Burden of knee osteoarthritis in the Middle East and North Africa (MENA): an epidemiological analysis from 1990 to 2019

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

BACKGROUND

Osteoarthritis knee poses a substantial and pervasive global health challenge.

METHODS

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

RESULTS

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

CONCLUSION

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

Public Awareness and Knowledge Gaps in Osteoarthritis Prevention in the UAE: A Cross-Sectional Study on Risk Factors and Lifestyle Influences

Background Osteoarthritis (OA) is a prevalent joint disorder affecting people globally, including in the UAE, where urbanization, sedentary lifestyles, and dietary habits have increased its occurrence. This study examines public awareness of OA and preventive measures in the UAE, aiming to identify knowledge gaps and emphasize the need for educational interventions to promote healthier choices and OA prevention. Methods A cross-sectional study was conducted with a self-administered online questionnaire distributed widely across internet platforms. The survey collected demographic information, factors influencing OA prevention knowledge, and participants' awareness of OA prevention and associated risk factors. A total of 394 UAE residents participated. Data analysis was conducted using IBM SPSS Statistics for Windows, Version 29 (Released 2023; IBM Corp., Armonk, New York, United States). Results Among the 394 participants, 45.4% were aged 18-29, with nearly equal gender representation (51.3% male, 48.7% female). Most held undergraduate degrees (57.6%), and most (57.4%) were Arab non-Emiratis. Regarding OA awareness, 44.2% had low knowledge levels, while 21.8% showed high awareness. Nearly all respondents (95.7%) identified OA as joint-related, and 73.6% recognized weight management as preventive, though only 67% knew OA could affect multiple joints. Common misconceptions included beliefs that OA equally affects genders (27.9%) and that it's caused by cold, damp weather (22.8%). Awareness of treatments like physiotherapy was moderate (66.8%), yet knowledge of advanced options like injections was low (38.8%). Significant correlations were found between OA awareness and factors like age, ethnicity, education, employment, and income. Conclusion Limited public awareness of OA and preventive measures exists in the UAE, underscoring the need for targeted public health education to address misconceptions and improve understanding.

Does the duration of antibiotic treatment following one-stage treatment of infected total knee arthroplasty influence the eradication rate? A systematic review

PURPOSE

The aim of this study was to perform a systematic review of the current literature to elucidate the optimal duration of systemic antibiotic therapy following one-stage revision TKA in the setting of PJI.

METHODS

We conducted an electronic search in four databases including Medline (PubMed), Scopus, Web of Science, and Cochrane Central Register of Controlled Trials without any publication date, language or study design filter on October 1, 2022. The search strategy adhered to PRISMA guidelines and consisted of four main keywords categories which were knee arthroplasty or knee prosthesis, infection and one-stage/single-stage revision. Duration of antibiotic administration were classified to three groups: short-term IV therapy (≤ two weeks), short-term IV therapy plus oral therapy, and long-term IV therapy (minimum six weeks).

RESULTS

We identified 963 studies, of which 21 were included in the systematic review. Coagulase-negative Staphylococcal species were the most frequently isolated pathogens. The mean eradication rate for all the studies analyzed was 88.4% (range, 62.5-100%). Short-term IV + long-term oral antibiotic therapy demonstrated significantly higher eradication rate compared to the other two regimens following one-stage revision TKA (p = 0.023) (Table 4). In the ten studies with great than five years of follow-up, this difference was no longer statistically significant. Subgroup analysis of antibiotic-loaded cement (ABLC) usage demonstrated higher eradication rates with short-term IV + long-term oral (92.8%) and long-term IV antibiotics (89.7%) compared to short-term IV antibiotics alone (p = 0.006).

CONCLUSION

We demonstrated that short-term IV antibiotics followed by oral antibiotics had similar eradication rates to long-term IV antibiotics in long-term studies, which were both superior to short-term IV antibiotics alone. Nevertheless, there remains a need for prospective and randomized studies to further elucidate a patient-based protocol for the type and duration of antibiotic use following one-stage PJI treatment of the knee.

Diagnostic value of ultrasonography in knee osteoarthritis: A systematic review

Background

Knee osteoarthritis (KOA) is the most expected diagnosis for an arthropathy that causes discomfort and disability in older adults. Radiography is frequently used to assess patients with KOA and there have been few prior research evaluating the diagnostic efficacy of ultrasonography (US). The current study sought to assess the diagnostic efficacy of the US in identifying various characteristics of KOA in the scientific literature.

Materials and Methods

This study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta Analyses statement. A systematic search in PubMed, Web of Science, Scopus, and Embase databases was completed in March 2023. This study focused on the diagnostic value of US in KOA, including sensitivity, specificity, positive predictive value, and negative predictive value. The quality assessment was conducted using the Joanna Briggs Institute critical appraisal tools.

Results

Out of 552 records of database searches, finally, two studies met this systematic review's eligibility criteria and were included in the study. Both of the included studies were cross sectional studies. US demonstrated remarkable sensitivity with adequate specificity for the detection of radiographic knee OA; however, it was found not to be an appropriate method for the detection of early KOA.

Conclusion

This study as the first systematic review aims to evaluate the diagnostic performance of US in detecting KOA. These findings shed light on the importance of investigating the different US features in the evaluation of KOA to reach appropriate sensitivity and specificity in the diagnosis.

Robotic assisted Total Knee Arthroplasty (TKA) is not associated with increased patient satisfaction: a systematic review and meta-analysis

PURPOSE

Total knee arthroplasty (TKA) is a common orthopedic surgery, yet postoperative dissatisfaction persists in around 20% of cases. Robotic total knee arthroplasty (rTKA) promises enhanced precision, but its impact on patient satisfaction compared to conventional TKA remains controversial (cTKA). This systematic review aims to evaluate patient satisfaction post-rTKA and compare outcomes with cTKA.

METHODS

Papers from the following databases were identified and reviewed: PubMed, Scopus, Web of Science, and the Cochrane Online Library, using keywords like "Knee replacement," "Total knee arthroplasty," "Robotic," and "Patient satisfaction." Extracted data included patient satisfaction measures, Knee Society Score, Oxford Knee Score, Forgotten Joint Score, SF-36, HSS, and KOOS. Statistical analysis, including odds ratio and 95% CI was performed using R software. Heterogeneity was assessed using Cochrane's Q test.

RESULTS

The systematic review included 17 articles, involving 1148 patients (571 in the rTKA group and 577 in the cTKA group) assessing patient satisfaction following rTKA. An analysis of proportions reveals rTKA satisfaction rate was 95%, while for cTKA, it was 91%. A meta-analysis comparing rTKA and cTKA found no statistically significant difference in patient satisfaction. Additionally, various patient-reported outcome measures (PROMs) were examined, showing mixed results across different studies and follow-up periods.

CONCLUSIONS

The results of this study found no difference in patient satisfaction outcomes in the short to mid-term for rTKA compared to conventional methods. This study does not assert superiority for the robotic approach, highlighting the need for careful consideration of various factors influencing outcomes in knee arthroplasty.

The burden of knee osteoarthritis worldwide, regionally, and nationally from 1990 to 2019, along with an analysis of cross-national inequalities

OBJECTIVE

To describe the disease burden of knee osteoarthritis (KOA) globally, regionally, and in 204 countries by age, sex, and sociodemographic index (SDI) from 1990 to 2019, and to explore cross-national inequalities across SDI.

METHODS

The Global Burden of Disease (GBD) 2019 database collected data on KOA worldwide from 1990 to 2019, including prevalence, incidence, years lived with disability (YLDs). The average annual percentage change (AAPC) was used to measure temporal trends. In addition, the inequality slope index and the health concentration index were calculated to quantify the unequal distribution of the burden of KOA across 204 countries worldwide.

RESULTS

In 2019, the global age-standardized prevalence rate increased by 7.5% compared with 1990, and the age-standardized incidence rate increased by about 6.2%; The age-standardized YLDs rate increased by about 7.8%. In addition to the Republic of Korea and the United States of America, the disease burden of KOA has increased year by year in other countries around the world. The incidence of KOA was highest at ages 50-59, while the prevalence and rates of YLDs were highest at ages 75-84. The burden of KOA was higher in women than in men. Cross-country inequality suggests that the inequality in the burden of KOA between high SDI and low SDI countries becomes greater, and that countries with high SDI bear a disproportionately high burden.

CONCLUSION

The global KOA burden has risen steadily between 1990 and 2019, and cross-national inequality gaps remain large. Targeted measures must therefore be taken to address this inequality and the increasing global KOA disease burden.

Global burden and socioeconomic impact of knee osteoarthritis: a comprehensive analysis

Objective

To report the trend changes of the prevalence, incidence, and disability-adjusted life years (DALYs) of knee osteoarthritis (KOA) according to age, sex, sociodemographic index (SDI), and income.

Methods

This analysis used estimates from the broader Global Burden of Disease (GBD) study 2019, which covered 201 countries from 1990 to 2019. National prevalence, incidence, and DALYs were shown by using ggplot2 and maps packages. Five-year intervals were used for age groupings. The Commonwealth and the World Bank income classifications were used for income grouping.

Results

Globally, there were ~364.58 million prevalent cases (females: 225.16 million), 29.51 million incident cases (females: 17.53 million), and 11.53 million DALYs (females: 7.09 million) due to KOA in 2019. The Western Pacific Region had a high endemicity of ~7,319.87 cases per 100,000 people (7.64%). Japan's prevalence rate (12,610.12 cases per 100,000 population) was 10 times that of Somalia (1,178.23) in 2019. In 200 countries (except the United Arab Emirates), the prevalence, incidence, and DALY rates of KOA in 2019 were higher among females than among males and increased with age up to the oldest age group. The prevalence was highest in the high-middle SDI countries, and the incidence and DALYs were highest in the middle SDI countries.

Conclusion

There was a large burden of KOA worldwide, with some notable intercountry variation. Some countries had 10 times the burden of other countries. Increasing population awareness regarding the prevalence, incidence, and DALYs of KOA with a focus on the population in the Western Pacific Region is needed, particularly for older females. informs health policy development, and contributes to improving the efficiency, equity, and effectiveness of healthcare systems.

Increasing Burden of Lower-Extremity Fractures in the Middle East and North Africa (MENA): A 30-Year Epidemiological Analysis

BACKGROUND

Lower-extremity fractures (LEFs) account for >30% of all skeletal injuries, contributing to the global health and economic burden. Fracture epidemiology in the Middle East and North Africa (MENA) region has been studied little. Health factors and disease epidemiology differ greatly among populations in MENA despite cultural, political, and economic similarities among the region's countries. This study examined the epidemiology of LEFs and the need for rehabilitation in MENA from 1990 to 2019.

METHODS

We examined the epidemiology of fractures of the pelvis, hip, femur, patella, tibia, fibula, ankle, and foot bones using Global Burden of Disease (GBD) data. Fracture incidence, counts, and rates were measured for males and females across age groups in the 21 MENA countries as identified by the GBD data set. Associations between years of healthy life lost due to disability (YLD) resulting from fracture and the Socio-demographic Index (SDI) were analyzed.

RESULTS

In contrast to the global trend, the age-standardized incidence rate (ASIR) of LEFs in the MENA region increased by 4.57% from 1990 to 2019. In 2019, the highest ASIR among fractures was attributed to fractures of the patella, fibula, tibia, or ankle (434.36 per 100,000), most frequently occurring among those 20 to 24 years of age. In 2019, the highest ASIR of all fractures was noted in Saudi Arabia (2,010.56 per 100,000) and the lowest, in Sudan (523.29 per 100,000). The greatest increases from 1990 to 2019 in the ASIR of LEFs were noted in Yemen (132.39%), Syria (107.27%), and Afghanistan (94.47%), while the largest decreases were found in Kuwait (-62.72%), Sudan (-48.72%), and Iran (-45.37%). In 2019, the YLD rate of LEFs had increased to 277.65 per 100,000, up from 235.55 per 100,000 in 1990.

CONCLUSIONS

Between 1990 and 2019, LEFs increased in the MENA region. Violence, war, and road traffic accidents increased, leading to a high rate of fractures, especially among youth. Low bone-mineral density related to vitamin D deficiency has also been reported as a risk factor for fracture in the region. Regional health authorities should be informed of fracture patterns by this study.

LEVEL OF EVIDENCE

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

Catastrophic skin necrosis after total knee arthroplasty: a case report and review of the literature

Introduction and importance

There have been few cases of post total knee arthroplasty (TKA) skin necrosis reported. Here, the authors present our patient with skin necrosis post TKA on account of its extreme rarity, considerable risk factors, and importance of its treatment.

Case

This is a cautionary report on the rule of including previous single longitudinal incision in surgical approach. The authors included previous medial incision in ours and performed arthroplasty through medial parapatellar incisions. After noticing skin necrosis in front of patella, reoperation including flap and skin graft was done, leading to complete recovery.

Clinical discussion

While skin necrosis post TKA is not common, it can be present in high-risk patients who should be considered for a decrease in their risk factors. Preoperatively, underlying diseases should be under control. Intraoperation risk factors, in particular incision selection, and considerations about lateral retinacular release are important.

Conclusion

A balance must be achieved between the ability to expose the knee through a prior incision and avoiding extensive undermining of the subcutaneous flaps in patients with previous knee surgery. It may be a better approach to ignore medial incisions and use the classic midline incision.

Epidemiology of osteoarthritis: literature update 2022-2023

PURPOSE OF REVIEW

This review highlights recently published studies on osteoarthritis (OA) epidemiology, including topics related to understudied populations and joints, imaging, and advancements in artificial intelligence (AI) methods.

RECENT FINDINGS

Contemporary research has improved our understanding of the burden of OA in typically understudied regions, including ethnic and racial minorities in high-income countries, the Middle East and North Africa (MENA) and Latin America. Efforts have also been made to explore the burden and risk factors in OA in previously understudied joints, such as the hand, foot, and ankle. Advancements in OA imaging techniques have occurred alongside the developments of AI methods aiming to predict disease phenotypes, progression, and outcomes.

SUMMARY

Continuing efforts to expand our knowledge around OA in understudied populations will allow for the creation of targeted and specific interventions and inform policy changes aimed at reducing disease burden in these groups. The burden and disability associated with OA is notable in understudied joints, warranting further research efforts that may lead to effective therapeutic options. AI methods show promising results of predicting OA phenotypes and progression, which also may encourage the creation of targeted disease modifying OA drugs (DMOADs).

Unhappy triad of the knee: What are the current concepts and opinions?

The association between injuries to the anterior cruciate ligament, medial collateral ligament, and medial meniscus (MM) has been known to orthopedic surgeons since 1936; O'Donoghue first used the term "unhappy triad" of the knee to describe this condition in 1950. Later studies revealed that involvement of the lateral meniscus is more common than MM in these cases, leading to a change in the definition. Recent studies have revealed that this triad may be primarily linked to knee anterolateral complex injuries. Although there is not a definite management protocol for this triad, we try to mention the most recent concepts about it in addition to expert opinions.