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Huppert A, Ambrosio L, Nwosu K, Pico A, Russo F, Vadalà G, Papalia R, Denaro V. Previous lumbar spine fusion increases the risk of dislocation following total hip arthroplasty in patients with hip-spine syndrome: a systematic review and meta-analysis. BMC Musculoskelet Disord 2024; 25:732. [PMID: 39272046 PMCID: PMC11395984 DOI: 10.1186/s12891-024-07823-1] [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: 05/21/2024] [Accepted: 08/26/2024] [Indexed: 09/15/2024] Open
Abstract
BACKGROUND With life expectancy on the rise, there has been an increase in patients with concomitant degenerative hip and spine pathology, defined as hip-spine syndrome (HSS). Patients affected by HSS may require both total hip arthroplasty (THA) and lumbar spinal fusion (LSF), although there is a paucity of data regarding how the sequential timing of these procedures may influence clinical outcomes. This study aims to compare complications and spinopelvic parameters in patients with HSS who underwent either LSF first or THA first. METHODS A systematic search of PubMed and Scopus was conducted for randomized and nonrandomized studies investigating complications and spinopelvic parameters in patients with HSS who had undergone THA and LSF. The Methodological Index for Non-Randomized Studies (MINORS) tool was utilized to assess the risk of bias in included studies. Relevant outcomes were pooled for meta-analysis. RESULTS Eleven articles were included in this study. There was a significantly higher THA dislocation rate in patients who had undergone LSF first compared to those who had THA first (OR: 3.17, 95% CI 1.23-8.15, P = 0.02). No significant difference was found in terms of THA aseptic loosening (OR: 0.86; 95% CI 0.32-2.32, p = 0.77) and revision rate (OR: 1.18, 95% CI: 0.53-2.62) between these two groups. Individuals who received THA only showed a significantly lower risk of hip dislocation (OR: 0.14, 95% CI: 0.08-0.25, P < 0.00001) and THA revision (OR: 0.22, 95% CI: 0.14-0.36, P < 0.00001) compared to patients with a previous LSF. CONCLUSIONS In HSS patients who underwent both LSF and THA, those who received LSF first displayed an increased risk of hip dislocation after subsequent THA. Additionally, the relative risks of dislocation and revision rate appeared significantly lower in patients who had undergone THA only when compared to THA patients with a history of previous LSF. Due to the impact of LSF on spinopelvic biomechanics, caution must be exercised when performing THA in individuals with instrumented spines. PROSPERO ID CRD42023412447. LEVEL OF EVIDENCE LL.
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Affiliation(s)
| | - Luca Ambrosio
- Research Unit of Orthopaedic and Trauma Surgery, Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University Hospital Foundation, Via Alvaro del Portillo 200, Rome, 00128, Italy
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | | | - Annie Pico
- University of Arizona College of Medicine, Phoenix, USA
| | - Fabrizio Russo
- Research Unit of Orthopaedic and Trauma Surgery, Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University Hospital Foundation, Via Alvaro del Portillo 200, Rome, 00128, Italy
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Gianluca Vadalà
- Research Unit of Orthopaedic and Trauma Surgery, Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University Hospital Foundation, Via Alvaro del Portillo 200, Rome, 00128, Italy.
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.
| | - Rocco Papalia
- Research Unit of Orthopaedic and Trauma Surgery, Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University Hospital Foundation, Via Alvaro del Portillo 200, Rome, 00128, Italy
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Vincenzo Denaro
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
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Giorgino R, Alessandri Bonetti M, Migliorini F, Nannini A, Vaienti L, Peretti GM, Mangiavini L. Management of hip osteoarthritis: harnessing the potential of mesenchymal stem cells-a systematic review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024:10.1007/s00590-024-04089-0. [PMID: 39254726 DOI: 10.1007/s00590-024-04089-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 08/25/2024] [Indexed: 09/11/2024]
Abstract
INTRODUCTION Hip osteoarthritis (OA) is a prevalent and debilitating condition, necessitating effective and safe treatment options. This systematic review aims to explore the potential of intra-articular mesenchymal stem cell (MSC) infiltrations as a therapeutic approach for hip OA. METHODS Following PRISMA guidelines, a systematic review was conducted, encompassing PubMed, Embase, and Cochrane Library databases. Inclusion criteria involved studies focusing on intra-articular MSC injections in patients with hip OA and reporting pain relief as an outcome measure. Quality assessment utilized the Newcastle-Ottawa scale and methodological index for non-randomized studies. RESULTS Ten studies were included in the review, exhibiting varied designs and sample sizes (316 patients). Outcome measures consisted of cartilage repair assessed through MRI and radiographies, pain scores (WOMAC, VAS, NRS), and functional improvements (HOS-ADL, OHS, FRI, PDQQ, LEFS). The studies reported favorable improvements in functional scores, pain relief, and cartilage repair/radiographic findings, with minimal reported adverse events. CONCLUSIONS Intra-articular MSC infiltrations demonstrate promise as an effective and safe therapeutic intervention for managing hip OA, offering pain relief and functional enhancements. Nevertheless, limited high-quality studies and outcome measure variations underscore the need for further research to establish definitive treatment guidelines. Future investigations should address optimal MSC utilization, long-term outcomes, and potential complications to ensure the success of MSC-based therapies for hip OA management, ultimately improving patient outcomes. The findings provide valuable insights into the potential of MSC-based treatments for hip OA, advocating further rigorous research in this field. TRIAL REGISTRATION The protocol was registered on PROSPERO database (CRD42023436973).
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Affiliation(s)
- Riccardo Giorgino
- Residency Program in Orthopaedics and Traumatology, University of Milan, 20161, Milan, Italy.
- I.R.C.C.S. Istituto Ortopedico Galeazzi, 20161, Milan, Italy.
| | | | - Filippo Migliorini
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), 39100, Bolzano, Italy
- Department of Life Sciences, Health, and Health Professions, Link Campus University, 00165, Rome, Italy
| | - Alessandra Nannini
- Residency Program in Orthopaedics and Traumatology, University of Milan, 20161, Milan, Italy
- I.R.C.C.S. Istituto Ortopedico Galeazzi, 20161, Milan, Italy
| | - Luca Vaienti
- Department of Plastic Surgery, University of Milan, 20161, Milan, Italy
| | - Giuseppe Michele Peretti
- I.R.C.C.S. Istituto Ortopedico Galeazzi, 20161, Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20122, Milan, Italy
| | - Laura Mangiavini
- I.R.C.C.S. Istituto Ortopedico Galeazzi, 20161, Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20122, Milan, Italy
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Ahlbrecht Y, Pilz O, Gresky J. Testing the Digital Atlas of Ancient Rare Diseases (DAARD) using a new case of Legg-Calvé-Perthes disease from Early Byzantine (500-700 CE) Olympia, Greece. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2024; 46:62-73. [PMID: 39079280 DOI: 10.1016/j.ijpp.2024.07.002] [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: 02/20/2024] [Revised: 07/13/2024] [Accepted: 07/14/2024] [Indexed: 08/25/2024]
Abstract
OBJECTIVE The first case of Legg-Calvé-Perthes disease (LCPD) in Greece is presented. LCPD, a rare disease, is discussed using the Digital Atlas of Ancient Rare Diseases (DAARD), which tests the benefits of the database for diagnosing and contextualizing the new case with 42 archaeological cases of LCPD recorded in the DAARD. MATERIALS A 30-40-year-old, probable male individual was found at the archaeological site of Olympia, Greece, dating to 500-700 CE. METHODS Biological sex, age-at-death and pathological changes were investigated using macroscopic and osteometric methods. The DAARD provided the typical characteristics of LCPD. RESULTS Pathological changes in both hip joints without any other related changes in the skeleton corresponded to the skeletal features of LCPD. The DAARD produced 42 cases of LCPD, most of which from Europe, with a preference for male sex and unilateral involvement of the hip joint. CONCLUSIONS The DAARD aids in diagnosing rare diseases and interpreting new cases in the context of already known studies. SIGNIFICANCE This study shows that the DAARD has the potential to help researchers move beyond the level of single case studies and create a broader picture of the history of rare diseases. LIMITATIONS This paper focuses on the benefits of the DAARD in relation to LCPD but not all rare diseases have been included in the database. SUGGESTIONS FOR FURTHER RESEARCH More rare diseases from archaeological contexts should be added to the DAARD to create a base for the interpretation of their history and expand our understanding of rare diseases in the past.
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Affiliation(s)
- Yannick Ahlbrecht
- German Archaeological Institute, Division of Natural Sciences, Im Dol 2-6, Berlin 14195, Germany
| | - Oliver Pilz
- German Archaeological Institute at Athens, Fidiou 1, Athens 10678, Greece
| | - Julia Gresky
- German Archaeological Institute, Division of Natural Sciences, Im Dol 2-6, Berlin 14195, Germany.
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Graham P. Progressive Hip Osteoarthritis. Orthop Nurs 2024; 43:300-302. [PMID: 39321441 DOI: 10.1097/nor.0000000000001070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/27/2024] Open
Affiliation(s)
- Patrick Graham
- Patrick Graham, RN, MSN, APRN/ANP-BC, Department of Orthopedics and Sports Medicine, Banner University Medical Center Tucson, Tucson, AZ
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Vorimore C, Adamczyk A, Laboudie P, Ricard MA, Beaule PE, Grammatopoulos G. Mid to long-term survivorship of hip arthroplasty in patients 40 years and younger. Orthop Traumatol Surg Res 2024:103978. [PMID: 39197638 DOI: 10.1016/j.otsr.2024.103978] [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] [Received: 05/03/2024] [Revised: 07/16/2024] [Accepted: 08/23/2024] [Indexed: 09/01/2024]
Abstract
BACKGROUND Etiology of hip osteoarthritis (OA) and survival of hip arthroplasty in the young (below 40-years-old) remains poorly described. Furthermore, joint survivorship mid to long-term and PROMs according to the etiology are unclear. The study aims were to 1) identify the indications for arthroplasty in the below 40-years-old cohort; 2) define hip arthroplasty outcomes in the young and 3) test whether patients with sequelae of pediatrics hip disease have inferior outcome compared to other patients. HYPOTHESIS Our hypothesis was that hip arthroplasty is a viable option for managing hip disease in patients under 40, with excellent survival rates and outcomes. MATERIAL AND METHODS This is an IRB approved, retrospective, consecutive, multi-surgeon, cohort study from a single academic center. Indication for hip arthroplasty of 346 patients (410 hips) below 40-years-old were studied; 239 underwent THA (58%) and 171 hip resurfacing (42%). Patient, surgical and implant factors were tested for association with implant survivorship and functional outcome for hip arthroplasty performed with a follow-up of more than two years. Pediatric hip sequelae patients were compared for survival and PROMs with the rest of the cohort. RESULTS The most common etiology of OA was FAI (47%), followed by pediatric hip sequelae (18%). The 10-year survivorship was 97.2% ± 1.2, mean OHS was 45.1 ± 6.3 and mean HHS was 93.4 ± 12.6. The pediatric hip sequelae subgroup demonstrated no differences in 10-year survivorship and better PROMs compared to rest (OHS: 46.6 ± 3.8; HHS: 96.0 ± 8.5). DISCUSSION The most common aetiologies amongst the young with hip OA is FAI and pediatric hip sequelae. Hip arthroplasty in the young presents excellent 10-year survivorship and PROMs. Excellent survival and PROMs in the young with pediatric hip sequelae provide important information for decision-making in this challenging population. LEVEL OF EVIDENCE III; retrospective cohort study.
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Affiliation(s)
- Camille Vorimore
- Department of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Andrew Adamczyk
- Department of Orthopedic Surgery, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Pierre Laboudie
- Service de Chirurgie Orthopédique, Traumatologique et Oncologique, Hôpital Cochin, Paris, France
| | - Marc Antoine Ricard
- Department of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Paul E Beaule
- Department of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
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Chen C, Kong D, Wang P, Li M, Gui R. Genetic polymorphisms of LMX1B and MLXIP are associated with hip osteoarthritis in the Chinese population. Biomark Med 2024; 18:695-702. [PMID: 39263770 PMCID: PMC11404616 DOI: 10.1080/17520363.2024.2389030] [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: 02/23/2024] [Accepted: 07/30/2024] [Indexed: 09/13/2024] Open
Abstract
Aims: A large genome-wide analyses of UK Biobank data reported 15 novel loci associated with the susceptibility of hip osteoarthritis (HOA). We aimed to replicate the association of these loci with HOA in the Chinese population.Methods: A total of 13 Single Nucleotide Polymorphisms were genotyped in 892 HOA patients and 1123 healthy controls.Results: The risk allele frequency of rs62578127 and rs11059094 was significantly higher in the patients than in the controls. The mRNA expression of LMX1B (p = 0.01) and MLXIP (p = 0.001) were significantly increased in HOA tissues.Conclusion: We successfully replicated two novel susceptible loci of HOA and further characterized two potential causative genes.
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Affiliation(s)
- Chuan Chen
- Department of Orthopedics Surgery, Third People's Hospital of Jiujiang City, Jiangxi Province, China
| | - Desheng Kong
- Department of Orthopedics Surgery, Third People's Hospital of Jiujiang City, Jiangxi Province, China
| | - Pin Wang
- Department of Orthopedics Surgery, Third People's Hospital of Jiujiang City, Jiangxi Province, China
| | - Ming Li
- Department of Orthopedics Surgery, Third People's Hospital of Jiujiang City, Jiangxi Province, China
| | - Ranran Gui
- Department of Orthopedics Surgery, Third People's Hospital of Jiujiang City, Jiangxi Province, China
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De Leo D, Temporiti F, Bleggi C, La Guardia M, Adamo P, Gatti R. Impaired Perception of Body-Weight Distribution Marks Functional Mobility Problems in Patients Undergoing Total Hip Arthroplasty. Percept Mot Skills 2024; 131:1163-1182. [PMID: 38805369 DOI: 10.1177/00315125241256405] [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] [Indexed: 05/30/2024]
Abstract
Hip osteoarthritis and total hip arthroplasty imply damaged articular and periarticular structures responsible for proprioception, and this damage may impair the accurate perception of body-weight distribution. In this study, we investigated proprioceptive abilities and accuracy perceiving body-weight distribution in patients undergoing total hip arthroplasty, and we assessed the associations between these abilities and body perception accuracy with functional mobility testing in 20 patients scheduled for total hip arthroplasty and 20 age-matched healthy participants. We assessed (a) absolute error in hip joint position sense (AE-JPS), (b) absolute error in body-weight distribution (AE-BWD) during standing and sit-to-stand tasks with open and closed eyes, and (c) functional mobility with the Timed Up and Go Test (TUG). We assessed patients undergoing hip arthroplasty before (T0) and five days after their surgery (T1), while control participants underwent a single evaluation. Relative to controls, participants undergoing surgery showed higher AE-JPS at 15° of hip flexion at T0 (p = .003) and at T1 (p = .007), greater AE-BWD during sit-to-stand with open eyes at T1 (p = .014) and with closed eyes at both T0 (p = .014) and at T1 (p < .001), and worse TUG at both T0 (p = .009) and T1 (p < .001). AE-BWD during sit-to-stand with closed eyes positively correlated with TUG at T0 (r = 0.55, p = .011) and at T1 (r = 0.51, p = .027). These findings suggested that impairments in body-weight distribution perception were evident both before and immediately after total hip arthroplasty, suggesting that these impairments may regularly mark these patients' functional mobility problems.
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Affiliation(s)
- Davide De Leo
- Physiotherapy Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Federico Temporiti
- Physiotherapy Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Carlotta Bleggi
- Physiotherapy Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Moreno La Guardia
- Physiotherapy Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Paola Adamo
- Physiotherapy Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Roberto Gatti
- Physiotherapy Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
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Lai A, Tamea C, Shou J, Okafor A, Sparks J, Dodd R, Lambert N, Woods C, Schulte O, Kovar S, Barrett T. Retrospective Evaluation of Cryopreserved Human Umbilical Cord Tissue Allografts in the Supplementation of Cartilage Defects Associated with Hip Osteoarthritis. J Clin Med 2024; 13:4040. [PMID: 39064079 PMCID: PMC11277460 DOI: 10.3390/jcm13144040] [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: 06/12/2024] [Revised: 06/27/2024] [Accepted: 06/29/2024] [Indexed: 07/28/2024] Open
Abstract
Background: Osteoarthritis is a chronic disorder that affects the synovial joints by the progressive loss of articular cartilage. In the hip, the largest weight-bearing joint, the deterioration of articular cartilage and acetabular labrum can cause pain, diminishing the quality of life for patients. This study presents changes in reported pain scales from patients who received Wharton's jelly applications to cartilage deterioration in the hip from the observational retrospective repository at Regenative Labs. Methods: Sixty-nine patients were selected based on inclusion criteria with patient-reported pain scales, including the Numeric Pain Rating Scale and the Western Ontario and McMaster University Osteoarthritis Index, collected at the initial application, 30, and 90-day follow-up visits. Thirteen patients received a second allograft application and had additional follow-up visits at 120 and 180 days. Results: Five of the six scales used showed a statistically significant improvement in average scores across the cohort. The greatest improvements were observed in the NPRS with a 31.36% improvement after 90 days and a 44.64% improvement for patients with two applications after 180 days. The minimal clinically important difference (MCID) was also calculated to determine the perceived value of care for each patient with 44.9% of patients exceeding the MCID and 78.3% reporting at least one level of improvement. Conclusions: The positive outcomes for the patients in this cohort suggest WJ to be a promising alternative care option for patients with structural tissue degeneration in the hip refractory to the current standard of care.
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Affiliation(s)
- Albert Lai
- Desert Physical Medicine and Pain Management, Indio, CA 92201, USA; (A.L.); (R.D.)
| | - Conrad Tamea
- Orthopedic Associates of Tampa Bay, Tampa, FL 33603, USA;
| | - John Shou
- Department of Pharmacology, Baylor College of Medicine, Houston, TX 77030, USA;
| | - Anthony Okafor
- Mathematics & Statistics, University of West Florida, Pensacola, FL 32514, USA; (A.O.); (J.S.)
| | - Jay Sparks
- Mathematics & Statistics, University of West Florida, Pensacola, FL 32514, USA; (A.O.); (J.S.)
| | - Renee Dodd
- Desert Physical Medicine and Pain Management, Indio, CA 92201, USA; (A.L.); (R.D.)
| | - Naomi Lambert
- Regenative Labs, Pensacola, FL 32501, USA; (C.W.); (O.S.); (S.K.); (T.B.)
| | - Crislyn Woods
- Regenative Labs, Pensacola, FL 32501, USA; (C.W.); (O.S.); (S.K.); (T.B.)
| | - Orion Schulte
- Regenative Labs, Pensacola, FL 32501, USA; (C.W.); (O.S.); (S.K.); (T.B.)
| | - Sarah Kovar
- Regenative Labs, Pensacola, FL 32501, USA; (C.W.); (O.S.); (S.K.); (T.B.)
| | - Tyler Barrett
- Regenative Labs, Pensacola, FL 32501, USA; (C.W.); (O.S.); (S.K.); (T.B.)
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Jingami S, Matsubara S, Kaburagi M, Sakuma K, Takano Y, Kume S, Okawa T, Matsuse H, Shiba N. Range of Motion Measurements of the Hip Joint Are Useful in Screening for Acetabular Dysplasia in Healthy Young Japanese Women. Kurume Med J 2024; 70:11-18. [PMID: 38763737 DOI: 10.2739/kurumemedj.ms7012011] [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] [Indexed: 05/21/2024]
Abstract
The purpose of this study is to clarify whether a hip range of motion (ROM) measurement is useful in screening for early hip osteoarthritis with acetabular dysplasia (AD). Subjects were 58 healthy Japanese women volunteers (21.1 ± 0.7 (20 - 22)). We evaluated a total of 116 hip joints in these 58 cases. Sharp angle and centeredge angle were 44.1° ± 3.1° (37.0° - 51.5°) and 30.7°± 6.2° (19.5° - 47.0°), respectively. AD was present in 47.4%, but there were no severe cases. First, we compared the ROM of the hip joints with AD (AD group) and without AD (control group) according to the Mann-Whitney U test. Extension angles and external rotation angles in the AD group were significantly smaller than in the control group (18.9°± 6.1° VS. 22.1°± 4.2°, p= 0.01636, 26.3°± 8.9° VS. 34.1°± 8.8°, p= 0.001362, respectively). Next, we evaluated the following factors associated with AD by logistic regression analysis after adjustment for age: flexion, extension and internal and external rotation angles of the hip joint. As a result, internal rotation and external rotation were extracted as related factors. The area under the ROC curve was determined to have a moderate accuracy (0.72996). Cut off values of internal rotation and external rotation angles were 50 degrees and 35 degrees, respectively. Our findings suggest that ROM measurement of the internal and external rotation angles would be useful as a screening for AD in healthy young Japanese women without symptoms.
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Affiliation(s)
- Syuichi Jingami
- Department of Physical Therapy, Faculty of Health Science, Kumamoto Health Science University
- Kurume University Graduate School of Medicine
| | - Shigehito Matsubara
- Department of Physical Therapy, Faculty of Health Science, Kumamoto Health Science University
| | - Makoto Kaburagi
- Department of Physical Therapy, Faculty of Health Science, Kumamoto Health Science University
| | - Katsuhiko Sakuma
- Department of Orthopedic and Rehabilitation, Kumamoto Seijo Hospital
| | - Yoshio Takano
- Department of Physical Therapy School of Health Sciences at Fukuoka, International University Health and Welfare
| | - Shinichiro Kume
- Department of Orthopedic Surgery, Kurume University Hospital
| | - Takahiro Okawa
- Department of Orthopedic Surgery, Kurume University Hospital
| | - Hiroo Matsuse
- Division of Rehabilitation, Kurume University Hospital
| | - Naoto Shiba
- Division of Rehabilitation, Kurume University Hospital
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Wadekar S, Gaddis JM, Middleton E, Xi Y, Mulligan E, Bialaszewski R, Laboret B, Wells J. The Morbidity of Greater Trochanteric Pain Syndrome Versus That of Patients Awaiting Total Hip Replacement. Orthopedics 2024; 47:205-210. [PMID: 38810128 DOI: 10.3928/01477447-20240520-03] [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: 05/31/2024]
Abstract
BACKGROUND Greater trochanteric pain syndrome (GTPS) is a commonly diagnosed medical issue, yet there are little data assessing the relative morbidity of GTPS. We sought to characterize the morbidity on presentation of GTPS and compare it to that of patients with end-stage hip osteoarthritis awaiting total hip arthroplasty. We hypothesized that patients with GTPS would have morbidity similar to or worse than that of patients with osteoarthritis. MATERIALS AND METHODS This retrospective case-control study examined patient-reported outcome measures of 156 patients with GTPS (193 hips) and 300 patients with hip osteoarthritis before total hip arthroplasty (326 hips). Patients with secondary hip conditions or previous hip surgeries were excluded from the study. Patient-reported outcome measures were analyzed using an equivalence test and two one-sided t tests. RESULTS Equivalence in mean visual analog scale pain scores between GTPS and osteoarthritis was established with a tolerance margin of ±10. The difference in mean visual analog scale pain scores was 0.35 (95% CI, -0.86 to 0.16; P=.02). The Hip disability and Osteoarthritis Outcome Score Quality of Life was much worse for patients with GTPS, placed well outside of the ±10 tolerance margin, and the difference in mean scores was 1.72 (95% Cl, -2.17 to -1.26; P=.99). Equivalence in mean UCLA Activity scores between GTPS and osteoarthritis was established with a tolerance margin of ±5. The difference in mean UCLA Activity scores was 0.002 (95% CI, -0.45 to 0.43; P<.01). CONCLUSION The morbidity and functional limitations of patients with GTPS were similar to those of patients undergoing total hip arthroplasty. GTPS remains a functional problem for patients, and clinicians and researchers should consider GTPS as seriously as hip osteoarthritis. [Orthopedics. 2024;47(4):205-210.].
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Fazio A, Di Martino A, Brunello M, Traina F, Marvi MV, Mazzotti A, Faldini C, Manzoli L, Evangelisti C, Ratti S. The involvement of signaling pathways in the pathogenesis of osteoarthritis: An update. J Orthop Translat 2024; 47:116-124. [PMID: 39021400 PMCID: PMC11254498 DOI: 10.1016/j.jot.2024.06.002] [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: 06/06/2023] [Revised: 04/09/2024] [Accepted: 06/02/2024] [Indexed: 07/20/2024] Open
Abstract
Osteoarthritis (OA) is one of the most common disabling pathologies, characterized by joint pain and reduced function, significantly worsening the quality of life. Even if important progresses have been made in OA research, little is yet known about the precise cellular and molecular mechanisms underlying OA. Understanding dysregulated signaling networks and their crosstalk in OA may offer a strong opportunity for the development of combined targeted therapies. Hence, this review highlights the recent findings on the main pathways involved in OA development, including Wnt, Notch, Hedgehog, MAPK, AMPK, and JAK/STAT, providing insights on current targeted therapies in OA patients' management. The translational potential of this article The identification of key signaling pathways involved in OA development and the investigation of their signaling crosstalk could pave the way for more effective treatments and improved management of OA patients in the future.
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Affiliation(s)
- Antonietta Fazio
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126, Bologna, Italy
| | - Alberto Di Martino
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126, Bologna, Italy
- Ist Orthopedic Department, IRCCS Istituto Ortopedico Rizzoli, 40136, Bologna, Italy
| | - Matteo Brunello
- Ist Orthopedic Department, IRCCS Istituto Ortopedico Rizzoli, 40136, Bologna, Italy
| | - Francesco Traina
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126, Bologna, Italy
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d'anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Maria Vittoria Marvi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126, Bologna, Italy
| | - Antonio Mazzotti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126, Bologna, Italy
- Ist Orthopedic Department, IRCCS Istituto Ortopedico Rizzoli, 40136, Bologna, Italy
| | - Cesare Faldini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126, Bologna, Italy
- Ist Orthopedic Department, IRCCS Istituto Ortopedico Rizzoli, 40136, Bologna, Italy
| | - Lucia Manzoli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126, Bologna, Italy
| | - Camilla Evangelisti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126, Bologna, Italy
| | - Stefano Ratti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126, Bologna, Italy
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12
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Mao Y, Qiu B, Wang W, Zhou P, Ou Z. Efficacy of home-based exercise in the treatment of pain and disability at the hip and knee in patients with osteoarthritis: a systematic review and meta-analysis. BMC Musculoskelet Disord 2024; 25:499. [PMID: 38926896 PMCID: PMC11201901 DOI: 10.1186/s12891-024-07585-w] [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: 10/18/2023] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND An increasing body of evidence suggests that home-based exercise (HBE) therapy has significant therapeutic effects on knee osteoarthritis (KOA) and hip osteoarthritis (HipOA), and it has advantages such as cost savings, strong operability, and good compliance compared with hospitalization and exercise courses. OBJECTIVE To evaluate the efficacy of HBE in the treatment of KOA and HipOA. METHODS A systematic search was conducted in PubMed, Cochrane, Web of Science, and Embase to collect randomized controlled trials. The retrieval time was from database establishment until March 6, 2024. Stata 15.1 software was used for data analysis. RESULTS A total of 16 randomized controlled trials involving 3,015participants were included, with 1,519 participants in the intervention group and 1,496 in the control group. The meta-analysis showed that, compared to the control group, HBE can significantly improve pain [SMD=-0.38, 95% CI (-0.58, -0.18); P = 0.001], joint function [SMD=-0.60, 95% CI (-1.01, -0.19); P = 0.004], balance ability [SMD=-0.67, 95% CI (-1.00, -0.34); P = 0.001], mobility (ADL) [SMD = 0.51, 95% CI (0.19, 0.82); P = 0.002] in patients with KOA and HipOA. There is no statistical difference in the improvement of joint stiffness [WMD = -0.80, 95% CI (-1.61, 0.01); P = 0.052]. In addition, subgroup analysis showed that HBE significantly improved pain, joint function, and balance ability in KOA patients compared with the control group. HipOA patients showed significant improvement in pain and joint function; However, HBE only improved activity ability in patients with comorbidities of KOA and HipOA. CONCLUSION HBE can effectively alleviate pain, improve joint function, and enhance physical function in patients with KOA and HipOA. However, more high-quality randomized controlled trials (RCTs) with large sample sizes and long-term interventions are needed to validate the efficacy of HBE due to limitations in the methodology and consistency of indicator outcomes in the included RCTs. REGISTRATION NUMBER We've registered with PROSPERO, and the number is CRD42023443085.
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Affiliation(s)
- Yichen Mao
- Guilin Traditional Chinese Medicine Hospital, No. 2, Lingui Road, Xiangshan District, Guilin City, Guangxi Province, 541000, China
| | - Boyuan Qiu
- Guilin Traditional Chinese Medicine Hospital, No. 2, Lingui Road, Xiangshan District, Guilin City, Guangxi Province, 541000, China
- Guangxi University of Traditional Chinese Medicine, Nanning, Guangxi, 530000, China
| | - Weiwei Wang
- Guangxi University of Traditional Chinese Medicine, Nanning, Guangxi, 530000, China
| | - Pengwei Zhou
- Guangxi University of Traditional Chinese Medicine, Nanning, Guangxi, 530000, China
| | - Zhixue Ou
- Guilin Traditional Chinese Medicine Hospital, No. 2, Lingui Road, Xiangshan District, Guilin City, Guangxi Province, 541000, China.
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Wehbe J, Jones S, Hodgson G, Afzal I, Clement ND, Sochart DH. Functional Outcomes and Satisfaction Rates in Patients Aged 80 Years or Older are Not Clinically Different From Their Younger (65 to 75 Years) Counterparts Following Total Hip Arthroplasty. J Arthroplasty 2024:S0883-5403(24)00573-4. [PMID: 38848789 DOI: 10.1016/j.arth.2024.05.088] [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] [Received: 07/05/2023] [Revised: 05/28/2024] [Accepted: 05/28/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND As the population ages, the proportion of elderly patients requiring total hip arthroplasty (THA) increases, but it is not clear whether older age independently influences outcome. The aim was to assess function, quality of life, and satisfaction after THA in patients ≥ 80 years compared with those aged between 65 and 75 years when adjusting for confounding factors. METHODS A single-center retrospective cohort study was performed between 2010 and 2019. A total 2,367 THAs were performed on patients ≥ 80 years and 5,113 on patients aged 65 to 75 years. The demographic data and length of stay (LOS) were recorded. Preoperative and 2-year postoperative Oxford Hip Scores (OHS), EuroQol (EQ-5D), and satisfaction scores were collected. Clinically meaningful difference was defined as 5 points in OHS and utility of 0.085 in EQ-5D. Regression analyses were performed to adjust for confounding factors. RESULTS Patients in ≥ 80-years group were more likely women (P < .001), have higher American Society of Anesthesiolgists grade (P < .001), worse preoperative OHS (mean difference [MD] 2.3, P < .001), and EQ-5D (MD 0.087, P < .001). Both age groups achieved clinically meaningful and statistically significant (P < .001) improvement in OHS and EQ-5D utility at 2 years. When adjusting for confounding variables, the ≥ 80-year-old group had significantly (P < .001) lower improvement in OHS (MD -1.9 points) and EQ-5D (MD -0.055 utility), but these differences were not clinically meaningful. There was no difference (P = .813) in satisfaction between the groups. When adjusting for confounding variables, ≥ 80-year-old group had increased risk of longer LOS (odds ratio 1.27, P < .001). CONCLUSIONS There were no clinically meaningful differences in hip-specific outcome or health-related quality of life according to age group, and both were equally satisfied with their outcome. The older age group did, however, have longer LOS. LEVEL OF EVIDENCE Level III retrospective cohort study.
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Affiliation(s)
- Jad Wehbe
- Academic Surgical Unit at South West London Elective Orthopaedic Centre, Epsom, United Kingdom
| | - Samantha Jones
- Academic Surgical Unit at South West London Elective Orthopaedic Centre, Epsom, United Kingdom
| | - Gregory Hodgson
- Academic Surgical Unit at South West London Elective Orthopaedic Centre, Epsom, United Kingdom
| | - Irrum Afzal
- Academic Surgical Unit at South West London Elective Orthopaedic Centre, Epsom, United Kingdom
| | - Nicholas D Clement
- Academic Surgical Unit at South West London Elective Orthopaedic Centre, Epsom, United Kingdom
| | - David H Sochart
- Academic Surgical Unit at South West London Elective Orthopaedic Centre, Epsom, United Kingdom
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Sato T, Yamate S, Utsunomiya T, Inaba Y, Ike H, Kinoshita K, Doi K, Kawano T, Shiomoto K, Hara T, Sonoda K, Kaneuji A, Takahashi E, Shimizu T, Takahashi D, Kohno Y, Kabata T, Inoue D, Matsuda S, Goto K, Mawatari T, Baba S, Takagi M, Ito J, Nakashima Y. Life Course Epidemiology of Hip Osteoarthritis in Japan: A Multicenter, Cross-Sectional Study. J Bone Joint Surg Am 2024; 106:966-975. [PMID: 38626018 DOI: 10.2106/jbjs.23.01044] [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: 04/18/2024]
Abstract
BACKGROUND The incidence of developmental dysplasia of the hip (DDH) in Japanese newborns has reduced drastically following a primary prevention campaign initiated around 1972 to 1973; this perinatal education campaign promoted maintaining the hips of newborns in the naturally flexed-leg position. The purpose of the present study was to describe the life course epidemiology of hip osteoarthritis (OA) in adolescent and adult patients and to assess its association with exposure to the primary prevention campaign for DDH. METHODS We included new patients with hip OA diagnosed from January 1, 2022, to December 31, 2022, at 12 core hospitals (8 special-function hospitals and 4 regional medical care support hospitals). The trend in the percentage of hips with a history of DDH treatment in childhood was estimated with use of a centered moving average using the birth year of the patient. We compared the prevalence of severe subluxation (Crowe type II, III, or IV) between patients with secondary hip OA due to hip dysplasia who were born in or before 1972 and those who were born in or after 1973. RESULTS Overall, 1,095 patients (1,381 hips) were included. The mean age at the time of the survey was 63.5 years (range, 15 to 95 years). A total of 795 patients (1,019 hips; 73.8% of hips) were diagnosed with secondary OA due to hip dysplasia. Approximately 13% to 15% of hips among patients born from 1963 to 1972 had a history of DDH treatment in childhood; however, the percentage decreased among patients born in or after 1973. The prevalence of severe subluxation (Crowe type II, III, or IV) among patients born in or after 1973 was 2.4%, which was significantly less than that among patients born in or before 1972 (11.1%; odds ratio, 0.20; p < 0.001). CONCLUSIONS As of 2022, secondary hip OA due to hip dysplasia is still responsible for most new cases of adolescent and adult hip OA seen in core hospitals in Japan. However, the perinatal education campaign initiated 50 years ago, which utilized a population approach and advocated for maintaining the hips of newborns in the naturally flexed-leg position, may have improved the environmental factors of DDH, as indicated by the apparently reduced need for treatment of DDH in childhood and the associated severe subluxation. This may result in a reduced need for challenging hip surgery later in life. LEVEL OF EVIDENCE Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Taishi Sato
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoshi Yamate
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takeshi Utsunomiya
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yutaka Inaba
- Department of Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Hiroyuki Ike
- Department of Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Koichi Kinoshita
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Kenichiro Doi
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Tsutomu Kawano
- Department of Orthopaedic Surgery, Kyushu Rosai Hospital, Kitakyushu, Japan
| | - Kyohei Shiomoto
- Department of Orthopaedic Surgery, Kyushu Rosai Hospital, Kitakyushu, Japan
| | - Toshihiko Hara
- Department of Orthopaedic Surgery, Aso Iizuka Hospital, Iizuka, Japan
| | - Kazuhiko Sonoda
- Department of Orthopaedic Surgery, Aso Iizuka Hospital, Iizuka, Japan
| | - Ayumi Kaneuji
- Department of Orthopaedic Surgery, Kanazawa Medical University, Kahoku, Japan
| | - Eiji Takahashi
- Department of Orthopaedic Surgery, Kanazawa Medical University, Kahoku, Japan
| | - Tomohiro Shimizu
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Daisuke Takahashi
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yusuke Kohno
- Department of Orthopaedic Surgery, Japan Community Healthcare Organization (JCHO) Kyushu Hospital, Kitakyushu, Japan
| | - Tamon Kabata
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Daisuke Inoue
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Koji Goto
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Taro Mawatari
- Department of Orthopaedic Surgery, Hamanomachi Hospital, Fukuoka, Japan
| | - Shoji Baba
- Department of Orthopaedic Surgery, Hamanomachi Hospital, Fukuoka, Japan
| | - Michiaki Takagi
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Juji Ito
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Wilms LM, Jannusch K, Weiss D, Steinfort N, Ziayee F, Antoch G, Minko P. Transarterial microembolization for the management of refractory chronic joint pain in osteoarthritis. ROFO-FORTSCHR RONTG 2024. [PMID: 38740066 DOI: 10.1055/a-2288-5743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Osteoarthritis (OA) is a chronic degenerative disease significantly impacting both patient quality of life and socioeconomics. Traditional treatment options, including pharmacological and surgical interventions, are often limited. Advancements in our understanding of the pathological mechanisms behind OA indicate the involvement of pathological angiogenesis. Transarterial microembolization (TAME), a minimally invasive radiological procedure, may present an innovative therapeutic approach. This review aims to consolidate current knowledge and experiences regarding TAME as a therapeutic modality for alleviating chronic joint pain associated with OA. It explores the role of TAME, focusing on its indications, patient selection, clinical outcomes, and future perspectives. Potential complications and associated risks are systematically addressed, alongside proposed strategies for risk mitigation and effective management.The presented patient cases originate from our institution, supplemented by a thorough review of relevant literature retrieved from PubMed.TAME represents a promising therapeutic approach, providing relief from the burden of joint diseases and substantially enhancing patient quality of life. Clinical outcomes emphasize the efficacy and safety of TAME in mitigating pain and improving functional capabilities in patients with chronic joint pain associated with OA. With mounting evidence of its therapeutic benefits and applicability to numerous joint-related pathologies, TAME offers a valuable addition to the arsenal of treatments for these conditions. · TAME is an innovative therapy for treating chronic joint pain related to OA.. · TAME is a technically challenging minimally invasive intervention requiring a high level of expertise.. · Understanding the challenges and complications of TAME can reduce risk and enhance procedural outcomes.. · Wilms LM, Jannusch K, Weiss D et al. Transarterial microembolization for the management of refractory chronic joint pain in osteoarthritis. Fortschr Röntgenstr 2024; DOI 10.1055/a-2288-5743.
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Affiliation(s)
- Lena Marie Wilms
- Diagnostic and Interventional Radiology, Heinrich-Heine-Universitat Düsseldorf, Düsseldorf, Germany
| | - Kai Jannusch
- Diagnostic and Interventional Radiology, Heinrich-Heine-Universitat Düsseldorf, Düsseldorf, Germany
| | - Daniel Weiss
- Diagnostic and Interventional Radiology, Heinrich-Heine-Universitat Düsseldorf, Düsseldorf, Germany
| | - Nilcolas Steinfort
- Diagnostic and Interventional Radiology, Heinrich-Heine-Universitat Düsseldorf, Düsseldorf, Germany
| | - Farid Ziayee
- Diagnostic and Interventional Radiology, Heinrich-Heine-Universitat Düsseldorf, Düsseldorf, Germany
| | - Gerald Antoch
- Diagnostic and Interventional Radiology, Heinrich-Heine-Universitat Düsseldorf, Düsseldorf, Germany
| | - Peter Minko
- Diagnostic and Interventional Radiology, Heinrich-Heine-Universitat Düsseldorf, Düsseldorf, Germany
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Unverzagt S, Bergmann A, Denny K, Frese T, Hirpa S, Weyer J. Physically demanding occupations among females and sex-related differences to develop osteoarthritis of the hip: a systematic review and meta-analysis. J Occup Med Toxicol 2024; 19:14. [PMID: 38711071 DOI: 10.1186/s12995-024-00415-8] [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: 01/24/2024] [Accepted: 04/25/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Hip osteoarthritis (HOA) is a leading cause of disability increasing with age and is more prevalent in women and in various physically demanding occupations. This systematic review identifies and summarises occupational exposures for women in physically demanding occupations and discusses sex differences and consequences. METHODS In this systematic review, we searched various electronic databases for reports published between date of database inception and October 2022. We included cohort studies and case-control studies that assessed the association between exposure to physically demanding occupations and the development of HOA. We then assessed the methodological quality of selected studies, extracted relative effects, compared the risk for women and men and meta-analytically reviewed the effects of physically demanding occupations. All steps were based on a study protocol published in PROSPERO (CRD42015016894). RESULTS We included six cohort studies and two case-control studies in this systematic review. These studies showed a considerably increased risk of developing HOA in both sexes. Women working in traditionally female-dominated occupations such as cleaning, sales, catering, childcare and hairdressing that are physically demanding, have a higher risk of developing HOA than men in similarly physically demanding occupations. Conversely, in traditionally male-dominated occupations with a high heterogeneity of work activities, such as agriculture, crafts, construction, as well as in low-skilled occupations, the risk was higher for men. One exception are health occupations, which are grouped together with a wide range of other technical occupations, making it difficult to draw conclusions. CONCLUSIONS Existing studies indicate an association between various occupations with a high physical workload and an increased risk of developing HOA. Occupational prevention and individual health promotion strategies should focus on reducing the effects of heavy physical workloads at work. The aforementioned as well as early detection should be specifically offered to women in female-dominated occupations and to people working in elementary occupations.
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Affiliation(s)
- Susanne Unverzagt
- Institute of General Practice and Family Medicine, Martin Luther University Halle-Wittenberg, Faculty of Medicine, Halle (Saale), Germany.
| | - Annekatrin Bergmann
- Department of Occupational Medicine, Martin Luther University Halle-Wittenberg, Faculty of Medicine, Halle (Saale), Germany
| | - Kathleen Denny
- Institute of General Practice and Family Medicine, Martin Luther University Halle-Wittenberg, Faculty of Medicine, Halle (Saale), Germany
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Martin Luther University Halle-Wittenberg, Faculty of Medicine, Halle (Saale), Germany
| | - Selamawit Hirpa
- Institute of General Practice and Family Medicine, Martin Luther University Halle-Wittenberg, Faculty of Medicine, Halle (Saale), Germany
| | - Johannes Weyer
- Department of Occupational Medicine, Martin Luther University Halle-Wittenberg, Faculty of Medicine, Halle (Saale), Germany
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17
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Lim B, Chai A, Shaalan M. A Cross-Sectional Analysis of the Readability of Online Information Regarding Hip Osteoarthritis. Cureus 2024; 16:e60536. [PMID: 38887325 PMCID: PMC11181007 DOI: 10.7759/cureus.60536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2024] [Indexed: 06/20/2024] Open
Abstract
Introduction Osteoarthritis (OA) is an age-related degenerative joint disease. There is a 25% risk of symptomatic hip OA in patients who live up to 85 years of age. It can impair a person's daily activities and increase their reliance on healthcare services. It is primarily managed with education, weight loss and exercise, supplemented with pharmacological interventions. Poor health literacy is associated with negative treatment outcomes and patient dissatisfaction. A literature search found there are no previously published studies examining the readability of online information about hip OA. Objectives To assess the readability of healthcare websites regarding hip OA. Methods The terms "hip pain", "hip osteoarthritis", "hip arthritis", and "hip OA" were searched on Google and Bing. Of 240 websites initially considered, 74 unique websites underwent evaluation using the WebFX online readability software (WebFX®, Harrisburg, USA). Readability was determined using the Flesch Reading Ease Score (FRES), Flesch-Kincaid Reading Grade Level (FKGL), Gunning Fog Index (GFI), Simple Measure of Gobbledygook (SMOG), Coleman-Liau Index (CLI), and Automated Readability Index (ARI). In line with recommended guidelines and previous studies, FRES >65 or a grade level score of sixth grade and under was considered acceptable. Results The average FRES was 56.74±8.18 (range 29.5-79.4). Only nine (12.16%) websites had a FRES score >65. The average FKGL score was 7.62±1.69 (range 4.2-12.9). Only seven (9.46%) websites were written at or below a sixth-grade level according to the FKGL score. The average GFI score was 9.20±2.09 (range 5.6-16.5). Only one (1.35%) website was written at or below a sixth-grade level according to the GFI score. The average SMOG score was 7.29±1.41 (range 5.4-12.0). Only eight (10.81%) websites were written at or below a sixth-grade level according to the SMOG score. The average CLI score was 13.86±1.75 (range 9.6-19.7). All 36 websites were written above a sixth-grade level according to the CLI score. The average ARI score was 6.91±2.06 (range 3.1-14.0). Twenty-eight (37.84%) websites were written at or below a sixth-grade level according to the ARI score. One-sample t-tests showed that FRES (p<0.001, CI -10.2 to -6.37), FKGL (p<0.001, CI 1.23 to 2.01), GFI (p<0.001, CI 2.72 to 3.69), SMOG (p<0.001, CI 0.97 to 1.62), CLI (p<0.001, CI 7.46 to 8.27), and ARI (p<0.001, CI 0.43 to 1.39) scores were significantly different from the accepted standard. One-way analysis of variance (ANOVA) testing of FRES scores (p=0.009) and CLI scores (p=0.009) showed a significant difference between categories. Post hoc testing showed a significant difference between academic and non-profit categories for FRES scores (p=0.010, CI -15.17 to -1.47) and CLI scores (p=0.008, CI 0.35 to 3.29). Conclusions Most websites regarding hip OA are written above recommended reading levels, hence exceeding the comprehension levels of the average patient. Readability of these resources must be improved to improve patient access to online healthcare information which can lead to improved patient understanding of their own condition and treatment outcomes.
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Affiliation(s)
- Brandon Lim
- Department of Medicine, School of Medicine, Trinity College Dublin, Dublin, IRL
| | - Ariel Chai
- Department of Medicine, School of Medicine, Trinity College Dublin, Dublin, IRL
| | - Mohamed Shaalan
- Department of Orthopaedics and Traumatology, The Mater Misericordiae University Hospital, Dublin, IRL
- Department of Trauma and Orthopaedics, St James's Hospital, Dublin, IRL
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18
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Welhaven HD, Viles E, Starke J, Wallace C, Bothner B, June RK, Hahn AK. Metabolomic profiles of cartilage and bone reflect tissue type, radiography-confirmed osteoarthritis, and spatial location within the joint. Biochem Biophys Res Commun 2024; 703:149683. [PMID: 38373382 DOI: 10.1016/j.bbrc.2024.149683] [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: 11/16/2023] [Revised: 02/09/2024] [Accepted: 02/12/2024] [Indexed: 02/21/2024]
Abstract
Osteoarthritis is the most common chronic joint disease, characterized by the abnormal remodeling of joint tissues including articular cartilage and subchondral bone. However, there are currently no therapeutic drug targets to slow the progression of disease because disease pathogenesis is largely unknown. Thus, the goals of this study were to identify metabolic differences between articular cartilage and subchondral bone, compare the metabolic shifts in osteoarthritic grade III and IV tissues, and spatially map metabolic shifts across regions of osteoarthritic hip joints. Articular cartilage and subchondral bone from 9 human femoral heads were obtained after total joint arthroplasty, homogenized and metabolites were extracted for liquid chromatography-mass spectrometry analysis. Metabolomic profiling revealed that distinct metabolic endotypes exist between osteoarthritic tissues, late-stage grades, and regions of the diseased joint. The pathways that contributed the most to these differences between tissues were associated with lipid and amino acid metabolism. Differences between grades were associated with nucleotide, lipid, and sugar metabolism. Specific metabolic pathways such as glycosaminoglycan degradation and amino acid metabolism, were spatially constrained to more superior regions of the femoral head. These results suggest that radiography-confirmed grades III and IV osteoarthritis are associated with distinct global metabolic and that metabolic shifts are not uniform across the joint. The results of this study enhance our understanding of osteoarthritis pathogenesis and may lead to potential drug targets to slow, halt, or reverse tissue damage in late stages of osteoarthritis.
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Affiliation(s)
- Hope D Welhaven
- Department of Chemistry & Biochemistry, Montana State University, Bozeman, MT, 59717, United States.
| | - Ethan Viles
- Department of Mechanical & Industrial Engineering, Montana State University, Bozeman, MT, 59717, United States.
| | - Jenna Starke
- Montana WWAMI, University of Washington School of Medicine, Seattle, WA, 98195, United States.
| | - Cameron Wallace
- Department of Orthopaedic Surgery, University of Utah Health, Salt Lake City, UT, 84103, United States.
| | - Brian Bothner
- Department of Chemistry & Biochemistry, Montana State University, Bozeman, MT, 59717, United States.
| | - Ronald K June
- Department of Mechanical & Industrial Engineering, Montana State University, Bozeman, MT, 59717, United States.
| | - Alyssa K Hahn
- Department of Biological and Environmental Sciences, Carroll College, Helena, MT, 59625, United States.
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Dong H, Maimaitimin M, Jiao C, Liu Y, Gao G, He T, Xu Y. Three-Dimensional Reconstruction of Computed Tomography Imaging Is Not Reliable in Assessing Acetabular Rim Osteophytes or Acetabular Rim Pathology in Patients With Femoroacetabular Impingement. Arthrosc Sports Med Rehabil 2024; 6:100892. [PMID: 38362483 PMCID: PMC10867424 DOI: 10.1016/j.asmr.2024.100892] [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: 09/04/2023] [Accepted: 01/08/2024] [Indexed: 02/17/2024] Open
Abstract
Purpose To determine the reliability of 3-dimensional (3D) reconstruction of computed tomography (CT) imaging in evaluating acetabular rim morphology or acetabular rim osteophyte (ARO) existence and to group patients with femoroacetabular impingement (FAI) by ARO extent on coronal sections of CT and further compare clinical differences among groups. Methods Patients who underwent primary hip arthroscopy for FAI by the same surgeon between August 2016 and December 2018 with minimum 2-year follow-up were enrolled. The ARO was evaluated both on the acetabular gross anatomy (AGA) and coronal sections of CT, for its position, width (unit: mm), area (unit: mm2), and CT value (unit: HU). Patients were divided into 4 groups based on the extent of ARO on coronal CT: group A (ARO anterior to 12 o'clock), group P (ARO posterior to 12 o'clock), group AP (ARO across 12 o'clock), and group N (no ARO). Inter- and intraobserver correlation was analyzed. Demographic data, FAI deformity indicators on imaging, quantitative measurements of ARO, and pre- and postoperative patient-reported outcomes were compared among groups. Results There were 229 patients (229 hips) enrolled in total, 122 male (53.3%) and 107 female (46.7%), with a mean age of 37.2 ± 10.2 years. The correlation between 2 observers for grouping ARO using AGA was positive but poor (Kendall Tau-b coefficient = 0.157, P = .008). Moderate correlation was found between grouping based on AGA and coronal CT by the same observer (Kendall Tau-b coefficient = 0.482, P = .000). The patients were divided into 4 groups: 84 patients (36.7%) in group N, 2 patients (0.9%) in group A, 69 patients (30.1%) in group P, and 74 patients (32.3%) in group AP. Group N was younger in age (35.4 ± 10.7 years) than group P (39.6 ± 10.2 years) (P = 0.012) and had a larger proportion of women (57.1%) than group AP (36.5%) (χ2 = 6.869, P = .032). There was a greater proportion of positive posterior wall sign in group P (52.2%) than 48.6% for group AP and 33.3% for group N (χ2 = 6.397, P = .041). Group N had 61 (72.6%) Tönnis grade 0 hips compared with 37 (50%) in group AP (P = .014). No statistical significance was found among groups in pre- and postoperative α angle, lateral center-edge angle, and patient-reported outcomes. The widths of ARO in group AP for the 3 marked points from anterior to posterior were 3.88 ± 1.86, 4.84 ± 2.72, and 6.66 ± 3.18, separately (P<.001); 15.73 ± 21.46, 19.22 ± 18.86, and 29.96 ± 17.05 for area (P<.01); and 652.67 ± 214.12, 677.10 ± 274.81, and 728.84 ± 232.39 for CT value (P<.05). For the ARO posterior to 12 o'clock, the group AP showed a larger width (6.66 ± 3.18), area (29.96 ± 17.05), and CT value (728.84 ± 232.39) than group P of (4.70 ± 2.25), (20.15 ± 12.91), and (641.84 ± 183.33) (P<.001). Conclusions The evaluation of ARO on AGA is poor consistent with definite double-rim sign on coronal CT. There is a tendency of size-enlarging and density-increasing for ARO from anterior to posterior along the acetabular rim. Younger age, female gender, lower Tönnis grade, and negative posterior wall sign showed lower rate of ARO development. Level of Evidence Level IV, diagnostic case series.
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Affiliation(s)
- Hanmei Dong
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing 100191, China
| | - Maihemuti Maimaitimin
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing 100191, China
| | - Chenbo Jiao
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing 100191, China
| | - Yuhao Liu
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing 100191, China
| | - Guanying Gao
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing 100191, China
| | - Tongchuan He
- Molecular Oncology Laboratory, Department of Orthopedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, Illinois, U.S.A
- Ministry of Education Key Laboratory of Diagnostic Medicine, and The Affiliated Hospitals of Chongqing Medical University, Chongqing, China
| | - Yan Xu
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing 100191, China
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20
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Hamans B, de Waard S, Kaarsemaker S, Janssen ERC, Sierevelt IN, Kerkhoffs GMMJ, Haverkamp D. Mid-term survival of the Optimys short stem: A prospective case series of 500 patients. World J Orthop 2024; 15:257-265. [PMID: 38596184 PMCID: PMC10999972 DOI: 10.5312/wjo.v15.i3.257] [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: 11/01/2023] [Revised: 12/13/2023] [Accepted: 01/16/2024] [Indexed: 03/15/2024] Open
Abstract
BACKGROUND In recent years, there has been an increase in the number of total hip arthroplasty procedures in the younger patient population. This active group has higher expectations of their prosthesis in comparison to the older population, and there is a greater physical demand for the prosthesis. Short femoral stems were introduced to retain proximal bone stock and joint biomechanics and became more common to implant in this specific population. Currently, the long-term survival and functional outcomes of various short stems are still being investigated in different clinics. AIM To determine the 5-year survival of the Optimys hip stem. METHODS This was a prospective multicenter cohort study of 500 patients conducted in two hospitals in the Netherlands. All patients received the Optimys short stem (Mathys Ltd, Bettlach, Switzerland). The primary outcome measure was survival of the hip stem, with revision as the endpoint. The secondary outcome measurements included patient-reported outcome measures (PROMs). Kaplan-Meier analysis was used to calculate the 5-year survival rate. Log-minus-log transformation was performed to calculate the 95% confidence interval (95%CI). Mixed model analyses were performed to assess the course of the PROMs during the 1st 2 years after surgery. Analyses were modeled separately for the 1st and 2nd years to calculate the yearly change in PROMs during both follow-up periods with accompanying 95%CIs. RESULTS The mean age of the total 500 patients was 62.3 years (standard deviation: 10.6) and 202 were male (40%). At a median follow-up of 5.5 years (interquartile range: 4.5-6.7), 7 patients were deceased and 6 revisions were registered, for infection (n = 3), subsidence (n = 2) and malposition (n = 1). This resulted in an overall 5-year survival of 98.8% (95%CI: 97.3-99.5). If infection was left out as reason for revision, a stem survival of 99.4% (95%CI: 98.1-99.8) was seen. Baseline questionnaires were completed by 471 patients (94%), 317 patients (63%) completed the 1-year follow-up questionnaires and 233 patients (47%) completed the 2-year follow-up. Both outcome measures significantly improved across all domains in the 1st year after the operation (P < 0.03 for all domains). In the 2nd year after surgery, no significant changes were observed in any domain in comparison to the 1-year follow-up. CONCLUSION The Optimys stem has a 5-year survival of 98.8%. Patient-reported outcome measures increased significantly in the 1st postoperative year with stabilization at the 2-year follow-up.
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Affiliation(s)
- Bryan Hamans
- Department of Orthopaedic Surgery, Xpert Clinic, Amsterdam 1101EA, Netherlands
| | - Sheryl de Waard
- Department of Orthopedic Surgery, Amsterdam University Medical Center, Amsterdam 1105 AZ, Netherlands
| | - Sjoerd Kaarsemaker
- Department of Orthopaedic Surgery, Viecuri Medisch Centrum, Venlo 5912 BL, Netherlands
| | - Esther R C Janssen
- Department of Orthopaedic Surgery, Viecuri Medisch Centrum, Venlo 5912 BL, Netherlands
| | - Inger N Sierevelt
- Centre for Orthopaedic Research, Spaarne Ziekenhuis, Hoofddorp 2134 TM, Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam UMC-Location AMC, Amsterdam 1105 AZ, Netherlands
| | - Daniël Haverkamp
- Department of Orthopedic Surgery, Xpert Orthopedic Surgery Clinic, Amsterdam 1101 EA, Netherlands
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21
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Lebleu J, Daniels K, Pauwels A, Dekimpe L, Mapinduzi J, Poilvache H, Bonnechère B. Incorporating Wearable Technology for Enhanced Rehabilitation Monitoring after Hip and Knee Replacement. SENSORS (BASEL, SWITZERLAND) 2024; 24:1163. [PMID: 38400321 PMCID: PMC10892564 DOI: 10.3390/s24041163] [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: 12/22/2023] [Revised: 01/20/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024]
Abstract
Osteoarthritis (OA) poses a growing challenge for the aging population, especially in the hip and knee joints, contributing significantly to disability and societal costs. Exploring the integration of wearable technology, this study addresses the limitations of traditional rehabilitation assessments in capturing real-world experiences and dynamic variations. Specifically, it focuses on continuously monitoring physical activity in hip and knee OA patients using automated unsupervised evaluations within the rehabilitation process. We analyzed data from 1144 patients who used a mobile health application after surgery; the activity data were collected using the Garmin Vivofit 4. Several parameters, such as the total number of steps per day, the peak 6-minute consecutive cadence (P6MC) and peak 1-minute cadence (P1M), were computed and analyzed on a daily basis. The results indicated that cadence-based measurements can effectively, and earlier, differ among patients with hip and knee conditions, as well as in the recovery process. Comparisons based on recovery status and type of surgery reveal distinctive trajectories, emphasizing the effectiveness of P6MC and P1M in detecting variations earlier than total steps per day. Furthermore, cadence-based measurements showed a lower inter-day variability (40%) compared to the total number of steps per day (80%). Automated assessments, including P1M and P6MC, offer nuanced insights into the patients' dynamic activity profiles.
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Affiliation(s)
- Julien Lebleu
- moveUp, 1000 Brussels, Belgium; (J.L.); (A.P.); (L.D.)
| | - Kim Daniels
- Department of PXL—Healthcare, PXL University of Applied Sciences and Arts, 3500 Hasselt, Belgium;
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium;
| | | | - Lucie Dekimpe
- moveUp, 1000 Brussels, Belgium; (J.L.); (A.P.); (L.D.)
| | - Jean Mapinduzi
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium;
- Filière de Kinésithérapie et Réadaptation, Département des Sciences Clinique, Institut National de la Santé Publique, 6807 Bujumbura, Burundi
| | - Hervé Poilvache
- Orthopedic Surgery Department, CHIREC, 1420 Braine-l’Alleud, Belgium
| | - Bruno Bonnechère
- Department of PXL—Healthcare, PXL University of Applied Sciences and Arts, 3500 Hasselt, Belgium;
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium;
- Technology-Supported and Data-Driven Rehabilitation, Data Sciences Institute, Hasselt University, 3590 Diepenbeek, Belgium
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22
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Correia R, Oliveira L, Andrade I, de Castro Correia M, Gonçalves E, Borges A, Lopes T, Carvalho JL. Ultrasound-Guided Radiofrequency Ablation for Chronic Hip Pain Due to Osteoarthritis. Cureus 2024; 16:e53743. [PMID: 38465076 PMCID: PMC10920965 DOI: 10.7759/cureus.53743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND AND AIMS Hip osteoarthritis (OA) has a prevalence of 2.9% in Portugal and is a related cause of pain and disability. A sufficient number of patients report these symptoms even after total hip arthroplasty (THA), while others are contraindicated to such surgery and suffer from uncontrolled pain. Percutaneous denervation of hip nerve branches using radiofrequency ablation (RFA) has emerged as a powerful therapeutic avenue to consider for patients with chronic hip pain. METHODS Between January 2020 and March 2021, 26 patients with chronic hip pain received ultrasound-guided RFA with a pericapsular nerve group (PENG) block technique adaptation. Patients suffering from chronic hip pain for more than three months with radiographic evidence of osteoarthritis were included. A numeric rating scale (NRS) and pain medication reduction were defined as outcome variables assessed before treatment and at three-, six-, nine-, and 12-month follow-ups. RESULTS All selected patients underwent the procedure. All the patients had hip osteoarthritis. Twelve-month follow-up data revealed a statistically significant decrease in the numeric rating scale. The mean NRS for pain was 2 after the procedure. Over 75% of patients reported >50% pain relief during the follow-up and 85% reduced pain medication consumption. No side effects were reported. CONCLUSION Hip sensory articular branch RFA is a treatment option with interesting outcomes for chronic hip pain, as demonstrated by our study.
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Affiliation(s)
- Rodrigo Correia
- Physical Medicine and Rehabilitation, Centro de Reabilitação do Norte, Vila Nova de Gaia, PRT
| | - Luís Oliveira
- Physical Medicine and Rehabilitation, Centro de Reabilitação do Norte, Vila Nova de Gaia, PRT
| | - Inês Andrade
- Physical Medicine and Rehabilitation, Centro de Medicina de Reabilitação de Alcoitão, Lisboa, PRT
| | | | - Eugénio Gonçalves
- Physical Medicine and Rehabilitation, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PRT
| | - Andre Borges
- Physical Medicine and Rehabilitation, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, PRT
| | - Tiago Lopes
- Intervention and Musculoskeletal Rehabilitation, Centro de Reabilitação do Norte, Vila Nova de Gaia, PRT
| | - José Luís Carvalho
- Intervention and Musculoskeletal Rehabilitation, Centro de Reabilitação do Norte, Vila Nova de Gaia, PRT
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Laboret B, Bialaszewski R, Gaddis J, Middleton E, Kendall B, Lynch K, Stewart A, Wells J. A social media analysis of patient-perceived complications following periacetabular osteotomy (PAO): a retrospective observational study. BMC Surg 2024; 24:36. [PMID: 38267893 PMCID: PMC10809620 DOI: 10.1186/s12893-024-02318-1] [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: 08/22/2023] [Accepted: 01/09/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Social media is a popular resource for patients seeking medical information and sharing experiences. Periacetabular osteotomy (PAO) is an accepted treatment for symptomatic acetabular dysplasia with a low published complication profile in specialty centers. Little is known regarding patient reporting of complications on social media following PAO. The purpose of this study was to describe the patient-perceived complications of PAO posted on social media and analyze how additional factors (postoperative timeframe, concomitant surgery) correlate with these complication posts. METHODS Facebook and Instagram were queried from 02/01/18-02/01/23; Twitter was searched over an extended range back to 02/01/11. Facebook posts (1054) were collected from the two most populated interest groups; "Periacetabular Osteotomy" and "PAO Australia." Instagram posts (1003) and Tweets (502) were found using the same five most popular hashtags: #PAOwarrior, #periacetabularosteotomy, #periacetabularosteotomysurgery, #PAOsurgery, and #PAOrecovery. Posts were assessed for demographic data, perspective, timing (early postoperative or late postoperative), additional surgeries, type of complication, and post engagement. RESULTS Facebook posts (1054), Instagram posts (1003), and Tweets (502) were assessed; 13.6% of posts included a complication. The majority of complications were reported > 6 months postoperatively with excessive pain being the most common complication (57.2%), including chronic pain (41.8%), acute pain (6.7%), and nerve pain (8.8%). Bony complications (6.7%), neurologic/psychiatric complications (3.8%), swelling (1.7%), infection (1.4%), other specified complications (16.2%), and unspecified complications (10.2%) were reported. Complication posts were found to be correlated with postoperative timeframe and concomitant surgery. Post engagement decreased in complication-related posts. CONCLUSIONS Few patients posted a perceived complication associated with PAO surgery. Of those who did, the majority reported unmanageable pain during the late postoperative period. Posts including a perceived complication were found to be positively correlated with postoperative timeframe and negatively correlated with concomitant surgery. This study found a higher pain complication rate, but a lower overall complication rate compared to prior studies. Considering the social media reported complications of PAO patients in addition to traditional outcome measures reveals which aspects of postoperative recovery are most important to patients themselves.
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Affiliation(s)
- Bretton Laboret
- University of Texas Southwestern Medical School, Dallas, TX, USA.
| | | | - John Gaddis
- University of Texas Rio Grande Valley, Edinburg, TX, USA
| | - Emily Middleton
- Department of Physical Therapy - School of Health Professions, University of Texas Southwestern, 6011 Harry Hines Blvd., Dallas, TX, 75390-8876, USA
| | - Brittany Kendall
- Baylor Scott & White Outpatient Rehabilitation - Frisco, 3800 Gaylord Pkwy Ste 130, Frisco, TX, 75034, USA
| | - Katie Lynch
- Baylor Scott & White Outpatient Rehabilitation - Frisco, 3800 Gaylord Pkwy Ste 130, Frisco, TX, 75034, USA
| | - Adina Stewart
- Department of Orthopedic Surgery, Baylor Scott and White Hip Preservation Center, 5220 W University Dr Ste 220, McKinney, TX, 75071, USA
| | - Joel Wells
- Department of Orthopedic Surgery, Baylor Scott and White Hip Preservation Center, 5220 W University Dr Ste 220, McKinney, TX, 75071, USA
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24
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Migliorini F, Maffulli N, Velaj E, Bell A, Kämmer D, Hildebrand F, Hofmann UK, Eschweiler J. Antithrombotic prophylaxis following total hip arthroplasty: a level I Bayesian network meta-analysis. J Orthop Traumatol 2024; 25:1. [PMID: 38194191 PMCID: PMC10776533 DOI: 10.1186/s10195-023-00742-2] [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: 06/06/2023] [Accepted: 12/11/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Several clinical investigations have compared different pharmacologic agents for the prophylaxis of venous thromboembolism (VTE). However, no consensus has been reached. The present investigation compared enoxaparin, fondaparinux, aspirin and non-vitamin K antagonist oral anticoagulants (NOACs) commonly used as prophylaxis following total hip arthroplasty (THA). A Bayesian network meta-analysis was performed, setting as outcomes of interest the rate of deep venous thrombosis (DVT), pulmonary embolism (PE) and major and minor haemorrhages. METHODS This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension statement for reporting systematic reviews incorporating network meta-analyses of healthcare interventions. All randomised controlled trials (RCTs) comparing two or more drugs used for the prophylaxis of VTE following THA were accessed. PubMed, Web of Science and Google Scholar databases were accessed in March 2023 with no time constraint. RESULTS Data from 31,705 patients were extracted. Of these, 62% (19,824) were women, with age, sex ratio, and body mass index (BMI) being comparable at baseline. Apixaban 5 mg, fondaparinux, and rivaroxaban 60 mg were the most effective in reducing the rate of DVT. Dabigatran 220 mg, apixaban 5 mg, and aspirin 100 mg were the most effective in reducing the rate of PE. Apixaban 5 mg, ximelagatran 2 mg and aspirin 100 mg were associated with the lowest rate of major haemorrhages, while rivaroxaban 2.5 mg, apixaban 5 mg and enoxaparin 40 mg were associated with the lowest rate of minor haemorrhages. CONCLUSION Administration of apixaban 5 mg demonstrated the best balance between VTE prevention and haemorrhage control following THA. Level of evidence Level I, network meta-analysis of RCTs.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Centre, Pauwelsstraße 30, 52074, Aachen, Germany.
- Department of Orthopedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical University, 39100, Bolzano, Italy.
- Department of Orthopaedic and Trauma Surgery, Eifelklinik St.Brigida, 52152, Simmerath, Germany.
| | - Nicola Maffulli
- Department of Medicine and Psychology, University of Rome "La Sapienza", Rome, Italy
- School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Stoke on Trent, ST4 7QB, UK
- Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Mile End Hospital, Queen Mary University of London, London, E1 4DG, UK
| | - Erlis Velaj
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Centre, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Andreas Bell
- Department of Orthopaedic and Trauma Surgery, Eifelklinik St.Brigida, 52152, Simmerath, Germany
| | - Daniel Kämmer
- Department of Orthopaedic and Trauma Surgery, Eifelklinik St.Brigida, 52152, Simmerath, Germany
| | - Frank Hildebrand
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Centre, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Ulf Krister Hofmann
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Centre, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Jörg Eschweiler
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, BG Klinikum Bergmannstrost Halle, Halle (Saale), Germany
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25
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de Sire A, Marotta N, Spanó R, Fasano S, Sgro M, Lippi L, Invernizzi M, Ammendolia A. Efficacy of proprioceptive neuromuscular facilitation on functioning in patients with bilateral hip osteoarthritis: A pilot randomized controlled trial. J Back Musculoskelet Rehabil 2024; 37:445-457. [PMID: 37955078 DOI: 10.3233/bmr-230148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
BACKGROUND Hip osteoarthritis (OA) is a chronic progressive disease that impresses a noticeable burden to society and healthcare systems. Physical exercise constitutes the first-line hip OA treatment approach, nevertheless, there is currently no gold standard method to treat this disease. OBJECTIVE To evaluate the efficacy of proprioceptive neuromuscular facilitation (PNF) on functioning in patients with hip OA. METHOD A pilot randomized controlled trial (RCT) was carried out on patients with painful bilateral hip OA with a body mass index (BMI) < 30 kg/m2. After the randomization, the experimental group was treated with PNF protocol and the control group with conventional physical therapy (10 sessions of manual therapy, 5 sessions/week for 2 weeks). The Harris Hip Score (HHS) was the primary outcome, whereas we assessed as secondary outcomes: pain, range of motion, and muscle strength of hip, physical performance, and quality of life. RESULTS Twenty patients (40 hips) were enrolled and randomized into two groups: PNF group (mean age: 70.7 ± 8.07; BMI: 25.1 ± 3.07; 7 females and 3 males) and control group (mean age: 74.9 ± 10.72; BMI: 26.8 ± 3.78; 6 females and 4 males). The results showed a statistically significant improvement of HHS in the study group (T1: 90.6 ± 5.63) than in the control group (T1: 77.3 ± 10.9) (between-group p value < 0.001). Three months after the treatment we have statistically significant maintenance in the PNF group (T2:89.6±6.32, within-group ΔT0-T2 p< 0.01) while the control group did not maintain the improvements recorded at T1 (T2: 71.4 ± 15.8). CONCLUSION The results of this pilot RCT showed that incorporating PNF exercises into the rehabilitation program yielded notable enhancements in improving lower limb function, strength and ROM in hip OA patients. Nonetheless, further prospective studies including wider sample size are needed to implement scientific knowledge on this physical therapy approach, in patients with hip osteoarthritis.
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Affiliation(s)
- Alessandro de Sire
- Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Nicola Marotta
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro "Magna Graecia", Catanzaro, Italy
- Department of Experimental and Clinical Medicine, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Riccardo Spanó
- Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
- S. Anna Institute, Crotone, Italy
| | - Stefano Fasano
- Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Maria Sgro
- Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Lorenzo Lippi
- Department of Health Sciences, University of Eastern Piedmont "A. Avogadro", Novara, Italy
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Marco Invernizzi
- Department of Health Sciences, University of Eastern Piedmont "A. Avogadro", Novara, Italy
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Antonio Ammendolia
- Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro "Magna Graecia", Catanzaro, Italy
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Kawde K, Khan KK, Pisulkar G, Taywade S, Jayasoorya A. Total Hip Arthroplasty in Ankylosing Spondylitis: A Case Report of Ankylosed Hip. Cureus 2024; 16:e51619. [PMID: 38314005 PMCID: PMC10837487 DOI: 10.7759/cureus.51619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 01/03/2024] [Indexed: 02/06/2024] Open
Abstract
Ankylosing spondylitis (AS) is a chronic inflammatory arthritic disease that primarily affects the axial skeleton, and its association with the secondary development of osteoarthritis (OA) in peripheral joints, particularly the hips, is increasingly recognized. This case report elucidates the diagnostic and therapeutic challenges encountered in a patient with bilateral hip osteoarthritis secondary to AS. The patient's medical history included AS and a failed attempt at core decompression of the left hip joint. The patient was managed with total hip arthroplasty (THA) on the left side due to persistent symptoms. Total hip arthroplasty on the left side involved a meticulous surgical approach, addressing the unique challenges posed by underlying ankylosis. The procedure was conducted uneventfully, with the implantation of a modular femoral head, uncemented femoral stem, and modular shell. Postoperatively, the patient experienced significant pain relief and improved functionality. Successful rehabilitation and management were integral to the overall positive outcome. This case report highlights the complex interplay between AS and hip osteoarthritis, emphasizing the importance of tailored diagnostic and therapeutic strategies. Successful total hip arthroplasty in the setting of AS-related hip osteoarthritis suggests that joint replacement can be effective, but ongoing research is necessary to optimize surgical planning and long-term outcomes in this patient population.
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Affiliation(s)
- Kevin Kawde
- Orthopedics, Jawaharlal Nehru Medical College, Wardha, IND
| | - Khizar K Khan
- Orthopedics, Jawaharlal Nehru Medical College, Wardha, IND
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Onoi Y, Matsumoto T, Sobajima S, Tsubosaka M, Hayashi S, Matsushita T, Iwaguro H, Kuroda R. Clinical use of autologous adipose-derived stromal vascular fraction cell injections for hip osteoarthritis. Regen Ther 2023; 24:94-102. [PMID: 37363753 PMCID: PMC10285449 DOI: 10.1016/j.reth.2023.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/04/2023] [Accepted: 06/07/2023] [Indexed: 06/28/2023] Open
Abstract
Introduction Currently, studies on adipose-derived stromal vascular fraction (SVF) cells are attracting increasing attention because they have the potential to differentiate into a subset of cell types, such as bone marrow-derived mesenchymal stromal cells (MSCs), and are easier to harvest than MSCs, thus making them easier to apply clinically. This study evaluated the short-term clinical outcomes of SVF cell therapy for hip osteoarthritis (OA). Methods Forty-two patients were enrolled in this study; these patients received a single injection comprising an average of 3.8 (standard deviation [SD], ±1.3) × 107 SVF cells into the hip joint. All patients were followed-up for at least 6 months. The mean age of the patients was 60.2 years (SD, ±9.4 years). Kellgren-Lawrence (KL) grades II, III, and IV based on radiography were 13, 13, and 16 patients, respectively. SVF cells were obtained from the subcutaneous fat of the abdomen or breech using a Celution® 800/CRS system. The average cell viability of SVF cells was 90.8% (SD, ±2.8%). Clinical assessments were performed using the Harris Hip Score (HHS), Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ) score, and visual analog scale (VAS) score to evaluate pain. Images were evaluated using radiography, and T2 mapping values were obtained using a 1.5-T magnetic resonance imaging system. These clinical and imaging assessments were followed from preoperatively to 6 months postoperatively. Results The HHS, JHEQ score, and VAS score improved significantly from 22.5 (SD, ±16.6), 26.6 (SD, ±11.3), and 75.5 (SD, ±15.8) preoperatively to 46.8 (SD, ±27.2), 39.4 (SD, ±19.7), and 46.5 (SD, ±27.9), respectively, at 6 months postoperatively. KL grade II showed significant improvement in clinical outcome from preoperative to postoperative, while KL grade IV showed slight or little improvement. The center edge angle, acetabular head index on the radiographs, and T2 mapping values did not change significantly from preoperatively to 6 months postoperatively. Conclusions SVF cell injection in the hip joint showed good short-term clinical efficacy for reducing hip OA symptoms. SVF cell therapy is thus an innovative and effective treatment for hip OA.
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Affiliation(s)
- Yuma Onoi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Satoshi Sobajima
- Department of Orthopaedic Surgery, Sobajima Clinic, Osaka, Japan
| | - Masanori Tsubosaka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shinya Hayashi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takehiko Matsushita
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hideki Iwaguro
- Department of Orthopaedic Surgery, Sobajima Clinic, Osaka, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Tang J, van Buuren MMA, Riedstra NS, Boel F, Runhaar J, Bierma-Zeinstra S, Agricola R. Cam morphology is strongly and consistently associated with development of radiographic hip osteoarthritis throughout 4 follow-up visits within 10 years. Osteoarthritis Cartilage 2023; 31:1650-1656. [PMID: 37598743 DOI: 10.1016/j.joca.2023.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 08/15/2023] [Accepted: 08/16/2023] [Indexed: 08/22/2023]
Abstract
OBJECTIVE To determine the association between cam morphology and the development of radiographic hip osteoarthritis (RHOA) at four time points within 10-year follow-up. DESIGN The nationwide prospective Cohort Hip and Cohort Knee study includes 1002 participants aged 45-65 years with 2-, 5-, 8-, and 10-year follow-ups. The associations of cam morphology (alpha angle >60°) and large cam morphology (alpha angle >78°) in hips free of osteoarthritis at baseline (Kellgren & Lawrence (KL) grade <2) with the development of both incident RHOA (KL grade≥2) and end-stage RHOA (KL grade≥3) were estimated using logistic regression with generalized estimating equation at each follow-up and using Cox regression over 10 years, adjusted for age, sex, and body mass index. RESULTS Both cam morphology and large cam morphology were associated with the development of incident RHOA at all follow-ups with adjusted Odd Ratios (aORs) ranging from 2.7 (95% Confidence interval 1.8-4.1) to 2.9 (95% CI 2.0-4.4) for cam morphology and ranging from 2.5 (95% CI 1.5-4.3) to 4.2 (95% CI 2.2-8.3) for large cam morphology. For end-stage RHOA, cam morphology resulted in aORs ranging from 4.9 (95% CI 1.8-13.2) to 8.5 (95% CI 1.1-64.4), and aORs for large cam morphology ranged from 6.7 (95% CI 3.1-14.7) to 12.7 (95% CI 1.9-84.4). CONCLUSIONS Cam morphology poses the hip at 2-13 times increased odds for developing RHOA within a 10-year follow-up. The association was particularly strong for large cam morphology and end-stage RHOA, while the strength of association was consistent over time.
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Affiliation(s)
- Jinchi Tang
- Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Michiel M A van Buuren
- Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Noortje S Riedstra
- Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Fleur Boel
- Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Jos Runhaar
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Sita Bierma-Zeinstra
- Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Rintje Agricola
- Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
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Vassileva MT, Kim JS, Valle AGD, Harris MD, Pedoia V, Lattanzi R, Kraus VB, Pascual-Garrido C, Bostrom MP. Arthritis Foundation/HSS Workshop on Hip Osteoarthritis, Part 2: Detecting Hips at Risk: Early Biomechanical and Structural Mechanisms. HSS J 2023; 19:428-433. [PMID: 37937085 PMCID: PMC10626933 DOI: 10.1177/15563316231192097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/01/2023] [Indexed: 11/09/2023]
Abstract
Far more publications are available for osteoarthritis of the knee than of the hip. Recognizing this research gap, the Arthritis Foundation (AF), in partnership with the Hospital for Special Surgery (HSS), convened an in-person meeting of thought leaders to review the state of the science of and clinical approaches to hip osteoarthritis. This article summarizes the recommendations gleaned from 5 presentations given in the "early hip osteoarthritis" session of the 2023 Hip Osteoarthritis Clinical Studies Conference, which took place on February 17 and 18, 2023, in New York City. It also summarizes the workgroup recommendations from a small-group discussion on clinical research gaps.
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Affiliation(s)
| | | | | | - Michael D Harris
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Riccardo Lattanzi
- Department of Radiology, NYU Grossman School of Medicine, New York, NY, USA
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Ronconi G, Codazza S, Panunzio M, La Cagnina F, Ariani M, Gatto DM, Coraci D, Ferrara PE. The Effects of Ultrasound-Guided Intra-Articular Injections with Hyaluronic Acid and Corticosteroids in Patients with Hip Osteoarthritis: A Long-Term Real-World Analysis. J Clin Med 2023; 12:6600. [PMID: 37892738 PMCID: PMC10607283 DOI: 10.3390/jcm12206600] [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: 09/17/2023] [Revised: 10/11/2023] [Accepted: 10/14/2023] [Indexed: 10/29/2023] Open
Abstract
Intra-articular (IA) ultrasound-guided hip injections are currently considered a cornerstone of the conservative management of symptomatic hip osteoarthritis (HOA), although their effect on clinical outcomes has not been fully elucidated.The purpose of this study is to investigate the effectiveness of ultrasound-guided IA hip injections of hyaluronic acid (HA) with or without corticosteroids (CS) on pain relief and functional improvement in patients with HOA. In total, 167 patients with HOA were assessed at baseline (T0) and 12 months after injection (T1) using the VAS and GLFS scores. The sample consisted mainly of female subjects (58.1%), presenting an average age of 70.6 ± 12.2 years and grade 3 HOA (63.9%) according to the Kellgren-Lawrence classification. Most of the patients (76.2%) underwent unilateral hip injection with a combination of medium-high molecular weight HA (1500-2000 kDa) and CS. At T1, lower use of anti-inflammatory drugs, an increase in the consumption of chondroprotectors, and an overall reduction of instrumental physical therapies and therapeutic exercise were recorded. In addition, a statistically significant intragroup and between-group decrease observed at T1 for both the VAS and GLFS. Study results suggested that intra-articular hip injections with HA alone and with CS could represent a useful therapeutic tool for pain reduction and functional improvement for patients with hip osteoarthritis.
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Affiliation(s)
- Gianpaolo Ronconi
- Department of Rehabilitation, Catholic University of Sacred Heart, 00168 Rome, Italy;
- Department of Ageing, Neurosciences, Head-Neck and Orthopaedics Sciences, University Polyclinic Foundation Agostino Gemelli IRCSS, 00168 Rome, Italy; (M.A.); (D.M.G.); (P.E.F.)
| | - Sefora Codazza
- Department of Ageing, Neurosciences, Head-Neck and Orthopaedics Sciences, University Polyclinic Foundation Agostino Gemelli IRCSS, 00168 Rome, Italy; (M.A.); (D.M.G.); (P.E.F.)
| | | | - Fabiana La Cagnina
- Physical and Rehabilitation Medicine, University of Rome Tor Vergata, 00133 Rome, Italy;
| | - Mariantonietta Ariani
- Department of Ageing, Neurosciences, Head-Neck and Orthopaedics Sciences, University Polyclinic Foundation Agostino Gemelli IRCSS, 00168 Rome, Italy; (M.A.); (D.M.G.); (P.E.F.)
| | - Dario Mattia Gatto
- Department of Ageing, Neurosciences, Head-Neck and Orthopaedics Sciences, University Polyclinic Foundation Agostino Gemelli IRCSS, 00168 Rome, Italy; (M.A.); (D.M.G.); (P.E.F.)
| | - Daniele Coraci
- Department of Neuroscience, Section of Rehabilitation, University of Padova, 35122 Padova, Italy;
| | - Paola Emilia Ferrara
- Department of Ageing, Neurosciences, Head-Neck and Orthopaedics Sciences, University Polyclinic Foundation Agostino Gemelli IRCSS, 00168 Rome, Italy; (M.A.); (D.M.G.); (P.E.F.)
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Hooks JB, Dayya D. Treatment of Chronic Degenerative Hip Pain in a Male Patient With Cerebral Palsy Four Decades After Reverse Osteotomy. Cureus 2023; 15:e46495. [PMID: 37927768 PMCID: PMC10624556 DOI: 10.7759/cureus.46495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2023] [Indexed: 11/07/2023] Open
Abstract
Patients with cerebral palsy (CP) frequently require surgical hip interventions in early adulthood due to spasticity-related gait abnormalities. In most instances, these cases are characterized by severe restrictions on mobility. This is the case of a male patient with CP who underwent right proximal femoral open reduction internal fixation (ORIF) and reverse osteotomy for right hip subluxation in young adulthood. Patients with CP who undergo total hip arthroplasty (THA) or ORIF with reverse osteotomy often require future revision. The patient was initially given an estimated 10-year longevity for his plate and screw construct (hardware). Forty-four years later, the patient presented with debilitating chronic bilateral hip pain, requiring the assistance of a cane for ambulation. There is a limited body of knowledge on ORIF and reverse osteotomy follow-up in patients with CP within a 30- to 50-year period. At the 44th-year follow-up, CT and X-ray imaging found postoperative changes in the right femur, including intact hardware, bilateral acetabular dysplasia, right femoral stress fracture, progression of hip arthritis, and right iliopsoas bursitis. Surgery for hardware revision was not indicated. Gradual restoration of function was achieved over a 14-month period with conservative management. This case suggests that physical therapy (PT), exercise, and sporadic non-steroidal anti-inflammatory drug (NSAID) use are effective for improving chronic degenerative changes, associated bursitis, and loss of function in patients who developed CP-induced gait complications in young adulthood. These improvements can be made several decades after undergoing ORIF and osteotomies. This course of treatment was effective in improving the patient's quality of life without additional surgical interventions.
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Affiliation(s)
- John B Hooks
- Medicine, College of Osteopathic Medicine, University of New England, Biddeford, USA
| | - David Dayya
- Family Medicine, New England Healthcare, New Canaan, USA
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Bindumadhavan S, Sharma A, Killampalli V. Functional and Radiological Outcomes Following Simultaneous Bilateral Total Hip Arthroplasty: Analysis of a Retrospective Series. Cureus 2023; 15:e46361. [PMID: 37920626 PMCID: PMC10619522 DOI: 10.7759/cureus.46361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2023] [Indexed: 11/04/2023] Open
Abstract
Introduction The prevalence of bilateral hip arthritis continues to rise. With the dramatic change in the practice of modern-day arthroplasty with standard operating protocols and guidelines in place to reduce the incidence of surgical site infection and peri-operative thromboembolic events, simultaneous bilateral total hip replacement (THR) has been considered a viable option to reduce morbidity. The efficacy of simultaneous bilateral THR with regard to patient outcomes and complications has been debated. The aim of this study was to assess and compare the functional outcomes, radiological outcomes, and complications following bilateral simultaneous THR with the existing literature. Methods We conducted a retrospective study of 28 patients who underwent simultaneous bilateral THR by a single surgeon at a district general hospital in the United Kingdom between 2010 and 2019. All the patients in the study were operated on via the posterior approach to the hip and received uncemented implants. Data on blood loss and hospital stay were collected from the hospital records. The radiological outcomes were studied from the post-operative radiographs. The patient-reported outcomes were measured via a telephone session at an average follow-up of 7.8 years. Results Our results noted a statistically significant drop in haemoglobin after the procedure from a mean of 13.5 g/dl to 9.05 g/dl (t: -15.84, p < 0.00001). The average blood loss was 643 ml +/- 330 ml (200-1850 ml). Nine patients (32.1%) required blood transfusions and a total of 21 units were transfused. The mean duration of stay in the hospital was 6.7 days (three to 20 days). There were no intra-operative/immediate/early post-operative complications. The revision rate was 1.7%, as one patient had a revision of the femoral component following a peri-prosthetic fracture. The mean visual analogue scale pain score was 1.51 +/- 0.58 (1-3). The mean Oxford Hip Score improved from 19.5 (12-28) pre-operatively to 44.3 (37-48) post-operatively at the time of the study (t: -21.88945; p < 0.00001), with the difference being statistically significant using a paired t-test. From the series, 14 (50%) patients were found to have limb length discrepancies. The mean limb length discrepancy was found to be 2.3 mm (0-16 mm). In 13 of the 28 patients (46.4%), the global hip offset was equal on both sides. In two patients, the difference in the global hip offset was more than 10 mm. Conclusion We reported good patient-reported functional outcomes with simultaneous bilateral THR with a low complication rate. Despite the lack of opportunity to template the second hip, the limb length and global hip offset can be restored after a simultaneous bilateral THR.
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Affiliation(s)
| | - Anirudh Sharma
- Trauma and Orthopaedics, Worcestershire Royal Hospital, Worcester, GBR
| | - Vijay Killampalli
- Trauma and Orthopaedics, North West Anglia NHS Foundation Trust, Huntingdon, GBR
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Luo H, Zhu Y, Guo B, Ruan Z, Liu Z, Fan Z, Zhao S. Causal relationships between CD25 on immune cells and hip osteoarthritis. Front Immunol 2023; 14:1247710. [PMID: 37731506 PMCID: PMC10507251 DOI: 10.3389/fimmu.2023.1247710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/21/2023] [Indexed: 09/22/2023] Open
Abstract
Objectives Previous research has indicated a potential association between immune factors and osteoarthritis (OA), but the causal relationship between CD25 expression on immune cells and hip OA remains enigmatic. To shed light on this relationship, this study utilized the two-sample Mendelian Randomization (MR) method. Methods Leveraging genome-wide association studies (GWAS) data from the UK Biobank and arcOGEN, the investigation encompasses a substantial European cohort comprising 15,704 hip OA cases and 378,169 controls. Genetic insights into CD25 stem from a subgroup of 3,757 individuals with European ancestry, encompassing 77 CD25-related traits. Several MR methods were applied, and robustness was assessed through heterogeneity and sensitivity analysis. Results Among the 77 traits examined, 66 shared the same single nucleotide polymorphisms (SNPs) with hip OA. Of these, 7 CD25-related traits were found to be causally associated with hip OA (adjusted P><0.05), with F-statistics ranging from 33 to 122. These traits are specifically related to CD4+CD25+ T cells, exhibiting odds ratios (OR) and 95% confidence intervals (CI) less than 1. Notably, no causal link was discerned with the CD8+CD25+ T cell subset. Within absolute count (AC) and relative count (RC) trait types, a significant causal relationship was observed solely between CD4+CD25+ T cells and hip OA, without subtype localization. A more intricate examination of CD25 expression levels within the CD4+CD25+ T cell subset revealed a correlation with the CD39+ regulatory T (Treg) subset and hip OA, particularly within the CD39+ activated Treg subset. Furthermore, a notable causal relationship emerged between CD25 expression levels in the CD45RA- not Treg subset and hip OA. However, no significant causal link was established with any subsets of B cells. Conclusion The genetic prediction suggests that CD25, particularly within the realm of CD4+CD25+ T cells, may exert a protective influence against the development of hip OA. These findings provide a novel therapeutic approach for the prevention and treatment of hip OA.
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Affiliation(s)
- Hao Luo
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yong Zhu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Bin Guo
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Zhe Ruan
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Zhi Liu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Zhihua Fan
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
| | - Shushan Zhao
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
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Husen M, Leland DP, Melugin HP, Poudel K, Hevesi M, Levy BA, Krych AJ. Progression of Osteoarthritis at Long-term Follow-up in Patients Treated for Symptomatic Femoroacetabular Impingement With Hip Arthroscopy Compared With Nonsurgically Treated Patients. Am J Sports Med 2023; 51:2986-2995. [PMID: 37551688 DOI: 10.1177/03635465231188114] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
BACKGROUND Femoroacetabular impingement (FAI) is a common cause of hip pain, especially in young patients. When left untreated, it has been demonstrated to be a risk factor for the onset or progression of osteoarthritis (OA) and has been identified as one of the main contributors leading to the need for total hip arthroplasty (THA) at a young age. While the short-term therapeutic potential of hip arthroscopy is widely recognized, little is known regarding its potential mid- to long-term preventive effect on the progression of hip OA. PURPOSE To (1) report clinical outcomes of arthroscopically treated FAI syndrome with a minimum 5-year follow-up and compare the results to a cohort with FAI treated nonsurgically and (2) determine the influence of hip arthroscopy on the onset and progression of hip OA in patients diagnosed with FAI. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Patients who had hip pain and were diagnosed with FAI were included. Exclusion criteria were (1) previous or concomitant hip surgery, (2) <5 years of follow-up, and (3) insufficient radiographs. Patients treated with hip arthroscopy were compared with a cohort of patients with FAI who were treated nonsurgically. Kaplan-Meier estimates of failure (defined as conversion to THA) were performed. Bivariate analysis and Cox regression were used to identify factors associated with inferior clinical and radiographic outcomes. RESULTS A total of 957 patients (650 female, 307 male; 1114 hips) (mean age, 28.03 ± 8.9 years [range, 6.5-41.0 years]) with FAI were included. A total of 132 hips underwent hip arthroscopy and 982 hips were nonoperatively treated. The mean follow-up was 12.5 ± 4.7 years (range, 5.0-23.4 years). At the final follow-up, the rate of OA progression was 26.5% in the operative group and 35.2% in the nonoperative cohort (P < .01). Conversion to THA was performed in 6.8% of the surgical patients and 10.5% of the initially nonsurgical patients (P = .19). Additionally, there was no significant difference in the risk of failure between the operatively and nonoperatively treated patients. Male sex, increased age at initial diagnosis, presence of cam morphology, and increased initial Tönnis grade were risk factors for failure (male sex: hazard ratio [HR], 2.3; P < .01; per year of increased age: HR, 1.1; P < .01; presence of cam: HR, 3.5; P < .01; per Tönnis grade: HR, 4.0; P < .01). CONCLUSION At a mean follow-up of nearly 13 years, 7% of patients of the surgical group experienced progression to THA, compared with 11% of the nonoperative control group. While most of the operative group showed little to no OA at final follow-up, moderate OA (Tönnis grade 2) was present in 12% of the cohort compared with 22% of nonsurgical patients. Increased age at diagnosis, male sex, presence of a cam morphology, and presence of initial arthritic joint changes were found to be risk factors for failure. The results of this study demonstrated evidence for a preventive effect of hip arthroscopy on the development and progression of OA in young patients with FAI at mid- to long-term follow-up.
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Affiliation(s)
- Martin Husen
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Orthopaedic Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Devin P Leland
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Heath P Melugin
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Keshav Poudel
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mario Hevesi
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Bruce A Levy
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron J Krych
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Zhou Y, Chen X, Chen C, Cao Y. The efficacy and safety of duloxetine for the treatment of patients after TKA or THA: A systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e34895. [PMID: 37653762 PMCID: PMC10470761 DOI: 10.1097/md.0000000000034895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/29/2023] [Accepted: 08/03/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Duloxetine, a serotonin-norepinephrine dual reuptake inhibitor, may improve analgesia after total joint arthroplasty (TJA). However, there is still no consensus on its effectiveness and safety. We conducted the meta-analysis to investigate the analgesic effect and safety of duloxetine for the treatment of patients received total knee or hip arthroplasty. METHODS Pubmed, Cochrane Central Registry for Clinical Trials, Embase, OVID, Web of Science, and Google Scholar were searched using a predetermined search strategy from inception to September 21, 2022. Only randomized controlled trials of duloxetine in treatment of patients after total knee or hip arthroplasty were included. Data collection and extraction, quality assessment, and data analyses were performed according to the Cochrane standards. RESULTS A total of 8 randomized controlled trials with 739 patients were included in the literature review of postoperative pain and adverse effects. The result of meta-analysis showed statistically significant lower opioid requirement with duloxetine (P < .05) for the different postoperative period. Duloxetine group had significant reductions in visual analog score for the 24-hour (walking: WMD = -0.98; 95% confidence interval [CI] = -1.69 to -0.26, P = .007; resting: WMD = -1.06; 95%CI = -1.85 to -0.27, P = .008) and 1-week (walking: WMD = -0.96; 95%CI = -1.42 to -0.50, P < .001; resting: WMD = -0.69; 95%CI = -1.22 to -0.16, P = .01); knee injury and osteoarthritis outcome score over 3-month (WMD = 2.94; 95%CI = -0.30 to 6.18, P = .008) and complication (odds ratio = 4.74; 95%CI = 0.23 to 96.56, P = .01) postoperative period compared with the control group. However, no difference on numeric rating scale (P > .05) for the different postoperative period; visual analog score (P > .05) for the 6-week or 3-month and knee injury and osteoarthritis outcome score (P > .05) for the 6-week postoperative period. Furthermore, it did not increase the incidence of adverse effects (odds ratio = 0.87; 95%CI = 0.72 to 1.05, P = .15). CONCLUSION Duloxetine could decrease the opioids consumption and relieve early postoperative pain without increasing the risk of adverse medication effects in patients undergoing total knee or hip arthroplasty. Considering the ongoing opioid epidemic, duloxetine could act as a good supplement in multimodal pain management protocol for patients undergoing total joint arthroplasty.
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Affiliation(s)
- Yongqiang Zhou
- Department of Orthopedic Surgery, The First People’s Hospital of Neijiang, Neijiang, China
| | - Xiao Chen
- Department of Orthopedic Surgery, The First People’s Hospital of Neijiang, Neijiang, China
| | - Chang Chen
- Department of Orthopedic Surgery, The First People’s Hospital of Neijiang, Neijiang, China
| | - Yuan Cao
- Department of Orthopedic Surgery, The First People’s Hospital of Neijiang, Neijiang, China
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Ehmig J, Engel G, Lotz J, Lehmann W, Taheri S, Schilling AF, Seif Amir Hosseini A, Panahi B. MR-Imaging in Osteoarthritis: Current Standard of Practice and Future Outlook. Diagnostics (Basel) 2023; 13:2586. [PMID: 37568949 PMCID: PMC10417111 DOI: 10.3390/diagnostics13152586] [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: 06/28/2023] [Revised: 07/30/2023] [Accepted: 08/01/2023] [Indexed: 08/13/2023] Open
Abstract
Osteoarthritis (OA) is a common degenerative joint disease that affects millions of people worldwide. Magnetic resonance imaging (MRI) has emerged as a powerful tool for the evaluation and monitoring of OA due to its ability to visualize soft tissues and bone with high resolution. This review aims to provide an overview of the current state of MRI in OA, with a special focus on the knee, including protocol recommendations for clinical and research settings. Furthermore, new developments in the field of musculoskeletal MRI are highlighted in this review. These include compositional MRI techniques, such as T2 mapping and T1rho imaging, which can provide additional important information about the biochemical composition of cartilage and other joint tissues. In addition, this review discusses semiquantitative joint assessment based on MRI findings, which is a widely used method for evaluating OA severity and progression in the knee. We analyze the most common scoring methods and discuss potential benefits. Techniques to reduce acquisition times and the potential impact of deep learning in MR imaging for OA are also discussed, as these technological advances may impact clinical routine in the future.
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Affiliation(s)
- Jonathan Ehmig
- Institute of Diagnostic and Interventional Radiology, University Medical Center Göttingen, 37075 Göttingen, Germany; (J.E.); (G.E.)
| | - Günther Engel
- Institute of Diagnostic and Interventional Radiology, University Medical Center Göttingen, 37075 Göttingen, Germany; (J.E.); (G.E.)
| | - Joachim Lotz
- Institute of Diagnostic and Interventional Radiology, University Medical Center Göttingen, 37075 Göttingen, Germany; (J.E.); (G.E.)
| | - Wolfgang Lehmann
- Clinic of Trauma, Orthopedics and Reconstructive Surgery, Georg-August-University of Göttingen, 37075 Göttingen, Germany
| | - Shahed Taheri
- Clinic of Trauma, Orthopedics and Reconstructive Surgery, Georg-August-University of Göttingen, 37075 Göttingen, Germany
| | - Arndt F. Schilling
- Clinic of Trauma, Orthopedics and Reconstructive Surgery, Georg-August-University of Göttingen, 37075 Göttingen, Germany
| | - Ali Seif Amir Hosseini
- Institute of Diagnostic and Interventional Radiology, University Medical Center Göttingen, 37075 Göttingen, Germany; (J.E.); (G.E.)
| | - Babak Panahi
- Institute of Diagnostic and Interventional Radiology, University Medical Center Göttingen, 37075 Göttingen, Germany; (J.E.); (G.E.)
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Salis Z, Lui LY, Lane NE, Ensrud K, Sainsbury A. Investigation of the association of weight loss with radiographic hip osteoarthritis in older community-dwelling female adults. J Am Geriatr Soc 2023; 71:2451-2461. [PMID: 37074126 PMCID: PMC10624600 DOI: 10.1111/jgs.18371] [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: 12/07/2022] [Revised: 03/06/2023] [Accepted: 03/18/2023] [Indexed: 04/20/2023]
Abstract
OBJECTIVE Most guidelines recommending weight loss for hip osteoarthritis are based on research on knee osteoarthritis. Prior studies found no association between weight loss and hip osteoarthritis, but no previous studies have targeted older adults. Therefore, we aimed to determine whether there is any clear benefit of weight loss for radiographic hip osteoarthritis in older adults because weight loss is associated with health risks in older adults. METHODS We used data from white female participants aged ≥65 years from the Study of Osteoporotic Fractures. Our exposure of interest was weight change from baseline to follow-up at 8 years. Our outcomes were the development of radiographic hip osteoarthritis (RHOA) and the progression of RHOA over 8 years. Generalized estimating equations (clustering of 2 hips per participant) were used to investigate the association between exposure and outcomes adjusted for major covariates. RESULTS There was a total of 11,018 hips from 5509 participants. There was no associated benefit of weight loss for either of our outcomes. The odds ratios (95% confidence intervals) for the development and progression of RHOA were 0.99 (0.92-1.07) and 0.97 (0.86-1.09) for each 5% weight loss, respectively. The results were consistent in sensitivity analyses where participants were limited to those who reported trying to lose weight and who also had a body mass index in the overweight or obese range. CONCLUSION Our findings suggest no associated benefit of weight loss in older female adults in the structure of the hip joint as assessed by radiography.
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Affiliation(s)
- Zubeyir Salis
- Centre for Big Data Research in Health, The University of New South Wales, Kensington, New South Wales, Australia
| | - Li-Yung Lui
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, California, USA
| | - Nancy E Lane
- Department of Medicine, School of Medicine, University of California at Davis, Sacramento, California, USA
| | - Kristine Ensrud
- Department of Medicine and Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
| | - Amanda Sainsbury
- School of Human Sciences, The University of Western Australia, Perth, Western Australia, Australia
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Tsuchiya M, Fukushima K, Takata K, Ohashi Y, Uchiyama K, Takahira N, Saito H, Tsukada A, Inoue G, Takaso M, Uchida K. Increase in TPSB2 and TPSD1 Expression in Synovium of Hip Osteoarthritis Patients Who Are Overweight. Int J Mol Sci 2023; 24:11532. [PMID: 37511292 PMCID: PMC10380195 DOI: 10.3390/ijms241411532] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/14/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
While research suggests that increasing body mass index (BMI) is a risk factor for hip osteoarthritis (HOA), the mechanisms of this effect are not fully understood. Tryptases are among the main proteases found in mast cells (MCs) and contribute to OA pathology. TPSB2, which encodes β-tryptase, is increased in the synovium of overweight and obese knee OA patients. However, it remains unclear whether tryptase in the synovium of HOA is increased with increasing BMI. Here, we investigated tryptase genes (TPSB2 and TPSD1) in the synovium of overweight HOA patients. Forty-six patients radiographically diagnosed with HOA were allocated to two groups based on BMI, namely normal (<25 kg/m2) and overweight (25-29.99 kg/m2). TPSB2 and TPSD1 expression in the synovium of the two groups was compared using real-time polymerase chain reaction. To compare TPSB2 and TPSD1 expression in MCs between the groups, we isolated the MC-rich fraction (MC-RF) and MC-poor fraction (MC-PF), extracted using magnetic isolation. TPSB2 and TPSD1 expression was increased in the overweight group compared with the normal group. Expression of both genes in the MC-RF was significantly higher than that in MC-PF in both groups. However, TPSB2 and TPSD1 expression levels in the MC-RF did not differ between the groups. Tryptase genes were highly expressed in the synovium of overweight HOA patients. Further investigation to reveal the role of tryptase in the relationship between increasing BMI and HOA pathology is required.
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Affiliation(s)
- Maho Tsuchiya
- Department of Orthopedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara City 252-0374, Japan; (M.T.); (K.F.); (K.T.); (Y.O.); (H.S.); (A.T.); (G.I.); (M.T.)
| | - Kensuke Fukushima
- Department of Orthopedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara City 252-0374, Japan; (M.T.); (K.F.); (K.T.); (Y.O.); (H.S.); (A.T.); (G.I.); (M.T.)
| | - Ken Takata
- Department of Orthopedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara City 252-0374, Japan; (M.T.); (K.F.); (K.T.); (Y.O.); (H.S.); (A.T.); (G.I.); (M.T.)
| | - Yoshihisa Ohashi
- Department of Orthopedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara City 252-0374, Japan; (M.T.); (K.F.); (K.T.); (Y.O.); (H.S.); (A.T.); (G.I.); (M.T.)
| | - Katsufumi Uchiyama
- Department of Patient Safety and Healthcare Administration, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara City 252-0374, Japan;
| | - Naonobu Takahira
- Department of Rehabilitation, Kitasato University School of Allied Health Sciences, 1-15-1 Kitasato, Minami-ku, Sagamihara City 252-0373, Japan;
| | - Hiroki Saito
- Department of Orthopedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara City 252-0374, Japan; (M.T.); (K.F.); (K.T.); (Y.O.); (H.S.); (A.T.); (G.I.); (M.T.)
| | - Ayumi Tsukada
- Department of Orthopedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara City 252-0374, Japan; (M.T.); (K.F.); (K.T.); (Y.O.); (H.S.); (A.T.); (G.I.); (M.T.)
| | - Gen Inoue
- Department of Orthopedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara City 252-0374, Japan; (M.T.); (K.F.); (K.T.); (Y.O.); (H.S.); (A.T.); (G.I.); (M.T.)
| | - Masashi Takaso
- Department of Orthopedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara City 252-0374, Japan; (M.T.); (K.F.); (K.T.); (Y.O.); (H.S.); (A.T.); (G.I.); (M.T.)
| | - Kentaro Uchida
- Department of Orthopedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara City 252-0374, Japan; (M.T.); (K.F.); (K.T.); (Y.O.); (H.S.); (A.T.); (G.I.); (M.T.)
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Salis Z, Sainsbury A. Association of Change in Body Mass Index With Incidence and Progression of the Structural Defects of Hip Osteoarthritis: Data From the Osteoarthritis Initiative and the Cohort Hip and Cohort Knee study. Arthritis Care Res (Hoboken) 2023; 75:1527-1537. [PMID: 36354244 PMCID: PMC10952232 DOI: 10.1002/acr.25057] [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: 03/15/2022] [Revised: 10/14/2022] [Accepted: 11/08/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To define the association between change in body mass index (BMI) and the incidence and progression of structural defects of hip osteoarthritis as assessed by radiography. METHODS We used data from 2 independent cohort studies: the Osteoarthritis Initiative (OAI) and the Cohort Hip and Cohort Knee (CHECK) study. Our exposure was change in BMI from baseline to 4-5 years' follow-up. Our outcomes were the incidence and progression of structural defects of hip osteoarthritis as assessed using a modified Croft grade in OAI and the Kellgren/Lawrence grade in the CHECK study. To study incidence, we created incidence cohorts of hips without definite overall structural defects at baseline (i.e., grade <2) and then investigated the odds of hips having definite overall structural defects at follow-up (i.e., grade ≥2). To study progression, we created progression cohorts of hips with definite overall structural defects at baseline (i.e., grade ≥2) and then investigated the odds of having a grade increase of ≥1 from baseline to follow-up. RESULTS There was a total of 5,896 and 1,377 hips in the incidence cohorts, and 303 and 129 hips in the progression cohorts for the OAI and CHECK study, respectively. Change in BMI (decrease or increase) was not associated with any change in odds of the incidence or progression of definite structural defects of hip osteoarthritis in either the OAI or CHECK cohorts. CONCLUSION Weight loss may not be an effective strategy for preventing, slowing, or delaying the structural defects of hip osteoarthritis over 4-5 years.
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Affiliation(s)
- Zubeyir Salis
- University of New South WalesKensingtonNew South WalesAustralia
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Stasi S, Sarantis M, Papathanasiou G, Evaggelou-Sossidis G, Stamou M, Tzefronis D, Macheras G. Stair Climbing Ability and Identification of the Nine Stairs Ascent and Descent Test Cut-Off Points in Hip Osteoarthritis Patients: A Retrospective Study. Cureus 2023; 15:e41095. [PMID: 37519506 PMCID: PMC10380059 DOI: 10.7759/cureus.41095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2023] [Indexed: 08/01/2023] Open
Abstract
Objectives As the prevalence and incidence of hip osteoarthritis (hip OA) continue to rise, measuring the impact of hip OA severity on a patient's functionality is essential. Stair walking is a particularly relevant task to assess hip OA patients, as difficulty with stair ascent is one of the driving factors in deciding to undergo a total hip arthroplasty. Although stairs tests often arise in post-arthroplasty measures, there is a lack of reported stairs performance time in hip OA patients. Therefore, this retrospective study aimed to report the stair performance time of hip OA patients categorized by disease severity and determine cut-off points that differentiate between severity grades. Materials and methods The patient selection was based on the review of de-identified data from our research laboratory database. 254 hip OA patients (aged ≥ 50 years) were divided according to the Kellgren-Lawrence classification system into three groups: Grade 2 (n=68), Grade 3 (n=109), and Grade 4 (n= 68). The stair-walking ability was evaluated using the 9S-A/D test. The time taken to ascend and descend the stairs was measured separately, and the total time (9S-A/D) was also recorded. The one-way ANOVA model, Welch test, Games-Howell posthoc test, Chi-Square tests, and Two-Way ANOVA model were used for the statistical analysis of the data. The cut-off points were obtained by receiver operating curve (ROC) analysis. The statistical significance was set at p<0.05. Results Homogeneity was found between the three groups regarding demographic and clinical characteristics, except age and gender (p<0.001). The comparison of the variables (9S-ascent, 9S-descent, and 9S-A/D) between groups, adjusted for gender and age, showed significant differences: Grade 2 individuals had shorter performance times compared to those in Grade 3 and Grade 4 (p<0.005). Simultaneously, patients with Grade 3 hip OA have a shorter performance time than those with Grade 4 hip OA (p<0.005). Regarding ROC analysis of Grade 2 versus Grade 3: The AUCs of 9S-ascend, 9S-descent, and 9S-A/D were 0.742 (95%CI 0.67-0.81), 0.734 (95%CI 0.66-0.81), and 0.745 (95%CI 0.54-0.90), respectively (all p values <0.005). The cut-off points of 9S-ascend, 9S-descent, and 9S-A/D were 8.7 s (sensitivity 56%, specificity 88%), 7.1 s (sensitivity 58%, specificity 80%), and 16.25 s (sensitivity 54%, specificity 90%), respectively. Concerning ROC analysis of Grade 3 versus Grade 4: The AUCs of 9S-ascend, 9S-descent, and 9S-A/D were 0.702 (95%CI 0.62-0.78), 0.711 (95%CI 0.63-0.79), and 0.715 (95%CI 0.64-0.80), respectively (all p values <0.005). The cut-off points of 9S-ascend, 9S-descent, and 9S-A/D were 11.5 s (sensitivity 66%, specificity 65%), 8.3 s (sensitivity 71%, specificity 62%), and 19.05 s (sensitivity 71%, specificity 61%), respectively. Conclusions The study provides evidence that the progression of hip OA affected stair walking; the performance time of 9S-ascent, 9S-ascent, and 9S-A/D tests was significantly longer as the severity of hip OA worsened. ROC analysis results show tests' ability to distinguish the cut-off point between different hip OA grades. However, further research is required for the reporting and classification of stair performance time values in hip OA patients and to further investigate the ability of 9S-ascent, 9S-descent, and 9S-A/D tests to predict the grade of hip OA.
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Affiliation(s)
- Sophia Stasi
- Laboratory of Neuromuscular and Cardiovascular Study of Motion (LANECASM) Physiotherapy Department, University of West Attica (UNIWA), Athens, GRC
| | - Michail Sarantis
- Laboratory of Neuromuscular and Cardiovascular Study of Motion (LANECASM) Physiotherapy Department, University of West Attica (UNIWA), Athens, GRC
| | - George Papathanasiou
- Laboratory of Neuromuscular and Cardiovascular Study of Motion (LANECASM) Physiotherapy Department, University of West Attica (UNIWA), Athens, GRC
| | - George Evaggelou-Sossidis
- Laboratory of Neuromuscular and Cardiovascular Study of Motion (LANECASM) Physiotherapy Department, University of West Attica (UNIWA), Athens, GRC
| | - Magda Stamou
- Laboratory of Neuromuscular and Cardiovascular Study of Motion (LANECASM) Physiotherapy Department, University of West Attica (UNIWA), Athens, GRC
| | - Dimitrios Tzefronis
- 7th Orthopaedic Department, Henry Dunant Hospital, Athens, GRC
- Department of Minimal Invasive Orthopaedic Surgery, Athens Medical Center, Athens, GRC
| | - George Macheras
- 7th Orthopaedic Department, Henry Dunant Hospital, Athens, GRC
- Laboratory of Neuromuscular and Cardiovascular Study of Motion (LANECASM) Physiotherapy Department, University of West Attica (UNIWA), Athens, GRC
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Ezumi S, Iwamoto Y, Kawakami W, Hashizume T, Ota M, Ishii Y, Ozawa J, Takahashi M. Hip adduction angle during wider step-width gait affects hip adduction moment impulse. Gait Posture 2023; 103:229-234. [PMID: 37270912 DOI: 10.1016/j.gaitpost.2023.05.024] [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] [Received: 02/16/2023] [Revised: 05/07/2023] [Accepted: 05/24/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Decreasing an external hip adduction moment (HAM) impulse during stance is important to prevent the progression of hip osteoarthritis. A hip adduction angle (HAA) during walking influences the HAM impulse. Although a wider step-width (WS) gait is a gait modification to decrease a peak HAM, no study has reported the HAM impulse and HAA. RESEARCH QUESTION We investigated whether the HAA influences the peak HAM and HAM impulse during WS gait. METHODS Twenty-six healthy young adults walked with normal step-width (NS) and WS comfortably. They were not instructed about hip adduction motion during gait, and the peak HAM, HAM impulse, HAA, and other gait parameters were evaluated using a 3D motion capture system. The participants were divided into two groups according to the HAA size during WS gait. The percentage reduction of HAM variables (the WS condition relative to the NS condition) and other gait parameters were compared between the groups. RESULTS No difference in gait parameters was found between the groups. The percentage reduction of the HAM impulse in participants with smaller HAA was significantly higher than that in participants with larger HAA (14.5 % vs. 1.6 %, p < 0.01). Also, during normal step-width gait, the large HAA group showed a significantly larger HAA compared to the small HAA group (about 3°). SIGNIFICANCE Participants with smaller HAA could decrease the HAM impulse more effectively during WS gait compared with those with larger HAA. Thus, the HAA would influence the HAM impulse reduction effect on the WS gait. We recommend paying attention to the HAA to decrease the HAM with the WS gait.
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Affiliation(s)
- Shun Ezumi
- Department of Neuromechanics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yoshitaka Iwamoto
- Department of Neuromechanics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan; Center for Advanced Practice and Research of Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Wataru Kawakami
- Department of Neuromechanics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takato Hashizume
- Department of Neuromechanics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Mitsuhiro Ota
- Department of Neuromechanics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan; Department of Physical Therapy, Hiroshima College of Rehabilitation, Hiroshima, Japan
| | - Yosuke Ishii
- Department of Neuromechanics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan; Center for Advanced Practice and Research of Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Junya Ozawa
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Hiroshima, Japan
| | - Makoto Takahashi
- Department of Neuromechanics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan; Center for Advanced Practice and Research of Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Kearns GA, Moore AK, Munger L, Seth S, Day M. Care for the patient with hip pain. Nurse Pract 2023; 48:21-28. [PMID: 37458312 DOI: 10.1097/01.npr.0000000000000038] [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: 07/20/2023]
Abstract
ABSTRACT Hip pain is a common and sometimes disabling condition that affects adults in the primary care setting. The NP must understand the assessment, diagnosis, and treatment options for patients with hip pain. Proper care of these patients often involves conservative medical management and coordination with physical therapy.
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Fernández MT, Aguirre JA, López S. Posterior Quadratus Lumborum Block, A Novel Approach to Treat Chronic Hip Pain: A Case Series. A A Pract 2023; 17:e01671. [PMID: 36930793 DOI: 10.1213/xaa.0000000000001671] [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: 03/19/2023]
Abstract
Osteoarthritis frequently results in chronic pain and has a major impact on patients' quality of life. We present a case series of 20 patients with chronic hip pain who received a posterior quadratus lumborum block with the aim of improving their pain and, consequently, their quality of life. The results showed global improvement in pain and quality of life. These preliminary results support our conclusion. Posterior quadratus lumborum block is a safe and minimally invasive option for refractory chronic hip pain.
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Affiliation(s)
- María T Fernández
- From the Department of Anesthesiology, Rio Hortega University Hospital, Valladolid, Spain
| | - José A Aguirre
- Department of Anesthesiology, Intensive Care and Pain Medicine, Balgrist University Hospital, Zürich, Switzerland
| | - Servando López
- Department of Anesthesiology, Abente y Lago Hospital, A Coruña, Spain
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Paterson KL, Bennell KL, Metcalf BR, Jones SE, Campbell PK, McManus F, Lamb KE, Hinman RS. Shoes for self-managing chronic hip Pain: the SCHIPP randomized clinical trial protocol. BMC Musculoskelet Disord 2023; 24:141. [PMID: 36814221 PMCID: PMC9948330 DOI: 10.1186/s12891-023-06235-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 02/08/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Chronic hip pain is common and disabling and is largely due to osteoarthritis (OA). Self-management is recommended by international OA clinical guidelines yet there are few effective treatment options. Footwear has been suggested as a self-management approach, given that foot motion influences hip forces. Currently, guidelines advocate 'stable supportive' shoes for people with OA, however this is based solely on expert opinion given no research has investigated whether these shoes are effective at reducing symptoms in people with OA-related chronic hip pain. Therefore, this randomized controlled trial (RCT) aims to determine if stable supportive footwear reduces hip pain during walking compared to flat flexible footwear in people with chronic hip pain consistent with OA. METHODS This trial is a 6-month, participant- and assessor-blinded, pragmatic, comparative effectiveness, superiority RCT conducted in Melbourne, Australia. We are recruiting 120 participants aged over 45 years with chronic hip pain consistent with OA from the community. Following baseline assessment, participants are randomized to receive either i) stable supportive shoes or ii) flat flexible shoes. Participants are permitted to choose two different pairs of shoes in their allocated group from a range of options that match prespecified shoe classification criteria. They are advised to wear either pair of study shoes daily for a minimum of 6 hours each day for 6 months. The primary outcome is the 6-month change in average hip pain on walking in the last week. Secondary outcomes include changes in other measures of hip pain, symptoms, function in daily living and sports and recreation, hip-related quality of life, pain at other sites, adverse events, and physical activity. Other measures include co-intervention use, adherence, shoe comfort, descriptive characteristics, footwear characteristics, and objective foot measures. DISCUSSION This RCT will determine whether stable supportive shoes reduce hip pain during walking more than flat flexible shoes in people with chronic hip pain. Outcomes will help to inform footwear recommendations in international clinical guidelines for OA-related chronic hip pain, which to date have been based solely on expert opinion because of an absence of RCTs. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry reference: ACTRN12621001532897.
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Affiliation(s)
- Kade L. Paterson
- grid.1008.90000 0001 2179 088XCentre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Kim L. Bennell
- grid.1008.90000 0001 2179 088XCentre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Ben R. Metcalf
- grid.1008.90000 0001 2179 088XCentre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Sarah E. Jones
- grid.1008.90000 0001 2179 088XCentre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Penny K. Campbell
- grid.1008.90000 0001 2179 088XCentre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Fiona McManus
- grid.1008.90000 0001 2179 088XBiostatistics Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Karen E. Lamb
- grid.1008.90000 0001 2179 088XBiostatistics Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Rana S. Hinman
- grid.1008.90000 0001 2179 088XCentre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Australia
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A Novel Approach for Fluoroscopic Guided Intra-articular Hip Injections: Technique Description and Case Series. Am J Phys Med Rehabil 2023; 102:e15-e17. [PMID: 36166654 DOI: 10.1097/phm.0000000000002112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
ABSTRACT Fluoroscopic guided intra-articular hip injections generally utilize a standard anterior-posterior view. However, this approach can expose patients to inadvertent femoral nerve or vessel infiltration owing to the proximity of the neurovascular bundle to the joint space. This case-series study describes a novel technique using fluoroscopic ipsilateral oblique angulation and caudal tilt of the image intensifier. With this view, the clinician can advance the needle in a lateral to medial trajectory to obtain intra-articular access and minimize the risk of complications. This method was performed in five patients with refractory chronic hip osteoarthritis, which resulted in notable pain improvements and no reported adverse events. The suggested technique could provide a safer alternative to the anterior-posterior imaging technique for intra-articular hip injections by avoiding the femoral neurovascular bundle, limiting needle repositioning, and offering a satisfactory postprocedural analgesic effect.
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Pironti P, Ambrosanio A, Vismara V, Viganò M, Bucci E, Sirtori P, Peretti GM, Mangiavini L. One-stage vs two-stage bilateral THA in Lombardy: a cost-effectiveness analysis. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2023; 21:3. [PMID: 36647163 PMCID: PMC9841130 DOI: 10.1186/s12962-023-00418-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 01/09/2023] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) is the most common treatment for primary and secondary end-stage hip osteoarthritis (OA). Almost 20% of all patients undergoing primary THA suffer from bilateral hip OA and, consequently, will need a contralateral procedure to be performed in the following years. The aim of this study is to evaluate the cost-effectiveness and the reliability of one-stage bilateral THA (1-BTHA) compared to two-stage bilateral THA (2-BTHA), in low-risk patients, performed with anterior minimally invasive surgery (AMIS). METHODS Single patient's costs were obtained by dividing the annual costs report by the number of hospitalizations, considering the diagnosis related group (DRG) of the two procedures. Then, 16 patients undergoing 1-BTHA and 8 undergoing 2-BTHA were examined. Hemoglobin (Hb) values before surgery and before discharge, transfusion rate and the occurrence of post-operative complications were observed. RESULTS Procedural costs were divided in different subgroups: pre-hospitalization, operating room, hospital stay, post-operative follow-up and other costs. 1-BTHA total costs amount to 5.754,82€, while performing 2-BTHA costs 7.624,32€. However, considering DRG reimbursement, the hospital's profit margin following 1-BTHA is lower than that following 2-BTHA (6.346,18€ versus 9.261,68€). Surgical time was found not to be significantly different between 1-BTHA and 2-BTHA (141,13 ± 26,1 min vs 164,8 ± 44,3 min; p = 0,111). The two groups showed a statistically significant difference in Hb decrease (4,8 ± 1,3 g/dl vs 3,3 ± 0,9; p = 0,001), despite no variances in transfusion rate. No further complications were observed in either group. CONCLUSIONS This study demonstrates how, in carefully selected patients, 1-BTHA performed with AMIS is a cost-effective and safe technique compared to 2-BTHA, resulting in a shorter OR time, LOS and lower overall costs. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Pierluigi Pironti
- grid.4708.b0000 0004 1757 2822Residency Program in Orthopedics and Traumatology, University of Milan, Milan, Italy
| | - Andrea Ambrosanio
- grid.4708.b0000 0004 1757 2822Residency Program in Orthopedics and Traumatology, University of Milan, Milan, Italy
| | - Valeria Vismara
- grid.4708.b0000 0004 1757 2822Residency Program in Orthopedics and Traumatology, University of Milan, Milan, Italy
| | - Marco Viganò
- grid.417776.4IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20161 Milan, Italy
| | - Eugenia Bucci
- grid.417776.4IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20161 Milan, Italy
| | - Paolo Sirtori
- grid.417776.4IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20161 Milan, Italy
| | - Giuseppe M Peretti
- grid.417776.4IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20161 Milan, Italy ,grid.4708.b0000 0004 1757 2822Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Laura Mangiavini
- grid.417776.4IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20161 Milan, Italy ,grid.4708.b0000 0004 1757 2822Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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Paraliov AT, Iacov-Craitoiu MM, Mogoantă MM, Predescu OI, Mogoantă L, Crăiţoiu Ș. Management and Treatment of Coxarthrosis in the Orthopedic Outpatient Clinic. CURRENT HEALTH SCIENCES JOURNAL 2023; 49:102-109. [PMID: 37780193 PMCID: PMC10541077 DOI: 10.12865/chsj.49.01.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 02/23/2023] [Indexed: 10/03/2023]
Abstract
Coxarthrosis, or hip osteoarthritis (OA), is one of the main causes of hip pain, which can affect patients of all ages, being one of the most common reasons for patients presenting to the specialized outpatient clinic. The objective of our research was to determine the number of patients with coxarthrosis who presented to the Department of Orthopaedics and Traumatology within the Emergency County Hospital of Drobeta Turnu Severin, between 2017-2019, the sex, age, social environment of the patients. All patients underwent a thorough clinical examination to determine the risk factors, the favouring factors and their correlation with the paraclinical data obtained through imaging investigation (pelvis X-ray, computer tomography and nuclear magnetic resonance). The study included 462 patients, aged between 23 and 89 years old, who were diagnosed with varying degrees of coxarthrosis within the specialized outpatient clinic. The main risk factors were obesity, osteoporosis, chronic smoking, rural environment, female sex, the existence of a hip injury and intense physical exertion. The main purpose of the research was to analyse a series of data, which would bring information on the incidence, distribution by age groups, sex, living environment and professional activity of the population with coxarthrosis, in order to develop a therapeutic management as effective as possible.
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Affiliation(s)
- Anton Tiberiu Paraliov
- PhD Student, Department of Histology, University of Medicine and Pharmacy of Craiova, Romania
- Departament of Orthopedics, Emergency County Hospital of Drobeta Turnu Severin, Mehedinti County, Romania
| | | | | | - Octavian Ion Predescu
- Department of Nursing, Faculty of Nursing, Târgu Jiu Subsidiary, Titu Maiorescu University, Bucharest, Romania
| | - Laurențiu Mogoantă
- Department of Histology, University of Medicine and Pharmacy of Craiova, Romania
| | - Ștefania Crăiţoiu
- Department of Histology, University of Medicine and Pharmacy of Craiova, Romania
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Quarterman JC, Phruttiwanichakun P, Fredericks DC, Salem AK. Zoledronic Acid Implant Coating Results in Local Medullary Bone Growth. Mol Pharm 2022; 19:4654-4664. [PMID: 36378992 PMCID: PMC9727731 DOI: 10.1021/acs.molpharmaceut.2c00644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Osteoarthritis (OA) can necessitate surgical interventions to restore the function of the joint in severe cases. Joint replacement surgery is one of the procedures implemented to replace the damaged joint with prosthetic implants in severe cases of OA. However, after successful implantation, a fraction of OA patients still require revision surgery due to aseptic prosthetic loosening. Insufficient osseointegration is one of the factors that contribute to such loosening of the bone implant, which is commonly made from titanium-based materials. Zoledronic acid (ZA), a potent bisphosphonate agent, has been previously shown to enhance osseointegration of titanium implants. Herein, we fabricated ZA/Ca composites using a reverse microemulsion method and coated them with 1,2-dioleoyl-sn-glycero-3-phosphate monosodium salt (DOPA) to form ZA/Ca/DOPA composites. Titanium alloy screws were subsequently dip-coated with a suspension of the ZA/Ca/DOPA composites and poly(lactic-co-glycolic) acid (PLGA) in chloroform to yield Za/PLGA-coated screws. The coated screws exhibited a biphasic in vitro release profile with an initial burst release within 48 h, followed by a sustained release over 1 month. To assess their performance in vivo, the Za/PLGA screws were then implanted into the tibiae of Sprague-Dawley rats. After 8 weeks, microCT imaging showed new bone growth along the medullary cavity around the implant site, supporting the local release of ZA to enhance bone growth around the implant. Histological staining further confirmed the presence of new mineralized medullary bone growth resembling the cortical bone. Such local medullary growth represents an opportunity for future studies with alternative coating methods to fine-tune the local release of ZA from the coating and enhance complete osseointegration of the implant.
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Affiliation(s)
- Juliana C. Quarterman
- Department
of Pharmaceutical Sciences and Experimental Therapeutics, College
of Pharmacy, University of Iowa, Iowa City, Iowa 52242, United States
| | - Pornpoj Phruttiwanichakun
- Department
of Pharmaceutical Sciences and Experimental Therapeutics, College
of Pharmacy, University of Iowa, Iowa City, Iowa 52242, United States
| | - Douglas C. Fredericks
- The
Bone Healing Research Laboratory, Department of Orthopedics and Rehabilitation,
Carver College of Medicine, University of
Iowa, Iowa City, Iowa 52242, United
States
| | - Aliasger K. Salem
- Department
of Pharmaceutical Sciences and Experimental Therapeutics, College
of Pharmacy, University of Iowa, Iowa City, Iowa 52242, United States,
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Yang D, Cao G, Ba X, Jiang H. Epigallocatechin-3- O-gallate promotes extracellular matrix and inhibits inflammation in IL-1β stimulated chondrocytes by the PTEN/miRNA-29b pathway. PHARMACEUTICAL BIOLOGY 2022; 60:589-599. [PMID: 35260041 PMCID: PMC8920401 DOI: 10.1080/13880209.2022.2039722] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
CONTEXT Epigallocatechin-3-O-gallate (EGCG) exhibits anti-arthritic activity. MiR-29b-3p provokes chondrocyte apoptosis and promotes the initiation and development of osteoarthritis (OA). OBJECTIVE To explore the roles of EGCG and miR-29b-3p in interleukin-1β (IL-1β)-stimulated chondrocytes. MATERIALS AND METHODS HE and Safranin O staining were used to detect the pathological changes of cartilage tissue in OA patients and healthy people. OA-like chondrocyte injury was mimicked by 5 ng/mL IL-1β stimulation for 24 h in vitro, and after transfection with miR-29b-3p mimics and pcDNA-PTEN, IL-1β-stimulated chondrocytes were pre-treated with EGCG (20 and 50 μM) for 2 h. Cell viability, colony numbers, apoptosis rate, the levels of IL-6 and matrix metalloproteinase-13 (MMP-13), miR-19b-3p, PTEN and apoptosis-associated proteins in chondrocytes were evaluated. RESULTS MiR-29b-3p level was upregulated in cartilage tissues of OA patients (3.5-fold change, p < 0.001) and IL-1β stimulated chondrocytes (two fold change, p < 0.001). The matrix staining was weakened and unevenly distributed, and the chondrocytes were arranged disorderly in the tissues of patients with OA. EGCG (20 and 50 μM) increases viability and decreases the levels of miR-29b-3p and MMP-13 and IL-6 in IL-1β stimulated chondrocytes (p < 0.05). MiR-29b-3p mimics reversed the effects above 50 μM EGCG (p < 0.05). Furthermore, PTEN overexpression abrogated the effects of miR-29b-3p mimics on viability, colony numbers, apoptosis rate and the levels of Bcl-2, MMP-13, IL-6, Bax and cleaved caspase 3 in IL-1β-stimulated chondrocytes (p < 0.01). DISCUSSION AND CONCLUSIONS EGCG is a potential candidate for the treatment of OA, which also can be explored in a novel therapeutic method for other degenerative or inflammatory disorders.
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Affiliation(s)
- Dong Yang
- Department of Orthopaedics, Liyang Peoples’ Hospital, Changzhou, PR China
- CONTACT Dong Yang Department of Orthopaedics, Liyang Peoples’ Hospital, No. 70, Jianshe West Road, Liyang, Changzhou, Jiangsu Province213361, PR China
| | - Guanghua Cao
- Department of Orthopaedics, Liyang Peoples’ Hospital, Changzhou, PR China
| | - Xiaorong Ba
- Department of Orthopaedics, Liyang Peoples’ Hospital, Changzhou, PR China
| | - Haibo Jiang
- Department of Orthopaedics, Liyang Peoples’ Hospital, Changzhou, PR China
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Jensen J, Graumann O, Overgaard S, Gerke O, Lundemann M, Haubro MH, Varnum C, Bak L, Rasmussen J, Olsen LB, Rasmussen BSB. A Deep Learning Algorithm for Radiographic Measurements of the Hip in Adults-A Reliability and Agreement Study. Diagnostics (Basel) 2022; 12:2597. [PMID: 36359441 PMCID: PMC9689405 DOI: 10.3390/diagnostics12112597] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/22/2022] [Accepted: 10/24/2022] [Indexed: 08/04/2023] Open
Abstract
Hip dysplasia (HD) is a frequent cause of hip pain in skeletally mature patients and may lead to osteoarthritis (OA). An accurate and early diagnosis may postpone, reduce or even prevent the onset of OA and ultimately hip arthroplasty at a young age. The overall aim of this study was to assess the reliability of an algorithm, designed to read pelvic anterior-posterior (AP) radiographs and to estimate the agreement between the algorithm and human readers for measuring (i) lateral center edge angle of Wiberg (LCEA) and (ii) Acetabular index angle (AIA). The algorithm was based on deep-learning models developed using a modified U-net architecture and ResNet 34. The newly developed algorithm was found to be highly reliable when identifying the anatomical landmarks used for measuring LCEA and AIA in pelvic radiographs, thus offering highly consistent measurement outputs. The study showed that manual identification of the same landmarks made by five specialist readers were subject to variance and the level of agreement between the algorithm and human readers was consequently poor with mean measured differences from 0.37 to 9.56° for right LCEA measurements. The algorithm displayed the highest agreement with the senior orthopedic surgeon. With further development, the algorithm may be a good alternative to humans when screening for HD.
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Affiliation(s)
- Janni Jensen
- Department of Radiology, Odense University Hospital, 5000 Odense, Denmark
- Research and Innovation Unit of Radiology, University of Southern Denmark, 5230 Odense, Denmark
- Open Patient Data Explorative Network, OPEN, Odense University Hospital, 5000 Odense, Denmark
| | - Ole Graumann
- Department of Radiology, Odense University Hospital, 5000 Odense, Denmark
- Research and Innovation Unit of Radiology, University of Southern Denmark, 5230 Odense, Denmark
| | - Søren Overgaard
- Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital, Bispebjerg, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 1165 Copenhagen, Denmark
| | - Oke Gerke
- Department of Clinical Research, University of Southern Denmark, 5230 Odense, Denmark
- Department of Nuclear Medicine, Odense University Hospital, 5000 Odense, Denmark
| | | | - Martin Haagen Haubro
- Department of Orthopedic Surgery and Traumatology, Odense University Hospital, 5000 Odense, Denmark
| | - Claus Varnum
- Department of Orthopedic Surgery and Traumatology, Odense University Hospital, 5000 Odense, Denmark
- Department of Orthopedic Surgery, Lillebaelt Hospital—Vejle, University Hospital of Southern Denmark, 7100 Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, 5230 Odense, Denmark
| | - Lene Bak
- Department of Radiology, Odense University Hospital, 5000 Odense, Denmark
| | - Janne Rasmussen
- Department of Radiology, Odense University Hospital, 5700 Svendborg, Denmark
| | - Lone B. Olsen
- Department of Radiology, Odense University Hospital, 5000 Odense, Denmark
| | - Benjamin S. B. Rasmussen
- Department of Radiology, Odense University Hospital, 5000 Odense, Denmark
- Research and Innovation Unit of Radiology, University of Southern Denmark, 5230 Odense, Denmark
- Department of Radiology, Odense University Hospital, 5700 Svendborg, Denmark
- CAI-X (Centre for Clinical Artificial Intelligence), Odense University Hospital, University of Southern Denmark, 5230 Odense, Denmark
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