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Kikuchi N, Kanamori A, Kadone H, Okuno K, Hyodo K, Yamazaki M. Varus knee osteoarthritis with ankle osteoarthritis demonstrates greater hindfoot inversion and larger ankle inversion loading during gait following total knee arthroplasty compared to varus knee osteoarthritis alone. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38738824 DOI: 10.1002/ksa.12249] [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: 03/13/2024] [Revised: 04/27/2024] [Accepted: 04/30/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE Although patients with varus knee osteoarthritis (KOA) and concurrent ankle osteoarthritis (AOA) may experience increased ankle joint pain after total knee arthroplasty (TKA), the underlying mechanism remains unclear. This study aimed to investigate the effects of concurrent AOA on ankle and hindfoot alignment, frontal plane ankle and hindfoot biomechanics during gait following TKA and the clinical outcomes. METHODS Twenty-four patients with varus KOA who underwent TKA were included in this retrospective cohort study. Patients were categorized into two groups: with and without AOA. Radiographic evaluations of lower-limb, ankle and hindfoot alignment, and knee and ankle clinical outcomes were conducted preoperatively and 6 months postoperatively. In addition, gait analyses were performed to investigate knee, ankle and hindfoot kinematics and kinetics. Each data was compared between patients with and without AOA. RESULTS Concomitant AOA was found in eight ankles. The AOA group exhibited greater postoperative hindfoot varus and increased postoperative ankle pain than the non-AOA group. Gait analysis showed no significant differences in knee varus alignment or tibial tilt after TKA between the groups. However, the AOA group demonstrated significantly greater hindfoot inversion and larger ankle inversion loading. CONCLUSION One third of patients who underwent TKA had concurrent AOA associated with hindfoot varus. Despite achieving proper coronal knee alignment postoperatively, these patients experienced greater hindfoot and ankle joint inversion load during gait. Surgeons should consider the inability to evert the hindfoot and the possibility of increased ankle joint pain when planning and performing TKA. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Naoya Kikuchi
- Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Akihiro Kanamori
- Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hideki Kadone
- Center for Cybernics Research, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Kosuke Okuno
- Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Kojiro Hyodo
- Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Zhao Z, Yang T, Qin C, Zhao M, Zhao F, Li B, Liu J. Exploring the potential of the sit-to-stand test for self-assessment of physical condition in advanced knee osteoarthritis patients using computer vision. Front Public Health 2024; 12:1348236. [PMID: 38384889 PMCID: PMC10880867 DOI: 10.3389/fpubh.2024.1348236] [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: 12/02/2023] [Accepted: 01/17/2024] [Indexed: 02/23/2024] Open
Abstract
Introduction Knee osteoarthritis (KOA) is a prevalent condition often associated with a decline in patients' physical function. Objective self-assessment of physical conditions poses challenges for many advanced KOA patients. To address this, we explored the potential of a computer vision method to facilitate home-based physical function self-assessments. Methods We developed and validated a simple at-home artificial intelligence approach to recognize joint stiffness levels and physical function in individuals with advanced KOA. One hundred and four knee osteoarthritis (KOA) patients were enrolled, and we employed the WOMAC score to evaluate their physical function and joint stiffness. Subsequently, patients independently recorded videos of five sit-to-stand tests in a home setting. Leveraging the AlphaPose and VideoPose algorithms, we extracted time-series data from these videos, capturing three-dimensional spatiotemporal information reflecting changes in key joint angles over time. To deepen our study, we conducted a quantitative analysis using the discrete wavelet transform (DWT), resulting in two wavelet coefficients: the approximation coefficients (cA) and the detail coefficients (cD). Results Our analysis specifically focused on four crucial joint angles: "the right hip," "right knee," "left hip," and "left knee." Qualitative analysis revealed distinctions in the time-series data related to functional limitations and stiffness among patients with varying levels of KOA. In quantitative analysis, we observed variations in the cA among advanced KOA patients with different levels of physical function and joint stiffness. Furthermore, there were no significant differences in the cD between advanced KOA patients, demonstrating different levels of physical function and joint stiffness. It suggests that the primary difference in overall movement patterns lies in the varying degrees of joint stiffness and physical function among advanced KOA patients. Discussion Our method, designed to be low-cost and user-friendly, effectively captures spatiotemporal information distinctions among advanced KOA patients with varying stiffness levels and functional limitations utilizing smartphones. This study provides compelling evidence for the potential of our approach in enabling self-assessment of physical condition in individuals with advanced knee osteoarthritis.
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Affiliation(s)
- Zhengkuan Zhao
- Department of Joint, Tianjin Hospital, Tianjin, China
- Tianjin Medical University, Tianjin, China
| | - Tao Yang
- Department of Joint, Tianjin Hospital, Tianjin, China
| | - Chao Qin
- Department of Joint, Tianjin Hospital, Tianjin, China
- Tianjin Medical University, Tianjin, China
| | - Mingkuan Zhao
- National Elite Institute of Engineering, Chongqing University, Chongqing, China
| | - Fuhao Zhao
- Department of Nephrology, Tianjin Hospital, Tianjin, China
| | - Bing Li
- Department of Joint, Tianjin Hospital, Tianjin, China
| | - Jun Liu
- Department of Joint, Tianjin Hospital, Tianjin, China
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Ma W, Wang F, Sun S, Ding L, Wang L, Yu T, Zhang Y. Novel ideas for the comprehensive evaluation of varus knee osteoarthritis: radiological measurements of the morphology of the lateral knee joint. J Orthop Surg Res 2023; 18:196. [PMID: 36915200 PMCID: PMC10010041 DOI: 10.1186/s13018-023-03684-x] [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: 04/02/2022] [Accepted: 03/06/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND The lateral anatomical and morphological characteristics of knees with varus knee osteoarthritis (OA) have not received sufficient attention. This study used several radiological parameters to describe the morphological characteristics of the lateral knee with OA to determine whether there are relationships between varus knee OA and parameters such as lateral plateau widening (LPW), proximal fibula curvature (PFC), and fibula height (FH). METHODS The study retrospectively analyzed 1072 subjects who underwent standard radiography for diagnosing or evaluating symptomatic knee joint disease. The 163 Kellgren and Lawrence (K-L) grades 0 and I knees were categorized into the no-knee-OA group, and the 909 K-L grades II-IV knees were classified into the knee-OA group. Medial proximal tibial angle, joint line convergence angle, hip-knee-ankle angle, LPW, PFC, and FH were measured. T tests and chi-square tests were used to compare each index between the two groups. Binary logistic regression was performed to examine the correlation between indexes and knee OA occurrence. Ordinal logistic analysis, principal component analysis, and multivariable linear regression analysis were performed to examine the correlations between the three lateral parameters and K-L grades and the degree of varus deformity. RESULTS LPW and PFC were significantly greater and FH was significantly smaller in the knee-OA group than in the no-knee-OA group. LPW, PFC, and FH were correlated with knee OA occurrence. One principal component, named the comprehensive principal component score of varus deformity, was extracted from the three indexes, and the total variance of the principal component interpretation was 76.60%. Ordinal logistics and multivariable linear regression analysis showed that, after adjusting for age and BMI, LPW and PFC were positively correlated with K-L grading and varus deformity. FH was significantly and negatively correlated with K-L grading and varus deformity (all P < 0.05). CONCLUSIONS Regular morphological changes take place in the lateral knee with varus OA, including lateral dislocation of the tibial plateau, proximal fibula bending, and upward movement of the fibular head. Changes in LPW, PFC, and FH could enable a more comprehensive assessment of varus knee OA occurrence, severity, and deformity. Level of evidence Retrospective Study Level III.
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Affiliation(s)
- Wenru Ma
- Department of Sports Medicine, Affiliated Hospital of Qingdao University, 59 Haier Road, Laoshan District, QingDao, 266000, Shandong Province, China.,Department of Clinical Medicine, Qingdao University, Qingdao, Shandong Province, China
| | - Fengkun Wang
- Department of Sports Medicine, Affiliated Hospital of Qingdao University, 59 Haier Road, Laoshan District, QingDao, 266000, Shandong Province, China.,Department of Clinical Medicine, Qingdao University, Qingdao, Shandong Province, China
| | - Shengnan Sun
- Department of Clinical Medicine, Qingdao University, Qingdao, Shandong Province, China
| | - Lei Ding
- Department of Quality Management Evaluation, Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Lu Wang
- Department of Education and Training, Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Tengbo Yu
- Department of Sports Medicine, Affiliated Hospital of Qingdao University, 59 Haier Road, Laoshan District, QingDao, 266000, Shandong Province, China. .,Department of Orthopedics, Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China. .,Institute of Sports Medicine and Rehabilitation, Qingdao University, Qingdao, Shandong Province, China.
| | - Yi Zhang
- Department of Sports Medicine, Affiliated Hospital of Qingdao University, 59 Haier Road, Laoshan District, QingDao, 266000, Shandong Province, China. .,Department of Orthopedics, Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China. .,Shandong Institute of Traumatic Orthopedics, Qingdao, Shandong Province, China.
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Wang Z, Zheng Y, Meng D, Li H, Ji C, Wang J. Anatomical Imaging Study on Uneven Settlement of the Proximal Tibia. Orthop Surg 2022; 15:239-246. [PMID: 36519383 PMCID: PMC9837255 DOI: 10.1111/os.13632] [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: 08/21/2022] [Revised: 10/31/2022] [Accepted: 11/12/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Uneven settlement of the proximal tibia significantly contributes to the onset and progression of medial compartment knee OA; however, the specific location and variations of proximal tibial deformity remain unclear. Therefore, this study aimed to explore the effects of the anatomic morphology of different tibial regions on proximal tibial vara and proximal tibial microstructural changes with age in both sexes to reveal the pattern of uneven settlement of the proximal tibia. METHODS In this retrospective study, we reviewed the radiographs of 414 patients (789 legs) between May and September 2021. The medial proximal tibial angle (MPTA) and four anatomic angles of the tibia (i.e., the tibial plateau-epiphyseal line [PT-EL] angle, epiphyseal line-tibial platform [EL-PF] angle, epiphyseal axis inclination angle [EAIA], and subepiphyseal axis inclination angle [SAIA]) were measured. The effect of each angle on MPTA and their changes with age in both sexes were investigated using Pearson's correlation coefficient and multiple linear regression. RESULTS In females, PT-EL angle, EL-PF angle, and SAIA negatively correlated with MPTA (r = -0.325, -0.246, and -0.502; p < 0.05), and EAIA positively correlated with MPTA (r = 0.099, p < 0.05). Regression analysis showed that the correlations between MPTA and PT-EL angle, EL-PF angle, and SAIA were significant (β = -1.003, -0.013, and -0.971; adjusted R2 = 0.979). Furthermore, MPTA negatively correlated with age (r = -0.202, p < 0.05); PT-EL angle and EAIA positively correlated with age (r = 0.237 and 0.142, p < 0.05). Regression analysis showed that only the correlation between PT-EL angle and age was significant (β = 5.635, p < 0.05). In males, PT-EL angle, EL-PF angle, and SAIA negatively correlated with MPTA (r = -0.270, -0.267, and -0.533; p < 0.05), and EAIA positively correlated with MPTA (r = 0.135, p < 0.05). Regression analysis showed that the correlations between MPTA and PT-EL angle, EL-PF angle, and SAIA were significant (β = -0.992, -0.017, and -0.958; adjusted R2 = 0.970). However, there was no significant correlation between age and any of the measured angles (p > 0.05). CONCLUSIONS Proximal tibial vara is affected by the anatomic morphology of the epiphyseal and subepiphyseal regions. In females, the uneven settlement of the epiphysis progresses with age and may be responsible for dynamic varus deformity of the proximal tibia.
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Affiliation(s)
- Zhijie Wang
- Hebei Medical University Third Affiliated HospitalShijiazhuangChina
| | - Yi Zheng
- Hebei Medical University Third Affiliated HospitalShijiazhuangChina
| | - Decheng Meng
- Hebei Medical University Third Affiliated HospitalShijiazhuangChina
| | - Handi Li
- Hebei Medical University Third Affiliated HospitalShijiazhuangChina
| | - Chenni Ji
- Hebei Medical University Third Affiliated HospitalShijiazhuangChina
| | - Juan Wang
- Hebei Medical University Third Affiliated HospitalShijiazhuangChina
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Roney AR, Kraszewski AP, Demetracopoulos CA, Hillstrom HJ, Deland JT, de Cesar Netto C, Saito GH, Day J, Ellis SJ. Knee Kinetics and Kinematics in Patients With Ankle Arthroplasty and Ankle Arthrodesis. HSS J 2022; 18:408-417. [PMID: 35846266 PMCID: PMC9247585 DOI: 10.1177/15563316211007839] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 11/20/2020] [Indexed: 02/07/2023]
Abstract
Background: Previous literature suggests that patients treated with total ankle arthroplasty (TAA) versus ankle arthrodesis (AA) may have better function and lower risk for adjacent joint arthritis in the foot. Little is known on how these interventions affect proximal joints such as the knee. Questions: We sought to assess whether patients with TAA and AA exhibited altered biomechanics linked to the onset and progression of knee osteoarthritis (KOA). We used the knee adduction moment (KAM), a surrogate measure for the mechanical load experienced at the medial tibiofemoral compartment, because it is linked with the onset and progression of KOA. Methods: At a minimum of 2 years postoperatively, instrumented 3-dimensional walking gait was recorded in 10 TAA and 10 AA patients at self-selected walking speeds. TAA patients had either a Salto Talaris or INBONE prosthesis. Average first and second peak KAMs (Nm/kg), KAM impulse (Nm-s/kg), and range-of-motion (ROM, °) were calculated on both the affected and unaffected limbs for each patient. Results: There were no significant differences in the KAM's first and second peaks, impulse, or knee ROM in any plane between the unaffected and affected limbs, or between TAA and AA. Conclusion: TAA and AA may not meaningfully affect ipsilateral knee kinetics and KAMs in short-term follow-up. This study highlights the importance of continuing to study these parameters in larger cohorts of patients with longer follow-up to determine how our treatment of end-stage ankle arthritis may affect the incidence or progression of ipsilateral KOA.
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Affiliation(s)
- Andrew R. Roney
- Foot and Ankle Service, Hospital for
Special Surgery, New York, NY, USA
| | | | | | | | | | | | | | - Jonathan Day
- Foot and Ankle Service, Hospital for
Special Surgery, New York, NY, USA
| | - Scott J. Ellis
- Foot and Ankle Service, Hospital for
Special Surgery, New York, NY, USA,Scott J. Ellis, MD, Foot and Ankle Service,
Hospital for Special Surgery, 535 East 72nd St, 5th Floor, New York, NY 10021,
USA.
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6
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Xu X, Yang J, Li J, Yao D, Deng P, Chen B, Liu Y. Relationship between the height of fibular head and the incidence and severity of knee osteoarthritis. Open Med (Wars) 2022; 17:1330-1337. [PMID: 35937003 PMCID: PMC9307141 DOI: 10.1515/med-2022-0523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 12/04/2022] Open
Abstract
The purpose of this study was to investigate the correlation between fibular head height and the incidence and severity of osteoarthritis associated with varus knee deformity. The fibular head height, joint line convergence angle (JLCA) and medial proximal tibial angle (MPTA) were measured in a three-dimensional model. Ordinal multivariate logistic regression was used to analyze the correlation between fibular head height and Kellgren–Lawrence (K–L) grade. Pearson correlation was used to analyze the correlation between fibular head height and K–L grade. A total of 232 patients (232 knees) were finally included in the study. There were significant differences in JLCA and hip–knee–ankle angle (P < 0.05), and both JLCA and hip–knee–ankle angle increased with severe aggravation of K–L grade. Both fibular head height and MPTA decreased as the K–L grade was severely aggravated. There was a significant negative correlation between K–L grade and fibular head height (r = −0.812, P < 0.001). Furthermore, there was a significant negative correlation between fibular head height and hip–knee–ankle angle (r = −0.7905, P < 0.001). In addition to body mass index, fibular head height is a risk factor for the pathogenesis of osteoarthritis associated with varus knee deformity; the smaller the fibular head height, the more severe the degree of varus deformity.
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Affiliation(s)
- Xinghui Xu
- Department of Joint Orthopaedic, Baoji Hospital of Traditional Chinese Medicine , Baoji , Shaanxi, 721000 , China
| | - Jin Yang
- Department of Traumatology, Orthopedics Hospital, Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine , Shaanxi , China
| | - Jun Li
- Department of Joint Orthopaedic, Baoji Hospital of Traditional Chinese Medicine , Baoji , Shaanxi, 721000 , China
| | - Deping Yao
- Department of Radiology, Baoji Hospital of Traditional Chinese Medicine , Baoji , Shaanxi, 721000 , China
| | - Pan Deng
- Department of Joint Orthopaedic, The First Clinical Medical College, Guangzhou University of Chinese Medicine , Guangzhou , Guangdong 510405 , China
| | - Boliang Chen
- Department of Joint Orthopaedic, Baoji Hospital of Traditional Chinese Medicine , Baoji , Shaanxi, 721000 , China
| | - Yifei Liu
- Department of Joint Orthopaedic, Baoji Hospital of Traditional Chinese Medicine , Baoji , Shaanxi, 721000 , China
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7
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Rapagna S, Roberts BC, Solomon LB, Reynolds KJ, Thewlis D, Perilli E. Relationships between tibial articular cartilage, in vivo external joint moments and static alignment in end-stage knee osteoarthritis: A micro-CT study. J Orthop Res 2022; 40:1125-1134. [PMID: 34191337 DOI: 10.1002/jor.25140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/16/2021] [Accepted: 06/25/2021] [Indexed: 02/04/2023]
Abstract
Biomechanical factors (e.g., joint loading) have a significant role in the progression of osteoarthritis (OA). However, some relationships between in vivo joint loading indices and tibial cartilage thickness are conflicting. This study investigated relationships between pre-operative in vivo external knee joint moments, joint alignment and regional tibial cartilage thickness using micro-CT in subjects with end-stage knee OA. Tibial plateaus from 25 patients that underwent knee replacement for OA were micro-CT scanned (17 µm/voxel). Prior to surgery, subjects underwent gait analysis to calculate external knee moments. The mechanical axis deviation (MAD) was obtained from pre-operative radiographs. Cartilage thickness (Cart.Th) was analyzed from micro-CT images, in anteromedial, anterolateral, posteromedial and posterolateral subregions of interest. Medial-to-lateral Cart.Th ratios were also explored. Relationships between Cart.Th and joint loading indices were examined using Pearson's correlations. Significant correlations were found between Cart.Th and joint loading indices, positive anteromedially with the first peak knee adduction moment (r = 0.55, p < 0.01) and external rotation moment (ERM; r = 0.52, p < 0.01), and negative with MAD (r = -0.76, p < 0.001). In the lateral regions, these correlations had opposite signs. The medial-to-lateral Cart.Th ratio correlated strongly with ERM (r = 0.63, p = 0.001) and MAD (r = -0.75, p < 0.001). Joint loading indices correlated with regional cartilage thickness values and their medial-to-lateral ratios in end-stage knee OA subjects, with higher regional loads corresponding to thinner cartilage. These relationships have the opposite sign compared to the subchondral bone microarchitecture found in our previous study on the same specimens, which may suggest a complementary bone-cartilage interplay in response to loading.
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Affiliation(s)
- Sophie Rapagna
- Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia
| | - Bryant C Roberts
- Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia.,Department of Oncology & Metabolism and Insigneo Institute for in silico Medicine, The University of Sheffield, Sheffield, UK
| | - Lucian B Solomon
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia.,Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Karen J Reynolds
- Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia
| | - Dominic Thewlis
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia.,Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Egon Perilli
- Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia
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Elsheikh R, Makram AM, Makram OM, Tamer A, Hafez MA. Femoral bowing in the Arab population: A cross-sectional study and literature review. TRANSLATIONAL RESEARCH IN ANATOMY 2022. [DOI: 10.1016/j.tria.2021.100160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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9
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Kikuchi N, Kanamori A, Kadone H, Okuno K, Hyodo K, Yamazaki M. Radiographic analysis using the hip-to-calcaneus line and its association with lower limb joint kinetics in varus knee osteoarthritis. Knee 2022; 35:142-148. [PMID: 35316776 DOI: 10.1016/j.knee.2022.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/23/2022] [Accepted: 03/07/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND This study aimed to (1) determine whether the hip to ankle (HA) line or hip to calcaneus (HC) line better reflects knee coronal plane kinetics, (2) to examine whether the HC line reflects ankle coronal plane kinetics, and (3) to evaluate the radiological and biomechanical aspects of ankle in varus knee osteoarthritis (OA). METHODS Full-length, postero-anterior radiographs (hip-to-calcaneus radiographs) were taken and gait analysis was performed in 21 varus knee OA patients. The %HA where the HA lines pass through the tibial plateau, and the %HC and the mechanical ankle joint axis point (MAJAP), where the HC line passes through the tibial plateau and tibial plafond, respectively, were calculated. Knee adduction angular impulse (KAAI) and ankle inversion angular impulse (AIAI) were collected as kinetic data. Finally, we divided the patients into two groups with and without ankle OA, and compared each parameter between both groups. RESULTS The %HA and %HC were correlated with KAAI (%HA; r = -0.68, P = 0.001, %HC; r = -0.81, P < 0.001, respectively) and MAJAP was correlated with AIAI (r = -0.55, P = 0.009). MAJAP was significantly smaller, and KAAI and AIAI were significantly larger in the ankle OA group. CONCLUSIONS Radiographic analysis using the HC line was more strongly correlated to knee joint kinetics than the HA line and was also correlated to ankle joint kinetics. Assessing lower limb alignment using the HC line could be useful to evaluate the knee and ankle joints for varus knee OA.
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Affiliation(s)
- Naoya Kikuchi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
| | - Akihiro Kanamori
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hideki Kadone
- Center for Cybernics Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kosuke Okuno
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kojiro Hyodo
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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10
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Pedersen JR, Skou ST, Roos EM, Shakoor N, Thorlund JB. Changes in medial-to-lateral knee joint loading patterns assessed by Dual-Energy X-ray Absorptiometry following supervised neuromuscular exercise therapy and patient education in patients with knee osteoarthritis: an exploratory cohort study. Physiother Theory Pract 2022; 39:1205-1214. [PMID: 35139736 DOI: 10.1080/09593985.2022.2036885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The mechanisms underlying pain reductions following exercise therapy in patients with knee osteoarthritis (OA) are poorly understood. One mechanism could be changes in mechanical knee joint loading. OBJECTIVE To investigate if a neuromuscular exercise therapy and patient education intervention could alter knee joint loading assessed by Dual-Energy X-ray Absorptiometry (DXA) in people with knee OA. METHODS Participants with symptomatic knee OA were evaluated before and 26 weeks after an 8-week supervised neuromuscular exercise therapy and patient education intervention (Good Life with OsteoArthritis in Denmark). DXA scans were used to estimate the medial-to-lateral tibial plateau bone mineral density (BMD) ratio. The Knee Injury and Osteoarthritis Outcome Score was used to assess improvements in knee pain, symptoms, physical function, and knee-related quality of life. Changes in physical function were assessed with the 30-second chair stand test and the 40-meter fast paced walk test. RESULTS Of 42 participants recruited, 30 (21 females, mean age 64 ± 7.9 years) had full data available. Medial-to-lateral tibial BMD ratio increased non-significantly by 0.02 (95% CI -0.01 to 0.06) (indicating higher medial load) from baseline to 26-weeks follow-up. Participants had statistically significant improvements of 21% in pain, 17% in symptoms, 14% in ADL, 17% in knee-related quality of life, 13% in chair stand ability, and 6% in walking speed. CONCLUSIONS In this exploratory cohort study, following an 8-weeks supervised exercise therapy and patient education intervention, the medial-to-lateral tibial BMD ratio did not seem to change.
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Affiliation(s)
- Julie Rønne Pedersen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Søren T Skou
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Ewa M Roos
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Najia Shakoor
- Department of Internal Medicine, Division of Rheumatology Rush University Medical Center, Chicago, IL, USA
| | - Jonas Bloch Thorlund
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
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11
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Han X, Cui J, Chu L, Zhang W, Xie K, Jiang X, He Z, Du J, Ai S, Sun Q, Wang L, Wu H, Yan M, Yu Z. Abnormal subchondral trabecular bone remodeling in knee osteoarthritis under the influence of knee alignment. Osteoarthritis Cartilage 2022; 30:100-109. [PMID: 34699993 DOI: 10.1016/j.joca.2021.10.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 08/06/2021] [Accepted: 10/13/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This study aimed to investigate the abnormal subchondral trabecular bone (STB) remodeling in knee osteoarthritis (OA) under the influence of knee alignment [hip-knee-ankle (HKA) angle]. DESIGN Forty-one patients with knee OA underwent radiographic examination before total knee arthroplasty (TKA) for the measurement of HKA angle. Tibial plateau specimens obtained during TKA were used for histomorphometric analyses to assess STB remodeling and cartilage degradation. Tartrate-resistant acidic phosphatase (TRAP) staining was used to test osteoclast activity. Osterix, osteocalcin, and sclerostin expression in the STB were determined using immunohistochemistry. RESULTS The interaction between HKA angle and side (medial vs lateral of tibial plateau) was the main significant influence factor for STB remodeling and microstructure. The STB with the deviation of the knee alignment was accompanied by obvious abnormal bone remodeling and microstructural sclerosis. Bone volume fraction (BV/TV) was the only significant influence factor for OARSI score, the larger the BV/TV of STB, the higher the OARSI score of cartilage. Moreover, the tibial plateau affected by alignment had more TRAP + osteoclasts, Osterix + osteoprogenitors, and osteocalcin + osteoblasts and fewer sclerostin + osteocytes. CONCLUSIONS The variation of tibial plateau STB remodeling activity and microstructure was associated with HKA angle and cartilage degradation. Knee malalignment may cause abnormal STB remodeling and microstructural sclerosis, which may potentially affect load stress transmission from the cartilage to the STB, thus resulting in accelerated knee OA progression.
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Affiliation(s)
- Xuequan Han
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Junqi Cui
- Department of Pathology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Linyang Chu
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China.
| | - Weituo Zhang
- Clinical Research Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - Kai Xie
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Xu Jiang
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Zihao He
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Jingke Du
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Songtao Ai
- Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Qi Sun
- Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Liao Wang
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Haishan Wu
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Mengning Yan
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Zhifeng Yu
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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12
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Anijs T, Eemers S, Minoda Y, Wolfson D, Verdonschot N, Janssen D. Computational tibial bone remodeling over a population after total knee arthroplasty: A comparative study. J Biomed Mater Res B Appl Biomater 2021; 110:776-786. [PMID: 34661334 PMCID: PMC9297982 DOI: 10.1002/jbm.b.34957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/20/2021] [Accepted: 10/05/2021] [Indexed: 11/19/2022]
Abstract
Periprosthetic bone loss is an important factor in tibial implant failure mechanisms in total knee arthroplasty (TKA). The purpose of this study was to validate computational postoperative bone response using longitudinal clinical DEXA densities. Computational remodeling outcome over a population was obtained by incorporating the strain‐adaptive remodeling theory in finite element (FE) simulations of 26 different tibiae. Physiological loading conditions were applied, and bone mineral density (BMD) in three different regions of interest (ROIs) was considered over a postoperative time of 15 years. BMD outcome was compared directly to previously reported clinical BMD data of a comparable TKA cohort. Similar trends between computational and clinical bone remodeling over time were observed in the two proximal ROIs, with most rapid bone loss taking place in the initial months after TKA and BMD starting to level in the following years. The extent of absolute proximal BMD change was underestimated in the FE population compared with the clinical subject group, which might be the result of significantly higher initial clinical baseline BMD values. Large differences in remodeling response were found in the distal ROI, in which resorption was measured clinically, but a large BMD increase was predicted by the FE models. Multiple computational limitations, related to the FE mesh, loading conditions, and strain‐adaptive algorithm, likely contributed to the extensive local bone formation. Further research incorporating subject‐specific comparisons using follow‐up CT scans and more extensive physiological knee loading is recommended to optimize bone remodeling more distal to the tibial baseplate.
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Affiliation(s)
- Thomas Anijs
- Orthopedic Research Laboratory, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Sanne Eemers
- Orthopedic Research Laboratory, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Yukihide Minoda
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - David Wolfson
- DePuy Synthes Joint Reconstruction, WW Research & Development, Leeds, UK
| | - Nico Verdonschot
- Orthopedic Research Laboratory, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.,Laboratory for Biomechanical Engineering, University of Twente, Faculty of Engineering Technology, Enschede, The Netherlands
| | - Dennis Janssen
- Orthopedic Research Laboratory, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
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13
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Rapagna S, Roberts BC, Solomon LB, Reynolds KJ, Thewlis D, Perilli E. Tibial cartilage, subchondral bone plate and trabecular bone microarchitecture in varus- and valgus-osteoarthritis versus controls. J Orthop Res 2021; 39:1988-1999. [PMID: 33241575 DOI: 10.1002/jor.24914] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 10/26/2020] [Accepted: 11/08/2020] [Indexed: 02/04/2023]
Abstract
This preliminary study quantified tibia cartilage thickness (Cart.Th), subchondral bone plate thickness (SBPl.Th) and subchondral trabecular bone (STB) microarchitecture in subjects with varus- or valgus- malaligned knees diagnosed with end-stage knee osteoarthritis (OA) and compared them to controls (non-OA). Tibial plateaus from 25 subjects with knee-OA (undergoing knee arthroplasty) and 15 cadavers (controls) were micro-CT scanned (17 µm/voxel). Joint alignment was classified radiographically for OA subjects (varus-aligned n = 18, valgus-aligned n = 7). Cart.Th, SBPl.Th, STB bone volume fraction (BV/TV) and their medial-to-lateral ratios were analyzed in anteromedial, anterolateral, posteromedial and posterolateral subregions. Varus-OA and valgus-OA were compared to controls. Compared to controls (1.19-1.54 mm), Cart.Th in varus-OA was significantly lower anteromedially (0.58 mm, -59%) and higher laterally (2.19-2.47 mm, +60-63%); in valgus-OA, Cart.Th was significantly higher posteromedially (1.86 mm, +56%). Control medial-to-lateral Cart.Th ratios were around unity (0.8-1.1), in varus-OA significantly below (0.2-0.6) and in valgus-OA slightly above (1.0-1.3) controls. SBPl.Th and BV/TV were significantly higher medially in varus-OA (0.58-0.72 mm and 37-44%, respectively) and laterally in valgus-OA (0.60-0.61 mm and 32-37%), compared to controls (0.26-0.47 mm and 18-37%). In varus-OA, the medial-to-lateral SBPl.Th and BV/TV ratios were above unity (1.4-2.4) and controls (0.8-2.1); in valgus-OA they were closer to unity (0.8-1.1) and below controls. Varus- and valgus-OA tibia differ significantly from controls in Cart.Th, SBPl.Th and STB microarchitecture depending on joint alignment, suggesting structural changes in OA may reflect differences in medial-to-lateral load distribution upon the tibial plateau. Here we identified an inverse relationship between cartilage thickness and underlying subchondral bone, suggesting a whole-joint response in OA to daily stimuli.
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Affiliation(s)
- Sophie Rapagna
- Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia
| | - Bryant C Roberts
- Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia.,Department of Oncology and Metabolism, Insigneo Institute for In Silico Medicine, The University of Sheffield, Sheffield, UK
| | - Lucian B Solomon
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia.,Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Karen J Reynolds
- Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia
| | - Dominic Thewlis
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia
| | - Egon Perilli
- Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia
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14
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Towards a Standard Approach to Assess Tibial Bone Loss Following Total Knee Arthroplasty. Clin Rev Bone Miner Metab 2021. [DOI: 10.1007/s12018-021-09276-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AbstractLong-term implant failure in the form of aseptic loosening and periprosthetic fracture is the most common cause of revision procedures in total knee arthroplasty (TKA). While early loosening can often be attributed to failure of primary fixation, late implant failure could be associated with loss of fixation secondary to bone resorption, as a result of stress shielding in the proximal tibia. This current review study was performed to identify the clinical effects of different implant-, patient-, and surgery-related biomechanical factors on TKA-related tibial bone loss in clinical reality. Implant-related factors considered were the fixation method, and the implant type, geometry, and stiffness. In terms of patient characteristics, the effects of age, sex, knee alignment, bone density, body weight, and activity level were analyzed. The clinical literature on these topics mostly concerned longitudinal radiographic studies investigating the effect of a single factor on changes in the proximal tibia over time using bone densitometry. Implant stiffness, implant geometry and knee alignment were the only factors consistently found to affect regional bone density changes over time. Each clinical study used its own specific study design, with different definitions used for the baseline density, time points of baseline and follow-up measurements, and regions of interest. Due to the differences in study design, direct comparison between the clinical impact of different biomechanical factors was not possible. Based on the findings over the densitometry studies, a standardized guideline was proposed to allow reliable comparison between consistently reported outcome of future radiographic TKA studies.
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15
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Thewlis D, Waters A, Solomon LB, Perilli E. Investigating in vivo knee volumetric bone mineral density and walking gait mechanics in healthy people. Bone 2021; 143:115662. [PMID: 32987197 DOI: 10.1016/j.bone.2020.115662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 09/15/2020] [Accepted: 09/22/2020] [Indexed: 10/23/2022]
Abstract
The aim of this study was to investigate if the distribution of subchondral volumetric bone mineral density (vBMD) from peripheral quantitative computed tomography (pQCT) is related to estimates of knee joint loads calculated during walking gait in healthy young people. We recruited 19 young (age 18-40 years) healthy people with no self-reported knee pain or pathology. For all participants we collected two forms of data: (1) pQCT data at 2% of tibia length (from the proximal joint line) using a Stratec XCT3000 scanner at 0.2 × 0.2 mm in plane resolution; and (2) indices of joint loading, specifically external joint moment, at the indexed knee during walking gait. Joint moments were calculated from motion capture and ground reaction force data. pQCT scans were performed immediately prior to gait analysis. A sub-group of 9 participants attended a second scanning session to establish the reproducibility of the pQCT workflow. vBMD was extracted for four sub-regions (anteromedial, anterolateral, posteromedial and posterolateral). Reproducibility of the pQCT workflow was good to excellent (ICCs 0.832-0.985) with minimal detectable differences ranging from 2.3-39.5 mg HA/cm3. Significant independent correlations were identified between the external rotation moment and the medial-to-lateral (r = 0.517), posteromedial-to-posterolateral (r = 0.627) and posteromedial-to-anterolateral (r = 0.518) vBMD ratios, and between the knee adduction moment and the medial-to-lateral (r = -0.476) and posteromedial-to-posterolateral (r = -0.497) vBMD ratios. There appear to be significant relationships between measures of vBMD from pQCT and indices of joint loading in healthy people. These data are the first to combine imaging at the resolution available with pQCT and indices of joint loading in the same cohort.
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Affiliation(s)
- Dominic Thewlis
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide 5000, Australia.
| | - Andrew Waters
- Adelaide Medical School, The University of Adelaide, Australia.
| | - Lucian B Solomon
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide 5000, Australia; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Australia.
| | - Egon Perilli
- Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia.
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16
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Association between knee alignment, osteoarthritis disease severity, and subchondral trabecular bone microarchitecture in patients with knee osteoarthritis: a cross-sectional study. Arthritis Res Ther 2020; 22:203. [PMID: 32887657 PMCID: PMC7487480 DOI: 10.1186/s13075-020-02274-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 07/20/2020] [Indexed: 01/19/2023] Open
Abstract
Background Knee osteoarthritis (OA) is a common disabling disease involving the entire joint tissue, and its onset and progression are affected by many factors. However, the current number of studies investigating the relationship between subchondral trabecular bone (STB), knee alignment, and OA severity is limited. We aimed to investigate the variation in tibial plateau STB microarchitecture in end-stage knee OA patients and their association with knee alignment (hip-knee-ankle, HKA, angle) and OA severity. Methods Seventy-one knee OA patients scheduled for total knee arthroplasty (TKA) underwent preoperative radiography to measure the HKA angle and Kellgren-Lawrence grade. Tibial plateaus collected from TKA were scanned using micro-computed tomography to analyze the STB microarchitecture. Histological sections were used to assess cartilage degeneration (OARSI score). Correlations between the HKA angle, OA severity (OARSI score, Kellgren-Lawrence grade), and STB microarchitecture were evaluated. Differences in STB microstructural parameters between varus and valgus alignment groups based on the HKA angle were examined. Results The HKA angle was significantly correlated with all STB microarchitecture parameters (p < 0.01). The HKA angle was more correlated with the medial-to-lateral ratios of the microarchitecture parameters than with the medial or lateral tibia plateaus. The HKA angle and all STB microarchitecture parameters are significantly correlated with both the OARSI score and Kellgren-Lawrence grade (p < 0.01). Conclusions The STB microarchitecture is associated with the HKA angle and OA severity. With the increase of the knee alignment deviation and OA severity, the STB of the affected side tibial plateau increased in bone volume, trabecular number, and trabecular thickness and decreased in trabecular separation.
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17
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Anijs T, Wolfson D, Verdonschot N, Janssen D. Population-based effect of total knee arthroplasty alignment on simulated tibial bone remodeling. J Mech Behav Biomed Mater 2020; 111:104014. [PMID: 32810653 DOI: 10.1016/j.jmbbm.2020.104014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/27/2020] [Accepted: 07/26/2020] [Indexed: 11/25/2022]
Abstract
Periprosthetic bone loss is an important factor in tibial implant failure mechanisms in total knee arthroplasty (TKA). The purpose of this study was to determine the effect of postoperative knee alignment and population variation on tibial bone remodeling, to assess long-term stability of a knee replacement. Strain-adaptive finite element (FE) remodeling simulations were conducted following kinematic and mechanical alignment of a cemented fixed-bearing implant after TKA; kinematic TKA alignment was assumed to be more consistent with the preoperative varus alignment, while mechanical alignment was defined according to the neutral mechanical axes. To account for the effect of tibial variation on the outcome, bone remodeling was considered over a population of 47 subjects. Bone mineral density (BMD) was analyzed over three regions of interest (ROIs); medial, lateral and distal. The two proximal ROIs showed an average decrease in BMD in both alignments after two years. Greater overall proximal bone loss was found in the mechanical postoperative knees in comparison with kinematically aligned implants. Bone resorption was also concentrated more medially in mechanical alignment: increased medial ROI bone loss was found in every subject compared to kinematic alignment; while in the lateral ROI, higher regional two-year BMD was found in 39 of the 47 cases (82.9%) following mechanical alignment. Two distinct remodeling pathways were identified over both alignments, based on the variance in density change over the population; displaying predominant bone apposition either around the distal tip of the keel or at the lateral cortex. This study demonstrates that correction of native varus alignment to neutral mechanical alignment leads to an increase in medial bone resorption. Large variation between specimens illustrates the benefit of population-based FE analyses over single model studies.
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Affiliation(s)
- Thomas Anijs
- Radboud University Medical Center, Radboud Institute for Health Sciences, Orthopaedic Research Laboratory, Nijmegen, the Netherlands.
| | - David Wolfson
- DePuy Synthes Joint Reconstruction, WW Research & Development, Leeds, UK
| | - Nico Verdonschot
- Radboud University Medical Center, Radboud Institute for Health Sciences, Orthopaedic Research Laboratory, Nijmegen, the Netherlands; University of Twente, Laboratory for Biomechanical Engineering, Faculty of Engineering Technology, Enschede, the Netherlands
| | - Dennis Janssen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Orthopaedic Research Laboratory, Nijmegen, the Netherlands
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18
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Wang S, Mo S, Chung RCK, Shull PB, Ribeiro DC, Cheung RTH. How foot progression angle affects knee adduction moment and angular impulse in people with and without medial knee osteoarthritis: a meta-analysis. Arthritis Care Res (Hoboken) 2020; 73:1763-1776. [PMID: 33242375 DOI: 10.1002/acr.24420] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 08/11/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate effects of foot progression angle (FPA) modification on the first and second peaks of external knee adduction moment (EKAM) and knee adduction angular impulse (KAAI) in individuals with and without medial knee osteoarthritis (OA) during level walking. METHODS PubMed, Embase, CINAHL, Web of Science and SPORTDiscus were searched from inception to February 2020 by two independent reviewers. Included studies compared FPA modification (toe-in or toe-out gait) interventions to lower EKAM and/or KAAI with natural walking. Studies were required to report the first or second peaks of EKAM or KAAI. RESULTS Sixteen studies were included and more than 85% of included patients were graded with Kellgren-Lawrence II-IV knee OA. Toe-in gait reduced the first EKAM peak (standard mean difference (SMD): -0.75; 95%CI: -1.05~-0.45) and KAAI (SMD: -0.46; 95%CI: -0.86~-0.07), while toe-out gait reduced the second EKAM peak (SMD: -1.04; 95%CI: -1.34~-0.75) in healthy individuals. For patients with knee OA, toe-out gait reduced the second EKAM peak (SMD: -0.53; 95%CI: -0.75~-0.31) and KAAI (SMD: -0.26; 95%CI: -0.49~-0.03) while toe-in gait did not affect both EKAM peaks and KAAI. CONCLUSION Discrepancy in biomechanical effects of FPA modification was demonstrated between individuals with and without medial knee OA. Compared with natural walking, both toe-in and toe-out gait may be more effective in lowering EKAM and KAAI in healthy individuals. Toe-out gait may reduce EKAM and KAAI in patients with mild to severe knee OA. There is insufficient data from patients with early-stage knee OA, indicating future research is required.
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Affiliation(s)
- Sizhong Wang
- Gait & Motion Analysis Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong.,Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, Otago, New Zealand
| | - Shiwei Mo
- Gait & Motion Analysis Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong.,Division of Sports Science and Physical Education, Shenzhen University, Shenzhen, Guangdong, People's Republic of China
| | - Raymond C K Chung
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Peter B Shull
- State Key Laboratory of Mechanical Systems and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Daniel C Ribeiro
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, Otago, New Zealand
| | - Roy T H Cheung
- Gait & Motion Analysis Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong.,School of Health Sciences, Western Sydney University, NSW, Australia, Penrith South
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19
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Miles C, Greene A. The effect of treatment with a non-invasive foot worn biomechanical device on subjective and objective measures in patients with knee osteoarthritis- a retrospective analysis on a UK population. BMC Musculoskelet Disord 2020; 21:386. [PMID: 32546226 PMCID: PMC7298846 DOI: 10.1186/s12891-020-03382-3] [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: 02/24/2020] [Accepted: 05/29/2020] [Indexed: 11/23/2022] Open
Abstract
Background Osteoarthritis is a major cause of pain and disability worldwide, therefore ways of treating this condition are paramount to a successful health system. The purpose of the study was to investigate the changes in spatial-temporal gait parameters and clinical measurements following treatment with a non-invasive foot-worn biomechanical device on patients with knee osteoarthritis within the UK. Methods A retrospective analysis was carried out on 455 patients with knee osteoarthritis. All patients were evaluated using a computerized gait test and two self-assessment questionnaires (WOMAC and SF-36) at baseline and after 3 and 6 months of treatment. The biomechanical device is a shoe-like device with convex pods under the sole that have the capability of changing foot centre of pressure and training neuromuscular control. The device was individually calibrated for each patient to minimise symptoms whilst walking and train neuromuscular control. Patients used the device for short periods during activities of daily living. Repeated measures statistical analyses were performed to compare differences over time. Results After 6 months of treatment significant improvements were seen in all gait parameters (p < 0.01). Specifically, gait velocity, step length and single limb support of the more symptomatic knee improved by 13, 7.8 and 3%, respectively. These were supported by significant improvements in pain, function and quality of life (48.6, 45.7 and 22% respectively; p < 0.001). A sub-group analysis revealed no baseline differences between those who were recommended joint replacement and those who were not. Both groups improved significantly over time (p < 0.05 for all). Conclusions Our results suggest that the personalised biomechanical treatment can improve gait patterns, pain, function and quality of life. It may provide an additional solution to managing UK patients suffering from knee osteoarthritis but needs to be tested in a controlled setting first.
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Affiliation(s)
- Christopher Miles
- Sport and Exercise Science Research Centre, Department of Life Sciences, University of Roehampton, 19 Conifer drive, Brentwood, London, CM14 5TZ, UK.
| | - Andrew Greene
- Sport and Exercise Science Research Centre, Department of Life Sciences, University of Roehampton, 19 Conifer drive, Brentwood, London, CM14 5TZ, UK
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20
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Ishii Y, Noguchi H, Sato J, Ishii H, Ishii R, Todoroki K, Ezawa N, Toyabe SI. Size of Medial Knee Osteophytes Correlates With Knee Alignment But Not With Coronal Laxity in Patients With Medial Knee Osteoarthritis. J Orthop Res 2020; 38:639-644. [PMID: 31709593 DOI: 10.1002/jor.24501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 10/25/2019] [Indexed: 02/04/2023]
Abstract
The severity of osteoarthritis (OA) has been related to osteophyte size. However, the effects on osteophyte size of repeated and increased loading associated with joint laxity and varus misalignment remain unclear. We investigated these relationships in patients with medial knee OA and compared the performances of computed tomography (CT) and radiography for assessing osteophyte parameters. We examined knee joint alignment on radiographs and knee laxity using arthrometry in 191 patients with medial knee OA who were undergoing total knee arthroplasty. We also measured femur and tibia osteophyte distance (largest perpendicular distance from the cortical line to outer margin of the osteophyte) using radiography and CT, osteophyte areas (largest area surrounded by the outer margin of an osteophyte) by CT and determined the locations of the osteophytes in the femur and tibia by CT. We then analyzed the correlations between the variables using Spearman's rank correlation tests. Osteophyte sizes in the femur and tibia as determined by radiography (distance) or CT (distance and area) were positively correlated with the degree of varus alignment but not with medial or lateral laxity. There was also a significant correlation between maximum osteophyte distances measured by radiography and CT. The greatest number and the largest osteophytes were located in the posterior third of the femur and middle third of the tibia, respectively. Osteophyte size was correlated with preoperative knee alignment but not with knee laxity in patients with medial knee OA. Osteophyte size can be evaluated using conventional radiography, without the need for CT. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:639-644, 2020.
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Affiliation(s)
- Yoshinori Ishii
- Ishii Orthopaedic & Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama, 361-0037, Japan
| | - Hideo Noguchi
- Ishii Orthopaedic & Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama, 361-0037, Japan
| | - Junko Sato
- Ishii Orthopaedic & Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama, 361-0037, Japan
| | - Hana Ishii
- School of Plastic Surgery, Kanazawa Medical University, 1-1 Daigaku Uchinada, Ishikawa, 920-0253, Japan
| | - Ryo Ishii
- Sado General Hospital, 161 Chikusa Sado, Niigata, 952-1209, Japan
| | - Koji Todoroki
- Ishii Orthopaedic & Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama, 361-0037, Japan
| | - Nobukazu Ezawa
- Ishii Orthopaedic & Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama, 361-0037, Japan
| | - Shin-Ichi Toyabe
- Niigata University Crisis Management Office, Niigata University Hospital, Niigata University Graduate School of Medical and Dental Sciences, 1 Asahimachi Dori Niigata, Niigata, 951-8520, Japan
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Lindsey B, Eddo O, Caswell SV, Prebble M, Cortes N. Reductions in peak knee abduction moment in three previously studied gait modification strategies. Knee 2020; 27:102-110. [PMID: 31806505 DOI: 10.1016/j.knee.2019.09.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 09/27/2019] [Accepted: 09/29/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND First peak internal knee abduction moment (KAM) has been associated with knee osteoarthritis. Gait modification including trunk lean, medial knee thrust, and toe-in gait have shown to reduce KAM. Due to heterogeneity between study designs, it remains unclear which strategy is most effective. We compared the effects of these modifications in healthy individuals to determine their effectiveness to reduce KAM, internal knee extension moment (KEM), and medial contact force (MCF). METHODS Twenty healthy individuals volunteered for this study (26.7 ± 4.7 years, 1.75 ± 0.1 m, 73.4 ± 12.4 kg). Using real-time biofeedback, we collected 10 trials for each modification using individualized gait parameters based on participants' baseline mean and standard deviation (SD). Two sizes of each modification were tested: 1-3 SD greater (toe-in and trunk lean) or lesser (knee adduction) than baseline for the first five trials and 3-5 SD greater or lesser than baseline for the last five trials. RESULTS A significant main effect was found for KAM and KEM (p < .001). All modifications reduced KAM from baseline by at least five percent; however, only medial knee thrust and small trunk lean resulted in significant KAM reductions. Only medial knee thrust reduced KEM from baseline. MCF was unchanged. CONCLUSION Medial knee thrust was superior to trunk lean and toe-in modifications in reducing KAM. Subsequent increases in KEM and variation in individual responses to modification suggests that future interventions should be individualized by type and magnitude to optimize KAM reductions and avoid detrimental effects.
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Affiliation(s)
- Bryndan Lindsey
- George Mason University, Sports Medicine Assessment, Research & Testing (SMART) Laboratory, Manassas, VA, United States of America
| | - Oladipo Eddo
- George Mason University, Sports Medicine Assessment, Research & Testing (SMART) Laboratory, Manassas, VA, United States of America
| | - Shane V Caswell
- George Mason University, Sports Medicine Assessment, Research & Testing (SMART) Laboratory, Manassas, VA, United States of America
| | - Matt Prebble
- George Mason University, Sports Medicine Assessment, Research & Testing (SMART) Laboratory, Manassas, VA, United States of America
| | - Nelson Cortes
- George Mason University, Sports Medicine Assessment, Research & Testing (SMART) Laboratory, Manassas, VA, United States of America; George Mason University, Department of Bioengineering, Fairfax VA, United States of America.
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22
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Wannop JW, Foreman T, Madden R, Stefanyshyn D. Influence of the composition of artificial turf on rotational traction and athlete biomechanics. J Sports Sci 2019; 37:1849-1856. [DOI: 10.1080/02640414.2019.1598923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- John William Wannop
- Human Performance Lab, Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Teague Foreman
- Human Performance Lab, Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Ryan Madden
- Human Performance Lab, Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Darren Stefanyshyn
- Human Performance Lab, Faculty of Kinesiology, University of Calgary, Calgary, Canada
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Ishii Y, Noguchi H, Sato J, Ishii H, Todoroki K, Toyabe SI. Association between bone mineral density distribution and various radiographic parameters in patients with advanced medial osteoarthritis of the knee. J Orthop Sci 2019; 24:686-692. [PMID: 30630770 DOI: 10.1016/j.jos.2018.12.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 10/16/2018] [Accepted: 12/19/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE Patients with severe osteoarthritis (OA) of the knee have changes in bone mineral density (BMD) of the distal femur and proximal tibia. Correlations between the medial-to-lateral BMD (M/L-BMD) ratio (which normalizes the potentially confounding effects of body size and sex on BMD) and radiographic parameters that indicate OA progression have not been adequately studied. The purpose of this study was to evaluate correlations between radiographic indicators of OA progression and femoral and tibial M/L-BMD ratios. METHODS A consecutive series of 182 knees in 156 patients with advanced medial knee OA who underwent total knee arthroplasty were included. We evaluated correlations between the femoral and tibial M/L-BMD ratios and various radiographic parameters, including tibiofemoral angle (TFA), mechanical axis angle (MAA), tibial coronal angle, tibiofemoral subluxation (%), load-bearing axis deviation at the tibial plateau (%), and medial and lateral laxity. RESULTS Univariate analyses using Spearman's correlation coefficient revealed significant positive correlations between femoral and tibial M/L-BMD ratios and both TFA and MAA and negative correlations with tibial coronal angle and load-bearing axis deviation. Multivariate analyses showed significant associations between TFA and the femoral M/L-BMD ratio (β = 0.434, p < 0.001) and between MAA and the tibial M/L-BMD ratio (β = 0.384, p < 0.001). CONCLUSION BMD distribution around the knee might be predictable with radiographic parameters such as the TFA for the femur and MAA for the tibia. The findings of this study provide in vivo data on the evaluation of preoperative femoral and tibial M/L-BMD ratios without dual-energy X-ray absorptiometry.
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Affiliation(s)
- Yoshinori Ishii
- Ishii Orthopaedic & Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama, 361-0037, Japan.
| | - Hideo Noguchi
- Ishii Orthopaedic & Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama, 361-0037, Japan.
| | - Junko Sato
- Ishii Orthopaedic & Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama, 361-0037, Japan.
| | - Hana Ishii
- Kouseiren Takaoka Hospital, 5-10 Eirakutyo Takaoka, Toyama, 933-8555, Japan.
| | - Koji Todoroki
- Ishii Orthopaedic & Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama, 361-0037, Japan.
| | - Shin-Ichi Toyabe
- Niigata University Crisis Management Office, Niigata University Hospital, Niigata University Graduate School of Medical and Dental Sciences, 1 Asahimachi Dori Niigata, Niigata, 951-8520, Japan.
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24
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Edd SN, Omoumi P, Andriacchi TP, Jolles BM, Favre J. Modeling knee osteoarthritis pathophysiology using an integrated joint system (IJS): a systematic review of relationships among cartilage thickness, gait mechanics, and subchondral bone mineral density. Osteoarthritis Cartilage 2018; 26:1425-1437. [PMID: 30056214 DOI: 10.1016/j.joca.2018.06.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 06/08/2018] [Accepted: 06/26/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To introduce an integrated joint system (IJS) model of joint health and osteoarthritis (OA) pathophysiology through a systematic review of the cross-sectional relationships among three knee properties (cartilage thickness, gait mechanics, and subchondral bone mineral density). METHODS Searches using keywords associated with the three knee properties of interest were performed in PubMed, Scopus, and Ovid databases. English-language articles reporting cross-sectional correlations between at least two knee properties in healthy or tibiofemoral OA human knees were included. A narrative synthesis of the data was conducted. RESULTS Of the 5600 retrieved articles, 13 were included, eight of which reported relationships between cartilage thickness and gait mechanics. The 744 tested knees were separated into three categories based on knee health: 199 healthy, 340 at-risk/early OA, and 205 late OA knees. Correlations between knee adduction moment and medial-to-lateral cartilage thickness ratios were generally positive in healthy, inconclusive in at-risk/early OA, and negative in late OA knees. Knee adduction moment was positively correlated with medial-to-lateral tibial subchondral bone mineral density ratios in knees of all health categories. One study reported a positive correlation between lateral tibial subchondral bone mineral density and femoral cartilage thickness in at-risk/early OA knees. CONCLUSIONS The correlations identified between knee properties in this review agreed with the proposed relationship-based IJS model of OA pathophysiology. Accordingly, the IJS model could provide insights into overcoming current barriers to developing disease-modifying treatments by considering multiple aspects of OA disease, aspects that could be assessed simultaneously at an in vivo system level.
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Affiliation(s)
- S N Edd
- Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne (UNIL), Department of Musculoskeletal Medicine (DAL), Swiss BioMotion Lab, Lausanne, Switzerland.
| | - P Omoumi
- Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne (UNIL), Department of Diagnostic and Interventional Radiology, Lausanne, Switzerland.
| | - T P Andriacchi
- Department of Mechanical Engineering, Stanford, CA, USA; Palo Alto Veterans Affairs, Palo Alto, CA, USA; Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA, USA.
| | - B M Jolles
- Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne (UNIL), Department of Musculoskeletal Medicine (DAL), Swiss BioMotion Lab, Lausanne, Switzerland; Ecole Polytechnique Fédérale de Lausanne (EPFL), Institute of Microengineering, Lausanne, Switzerland.
| | - J Favre
- Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne (UNIL), Department of Musculoskeletal Medicine (DAL), Swiss BioMotion Lab, Lausanne, Switzerland.
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Ishii Y, Noguchi H, Sato J, Ishii H, Todoroki K, Toyabe S. Medial and lateral laxity in knees with advanced medial osteoarthritis. Osteoarthritis Cartilage 2018; 26:666-670. [PMID: 29428318 DOI: 10.1016/j.joca.2018.01.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 01/19/2018] [Accepted: 01/31/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE An increase in coronal laxity is recognized as a risk factor for progression of knee osteoarthritis (OA). The purpose of this study was to evaluate coronal laxity, which was defined as the angular motion from the neutral, unloaded (baseline) position to the loaded position, in patients with advanced medial knee OA. METHOD Preoperative coronal laxity was assessed using radiographs in patients with medial knee OA undergoing total knee arthroplasty by applying a force of 150 N with an arthrometer. A consecutive series of 211 knees with OA and 40 normal control knees were examined. A knee with OA was defined as clinically "balanced" when the difference between medial and lateral laxity was 3° or less. Values are expressed as median [25th, 75th percentile]. RESULTS The laxity was 4° [3, 5] from the baseline on the medial side and 3° [2, 4] on the lateral side. The distribution of medial and lateral laxity indicated that 90% (189/211) of patients fell within 3°. The equivalence test showed that the medial and lateral laxity was similar, with an equivalence margin of 3° (P < 0.001). In the control knees, the laxity was 3° [2, 4] from the baseline on the medial side and 2° [2, 4] on the lateral side. The differences between the knees with advanced OA and the controls were significant (P = 0.005, medial; P = 0.006, lateral). CONCLUSION This study showed that a clinically balanced knee was maintained even in patients with advanced medial knee OA.
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Affiliation(s)
- Y Ishii
- Ishii Orthopaedic & Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama 361-0037, Japan.
| | - H Noguchi
- Ishii Orthopaedic & Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama 361-0037, Japan.
| | - J Sato
- Ishii Orthopaedic & Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama 361-0037, Japan.
| | - H Ishii
- Kouseiren Takaoka Hospital, 5-10 Eirakutyo Takaoka, Toyama 933-8555, Japan.
| | - K Todoroki
- Ishii Orthopaedic & Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama 361-0037, Japan.
| | - S Toyabe
- Niigata University Crisis Management Office, Niigata University Hospital, Niigata University Graduate School of Medical and Dental Sciences, 1 Asahimachi Dori Niigata, Niigata 951-8520, Japan.
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Roberts BC, Solomon LB, Mercer G, Reynolds KJ, Thewlis D, Perilli E. Relationships between in vivo dynamic knee joint loading, static alignment and tibial subchondral bone microarchitecture in end-stage knee osteoarthritis. Osteoarthritis Cartilage 2018; 26:547-556. [PMID: 29382604 DOI: 10.1016/j.joca.2018.01.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 01/11/2018] [Accepted: 01/18/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To study, in end-stage knee osteoarthritis (OA) patients, relationships between indices of in vivo dynamic knee joint loads obtained pre-operatively using gait analysis, static knee alignment, and the subchondral trabecular bone (STB) microarchitecture of their excised tibial plateau quantified with 3D micro-CT. DESIGN Twenty-five knee OA patients scheduled for total knee arthroplasty underwent pre-operative gait analysis. Mechanical axis deviation (MAD) was determined radiographically. Following surgery, excised tibial plateaus were micro-CT-scanned and STB microarchitecture analysed in four subregions (anteromedial, posteromedial, anterolateral, posterolateral). Regional differences in STB microarchitecture and relationships between joint loading and microarchitecture were examined. RESULTS STB microarchitecture differed among subregions (P < 0.001), anteromedially exhibiting highest bone volume fraction (BV/TV) and lowest structure model index (SMI). Anteromedial BV/TV and SMI correlated strongest with the peak external rotation moment (ERM; r = -0.74, r = 0.67, P < 0.01), despite ERM being the lowest (by factor of 10) of the moments considered, with majority of ERM measures below accuracy thresholds; medial-to-lateral BV/TV ratios correlated with ERM, MAD, knee adduction moment (KAM) and internal rotation moment (|r|-range: 0.54-0.74). When controlling for walking speed, KAM and MAD, the ERM explained additional 11-30% of the variations in anteromedial BV/TV and medial-to-lateral BV/TV ratio (R2 = 0.59, R2 = 0.69, P < 0.01). CONCLUSIONS This preliminary study suggests significant associations between tibial plateau STB microarchitecture and knee joint loading indices in end-stage knee OA patients. Particularly, anteromedial BV/TV correlates strongest with ERM, whereas medial-to-lateral BV/TV ratio correlates strongest with indicators of medial-to-lateral joint loading (MAD, KAM) and rotational moments. However, associations with ERM should be interpreted with caution.
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Affiliation(s)
- B C Roberts
- The Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia
| | - L B Solomon
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia
| | - G Mercer
- Department of Orthopaedic Surgery, Repatriation General Hospital, Daws Park, South Australia, Australia
| | - K J Reynolds
- The Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia
| | - D Thewlis
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia; Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - E Perilli
- The Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia.
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An intact fibula may contribute to allow early weight bearing in surgically treated tibial plateau fractures. Knee Surg Sports Traumatol Arthrosc 2018; 26:756-761. [PMID: 28255659 DOI: 10.1007/s00167-017-4428-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 01/03/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE The role of the proximal tibiofibular joint (PTFJ) in tibial plateau fractures is unknown. The purpose of this study was to assess, with finite-element (FE) calculations, differences in interfragmentary movement (IFM) in a split fracture of lateral tibial plateau, with and without intact fibula. It was hypothesized that an intact fibula could positively contribute to the mechanical stabilization of surgically reduced lateral tibial plateau fractures. METHODS A split fracture of the lateral tibial plateau was recreated in an FE model of a human tibia. A three-dimensional FE model geometry of a human femur-tibia system was obtained from the VAKHUM project database, and was built from CT images from a subject with normal bone morphologies and normal alignment. The mesh of the tibia was reconverted into a geometry of NURBS surfaces. The fracture was reproduced using geometrical data from patient radiographs, and two models were created: one with intact fibula and other without fibula. A locking screw plate and cannulated screw systems were modelled to virtually reduce the fracture, and 80 kg static body weight was simulated. RESULTS Under mechanical loads, the maximum interfragmentary movement achieved with the fibula was about 30% lower than without fibula, with both the cannulated screws and the locking plate. When the locking plate model was loaded, intact fibula contributed to lateromedial forces on the fractured fragments, which would be clinically translated into increased normal compression forces in the fractured plane. The intact fibula also reduced the mediolateral forces with the cannulated screws, contributing to stability of the construct. CONCLUSION This FE model showed that an intact fibula contributes to the mechanical stability of the lateral tibial plateau. In combination with a locking plate fixation, early weight bearing may be allowed without significant IFM, contributing to an early clinical and functional recovery of the patient.
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Lo GH, Merchant MG, Driban JB, Duryea J, Price LL, Eaton CB, McAlindon TE. Knee Alignment Is Quantitatively Related to Periarticular Bone Morphometry and Density, Especially in Patients With Osteoarthritis. Arthritis Rheumatol 2018; 70:212-221. [PMID: 28940779 DOI: 10.1002/art.40325] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 09/13/2017] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Static alignment influences knee loading and predicts osteoarthritis (OA) progression. Periarticular bone is important in dispersing forces across the knee, and there is substantial evidence for molecular crosstalk between cartilage and subchondral bone. The aim of this study was to evaluate the relationship between periarticular trabecular bone morphology and bone mineral density (BMD) and knee alignment in OA. METHODS This was a cross-sectional analysis of participants in the Osteoarthritis Initiative Bone Ancillary Study. Dual x-ray absorptiometry (DXA) was performed to measure tibial periarticular bone mineral density (paBMD). Magnetic resonance imaging of knee trabecular bone was performed to calculate the apparent bone volume fraction (aBVF), apparent trabecular number (aTbN), apparent trabecular spacing (aTbSp), and apparent trabecular thickness (aTbTh). Static alignment was assessed by measuring the hip-knee-ankle (HKA) angle on long-limb films. RESULTS The study group comprised 436 participants (mean ± SD age 65.4 ± 9.2 years, 46% female, mean ± SD body mass index 29.6 ± 4.6 kg/m2 ), 71% of whom had OA. Correlations between the HKA angle and medial:lateral paBMD, medial paBMD, aBVF, aTbN, aTbTh, and aTbSp were -0.63, -0.34, -0.29, -0.32, -0.22, and 0.30, respectively. More varus alignment was associated with higher medial:lateral paBMD, medial paBMD, aBVF, aTbN, aTbTh, and lower aTbSp. In OA knees, the results were more pronounced. In non-OA knees, the most consistent association was with medial:lateral paBMD. CONCLUSION Static alignment was associated with medial:lateral paBMD in all knees and with medial paBMD and trabecular morphometry in OA knees only. Aberrant knee loading may lead to increased relative subchondral bone density, which is partly related to a higher aBVF and a greater number of thicker trabeculae with smaller intertrabecular spacing. Knee DXA may be a useful early biomarker of knee OA.
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Affiliation(s)
- Grace H Lo
- Baylor College of Medicine and Houston VA Health Services Research & Development Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Medical Center, Houston, Texas
| | - Mehveen G Merchant
- Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | | | - Lori Lyn Price
- Tufts Medical Center and Tufts University, Boston, Massachusetts
| | - Charles B Eaton
- Memorial Hospital of Rhode Island and Alpert Medical School of Brown University, Pawtucket, Rhode Island
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Dell'Isola A, Smith SL, Andersen MS, Steultjens M. Knee internal contact force in a varus malaligned phenotype in knee osteoarthritis (KOA). Osteoarthritis Cartilage 2017; 25:2007-2013. [PMID: 28882753 DOI: 10.1016/j.joca.2017.08.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 08/23/2017] [Accepted: 08/26/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE Multiple phenotypes characterized by different disease mechanisms have been hypothesized to explain the large variability in the knee osteoarthritis (KOA) population. The purpose of this study was: to estimate and compare the medial and lateral knee compression forces (CF) during gait of three subgroups of KOA subjects characterized by different alignment and cartilage disruption patterns. METHODS A secondary data analysis was conducted on a sample of 39 KOA subjects and 18 controls (C). The patients were classified in the different groups according to the following criteria: Varus medial disease (VMD) (12): varus alignment and predominant medial cartilage degeneration Varus generalized disease (VGD) (17): varus alignment and cartilage degeneration that extends to the lateral compartment. Neutral alignment (NA) (10): neutral alignment. The total, medial and lateral CF corrected for body weight were estimated using an inverse dynamics model (AnyBody Modeling System, AnyBody Technology) during stance. RESULTS The impulse of the medial compressive force (MCF) (overall effect of the CF over the stance) was significantly higher (P < 0.01) in the VMD compared to all the other groups. Peak MCF was higher in the VMD compared to all the other groups, but the difference reached significance only when compared to the VGD group (P < 0.05). The results of the regression analysis showed a significant relationship in the VMD group between alignment and impulse of the MCF (R2 = 0.62; P < 0.01). This relationship disappears in the other groups. CONCLUSIONS These findings suggest the existence of a phenotype characterized by increased MCF.
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Affiliation(s)
- A Dell'Isola
- Institute of Applied Health Research/School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK.
| | - S L Smith
- Institute of Applied Health Research/School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK.
| | - M S Andersen
- Department of Mechanical, Manufacturing and Management Engineering, Aalborg University, Denmark.
| | - M Steultjens
- Institute of Applied Health Research/School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK.
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Ishii Y, Noguchi H, Sato J, Ishii H, Todoroki K, Toyabe SI. Association between body weight and proximal tibial bone mineral density after bilateral total knee arthroplasty. Knee 2017; 24:1153-1159. [PMID: 28803758 DOI: 10.1016/j.knee.2017.06.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 06/09/2017] [Accepted: 06/27/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Proximal tibial bone mineral density (BMD) has been studied for its potential impact on subsidence and loosening of the tibial component after total knee arthroplasty (TKA). However, no known studies of proximal tibial BMD after TKA have evaluated the effect of major impact factors such as body weight (BW), muscle strength, and level of activity. We aim to determine whether factors such as level of activity, quadriceps strength, BW, gender, age, and prosthetic design affect proximal tibial BMD over the mid- to long-term following TKA. METHODS We evaluated 36 patients (72 knees) who were undergoing bilateral TKA performed by a single surgeon. Median follow up time was 115months (range, 60-211months) for a minimum of five years. We measured BMD in the proximal tibia and used a hand-held dynamometer to measure quadriceps isometric strength, recording the maximum value of three measurements for each patient. RESULTS Univariate analyses using Spearman's correlation coefficient for continuous variables revealed a weak negative correlation between age and BMD (r=-0.316, P=0.007) and a moderate positive correlation between BW and BMD (r=0.430, P<0.001). However, no significant correlations were found between the other factors above and BMD for continuous and discrete variables. Based on multivariate analyses, only BW had a significant effect on BMD (β=0.342, P=0.003). CONCLUSIONS BW is the most impact factor on the proximal tibial BMD after mid- to long-term follow up TKA. Therefore, the management of BW may contribute to prevention of decline of tibial BMD for TKA patients owing to aging.
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Affiliation(s)
- Yoshinori Ishii
- Ishii Orthopaedic & Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama 361-0037, Japan.
| | - Hideo Noguchi
- Ishii Orthopaedic & Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama 361-0037, Japan
| | - Junko Sato
- Ishii Orthopaedic & Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama 361-0037, Japan
| | - Hana Ishii
- Kouseiren Takaoka Hospital, 5-10 Eirakutyo Takaoka, Toyama 933-8555, Japan
| | - Koji Todoroki
- Ishii Orthopaedic & Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama 361-0037, Japan
| | - Shin-Ichi Toyabe
- Niigata University Crisis Management Office, Niigata University Hospital, Niigata University Graduate School of Medical and Dental Sciences, 1 Asahimachi Dori Niigata, Niigata 951-8520, Japan
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Roberts BC, Solomon LB, Mercer G, Reynolds KJ, Thewlis D, Perilli E. Joint loading and proximal tibia subchondral trabecular bone microarchitecture differ with walking gait patterns in end-stage knee osteoarthritis. Osteoarthritis Cartilage 2017. [PMID: 28642164 DOI: 10.1016/j.joca.2017.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To (1) stratify patient subgroups according to their distinct walking gait patterns in end-stage knee osteoarthritis (OA); (2) compare measures of joint loading and proximal tibia subchondral trabecular bone (STB) microarchitecture among these gait subgroups. DESIGN Twenty-five knee OA patients undergoing total knee arthroplasty (TKA) had pre-operative gait analysis. Following surgery, excised tibial plateaus were micro-CT-scanned and STB microarchitecture analysed in four tibial condylar regions of interest. Peak knee moments were input to k-means cluster analysis, to identify subgroups with homogeneous gait patterns. Joint loading and STB microarchitecture parameters were compared among gait subgroups (Kruskal-Wallis, Bonferroni-corrected Mann-Whitney U tests). RESULTS Three gait subgroups were revealed: biphasics (n = 7), flexors (n = 9), counter-rotators (n = 9). Peak knee adduction moment (KAM) and KAM impulse were significantly higher (P < 0.05) in biphasics than in flexors and counter-rotators (KAM = -0.65, -0.40 and -0.21 Nm/kg, respectively), suggesting a higher medial-to-lateral tibiofemoral load ratio in biphasics. Interestingly, STB medial-to-lateral bone volume fraction (BV/TV) ratio was also significantly higher (more than double) in biphasics and flexors than in counter-rotators (2.24, 2.00 and 1.00, respectively), whereas in biphasics it was only 10% higher than in flexors and not significantly so. CONCLUSIONS Within the confines of the limited sample size, data suggests that different mechanisms between the biphasic and flexor gait subroups may generate comparable loads upon the tibial plateau and corresponding bony responses, despite significantly lower KAM indices in flexors. Hence, in flexor gait OA patients, conservative treatments designed to reduce KAM, may not be appropriate. Understanding joint loading among walking gait patterns and relationships to bone microarchitecture may aid at identifying/improving management of persons at risk for developing knee OA.
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Affiliation(s)
- B C Roberts
- The Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia
| | - L B Solomon
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia
| | - G Mercer
- Department of Orthopaedic Surgery, Repatriation General Hospital, Daws Park, South Australia, Australia
| | - K J Reynolds
- The Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia
| | - D Thewlis
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia; Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - E Perilli
- The Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia.
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Wannop JW, Killick A, Madden R, Stefanyshyn DJ. The influence of gearing footwear on running biomechanics. FOOTWEAR SCIENCE 2017. [DOI: 10.1080/19424280.2017.1342705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- John William Wannop
- Human Performance Lab, Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Anthony Killick
- Human Performance Lab, Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Ryan Madden
- Human Performance Lab, Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Darren J Stefanyshyn
- Human Performance Lab, Faculty of Kinesiology, University of Calgary, Calgary, Canada
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Yu X, Zhao L, Yu Z, Yu C, Bi J, Sun B, Cong H. Sivelestat sodium hydrate improves post-traumatic knee osteoarthritis through nuclear factor-κB in a rat model. Exp Ther Med 2017; 14:1531-1537. [PMID: 28810618 PMCID: PMC5526152 DOI: 10.3892/etm.2017.4684] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 03/10/2017] [Indexed: 12/15/2022] Open
Abstract
As a specific inhibitor of neutrophil elastase, sivelestat sodium hydrate has primarily been used in the treatment of acute lung injury caused by various factors since its approval in 2002. Sivelestat sodium hydrate also improves post-traumatic knee osteoarthritis (KOA), although its underlying mechanisms of action have yet to be elucidated. The aim of the current study was to determine if sivelestat sodium hydrate improves post-traumatic KOA through nuclear factor (NF)-κB in a rat model. Treatment with sivelestat sodium hydrate significantly inhibited the induction of structural changes and significantly increased the vertical episode count and ipsilateral static weight bearing of the joint in KOA rats (all P<0.01). Sivelestat sodium hydrate significantly inhibited tumor necrosis factor-α and interleukin-6 production, serum nitrite levels, inducible nitric oxide synthase protein expression and high mobility group box 1 (HMGB1) secretion in KOA rats compared with the model group (all P<0.01). Sivelestat sodium hydrate also significantly suppressed p50/p65 DNA binding activity and NF-κB and phosphorylated inhibitor of κB protein expression in the joints of KOA rats compared with the model group (all P<0.01). These results suggest that sivelestat sodium hydrate improves post-traumatic KOA through HMGB1 and NF-κB in rats.
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Affiliation(s)
- Xiaofeng Yu
- Department of Joint Surgery, Weihai Central Hospital, Weihai, Shandong 264400, P.R. China
| | - Lijun Zhao
- Department of Operating Theatre, Weihai Central Hospital, Weihai, Shandong 264400, P.R. China
| | - Zhiping Yu
- Department of Joint Surgery, Weihai Central Hospital, Weihai, Shandong 264400, P.R. China
| | - Changzheng Yu
- Department of Joint Surgery, Weihai Central Hospital, Weihai, Shandong 264400, P.R. China
| | - Jianfei Bi
- Department of Joint Surgery, Weihai Central Hospital, Weihai, Shandong 264400, P.R. China
| | - Binglong Sun
- Department of Joint Surgery, Weihai Central Hospital, Weihai, Shandong 264400, P.R. China
| | - Haibo Cong
- Department of Joint Surgery, Weihai Central Hospital, Weihai, Shandong 264400, P.R. China
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Whelton C, Thomas A, Elson DW, Metcalfe A, Forrest S, Wilson C, Holt C, Whatling G. Combined effect of toe out gait and high tibial osteotomy on knee adduction moment in patients with varus knee deformity. Clin Biomech (Bristol, Avon) 2017; 43:109-114. [PMID: 28237873 DOI: 10.1016/j.clinbiomech.2017.02.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 02/09/2017] [Accepted: 02/13/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Gait adaptations, including toe out gait, have been proposed as treatments for knee osteoarthritis. The clinical application of toe out gait, however, is unclear. This study aims to identify the changes in Knee adduction moment in varus knee deformity assessing toe out gait as an alternative to high tibial osteotomy, and if any change in dynamic loading persists post operatively, when anatomical alignment is restored. METHODS Three-dimensional motion analysis was performed on 17 patients with medial compartment knee osteoarthritis and varus deformity prior to undergoing high tibial osteotomy, 13 patients were assessed post-operatively, and results compared to 13 healthy controls. FINDINGS Pre-operatively, there was no significant difference between natural and toe out gait for measures of knee adduction moment. Post high tibial osteotomy, first (2.70 to 1.51% BW·h) and second peak (2.28 to 1.21% BW·h) knee adduction moment were significantly reduced, as was knee adduction angular impulse (1.00 to 0.52% BW·h·s), to a healthy level. Adopting toe out gait post-operatively reduced the second peak further to a level below that of healthy controls. INTERPRETATION Increasing the foot progression angle from 20° (natural) to 30° in isolation did not significantly alter the knee adduction moment or angular impulse. This suggests that adopting a toe out gait, in isolation, in an already high natural foot progression angle, is not of benefit. Adopting toe out gait post-operatively, however, resulted in a further reduction in the second peak to below that of the healthy control cohort, however, this may increase lateral compartment load.
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Affiliation(s)
- C Whelton
- Arthritis Research UK Biomechanics and Bioengineering Centre, Cardiff University, Cardiff, UK; Cardiff School of Engineering, Trevithick Building, Cardiff, UK
| | - A Thomas
- Arthritis Research UK Biomechanics and Bioengineering Centre, Cardiff University, Cardiff, UK; Cardiff School of Engineering, Trevithick Building, Cardiff, UK
| | - D W Elson
- Arthritis Research UK Biomechanics and Bioengineering Centre, Cardiff University, Cardiff, UK; Cardiff and Vale Orthopaedic Centre, University Hospital of Wales, Cardiff, UK
| | - A Metcalfe
- Arthritis Research UK Biomechanics and Bioengineering Centre, Cardiff University, Cardiff, UK; Cardiff School of Engineering, Trevithick Building, Cardiff, UK; Cardiff and Vale Orthopaedic Centre, University Hospital of Wales, Cardiff, UK
| | - S Forrest
- Arthritis Research UK Biomechanics and Bioengineering Centre, Cardiff University, Cardiff, UK; Cardiff School of Engineering, Trevithick Building, Cardiff, UK
| | - C Wilson
- Arthritis Research UK Biomechanics and Bioengineering Centre, Cardiff University, Cardiff, UK; Cardiff and Vale Orthopaedic Centre, University Hospital of Wales, Cardiff, UK
| | - C Holt
- Arthritis Research UK Biomechanics and Bioengineering Centre, Cardiff University, Cardiff, UK; Cardiff School of Engineering, Trevithick Building, Cardiff, UK
| | - G Whatling
- Arthritis Research UK Biomechanics and Bioengineering Centre, Cardiff University, Cardiff, UK; Cardiff School of Engineering, Trevithick Building, Cardiff, UK.
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Graf E, Wannop JW, Schlarb H, Stefanyshyn D. Effect of torsional stiffness on biomechanical variables of the lower extremity during running. FOOTWEAR SCIENCE 2017. [DOI: 10.1080/19424280.2016.1271365] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Eveline Graf
- School of Health Professions, Zürcher Hochschule für Angewandte Wissenschaften, Winterthur, Switzerland
| | - John William Wannop
- Human Performance Lab, Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Heiko Schlarb
- Adidas Innovation Team Adidas AG, Herzogenaurach, Germany
| | - Darren Stefanyshyn
- Human Performance Lab, Faculty of Kinesiology, University of Calgary, Calgary, Canada
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Ishii Y, Noguchi H, Sato J, Todoroki K, Ezawa N, Toyabe SI. Preoperative Periarticular Knee Bone Mineral Density in Osteoarthritic Patients Undergoing TKA. Open Orthop J 2016; 10:396-403. [PMID: 27583058 PMCID: PMC4995525 DOI: 10.2174/1874325001610010396] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 06/10/2016] [Accepted: 07/15/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Preoperative periarticular bone quality is affected by joint loading. The purpose of this study was to determine the periarticular bone mineral density of the knee joint of patients undergoing total knee arthroplasty, and whether the location of the load-bearing axis correlates with the measured bone mineral density. MATERIALS AND METHODS The bone mineral densities of the medial and lateral femoral condyles and the medial and lateral tibial condyles were analyzed in consecutive 116 osteoarthritic patients (130 knees) by dual energy x-ray absorptiometry. RESULTS The median bone mineral density values in the condyles were 1.138 in femoral medial, 0.767 in femoral lateral, 1.056 in tibial medial, and 0.714 in tibial lateral. The medial condyles showed significantly higher bone mineral densities than the lateral condyles in both the femur and tibia. In addition, the femoral medial showed significantly higher bone mineral density levels than the tibial medial, and the femoral lateral condyle had higher bone mineral density levels than the tibial lateral. The bone mineral density Medial/Lateral ratio was significantly negatively correlated with the location (tibial medial edge 0%, lateral edge 100%) of the load-bearing axis in the femur and tibia. CONCLUSION Preoperative bone mineral density values may provide against the changes in bone mineral density after total knee arthroplasty by reflecting the correlation with joint loading axis. These results help explain why total knee arthroplasty has such good long-term clinical outcomes with a low frequency of component loosening and periarticular fractures despite a high degree of postoperative bone loss.
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Affiliation(s)
| | - Hideo Noguchi
- Ishii Orthopaedic and Rehabilitation Clinic, Saitama, Japan
| | - Junko Sato
- Ishii Orthopaedic and Rehabilitation Clinic, Saitama, Japan
| | - Koji Todoroki
- Ishii Orthopaedic and Rehabilitation Clinic, Saitama, Japan
| | - Nobukazu Ezawa
- Ishii Orthopaedic and Rehabilitation Clinic, Saitama, Japan
| | - Shin-Ichi Toyabe
- Department of Medical Informatics, Niigata University Medical and Dental Hospital, Niigata, Japan
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Changes in the three-dimensional load-bearing axis after mobile-bearing total knee arthroplasty. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2016; 26:537-43. [PMID: 27100865 DOI: 10.1007/s00590-016-1772-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 03/28/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The purpose of this study was to assess changes in the three-dimensional (3D) load-bearing mechanical axis (LBMA) preoperatively and at 3 weeks and more than 1-year follow-up after total knee arthroplasty (TKA), and effects of the degree of constraint in the anteroposterior (AP) direction because of the retention of the posterior cruciate ligament (PCL) and the implant design on the changes in LBMA. METHODS We evaluated 157 knees from 131 patients, including 79 knees that received meniscal-bearing-type (PCL-retaining) and 78 knees that received rotating-platform-type (PCL-substituting) prostheses. Quantitative 3D computed tomography was used to assess changes in the location of the pre- and postoperative LBMA at the tibial plateau level. RESULTS Changes in the 3D axis were mainly found from medial to lateral and posterior to anterior in both implant designs with no significant differences. Change in the mediolateral (ML) direction was improved soon after TKA, but change in the AP direction improved more gradually over time. The different constraints in the AP direction because of the retention of the PCL and different implant designs did not affect the changes in the LBMA. CONCLUSIONS The LBMA in the AP direction more than 1 year postoperatively, as well as the LBMA in the ML direction at 3 weeks, appears to shift toward the location found in normal knees after TKA, regardless of the type of prosthetic constraint. These changes may be an important factor that influences the periarticular knee bone mineral density which load bearing may be related to. LEVEL OF EVIDENCE Level II, Prognostic study.
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Fixation of a split fracture of the lateral tibial plateau with a locking screw plate instead of cannulated screws would allow early weight bearing: a computational exploration. INTERNATIONAL ORTHOPAEDICS 2016; 40:2163-2169. [PMID: 26780714 DOI: 10.1007/s00264-015-3106-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 12/29/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To assess, with finite element (FE) calculations, whether immediate weight bearing would be possible after surgical stabilization either with cannulated screws or with a locking plate in a split fracture of the lateral tibial plateau (LTP). METHODS A split fracture of the LTP was recreated in a FE model of a human tibia. A three-dimensional FE model geometry of a human femur-tibia system was obtained from the VAKHUM project database, and was built from CT images from a subject with normal bone morphologies and normal alignment. The mesh of the tibia was reconverted into a geometry of NURBS surfaces. A split fracture of the lateral tibial plateau was reproduced by using geometrical data from patient radiographs. A locking screw plate (LP) and a cannulated screw (CS) systems were modelled to virtually reduce the fracture and 80 kg static body-weight was simulated. RESULTS While the simulated body-weight led to clinically acceptable interfragmentary motion, possible traumatic bone shear stresses were predicted nearby the cannulated screws. With a maximum estimation of about 1.7 MPa maximum bone shear stresses, the Polyax system might ensure more reasonable safety margins. CONCLUSIONS Split fractures of the LTP fixed either with locking screw plate or cannulated screws showed no clinically relevant IFM in a FE model. The locking screw plate showed higher mechanical stability than cannulated screw fixation. The locking screw plate might also allow full or at least partial weight bearing under static posture at time zero.
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Chen Y, Huang YC, Lu WW. Is subchondral bone mineral density associated with nocturnal pain in knee osteoarthritis patients? Osteoarthritis Cartilage 2015; 23:2297-2298. [PMID: 26162803 DOI: 10.1016/j.joca.2015.05.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 05/21/2015] [Indexed: 02/02/2023]
Affiliation(s)
- Y Chen
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The University of Hong Kong, Hong Kong; Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, USA.
| | - Y-C Huang
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The University of Hong Kong, Hong Kong.
| | - W W Lu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The University of Hong Kong, Hong Kong; Center for Human Tissue and Organs Degeneration and Shenzhen Key Laboratory of Marine Biomedical Materials, Shenzhen Institutes of Advanced Technology, CAS, China; Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, The University of Hong Kong Shenzhen Hospital, China.
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Burnett WD, Kontulainen SA, McLennan CE, Hazel D, Talmo C, Hunter DJ, Wilson DR, Johnston JD. Response to Letter to the Editor: 'Is subchondral bone mineral density associated with nocturnal pain in knee osteoarthritis patients?'. Osteoarthritis Cartilage 2015; 23:2299-2301. [PMID: 26162805 DOI: 10.1016/j.joca.2015.06.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 06/29/2015] [Indexed: 02/02/2023]
Affiliation(s)
- W D Burnett
- Division of Biomedical Engineering, University of Saskatchewan, Saskatoon, SK, Canada
| | - S A Kontulainen
- Division of Biomedical Engineering, University of Saskatchewan, Saskatoon, SK, Canada; College of Kinesiology, University of Saskatchewan, Saskatoon, SK, Canada
| | - C E McLennan
- Division of Research, New England Baptist Hospital, Boston, MA, USA
| | - D Hazel
- Division of Research, New England Baptist Hospital, Boston, MA, USA
| | - C Talmo
- Division of Research, New England Baptist Hospital, Boston, MA, USA
| | - D J Hunter
- Institute of Bone and Joint Research, University of Sydney, Sydney, NSW, Australia
| | - D R Wilson
- Department of Orthopaedics and Centre for Hip Health and Mobility, University of British Columbia and Vancouver Costal Health Research Institute, Vancouver, BC, Canada
| | - J D Johnston
- Division of Biomedical Engineering, University of Saskatchewan, Saskatoon, SK, Canada; Department of Mechanical Engineering, University of Saskatchewan, SK, Canada.
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Beckwée D, Vaes P, Shahabpour M, Muyldermans R, Rommers N, Bautmans I. The Influence of Joint Loading on Bone Marrow Lesions in the Knee: A Systematic Review With Meta-analysis. Am J Sports Med 2015; 43:3093-107. [PMID: 25634907 DOI: 10.1177/0363546514565092] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Bone marrow lesions (BMLs) are considered as predictors of pain, disability, and structural progression of knee osteoarthritis. The relationship between knee loading and BMLs is not yet completely understood. PURPOSE To summarize the available evidence regarding the relationship between joint loading and the prevalence and progression of BMLs in the tibiofemoral joint. STUDY DESIGN Meta-analysis. METHODS Three databases (PubMed, Web of Science, and The Cochrane Library) were systematically screened for studies encompassing BMLs and changes in knee loading. A methodological quality assessment was conducted, and a meta-analysis computing overall odds ratios (ORs) was performed where possible. RESULTS A total of 29 studies involving 7641 participants were included. Mechanical loading was categorized as body weight and composition, compartmental load, structural lesion, and physical activity. High compartmental loads and structural lesions increased the risk for BMLs (overall ORs ranging from 1.56 [95% CI, 1.13-2.15] to 8.2 [95% CI, 4.4-15.1]; P = .006). Body weight increased the risk for BMLs to a lesser extent (overall OR, 1.03; 95% CI, 1.01-1.05; P = .007). Contradictory results for the effect of physical activity on BMLs were found. CONCLUSION Augmented compartmental loads and structural lesions increased the risk of the presence or progression of BMLs. Body weight increased the risk for BMLs to a lesser extent. Contradictory results for the effect of physical activity on BMLs may be explained by a dose-response relationship, knee alignment, and structural lesions. CLINICAL RELEVANCE It has been shown that unloading the knee temporarily may induce beneficial effects on osteoarthritis-related structural changes. Therefore, an early recognition of BMLs in the aging athlete's knee may provide information to counter the onset and aggravation of symptomatic knee osteoarthritis by reducing the knee load.
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Affiliation(s)
- David Beckwée
- Department of Rehabilitation Sciences Research, Vrije Universiteit Brussel, Brussels, Belgium
| | - Peter Vaes
- Department of Rehabilitation Sciences Research, Vrije Universiteit Brussel, Brussels, Belgium
| | - Maryam Shahabpour
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Ronald Muyldermans
- Department of Rehabilitation Sciences Research, Vrije Universiteit Brussel, Brussels, Belgium
| | - Nikki Rommers
- Department of Rehabilitation Sciences Research, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ivan Bautmans
- Department of Frailty in Ageing Research, Vrije Universiteit Brussel, Brussels, Belgium
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Van Spil WE, Welsing PMJ, Bierma-Zeinstra SMA, Bijlsma JWJ, Roorda LD, Cats HA, Lafeber FPJG. The ability of systemic biochemical markers to reflect presence, incidence, and progression of early-stage radiographic knee and hip osteoarthritis: data from CHECK. Osteoarthritis Cartilage 2015; 23:1388-97. [PMID: 25819579 DOI: 10.1016/j.joca.2015.03.023] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Revised: 02/23/2015] [Accepted: 03/15/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To relate systemic biochemical markers of joint metabolism to presence, incidence, and progression of early-stage radiographic knee and/or hip osteoarthritis (OA). METHOD The cartilage markers uCTX-II, sCOMP, sPIIANP, and sCS846, bone markers uCTX-I, uNTX-I, sPINP, and sOC, and synovial markers sHA and sPIIINP were assessed by enzyme-linked immunosorbent assay or radioactive immunoassay in baseline samples of CHECK (Cohort Hip and Cohort Knee), a cohort study of early-stage symptomatic knee and/or hip OA. Knee and hip radiographs were obtained at baseline and 5-year follow-up. Presence of OA at baseline was defined as Kellgren and Lawrence (K&L) = 1 (maximum observed). Incidence of OA was defined as K&L = 0 at baseline and K&L ≥ 1 at 5-year follow-up. Progression of OA was defined as K&L = 1 at baseline and K&L ≥ 2 at 5-year follow-up. RESULTS Data were available for 801 subjects at baseline and for 723 subjects at both baseline and 5-year follow-up. Multiple cartilage and synovial markers showed positive associations with presence and progression of knee and hip OA and with incidence of hip OA, except for negative associations of uCTX-II and sCOMP with incidence of knee OA. uCTX-II and sCOMP showed multiple interactions with other biomarkers in their associations with knee and hip OA. Bone markers were positively associated with presence of radiographic knee OA, but negatively associated with progression of radiographic hip OA. CONCLUSION Especially metabolism in cartilage and synovial matrix appear to be of relevance in knee and hip OA. The role of bone metabolism appears to differ between knee and hip OA.
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Affiliation(s)
- W E Van Spil
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
| | - P M J Welsing
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
| | - S M A Bierma-Zeinstra
- Department of General Practice, Department of Orthopaedics, University Medical Center Rotterdam - Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - J W J Bijlsma
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
| | - L D Roorda
- Amsterdam Rehabilitation Research Center, Reade, PO Box 58271, 1040 HG, Amsterdam, The Netherlands.
| | - H A Cats
- Sint Maartenskliniek, PO Box 9011, 6500 GM, Nijmegen, The Netherlands.
| | - F P J G Lafeber
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
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Wannop JW, Stefanyshyn DJ. The effect of translational and rotational traction on lower extremity joint loading. J Sports Sci 2015; 34:613-20. [PMID: 26176985 DOI: 10.1080/02640414.2015.1066023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Previous studies have linked footwear traction to lower extremity non-contact injury; however, these studies mainly focussed on rotational traction exclusively. While studies have shown that increases in traction lead to increases in joint loading, represented by joint moments, these studies failed to determine how the individual components of rotational and translational traction affect joint loading. Therefore, this study investigated how each component of traction independently affects lower extremity joint loading. Traction testing was performed using a robotic testing machine on three shoes that had independent alterations of translational and rotational traction. All testing was conducted on a sample piece of artificial turf. Kinematic and kinetic data were then collected on 10 athletes performing two cutting movements in each shoe condition. As rotational and translational traction were independently altered, decreased rotational traction led to significant decreases in transverse and frontal plane joint loading at the ankle and knee joints, while increases in translational traction led to increases in frontal plane joint loading at the ankle and knee joints. Increases in joint loading in the transverse and frontal planes are one of the possible mechanisms of lower extremity non-contact injury. Both translational and rotational traction can independently alter the joint loading.
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Affiliation(s)
- John W Wannop
- a Human Performance Lab , University of Calgary , Calgary , Alberta , Canada
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Chang AH, Moisio KC, Chmiel JS, Eckstein F, Guermazi A, Prasad PV, Zhang Y, Almagor O, Belisle L, Hayes K, Sharma L. External knee adduction and flexion moments during gait and medial tibiofemoral disease progression in knee osteoarthritis. Osteoarthritis Cartilage 2015; 23:1099-106. [PMID: 25677110 PMCID: PMC4470726 DOI: 10.1016/j.joca.2015.02.005] [Citation(s) in RCA: 180] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 12/31/2014] [Accepted: 02/01/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Test the hypothesis that greater baseline peak external knee adduction moment (KAM), KAM impulse, and peak external knee flexion moment (KFM) during the stance phase of gait are associated with baseline-to-2-year medial tibiofemoral cartilage damage and bone marrow lesion progression, and cartilage thickness loss. METHODS Participants all had knee OA in at least one knee. Baseline peak KAM, KAM impulse, and peak KFM (normalized to body weight and height) were captured and computed using a motion analysis system and six force plates. Participants underwent MRI of both knees at baseline and 2 years later. To assess the association between baseline moments and baseline-to-2-year semiquantitative cartilage damage and bone marrow lesion progression and quantitative cartilage thickness loss, we used logistic and linear regressions with generalized estimating equations (GEE), adjusting for gait speed, age, gender, disease severity, knee pain severity, and medication use. RESULTS The sample consisted of 391 knees (204 persons): mean age 64.2 years (SD 10.0); BMI 28.4 kg/m(2) (5.7); 156 (76.5%) women. Greater baseline peak KAM and KAM impulse were each associated with worsening of medial bone marrow lesions, but not cartilage damage. Higher baseline KAM impulse was associated with 2-year medial cartilage thickness loss assessed both as % loss and as a threshold of loss, whereas peak KAM was related only to % loss. There was no relationship between baseline peak KFM and any medial disease progression outcome measures. CONCLUSION Findings support targeting KAM parameters in an effort to delay medial OA disease progression.
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Affiliation(s)
- A H Chang
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - K C Moisio
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - J S Chmiel
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - F Eckstein
- Institute of Anatomy, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria.
| | - A Guermazi
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA.
| | - P V Prasad
- Department of Radiology, NorthShore University HealthSystem, Evanston, IL, USA.
| | - Y Zhang
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - O Almagor
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - L Belisle
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - K Hayes
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - L Sharma
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Sepriano A, Roman-Blas JA, Little RD, Pimentel-Santos F, Arribas JM, Largo R, Branco JC, Herrero-Beaumont G. DXA in the assessment of subchondral bone mineral density in knee osteoarthritis--A semi-standardized protocol after systematic review. Semin Arthritis Rheum 2015; 45:275-83. [PMID: 26188773 DOI: 10.1016/j.semarthrit.2015.06.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 05/16/2015] [Accepted: 06/12/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Subchondral bone mineral density (sBMD) contributes to the initiation and progression of knee osteoarthritis (OA). Reliable methods to assess sBMD status may predict the response of specific OA phenotypes to targeted therapies. While dual-energy X-ray absorptiometry (DXA) of the knee can determine sBMD, no consensus exists regarding its methodology. OBJECTIVE Construct a semi-standardized protocol for knee DXA to measure sBMD in patients with OA of the knee by evaluating the varying methodologies present in existing literature. METHODS We performed a systematic review of original papers published in PubMed and Web of Science from their inception to July 2014 using the following search terms: subchondral bone, osteoarthritis, and bone mineral density. RESULTS DXA of the knee can be performed with similar reproducibility values to those proposed by the International Society for Clinical Densitometry for the hip and spine. We identified acquisition view, hip rotation, knee positioning and stabilization, ROI location and definition, and the type of analysis software as important sources of variation. A proposed knee DXA protocol was constructed taking into consideration the results of the review. CONCLUSIONS DXA of the knee can be reliably performed in patients with knee OA. Nevertheless, we found substantial methodological variation across previous studies. Methodological standardization may provide a foundation from which to establish DXA of the knee as a valid tool for identification of SB changes and as an outcome measure in clinical trials of disease modifying osteoarthritic drugs.
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Affiliation(s)
- Alexandre Sepriano
- Rheumatology Department, CHLO-Hospital Egas Moniz, Lisbon, Portugal; Chronic Diseases Study Center (CEDOC), NOVA Medical School, UNL, Lisbon, Portugal
| | - Jorge A Roman-Blas
- Bone and Joint Research Unit, IIS Fundación Jiménez Díaz, Universidad Autónoma, Av. Reyes Católicos 2, 28040 Madrid, Spain
| | - Robert D Little
- Bone and Joint Research Unit, IIS Fundación Jiménez Díaz, Universidad Autónoma, Av. Reyes Católicos 2, 28040 Madrid, Spain; Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia
| | - Fernando Pimentel-Santos
- Rheumatology Department, CHLO-Hospital Egas Moniz, Lisbon, Portugal; Chronic Diseases Study Center (CEDOC), NOVA Medical School, UNL, Lisbon, Portugal
| | - Jose María Arribas
- Bone and Joint Research Unit, IIS Fundación Jiménez Díaz, Universidad Autónoma, Av. Reyes Católicos 2, 28040 Madrid, Spain
| | - Raquel Largo
- Bone and Joint Research Unit, IIS Fundación Jiménez Díaz, Universidad Autónoma, Av. Reyes Católicos 2, 28040 Madrid, Spain
| | - Jaime C Branco
- Rheumatology Department, CHLO-Hospital Egas Moniz, Lisbon, Portugal; Chronic Diseases Study Center (CEDOC), NOVA Medical School, UNL, Lisbon, Portugal
| | - Gabriel Herrero-Beaumont
- Bone and Joint Research Unit, IIS Fundación Jiménez Díaz, Universidad Autónoma, Av. Reyes Católicos 2, 28040 Madrid, Spain.
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Staged medial opening wedge high tibial osteotomy for bilateral varus gonarthrosis: biomechanical and clinical outcomes. Knee Surg Sports Traumatol Arthrosc 2014; 22:2672-81. [PMID: 23760039 DOI: 10.1007/s00167-013-2559-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 05/29/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE (1) To evaluate the effect of staged bilateral medial opening wedge high tibial osteotomy (HTO) on established biomechanical risk factors for disease progression and on validated measures of pain and function and (2) To compare outcomes in patients having the second surgery staged within or beyond 12 months of the first surgery. METHODS Thirty-seven patients with bilateral varus alignment and medial compartment osteoarthritis underwent staged bilateral medial opening wedge HTO (21 within and 16 beyond 12 months). Patients underwent full-limb standing anteroposterior radiographs to determine frontal plane alignment (mechanical axis angle) and three-dimensional gait analysis to estimate the distribution of load across the tibiofemoral compartments (external knee adduction moment). Patients also completed the Knee Injury and Osteoarthritis Outcomes Scores (KOOS), the Lower Extremity Functional Scale, the Short Form Health Survey and the six-minute walk test (6MWT). Patients (both limbs) were evaluated before and approximately 6, 12 and 24 months after each surgery. RESULTS There were statistically and clinically significant changes in both limbs that were of similar magnitudes and that remained relatively stable over time postoperatively. Mean (95% CI) improvements in outcomes were as follows. Mechanical axis angle: 9.4° (8.4°, 10.4°) (i.e. average change of both limbs), peak knee adduction moment: -1.7%BW*Ht (-2.1, -1.4 %BW*Ht) (i.e. average change of both limbs), 6MWT: 36.7 m (19.4, 54.0 m), SF-12 Physical Component Summary: 12.0 (8.5, 15.5) and KOOS Pain: 25.4 (19.6, 31.2). Other than the shorter time period to reach maximum benefit of both surgeries, there were no remarkable differences at final assessment between patients having surgeries staged within or beyond 12 months. CONCLUSIONS The present findings demonstrate that patients with bilateral varus gonarthrosis experience marked improvements in established biomechanical risk factors for disease progression bilaterally (mechanical axis angles and external knee adduction moments), as well as clinically important improvements in patient-important outcomes, after staged medial opening wedge HTO. Current findings suggest no difference in outcomes for patients who have the second surgery staged within or beyond 12 months of the first surgery. LEVEL OF EVIDENCE IV.
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Bout-Tabaku S, Shults J, Zemel BS, Leonard MB, Berkowitz RI, Stettler N, Burnham JM. Obesity is associated with greater valgus knee alignment in pubertal children, and higher body mass index is associated with greater variability in knee alignment in girls. J Rheumatol 2014; 42:126-33. [PMID: 25362652 DOI: 10.3899/jrheum.131349] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE In adults, osteoarthritis (OA) is associated with obesity and knee alignment. Whether knee alignment differences develop during childhood and are associated with obesity is unknown. We assessed the distribution of knee alignment in children and adolescents, and determined how knee alignment differs between obese and nonobese children. METHODS This cross-sectional study examined knee alignment in 155 healthy weight and 165 obese subjects. Knee alignment [metaphyseal-diaphyseal angle (MDA) and anterior tibiofemoral angle (ATFA)] and fat mass were measured using whole body dual-energy X-ray absorptiometry (DEXA). National reference data were used to generate age- and sex-specific body mass index (BMI, kg/m(2)) Z-scores. Multivariable linear regression was used to identify independent factors associated with ATFA and MDA. RESULTS The mean MDA and ATFA were similar between obese and nonobese subjects. In stratified analyses, females had greater variability in MDA and ATFA values (p < 0.001 and p = 0.04, respectively) at higher BMI Z-scores. Compared with healthy weight controls, obese subjects had less valgus of the MDA prior to the onset of puberty (+ 2.0°, p = 0.001), but had greater valgus at later pubertal stages (-1.9°, p = 0.01). CONCLUSION We found significantly greater variability in knee alignment among females at higher BMI Z-scores, and greater valgus alignment in obese adolescents in late puberty. The major limitation is the use of DEXA for assessment of alignment, which needs validation against longstanding radiographs. Longitudinal studies are needed to determine whether childhood obesity is a risk factor for progressive malalignment that may predispose to pain and risk of early osteoarthritis.
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Affiliation(s)
- Sharon Bout-Tabaku
- From the Department of Pediatrics, Division of Rheumatology, Nationwide Children's Hospital; the Ohio State University College of Medicine, Columbus, Ohio; Department of Pediatrics, Division of Rheumatology, Division of Gastroenterology and Nutrition, Division of Nephrology, The Children's Hospital of Philadelphia; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; the Lewin Group, Falls Church, Virginia, USA.S. Bout-Tabaku, MD, MSc, Assistant Professor, Department of Pediatrics, Division of Rheumatology, Nationwide Children's Hospital, and the Ohio State University College of Medicine; J. Shults, PhD, Associate Professor of Biostatistics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, B.S. Zemel, PhD, Professor of Pediatrics, Department of Pediatrics, Division of Gastroenterology and Nutrition, The Children's Hospital of Philadelphia, and the University of Pennsylvania School of Medicine; M.B. Leonard, MD, MSCE, Professor of Pediatrics, Department of Pediatrics, Division of Nephrology, The Children's Hospital of Philadelphia, and the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine; R.I. Berkowitz, MD, Professor of Psychiatry, University of Pennsylvania School of Medicine; N. Stettler, MD, MSCE, Managing Consultant, the Lewin Group; J.M. Burnham, MD, MSCE, Associate Professor of Pediatrics, Department of Pediatrics, Division of Rheumatology, The Children's Hospital of Philadelphia, and the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine.
| | - Justine Shults
- From the Department of Pediatrics, Division of Rheumatology, Nationwide Children's Hospital; the Ohio State University College of Medicine, Columbus, Ohio; Department of Pediatrics, Division of Rheumatology, Division of Gastroenterology and Nutrition, Division of Nephrology, The Children's Hospital of Philadelphia; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; the Lewin Group, Falls Church, Virginia, USA.S. Bout-Tabaku, MD, MSc, Assistant Professor, Department of Pediatrics, Division of Rheumatology, Nationwide Children's Hospital, and the Ohio State University College of Medicine; J. Shults, PhD, Associate Professor of Biostatistics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, B.S. Zemel, PhD, Professor of Pediatrics, Department of Pediatrics, Division of Gastroenterology and Nutrition, The Children's Hospital of Philadelphia, and the University of Pennsylvania School of Medicine; M.B. Leonard, MD, MSCE, Professor of Pediatrics, Department of Pediatrics, Division of Nephrology, The Children's Hospital of Philadelphia, and the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine; R.I. Berkowitz, MD, Professor of Psychiatry, University of Pennsylvania School of Medicine; N. Stettler, MD, MSCE, Managing Consultant, the Lewin Group; J.M. Burnham, MD, MSCE, Associate Professor of Pediatrics, Department of Pediatrics, Division of Rheumatology, The Children's Hospital of Philadelphia, and the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine
| | - Babette S Zemel
- From the Department of Pediatrics, Division of Rheumatology, Nationwide Children's Hospital; the Ohio State University College of Medicine, Columbus, Ohio; Department of Pediatrics, Division of Rheumatology, Division of Gastroenterology and Nutrition, Division of Nephrology, The Children's Hospital of Philadelphia; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; the Lewin Group, Falls Church, Virginia, USA.S. Bout-Tabaku, MD, MSc, Assistant Professor, Department of Pediatrics, Division of Rheumatology, Nationwide Children's Hospital, and the Ohio State University College of Medicine; J. Shults, PhD, Associate Professor of Biostatistics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, B.S. Zemel, PhD, Professor of Pediatrics, Department of Pediatrics, Division of Gastroenterology and Nutrition, The Children's Hospital of Philadelphia, and the University of Pennsylvania School of Medicine; M.B. Leonard, MD, MSCE, Professor of Pediatrics, Department of Pediatrics, Division of Nephrology, The Children's Hospital of Philadelphia, and the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine; R.I. Berkowitz, MD, Professor of Psychiatry, University of Pennsylvania School of Medicine; N. Stettler, MD, MSCE, Managing Consultant, the Lewin Group; J.M. Burnham, MD, MSCE, Associate Professor of Pediatrics, Department of Pediatrics, Division of Rheumatology, The Children's Hospital of Philadelphia, and the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine
| | - Mary B Leonard
- From the Department of Pediatrics, Division of Rheumatology, Nationwide Children's Hospital; the Ohio State University College of Medicine, Columbus, Ohio; Department of Pediatrics, Division of Rheumatology, Division of Gastroenterology and Nutrition, Division of Nephrology, The Children's Hospital of Philadelphia; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; the Lewin Group, Falls Church, Virginia, USA.S. Bout-Tabaku, MD, MSc, Assistant Professor, Department of Pediatrics, Division of Rheumatology, Nationwide Children's Hospital, and the Ohio State University College of Medicine; J. Shults, PhD, Associate Professor of Biostatistics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, B.S. Zemel, PhD, Professor of Pediatrics, Department of Pediatrics, Division of Gastroenterology and Nutrition, The Children's Hospital of Philadelphia, and the University of Pennsylvania School of Medicine; M.B. Leonard, MD, MSCE, Professor of Pediatrics, Department of Pediatrics, Division of Nephrology, The Children's Hospital of Philadelphia, and the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine; R.I. Berkowitz, MD, Professor of Psychiatry, University of Pennsylvania School of Medicine; N. Stettler, MD, MSCE, Managing Consultant, the Lewin Group; J.M. Burnham, MD, MSCE, Associate Professor of Pediatrics, Department of Pediatrics, Division of Rheumatology, The Children's Hospital of Philadelphia, and the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine
| | - Robert I Berkowitz
- From the Department of Pediatrics, Division of Rheumatology, Nationwide Children's Hospital; the Ohio State University College of Medicine, Columbus, Ohio; Department of Pediatrics, Division of Rheumatology, Division of Gastroenterology and Nutrition, Division of Nephrology, The Children's Hospital of Philadelphia; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; the Lewin Group, Falls Church, Virginia, USA.S. Bout-Tabaku, MD, MSc, Assistant Professor, Department of Pediatrics, Division of Rheumatology, Nationwide Children's Hospital, and the Ohio State University College of Medicine; J. Shults, PhD, Associate Professor of Biostatistics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, B.S. Zemel, PhD, Professor of Pediatrics, Department of Pediatrics, Division of Gastroenterology and Nutrition, The Children's Hospital of Philadelphia, and the University of Pennsylvania School of Medicine; M.B. Leonard, MD, MSCE, Professor of Pediatrics, Department of Pediatrics, Division of Nephrology, The Children's Hospital of Philadelphia, and the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine; R.I. Berkowitz, MD, Professor of Psychiatry, University of Pennsylvania School of Medicine; N. Stettler, MD, MSCE, Managing Consultant, the Lewin Group; J.M. Burnham, MD, MSCE, Associate Professor of Pediatrics, Department of Pediatrics, Division of Rheumatology, The Children's Hospital of Philadelphia, and the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine
| | - Nicolas Stettler
- From the Department of Pediatrics, Division of Rheumatology, Nationwide Children's Hospital; the Ohio State University College of Medicine, Columbus, Ohio; Department of Pediatrics, Division of Rheumatology, Division of Gastroenterology and Nutrition, Division of Nephrology, The Children's Hospital of Philadelphia; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; the Lewin Group, Falls Church, Virginia, USA.S. Bout-Tabaku, MD, MSc, Assistant Professor, Department of Pediatrics, Division of Rheumatology, Nationwide Children's Hospital, and the Ohio State University College of Medicine; J. Shults, PhD, Associate Professor of Biostatistics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, B.S. Zemel, PhD, Professor of Pediatrics, Department of Pediatrics, Division of Gastroenterology and Nutrition, The Children's Hospital of Philadelphia, and the University of Pennsylvania School of Medicine; M.B. Leonard, MD, MSCE, Professor of Pediatrics, Department of Pediatrics, Division of Nephrology, The Children's Hospital of Philadelphia, and the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine; R.I. Berkowitz, MD, Professor of Psychiatry, University of Pennsylvania School of Medicine; N. Stettler, MD, MSCE, Managing Consultant, the Lewin Group; J.M. Burnham, MD, MSCE, Associate Professor of Pediatrics, Department of Pediatrics, Division of Rheumatology, The Children's Hospital of Philadelphia, and the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine
| | - Jon M Burnham
- From the Department of Pediatrics, Division of Rheumatology, Nationwide Children's Hospital; the Ohio State University College of Medicine, Columbus, Ohio; Department of Pediatrics, Division of Rheumatology, Division of Gastroenterology and Nutrition, Division of Nephrology, The Children's Hospital of Philadelphia; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; the Lewin Group, Falls Church, Virginia, USA.S. Bout-Tabaku, MD, MSc, Assistant Professor, Department of Pediatrics, Division of Rheumatology, Nationwide Children's Hospital, and the Ohio State University College of Medicine; J. Shults, PhD, Associate Professor of Biostatistics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, B.S. Zemel, PhD, Professor of Pediatrics, Department of Pediatrics, Division of Gastroenterology and Nutrition, The Children's Hospital of Philadelphia, and the University of Pennsylvania School of Medicine; M.B. Leonard, MD, MSCE, Professor of Pediatrics, Department of Pediatrics, Division of Nephrology, The Children's Hospital of Philadelphia, and the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine; R.I. Berkowitz, MD, Professor of Psychiatry, University of Pennsylvania School of Medicine; N. Stettler, MD, MSCE, Managing Consultant, the Lewin Group; J.M. Burnham, MD, MSCE, Associate Professor of Pediatrics, Department of Pediatrics, Division of Rheumatology, The Children's Hospital of Philadelphia, and the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine
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Wang H, Fleischli JE, Hutchinson ID, Zheng NN. Knee moment and shear force are correlated with femoral tunnel orientation after single-bundle anterior cruciate ligament reconstruction. Am J Sports Med 2014; 42:2377-85. [PMID: 25062662 DOI: 10.1177/0363546514541232] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Increasing evidence has shown that anatomic single-bundle anterior cruciate ligament reconstruction (ACLR) better restores normal knee kinematics and functionality than nonanatomic ACLR. Whether anatomic reconstruction results in better knee kinetics during daily activities has not been fully investigated. PURPOSE To assess the relationship between femoral tunnel angle and kinetic parameters of the knee joint during walking after single-bundle ACLR and to compare the radiographic and kinetic results of patients who underwent anatomic ACLR with those of patients who underwent nonanatomic ACLR. STUDY DESIGN Controlled laboratory study. METHODS Twenty-one patients who underwent unilateral ACLR were recruited, and 20 healthy subjects from a previous study were used as a control group. All surgical procedures were performed by a single surgeon, 11 using the transtibial (TT) technique and 10 using the anteromedial portal (AMP) technique. Femoral tunnel orientation was measured from posterior-to-anterior radiographs. Dynamic knee joint moments and shear forces during gait were evaluated using 3-dimensional motion analysis and inverse dynamics. Relationships between femoral tunnel angles and kinetic results were evaluated via linear regression. Results were compared between 2 ACLR groups and controls using 1-way analysis of variance. RESULTS Femoral tunnel angle had significant correlations with peak external knee flexion moment and posterior shear force during early stance. The TT group had a significantly smaller (more vertical) mean femoral tunnel angle (19.4° ± 4.1°) than the AMP group (36.4° ± 5.8°). Significant reductions were found in the normalized peak external knee flexion moment (TT, 0.15 ± 0.12 Nm/kg·m; AMP, 0.25 ± 0.12 Nm/kg·m; control, 0.25 ± 0.16 Nm/kg·m) (P = .032) and posterior shear force (TT, 0.64 ± 0.55 N/kg; AMP, 1.10 ± 0.58 N/kg; control, 1.35 ± 0.55 N/kg) (P = .024) in the TT group compared with controls, but not in the AMP group. Moreover, a significantly greater medial shear force was found in the TT group during the late stance phase (TT, 1.08 ± 0.32 N/kg; AMP, 0.89 ± 0.26 N/kg; control, 0.83 ± 0.22 N/kg) (P = .038). A greater peak external knee adduction moment was found in both ACL groups during the early stance phase (TT, 0.25 ± 0.07 Nm/kg·m; AMP, 0.25 ± 0.07 Nm/kg·m; control, 0.19 ± 0.05 Nm/kg·m) (P < .01). CONCLUSION Knee joint kinetic changes are seen within months (~10 months) after ACLR. This study revealed significant relationships between femoral tunnel orientation and postoperative knee joint flexion moment and posterior shear force during walking. The AMP technique provides better restoration of these knee kinetic parameters compared with the TT technique at this postoperative time point. CLINICAL RELEVANCE The femoral tunnel angle measured from plain radiographs can be used as an important metric of postoperative knee joint kinetics. This information provides a better understanding of the knee joint's biomechanical environment after ACLR using commonly used single-bundle techniques.
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Affiliation(s)
- Hongsheng Wang
- Department of Mechanical Engineering and Engineering Science, University of North Carolina at Charlotte, Charlotte, North Carolina, USA Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
| | - James E Fleischli
- Sports Medicine Center, OrthoCarolina, Charlotte, North Carolina, USA
| | - Ian D Hutchinson
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
| | - Naiquan Nigel Zheng
- Department of Mechanical Engineering and Engineering Science, University of North Carolina at Charlotte, Charlotte, North Carolina, USA Center for Biomedical Engineering and Science, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
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Chang AH, Chmiel JS, Moisio KC, Almagor O, Zhang Y, Cahue S, Sharma L. Varus thrust and knee frontal plane dynamic motion in persons with knee osteoarthritis. Osteoarthritis Cartilage 2013; 21:1668-73. [PMID: 23948980 PMCID: PMC4014355 DOI: 10.1016/j.joca.2013.08.007] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 07/26/2013] [Accepted: 08/04/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Varus thrust visualized during walking is associated with a greater medial knee load and an increased risk of medial knee osteoarthritis (OA) progression. Little is known about how varus thrust presence determined by visual observation relates to quantitative gait kinematic data. We hypothesized that varus thrust presence is associated with greater knee frontal plane dynamic movement during the stance phase of gait. METHODS Participants had knee OA in at least one knee. Trained examiners assessed participants for varus thrust presence during ambulation. Frontal plane knee motion during ambulation was captured using external passive reflective markers and an 8-camera motion analysis system. To examine the cross-sectional relationship between varus thrust and frontal plane knee motion, we used multivariable regression models with the quantitative motion measures as dependent variables and varus thrust (present/absent) as predictor; models were adjusted for age, gender, body mass index (BMI), gait speed, and knee static alignment. RESULTS 236 persons [mean BMI: 28.5 kg/m(2) (standard deviation (SD) 5.5), mean age: 64.9 years (SD 10.4), 75.8% women] contributing 440 knees comprised the study sample. 82 knees (18.6%) had definite varus thrust. Knees with varus thrust had greater peak varus angle and greater peak varus angular velocity during stance than knees without varus thrust (mean differences 0.90° and 6.65°/s, respectively). These patterns remained significant after adjusting for age, gender, BMI, gait speed, and knee static alignment. CONCLUSION Visualized varus thrust during walking was associated with a greater peak knee varus angular velocity and a greater peak knee varus angle during stance phase of gait.
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Affiliation(s)
- Alison H. Chang
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Joan S. Chmiel
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Kirsten C. Moisio
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Orit Almagor
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Yunhui Zhang
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - September Cahue
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Leena Sharma
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Boudenot A, Pallu S, Toumi H, Loiseau Peres S, Dolleans E, Lespessailles E. Tibial subchondral bone mineral density: sources of variability and reproducibility. Osteoarthritis Cartilage 2013; 21:1586-94. [PMID: 23887081 DOI: 10.1016/j.joca.2013.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 07/04/2013] [Accepted: 07/13/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVES It has been shown that subchondral bone mineral density (sBMD) measurement may be a relevant parameter of osteoarthritis (OA) progression. However, factors implicating the reproducibility and contributing to the variability of the measurement have not been fully described. Thus, the aim of this study was to explore the reproducibility of sBMD by Dual energy X-ray Absorptiometry (DXA) and to further examine its sources of variability. METHODS In this study, short-term, intra and inter-observer reproducibility of sBMD was examined on knee images obtained on DXA scans. The influence of software (lumbar spine and forearm modes), knee positioning (flexion or extension), site and size of regions of interest (ROI) and use of rice, on both lateral and medial tibial sBMD, were assessed. Root mean square coefficient of variation (RMS CV) and least significant changes (LSC) were calculated. RESULTS The short-term precision of sBMD ranged between 2.24% and 5.12% for RMS CV and between 0.053 and 0.135 g/cm(2) for LSC. Good intra-observer precision was found for knee flexion conditions whatever the software used (RMS CV ranging from 0.43 to 1.41%). The reproducibility was dependant from the ROI size (the ROI including joint space exhibiting better precision results than ROI including solely the subchondral plate). For a constant size of the ROI, the precision results were site-dependant. Inter-observer RMS CV results ranged from 0.59 to 5.01% according to ROI and software used. For the specific task of monitoring medial sBMD in the ROI including solely subchondral plate, forearm flexion condition produced the highest intra-observer and short-term precision (respectively RMS CV: 0.45% and 2.77%; LSC: 0.013 and 0.080 g/cm(2)). CONCLUSION Taking account into the excellent precision of the sBMD measurements expressed as RMS CV with the protocol proposed in the present study, clinical application of these measurements might be envisaged.
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Affiliation(s)
- A Boudenot
- EA 4708, Imagerie Multimodale, Multiéchelles et Modélisation du Tissu Osseux et articulaire (I3MTO), Université d'Orléans, Orléans, France.
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