E, Knapik J. Risk factors for development of lower limb osteoarthritis in physically demanding occupations: A narrative umbrella review. J Occup Health 2019; 62:e12103. [PMID: 31828895 PMCID: PMC6970406 DOI: 10.1002/1348-9585.12103] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/19/2019] [Accepted: 11/20/2019] [Indexed: 01/08/2023] Open
Abstract
Objectives Osteoarthritis (OA) is a common disorder which affects the joints. As relationships between occupational factors and lower limb OA have been widely studied in systematic reviews, the aim of this umbrella review was to synthesize their key findings in the risk factors for development of lower limb OA. Methods A systematic search was conducted using the databases PUBMED, Cumulative Index of Nursing and Allied Health Literature, and Elton B Stevens Company to identify reviews examining associations between lower limb OA and occupational tasks. These reviews were rated for their methodological quality before key data were extracted and synthesized. Results Sixteen reviews were found, seven pertained to the knee, four to the hip, two to a variety of joints, and three to both the hip and knee. One was deemed to be of high methodological quality, one of critically low methodological quality, and the others of moderate methodological quality. The reviews found moderate to good evidence for heavy occupational lifting to be associated with an increased risk of OA at the knee and the hip. Kneeling, squatting, and climbing, previous injuries to joints, being overweight and obese were also predictive of lower limb OA. Conclusion Occupations which involve heavy physical workloads increase the risk of developing lower limb OA. Heavy lifting, squatting, knee bending, kneeling, and climbing may all increase the risk of developing OA in both the knees and hips. Efforts to reduce exposure to these tasks, reducing joint injuries, optimizing bodyweight may reduce the risks of lower limb OA for occupations which are physically demanding.
Collapse
Affiliation(s)
- Ben Schram
- Tactical Research Unit, Bond University, Robina, QLD, Australia
| | - Robin Orr
- Tactical Research Unit, Bond University, Robina, QLD, Australia
| | - Rodney Pope
- Tactical Research Unit, Bond University, Robina, QLD, Australia.,School of Community Health, Charles Sturt University, Albury, NSW, Australia
| | - Elisa Canetti
- Tactical Research Unit, Bond University, Robina, QLD, Australia
| | | |
Collapse
|
46
|
Silva GMD, Senna KMSE, Sousa EBD, Tura BR. [Budget impact analysis of viscosupplementation for non-surgical treatment of knee osteoarthritis]. CAD SAUDE PUBLICA 2019; 35:e00098618. [PMID: 31596396 DOI: 10.1590/0102-311x098618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 04/30/2019] [Indexed: 11/21/2022] Open
Abstract
Knee osteoarthritis affects 3.8% of the world population and manifests as pain, edema, stiffness, and reduced joint function, impacting the patient's quality of life. Treatment consists of the pharmacological, non-pharmacological, and surgical modalities. Viscosupplementation (intraarticular hyaluronate) has been proposed to relieve symptoms and potentially postpone surgery. This study estimated the budget impact of the association of this drug and non-surgical treatment (standard treatment) from the perspective of the Brazilian Unified National Health System. Based on the assumption that 5% of patients proceed to treatment and on the direct costs of the pharmacological and non-pharmacological modalities, the authors calculated the reference and alternative scenarios that compared the different treatment options in a three-year timeline. The principal analysis estimated an incremental budget impact of approximately BRL 126 million (U$ 32 million) for one vial of hyaluronate a year and BRL 252 million (USD 64 million) for two vials a year. Diacerein, an oral chondroprotector, assessed as an alternative, showed a budget impact of BRL 334 million (USD 86 million) in relation to standard treatment, representing a 24% cost increase compared to two vials a year of hyaluronate, making it less economically advantageous. Viscosupplementation can provide better quality of life for patients, reduce costs for the health system, and optimize the flow of care in health services. The estimates presented in this study can assist administrators in the best use of resources and thus in decision-making on the technology's incorporation.
Collapse
|
47
|
|
48
|
Ilfeld BM, Ball ST, Cohen SP, Hanling SR, Fowler IM, Wongsarnpigoon A, Boggs JW. Percutaneous Peripheral Nerve Stimulation to Control Postoperative Pain, Decrease Opioid Use, and Accelerate Functional Recovery Following Orthopedic Trauma. Mil Med 2019; 184:557-564. [PMID: 30901395 DOI: 10.1093/milmed/usy378] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 11/14/2018] [Indexed: 11/13/2022] Open
Abstract
Orthopedic trauma is a significant military problem, causing several of the most disabling conditions with high rates of separation from duty and erosion of military readiness. The objective of this report is to summarize the findings of case series of a non-opioid therapy-percutaneous peripheral nerve stimulation (PNS) - and describe its potential for postoperative analgesia, early opioid cessation, and improved function following orthopedic trauma. Percutaneous PNS has been evaluated for the treatment of multiple types of pain, including two case series on postoperative pain following total knee replacement (n = 10 and 8, respectively) and a case series on postamputation pain (n = 9). The orthopedic trauma induced during TKR is highly representative of multiple types of orthopedic trauma sustained by Service members and frequently produces intense, prolonged postoperative pain and extended opioid use following surgery. Collectively, the results of these three clinical studies demonstrated that percutaneous PNS can provide substantial pain relief, reduce opioid use, and improve function. These outcomes suggest that there is substantial potential for the use of percutaneous PNS following orthopedic trauma.
Collapse
Affiliation(s)
- Brian M Ilfeld
- University of California San Diego, 200 W Arbor Drive, San Diego, CA
| | - Scott T Ball
- University of California San Diego, 200 W Arbor Drive, San Diego, CA
| | - Steven P Cohen
- Johns Hopkins School of Medicine, Department of Anesthesiology and Critical Care Medicine, 1800 Orleans Street, Baltimore, MD
| | - Steven R Hanling
- Medical College of Georgia, Department of Anesthesiology & Perioperative Medicine, BIW-2144 1120 15th Street, Augusta, GA
| | - Ian M Fowler
- Naval Medical Center San Diego, Department of Anesthesiology, 34800 Bob Wilson Dr, San Diego, CA
| | | | - Joseph W Boggs
- SPR Therapeutics, 22901 Millcreek Boulevard, Suite 110, Cleveland, OH
| |
Collapse
|
49
|
Rhon DI, Greenlee TA, Sissel CD, Reiman MP. The two-year incidence of hip osteoarthritis after arthroscopic hip surgery for femoroacetabular impingement syndrome. BMC Musculoskelet Disord 2019; 20:266. [PMID: 31153368 PMCID: PMC6545211 DOI: 10.1186/s12891-019-2646-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 05/20/2019] [Indexed: 12/30/2022] Open
Abstract
Background One of the reported goals of hip preservation surgery is to prevent or delay the onset of osteoarthritis. This includes arthroscopic surgery to manage Femoroacetabular Impingement (FAI) Syndrome. The purpose of this study was to describe the prevalence of clinically-diagnosed hip OA within 2 years after hip arthroscopy for FAI syndrome, and 2) determine which variables predict a clinical diagnosis of OA after arthroscopy. Methods Observational analysis of patients undergoing hip arthroscopy between 2004 and 2013, utilizing the Military Health System Data Repository. Individuals with prior cases of osteoarthritis were excluded. Presence of osteoarthritis was based on diagnostic codes rendered by a medical provider in patient medical records. Adjusted odds ratios (95% CI) for an osteoarthritis diagnosis were reported for relevant clinical and demographic variables. Results Of 1870 participants in this young cohort (mean age 32.2 years), 21.9% (N = 409) had a postoperative clinical diagnosis of hip osteoarthritis within 2 years. The 3 significant predictors in the final model were older age (OR = 1.04; 95%CI = 1.02, 1.05), male sex (OR = 1.31; 95%CI = 1.04, 1.65), and having undergone an additional hip surgery (OR = 2.33; 95% CI = 1.72, 3.16). Military status and post-surgical complications were not risk factors. Conclusion A clinical diagnosis of hip osteoarthritis was found in approximately 22% of young patients undergoing hip arthroscopy in as little as 2 years. These rates may differ when using alternate criteria to define OA, such as radiographs, and likely underestimate the prevalence. A more comprehensive approach, considering various criteria to detect OA will likely be necessary to accurately identify the true rates. Females were at lower risk, while increasing age and multiple surgeries increased the risk for an OA diagnosis. OA onset still occurs after “hip preservation” surgery in a substantial number of individuals within 2 years. This should be considered when estimating rates of disease prevention after surgery. Prospective trials with sound methodology are needed to determine accurate rates and robust predictors of osteoarthritis onset after hip preservation surgery.
Collapse
Affiliation(s)
- Daniel I Rhon
- Physical Performance Service Line, G 3/5/7, US Army Office of the Surgeon General, Falls Church, VA, USA. .,Baylor University, Road, Bldg 2841, Suite 1301; JBSA Fort Sam Houston, Stanley, TX, 3630, USA.
| | - Tina A Greenlee
- Center for the Intrepid, Brooke Army Medical Center, 3551 Roger Brooke Drive, San Antonio, TX, USA
| | | | - Michael P Reiman
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| |
Collapse
|
50
|
Efficacy of Triamcinolone Acetonide Extended-Release in Participants with Unilateral Knee Osteoarthritis: A Post Hoc Analysis. Adv Ther 2019; 36:1398-1411. [PMID: 30968336 PMCID: PMC6824457 DOI: 10.1007/s12325-019-00944-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Indexed: 02/06/2023]
Abstract
Introduction Osteoarthritis (OA) is common and its prevalence is increased in military service members. In a phase 3 randomized controlled trial (NCT02357459), a single intra-articular injection of an extended-release formulation of triamcinolone acetonide (TA-ER) in participants with unilateral or bilateral knee OA demonstrated substantial improvement in pain and symptoms. Bilateral knee pain has emerged as a confounding factor in clinical trials when evaluating the effect of a single intra-articular injection. Furthermore, unilateral disease is frequently first to emerge in active military personnel secondary to prior traumatic joint injury. In this post hoc analysis, we assessed efficacy and safety of TA-ER in a subgroup of participants with unilateral knee OA. Methods Participants ≥ 40 years of age with symptomatic knee OA were randomized to a single intra-articular injection of TA-ER 32 mg, TA crystalline suspension (TAcs) 40 mg, or saline-placebo. Average daily pain (ADP)-intensity and rescue medication use were collected at each of weeks 1–24 postinjection; Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)-A (pain), WOMAC-B (stiffness), WOMAC-C (function), and Knee Injury and Osteoarthritis Outcome Score Quality of Life (KOOS-QoL) were collected at weeks 4, 8, 12, 16, 20, and 24 postinjection. Adverse events (AEs) were assessed throughout the study. Participants with unilateral knee OA were selected for this analysis. Results Of 170 participants with unilateral OA (TA-ER, N = 51; saline-placebo, N = 60; TAcs, N = 59), 42% were male and 89% were white. TA-ER significantly (p < 0.05) improved ADP-intensity vs. saline-placebo (weeks 1–24) and TAcs (weeks 4–21). TA-ER significantly (p < 0.05) improved WOMAC-A vs. saline-placebo (all time points) and TAcs (weeks 4, 8, 12, 24). Consistent outcomes were observed for rescue medication, WOMAC-B, WOMAC-C, and KOOS-QoL. AEs were similar in frequency/type across treatments. Conclusion TA-ER provided 5–6 months’ pain relief that consistently exceeded saline-placebo and TAcs, suggesting that TA-ER injected intra-articularly into the affected knee may be an effective non-opioid treatment option. Although the participants included in this analysis did not fully represent the diverse demographics of active service members, the substantial unmet medical need in the military population suggests that TA-ER may be an important treatment option; additional studies of TA-ER in active military patients are needed. Trial Registration ClinicalTrials.gov NCT02357459. Funding Flexion Therapeutics, Inc. Plain Language Summary Plain language summary available for this article.
Collapse
|