1
|
Hafiz H, Yousefsani SA, Moradi A, Akbarzadeh A, Jirofti N. Contribution of Soft Tissue Passive Forces in Thumb Carpometacarpal Joint Distraction. Ann Biomed Eng 2024; 52:1991-1999. [PMID: 38503946 DOI: 10.1007/s10439-024-03492-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 03/10/2024] [Indexed: 03/21/2024]
Abstract
Thumb carpometacarpal joint space changes when the surrounding soft tissues including the capsule, ligaments, and tendons are stretched or pulled away. When at rest, joint forces originate from passive contraction of muscles and the involvement of joint capsule and ligaments. Previous biomechanical models of hand and finger joints have mostly focused on the assessment of joint properties when muscles were active. This study aims to present an experimental-numerical biomechanical model of thumb carpometacarpal joint to explore the contribution of tendons, ligaments, and other soft tissues in the passive forces during distraction. Five fresh cadaveric specimens were tested using a distractor device to measure the applied forces upon gradual distraction of the intact joint. The subsequent step involved inserting a minuscule sensor into the joint capsule through a small incision, while preserving the integrity of tendons and ligaments, in order to accurately measure the fundamental intra-articular forces. A numerical model was also used to calculate the passive forces of tendons and ligaments. Before the separation of bones, the forces exerted by tendons and ligaments were relatively small compared to the capsule force, which accounted for approximately 92% of the total applied force. Contribution of tendons and ligaments, however, increased by further distraction. The passive force contribution by tendons at 2-mm distraction was determined less than 11%, whereas it reached up to 74% for the ligaments. The present study demonstrated that the ligament-capsule complex plays significant contribution in passive forces of thumb carpometacarpal joint during distraction.
Collapse
Affiliation(s)
- Hamed Hafiz
- Department of Mechanical Engineering, Ferdowsi University of Mashhad, P.O. Box: 9177948974, Mashhad, Iran
| | | | - Ali Moradi
- Orthopedics Research Center, Department of Orthopedic Surgery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Akbarzadeh
- Department of Mechanical Engineering, FUM Center of Advanced Rehabilitation and Robotics Research (FUM CARE), Ferdowsi University of Mashhad, Mashhad, Iran
| | - Nafiseh Jirofti
- Orthopedics Research Center, Department of Orthopedic Surgery, Mashhad University of Medical Sciences, Mashhad, Iran
| |
Collapse
|
2
|
Liu X, Chen R, Song Z, Sun Z. Exercise following joint distraction inhibits muscle wasting and delays the progression of post-traumatic osteoarthritis in rabbits by activating PGC-1α in skeletal muscle. J Orthop Surg Res 2024; 19:325. [PMID: 38822418 PMCID: PMC11141044 DOI: 10.1186/s13018-024-04803-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 05/21/2024] [Indexed: 06/03/2024] Open
Abstract
OBJECTIVE Muscle wasting frequently occurs following joint trauma. Previous research has demonstrated that joint distraction in combination with treadmill exercise (TRE) can mitigate intra-articular inflammation and cartilage damage, consequently delaying the advancement of post-traumatic osteoarthritis (PTOA). However, the precise mechanism underlying this phenomenon remains unclear. Hence, the purpose of this study was to examine whether the mechanism by which TRE following joint distraction delays the progression of PTOA involves the activation of peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC-1α), as well as its impact on muscle wasting. METHODS Quadriceps samples were collected from patients with osteoarthritis (OA) and normal patients with distal femoral fractures, and the expression of PGC-1α was measured. The hinged external fixator was implanted in the rabbit PTOA model. One week after surgery, a PGC-1α agonist or inhibitor was administered for 4 weeks prior to TRE. Western blot analysis was performed to detect the expression of PGC-1α and Muscle atrophy gene 1 (Atrogin-1). We employed the enzyme-linked immunosorbent assay (ELISA) technique to examine pro-inflammatory factors. Additionally, we utilized quantitative real-time polymerase chain reaction (qRT-PCR) to analyze genes associated with cartilage regeneration. Synovial inflammation and cartilage damage were evaluated through hematoxylin-eosin staining. Furthermore, we employed Masson's trichrome staining and Alcian blue staining to analyze cartilage damage. RESULTS The decreased expression of PGC-1α in skeletal muscle in patients with OA is correlated with the severity of OA. In the rabbit PTOA model, TRE following joint distraction inhibited the expressions of muscle wasting genes, including Atrogin-1 and muscle ring finger 1 (MuRF1), as well as inflammatory factors such as interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α) in skeletal muscle, potentially through the activation of PGC-1α. Concurrently, the production of IL-1β, IL-6, TNF-α, nitric oxide (NO), and malondialdehyde (MDA) in the synovial fluid was down-regulated, while the expression of type II collagen (Col2a1), Aggrecan (AGN), SRY-box 9 (SOX9) in the cartilage, and superoxide dismutase (SOD) in the synovial fluid was up-regulated. Additionally, histological staining results demonstrated that TRE after joint distraction reduced cartilage degeneration, leading to a significant decrease in OARSI scores.TRE following joint distraction could activate PGC-1α, inhibit Atrogin-1 expression in skeletal muscle, and reduce C-telopeptides of type II collagen (CTX-II) in the blood compared to joint distraction alone. CONCLUSION Following joint distraction, TRE might promote the activation of PGC-1α in skeletal muscle during PTOA progression to exert anti-inflammatory effects in skeletal muscle and joint cavity, thereby inhibiting muscle wasting and promoting cartilage regeneration, making it a potential therapeutic intervention for treating PTOA.
Collapse
Affiliation(s)
- Xinghui Liu
- School of Basic Medical Sciences, Hubei University of Arts and Science, Xiangyang, Hubei, 441000, China
| | - Rong Chen
- Department of Traumatic Orthopedics, Xiangyang Hospital of Traditional Chinese Medicine (Xiangyang Institute of Traditional Chinese Medicine), No. 24 Changzheng Road, Xiangyang, Hubei, 441001, China
| | - Zhenfei Song
- Department of Traumatic Orthopedics, Xiangyang Hospital of Traditional Chinese Medicine (Xiangyang Institute of Traditional Chinese Medicine), No. 24 Changzheng Road, Xiangyang, Hubei, 441001, China
| | - Zhibo Sun
- Department of Traumatic Orthopedics, Xiangyang Hospital of Traditional Chinese Medicine (Xiangyang Institute of Traditional Chinese Medicine), No. 24 Changzheng Road, Xiangyang, Hubei, 441001, China.
| |
Collapse
|
3
|
Moradi A, Daliri M, Rezaeian A, Hafiz H, Hajiaghajani G, Hedjazi A, Akbarzadeh A. A new magnetic internal distractor: cadaveric study of changes in trapeziometacarpal joint forces. J Hand Surg Eur Vol 2024; 49:436-443. [PMID: 37882683 DOI: 10.1177/17531934231203301] [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: 10/27/2023]
Abstract
Distraction is a new treatment for trapeziometacarpal joint osteoarthritis. The purpose of this study was to test the efficiency of magnetic distraction using a new internal distractor in cadavers. The distractor consists of two magnets embedded inside titanium capsules that are implanted on either side of the trapeziometacarpal joint with the same poles facing each other, so that the force between the magnets distracts the joint. Intra-articular forces were recorded pre-implantation, immediately after implantation and again 10 minutes later. We also studied the changes in the forces before and after the procedure in different thumb positions. Our findings show that the trapeziometacarpal joint could be offloaded in all the studied trapeziometacarpal positions.
Collapse
Affiliation(s)
- Ali Moradi
- Orthopedics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahla Daliri
- Orthopedics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amin Rezaeian
- Orthopedics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamed Hafiz
- Mechanical Engineering Department, Ferdowsi University of Mashhad, Mashhad, Iran
| | | | - Arya Hedjazi
- Legal Medicine Research Center, Tehran, Iran, Legal Medicine Organization, Tehran, Iran
| | - Alireza Akbarzadeh
- Mechanical Engineering Department, Ferdowsi University of Mashhad, Mashhad, Iran
| |
Collapse
|
4
|
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.
Collapse
|
5
|
Peng L, Li R, Xu S, Ding K, Wu Y, Li H, Wang Y. Harnessing joint distraction for the treatment of osteoarthritis: a bibliometric and visualized analysis. Front Bioeng Biotechnol 2023; 11:1309688. [PMID: 38026890 PMCID: PMC10666289 DOI: 10.3389/fbioe.2023.1309688] [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: 10/08/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023] Open
Abstract
Osteoarthritis (OA) stands as a prevalent degenerative joint ailment, demanding immediate attention towards the development of efficacious therapeutic interventions. Presently, a definitive cure for OA remains elusive, and when conservative treatment modalities prove ineffective, resorting to a joint prosthesis becomes imperative. Temporary distraction emerges as a pivotal joint-preserving intervention in human OA patients, conferring both clinical amelioration and structural enhancements. Although extant clinical investigations exist, they are characterized by relatively modest sample sizes. Nonetheless, these studies furnish compelling evidence affirming that joint distraction engenders sustained clinical amelioration and structural refinement. Despite substantial strides in the last decade, a bibliometric analysis of joint distraction within the realm of osteoarthritis treatment research has been conspicuously absent. In this context, we have undertaken a comparative investigation utilizing bibliometric methodologies to scrutinize the landscape of joint distraction within osteoarthritis treatment. Our comprehensive analysis encompassed 469 scholarly articles. Our findings evince a consistent escalation in global research interest and publication output pertaining to this subject. The United States emerged as the frontrunner in international collaboration, publication count, and citation frequency, underscoring its preeminence in this domain. The journal "Osteoarthritis and Cartilage" emerged as the principal platform for disseminating research output on this subject. Notably, Mastbergen SC emerged as the most prolific contributor in terms of authorship. The identified keywords predominantly revolved around non-surgical interventions and joint arthroscopy procedures. This bibliometric analysis, augmented by visual representations, furnishes invaluable insights into the evolutionary trajectory of joint distraction as an osteoarthritis treatment modality spanning from 2003 to 2023. These insights will serve as a compass for the scientific community, facilitating further exploration in this promising domain.
Collapse
Affiliation(s)
- Liqing Peng
- Department of Orthopedics, First People’s Hospital of Shuangliu District, Chengdu, China
| | - Runmeng Li
- School of Medicine, Nankai University, Tianjin, China
| | - Shengxi Xu
- Department of Orthopedics, First People’s Hospital of Shuangliu District, Chengdu, China
| | - Keyuan Ding
- Department of Orthopedics, First People’s Hospital of Shuangliu District, Chengdu, China
| | - Yan Wu
- Department of Orthopedics, First People’s Hospital of Shuangliu District, Chengdu, China
| | - Hao Li
- School of Medicine, Nankai University, Tianjin, China
| | - Yong Wang
- Department of Orthopedics, First People’s Hospital of Shuangliu District, Chengdu, China
| |
Collapse
|
6
|
Diduch DR, Crawford DC, Ranawat AS, Victor J, Flanigan DC. Implantable Shock Absorber Provides Superior Pain Relief and Functional Improvement Compared With High Tibial Osteotomy in Patients with Mild-to-Moderate Medial Knee Osteoarthritis: A 2-Year Report. Cartilage 2023; 14:152-163. [PMID: 36823955 PMCID: PMC10416201 DOI: 10.1177/19476035231157335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/25/2023] [Accepted: 01/26/2023] [Indexed: 02/25/2023] Open
Abstract
OBJECTIVE Up to 10 million Americans below the age of 65 years have symptomatic knee osteoarthritis (OA) and may not yet be candidates for arthroplasty. In response, a subcutaneous implantable shock absorber (ISA) that unloads the knee has been developed. The safety and effectiveness of ISA treatment were compared against a surgical unloading control, high tibial osteotomy (HTO). DESIGN This was a prospective open-label cohort study with a historical control arm. Subjects underwent ISA placement or HTO. The primary endpoint was a composite variable combining pain, function, specific adverse events, integrity of implant or hardware, and conversion to subsequent surgery. Pain and function outcomes (Western Ontario and McMaster Universities Arthritis Index scores) were assessed through 24 months. Adverse events were tracked. RESULTS The primary endpoint demonstrated superiority of the ISA arm versus the HTO arm, with 85.6% of ISA subjects meeting all criteria compared with 65.5% of HTO subjects. In addition, all 5 secondary endpoints showed superiority of ISA over HTO. At 24 months, the proportions of subjects considered responders were 95.8% (ISA) versus 87.9% (HTO) for pain and 91.7% (ISA) versus 81.3% (HTO) for function. The ISA procedure was well tolerated, with 13.4 days to full weightbearing status versus 58.0 days for the HTO arm. CONCLUSIONS Treatment with an ISA demonstrated noninferiority and superiority versus treatment with HTO in subjects aged 25-65 years who had OA of the medial knee. Treatment with ISA has high clinical benefit and is durable through at least 24 months.
Collapse
Affiliation(s)
- David R. Diduch
- Department of Orthopedic Surgery, University of Virginia, Charlottesville, VA, USA
| | | | | | | | | |
Collapse
|
7
|
Kaneguchi A, Yamaoka K, Ozawa J. The effects of the amount of weight bearing on articular cartilage early after ACL reconstruction in rats. Connect Tissue Res 2023; 64:186-204. [PMID: 36334016 DOI: 10.1080/03008207.2022.2141627] [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: 11/06/2022]
Abstract
PURPOSE Osteoarthritis that develops after anterior cruciate ligament (ACL) reconstruction is a critical issue. We examined the effects of the amount of weight bearing early after ACL reconstruction on articular cartilage. MATERIALS AND METHODS Rats were divided into groups according to the treatment received: untreated control, ACL reconstruction (ACLR), ACL reconstruction plus hindlimb unloading (ACLR + HU), and ACL reconstruction plus morphine administration (ACLR + M). ACL reconstruction was performed on the right knee throughout the groups. To assess the amount of weight bearing, one-hindlimb standing time ratio (STR; operated side/contralateral side) during treadmill locomotion was evaluated during the experimental period. At day 7 or 14 post-surgery, cartilage degeneration of the medial tibial plateau was histologically assessed. RESULTS In the ACLR group, reduction in weight bearing characterized by significantly reduced STR was observed between day 1 and 7. Reduction in weight bearing was partially attenuated by morphine administration. Compared with the control group, the ACLR group exhibited an increased Mankin score that was accompanied by increased cyclooxygenase-2 expression in the anterior region. In the ACLR + HU group, Mankin scores were significantly higher in the middle and posterior regions, and cartilage thickness in these regions was significantly thinner than those in the ACLR group. In the ACLR + M group, although chondrocyte density in the anterior region was increased, all other parameters were not significantly different from those in the ACLR group. CONCLUSIONS Our results suggest that early weight bearing after ACL reconstruction is important to reduce cartilage degeneration.
Collapse
Affiliation(s)
- Akinori Kaneguchi
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Higashi-Hiroshima, Japan
| | - Kaoru Yamaoka
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Higashi-Hiroshima, Japan
| | - Junya Ozawa
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Higashi-Hiroshima, Japan
| |
Collapse
|
8
|
Ankle joint contact force profiles differ between those with and without chronic ankle instability during walking. Gait Posture 2023; 100:1-7. [PMID: 36459912 DOI: 10.1016/j.gaitpost.2022.11.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 11/15/2022] [Accepted: 11/24/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Individuals with chronic ankle instability (CAI) exhibit aberrant gait biomechanics relative to uninjured controls. Altered gait biomechanics likely contribute aberrant joint loading and subsequent early onset ankle joint degeneration. Joint (i.e. cartilage) loading cannot be directly measured without invasive procedures but can be estimated via joint contact forces (JCF) generated from musculoskeletal modeling. However, no investigation has quantified JCF in those with CAI during walking despite the link between ligamentous injury and ankle post-traumatic ankle osteoarthritis. RESEARCH QUESTION Do patients with CAI exhibit altered ankle compressive and shear JCF profiles during the stance phase of walking compared to those without CAI? METHODS Ten individuals with CAI and 10 individuals without a history of ankle sprain completed a gait assessment at their self-selected speed on an instrumented treadmill. Musculoskeletal modeling was applied to estimate ankle JCF variables within a generic model. Variables included the peak, impulse, and loading rates for compressive, anteroposterior shear, and mediolateral shear JCF. RESULTS Those with CAI had significantly different JCF forces, relative to uninjured controls, in all directions. More specifically, lower compressive peak and impulse values were noted while higher anteroposterior shearing forces (1 st peak, impulse, loading late) were observed in those with CAI. Those with CAI also demonstrated higher mediolateral shearing forces (1 st peak and impulse). SIGNIFICANCE Our finding suggests that those with CAI exhibit different ankle joint loading patterns than uninjured controls. Directionality of the identified differences depends on the axis of movement.
Collapse
|
9
|
Effects of Immobilization and Swimming on the Progression of Osteoarthritis in Mice. Int J Mol Sci 2022; 24:ijms24010535. [PMID: 36613978 PMCID: PMC9820595 DOI: 10.3390/ijms24010535] [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: 08/03/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 12/30/2022] Open
Abstract
Osteoarthritis (OA) is a chronic joint disease characterized by the degeneration of articular cartilage and thickening and sclerosis of the subchondral bone. Mechanical factors play significant roles in the development and progression of OA, but it is still controversial whether exercise or rest is a more effective treatment for OA patients. In this study, we compared the effects of swimming and immobilization at different stages of OA in mice. Four weeks (the middle stage of OA) or eight weeks (the late stage of OA) after DMM (destabilization of the medial meniscus) surgery, the mice were subjected to four-week immobilization or swimming. Ink blot analysis and a beam walking test were performed to measure the gait and balance ability. Histological analysis was performed to determine the trabecular bone area, the thickness of subchondral bone, the thickness of the cartilage, the OARSI score, and the expression of MMP13 (matrix metalloproteinases) and IL-6 (interleukin). The results showed that at the middle stage of OA, both immobilization and swimming slowed down the progression of OA. Immobilization relieved OA to a certain extent by decreasing the production of regulatory factors to attenuate the degeneration of cartilage, which partly relieved the effects of DMM on gait, mainly in the hindlimb. Swimming mainly attenuated the thickening and rescued the area of subchondral bone.
Collapse
|
10
|
Alipour S, Nour S, Attari SM, Mohajeri M, Kianersi S, Taromian F, Khalkhali M, Aninwene GE, Tayebi L. A review on in vitro/ in vivo response of additively manufactured Ti-6Al-4V alloy. J Mater Chem B 2022; 10:9479-9534. [PMID: 36305245 DOI: 10.1039/d2tb01616h] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Bone replacement using porous and solid metallic implants, such as Ti-alloy implants, is regarded as one of the most practical therapeutic approaches in biomedical engineering. The bone is a complex tissue with various mechanical properties based on the site of action. Patient-specific Ti-6Al-4V constructs may address the key needs in bone treatment for having customized implants that mimic the complex structure of the natural tissue and diminish the risk of implant failure. This review focuses on the most promising methods of fabricating such patient-specific Ti-6Al-4V implants using additive manufacturing (AM) with a specific emphasis on the popular subcategory, which is powder bed fusion (PBF). Characteristics of the ideal implant to promote optimized tissue-implant interactions, as well as physical, mechanical/chemical treatments and modifications will be discussed. Accordingly, such investigations will be classified into 3B-based approaches (Biofunctionality, Bioactivity, and Biostability), which mainly govern native body response and ultimately the success in implantation.
Collapse
Affiliation(s)
- Saeid Alipour
- Department of Materials Science and Engineering, Missouri University of Science and Technology, Rolla, MO 65409, USA
| | - Shirin Nour
- Tissue Engineering Group, Department of Biomedical Engineering, University of Melbourne, VIC 3010, Australia.,Polymer Science Group, Department of Chemical Engineering, University of Melbourne, VIC 3010, Australia
| | - Seyyed Morteza Attari
- Department of Material Science and Engineering, University of Connecticut, Storrs, Connecticut, USA
| | - Mohammad Mohajeri
- Department of Biomedical Engineering, College of Engineering, Texas A&M University, TX, USA
| | - Sogol Kianersi
- CÚRAM, SFI Centre for Research in Medical Devices, Biomedical Sciences, University of Galway, Galway, Ireland
| | - Farzaneh Taromian
- Department of Life Science Engineering, Faculty of New Sciences and Technologies, University of Tehran, Tehran, Iran
| | - Mohammadparsa Khalkhali
- Department of Life Science Engineering, Faculty of New Sciences and Technologies, University of Tehran, Tehran, Iran
| | - George E Aninwene
- Department of Bioengineering, Henry Samueli School of Engineering and Applied Sciences, University of California-Los Angeles, Los Angeles, California, USA.,Center for Minimally Invasive Therapeutics (C-MIT), University of California-Los Angeles, Los Angeles, California, USA.,California NanoSystems Institute (CNSI), University of California-Los Angeles, Los Angeles, California, USA
| | - Lobat Tayebi
- School of Dentistry, Marquette University, Milwaukee, Wisconsin, USA.
| |
Collapse
|
11
|
Kim MS, Koh IJ, Choi KY, Kim BS, In Y. Changes in joint space width over time and risk factors for deterioration of joint space width after medial opening-wedge high tibial osteotomy. Arch Orthop Trauma Surg 2022; 142:2513-2524. [PMID: 33786646 DOI: 10.1007/s00402-021-03876-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 03/23/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the changes in joint space width (JSW) over time after medial opening-wedge high tibial osteotomy (MOWHTO) and identify risk factors for deterioration of JSW using anteroposterior (AP) and Rosenberg views. METHODS We retrospectively analyzed changes in JSW of 104 MOWHTO patients whose preoperative osteoarthritis (OA) grade was K-L grade 3 or less on AP and Rosenberg views. Serial changes in JSW were assessed from preoperatively to at least 3 years postoperatively. Patients were divided into two groups according to JSW change patterns on each of AP and Rosenberg views: non-deterioration group had either unchanged or increased JSW, and deterioration group had decreased JSW. Clinical outcomes were compared using Western Ontario and McMaster Universities OA Index (WOMAC) score between groups. Multivariate logistic regression analysis was performed to identify risk factors for deterioration of JSW. RESULTS JSW on average for all patients increased 0.5 mm and 0.8 mm on AP and Rosenberg views, respectively (p < 0.05). Non-deterioration group showed significant improvement based on patient-reported outcomes (WOMAC) than deterioration group (all p < 0.05). Undercorrection was an independent risk factor for failure to achieve maintained or increased JSW on both AP (OR 6.885, 95% CI 1.976-23.986, p = 0.002) and Rosenberg (OR 12.756, 95% CI 2.952-55.129, p = 0.001) views. CONCLUSION JSW increased gradually and continuously on standing AP and Rosenberg views until postoperative 3 years after MOWHTO. Deterioration of JSW following MOWHTO was closely related to the undercorrection and affected clinical outcomes. LEVEL OF EVIDENCE Level III, case control study.
Collapse
Affiliation(s)
- Man Soo Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - In Jun Koh
- Department of Orthopaedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021, Tongil Ro, Eunpyeong-gu, Seoul, 03312, Republic of Korea
| | - Keun Young Choi
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Bo Seoung Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Yong In
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
| |
Collapse
|
12
|
Efficacy of unloader knee orthosis and lateral wedge insole on static balance in medial knee osteoarthritis. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2022. [DOI: 10.1177/22104917221095256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Medial knee osteoarthritis can contribute to pain and stiffness, interfere with balance and limit functional activities of daily living. Unloader knee orthosis or lateral wedged insoles are current conservative approaches used to treat these conditions. The aim of this study was to identify and compare the effects of them on the balance parameters. Methods 66 subjects with mild to moderate medial knee osteoarthritis were randomly assigned to wear unloader knee brace or full-length 6° lateral wedge insole. Primary outcome balance parameters were stability %, path length and average velocity of center of pressure and mobility score which were investigated by HUMAC® Balance and Tilt system. Secondary outcome measures were knee function score using Knee Injury and Osteoarthritis Outcome Score scale. Assessment was performed at baseline and six months post orthotic intervention period. Findings Both orthoses improved all parameters compared to the baseline condition (p < 0.05). Unloader knee orthosis showed a significant improvement in all balance parameters compared to lateral wedged insoles (p < 0.001) except mobility scores (p = 0.527). Except activities of daily living (p = 0.752) and sports and recreational activities (p = 0.437), unloader knee orthosis had a greater effect on the pain (p = 0.002) and symptoms (p < 0.001) sub scales than lateral wedged insoles. However, quality of life sub-scale scores for insoles were more effective than the knee orthosis. Interpretation Unloader knee orthosis improved balance and knee function scores more than lateral wedged insole, though both orthoses produced significantly improved results compared to baseline assessment.
Collapse
|
13
|
Jansen MP, Mastbergen SC. Joint distraction for osteoarthritis: clinical evidence and molecular mechanisms. Nat Rev Rheumatol 2022; 18:35-46. [PMID: 34616035 DOI: 10.1038/s41584-021-00695-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2021] [Indexed: 12/20/2022]
Abstract
Joint distraction, the prolonged mechanical separation of the bones at a joint, has emerged as a joint-preserving treatment for end-stage osteoarthritis, with the gradually growing promise of implementation in regular clinical practice. Joint distraction of the knee has been most extensively studied, with these studies showing prolonged symptomatic improvement in combination with repair of cartilage tissue in degenerated knee joints, supporting the concept that cartilage repair can translate into real clinical benefit. The reversal of tissue degeneration observed with joint distraction could be the result of one or a combination of various proposed mechanisms, including partial unloading, synovial fluid pressure oscillation, mechanical and biochemical changes in subchondral bone, adhesion and chondrogenic commitment of joint-derived mesenchymal stem cells or a change in the molecular milieu of the joint. The overall picture that emerges from the combined evidence is relevant for future research and treatment-related improvements of joint distraction and for translation of the insights gained about tissue repair to other joint-preserving techniques. It remains to be elucidated whether optimizing the biomechanical conditions during joint distraction can actually cure osteoarthritis rather than only providing temporary symptomatic relief, but even temporary relief might be relevant for society and patients, as it will delay joint replacement with a prosthesis at an early age and thereby avert revision surgery later in life. Most importantly, improved insights into the underlying mechanisms of joint repair might provide new leads for more targeted treatment options.
Collapse
Affiliation(s)
- Mylène P Jansen
- Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Simon C Mastbergen
- Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands.
| |
Collapse
|
14
|
Hsia AW, Jbeily EH, Mendez ME, Cunningham HC, Biris KK, Bang H, Lee CA, Loots GG, Christiansen BA. Post-traumatic osteoarthritis progression is diminished by early mechanical unloading and anti-inflammatory treatment in mice. Osteoarthritis Cartilage 2021; 29:1709-1719. [PMID: 34653605 PMCID: PMC8678362 DOI: 10.1016/j.joca.2021.09.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 09/08/2021] [Accepted: 09/22/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Post-traumatic osteoarthritis (PTOA) is a degenerative joint disease initiated by injury. Early phase (0-7 days) treatments often include rest (unloading) and anti-inflammatory medications, but how those early interventions impact PTOA progression is unknown. We hypothesized that early unloading and anti-inflammatory treatment would diminish joint inflammation and slow PTOA progression. DESIGN Mice were injured with non-invasive ACL rupture followed by hindlimb unloading (HLU) or normal cage activity (ground control: GC) for 7 days, after which all mice were allowed normal cage activity. HLU and GC mice were treated with daily celecoxib (CXB; 10 mg/kg IP) or vehicle. Protease activity was evaluated using in vivo fluorescence imaging, osteophyte formation and epiphyseal trabecular bone were quantified using micro-computed tomography, and synovitis and articular cartilage were evaluated using whole-joint histology at 7, 14, 21, and 28 days post-injury. RESULTS HLU significantly reduced protease activity (-22-30% compared to GC) and synovitis (-24-50% relative to GC) at day 7 post-injury (during unloading), but these differences were not maintained at later timepoints. Similarly, trabecular bone volume was partially preserved in HLU mice at during unloading (-14-15% BV/TV for HLU mice, -21-22% for GC mice relative to uninjured), but these differences were not maintained during reloading. Osteophyte volume was reduced by both HLU and CXB, but there was not an additive effect of these treatments (HLU: -46%, CXB: -30%, HLU + CXB: -35% relative to vehicle GC at day 28). CONCLUSIONS These data suggest that early unloading following joint injury can reduce inflammation and potentially slow PTOA progression.
Collapse
Affiliation(s)
- A W Hsia
- University of California Davis Health, Department of Orthopaedic Surgery, Lawrence J. Ellison Musculoskeletal Research Center, 4635 2nd Ave, Suite 2000, Sacramento, CA 95817, USA.
| | - E H Jbeily
- University of California Davis Health, Department of Orthopaedic Surgery, Lawrence J. Ellison Musculoskeletal Research Center, 4635 2nd Ave, Suite 2000, Sacramento, CA 95817, USA.
| | - M E Mendez
- Lawrence Livermore National Laboratory, Physical and Life Sciences Directorate, 7000 East Avenue, L-452, Livermore, CA 94550, USA.
| | - H C Cunningham
- University of California Davis Health, Department of Orthopaedic Surgery, Lawrence J. Ellison Musculoskeletal Research Center, 4635 2nd Ave, Suite 2000, Sacramento, CA 95817, USA.
| | - K K Biris
- University of California Davis Health, Department of Orthopaedic Surgery, Lawrence J. Ellison Musculoskeletal Research Center, 4635 2nd Ave, Suite 2000, Sacramento, CA 95817, USA.
| | - H Bang
- University of California Davis Health, Department of Public Health Sciences, Sciences 1C, Suite 145, Davis, CA 95616, USA.
| | - C A Lee
- University of California Davis Health, Department of Orthopaedic Surgery, Lawrence J. Ellison Musculoskeletal Research Center, 4635 2nd Ave, Suite 2000, Sacramento, CA 95817, USA.
| | - G G Loots
- Lawrence Livermore National Laboratory, Physical and Life Sciences Directorate, 7000 East Avenue, L-452, Livermore, CA 94550, USA.
| | - B A Christiansen
- University of California Davis Health, Department of Orthopaedic Surgery, Lawrence J. Ellison Musculoskeletal Research Center, 4635 2nd Ave, Suite 2000, Sacramento, CA 95817, USA.
| |
Collapse
|
15
|
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.
Collapse
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
| |
Collapse
|
16
|
He Z, Nie P, Lu J, Ling Y, Guo J, Zhang B, Hu J, Liao J, Gu J, Dai B, Feng Z. Less mechanical loading attenuates osteoarthritis by reducing cartilage degeneration, subchondral bone remodelling, secondary inflammation, and activation of NLRP3 inflammasome. Bone Joint Res 2020; 9:731-741. [PMID: 33399476 PMCID: PMC7640939 DOI: 10.1302/2046-3758.910.bjr-2019-0368.r2] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Aims Osteoarthritis (OA) is a disabling joint disorder and mechanical loading is an important pathogenesis. This study aims to investigate the benefits of less mechanical loading created by intermittent tail suspension for knee OA. Methods A post-traumatic OA model was established in 20 rats (12 weeks old, male). Ten rats were treated with less mechanical loading through intermittent tail suspension, while another ten rats were treated with normal mechanical loading. Cartilage damage was determined by gross appearance, Safranin O/Fast Green staining, and immunohistochemistry examinations. Subchondral bone changes were analyzed by micro-CT and tartrate-resistant acid phosphatase (TRAP) staining, and serum inflammatory cytokines were evaluated by enzyme-linked immunosorbent assay (ELISA). Results Our radiographs showed that joint space was significantly enlarged in rats with less mechanical loading. Moreover, cartilage destruction was attenuated in the less mechanical loading group with lower histological damage scores, and lower expression of a disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS)-5, matrix metalloproteinase (MMP)-3, and MMP-13. In addition, subchondral bone abnormal changes were ameliorated in OA rats with less mechanical loading, as reduced bone mineral density (BMD), bone volume/tissue volume (BV/TV), and number of osteophytes and osteoclasts in the subchondral bone were observed. Finally, the level of serum inflammatory cytokines was significantly downregulated in the less mechanical loading group compared with the normal mechanical loading group, as well as the expression of NACHT, LRR, and PYD domains-containing protein 3 (NLRP3), caspase-1, and interleukin 1β (IL-1β) in the cartilage. Conclusion Less mechanical loading alleviates cartilage destruction, subchondral bone changes, and secondary inflammation in OA joints. This study provides fundamental insights into the benefit of non-weight loading rest for patients with OA. Cite this article: Bone Joint Res 2020;9(10):731–741.
Collapse
Affiliation(s)
- Zhennian He
- Department of Orthopedic Surgery, Beilun District People's Hospital, Ningbo, China
| | - Pengfei Nie
- Department of Orthopedic Surgery, Beilun District People's Hospital, Ningbo, China
| | - Jianli Lu
- Department of Orthopedic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yong Ling
- Department of Orthopedic Surgery, Beilun District People's Hospital, Ningbo, China
| | - Jian Guo
- Department of Orthopedic Surgery, Beilun District People's Hospital, Ningbo, China
| | - Bin Zhang
- Department of Orthopedic Surgery, Beilun District People's Hospital, Ningbo, China
| | - Jianghua Hu
- Department of Orthopedic Surgery, Beilun District People's Hospital, Ningbo, China
| | - Jiawei Liao
- Department of Orthopedic Surgery, Beilun District People's Hospital, Ningbo, China
| | - Jie Gu
- Department of Orthopedic Surgery, Beilun District People's Hospital, Ningbo, China
| | - Bo Dai
- Department of Orthopedic Surgery, Beilun District People's Hospital, Ningbo, China
| | - Zhiyun Feng
- Department of Orthopedic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| |
Collapse
|
17
|
Chen L, Zheng JJY, Li G, Yuan J, Ebert JR, Li H, Papadimitriou J, Wang Q, Wood D, Jones CW, Zheng M. Pathogenesis and clinical management of obesity-related knee osteoarthritis: Impact of mechanical loading. J Orthop Translat 2020; 24:66-75. [PMID: 32695606 PMCID: PMC7349942 DOI: 10.1016/j.jot.2020.05.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 04/28/2020] [Accepted: 05/02/2020] [Indexed: 12/16/2022] Open
Abstract
Obesity-related osteoarthritis (OA) is a complex, multifactorial condition that can cause significant impact on patients' quality of life. Whilst chronic inflammation, adipocytokines and metabolic factors are considered to be important pathogenic factors in obesity related OA, there has been limited investigation into the biomechanical impact of obesity on OA development. This review aims to demonstrate that mechanical factors are the major pathological cause of obesity-related OA. The effect of obesity on pathological changes to the osteochondral unit and surrounding connective tissues in OA is summarized, as well as the impact of obesity-related excessive and abnormal joint loading, concomitant joint malalignment and muscle weakness. An integrated therapeutic strategy based on this multi-factorial presentation is presented, to assist in the management of obesity related OA. THE TRANSLATIONAL POTENTIAL OF THIS ARTICLE Despite the high prevalence of obesity-related OA, there is no specific guideline available for obesity-related OA management. In this review, we demonstrated the pathological changes of obesity-related OA and summarized the impact of biomechanical factors by proposing a hypothetical model of obesity-related OA change. Therapeutic strategies based on adjusting abnormal mechanical effects are presented to assist in the management of obesity-related OA.
Collapse
Affiliation(s)
- Lianzhi Chen
- Centre for Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | | | - Guangyi Li
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jun Yuan
- Centre for Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
- Perron Institute for Neurological and Translational Science, Perth, Western Australia, Australia
| | - Jay R. Ebert
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, Western Australia, Australia
| | - Hengyuan Li
- Department of Orthopedics, Second Affiliated Hospital of Zhejiang University, School of Medicine, Zhejiang, China
| | - John Papadimitriou
- Centre for Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
- Pathwest Laboratories, Perth, Western Australia, Australia
| | - Qingwen Wang
- Department of Rheumatism and Immunology, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - David Wood
- Centre for Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Christopher W. Jones
- Fiona Stanley Hospital Group, Perth, Western Australia, Australia
- Curtin University Medical School, Perth, Western Australia, Australia
| | - Minghao Zheng
- Centre for Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
- Perron Institute for Neurological and Translational Science, Perth, Western Australia, Australia
| |
Collapse
|
18
|
Hussin MS, Fernandez J, Ramezani M, Kumar P, Kelly PA. Analytical and computational sliding wear prediction in a novel knee implant: a case study. Comput Methods Biomech Biomed Engin 2020; 23:143-154. [PMID: 31928215 DOI: 10.1080/10255842.2019.1709118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Osteoarthritis (OA) is a commonly occurring cartilage degenerative disease. The end stage treatment is Total Knee Arthroplasty (TKA), which can be costly in terms of initial surgery, but also in terms of revision knee arthroplasty, which is quite often required. A novel conceptual knee implant has been proposed to function as a reducer of stress across the joint surface, to extend the period of time before TKA becomes necessary. The objective of this paper is to develop a computational model which can be used to assess the wear arising at the implant articulating surfaces. Experimental wear coefficients were determined from physical testing, the results of which were verified using a semi-analytical model. Experimental results were incorporated into an anatomically correct computational model of the knee and implant. The wear-rate predicted for the implant was 27.74 mm3 per million cycles (MC) and the wear depth predicted was 1.085 mm/MC. Whereas the wear-rate is comparable to that seen in conventional knee implants, the wear depth is significantly higher than for conventional knee prostheses, and indicates that, in order to be viable, wear-rates should be reduced in some way, perhaps by using low-wear polymers.
Collapse
Affiliation(s)
- Mohd Sabri Hussin
- Department of Engineering Science, University of Auckland, Auckland, New Zealand.,School of Manufacturing Engineering, Universiti Malaysia Perlis, Perlis, Malaysia
| | - Justin Fernandez
- Department of Engineering Science, University of Auckland, Auckland, New Zealand.,Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Maziar Ramezani
- Department of Mechanical Engineering, Auckland University of Technology, Auckland, New Zealand
| | | | - Piaras A Kelly
- Department of Engineering Science, University of Auckland, Auckland, New Zealand
| |
Collapse
|
19
|
van Veen B, Montefiori E, Modenese L, Mazzà C, Viceconti M. Muscle recruitment strategies can reduce joint loading during level walking. J Biomech 2019; 97:109368. [PMID: 31606129 DOI: 10.1016/j.jbiomech.2019.109368] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 09/18/2019] [Accepted: 09/22/2019] [Indexed: 10/25/2022]
Abstract
Joint inflammation, with consequent cartilage damage and pain, typically reduces functionality and affects activities of daily life in a variety of musculoskeletal diseases. Since mechanical loading is an important determinant of the disease process, a possible conservative treatment is the unloading of joints. In principle, a neuromuscular rehabilitation program aimed to promote alternative muscle recruitments could reduce the loads on the lower-limb joints during walking. The extent of joint load reduction one could expect from this approach remains unknown. Furthermore, assuming significant reductions of the load on the affected joint can be achieved, it is unclear whether, and to what extent, the other joints will be overloaded. Using subject-specific musculoskeletal models of four different participants, we computed the muscle recruitment strategies that minimised the hip, knee and ankle contact force, and predicted the contact forces such strategies induced at the other joints. Significant reductions of the peak force and impulse at the knee and hip were obtained, while only a minimal effect was found at the ankle joint. Adversely, the peak force and the impulse in non-targeted joints increased when aiming to minimize the load in an adjacent joint. These results confirm the potential of alternative muscle recruitment strategies to reduce the loading at the knee and the hip, but not at the ankle. Therefore, neuromuscular rehabilitation can be targeted to reduce the loading at affected joints but must be considered carefully in patients with multiple joints affected due to the potential adverse effects in non-targeted joints.
Collapse
Affiliation(s)
- Bart van Veen
- Department of Mechanical Engineering and INSIGNEO Institute for in Silico Medicine, University of Sheffield, UK
| | - Erica Montefiori
- Department of Mechanical Engineering and INSIGNEO Institute for in Silico Medicine, University of Sheffield, UK
| | - Luca Modenese
- Department of Mechanical Engineering and INSIGNEO Institute for in Silico Medicine, University of Sheffield, UK; Department of Civil and Environmental Engineering, Imperial College London, UK
| | - Claudia Mazzà
- Department of Mechanical Engineering and INSIGNEO Institute for in Silico Medicine, University of Sheffield, UK.
| | - Marco Viceconti
- Department of Industrial Engineering, Alma Mater Studiorum - University of Bologna, Italy; Medical Technology Lab, Rizzoli Orthopaedic Institute, Bologna, Italy
| |
Collapse
|
20
|
Palmer JS, Monk AP, Hopewell S, Bayliss LE, Jackson W, Beard DJ, Price AJ. Surgical interventions for symptomatic mild to moderate knee osteoarthritis. Cochrane Database Syst Rev 2019; 7:CD012128. [PMID: 31322289 PMCID: PMC6639936 DOI: 10.1002/14651858.cd012128.pub2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Osteoarthritis affecting the knee is common and represents a continuum of disease from early cartilage thinning to full-thickness cartilage loss, bony erosion, and deformity. Many studies do not stratify their results based on the severity of the disease at baseline or recruitment. OBJECTIVES To assess the benefits and harms of surgical intervention for the management of symptomatic mild to moderate knee osteoarthritis defined as knee pain and radiographic evidence of non-end stage osteoarthritis (Kellgren-Lawrence grade 1, 2, 3 or equivalent on MRI/arthroscopy). Outcomes of interest included pain, function, radiographic progression, quality of life, short-term serious adverse events, re-operation rates and withdrawals due to adverse events. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Embase up to May 2018. We also conducted searches of ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform for ongoing trials. Authors of trials were contacted if some but not all their participants appeared to fit our inclusion criteria. SELECTION CRITERIA We included randomised controlled trials that compared surgery to non-surgical interventions (including sham and placebo control groups, exercise or physiotherapy, and analgesic or other medication), injectable therapies, and trials that compared one type of surgical intervention to another surgical intervention in people with symptomatic mild to moderate knee osteoarthritis. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials and extracted data using standardised forms. We analysed the quality of evidence using the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach. MAIN RESULTS A total of five studies involving 566 participants were identified as eligible for this review. Single studies compared arthroscopic partial meniscectomy to physical therapy (320 participants), arthroscopic surgery (debridement ± synovectomy ± chondroplasty) to closed needle joint lavage with saline (32 participants) and high tibial osteotomy surgery to knee joint distraction surgery (62 participants). Two studies (152 participants) compared arthroscopic surgery (washout ± debridement; debridement) to a hyaluronic acid injection. Only one study was at low risk of selection bias, and due to the difficulty of blinding participants to their treatment, all studies were at risk of performance and detection bias.Reporting of results in this summary has been restricted to the primary comparison: surgical intervention versus non-surgical intervention.A single study, included 320 participants with symptoms consistent with meniscal tear. All subjects had the meniscal tear confirmed on knee MRI and radiographic evidence of mild to moderate osteoarthritis (osteophytes, cartilage defect or joint space narrowing). Patients with severe osteoarthritis (KL grade 4) were excluded. The study compared arthroscopic partial meniscectomy and physical therapy to physical therapy alone (a six-week individualised progressive home exercise program). This study was at low risk of selection bias and outcome reporting biases, but was susceptible to performance and detection biases. A high rate of cross-over (30.2%) occurred from the physical therapy group to the arthroscopic group.Low-quality evidence suggests there may be little difference in pain and function at 12 months follow-up in people who have arthroscopic partial meniscectomy and those who have physical therapy. Evidence was downgraded to low quality due to risk of bias and imprecision.Mean pain was 19.3 points on a 0 to 100 point KOOS pain scale with physical therapy at 12 months follow-up and was 0.2 points better with surgery (95% confidence interval (CI) 4.05 better to 3.65 points worse with surgery, an absolute improvement of 0.2% (95% CI 4% better to 4% worse) and relative improvement 0.4% (95% CI 9% better to 8% worse) (low quality evidence). Mean function was 14.5 on a 0 to 100 point KOOS function scale with physical therapy at 12 months follow-up and 0.8 points better with surgery (95% CI 4.3 better to 2.7 worse); 0.8% absolute improvement (95% CI 4% better to 3% worse) and 2.1% relative improvement (95% CI 11% better to 7% worse) (low quality evidence).Radiographic structural osteoarthritis progression and quality of life outcomes were not reported.Due to very low quality evidence, we are uncertain if surgery is associated with an increased risk of serious adverse events, incidence of total knee replacement or withdrawal rates. Evidence was downgraded twice due to very low event rates, and once for risk of bias.At 12 months, the surgery group had a total of three serious adverse events including fatal pulmonary embolism, myocardial infarction and hypoxaemia. The physical therapy alone group had two serious adverse events including sudden death and stroke (Peto OR 1.58, 95% CI 0.27 to 9.21); 1% more events with surgery (95% CI 2% less to 3% more) and 58% relative change (95% CI 73% less to 821% more). One participant in each group withdrew due to adverse events.Two of 164 participants (1.2%) in the physical therapy group and three of 156 in the surgery group underwent conversion to total knee replacement within 12 months (Peto OR 1.76, 95% CI 0.43 to 7.13); 1% more events with surgery (95% CI 2% less to 5% more); 76% relative change (95% CI 57% less to 613% more). AUTHORS' CONCLUSIONS The review found no placebo-or sham-controlled trials of surgery in participants with symptomatic mild to moderate knee osteoarthritis. There was low quality evidence that there may be no evidence of a difference between arthroscopic partial meniscectomy surgery and a home exercise program for the treatment of this condition. Similarly, low-quality evidence from a few small trials indicates there may not be any benefit of arthroscopic surgery over other non-surgical treatments including saline irrigation and hyaluronic acid injection, or one type of surgery over another. We are uncertain of the risk of adverse events or of progressing to total knee replacement due to very small event rates. Thus, there is uncertainty around the current evidence to support or oppose the use of surgery in mild to moderate knee osteoarthritis. As no benefit has been demonstrated from the low quality trials included in this review, it is possible that future higher quality trials for these surgical interventions may not contradict these results.
Collapse
Affiliation(s)
- Jonathan S Palmer
- University of OxfordNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal SciencesWindmill Road, HeadingtonOxfordUKOX3 7LD
| | - A Paul Monk
- University of OxfordNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal SciencesWindmill Road, HeadingtonOxfordUKOX3 7LD
| | - Sally Hopewell
- University of OxfordNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS)Botnar Research Centre, Windmill RoadOxfordOxfordshireUKOX3 7LD
| | - Lee E Bayliss
- University of OxfordNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal SciencesWindmill Road, HeadingtonOxfordUKOX3 7LD
| | - William Jackson
- Oxford University Hospitals NHS TrustNuffield Orthopaedic CentreWindmill RoadOxfordUKOX3 7LD
| | - David J Beard
- University of OxfordNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal SciencesWindmill Road, HeadingtonOxfordUKOX3 7LD
| | - Andrew J Price
- University of OxfordNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal SciencesWindmill Road, HeadingtonOxfordUKOX3 7LD
| | | |
Collapse
|
21
|
Spitters TW, Stamatialis D, Petit A, Leeuw MGD, Karperien M. In Vitro Evaluation of Small Molecule Delivery into Articular Cartilage: Effect of Synovial Clearance and Compressive Load. Assay Drug Dev Technol 2019; 17:191-200. [DOI: 10.1089/adt.2018.907] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Tim W.G.M. Spitters
- Department of Developmental BioEngineering, MIRA Institute, University of Twente, Enschede, The Netherlands
| | - Dimitrios Stamatialis
- Biomaterials Science and Technology Group, MIRA Institute, University of Twente, Enschede, The Netherlands
| | | | | | - Marcel Karperien
- Department of Developmental BioEngineering, MIRA Institute, University of Twente, Enschede, The Netherlands
| |
Collapse
|
22
|
Sun ZB, Peng H. Experimental Study on the Prevention of Posttraumatic Osteoarthritis in the Rabbit Knee Using a Hinged External Fixator in Combination with Exercises. J INVEST SURG 2019; 32:552-559. [PMID: 30644773 DOI: 10.1080/08941939.2018.1543483] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Zhi-Bo Sun
- Department of Orthopedics, Renmin Hospital, Wuhan University, Wuhan, Hubei 430060, China
| | - Hao Peng
- Department of Orthopedics, Renmin Hospital, Wuhan University, Wuhan, Hubei 430060, China
| |
Collapse
|
23
|
Jansen MP, van der Weiden GS, Van Roermund PM, Custers RJH, Mastbergen SC, Lafeber FPJG. Initial tissue repair predicts long-term clinical success of knee joint distraction as treatment for knee osteoarthritis. Osteoarthritis Cartilage 2018; 26:1604-1608. [PMID: 30138728 DOI: 10.1016/j.joca.2018.08.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 07/18/2018] [Accepted: 08/06/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Knee joint distraction (KJD), a joint-preserving surgery for severe osteoarthritis (OA), provides clinical and structural improvement and postpones the need for total knee arthroplasty (TKA). This study evaluates 9-year treatment outcome and identifies characteristics predicting long-term treatment success. DESIGN Patients with severe tibiofemoral OA (n = 20; age<60 years) indicated for TKA were treated with KJD. Questionnaires, radiographs, and magnetic resonance imaging (MRI) were used for evaluation. Survival after treatment was analyzed, where 'failure' was defined by TKA over time. RESULTS 9-year survival was 48%, and 72% for men (compared to 14% for women; P = 0.035) and 73% for those with a first-year minimum joint space width (JSW) increase of >0.5 mm (compared to 0% for <0.05 mm; P = 0.002). Survivors still reported clinical improvement compared to baseline (ΔWOMAC +29.9 points (95%CI 16.9-42.9; P = 0.001), ΔVAS -46.8 mm (-31.6-61.9; P < 0.001)). Surprisingly, patients getting TKA years after KJD still reported clinical improvement although less pronounced (ΔWOMAC +20.5 points (-1.8-42.8; P = 0.067), ΔVAS -25.4 mm (-3.2-47.7; P = 0.030)). Survivors showed long-lasting minimum JSW increase (baseline 0.3 mm (IQR 1.9), follow-up 1.3 mm (2.5); P = 0.017) while 'failures' did not (baseline 0.4 mm (1.8), follow-up 0.2 mm (1.5); P = 0.161). First-year minimum JSW on radiographs and cartilage thickness increase on MRI predict 9-year survival (HR 0.05 and 0.12, respectively; both P < 0.026). Male gender was associated with survival (HR 0.24; P = 0.050). CONCLUSIONS KJD shows long-lasting clinical and structural improvement. In addition to a greater survival rate for males (>two out of three), the initial cartilage repair activity appears to be important for long-term clinical success.
Collapse
Affiliation(s)
- M P Jansen
- Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - G S van der Weiden
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - P M Van Roermund
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - R J H Custers
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - S C Mastbergen
- Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - F P J G Lafeber
- Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands.
| |
Collapse
|
24
|
Solomonow-Avnon D, Herman A, Wolf A. Mechanism of reducing knee adduction moment by shortening of the knee lever arm via medio-lateral manipulation of foot center of pressure: A pilot study. J Biomech 2018; 83:143-149. [PMID: 30527391 DOI: 10.1016/j.jbiomech.2018.11.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 10/20/2018] [Accepted: 11/23/2018] [Indexed: 10/27/2022]
Abstract
Prominent conservative treatment options for medial-compartment knee osteoarthritis include footwear that reduces knee adduction moment (KAM) correlated with detrimental loads in the medial compartment of the knee, thus providing clinical benefit. The proposed mechanism by which they reduce KAM is a lateral shift in foot center of pressure (COP) and a consequent shortening of the knee lever arm (KLA), thereby reducing KAM, which can be simply calculated as KLA multiplied by the frontal plane ground reaction force (FP-GRF). The present study investigated this mechanism for a unique biomechanical device capable of shifting COP by means of moveable convex elements attached to the shoe. Fourteen healthy young male subjects underwent gait analysis in two COP configurations of the device for comparison: (1) laterally and (2) medially deviated. Average midstance KLA and KAM were decreased by 8.2% and 8.7%, respectively, in the lateral COP compared to medial. Ground reaction force parameters, frontal plane knee angle (FP-KA), and spine lateral flexion angle (SLF) did not differ between COP configurations. No study parameters differed for terminal stance. Linear mixed effects models showed that COP and FP-GRF components, but not FP-KA and SLF, were significant predictors of KLA. In addition, KLA and FP-GRF were significant predictors of KAM; although, FP-GRF did not change significantly with medio-lateral COP shift, while KLA did. This suggests that the mechanism by which the study device reduces KAM is primarily through shortening of KLA brought on by a lateral shift in COP.
Collapse
Affiliation(s)
- Deborah Solomonow-Avnon
- Biorobotics and Biomechanics Lab (BRML), Faculty of Mechanical Engineering, Technion - Israel Institute of Technology, Haifa 32000, Israel.
| | - Amir Herman
- Department of Orthopaedic Surgery, Assuta Ashdod Medical Center, Ashdod, Israel
| | - Alon Wolf
- Biorobotics and Biomechanics Lab (BRML), Faculty of Mechanical Engineering, Technion - Israel Institute of Technology, Haifa 32000, Israel
| |
Collapse
|
25
|
Hip movement pathomechanics of patients with hip osteoarthritis aim at reducing hip joint loading on the osteoarthritic side. Gait Posture 2018; 59:11-17. [PMID: 28968547 DOI: 10.1016/j.gaitpost.2017.09.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 04/11/2017] [Accepted: 09/19/2017] [Indexed: 02/02/2023]
Abstract
This study aims at defining gait pathomechanics in patients with hip osteoarthritis (OA) and their effect on hip joint loading by combining analyses of hip kinematics, kinetics and contact forces during gait. Twenty patients with hip OA and 17 healthy volunteers matched for age and BMI performed three-dimensional gait analysis. Hip OA level was evaluated based on plane radiographs using the Tönnis classification. Hip joint kinematics, kinetics as well as hip contact forces were calculated. Waveforms were time normalized and compared between groups using statistical parametric mapping analysis. Patients walked with reduced hip adduction angle and reduced hip abduction and external rotation moments. The work generated by the hip abductors during the stance phase of gait was largely decreased. These changes resulted in a decrease and a more vertical and anterior orientation of the hip contact forces compared to healthy controls. This study documents alterations in hip kinematics and kinetics resulting in decreased hip loading in patients with hip OA. The results suggested that patients altered their gait to increase medio-lateral stability, thereby decreasing demand on the hip abductors. These findings support discharge of abductor muscles that may bear clinical relevance of tailored rehabilitation targeting hip abductor muscles strengthening and gait retraining.
Collapse
|
26
|
van der Woude JTA, Wiegant K, van Roermund PM, Intema F, Custers RJ, Eckstein F, van Laar JM, Mastbergen SC, Lafeber FP. Five-Year Follow-up of Knee Joint Distraction: Clinical Benefit and Cartilaginous Tissue Repair in an Open Uncontrolled Prospective Study. Cartilage 2017; 8:263-271. [PMID: 28618871 PMCID: PMC5625862 DOI: 10.1177/1947603516665442] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objective In end-stage knee osteoarthritis, total knee arthroplasty (TKA) may finally become inevitable. At a relatively young age, this comes with the risk of future revision surgery. Therefore, in these cases, joint preserving surgery such as knee joint distraction (KJD) is preferred. Here we present 5-year follow-up data of KJD. Design Patients ( n = 20; age <60 years) with conservative therapy resistant tibiofemoral osteoarthritis considered for TKA were treated. Clinical evaluation was performed by questionnaires. Change in cartilage thickness was quantified on radiographs and magnetic resonance images (MRI). The 5-year changes after KJD were evaluated and compared with the natural progression of osteoarthritis using Osteoarthritis Initiative data. Results Five-years posttreatment, patients still reported clinical improvement from baseline: ΔWOMAC (Western Ontario and McMaster Universities Arthritis Index) +21.1 points (95% CI +8.9 to +33.3; P = 0.002), ΔVAS (visual analogue scale score) pain -27.6 mm (95%CI -13.3 to -42.0; P < 0.001), and minimum radiographic joint space width (JSW) of the most affected compartment (MAC) remained increased as well: Δ +0.43 mm (95% CI +0.02 to +0.84; P = 0.040). Improvement of mean JSW (x-ray) and mean cartilage thickness (MRI) of the MAC, were not statistically different from baseline anymore (Δ +0.26 mm; P = 0.370, and Δ +0.23 mm; P = 0.177). Multivariable linear regression analysis indicated that KJD treatment was associated with significantly less progression in mean and min JSW (x-ray) and mean cartilage thickness (MRI) compared with natural progression (all Ps <0.001). Conclusions KJD treatment results in prolonged clinical benefit, potentially explained by an initial boost of cartilaginous tissue repair that provides a long-term tissue structure benefit as compared to natural progression. Level of evidence, II.
Collapse
Affiliation(s)
- Jan-Ton A.D. van der Woude
- Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, the Netherlands,Department of Orthopedics, Maartenskliniek Woerden, the Netherlands
| | - Karen Wiegant
- Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Peter M. van Roermund
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, the Netherlands,Department of Orthopedics, Medical Centre Amstelveen, Amstelveen, the Netherlands
| | - Femke Intema
- Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Roel J.H. Custers
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Felix Eckstein
- Institute of Anatomy, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria
| | - Jaap M. van Laar
- Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Simon C. Mastbergen
- Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Floris P.J.G. Lafeber
- Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, the Netherlands,Floris P.J.G. Lafeber, Rheumatology & Clinical Immunology, University Medical Center Utrecht, PO Box 85500, F02.127, 3508 GA Utrecht, the Netherlands.
| |
Collapse
|
27
|
van der Woude JAD, Wiegant K, van Heerwaarden RJ, Spruijt S, van Roermund PM, Custers RJH, Mastbergen SC, Lafeber FPJG. Knee joint distraction compared with high tibial osteotomy: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2017; 25:876-886. [PMID: 27106926 PMCID: PMC5332499 DOI: 10.1007/s00167-016-4131-0] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 04/05/2016] [Indexed: 12/27/2022]
Abstract
PURPOSE Both, knee joint distraction as a relatively new approach and valgus-producing opening-wedge high tibial osteotomy (HTO), are knee-preserving treatments for knee osteoarthritis (OA). The efficacy of knee joint distraction compared to HTO has not been reported. METHODS Sixty-nine patients with medial knee joint OA with a varus axis deviation of <10° were randomized to either knee joint distraction (n = 23) or HTO (n = 46). Questionnaires were assessed at baseline and 3, 6, and 12 months. Joint space width (JSW) as a surrogate measure for cartilage thickness was determined on standardized semi-flexed radiographs at baseline and 1-year follow-up. RESULTS All patient-reported outcome measures (PROMS) improved significantly over 1 year (at 1 year p < 0.02) in both groups. At 1 year, the HTO group showed slightly greater improvement in 4 of the 16 PROMS (p < 0.05). The minimum medial compartment JSW increased 0.8 ± 1.0 mm in the knee joint distraction group (p = 0.001) and 0.4 ± 0.5 mm in the HTO group (p < 0.001), with minimum JSW improvement in favour of knee joint distraction (p = 0.05). The lateral compartment showed a small increase in the knee joint distraction group and a small decrease in the HTO group, leading to a significant increase in mean JSW for knee joint distraction only (p < 0.02). CONCLUSION Cartilaginous repair activity, as indicated by JSW, and clinical outcome improvement occurred with both, knee joint distraction and HTO. These findings suggest that knee joint distraction may be an alternative therapy for medial compartmental OA with a limited mechanical leg malalignment. LEVEL OF EVIDENCE Randomized controlled trial, Level I.
Collapse
Affiliation(s)
- J. A. D. van der Woude
- Limb and Knee Reconstruction Unit, Department of Orthopedic Surgery, Maartenskliniek Woerden, Woerden, The Netherlands ,0000000090126352grid.7692.aRheumatology and Clinical Immunology, University Medical Center Utrecht, F02.217, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - K. Wiegant
- 0000000090126352grid.7692.aRheumatology and Clinical Immunology, University Medical Center Utrecht, F02.217, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - R. J. van Heerwaarden
- Limb and Knee Reconstruction Unit, Department of Orthopedic Surgery, Maartenskliniek Woerden, Woerden, The Netherlands
| | - S. Spruijt
- Limb and Knee Reconstruction Unit, Department of Orthopedic Surgery, Maartenskliniek Woerden, Woerden, The Netherlands
| | - P. M. van Roermund
- 0000000090126352grid.7692.aDepartment of Orthopedics, UMC Utrecht, Utrecht, The Netherlands
| | - R. J. H. Custers
- 0000000090126352grid.7692.aDepartment of Orthopedics, UMC Utrecht, Utrecht, The Netherlands
| | - S. C. Mastbergen
- 0000000090126352grid.7692.aRheumatology and Clinical Immunology, University Medical Center Utrecht, F02.217, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - F. P. J. G. Lafeber
- 0000000090126352grid.7692.aRheumatology and Clinical Immunology, University Medical Center Utrecht, F02.217, PO Box 85500, 3508 GA Utrecht, The Netherlands
| |
Collapse
|
28
|
Kwee RM, Wirth W, Hafezi-Nejad N, Zikria BA, Guermazi A, Demehri S. Role of physical activity in cartilage damage progression of subjects with baseline full-thickness cartilage defects in medial tibiofemoral compartment: data from the Osteoarthritis Initiative. Osteoarthritis Cartilage 2016; 24:1898-1904. [PMID: 27327782 DOI: 10.1016/j.joca.2016.06.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 05/21/2016] [Accepted: 06/11/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the association between physical activity and cartilage damage progression in medial tibiofemoral compartment (MTFC) using 2-year follow-up magnetic resonance imaging (MRI) in subjects with denuded areas of subchondral bone (dABs) at the central weight-bearing medial femur (cMF) at baseline MRI examination. METHODS One hundred subjects from the Osteoarthritis Initiative (OAI) progression cohort with dABs at the cMF at 3T MRI at baseline (51% men; mean age 62.2 years, range 45-79) were included. Sagittal 3D dual-echo steady-state with water excitation images were used to assess 2-year MTFC cartilage change. Associations between 2-year average Physical Activity Scale for the Elderly (PASE) and 2-year MTFC cartilage change were assessed by linear regression analysis. Subgroup analyses were performed. RESULTS No associations between PASE and 2-year MTFC cartilage change were observed in the entire cohort. Similarly, in the subgroup with cartilage loss during the 2 years, the non-refuted confidence intervals for the regression coefficients were tightly clustered around the null value (regression coefficients for: mean cMF.ThCtAB = -0.00059; 98.75% CI: -0.00130 to 0.00012), cMF.dAB% = 0.02176; 98.75% CI: -0.02514 to 0.06865, Mean MT.ThCtAB = -0.00013; 98.75% CI: -0.00064 to 0.00038, MT.dAB% = 0.02543; 98.75% CI: -0.01485 to 0.06571. CONCLUSION In the entire group of subjects with dABs at the cMF at baseline, no association between physical activity and 2-year MTFC cartilage change was detected. Due to the limited sample size of our study, small-sized effects may not have been detected in our study.
Collapse
Affiliation(s)
- R M Kwee
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Radiology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - W Wirth
- Institute of Anatomy, Paracelsus Medical University, Salzburg, Austria; Chondrometrics GmbH, Ainring, Germany
| | - N Hafezi-Nejad
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - B A Zikria
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A Guermazi
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA
| | - S Demehri
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| |
Collapse
|
29
|
Spaans AJ, Minnen LPV, Braakenburg A, Mink van der Molen AB. Joint distraction for thumb carpometacarpal osteoarthritis: a feasibility study with 1-year follow-up. J Plast Surg Hand Surg 2016; 51:254-258. [PMID: 27758127 DOI: 10.1080/2000656x.2016.1241789] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The purpose of this pilot study was to evaluate the feasibility of joint distraction of the first carpometacarpal (CMC1) joint in patients with CMC1 osteoarthritis (OA). METHODS An external joint distractor was placed over the CMC1 joint by K-wire fixation in the trapezium and the metacarpal. The joint was distracted 3 mm during surgery. The device was then kept in place for 8 weeks. Disabilities of the Arm, Shoulder, and Hand (DASH) score, Michigan Hand Outcome Questionnaire (MHQ), Visual Analogue Scale (VAS), and grip strength were recorded preoperatively and at set postoperative intervals. RESULTS Five female patients with an average age of 53 years (range = 41-61) were included. One year postoperatively, average DASH, MHQ, and VAS scores improved compared to preoperative values; DASH 53 to 27, MHQ 48 to 76, and VAS pain 48 to 14. There were no technical problems associated with the device. One patient had a local pin site infection treated successfully with oral antibiotics. CONCLUSIONS This study concludes that joint distraction of the osteoarthritic CMC1 joint is technically feasible. In this small, prospective pilot study the majority of the results were favourable during short-term follow-up.
Collapse
Affiliation(s)
- Anne J Spaans
- a Department of Plastic and Hand Surgery , St Antonius Hospital Nieuwegein/Utrecht , The Netherlands.,b Department of Plastic, Reconstructive and Hand Surgery , Universital Medical Center Utrecht , The Netherlands
| | - L Paul van Minnen
- c Department of Plastic Surgery , Royal Adelaide Hospital , Adelaide , Australia
| | - Assa Braakenburg
- a Department of Plastic and Hand Surgery , St Antonius Hospital Nieuwegein/Utrecht , The Netherlands
| | - Aebele B Mink van der Molen
- a Department of Plastic and Hand Surgery , St Antonius Hospital Nieuwegein/Utrecht , The Netherlands.,b Department of Plastic, Reconstructive and Hand Surgery , Universital Medical Center Utrecht , The Netherlands
| |
Collapse
|
30
|
Pharmacologic and Non-Pharmacologic Treatment of Osteoarthritis. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2016. [DOI: 10.1007/s40674-016-0042-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
31
|
Palmer JS, Monk AP, Hopewell S, Bayliss LE, Jackson W, Beard DJ, Price AJ. Surgical interventions for early structural knee osteoarthritis. Hippokratia 2016. [DOI: 10.1002/14651858.cd012128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jonathan S Palmer
- University of Oxford; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences; Windmill Road, Headington Oxford UK OX3 7LD
| | - A Paul Monk
- University of Oxford; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences; Windmill Road, Headington Oxford UK OX3 7LD
| | - Sally Hopewell
- University of Oxford; Oxford Clinical Trials Research Unit; NDORMS Windmill Road Oxford Oxfordshire UK OX3 7LD
| | - Lee E Bayliss
- University of Oxford; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences; Windmill Road, Headington Oxford UK OX3 7LD
| | - William Jackson
- Oxford University Hospitals NHS Trust; Nuffield Orthopaedic Centre; Windmill Road Oxford UK OX3 7LD
| | - David J Beard
- University of Oxford; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences; Windmill Road, Headington Oxford UK OX3 7LD
| | - Andrew J Price
- University of Oxford; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences; Windmill Road, Headington Oxford UK OX3 7LD
| |
Collapse
|
32
|
Chen Y, Sun Y, Pan X, Ho K, Li G. Joint distraction attenuates osteoarthritis by reducing secondary inflammation, cartilage degeneration and subchondral bone aberrant change. Osteoarthritis Cartilage 2015; 23:1728-35. [PMID: 26028135 DOI: 10.1016/j.joca.2015.05.018] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Revised: 05/15/2015] [Accepted: 05/21/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Osteoarthritis (OA) is a progressive joint disorder. To date, there is not effective medical therapy. Joint distraction has given us hope for slowing down the OA progression. In this study, we investigated the benefits of joint distraction in OA rat model and the probable underlying mechanisms. METHODS OA was induced in the right knee joint of rats through anterior cruciate ligament transaction (ACLT) plus medial meniscus resection. The animals were randomized into three groups: two groups were treated with an external fixator for a subsequent 3 weeks, one with and one without joint distraction; and one group without external fixator as OA control. Serum interleukin-1β level was evaluated by ELISA; cartilage quality was assessed by histology examinations (gross appearance, Safranin-O/Fast green stain) and immunohistochemistry examinations (MMP13, Col X); subchondral bone aberrant changes was analyzed by micro-CT and immunohistochemistry (Nestin, Osterix) examinations. RESULTS Characters of OA were present in the OA group, contrary to in general less severe damage after distraction treatment: firstly, IL-1β level was significantly decreased; secondly, cartilage degeneration was attenuated with lower histologic damage scores and the lower percentage of MMP13 or Col X positive chondrocytes; finally, subchondral bone abnormal change was attenuated, with reduced bone mineral density (BMD) and bone volume/total tissue volume (BV/TV) and the number of Nestin or Osterix positive cells in the subchondral bone. CONCLUSION In the present study, we demonstrated that joint distraction reduced the level of secondary inflammation, cartilage degeneration and subchondral bone aberrant change, joint distraction may be a strategy for slowing OA progression.
Collapse
Affiliation(s)
- Y Chen
- Department of Orthopaedics & Traumatology, Li Ka Shing Institute of Health Sciences and Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, PR China; The CUHK-ACC Space Medicine Centre on Health Maintenance of Musculoskeletal System, The Chinese University of Hong Kong Shenzhen Research Institute, Shenzhen, PR China
| | - Y Sun
- Department of Orthopaedics & Traumatology, Li Ka Shing Institute of Health Sciences and Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, PR China; The CUHK-ACC Space Medicine Centre on Health Maintenance of Musculoskeletal System, The Chinese University of Hong Kong Shenzhen Research Institute, Shenzhen, PR China
| | - X Pan
- Department of Orthopaedics and Traumatology, Bao-An District People's Hospital, Shenzhen, PR China
| | - K Ho
- Department of Orthopaedics & Traumatology, Li Ka Shing Institute of Health Sciences and Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, PR China; The CUHK-ACC Space Medicine Centre on Health Maintenance of Musculoskeletal System, The Chinese University of Hong Kong Shenzhen Research Institute, Shenzhen, PR China.
| | - G Li
- Department of Orthopaedics & Traumatology, Li Ka Shing Institute of Health Sciences and Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, PR China; The CUHK-ACC Space Medicine Centre on Health Maintenance of Musculoskeletal System, The Chinese University of Hong Kong Shenzhen Research Institute, Shenzhen, PR China; Key Laboratory for Regenerative Medicine, Ministry of Education, School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, PR China.
| |
Collapse
|
33
|
Nicholas ND, Ambler SB. External Rotation Strengthening With Manual Distraction for Individuals With Glenohumeral Osteoarthritis. Strength Cond J 2015. [DOI: 10.1519/ssc.0000000000000152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
34
|
Moyer RF, Birmingham TB, Bryant DM, Giffin JR, Marriott KA, Leitch KM. Valgus bracing for knee osteoarthritis: a meta-analysis of randomized trials. Arthritis Care Res (Hoboken) 2015; 67:493-501. [PMID: 25201520 DOI: 10.1002/acr.22472] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 09/02/2014] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To evaluate the effects of valgus knee bracing on pain and function, and compliance and complications, in patients with medial knee osteoarthritis (OA). METHODS A meta-analysis of randomized controlled trials that compared changes in patient-reported pain and/or function in patients with medial knee OA was performed. Seven databases were searched from their inception to January 2014. Two reviewers independently determined study eligibility, rated risk of bias, and extracted data. Pooled estimates and 95% confidence intervals (95% CIs) for standardized mean differences (SMDs) for the improvement in pain (and function) were calculated. Event rates (proportions) were calculated for studies that reported complications. RESULTS Six studies were included in the meta-analysis. Overall, there was a statistically significant difference favoring the valgus brace group for improvement in pain (SMD 0.33 [95% CI 0.13, 0.52], P = 0.001) and function (SMD 0.22 [95% CI 0.02, 0.41], P = 0.03). When compared to a control group that did not use an orthosis, the effect size was moderate for pain (SMD 0.56 [95% CI 0.03, 1.09], P = 0.04) and function (SMD 0.48 [95% CI 0.02, 0.95], P = 0.04). When compared to a control group that used a control orthosis, only a small, statistically significant effect for pain remained (SMD 0.33 [95% CI 0.08, 0.58], P = 0.01). Instructions for brace use varied considerably and compliance ranged from 45% to 100%. Up to 25% of patients reported minor complications with brace use. CONCLUSION Meta-analysis of randomized trials suggests valgus bracing for medial knee OA results in small-to-moderate improvements in pain. Effect sizes vary based on study design and warrant future research.
Collapse
|
35
|
Tiku ML, Sabaawy HE. Cartilage regeneration for treatment of osteoarthritis: a paradigm for nonsurgical intervention. Ther Adv Musculoskelet Dis 2015; 7:76-87. [PMID: 26029269 DOI: 10.1177/1759720x15576866] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Osteoarthritis (OA) is associated with articular cartilage abnormalities and affects people of older age: preventative or therapeutic treatment measures for OA and related articular cartilage disorders remain challenging. In this perspective review, we have integrated multiple biological, morphological, developmental, stem cell and homeostasis concepts of articular cartilage to develop a paradigm for cartilage regeneration. OA is conceptually defined as an injury of cartilage that initiates chondrocyte activation, expression of proteases and growth factor release from the matrix. This regenerative process results in the local activation of inflammatory response genes in cartilage without migration of inflammatory cells or angiogenesis. The end results are catabolic and anabolic responses, and it is the balance between these two outcomes that controls remodelling of the matrix and regeneration. A tantalizing clinical clue for cartilage regrowth in OA joints has been observed in surgically created joint distraction. We hypothesize that cartilage growth in these distracted joints may have a biological connection with the size of organs and regeneration. Therefore we propose a novel, practical and nonsurgical intervention to validate the role of distraction in cartilage regeneration in OA. The approach permits normal wake-up activity while during sleep; the index knee is subjected to distraction with a pull traction device. Comparison of follow-up magnetic resonance imaging (MRI) at 3 and 6 months of therapy to those taken before therapy will provide much-needed objective evidence for the use of this mode of therapy for OA. We suggest that the paradigm presented here merits investigation for treatment of OA in knee joints.
Collapse
Affiliation(s)
- Moti L Tiku
- Department of Medicine, Robert Wood Johnson Medical School, New Brunswick, NJ 08903-2681, USA
| | - Hatem E Sabaawy
- Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| |
Collapse
|
36
|
Wiegant K, Intema F, Roermund PM, Barten‐van Rijbroek AD, Doornebal A, Hazewinkel HAW, Lafeber FPJG, Mastbergen SC. Evidence of Cartilage Repair by Joint Distraction in a Canine Model of Osteoarthritis. Arthritis Rheumatol 2015; 67:465-74. [DOI: 10.1002/art.38906] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 10/02/2014] [Indexed: 12/24/2022]
Affiliation(s)
- Karen Wiegant
- University Medical Center UtrechtUtrechtThe Netherlands
| | - Femke Intema
- University Medical Center UtrechtUtrechtThe Netherlands
| | | | | | | | | | | | | |
Collapse
|
37
|
Low-intensity pulsed ultrasound (LIPUS) and pulsed electromagnetic field (PEMF) treatments affect degeneration of cultured articular cartilage explants. INTERNATIONAL ORTHOPAEDICS 2014; 39:549-57. [PMID: 25267432 DOI: 10.1007/s00264-014-2542-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 09/16/2014] [Indexed: 12/15/2022]
Abstract
PURPOSE Articular cartilage has some capacity for self-repair. Clinically used low-intensity pulsed ultrasound (LIPUS) and pulsed electromagnetic field (PEMF) treatments were compared in their potency to prevent degeneration using an explant model of porcine cartilage. METHODS Explants of porcine cartilage and human osteoarthritic cartilage were cultured for four weeks and subjected to daily LIPUS or PEMF treatments. At one, two, three and four weeks follow-up explants were prepared for histological assessment or gene expression (porcine only). RESULTS Non-treated porcine explants showed signs of atrophy of the superficial zone starting at one week. Treated explants did not. In LIPUS-treated explants cell clusters were observed. In PEMF-treated explants more hypertrophic-like changes were observed at later follow up. Newly synthesized tissue was present in treated explants. Gene expression profiles did indicate differences between the two methods. Both methods reduced expression of the aggrecan and collagen type II gene compared to the control. LIPUS treatment of human cartilage samples resulted in a reduction of degeneration according to Mankin scoring. PEMF treatment did not. CONCLUSIONS LIPUS or PEMF prevented degenerative changes in pig knee cartilage explants. LIPUS reduced degeneration in human cartilage samples. LIPUS treatment seems to have more potency in the treatment of osteoarthritis than PEMF treatment.
Collapse
|
38
|
Henriksen M, Creaby MW, Lund H, Juhl C, Christensen R. Is there a causal link between knee loading and knee osteoarthritis progression? A systematic review and meta-analysis of cohort studies and randomised trials. BMJ Open 2014; 4:e005368. [PMID: 25031196 PMCID: PMC4120424 DOI: 10.1136/bmjopen-2014-005368] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE We performed a systematic review, meta-analysis and assessed the evidence supporting a causal link between knee joint loading during walking and structural knee osteoarthritis (OA) progression. DESIGN Systematic review, meta-analysis and application of Bradford Hill's considerations on causation. DATA SOURCES We searched MEDLINE, Scopus, AMED, CINAHL and SportsDiscus for prospective cohort studies and randomised controlled trials (RCTs) from 1950 through October 2013. STUDY ELIGIBILITY CRITERIA We selected cohort studies and RCTs in which estimates of knee joint loading during walking were used to predict structural knee OA progression assessed by X-ray or MRI. DATA ANALYSES Meta-analysis was performed to estimate the combined OR for structural disease progression with higher baseline loading. The likelihood of a causal link between knee joint loading and OA progression was assessed from cohort studies using the Bradford Hill guidelines to derive a 0-4 causation score based on four criteria and examined for confirmation in RCTs. RESULTS Of the 1078 potentially eligible articles, 5 prospective cohort studies were included. The studies included a total of 452 patients relating joint loading to disease progression over 12-72 months. There were very serious limitations associated with the methodological quality of the included studies. The combined OR for disease progression was 1.90 (95% CI 0.85 to 4.25; I(2)=77%) for each one-unit increment in baseline knee loading. The combined causation score was 0, indicating no causal association between knee loading and knee OA progression. No RCTs were found to confirm or refute the findings from the cohort studies. CONCLUSIONS There is very limited and low-quality evidence to support for a causal link between knee joint loading during walking and structural progression of knee OA. TRIAL REGISTRATION NUMBER CRD42012003253.
Collapse
Affiliation(s)
- Marius Henriksen
- The Parker Institute, Copenhagen University Hospitals Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Mark W Creaby
- School of Exercise Science, Australian Catholic University, Brisbane, Queensland, Australia
| | - Hans Lund
- Faculty of Health Sciences, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Carsten Juhl
- Faculty of Health Sciences, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Department of Rheumatology and Gerontology, Copenhagen University Hospital Gentofte, Copenhagen, Denmark
| | - Robin Christensen
- The Parker Institute, Copenhagen University Hospitals Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Faculty of Health Sciences, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
39
|
Miller RH, Brandon SCE, Deluzio KJ. Predicting sagittal plane biomechanics that minimize the axial knee joint contact force during walking. J Biomech Eng 2014; 135:011007. [PMID: 23363218 DOI: 10.1115/1.4023151] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Both development and progression of knee osteoarthritis have been associated with the loading of the knee joint during walking. We are, therefore, interested in developing strategies for changing walking biomechanics to offload the knee joint without resorting to surgery. In this study, simulations of human walking were performed using a 2D bipedal forward dynamics model. A simulation generated by minimizing the metabolic cost of transport (CoT) resembled data measured from normal human walking. Three simulations targeted at minimizing the peak axial knee joint contact force instead of the CoT reduced the peak force by 12-25% and increased the CoT by 11-14%. The strategies used by the simulations were (1) reduction in gastrocnemius muscle force, (2) avoidance of knee flexion during stance, and (3) reduced stride length. Reduced gastrocnemius force resulted from a combination of changes in activation and changes in the gastrocnemius contractile component kinematics. The simulations that reduced the peak contact force avoided flexing the knee during stance when knee motion was unrestricted and adopted a shorter stride length when the simulated knee motion was penalized if it deviated from the measured human knee motion. A higher metabolic cost in an offloading gait would be detrimental for covering a long distance without fatigue but beneficial for exercise and weight loss. The predicted changes in the peak axial knee joint contact force from the simulations were consistent with estimates of the joint contact force in a human subject who emulated the predicted kinematics. The results demonstrate the potential of using muscle-actuated forward dynamics simulations to predict novel joint offloading interventions.
Collapse
Affiliation(s)
- Ross H Miller
- Department of Mechanical and Materials Engineering, Queen's University, Kingston, ON, K7L 3N6, Canada.
| | | | | |
Collapse
|
40
|
Arendt EA, Miller LE, Block JE. Early knee osteoarthritis management should first address mechanical joint overload. Orthop Rev (Pavia) 2014; 6:5188. [PMID: 24744839 PMCID: PMC3980155 DOI: 10.4081/or.2014.5188] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 01/30/2014] [Accepted: 02/10/2014] [Indexed: 12/12/2022] Open
Abstract
Early knee osteoarthritis poses a therapeutic dilemma to the musculoskeletal clinician. Despite the recent interest in arthroscopic and injectable regenerative therapies intended to repair or restore a focal target such as cartilage, meniscus, or subchondral bone, none have been shown to slow disease progression. A likely cause of these disappointing treatment outcomes is the failure to address chronic and excessive loading of the knee joint. A growing body of evidence suggests that first-line therapies for early knee osteoarthritis should emphasize unloading the knee joint since any potential therapeutic benefit of regenerative therapies will likely be attenuated by excessive mechanical demand at the knee joint. Minimally invasive medical devices such as patient-specific interpositional implants and extracapsular joint unloading implants are currently in development to address this clinical need.
Collapse
Affiliation(s)
- Elizabeth A Arendt
- Department of Orthopedic Surgery, University of Minnesota , Minneapolis, MN, USA
| | - Larry E Miller
- Miller Scientific Consulting Inc., Asheville, NC, USA ; The Jon Block Group, San Francisco, CA, USA
| | | |
Collapse
|
41
|
Sharifi S, Bulstra SK, Grijpma DW, Kuijer R. Treatment of the degenerated intervertebral disc; closure, repair and regeneration of the annulus fibrosus. J Tissue Eng Regen Med 2014; 9:1120-32. [PMID: 24616324 DOI: 10.1002/term.1866] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Revised: 09/19/2013] [Accepted: 11/25/2013] [Indexed: 12/25/2022]
Abstract
Degeneration of the intervertebral disc (IVD) and disc herniation are two causes of low back pain. The aetiology of these disorders is unknown, but tissue weakening, which primarily occurs due to inherited genetic factors, ageing, nutritional compromise and loading history, is the basic factor causing disc degeneration. Symptomatic disc herniation mainly causes radicular pain. Current treatments of intervertebral disc degeneration and low back pain are based on alleviating the symptoms and comprise administration of painkillers or surgical methods such as spinal fusion. None of these methods is completely successful. Current research focuses on regeneration of the IVD and particularly on regeneration of the nucleus pulposus. Less attention has been directed to the repair or regeneration of the annulus fibrosus, although this is the key to successful nucleus pulposus, and therewith IVD, repair. This review focuses on the importance of restoring the function of the annulus fibrosus, as well as on the repair, replacement or regeneration of the annulus fibrosus in combination with restoration of the function of the nucleus pulposus, to treat low back pain.
Collapse
Affiliation(s)
- Shahriar Sharifi
- University of Groningen, University Medical Center Groningen, W. J. Kolff Institute, Department of Biomedical Engineering, Groningen, The Netherlands
- MIRA Institute for Biomedical Technology and Technical Medicine, Department of Biomaterials Science and Technology, University of Twente, Enschede, The Netherlands
| | - Sjoerd K Bulstra
- University of Groningen, University Medical Center Groningen, Department of Orthopaedic Surgery, Groningen, The Netherlands
| | - Dirk W Grijpma
- University of Groningen, University Medical Center Groningen, W. J. Kolff Institute, Department of Biomedical Engineering, Groningen, The Netherlands
- MIRA Institute for Biomedical Technology and Technical Medicine, Department of Biomaterials Science and Technology, University of Twente, Enschede, The Netherlands
| | - Roel Kuijer
- University of Groningen, University Medical Center Groningen, W. J. Kolff Institute, Department of Biomedical Engineering, Groningen, The Netherlands
| |
Collapse
|
42
|
Guermazi A, Roemer FW, Felson DT, Brandt KD. Motion for debate: osteoarthritis clinical trials have not identified efficacious therapies because traditional imaging outcome measures are inadequate. ACTA ACUST UNITED AC 2014; 65:2748-58. [PMID: 23861096 DOI: 10.1002/art.38086] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 07/02/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Ali Guermazi
- Boston University School of Medicine, Boston, Massachusetts
| | | | | | | |
Collapse
|
43
|
Marijnissen ACA, Hoekstra MCL, Pré BCD, van Roermund PM, van Melkebeek J, Amendola A, Maathuis P, Lafeber FPJG, Welsing PMJ. Patient characteristics as predictors of clinical outcome of distraction in treatment of severe ankle osteoarthritis. J Orthop Res 2014; 32:96-101. [PMID: 23983196 DOI: 10.1002/jor.22475] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 07/31/2013] [Indexed: 02/04/2023]
Abstract
Osteoarthritis (OA) is a slowly progressive joint disease. Joint distraction can be a treatment of choice in case of severe OA. Prediction of failure will facilitate implementation of joint distraction in clinical practice. Patients with severe ankle OA, who underwent joint distraction were included. Survival analysis was performed over 12 years (n = 25 after 12 years). Regression analyses were used to predict failures and clinical benefit at 2 years after joint distraction (n = 111). Survival analysis showed that 44% of the patients failed, 17% within 2 years and 37% within 5 years after joint distraction (n = 48 after 5 years). Survival analysis in subgroups showed that the percentage failure was only different in women (30% after 2 years) versus men (after 11 years still no 30% failure). In the multivariate analyses female gender was predictive for failure 2 years after joint distraction. Gender and functional disability at baseline predicted more pain. Functional disability and pain at baseline were associated with more functional disability. Joint distraction shows a long-term clinical beneficial outcome. However, failure rate is considerable over the years. Female patients have a higher chance of failure during follow-up. Unfortunately, not all potential predictors could be investigated and other clinically significant predictors were not found.
Collapse
Affiliation(s)
- A C A Marijnissen
- Rheumatology & Clinical Immunology, UMC Utrecht, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands
| | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Influence of weak hip abductor muscles on joint contact forces during normal walking: probabilistic modeling analysis. J Biomech 2013; 46:2186-93. [PMID: 23891175 DOI: 10.1016/j.jbiomech.2013.06.030] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 06/28/2013] [Accepted: 06/30/2013] [Indexed: 11/22/2022]
Abstract
The weakness of hip abductor muscles is related to lower-limb joint osteoarthritis, and joint overloading may increase the risk for disease progression. The relationship between muscle strength, structural joint deterioration and joint loading makes the latter an important parameter in the study of onset and follow-up of the disease. Since the relationship between hip abductor weakness and joint loading still remains an open question, the purpose of this study was to adopt a probabilistic modeling approach to give insights into how the weakness of hip abductor muscles, in the extent to which normal gait could be unaltered, affects ipsilateral joint contact forces. A generic musculoskeletal model was scaled to each healthy subject included in the study, and the maximum force-generating capacity of each hip abductor muscle in the model was perturbed to evaluate how all physiologically possible configurations of hip abductor weakness affected the joint contact forces during walking. In general, the muscular system was able to compensate for abductor weakness. The reduced force-generating capacity of the abductor muscles affected joint contact forces to a mild extent, with 50th percentile mean differences up to 0.5 BW (maximum 1.7 BW). There were greater increases in the peak knee joint loads than in loads at the hip or ankle. Gluteus medius, particularly the anterior compartment, was the abductor muscle with the most influence on hip and knee loads. Further studies should assess if these increases in joint loading may affect initiation and progression of osteoarthritis.
Collapse
|
45
|
Functional articular cartilage repair: here, near, or is the best approach not yet clear? Nat Rev Rheumatol 2013; 9:277-90. [DOI: 10.1038/nrrheum.2013.29] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
46
|
Crawford DC, Miller LE, Block JE. Conservative management of symptomatic knee osteoarthritis: a flawed strategy? Orthop Rev (Pavia) 2013; 5:e2. [PMID: 23705060 PMCID: PMC3662262 DOI: 10.4081/or.2013.e2] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 10/12/2012] [Indexed: 01/24/2023] Open
Abstract
Conservative management of medial compartment knee osteoarthritis (OA) is a misleading term used to describe the application of medical, orthotic, and/or rehabilitative therapies exclusive of surgical interventions. The implication of this nomenclature is that these therapies offer satisfactory symptom relief, alter disease progression, and have limited side effects. Unfortunately, conservative therapeutic options possesses few, if any, characteristics of an ideal treatment, namely one that significantly alleviates pain, improves knee function, and reduces medial compartmental loading without adverse side effects. As uncompensated mechanical loading is a primary culprit in the development and progression of knee OA, we propose that the therapeutic perspective of conservative treatment should shift from pharmacological treatments, which have no influence on joint loading, minimal potential to alter joint function, substantial associated risks, and significant financial costs, towards minimally invasive load absorbing therapeutic interventions. A safe and effective minimally invasive medical device specifically engineered for symptomatic relief of medial knee OA by limiting joint contact forces has the potential to reduce the clinical and economic knee OA burden. This review characterizes the current standard of care recommendations for conservative management of medial compartment knee OA with respect to treatment efficacy, risk profile, and economic burden.
Collapse
Affiliation(s)
- Dennis C Crawford
- Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, OR
| | | | | |
Collapse
|
47
|
Roemhildt ML, Beynnon BD, Gauthier AE, Gardner-Morse M, Ertem F, Badger GJ. Chronic in vivo load alteration induces degenerative changes in the rat tibiofemoral joint. Osteoarthritis Cartilage 2013; 21:346-57. [PMID: 23123358 PMCID: PMC3556233 DOI: 10.1016/j.joca.2012.10.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Revised: 10/16/2012] [Accepted: 10/25/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We investigated the relationship between the magnitude and duration of sustained compressive load alteration and the development of degenerative changes in the rat tibiofemoral joint. METHODS A varus loading device was attached to the left hind limb of mature rats to apply increased compression to the medial compartment and decreased compression to the lateral compartment of the tibiofemoral joint of either 0% or 100% body weight for 0, 6 or 20 weeks. Compartment-specific assessment of the tibial plateaus included biomechanical measures (articular cartilage aggregate modulus, permeability and Poisson's ratio, and subchondral bone modulus) and histological assessments (articular cartilage, calcified cartilage, and subchondral bone thicknesses, degenerative scoring parameters, and articular cartilage cellularity). RESULTS Increased compression in the medial compartment produced significant degenerative changes consistent with the development of osteoarthritis (OA) including a progressive decrease in cartilage aggregate modulus (43% and 77% at 6 and 20 weeks), diminished cellularity (38% and 51% at 6 and 20 weeks), and increased histological degeneration. At 20 weeks, medial compartment articular cartilage thickness decreased 30% while subchondral bone thickness increased 32% and subchondral bone modulus increased 99%. Decreased compression in the lateral compartment increased calcified cartilage thickness, diminished region-specific subchondral bone thickness and revealed trends for reduced cellularity and decreased articular cartilage thickness at 20 weeks. CONCLUSIONS Altered chronic joint loading produced degenerative changes consistent with those observed clinically with the development of OA and may replicate the slow development of non-traumatic OA in which mechanical loads play a primary etiological role.
Collapse
Affiliation(s)
| | - B. D. Beynnon
- College of Medicine, Department of Orthopaedics and Rehabilitation, University of Vermont,
| | - A. E. Gauthier
- College of Medicine, Department of Orthopaedics and Rehabilitation, University of Vermont,
| | - M. Gardner-Morse
- College of Medicine, Department of Orthopaedics and Rehabilitation, University of Vermont,
| | - F. Ertem
- College of Medicine, Department of Orthopaedics and Rehabilitation, University of Vermont,
| | - G. J. Badger
- Department of Medical Biostatistics, University of Vermont,
| |
Collapse
|
48
|
Bowditch M, Miller LE, Block JE. Successful two-stage revision of a KineSpring® joint unloading implant: a case study. Int Med Case Rep J 2012; 5:91-5. [PMID: 23754932 PMCID: PMC3658263 DOI: 10.2147/imcrj.s38486] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Few nonsurgical treatment options are available to the patient with debilitating knee osteoarthritis (OA) that is refractory to conservative care. The KineSpring® System joint unloading implant is a unique device that reduces the load carried by the medial compartment of the knee joint by up to 13 kilograms during the stance phase of gait. We report a case of a male patient who underwent implant with the KineSpring System for symptomatic knee OA but subsequently required revision due to local infection. We performed a novel two-stage revision procedure where the absorber unit was removed in the first phase and a new absorber was placed 3 months later after the infection resolved. A key finding of this case was that knee OA pain resolved with the KineSpring System, returned following explant of the absorber unit, and resolved again following implant of the new absorber. Another important aspect of this case was that the femoral and tibial bases of the KineSpring System remained in situ, which simplified each phase of the revision procedure.
Collapse
Affiliation(s)
- Mark Bowditch
- The Ipswich Hospital NHS Trust, Ipswich, Suffolk, UK
| | | | | |
Collapse
|
49
|
Knee Osteoarthritis Treatment with the KineSpring Knee Implant System: A Report of Two Cases. Case Rep Orthop 2012; 2012:297326. [PMID: 23304590 PMCID: PMC3523577 DOI: 10.1155/2012/297326] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 11/20/2012] [Indexed: 11/18/2022] Open
Abstract
Osteoarthritis (OA) is a leading cause of disability in middle-aged and older adults with the prevalence expected to increase by 40% by 2025. This dramatic projected increase in OA reflects, in large part, the alarming obesity epidemic. Indeed, it is now well understood that abnormal loading across the knee joint due to malalignment and/or excessive weight gain is responsible for accelerating OA progression. Consequently, there is a therapeutic need for alternative knee OA treatments that directly address joint overload to fill the gap between ineffective conservative care and invasive joint-modifying surgical procedures. We describe two cases that presented with bilateral knee OA resistant to conservative treatments, each with one knee previously and unsuccessfully treated with high tibial osteotomy to improve alignment and the contralateral knee successfully treated with a joint-preserving, load-absorbing implant (KineSpring Knee Implant System).
Collapse
|
50
|
van Meegeren MER, van Vulpen LFD, Roosendaal G, Lafeber FPJG, Mastbergen SC. Joint distraction: a treatment to consider for haemophilic arthropathy. Haemophilia 2012; 18:e418-20. [DOI: 10.1111/hae.12007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2012] [Indexed: 11/24/2022]
Affiliation(s)
| | | | - G. Roosendaal
- Department of Haematology; Van Creveld Clinic; University Medical Center (UMC) Utrecht; Utrecht; The Netherlands
| | - F. P. J. G. Lafeber
- Department of Rheumatology and Clinical Immunology; University Medical Center (UMC) Utrecht; Utrecht; The Netherlands
| | - S. C. Mastbergen
- Department of Rheumatology and Clinical Immunology; University Medical Center (UMC) Utrecht; Utrecht; The Netherlands
| |
Collapse
|