Modifiable lifestyle factors are associated with lower pain levels in adults with knee osteoarthritis

Knee Measurement System with Osteoarthritis Levels Using Artificial Cartilage and Skeletons

Knee osteoarthritis (OA), also known as degenerative arthritis, is a disease characterized by irreversible changes in the cartilage and bones comprising the joints, resulting in pain, impaired function, and deformity. Furthermore, independent of natural aging, the rate of change in joint cartilage has increased in recent years, which is mainly attributed to environmental factors. The rising incidence of knee-related disorders emphasizes the importance of analyzing the morphology and kinematics of knee structure. This study introduces a knee measurement system designed to replicate the motions of knee using 3D-printing technology, providing insights into knee mechanics with OA level. The research explores the stages of OA using the Kellgren-Lawrence (KL) grade scale, highlighting the variations in the force applied to the knee bone according to movement. The developed knee-simulation system, utilizing the four-bar-link theory, presents a novel approach to studying OA levels 0 to 4. As OA progresses, the cartilage deteriorates, affecting the movement of OA. The OA-based knee measurement system that incorporates soft tissues and skeletons can assist in developing a personalized diagnostic approach for knee disease. This will also help to enhance surgical effectiveness by facilitating the creation of personalized prosthetic joints for individual patients and offering a customized surgical simulation.

Finding the Goldilocks Zone of Mechanical Loading: A Comprehensive Review of Mechanical Loading in the Prevention and Treatment of Knee Osteoarthritis

In this review, we discuss the interaction of mechanical factors influencing knee osteoarthritis (KOA) and post-traumatic osteoarthritis (PTOA) pathogenesis. Emphasizing the importance of mechanotransduction within inflammatory responses, we discuss its capacity for being utilized and harnessed within the context of prevention and rehabilitation of osteoarthritis (OA). Additionally, we introduce a discussion on the Goldilocks zone, which describes the necessity of maintaining a balance of adequate, but not excessive mechanical loading to maintain proper knee joint health. Expanding beyond these, we synthesize findings from current literature that explore the biomechanical loading of various rehabilitation exercises, in hopes of aiding future recommendations for physicians managing KOA and PTOA and athletic training staff strategically planning athlete loads to mitigate the risk of joint injury. The integration of these concepts provides a multifactorial analysis of the contributing factors of KOA and PTOA, in order to spur further research and illuminate the potential of utilizing the body's own physiological responses to mechanical stimuli in the management of OA.

Impact of end-stage knee osteoarthritis on perceived physical function and quality of life: A descriptive study from Jordan

OBJECTIVE

Of the present study was to evaluate the impact of end-stage knee OA on patient's perception of their functional abilities and quality of life (QoL) using the self-reported questionnaire; the Knee Injury and Osteoarthritis Outcome Score (KOOS), and to determine the contribution of knee pain on patient's perceived outcomes.

METHODS

Patients with end-stage knee OA who are on the waiting list for total knee arthroplasty were recruited in this cross-sectional study. Patients were asked to fill out the KOOS questionnaire. Knee pain for both sides was quantified on a continuous scale from 0-10. Age, and anthropometric data were recorded. Descriptive statistics were calculated for patients' characteristics, and for the scores of each KOOS subscale. Hierarchical linear regression models were created to determine the contributions of knee pain on two KOOS subscales; the function in daily living (KOOS-ADL), and the knee-related quality of life (KOOS-QoL).

RESULTS

Patients in this study scored low across KOOS subscales (27.7% - 54.2%) with the QoL subscale being the lowest. After accounting for age and BMI, hierarchical linear regressions revealed that knee pain in both sides were determinants of self-perceived KOOS-ADLs, while only knee pain in the most-affected side significantly contributed to lower KOOS-QOL scores.

CONCLUSION

End-stage knee OA negatively impact the patients' perceived function and quality of life. Patients' KOOS scores were similar to those reported in other countries, with QoL being the domain most affected. Our findings demonstrate that the level of knee pain has a determinant effect on our patients' perceptions of functional abilities and QoL. As waiting-list patients, addressing knee pain with a targeted regimen prior to TKA, as well as increasing patient's awareness about knee pain management, may improve/ or minimize deterioration in perceived functional ability and QoL while awaiting TKA.

What Personal and Work-Related Characteristics of Dutch Construction Workers With Knee Osteoarthritis Are Associated With Future Work Ability?

OBJECTIVE

To assess personal and work-related characteristics of construction workers with knee osteoarthritis (KO) associated with their ability to perform their current profession in the following 2 years.

METHODS

A cross-sectional study was performed among Dutch construction workers diagnosed with KO using data from the Worker Health Surveillance. Logistic regression was used to assess the characteristics associated with future work ability.

RESULTS

On the basis of 344 construction workers with KO, being able to perform their current profession in 2 years' time was associated with working weekly 36 to 45 hours (odds ratio [OR], 3.0 to 6.3), performing high-intensity exercises 1 to 2 times weekly (OR, 2.0 to 2.6), being younger than 56 years (OR, 0.2 to 0.3), and not performing strenuous work activities such as lifting and kneeling (OR, 0.4 to 0.5).

CONCLUSIONS

To keep construction workers with KO at work, intervention studies should evaluate the effects of reducing strenuous work activities and promote leisure-time exercise.

Factors affecting pain and physical functions in patients with knee osteoarthritis: An observational study

Knee osteoarthritis (KOA) is more common as people age and have a higher body mass index (BMI). We must know the role of various factors in pain and physical functions in patients with KOA. Therefore, the present study sought to examine the factors associated with pain and physical functions in individuals with KOA. This cross-sectional observational study included patients with KOA (n = 125; 57 men, 68 women; mean age 52.9 years). Using the visual analogue scale and a reduced version of the Western Ontario McMaster Universities Osteoarthritis Index, pain severity and physical functions were assessed. Demographic factors such as age, BMI, sex, and Kellgren-Lawrence (K/L) radiographic grade of KOA were analyzed. Age (R = 0.263, P < .001), BMI (R = 0.379, P < .001), and K/L grade (R = 0.844, P < .001) were significantly associated with knee pain. Similarly, age (R = 0.310, P < .001), BMI (R = 0.374, P < .001), and K/L grade (R = 0.862, P < .001) were associated with physical functions. No significant association of sex with pain (R = 0.071, P = .440) and physical functions (R = 0.055, P = .545) was observed. Age, BMI, and K/L grade explained 71% and 74% of knee pain and physical functions, respectively. Age, BMI, and radiographic (K/L) grades were associated with pain and physical functions in patients with KOA. K/L grade was the most significant predictor of pain and physical functions in KOA.

Knowledge, Attitude, and Practice of Orthopedic Manual Physical Therapists Toward Lifestyle Screening and Education: A Descriptive Study

Introduction. Lifestyle-focused rehabilitation plans need to become part of the standard system of care for the treatment of chronic diseases. To achieve this goal, the KAP of rehabilitation professionals toward lifestyle medicine needs to be understood. This study investigated the niche of orthopedic manual physical therapy and is purposed as a foundational model for continued research. Method. A survey instrument was designed to investigate the KAP of orthopedic manual physical therapists toward lifestyle screening and education. Results. There were 155 participants of which 58.1-72.3% reported frequently talking to their patients about lifestyle topics, while 78.1-80.6% felt highly confident and competent while doing so. Additionally, 92.9-94.8% thought that lifestyle screening and education was important and that physical therapists should be doing it. Participants discussed exercise most frequently with their patients (96.1%) and alcohol the least (12.9%). Participants with advanced degrees (ie, PhD or DSc) had significantly higher Practice (MΔ= −3.755, P = .001) and Knowledge (MΔ= −4.14904, P = .020) ratings than those with entry-level physical therapy degrees. Conclusion. There was strong acceptance of lifestyle screening and education in orthopedic manual physical therapy with an emphasis on exercise. This study provides a foundational basis for continued research.

Barriers to and Facilitators of Physical Activity among Korean Female Adults with Knee Osteoarthritis and Comorbidity: A Qualitative Study

When knee osteoarthritis is combined with comorbidity, it is associated with limited physical activity. This study aimed to identify barriers to and facilitators of physical activity among Korean female adults with knee osteoarthritis and comorbidity, such as hypertension, diabetes, and dyslipidemia. A qualitative content analysis study was conducted. Ten female knee osteoarthritis participants with comorbidity were recruited at an orthopedic outpatient center in South Korea. Data were collected using in-depth interviews and were analyzed using a conventional content analysis method. Ten participants with a mean age of 70.7 years participated in this study. Four categories of barriers and three of facilitators were identified. Barriers to physical activity were physical hardships, lack of motivation, environmental restrictions, and lack of knowledge. Categories of facilitators were pain management, self-control in physical activity, and understanding the importance of physical activity. Participants did not express any social or environmental facilitators of physical exercise. Healthcare professionals should include social support and environmental facilities to achieve medical and institutional compliance. Understanding female adults with knee osteoarthritis and comorbidity would support provision of appropriately tailored interventions that account for the characteristics of the comorbidity.

The Relationship Between Daily Physical Activity and Pain in Individuals with Knee Osteoarthritis

Objective

Investigate the association between physical activity and pain severity in individuals with knee osteoarthritis.

Design

Cross-sectional; systematic review with meta-analyses.

Methods

Thirty-one participants with knee osteoarthritis underwent assessment of symptoms via self-report questionnaires and quantitative sensory testing. Following testing, physical activity and symptoms were monitored for seven days using accelerometers and logbooks. Cross-correlation analyses were performed on fluctuations in symptoms and physical activity across the week to detect the relative timing of the strongest association between pain and activity. These data were complemented by meta-analyses of studies that examined correlations between pain from knee osteoarthritis and physical activity or fitness.

Results

Pain severity at baseline correlated with moderate to vigorous physical activity (r2 = 0.161–0.212, P &lt; 0.05), whereby participants who were more physically active had less pain. Conversely, the peak of the cross-correlation analyses was most often positive and lagging, which indicated that pain was increased subsequent to periods of increased activity. These superficially discrepant findings were supported by the results of a meta-analysis of 13 studies and 9,363 participants, which identified significant heterogeneity for associations between physical activity and pain (I2 = 91%). Stronger inverse associations were found between fitness and pain.

Conclusions

Associations between physical activity and pain in people with knee osteoarthritis are variable and dynamic. These results reflect the beneficial impact of an active lifestyle and accompanying higher fitness. Yet, the side effect of acute periods of physical activity to transiently exacerbate pain may influence the behavior of some people to avoid activity because of pain.

Overcoming Barriers to Physical Activity in People with Osteoarthritis: the Role of Empathic Accuracy in Couples' Planning Discussions

BACKGROUND

Osteoarthritis (OA) is a common chronic joint disease with significant individual and public health consequences. Physical activity can reduce OA symptoms, but patients often fall below recommended levels. Social support from an intimate partner can help them become more active; however, some couples are better than others at enacting effective support. We examined the role of empathic accuracy (EA)-the ability to understand another person's thoughts and feelings-in couples' ability to identify strategies for overcoming barriers to increasing activity. We also examined whether EA was associated with changes in affect and with emotion regulation and communication skills.

METHOD

Forty-two insufficiently physically active participants with OA identified a barrier to becoming more active in a recorded discussion with their partner. Next, both rated self and partner thoughts and feelings during the discussion. Raters coded EA and whether discussions reached a solution. Affect and skills were assessed with validated questionnaires.

RESULTS

An actor-partner interdependence model found higher EA for participants in couples who reached a solution compared to those who did not reach a solution in the allotted time. Both partners' EA was associated with reduced negative affect in the other member of the couple. Unexpectedly, EA in people with OA was associated with reduced positive affect for their partners. EA was positively associated with one skill: emotional clarity.

CONCLUSION

Findings from this early-stage study suggest that EA can help couples manage health-related issues together. Emotional clarity emerged as a skill related to EA, suggesting avenues for additional research.

Lifestyle and Pain in Women With Knee Osteoarthritis

Osteoarthritis (OA) is the main cause of pain and disability in the elderly. The disease leads to chronic musculoskeletal pain, characterized by an abnormal excitability of pain conduction pathways, and lifestyle may interfere in this pathophysiological aspect. Thus, the aim of this study was to compare perceived pain, pressure pain threshold, and lifestyle of adult and elderly women with and without knee OA. A total of 143 women were recruited and divided into 2 groups: OA (n = 68) and control (n = 75). Volunteers were evaluated for pressure pain tolerance (algometry in vastus medialis and vastus lateralis muscles), perceived pain (visual analogue scale) and lifestyle (FANTASTIC questionnaire). Patients with OA of the present study presented higher weight (P = .001) and body mass index (P < .001) than controls. Results also revealed less tolerance to pressure pain (P < .001) and higher pain perception (P < .001) in patients with OA. OA group scored significantly lower in lifestyle questionnaire than controls (P = .03). Patients with OA in the present study who presented lifestyle scores below median presented significantly higher values of pain perception than the ones above it (P = .03). In conclusion, patients with OA present more sensitivity to pain, more perceived pain, and worse lifestyle than healthy individuals.

Regenerative Engineering for Knee Osteoarthritis Treatment: Biomaterials and Cell-Based Technologies

Knee osteoarthritis (OA) is the most common form of arthritis worldwide. The incidence of this disease is rising and its treatment poses an economic burden. Two early targets of knee OA treatment include the predominant symptom of pain, and cartilage damage in the knee joint. Current treatments have been beneficial in treating the disease but none is as effective as total knee arthroplasty (TKA). However, while TKA is an end-stage solution of the disease, it is an invasive and expensive procedure. Therefore, innovative regenerative engineering strategies should be established as these could defer or annul the need for a TKA. Several biomaterial and cell-based therapies are currently in development and have shown early promise in both preclinical and clinical studies. The use of advanced biomaterials and stem cells independently or in conjunction to treat knee OA could potentially reduce pain and regenerate focal articular cartilage damage. In this review, we discuss the pathogenesis of pain and cartilage damage in knee OA and explore novel treatment options currently being studied, along with some of their limitations.

Is Total Knee Replacement Justified in the Morbidly Obese? A Systematic Review

Total knee replacement (TKR) comprises a significant, growing aspect in the management of patients with advanced arthritis of the knee for which conservative medical therapy has failed. Obesity, a rising epidemic, is considered an important independent risk factor in the development of osteoarthritis (OA). An aging population and increasing incidence of obesity contribute to a higher prevalence of OA and a subsequent greater need for TKR. The numbers of morbidly obese (MO) people undergoing TKR has consistently been rising. However, there have been concerns among patients and surgeons about the outcomes and complications of TKR in MO patients, especially given the morbidities associated with obesity. The goal of this systematic review was to assess relevant, up-to-date data on the safety, outcomes, and complications associated with TKR in MO patients.