Knee osteoarthritis, degenerative meniscal lesion and osteonecrosis of the knee: Can a simple gait test direct us to a better clinical diagnosis

Three-dimensional gait analysis of orthopaedic common foot and ankle joint diseases

Walking is an indispensable mode of transportation for human survival. Gait is a characteristic of walking. In the clinic, patients with different diseases exhibit different gait characteristics. Gait analysis describes the specific situation of human gait abnormalities by observing and studying the kinematics and dynamics of limbs and joints during human walking and depicting the corresponding geometric curves and values. In foot and ankle diseases, gait analysis can evaluate the degree and nature of gait abnormalities in patients and provide an important basis for the diagnosis of patients' diseases, the correction of abnormal gait and related treatment methods. This article reviews the relevant literature, expounds on the clinical consensus on gait, and summarizes the gait characteristics of patients with common ankle and foot diseases. Starting from the gait characteristics of individuals with different diseases, we hope to provide support and reference for the diagnosis, treatment and rehabilitation of clinically related diseases.

Comparison of the efficacy of Oxford unicondylar replacement for the treatment of spontaneous osteonecrosis of the knee versus medial knee osteoarthritis: a meta-analysis

OBJECTIVE

Meta-analysis of the comparative efficacy of Oxford unicompartmental knee arthroplasty (OUKA) for the treatment of spontaneous osteonecrosis of the knee (SONK) and medial knee osteoarthritis (MKOA).

METHODS

A computerized search was conducted for literature related to OUKA treatments of SONK and MKOA across various databases, including the China National Knowledge Infrastructure, WAN FANG, VIP, SinoMed, Cochrane Library, PubMed, Embase, and Web of Science, covering the period from each database's inception to September 2023. Literature screening, quality assessment and data extraction were performed according to the inclusion and exclusion criteria. After extracting the literature data, RevMan 5.4 software was applied to analyse the postoperative knee function score, postoperative knee mobility, postoperative pain, bearing dislocation rate, aseptic loosening, postoperative progression of posterolateral arthritis, and revision rate.

RESULT

A total of 9 studies were included, including 6 cohort studies and 3 matched case‒control studies. A total of 1544 knees were included, including 183 in the SONK group and 1361 in the MKOA group. The meta-analysis results showed that the SONK and MKOA groups showed a significant difference in postoperative knee function scores [MD = 0.16, 95% CI (- 1.20, 1.51), P = 0.82], postoperative knee mobility [MD = - 0.05, 95% CI (- 1.99. 1.89), P = 0.96], postoperative pain [OR = 0.89, 95% CI (0.23, 3.45), P = 0.87], rate of bearing dislocation [OR = 1.28, 95% CI (0.34, 4.81), P = 0.71], aseptic loosening [OR = 2.22, 95% CI (0.56, 8.82), P = 0.26], postoperative posterolateral arthritis progression [OR = 2.14, 95% CI (0.47, 9.86), P = 0.33], and revision rate [OR = 1.28, 95% CI (0.53, 3.04), P = 0.58] were not statistically significant.

CONCLUSION

OUKA treatment with SONK and MKOA can achieve similar satisfactory clinical results.

Cissus quadrangularis (veldt grape) attenuates disease progression and anatomical changes in mono sodium iodoacetate (MIA)-induced knee osteoarthritis in the rat model

The Cissus quadrangularis (CQ) stem has interesting nutritional and pharmacological properties to promote the health of the skeletal system. It is a well-recognized plant in the conventional system of medicine in India for treating bone and joint-associated complications. This study focuses on identifying the active constituents from the stem and root extracts of CQ and validating its anti-osteoarthritic activity by the in vivo model. Notable levels of phenolics and flavonoids were found in the ethanol extracts of both CQ stem (CQSE) and root (CQRE), among other solvent fractions. UPLC-MS/MS analysis of these selective extracts resulted in different classes of active compounds from both positive and negative ionization modes. By analyzing their mass spectra and fragmentation pattern, 25 active compounds were identified. The CQSE and CQRE extracts, along with the standard drug (naproxen), were further tested in mono-sodium iodoacetate-induced experimental OA animals. The modulatory effects of the test extracts were assessed by haematology, synovial and cartilage marker profiling, radiology and histopathological analysis. The in vivo findings from the biochemical and physiological studies have led to the conclusion that the CQSE extract is a good choice for the management of OA. The results were substantially better than CQ root extract and naproxen drug-treated groups. Thus, CQS has bioactive constituents, which could facilitate recovery from joint tissue damage, cellular metabolism and associated risk factors attributable to dysfunctions in OA incidence and progression.

[Analysis of gait and effectiveness after unicompartmental knee arthroplasty]

Objective

To explore the gait trajectory characteristics and effectiveness after unicompartmental knee arthroplasty (UKA).

Methods

Thirty patients (30 knees) with anterior medial compartment osteoarthritis who were treated with UKA between January 2017 and December 2018 were selected as subjects (UKA group). According to age, gender, and side, 30 patients (30 knees) with knee osteoarthritis treated with total knee arthroplasty (TKA) were selected as control (TKA group). In addition to the range of motion (ROM) before operation showing significant difference between the two groups ( t=4.25, P=0.00), there was no significant difference in gender, age, disease duration, sides, body mass index, and preoperative hip-knee-ankle angle (HKA), Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score between the two groups ( P>0.05). The incision length, drainage volume within 24 hours after operation, and the changes of hemoglobin and albumin were recorded. The WOMAC score, ROM, and HKA before and after operation were compared between the two groups. At 1 year after operation, the gait trajectory characteristics of two groups were analyzed by Vicon three-dimensional gait capture system, and the absolute symmetry index (ASI) of the lower limbs of the two groups was calculated.

Results

The incisions of the two groups healed by first intention, with no complications. The incision length, drainage volume within 24 hours, and the changes of hemoglobin and albumin after operation in the UKA group were significantly smaller than those in the control group ( P<0.05). All patients were followed up completely, the follow-up time ranged from 13 to 20 months of UKA group (mean, 18 months) and 16 to 24 months of control group (mean, 20 months). The imaging review showed that the lower limb alignment of the two groups were restored to a neutral position, and the position of prosthesis was good. At 1 year after operation, the WOMAC score, HKA, and ROM of two groups were significantly improved when compared with those before operation ( P<0.05); the postoperative WOMAC score and ROM of the UKA group were significantly better than those of the control group ( P<0.05), and there was no significant difference in HKA between the two groups ( t=1.54， P=0.13). Gait analysis at 1 year after operation showed that the walking speed, stride length, knee extension at mid-stance, and flexion at swing in the UKA group were significantly better than those in the TKA group ( P<0.05); there was no significant difference in cadence, knee flexion at initial contact, and knee flexion at loading response between the two groups ( P>0.05). The ASI of bilateral knee flexion in the UKA group was significantly greater than that in the TKA group during the initial contact and loading response period ( P<0.05).

Conclusion

Compared with TKA, UKA has the advantages of small incision, less blood loss, and quicker functional recovery. The early gait after UKA is mainly manifested as the increase in walking speed, stride length, knee flexion at swing, and extension at mid-stance phase. From the analysis of gait symmetry, during the initial contact and loading response phase, the operation side after UKA undertakes more shock absorption and joint stabilization functions than the contralateral side.

A Parametric Identification Method of Human Gait Differences and its Application in Rehabilitation

In order to understand the regularity of human motion, characteristic description is widely used in gait analysis. For completely expressing gait information and providing more concise indicators, parametric description is also particularly significant as a means of analysis. Therefore, in this paper, the mathematical models of gait curves based on the generalized extension-Bézier curve were investigated, of which the shape parameters were used as individual gait characteristics to distinguish whether the gait is normal or not and to assist in judging rehabilitation. To evaluate the models, angle data from three joints (hip, knee, and ankle) were recorded with motion capture system when participants (10 healthy males and 6 male patients with ankle fracture) were walking at comfortable velocity along a walkway. Then, the shape parameters of each subject were obtained by applying the mathematical models, and the parameter range of the normal group was further summarized. Through comparison, it could be found that most shape parameters of patients exceed the normal ranges in varying degrees, and are concentrated on specific parameters. The results can not only help to judge the recovery stages of patients but also figure out the corresponding abnormal postures, so as to provide guidance for rehabilitation training.

Does unicompartmental knee arthroplasty have worse outcomes in spontaneous osteonecrosis of the knee than in medial compartment osteoarthritis? A systematic review and meta-analysis

INTRODUCTION

The role of unicompartmental knee arthroplasty (UKA) in spontaneous osteonecrosis of the knee (SONK) remains controversial, even though SONK involves only one compartment of the knee joint. We aimed to compare the survival rate and clinical outcomes of UKA in SONK and medial compartment osteoarthritis (MOA) via a meta-analysis of previous studies.

MATERIALS AND METHODS

MEDLINE, Embase, and Cochrane Library were searched up to January 2018 with keywords related to SONK and knee arthroplasty. Studies were selected with predetermined inclusion criteria: (1) medial UKA as the primary procedure, (2) reporting implant survival or clinical outcomes of osteonecrosis and osteoarthritis, and (3) follow-up period > 1 year. Quality assessment was performed using the risk of bias assessment tool for non-randomized studies. A random-effects model was used to estimate the pooled relative risk (RR) and standardized mean difference.

RESULTS

The incidence of UKA revision for any reason was significantly higher in SONK than in MOA group (pooled RR = 1.83, p = 0.009). However, the risk of revision due to aseptic loosening was not significantly different between the groups. Moreover, when stratified by the study quality, high-quality studies showed similar risk of overall revision in SONK and MOA (p = 0.71). Subgroup analysis revealed no significant difference in failure between SONK and MOA after cemented mobile and fixed bearing UKA. Results of uncemented UKA were reported only in one study, which showed higher failure of SONK compared to MOA. Clinical outcomes after UKA were similar between SONK and MOA (p = 0.66).

CONCLUSIONS

Cemented UKA has similar survival and clinical outcomes in SONK and MOA. Prospective studies designed specifically to compare the UKA outcomes in SONK and MOA are necessary.

Automatic Classification of Gait Impairments Using a Markerless 2D Video-Based System

Systemic disorders affecting an individual can cause gait impairments. Successful acquisition and evaluation of features representing such impairments make it possible to estimate the severity of those disorders, which is important information for monitoring patients' health evolution. However, current state-of-the-art systems perform the acquisition and evaluation of these features in specially equipped laboratories, typically limiting the periodicity of evaluations. With the objective of making health monitoring easier and more accessible, this paper presents a system that performs automatic detection and classification of gait impairments, based on the acquisition and evaluation of biomechanical gait features using a single 2D video camera. The system relies on two different types of features to perform classification: (i) feet-related features, such as step length, step length symmetry, fraction of foot flat during stance phase, normalized step count, speed; and (ii) body-related features, such as the amount of movement while walking, center of gravity shifts and torso orientation. The proposed system uses a support vector machine to decide whether the observed gait is normal or if it belongs to one of three different impaired gait groups. Results show that the proposed system outperforms existing markerless 2D video-based systems, with a classification accuracy of 98.8%.