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Eckstein F, Wirth W, Putz R. Sexual dimorphism in articular tissue anatomy - Key to understanding sex differences in osteoarthritis? Osteoarthritis Cartilage 2024; 32:1019-1031. [PMID: 38871022 DOI: 10.1016/j.joca.2024.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 05/06/2024] [Accepted: 05/31/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVE Osteoarthritis (OA) prevalence and incidence varies between women and men, but it is unknown whether this follows sex-specific differences in systemic factors (e.g. hormones) and/or differences in pre-morbid joint anatomy. We recognize that classifications of sex within humans cannot be reduced to female/male, but given the lack of literature on non-binary individuals, this review is limited to the sexual dimorphism of articular morphotypes. METHODS Based on a Pubmed search using relevant terms, and input from experts, we selected articles based on the authors' judgment of their relevance, interest, originality, and scientific quality; no "hard" bibliometric measures were used to evaluate their quality or importance. Focus was on clinical rather than pre-clinical studies, with most (imaging) data being available for the knee joint. RESULTS After introducing "sexual dimorphism", the specific literature on articular morphotypes is reviewed, structured by: radiographic joint space width (JSW), meniscus, ligaments, articular cartilage morphology, articular cartilage composition and deformation, and articular tissue response to treatment. CONCLUSIONS Sex-specific differences were clearly observed for JSW, meniscus damage, ligament size, and cartilage morphometry (volume, thickness, and surface areas) but not for cartilage composition. Ligament and cartilage measures were smaller in women even after matching for confounders. Taken together, the findings indicate that female (knee) joints may be structurally more vulnerable and at greater risk of OA. The "one size/sex fits all" approach must be abandoned in OA research, and all observational and interventional studies should report their results for sex-specific strata, at least in pre-specified secondary or post-hoc analyses.
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MESH Headings
- Humans
- Female
- Male
- Cartilage, Articular/pathology
- Cartilage, Articular/diagnostic imaging
- Sex Characteristics
- Osteoarthritis, Knee/diagnostic imaging
- Osteoarthritis, Knee/pathology
- Knee Joint/diagnostic imaging
- Knee Joint/pathology
- Sex Factors
- Osteoarthritis/diagnostic imaging
- Osteoarthritis/pathology
- Menisci, Tibial/diagnostic imaging
- Menisci, Tibial/pathology
- Menisci, Tibial/anatomy & histology
- Radiography
- Ligaments, Articular/anatomy & histology
- Ligaments, Articular/pathology
- Ligaments, Articular/diagnostic imaging
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Affiliation(s)
- Felix Eckstein
- Research Program for Musculoskeletal Imaging, Center for Anatomy and Cell Biology, Paracelsus Medical University, Salzburg, Austria; Ludwig Boltzmann Institute for Arthritis and Rehabilitation (LBIAR), Paracelsus Medical University, Salzburg, Austria; Chondrometrics GmbH, Freilassing, Germany.
| | - Wolfgang Wirth
- Research Program for Musculoskeletal Imaging, Center for Anatomy and Cell Biology, Paracelsus Medical University, Salzburg, Austria; Ludwig Boltzmann Institute for Arthritis and Rehabilitation (LBIAR), Paracelsus Medical University, Salzburg, Austria; Chondrometrics GmbH, Freilassing, Germany
| | - Reinhard Putz
- Anatomische Anstalt, Ludwig Maximilians Universität München, Munich, Germany
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Lee DW, Lee DR, Kim MA, Cho SI, Lee JK, Kim JG. Patients with advanced lateral osteoarthritis can return to sports and work after distraction arthroplasty plus lateral meniscal allograft transplantation combined with cartilage repair. Knee Surg Sports Traumatol Arthrosc 2022; 30:1990-2002. [PMID: 35165755 DOI: 10.1007/s00167-022-06864-0] [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: 08/26/2021] [Accepted: 01/01/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE This study aimed to report return to sports (RTS) and return to work (RTW) outcomes after distraction arthroplasty (DA) plus lateral meniscal allograft transplantation (MAT) combined with cartilage repair in active patients with advanced osteoarthritis. It was hypothesised that DA combined with lateral MAT would improve clinical and radiological outcomes and enable RTS and RTW for most patients. METHODS In total, 21 patients with advanced osteoarthritis (moderate to severe joint space narrowing at lateral edge on Rosenberg view and large cartilage defect of lateral femoral condyle) who underwent concomitant DA and MAT were retrospectively reviewed. Clinical outcomes were assessed using subjective knee scores [Lysholm score, International Knee Documentation Committee (IKDC) subjective knee score, and Tegner activity scale (TAS)] and functional tests (isokinetic extensor muscle strength test, single-leg vertical jump test, and single-leg hop for distance test). The rates of RTS, RTW, and satisfaction were evaluated. Radiological outcomes were assessed using magnetic resonance imaging (MRI) and X-ray (Rosenberg view). RESULTS The mean age at surgery and mean follow-up duration were 37.2 ± 5.9 years and 37.1 ± 5.4 months, respectively. All improvements in subjective scores were statistically significant (p < 0.001). The Lysholm score improved from 58.3 ± 8.1 to 84.3 ± 8.2, the IKDC subjective score from 53.9 ± 10.4 to 78.0 ± 7.7, and the TAS from 4.0 ± 0.5 to 5.1 ± 0.8. The limb symmetry index (LSI) (%) of the extensor peak torque at an angular velocity of 60°/s improved from 67.3 ± 19.2 to 88.4 ± 20.3% (p = 0.001). The LSI of the single-leg vertical jump test and single-leg hop for distance test improved from 62.8 ± 21.3 to 87.7 ± 19.5% and from 63.9 ± 20.8 to 85.5 ± 18.1%, respectively (all, p < 0.001). All patients were able to return to any sports activity and work. However, 67% and 90.5% returned to their defined or desired level of sports activity and occupation intensity, respectively. Further, 76.2% were very satisfied or somewhat satisfied with the outcome at the last follow-up. The JSW increased by 0.8 ± 0.4 to 2.3 ± 0.6 mm (p = 0.005). In more than 90% of patients, > 50% of cartilage lesion was covered. The mean graft extrusion was 2.6 ± 1.0 mm. CONCLUSION All patients who underwent distraction arthroplasty plus lateral MAT combined with cartilage repair returned to any sports and work at the last follow-up. Significant improvements in clinical outcomes and the radiographic joint space width were observed. However, the activity ability was somewhat reduced compared with the best preoperative level. This one-stage joint salvage treatment is a promising option for young and active patients with advanced OA who wish to return to high levels of sports activity and occupation intensity (≥ Tegner activity scale 4). LEVEL OF EVIDENCE III.
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Affiliation(s)
- Dhong Won Lee
- Department of Orthopaedic Surgery, KonKuk University Medical Center, Konkuk University College of Medicine, Seoul, Korea
| | - Dong Ryun Lee
- Department of Orthopaedic Surgery, KonKuk University Medical Center, Konkuk University College of Medicine, Seoul, Korea
| | - Min Ah Kim
- Sports Medical Center, HanYang University Myongji Hospital, Goyang-si, Gyeonggi-do, Korea
| | - Seung Ik Cho
- Sports Medical Center, KonKuk University Medical Center, Seoul, Korea
| | - Joon Kyu Lee
- Department of Orthopaedic Surgery, KonKuk University Medical Center, Konkuk University College of Medicine, Seoul, Korea
| | - Jin Goo Kim
- Department of Orthopaedic Surgery, HanYang University Myongji Hospital, 55, Hwasu-ro 14 beon-gil, Deogyang-gu, Goyang-si, Gyeonggi-do, 10475, Republic of Korea.
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Jansen MP, Boymans TA, Custers RJ, Van Geenen RC, Van Heerwaarden RJ, Huizinga MR, Nellensteijn JM, Sollie R, Spruijt S, Mastbergen SC. Knee Joint Distraction as Treatment for Osteoarthritis Results in Clinical and Structural Benefit: A Systematic Review and Meta-Analysis of the Limited Number of Studies and Patients Available. Cartilage 2021; 13:1113S-1123S. [PMID: 32698704 PMCID: PMC8808886 DOI: 10.1177/1947603520942945] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE Knee joint distraction (KJD) is a joint-preserving osteoarthritis treatment that may postpone a total knee arthroplasty (TKA) in younger patients. This systematic review and meta-analysis evaluates short- and long-term clinical benefit and tissue structure changes after KJD. DESIGN MEDLINE, EMBASE, and Web of Science were searched for eligible clinical studies evaluating at least one of the primary parameters: WOMAC, VAS-pain, KOOS, EQ5D, radiographic joint space width or MRI cartilage thickness after KJD. Random effects models were applied on all outcome parameters and outcomes were compared with control groups found in the included studies. RESULTS Eleven articles reporting on 7 different KJD cohorts with in total 127 patients and 5 control groups with multiple follow-up moments were included, of which 2 were randomized controlled trials. Significant improvements in all primary parameters were found and benefit lasted up to at least 9 years. Overall, outcomes were comparable with control groups, including high tibial osteotomy, although TKA showed better clinical response. CONCLUSIONS Current, still limited, evidence shows KJD causes clear benefit in clinical and structural parameters, both short- and long-term. Longer follow-up with more patients is necessary, to validate outcome and to potentially improve patient selection for this intensive treatment. Thus far, for younger knee osteoarthritis patients, KJD may be an option to consider.
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Affiliation(s)
- Mylène P. Jansen
- Department of Rheumatology &
Clinical Immunology, University Medical Center Utrecht, Utrecht, Netherlands,Mylène P. Jansen, Department of Rheumatology
& Clinical Immunology, University Medical Center Utrecht, Heidelberglaan 100
(G02.228), Utrecht, 3584CX, The Netherlands.
| | - Tim A.E.J. Boymans
- Department of Orthopaedic Surgery,
Maastricht UMC, Maastricht, Netherlands
| | - Roel J.H. Custers
- Department of Orthopaedic Surgery,
University Medical Center Utrecht, Utrecht, Netherlands
| | | | | | | | - Jorm M. Nellensteijn
- Department of Orthopaedic Surgery,
Medisch Spectrum Twente, Enschede, Netherlands
| | - Rob Sollie
- Department of Orthopaedic Surgery,
Annatommie mc, Amstelveen/Utrecht, Netherlands
| | - Sander Spruijt
- Department of Orthopaedic Surgery,
HagaZiekenhuis, The Hague, Netherlands
| | - Simon C. Mastbergen
- Department of Rheumatology &
Clinical Immunology, University Medical Center Utrecht, Utrecht, Netherlands
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Jansen MP, Welsing PMJ, Vincken KL, Mastbergen SC. Performance of knee image digital analysis of radiographs of patients with end-stage knee osteoarthritis. Osteoarthritis Cartilage 2021; 29:1530-1539. [PMID: 34343678 DOI: 10.1016/j.joca.2021.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 06/10/2021] [Accepted: 07/24/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Knee Image Digital Analysis (KIDA) is standardized radiographic analysis software for measuring osteoarthritis (OA) characteristics. It was validated in mild OA, but used for severe OA as well. The current goal was to evaluate the performance of KIDA in severe OA. DESIGN Of 103 patients, standardized radiographs were performed before and one and 2 years after treatment for severe OA. All radiographs were evaluated on subchondral bone density, joint space width (JSW), osteophytes, eminence height, and joint angle, twice within years by the same observer. Part of the radiographs were randomly selected for reevaluation twice within 1 month and evaluation by another observer. The intraclass correlation coefficient (ICC), smallest detectable difference (SDD) and coefficient of variation (CV) were calculated; the SDD and CV were compared to those in mild OA. The relation of severity with KIDA parameters and with observer differences was calculated with linear regression. RESULTS Intra-observer ICCs were higher in the 98 severe radiographs reanalyzed within 1 month (all >0.8) than the 293 reanalyzed within years (all >0.5; most >0.8) and than inter-observer ICCs (all >0.7). SDDs and CVs were smaller when reanalyzed within a month and comparable to those in mild OA. Some parameters showed bias between readings. Severity showed significant relation with osteophytes and JSW parameters, and with the observer variation in these parameters (all P < 0.04). CONCLUSIONS KIDA is a well-performing tool also for severe OA. In order to decrease variability and SDDs, images should be analyzed in a limited time frame and randomized order.
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Affiliation(s)
- M P Jansen
- Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - P M J Welsing
- Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - K L Vincken
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - S C Mastbergen
- Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, the Netherlands.
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Ottenhoff JSE, Teunis T, Braakenburg A, Mink van der Molen AB. Can we decrease the duration of basal thumb joint distraction for early osteoarthritis from 8 to 6 weeks? Study protocol for a non-inferiority randomized controlled trial. Trials 2021; 22:316. [PMID: 33933152 PMCID: PMC8088687 DOI: 10.1186/s13063-021-05283-9] [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: 07/22/2020] [Accepted: 04/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To our knowledge, to date, 52 patients with thumb carpometacarpal osteoarthritis (CMC1 OA) were treated with joint distraction. So far, most patients experienced improved physical function and less pain. After 2 years, only 1 patient proceeded to trapeziectomy. This study assesses if we can safely lower the distraction duration from 8 to 6 weeks for CMC1 joint distraction, maintaining the improvement in physical function and pain. METHODS This is a monocenter randomized controlled non-inferiority trial that includes patients younger than 65 years of age with ongoing symptoms of CMC1 OA and an established indication for surgery. All patients will be treated with CMC1 joint distraction. The primary outcome is to assess whether 6 weeks of joint distraction is not inferior to 8 weeks in terms of physical function at 1 year after surgery. Secondary outcomes will identify differences between groups at 1 year in pain intensity, patient satisfaction, hand health status, adverse event rates, treatment failure, differences in thumb strength and range of motion, and radiographic changes. DISCUSSION If safe, the duration of basal thumb joint distraction can be reduced to 6 weeks, reducing patient burden. Because this is a relatively new treatment, this trial will provide greater knowledge of potential adverse events. This knowledge allows for more informed decision making for patients considering CMC1 distraction treatment. Future studies can directly compare joint distraction to other treatments of CMC1 joint arthritis like splinting and trapeziectomy. TRIAL REGISTRATION Central Committee on Research Involving Human Subjects (CCMO), NL68225.100.18; registered on 9 August 2019. Medical Research Ethics Committees United (MEC-U), R19.003; registered on 9 August 2019. Netherlands Trial Register, NL8016 ; registered on 15 September 2019.
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Affiliation(s)
- Janna S E Ottenhoff
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands.
| | - Teun Teunis
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands
| | - Assa Braakenburg
- Department of Plastic, Reconstructive and Hand Surgery, St. Antonius Hospital, Koekoekslaan 1, 3435, CM, Nieuwegein, The Netherlands
| | - Aebele B Mink van der Molen
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, St. Antonius Hospital, Koekoekslaan 1, 3435, CM, Nieuwegein, The Netherlands
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