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Wang W, Jiang T, Zhang J, Liu J, Chan LC, Lin M, Li J, Ding C, Chiu KY, Fu H, Chan PK, Wen C. Subchondral bone expansion in advanced knee osteoarthritis: Relation with radiographic severity and role in surgical decision-making. OSTEOARTHRITIS AND CARTILAGE OPEN 2024; 6:100461. [PMID: 38558888 PMCID: PMC10979271 DOI: 10.1016/j.ocarto.2024.100461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/28/2024] [Accepted: 03/11/2024] [Indexed: 04/04/2024] Open
Abstract
Background Joint space width (JSW) is a traditional imaging marker for knee osteoarthritis (OA) severity, but it lacks sensitivity in advanced cases. We propose tibial subchondral bone area (TSBA), a new CT imaging marker to explore its relationship with OA radiographic severity, and to test its performance for classifying surgical decisions between unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) compared to JSW. Methods We collected clinical, radiograph, and CT data from 182 patients who underwent primary knee arthroplasty (73 UKA, 109 TKA). The radiographic severity was scored using Kellgren-Lawrence (KL) grading system. TSBA and JSW were extracted from 3D CT-reconstruction model. We used independent t-test to investigate the relationship between TSBA and KL grade, and binary logistic regression to identify factors associated with TKA risk. The accuracy of TSBA, JSW and established classification model in differentiating between UKA and TKA was assessed using AUC. Results All parameters exhibited inter- and intra-class coefficients greater than 0.966. Patients with KL grade 4 had significantly larger TSBA than those with KL grade 3. TSBA (0.708 of AUC) was superior to minimal/average JSW (0.547/0.554 of AUC) associated with the risk of receiving TKA. Medial TSBA, together with gender and Knee Society Knee Score, emerged as independent classification factors in multivariate analysis. The overall AUC of composite model for surgical decision-making was 0.822. Conclusion Tibial subchondral bone area is an independent imaging marker for radiographic severity, and is superior to JSW for surgical decision-making between UKA and TKA in advanced OA patients.
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Affiliation(s)
- Wei Wang
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Tianshu Jiang
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Jiang Zhang
- Department of Health Technology and Informatics, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Jun Liu
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Lok Chun Chan
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
- Research Institute of Smart Ageing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Mengqi Lin
- Department of Software Engineering, Faculty of Electrical and Computer Engineering, Jilin Jianzhu University, Changchun, China
| | - Jia Li
- Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Changhai Ding
- Clinical Research Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Kwong Yuen Chiu
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
| | - Henry Fu
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
| | - Ping Keung Chan
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
| | - Chunyi Wen
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
- Research Institute of Smart Ageing, The Hong Kong Polytechnic University, Hong Kong SAR, China
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Jansen MP, Roemer FW, Marijnissen AKCA, Kloppenburg M, Blanco FJ, Haugen IK, Berenbaum F, Lafeber FPJG, Welsing PMJ, Mastbergen SC, Wirth W. Exploring the differences between radiographic joint space width and MRI cartilage thickness changes using data from the IMI-APPROACH cohort. Skeletal Radiol 2023; 52:1339-1348. [PMID: 36607356 DOI: 10.1007/s00256-022-04259-3] [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: 09/19/2022] [Revised: 12/02/2022] [Accepted: 12/09/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Longitudinal weight-bearing radiographic joint space width (JSW) and non-weight-bearing MRI-based cartilage thickness changes often show weak correlations. The current objective was to investigate these correlations, and to explore the influence of different factors that could contribute to longitudinal differences between the two methods. METHODS The current study included 178 participants with medial osteoarthritis (OA) out of the 297 knee OA participants enrolled in the IMI-APPROACH cohort. Changes over 2 years in medial JSW (ΔJSWmed), minimum JSW (ΔJSWmin), and medial femorotibial cartilage thickness (ΔMFTC) were assessed using linear regression, using measurements from radiographs and MRI acquired at baseline, 6 months, and 1 and 2 years. Pearson R correlations were calculated. The influence of cartilage quality (T2 mapping), meniscal extrusion (MOAKS scoring), potential pain-induced unloading (difference in knee-specific pain scores), and increased loading (BMI) on the correlations was analyzed by dividing participants in groups based on each factor separately, and comparing correlations (slope and strength) between groups using linear regression models. RESULT Correlations between ΔMFTC and ΔJSWmed and ΔJSWmin were statistically significant (p < 0.004) but weak (R < 0.35). Correlations were significantly different between groups based on cartilage quality and on meniscal extrusion: only patients with the lowest T2 values and with meniscal extrusion showed significant moderate correlations. Pain-induced unloading or BMI-induced loading did not influence correlations. CONCLUSIONS While the amount of loading does not seem to make a difference, weight-bearing radiographic JSW changes are a better reflection of non-weight-bearing MRI cartilage thickness changes in knees with higher quality cartilage and with meniscal extrusion.
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Affiliation(s)
- Mylène P Jansen
- Department of Rheumatology & Clinical Immunology, HP G02.228 Heidelberglaan 100 3584CX, Utrecht, The Netherlands.
| | - Frank W Roemer
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, MA, USA
- Department of Radiology, Universitätsklinikum Erlangen and Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Anne Karien C A Marijnissen
- Department of Rheumatology & Clinical Immunology, HP G02.228 Heidelberglaan 100 3584CX, Utrecht, The Netherlands
| | - Margreet Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Francisco J Blanco
- Departamento de Fisioterapia Y Medicina, Grupo de Investigación de Reumatología (GIR), INIBIC - Complejo Hospitalario Universitario de A Coruña, SERGAS. Centro de Investigación CICA, Universidad de A Coruña, A Coruña, Spain. Servicio de Reumatologia, INIBIC- Universidade de A Coruña, A Coruña, Spain
| | - Ida K Haugen
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Francis Berenbaum
- Department of Rheumatology, AP-HP Saint-Antoine Hospital, Paris, France
- INSERM, Sorbonne University, Paris, France
| | - Floris P J G Lafeber
- Department of Rheumatology & Clinical Immunology, HP G02.228 Heidelberglaan 100 3584CX, Utrecht, The Netherlands
| | - Paco M J Welsing
- Department of Rheumatology & Clinical Immunology, HP G02.228 Heidelberglaan 100 3584CX, Utrecht, The Netherlands
| | - Simon C Mastbergen
- Department of Rheumatology & Clinical Immunology, HP G02.228 Heidelberglaan 100 3584CX, Utrecht, The Netherlands
| | - Wolfgang Wirth
- Department of Imaging & Functional Musculoskeletal Research, Institute of Anatomy & Cell Biology, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria
- Ludwig Boltzmann Inst. for Arthritis and Rehabilitation, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria
- Chondrometrics GmbH, Freilassing, Germany
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Butarbutar JCP, Mandagi T, Siahaan LD, Suginawan ET, Elson, Irvan. Prevalence of proximal tibia vara in Indonesian population with knee osteoarthritis. J Clin Orthop Trauma 2022; 29:101871. [PMID: 35510147 PMCID: PMC9058951 DOI: 10.1016/j.jcot.2022.101871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 04/05/2022] [Accepted: 04/13/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Proximal tibia vara has drawn interest since the concept of constitutional varus was introduced. Proximal tibia vara is a condition where the knee varus tilt the tibia condyle medially and shift the tibial articular surface medially. This condition affects medial proximal tibial angle measurements and the placement of the tibial implant in knee replacement surgery. Thus, it challenged the neutral knee arthroplasty alignment target because some people may present a proximal tibia vara. This study assesses the prevalence of the proximal tibia vara and the correlation to knee osteoarthritis grade. METHODS This retrospective study was carried out from January 2021 to June 2021. Eighty-five limbs were included with the following inclusion criteria: knee osteoarthritis patients who received a long view lower extremity radiograph. The exclusions criteria were (1) patients who had undergone arthroplasty and lower extremity surgery before and (2) valgus knee deformity. The outcomes in this study were HKAA, MAD, TAD, MPTA, PTRP, LDFA, and PTS. Intraclass correlation (ICC) using two-way mixed was used to assess the reproducibility of the radiographic parameters. Multiple logistic regression was used to evaluate the correlation between knee osteoarthritis grade and radiographs parameters (MAD and TAD). RESULT A total 85 limbs from 52 patients were assessed in this study. Proximal tibia vara was found in 18 knees (21%.). The logistic regression was performed to assess the correlation between the severity of the knee osteoarthritis and radiographic parameters (MAD, TAD, LDFA, and PTS) with an overall p-value < 0.001 and pseudo-R2 = 0.29. CONCLUSION A significant portion of patients with knee osteoarthritis have proximal tibia vara, and it is a pre-existing condition. Since the pre-existing proximal tibia vara affects preoperative measurements, a long-standing lower extremity x-ray is recommended to be obtained as part of knee replacement preparation.
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