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Chaharmahali L, Gandomi F, Yalfani A, Fazaeli A. The effect of mindfulness and motivational interviewing along with neuromuscular exercises on pain, function, and balance of women affected by knee osteoarthritis: a rater-blinded randomized controlled clinical trial. Disabil Rehabil 2024; 46:2650-2661. [PMID: 37376745 DOI: 10.1080/09638288.2023.2228691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 06/13/2023] [Accepted: 06/18/2023] [Indexed: 06/29/2023]
Abstract
PURPOSE This study aimed to evaluate the effect of motivational interviewing (MI) and mindfulness (MF) added to neuromuscular (NM) exercises on improving pain, function, balance, and quality of life in patients with knee osteoarthritis (KOA). METHODS This randomized clinical trial was conducted on sixty patients who were randomly assigned to the MI + NM, MF + NM, and NM groups. The groups received four training sessions for six weeks. Physical function with Western Ontario and McMaster Universities Arthritis Index timed up and go, going up and down eight stairs, pain with visual analogue scale, quality of life with SF36, and balance with Biodex were evaluated before and after interventions. RESULTS Within-group comparisons showed that NM + MI, NM + MF, and NM groups experienced significant improvement in all factors after six-week (p < 0.05). However, between groups, comparisons in the post-test revealed that the MI + NM group had a more significant effect on pain, function, and static balance than the MF + NM group. Nevertheless, the MF + NM group improved the quality of life better than the MI + NM and NM groups (p < 0.05). CONCLUSION Adding psychological interventions to physical exercises had a better effect on improving the symptoms of patients. Additionally, the MI showed more effectiveness in improving the symptoms of patients.
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Affiliation(s)
- Liana Chaharmahali
- Sports Injuries and Corrective Exercises Department, Faculty of Physical Education and Sport Sciences, Razi University, Kermanshah, Iran
| | - Farzaneh Gandomi
- Sports Injuries and Corrective Exercises Department, Faculty of Physical Education and Sport Sciences, Razi University, Kermanshah, Iran
| | - Ali Yalfani
- Sports Rehabilitation and Corrective Exercises Department, Faculty of Physical Education and Sport Sciences, Bu-Ali Sina University, Hamedan, Iran
| | - Alireza Fazaeli
- Rheumatology Department, Shahid Beheshti Hospital, Hamedan University of Medical Sciences, Hamedan, Iran
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Eijking HM, Verlaan L, Emans P, Boymans T, Meijer K, Senden R. Patient with knee osteoarthritis demonstrates improved knee adduction moment after knee joint distraction: a case report. Acta Orthop Belg 2024; 90:147-153. [PMID: 38669666 DOI: 10.52628/90.1.11515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
In this article we report a case of a 53-year-old patient diagnosed with end-stage osteoarthritis (OA) of the knee. The patient underwent treatment with knee joint distraction (KJD) with the aim to postpone total knee arthroplasty and prevent potential revision surgery. To assess the effect of KJD, a 3D gait analysis was performed preoperative and one year postoperative. In this patient, preoperative 3D gait analysis revealed an increased knee adduction moment (KAM) compared to healthy levels. Postoperative the KAM decreased, approaching healthy levels, suggesting potential improvements in disease status or in gait. Consequently, further investigation into the effectiveness of Knee Joint Distraction (KJD) as a treatment option for relatively young patients with knee OA is warranted. Gait analysis has emerged as an effective tool for assessing treatment outcomes of innovative treatment such as KJD at the individual level.
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Campbell TM, Laneuville O, Trudel G. Association of Knee Osteoarthritis and Flexion Contracture With Localized Tibial Articular Cartilage Loss: Data From the Osteoarthritis Initiative. J Rheumatol 2024; 51:285-290. [PMID: 38101919 DOI: 10.3899/jrheum.2023-0743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE To evaluate whether a knee flexion contracture (FC) was associated with localized tibial articular cartilage loss over a 1-year period using Osteoarthritis Initiative quantitative data. METHODS Five hundred seventy-eight participants from a previously established nested case-control study of people with radiographic knee OA with or without progression, based on radiographs and symptoms, had their knee range of extension measured at baseline and received magnetic resonance imaging (MRI) at baseline and 1 year. The tibial articular cartilage of the medial and lateral condyles was segmented into anterior, center, and posterior regions. We tested for associations between knee FC (defined as lack of extension to 0°), and localized changes in tibial articular cartilage thickness or percent of denuded bone (0 mm thickness) after 1 year relative to baseline using ANOVA, controlling for baseline MRI outcomes and clinical factors. RESULTS Knee FC was associated with denuded bone in the medial condyle center (β 0.44, 95% CI 0.02-0.86) and preserved cartilage thickness in the medial condyle posterior (β 0.01, 95% CI 0.002-0.03) regions. CONCLUSION Knee FC unloading the tibial center region and loading the posterior region was associated with localized articular cartilage loss centrally and preserved articular cartilage posteriorly. These findings are consistent with knee FC negatively affecting unloaded tibial articular cartilage.
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Affiliation(s)
- T Mark Campbell
- T.M. Campbell, MD, MSc, Department of Physical Medicine and Rehabilitation, Elisabeth Bruyère Hospital, and Bone and Joint Research Laboratory, Ottawa Hospital Research Institute, and Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, and Department of Medicine, Division of Physical Medicine and Rehabilitation, The Ottawa Hospital;
| | - Odette Laneuville
- O. Laneuville, PhD, Bone and Joint Research Laboratory, Ottawa Hospital Research Institute, and Department of Biology, University of Ottawa
| | - Guy Trudel
- G. Trudel, MD, MSc, Bone and Joint Research Laboratory, Ottawa Hospital Research Institute, and Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, and Department of Medicine, Division of Physical Medicine and Rehabilitation, The Ottawa Hospital, Ottawa, Ontario, Canada
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Campbell TM, Trudel G. Protecting the regenerative environment: selecting the optimal delivery vehicle for cartilage repair-a narrative review. Front Bioeng Biotechnol 2024; 12:1283752. [PMID: 38333081 PMCID: PMC10850577 DOI: 10.3389/fbioe.2024.1283752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 01/15/2024] [Indexed: 02/10/2024] Open
Abstract
Focal cartilage defects are common in youth and older adults, cause significant morbidity and constitute a major risk factor for developing osteoarthritis (OA). OA is the most common musculoskeletal (MSK) disease worldwide, resulting in pain, stiffness, loss of function, and is currently irreversible. Research into the optimal regenerative approach and methods in the setting of either focal cartilage defects and/or OA holds to the ideal of resolving both diseases. The two fundamentals required for cartilage regenerative treatment are 1) the biological element contributing to the regeneration (e.g., direct application of stem cells, or of an exogenous secretome), and 2) the vehicle by which the biological element is suspended and delivered. The vehicle provides support to the regenerative process by providing a protective environment, a structure that allows cell adherence and migration, and a source of growth and regenerative factors that can activate and sustain regeneration. Models of cartilage diseases include osteochondral defect (OCD) (which usually involve one focal lesion), or OA (which involves a more diffuse articular cartilage loss). Given the differing nature of these models, the optimal regenerative strategy to treat different cartilage diseases may not be universal. This could potentially impact the translatability of a successful approach in one condition to that of the other. An analogy would be the repair of a pothole (OCD) versus repaving the entire road (OA). In this narrative review, we explore the existing literature evaluating cartilage regeneration approaches for OCD and OA in animal then in human studies and the vehicles used for each of these two conditions. We then highlight strengths and challenges faced by the different approaches presented and discuss what might constitute the optimal cartilage regenerative delivery vehicle for clinical cartilage regeneration.
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Affiliation(s)
- T. Mark Campbell
- Elisabeth Bruyère Hospital, Ottawa, ON, Canada
- Bone and Joint Research Laboratory, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Guy Trudel
- Bone and Joint Research Laboratory, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital, Department of Medicine, Division of Physical Medicine and Rehabilitation, Ottawa, ON, Canada
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Fournier J, Trudel G, Feibel RJ, Uhthoff H, McGonagle D, Campbell TM. Asymmetric Flexion Contracture is Associated With Leg Length Inequality in Patients With Knee Osteoarthritis: Data From the Osteoarthritis Initiative. Arch Phys Med Rehabil 2023; 104:2067-2074. [PMID: 37209935 DOI: 10.1016/j.apmr.2023.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/28/2023] [Accepted: 04/19/2023] [Indexed: 05/22/2023]
Abstract
OBJECTIVE To evaluate whether knee flexion contracture (FC) was associated with leg length inequality (LLI) and/or morbidity in knee osteoarthritis (OA). DESIGN We accessed 2 databases: (1) the Osteoarthritis Initiative (OAI) cohort, including participants with, or at-risk of OA, and (2) the Ottawa Knee Osteoarthritis cross-sectional database (OKOA), including participants with primary advanced knee OA. Both included demographics, radiographic data, knee range of motion, leg length, pain, and function scales. SETTING Tertiary care academic rheumatology and orthopedic clinics. PARTICIPANTS Patients with or at-risk of primary OA. We included 881 OAI and 72 OKOA participants (N=953). INTERVENTION Not applicable. MAIN OUTCOME MEASURES The primary outcome tested the association between the difference in knee extensions of the OA and contralateral knees (the knee extension difference, or KExD) and LLI. This was evaluated using bivariate regression, followed by a multivariable linear regression model. RESULTS OAI participants had less severe knee OA [Kellgren and Lawrence (KL) score 1.9±1.3] vs OKOA (KL score 3.4±0.6). The KExD correlated with LLI for both databases (OAI: R=0.167; P≤.001; OKOA: R=0.339; P=.004). Multivariable regression showed an effect of KExD on LLI in both databases (OAI: β=0.37[0.18,0.57]; P<.001, OKOA: β=0.73[0.20,1.26]; P=.007). When broken down by subgroup, the OAI moderate-severe OA group showed a significant effect of KExD on LLI (β=0.60 [0.34,0.85]; P<.001). CONCLUSIONS OA-related loss of knee extension was associated with LLI for those with moderate-severe OA. Because LLI correlates with worse knee OA symptoms, discovering an FC should cue clinicians to evaluate for LLI, an easily-treatable finding that may help reduce OA-associated morbidity for those approaching the need for arthroplasty.
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Affiliation(s)
- John Fournier
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Guy Trudel
- Bone and Joint Lab, Ottawa Hospital Research Institute, Ottawa, Canada; Department of Medicine, Division of Physical and Rehabilitation Medicine, Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Canada
| | - Robert J Feibel
- The Ottawa Hospital, Division of Orthopedic Surgery, Ottawa, Canada
| | - Hans Uhthoff
- Bone and Joint Lab, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Dennis McGonagle
- University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - T Mark Campbell
- Bone and Joint Lab, Ottawa Hospital Research Institute, Ottawa, Canada; Elisabeth Bruyère Hospital, Ottawa, Canada.
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Sappey-Marinier E, Bini S. Unrestricted kinematic alignment corrects fixed flexion contracture in robotically aligned total knees without raising the joint line in extension. J Exp Orthop 2023; 10:114. [PMID: 37950808 PMCID: PMC10640542 DOI: 10.1186/s40634-023-00670-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/09/2023] [Indexed: 11/13/2023] Open
Abstract
PURPOSE Mechanically Aligned Total Knee Arthroplasty (MA TKA) typically addresses fixed flexion contractures (FFC) by raising the joint line during extension. However, in unrestricted Kinematically Aligned TKA (KA TKA) utilizing a caliper-based resection technique, the joint line is not raised. This study aims to determine the efficacy of KA TKA in restoring full extension in patients with FFC without increasing distal femoral resection, considering tibial bone resection and sagittal component positioning. METHODS A retrospective study was conducted by a single surgeon, involving patients who underwent primary robotically assisted cruciate retaining unrestricted KA TKA between June 1, 2021, and December 1, 2022. Complete intraoperative resection and alignment data were recorded, including the thickness of distal femoral and proximal tibial bone cuts. Patients with a preoperative FFC ≥ 5° (study group) were compared to those with FFC < 5° (control group). The impact of variations in tibial resection and sagittal component positioning was assessed by comparing the heights of medial and lateral resections, sagittal femoral component flexion, and tibial slope. Group comparisons were analyzed using the Wilcoxon Signed Rank Test, with a significance level set at p < 0.05. RESULTS A total of 48 KA TKA procedures met the inclusion criteria, with 24 performed on women. The mean preoperative FFC in the study group was 11.2° (range: 5-25°), while the control group exhibited 1° (range: 0-4°) (p < 0.001). There were no statistically significant differences observed between the study and control groups in terms of distal femoral resections, both medially (p = 0.14) and laterally (p = 0.23), as well as tibial resection heights, both medially (p = 0.66) and laterally (p = 0.74). The alignment of the femoral component flexion and tibial slope was comparable between the two groups (p = 0.31 and p = 0.54, respectively). All patients achieved within 5 degrees of full extension at closure. CONCLUSION Robotic arm-assisted unrestricted KA TKA effectively restores full extension without raising the joint line during extension for patients with a preoperative fixed flexion contracture. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Elliot Sappey-Marinier
- Department of Orthopaedic Surgery, Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, 69008, France.
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA.
| | - Stefano Bini
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA
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Suzuki Y, Ohkoshi Y, Kawakami K, Shimizu K, Chida S, Ukishiro K, Onodera T, Iwasaki K, Maeda T, Suzuki S, Kondo E, Iwasaki N. Assessing knee joint biomechanics and trunk posture according to medial osteoarthritis severity. Sci Rep 2023; 13:19186. [PMID: 37932370 PMCID: PMC10628121 DOI: 10.1038/s41598-023-46486-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 11/01/2023] [Indexed: 11/08/2023] Open
Abstract
During progression of knee osteoarthritis (OA), gait biomechanics changes three-dimensionally; however, its characteristics and trunk posture according to OA severity remain unknown. The present study investigated three-dimensional knee joint biomechanics and trunk posture according to knee OA severity. Overall, 75 patients (93 knees) with medial knee OA [Kellgren-Lawrence grade ≥ 2, grade 2: 20 patients with 24 knees (mean 60.0 years old); grade 3: 25 with 28 knees (mean 62.0 years old); grade 4: 30 with 41 knees (mean 67.9 years old)] and 14 healthy controls (23 knees, mean 63.6 years old) underwent gait analysis using an optical motion capture system and point cluster technique. In grade 2 knee OA, the relative contribution of the knee adduction moment (KAM) increased significantly (P < 0.05), and that of the knee flexion moment decreased (P < 0.05) prior to significant progression of varus knee deformity. Grade 3 knee OA showed significant exacerbation of varus knee deformity (P < 0.01) and KAM increase (P < 0.001). The maximum knee extension angle decreased (P < 0.05) and trunk flexion increased during gait in grade 4 knee OA (P < 0.001). Our study clarified the kinematics and kinetics of medial knee OA with trunk flexion according to severity. Kinetic conversion occurred in grade 2 knees prior to progression of varus deformities, knee flexion contractures, and sagittal imbalance during gait in patients with severe knee OA.
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Affiliation(s)
- Yuki Suzuki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15 jo, Nishi 7 chome, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
- Department of Orthopedic Surgery, Hakodate Orthopedic Clinic, Ishikawa-cho2-115, Hakodate, Hokkaido, 041-0802, Japan.
| | - Yasumitsu Ohkoshi
- Department of Orthopedic Surgery, Hakodate Orthopedic Clinic, Ishikawa-cho2-115, Hakodate, Hokkaido, 041-0802, Japan
| | - Kensaku Kawakami
- Department of Production Systems Eng., National Institute of Technology, Hakodate College, Tokura-cho 14-1, Hakodate, Hokkaido, 042-8501, Japan
| | - Kenta Shimizu
- Department of Rehabilitation, Hakodate Orthopedic Clinic, Ishikawa-cho2-115, Hakodate, Hokkaido, 041-0802, Japan
| | - Shuya Chida
- Department of Rehabilitation, Hakodate Orthopedic Clinic, Ishikawa-cho2-115, Hakodate, Hokkaido, 041-0802, Japan
| | - Kengo Ukishiro
- Department of Rehabilitation, Hakodate Orthopedic Clinic, Ishikawa-cho2-115, Hakodate, Hokkaido, 041-0802, Japan
| | - Tomohiro Onodera
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15 jo, Nishi 7 chome, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Koji Iwasaki
- Department of Functional Reconstruction for the Knee Joint, Graduate School of Medicine, Hokkaido University, Kita 15 jo, Nishi 7 chome, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Tatsunori Maeda
- Department of Orthopedic Surgery, Hakodate Orthopedic Clinic, Ishikawa-cho2-115, Hakodate, Hokkaido, 041-0802, Japan
| | - Sho'ji Suzuki
- Department of Complex and Intelligent Systems, Future University Hakodate, Kamedanakano-cho 116-2, Hakodate, Hokkaido, 041-8655, Japan
| | - Eiji Kondo
- Centre for Sports Medicine, Hokkaido University Hospital, Kita 14 jo Nishi 5 chome, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15 jo, Nishi 7 chome, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
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Campbell TM, Westby M, Ghogomu ET, Fournier J, Ghaedi BB, Welch V. Stretching, Bracing, and Devices for the Treatment of Osteoarthritis-Associated Joint Contractures in Nonoperated Joints: A Systematic Review and Meta-Analysis. Sports Health 2023; 15:867-877. [PMID: 36691685 PMCID: PMC10606959 DOI: 10.1177/19417381221147281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
CONTEXT Many patients with osteoarthritis (OA) develop range of motion (ROM) restrictions in their affected joints (contractures), associated with worse outcomes and rising healthcare costs. Effective treatment guidance for lost ROM in OA-affected joints is lacking. OBJECTIVE A systematic review and meta-analysis evaluating the effectiveness of stretching and/or bracing protocols on native (nonoperated) joint ROM in the setting of radiographically diagnosed OA. DATA SOURCES Seven databases, English-language. STUDY SELECTION Studies including participants with radiographically diagnosed OA in any native joint evaluating the effect of stretching or bracing on ROM. STUDY DESIGN Systematic review and meta-analysis. LEVEL OF EVIDENCE Level 2. DATA EXTRACTION Two reviewers independently screened articles for inclusion and assessed risk of bias in included trials. Primary outcomes were ROM, pain, and adverse events (AEs). RESULTS We identified 6284 articles. A total of 9 randomized controlled trials, all evaluating the knee, met eligibility criteria. For stretching, 3 pooled studies reported total ROM, which improved by mean difference (MD) of 9.3° (95% CI 5.0°,13.5°) versus controls. Two pooled studies showed improved knee flexion ROM (MD 10.8° [7.3°,14.2°]) versus controls. Five studies were pooled for knee extension with mean improvement 9.1° [3.4°,14.8°] versus controls. Seven pooled studies showed reduced pain (standardized MD 1.9 [1.2,2.6]). One study reported improved knee extension of 3.7° [2.9°,4.5°] with use of a device. No studies used orthoses. One study reported on AEs, with none noted. Performance bias was present in all included studies, and only 3 studies clearly reported blinding of outcome assessors. Strength of evidence for primary outcomes was considered moderate. CONCLUSION There was moderate-quality evidence that stretching is an effective strategy for improving knee total, flexion and extension ROM, and pain. Our findings suggest that stretching to regain joint ROM in OA is not futile and that stretching appears to be an appropriate conservative intervention to improve patient outcomes as part of a comprehensive knee OA treatment plan before arthroplasty.
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Affiliation(s)
- T. Mark Campbell
- Department of Physical Medicine and Rehabilitation, Elisabeth Bruyère Hospital, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bone and Joint Laboratory, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- The Ottawa Hospital, Department of Medicine, Ottawa, Ontario, Canada
- University of Ottawa, Department of Cellular and Molecular Medicine, Ottawa, Ontario, Canada
| | - Marie Westby
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | | | - John Fournier
- University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
| | | | - Vivian Welch
- University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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Zhi W, Boubez G, Al-Shakfa F, Kamel Y, Liu J, Shedid D, Yuh SJ, Rizkallah M. How Does Spino-Pelvic Fixation Affect Post-Operative Compensatory Mechanisms in Adult Spinal Deformity? Global Spine J 2023:21925682231200832. [PMID: 37684061 DOI: 10.1177/21925682231200832] [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] [Indexed: 09/10/2023] Open
Abstract
STUDY DESIGN Retrospective single-center multi-surgeon cohort study. OBJECTIVES Compare the post-operative changes in the compensatory mechanisms of the sagittal balance according to the type of pelvic fixation: S2-Alar-iliac screws (S2AI) vs iliac screws (IS) in patients with Adult spine deformity (ASD). METHODS ASD patients who underwent spino-pelvic fixation and remained with a PI-LL >10° mismatch post-operatively were included. Pre-operative and 1-year-follow-up PI, Lumbar lordosis (LL), pelvic tilt (PT), sacral slope (SS), thoracic kyphosis (TK), femur obliquity angle (FOA), knee flexion angle (KFA) and ankle flexion angle (AFA) were analyzed on EOS imaging. Patients were categorized based on their pelvic fixation type (S2AI vs IS), and the pre-operative to 1-year-post-operative changes (ΔX°) in the compensatory mechanisms were compared between groups. RESULTS Patients with S2AI (n = 53) and those with IS (n = 26) screws were comparable at baseline. ΔSS averaged 9.87° in the S2AI compared to 13.2° in the IS (P = .001), whereas the ΔKFA reached 6.01° in the S2AI as opposed to 3.06° in the IS (P = .02). The ΔPT was comparable between both groups (6.35°[S2AI group] vs 5.21°[ISgroup], P = .42). ΔTK, ΔLL, ΔFOA and ΔAFA were comparable between both groups. CONCLUSION The type of pelvic fixation impacts significantly the post-operative compensatory mechanisms in patients with ASD. Patients with S2AI screws are more likely to compensate their remaining post-operative PI-LL mismatch through their knees and less likely through their pelvis compared to patients with IS, despite similar changes in PT. This could be explained by an increased SI joint laxity in ASD patient and the lower resistance of the iliac connectors to the junctional mechanical stresses, allowing for sacro-iliac joint motion in patients with IS.
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Affiliation(s)
- Wang Zhi
- Department of Orthopedic Surgery, University of Montreal Health Center, Montreal, QC, Canada
| | - Ghassan Boubez
- Department of Orthopedic Surgery, University of Montreal Health Center, Montreal, QC, Canada
| | - Fidaa Al-Shakfa
- Department of Orthopedic Surgery, University of Montreal Health Center, Montreal, QC, Canada
| | | | - Jia Liu
- University of Montreal, Montreal, QC, Canada
| | - Daniel Shedid
- Department of Neurosurgery, University of Montreal Health Center, Montreal, QC, Canada
| | - Sung Joo Yuh
- Department of Neurosurgery, University of Montreal Health Center, Montreal, QC, Canada
| | - Maroun Rizkallah
- Department of Orthopedic Surgery, University of Montreal Health Center, Montreal, QC, Canada
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Li J, Ali KA, Xia C, Zhu M, Zhang W, Huang H. Anterolateral approach for posterolateral tibial plateau fractures. Acta Orthop Belg 2023; 89:354-361. [PMID: 37924554 DOI: 10.52628/89.2.11211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2023]
Abstract
The posterolateral tibial plateau fracture is an uncommon intra-articular injury and mostly needed surgery. However, its surgical approach remains controversial. This manuscript describes an anterolateral approach to treat posterolateral tibial plateau fractures and evaluates the patient's functional outcomes. From June 2018 to July 2021 seventeen patients with posterolateral tibial plateau fractures were surgically treated through an anterolateral approach. The intraoperative and postoperative follow-up indicators were recorded. The reduction quality of fractures was assessed using Rasmussen radiological score, and postsurgical functional recovery was estimated using Rasmussen clinical score and Lysholm score. The mean follow-up interval was 28.71 ± 9.61 months (range 18-44). The surgery time and blood loss were 111.06 ± 15.62 min (range 85-140) and 118.12 ± 38.45 mL (range 80-250) separately. Postoperatively, the Rasmussen radiological score was 16.24 ± 2.33 (range 12-18). The average time of bone union was 14.29 ± 1.53 weeks (range 12-18). At the final follow-up, the average PTS and MPTA were 9.71 ± 2.76° (range 5-14°) and 86.82 ± 2.04° (range 84-90°) separately. A satisfactory articular reduction was achieved in 16 patients (94.1%). The final ROM was 123.29 ± 19.70° (range 60-142°). The Rasmussen clinical score and Lysholm score were 25.71 ± 5.74 (range 10-30) and 91.47 ± 6.50 (range 75-98) separately. Anterolateral approach has minimal risk of intraoperative neurovascular injuries in the popliteal fossa with satisfactory results. The hardware removal was also facilitated. This approach is feasible, safe and efficient.
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Li Y, Hou Y, Sun J, Wei J, Chai Y, Guo M, Wang R. Therapeutic Effect of Acupotomy at Sanheyang for Cartilage Collagen Damage in Moderate Knee Osteoarthritis: A Rabbit Model. J Inflamm Res 2023; 16:2241-2254. [PMID: 37256203 PMCID: PMC10225278 DOI: 10.2147/jir.s400956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/02/2023] [Indexed: 06/01/2023] Open
Abstract
Objective Acupotomy based on the meridian-sinew theory of traditional Chinese medicine has benefits in treating knee osteoarthritis (KOA). The current study aims to prove that acupotomy at the sinew points of Sanheyang protect the knee joint and alleviate the progression of moderate KOA by evaluating KOA symptoms, cartilage structure, and analyzing the changes of cytokines in rabbit cartilage. Methods The model used was mono-iodoacetate-induced moderate KOA in the rabbit's right leg. Rabbits were divided into the model group, the acupotomy group, and the control group, with each group receiving two parts of treatment for 2 weeks and 4 weeks. We evaluated pain in the knee joint and range of motion. The articular cartilage sections were stained with Safranin O/Fast Green and Masson. We used immunohistochemistry and real-time PCR to detect the protein and mRNA expressions of collagen prototype II (COL-II), matrix metalloproteinase 13 (MMP13), and integrin-β1 (ITG-β1). Results Compared with the model group, the acupotomy group had higher body weight, lower pain score, higher range of motion, lower Mankin score, and significantly lower protein and mRNA expression of MMP13. After 4 weeks of treatment, Col-II expression in the acupotomy group was significantly higher than that in the model group and the expression of ITG-β1 in the model group was abnormally increased. Conclusion Acupotomy at Sanheyang improved the pain symptoms and range of joint motion in rabbits with moderate KOA, and could protect Col-II by regulating MMP13, which may be related to ITG-β1-mediated mechanical force transmission, thus reducing the damage to cartilage structure and delaying the progression of moderate KOA.
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Affiliation(s)
- Yuanyuan Li
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, 100029, People’s Republic of China
| | - Yimin Hou
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, 100029, People’s Republic of China
| | - Jiwei Sun
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, 100029, People’s Republic of China
| | - Jiabi Wei
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, 100029, People’s Republic of China
| | - Yemao Chai
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, 100029, People’s Republic of China
| | - Mengwei Guo
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, 100029, People’s Republic of China
| | - Rongguo Wang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, 100029, People’s Republic of China
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12
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Zhou G, Zhao M, Wang X, Geng X, Tian H. Demographic and radiographic factors for knee symptoms and range of motion in patients with knee osteoarthritis: a cross-sectional study in Beijing, China. BMC Musculoskelet Disord 2023; 24:378. [PMID: 37173724 PMCID: PMC10176682 DOI: 10.1186/s12891-023-06432-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 04/14/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Knee osteoarthritis (KOA) causes not only pain, stiffness, and dysfunction of the knee, but also the reduction of the joint range of motion (ROM). This study explored the demographic and radiographic factors for knee symptoms and ROM in patients with symptomatic KOA. METHODS The demographic variables, Kellgren-Lawrence (KL) grade, and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) of patients with symptomatic KOA recruited in Beijing were collected. The knee ROM of all patients were also measured. We analyzed the influencing factors for WOMAC and ROM using a generalize linear model, respectively. RESULTS This study included a total of 2034 patients with symptomatic KOA, including 530 males (26.1%) and 1504 females (73.0%), with a mean age of 59.17 (± 10.22) years. Patients with advanced age, overweight or obesity, a family history of KOA, a moderate-to-heavy manual labor job and use of nonsteroidal anti-inflammatory drugs (NSAIDs) had significantly higher WOMAC and lower ROM (all P < 0.05). The more the comorbidities, the higher the WOMAC (all P < 0.05). Patients with higher education had better ROM than those with only an elementary education(β = 4.905, P < 0.05). Compared with those KL = 0/1, the WOMAC of patients whose KL = 4 were higher (β = 0.069, P < 0.05), but the WOMAC of those KL = 2 were lower (β = -0.068, P < 0.05). ROM decreased with the increase of KL grade (all P < 0.05). CONCLUSIONS KOA patients with advanced age, overweight or obesity, a family history of KOA in first-degree relatives, a moderate-to-heavy manual labor job tended to have more severe clinical symptoms and worse ROM. Patients with more severe imaging lesions tend to have poorer ROM. Symptom management measures and regular ROM screening should be taken early to these people.
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Affiliation(s)
- Ge Zhou
- Department of Orthopedics, Peking University Third Hospital, No.49 North Garden Road, Haidian District, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, No.49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Minwei Zhao
- Department of Orthopedics, Peking University Third Hospital, No.49 North Garden Road, Haidian District, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, No.49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Xinguang Wang
- Department of Orthopedics, Peking University Third Hospital, No.49 North Garden Road, Haidian District, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, No.49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Xiao Geng
- Department of Orthopedics, Peking University Third Hospital, No.49 North Garden Road, Haidian District, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, No.49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Hua Tian
- Department of Orthopedics, Peking University Third Hospital, No.49 North Garden Road, Haidian District, Beijing, 100191, China.
- Engineering Research Center of Bone and Joint Precision Medicine, No.49 North Garden Road, Haidian District, Beijing, 100191, China.
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13
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Yokoyama M, Iijima H, Kubota K, Kanemura N. Exploring the modification factors of exercise therapy on biomechanical load in patients with knee osteoarthritis: a systematic review and meta-analysis. Clin Rheumatol 2023:10.1007/s10067-023-06553-4. [PMID: 36879173 DOI: 10.1007/s10067-023-06553-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 02/14/2023] [Accepted: 02/16/2023] [Indexed: 03/08/2023]
Abstract
The objective of this systematic review and meta-analysis is to clarify the effect of exercise therapy on the first peak knee adduction moment (KAM), as well as other biomechanical loads in patients with knee osteoarthritis (OA), and identify physical characteristics that influence differences in biomechanical load after exercise therapy. The data sources are PubMed, PEDro, and CINAHL, from study inception to May 2021. The eligibility criteria include studies evaluating the first peak (KAM), peak knee flexion moment (KFM), maximal knee joint compression force (KCF), or co-contraction during walking before and after exercise therapy in patients with knee OA. The risk of bias was independently assessed by two reviewers using PEDro and NIH scales. Among 11 RCTs and nine non-RCTs, 1119 patients with knee OA were included (average age: 63.7 years). As the results of meta-analysis, exercise therapy tended to increase the first peak KAM (SMD 0.11; 95% CI: -0.03-0.24), peak KFM (SMD 0.13; 95% CI: -0.03-0.29), and maximal KCF (SMD 0.09; 95% CI -0.05-0.22). An increased first peak KAM was significantly associated with a larger improvement in knee muscle strength and WOMAC pain. However, the quality of evidence regarding the biomechanical loads was low-to-moderate according to the GRADE approach. The improvement in pain and knee muscle strength may mediate the increase in first peak KAM, suggesting difficulty in balancing symptom relief and biomechanical load reduction. Therefore, exercise therapy may satisfy both aspects simultaneously when combined with biomechanical interventions, such as a valgus knee brace or insoles. Registration: PROSPERO (CRD42021230966).
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Affiliation(s)
- Moeka Yokoyama
- Sportology Center, Graduate School of Medicine, Juntendo University, Tokyo, Japan.,Graduate Course of Health and Social Services, Graduate School of Saitama Prefectural University, Saitama, Japan
| | - Hirotaka Iijima
- Graduate School of Medicine/Institute for Advanced Research, Nagoya University, Nagoya, Japan
| | - Keisuke Kubota
- Research & Development Center, Saitama Prefectural University, Saitama, Japan
| | - Naohiko Kanemura
- Department of Physical Therapy, Health and Social Services, Saitama Prefectural University, Saitama, Japan.
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14
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Yagi M, Taniguchi M, Tateuchi H, Yamagata M, Hirono T, Asayama A, Umehara J, Nojiri S, Kobayashi M, Ichihashi N. Properties of the iliotibial band and their relationships with gait parameters among patients with knee osteoarthritis. J Orthop Res 2022; 41:1177-1185. [PMID: 36222472 DOI: 10.1002/jor.25466] [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: 04/17/2022] [Revised: 09/27/2022] [Accepted: 10/08/2022] [Indexed: 02/04/2023]
Abstract
This study aimed to determine the thickness and stiffness of the iliotibial band (ITB) in patients with knee osteoarthritis (KOA) and to identify the gait parameters that are associated with ITB properties. Eighteen female patients with radiographically diagnosed medial KOA and knee pain (age: 69.7 ± 5.9 years, body mass index: 23.0 ± 3.1 kg/m2 ) and 22 age-matched female individuals without knee pain (age: 69.1 ± 7.0 years, body mass index: 21.6 ± 3.6 kg/m2 ) were included. Shear wave elastography images were obtained at the height of the proximal pole of the patella with the participants in the supine position, and the ITB thickness and shear wave velocity, which is a surrogate measure of stiffness, were calculated. In patients with KOA, the knee and hip joint angles and moments during walking were calculated using a motion analysis system. The shear wave velocity was significantly higher in patients with KOA than in asymptomatic adults (11.3 ± 1.0 vs. 10.0 ± 1.8 m/s, respectively; p = 0.010); however, the thickness did not differ between them (2.1 ± 0.3 vs. 2.0 ± 0.3 mm, respectively; p = 0.705). The time-integral value of the knee adduction moment (β = 0.507, p = 0.032) and maximum value of the hip flexion moment (β = 0.498, p = 0.036) were associated with the shear wave velocity. Meanwhile, no parameters were associated with the thickness. The ITB was stiffer in patients with KOA than in asymptomatic adults; such a stiffer ITB was associated with greater knee adduction and hip flexion moments during walking. Clinical Significance: Greater mechanical loading was associated with a stiffer ITB in patients with KOA.
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Affiliation(s)
- Masahide Yagi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan
| | - Masashi Taniguchi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan
| | - Hiroshige Tateuchi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan
| | - Momoko Yamagata
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan.,Faculty of Rehabilitation, Kansai Medical University, Hirakata, Osaka, Japan
| | - Tetsuya Hirono
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan.,Research Fellow of Japan Society for the Promotion of Science, Kojimachi Business Center Building, Chiyoda-ku, Tokyo, Japan.,School of Health and Sport Science, Chukyo University, Toyota, Aichi, Japan
| | - Akihiro Asayama
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan
| | - Jun Umehara
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan.,Faculty of Rehabilitation, Kansai Medical University, Hirakata, Osaka, Japan
| | - Shusuke Nojiri
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan
| | | | - Noriaki Ichihashi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan
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15
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Cruz-Montecinos C, Maas H, Cerda M, Pérez-Alenda S. Altered neural control of gait and its association with pain and joint impairment in adults with haemophilic arthropathy: Clinical and methodological implications. Haemophilia 2022; 28:497-504. [PMID: 35201643 DOI: 10.1111/hae.14517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/29/2022] [Accepted: 02/04/2022] [Indexed: 12/27/2022]
Abstract
INTRODUCTION It is unknown whether altered neural control is associated with clinical outcomes in people with haemophilic arthropathy (PWHA). The dynamic motor control index during walking (Walk-DMC) is a summary metric of neural control. AIMS The primary aim of this study was to apply the Walk-DMC to assess if people diagnosed with haemophilic arthropathy have impaired neural control of gait and investigate the association of Walk-DMC with pain and joint impairment. METHOD The Walk-DMC was assessed using surface electromyography in 11 leg muscles. Twenty-two PWHA and 15 healthy subjects walked on a 30-m walkway at 1 m/s. In addition, pain (visual analogue scale), knee flexion contracture (degrees) and joint impairment (Haemophilia Joint Health Score, HJHS) were assessed. The clinical outcomes were correlated with the Walk-DMC. Multiple regression analysis was performed to predict the Walk-DMC using the clinical outcomes. RESULTS In 13 PWHA the Walk-DMC was beyond the normal range (80-120 pts). PWHA with an altered Walk-DMC showed more years with arthropathy, more pain, higher knee flexion contracture and a higher HJHS score (P < .05, effect size > .8). Significant negative moderate associations between Walk-DMC and pain, knee flexion contracture and HJHS were found (P < .05). The model that best predicted the Walk-DMC was the pain with knee flexion contracture (R2 = .44; P = .004). CONCLUSIONS PWHA with abnormal neural control of gait also has more years with arthropathy, more pain, and more impaired joints. Our results indicate an association between the Walk-DMC index and joint damage, specifically with pain in combination with knee flexion contracture.
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Affiliation(s)
- Carlos Cruz-Montecinos
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain.,Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Laboratory of Clinical Biomechanics, Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Huub Maas
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Mauricio Cerda
- SCIAN-Lab, Programme of Integrative Biology, ICBM, & Center for Medical Informatics and Telemedicine, Faculty of Medicine, University of Chile, Santiago, Chile.,Biomedical Neuroscience Institute, Santiago, Chile
| | - Sofía Pérez-Alenda
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
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16
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Zhang L, Lin C, Liu Q, Gao J, Hou Y, Lin J. Incidence and related risk factors of radiographic knee osteoarthritis: a population-based longitudinal study in China. J Orthop Surg Res 2021; 16:474. [PMID: 34332606 PMCID: PMC8325223 DOI: 10.1186/s13018-021-02577-1] [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: 05/15/2021] [Accepted: 06/24/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To explore the incidence and risk factors for radiographic knee osteoarthritis (ROA) in a suburban area of China. METHODS Shunyi Osteoarthritis Study was a population-based, longitudinal study of knee osteoarthritis in Shunyi, a suburban area of Beijing, China. A total of 1295 residents aged over 50 years were recruited with fully informed by randomized cluster sampling and were followed up 3 years later. At the time of baseline and follow-up visits, participants completed a home interview questionnaire and received a clinical examination including height, weight, range of motion (ROM), chair stand test, 50-foot walk test, and weight-bearing posterior-anterior semi-flexed view of radiographs at tibiofemoral joints. The incident ROA for a knee was defined if its KL grade was no more than grade 1 at baseline visit and no less than grade 2 at the follow-up visit. A patient without ROA in both knees at the baseline visit and with ROA in at least one knee at the follow-up visit was viewed as an incident case of ROA in patient level. Generalized linear model and generalized estimating equation were performed to examine the association between socio-demographic factors, physical function as well as baseline knee joint condition, and incident ROA in patient and knee level. RESULTS A total of 1295 residents were recruited at baseline in 2014, and 962 (74.3%) residents were followed in 2017. The annual cumulative incidence of ROA was 3.6% at knee level and 5.7% at patient level. Older age (per year, adjusted odds ratio (OR) = 1.079; 95% confidence interval (CI), 1.042-1.117), overweight (adjusted OR = 2.086; 95% CI, 1.286-3.385), female (adjusted OR = 1.756; 95% CI, 1.074-2.877), less ROM (per degree, adjusted OR = 0.952; 95% CI, 0.923-0.983) and Kellgren and Lawrence (KL) grade 1 at baseline (adjusted OR = 8.527; 95% CI, 5.489-13.246) were risk factors for incident ROA. CONCLUSION The incidence of knee ROA in Chinese suburban area was high. Advanced age, female, overweight, less range of motion, and KL grade 1 at baseline were associated with an increased risk of incident ROA.
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Affiliation(s)
- Liyi Zhang
- Arthritis Clinic and Research Center, Peking University People's Hospital, Peking University, No. 11 Xizhimen South Road, Xicheng District, Beijing, 100044, China.,Arthritis Institute, Peking University, Beijing, China
| | - Chutong Lin
- Arthritis Clinic and Research Center, Peking University People's Hospital, Peking University, No. 11 Xizhimen South Road, Xicheng District, Beijing, 100044, China.,Arthritis Institute, Peking University, Beijing, China.,Department of Thoracic Surgery, Peking University Third Hospital, Peking University, Beijing, China
| | - Qiang Liu
- Arthritis Clinic and Research Center, Peking University People's Hospital, Peking University, No. 11 Xizhimen South Road, Xicheng District, Beijing, 100044, China.,Arthritis Institute, Peking University, Beijing, China
| | - Jiaxiang Gao
- Arthritis Clinic and Research Center, Peking University People's Hospital, Peking University, No. 11 Xizhimen South Road, Xicheng District, Beijing, 100044, China.,Arthritis Institute, Peking University, Beijing, China
| | - Yunfei Hou
- Arthritis Clinic and Research Center, Peking University People's Hospital, Peking University, No. 11 Xizhimen South Road, Xicheng District, Beijing, 100044, China.,Arthritis Institute, Peking University, Beijing, China
| | - Jianhao Lin
- Arthritis Clinic and Research Center, Peking University People's Hospital, Peking University, No. 11 Xizhimen South Road, Xicheng District, Beijing, 100044, China. .,Arthritis Institute, Peking University, Beijing, China.
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