1
|
Feng Y, Yang J, Zhang M, Wang H, Xi G. Association of Spontaneous Osteonecrosis of the Knee with Ipsilateral Meniscus and Posterior Root Tear: Systematic Review and Meta-analysis. Indian J Orthop 2024; 58:1188-1195. [PMID: 39170661 PMCID: PMC11333424 DOI: 10.1007/s43465-024-01140-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 03/23/2024] [Indexed: 08/23/2024]
Abstract
Objective The relationship between spontaneous osteonecrosis of the knee (SONK) and ipsilateral meniscus tear remains to be established, and the possible causes are clarified and summarized. Methods We conducted a search in Pubmed, Web of Science, Embase, and the Cochrane Library to include all English articles published from the establishment of the database until April 2023. The odds ratio (OR) and 95% confidence interval (CI) were calculated to evaluate the relationship between SONK and ipsilateral meniscus lesions. Results A total of 405 patients were included in eight articles, including 157 males and 248 females, with an average age of 63.94 years and an average BMI of 26.36 kg/m2. In patients with medial SONK, the prevalence of ipsilateral meniscus tear was 0.8982, 95% CI (0.7389, 0.9648), and the prevalence of ipsilateral posterior root tear was 0.6198, 95% CI (0.5169, 0.7118). The prevalence of ipsilateral meniscus tears in patients with lateral SONK was 0.2188, 95% CI (0.1150, 0.3711), and the prevalence of ipsilateral posterior root tears was 0.1667, 95% CI (0.1071, 0.2424). Conclusions SONK is significantly associated with meniscus or root tears, which limit meniscus function and lead to changes in the stress environment between the knee and the tibiofemur, increasing the chance of incomplete fracture. We suggest that the expression of SONK can be replaced with subchondral insufficiency fracture of the knee. Supplementary Information The online version contains supplementary material available at 10.1007/s43465-024-01140-4.
Collapse
Affiliation(s)
- Yuhua Feng
- Department of Orthopedics, Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, 030001 Shanxi China
| | - Jiaju Yang
- Department of Orthopedics, Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, 030001 Shanxi China
| | - Min Zhang
- Department of Orthopedics, Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, 030001 Shanxi China
| | - Haohao Wang
- Department of Orthopedics, Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, 030001 Shanxi China
| | - Gang Xi
- Department of Orthopedics, Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, 030001 Shanxi China
| |
Collapse
|
2
|
Crystal E, Brettle A, Maddox TW, Jones D, Walton MB. Effect of Medial Opening Wedge and External Rotational Humeral Osteotomies on Medial Elbow Compartment Pressure: An Ex Vivo Study. Vet Comp Orthop Traumatol 2024; 37:196-205. [PMID: 38395060 DOI: 10.1055/s-0044-1779711] [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: 02/25/2024]
Abstract
OBJECTIVE The aim of this study was to assess if the level of osteotomy (50 or 75% the length of the humerus), osteotomy angle (5, 10, or 20 degrees), direction of bone alteration (external rotational or medial opening wedge osteotomies), or orientation of osteotomy (perpendicular to the humeral long axis or perpendicular to the weight-bearing axis of the limb) affect pressure through the medial compartment of the elbow. STUDY DESIGN Humeral osteotomies were performed at 50 and 75% the length of the humerus on 12 canine cadaver thoracic limbs and patient-specific three-dimensional (3D) printed plates applied to induce the desired alteration. Sensors were placed into the medial and lateral aspects of the elbow joint and the limb compressed to 90 N in a universal testing system. RESULTS Increasing the angle of the induced change had a significant effect on the decreased load through the medial compartment. Performing the osteotomy at 75% of humeral length from proximal was significantly more effective at reducing the medial elbow load than performing it at 50%. Opening wedge osteotomies were more effective than external rotational osteotomies, but both were effective. Changing the direction of the osteotomy (comparing transverse to oblique) did not significantly affect the load reduction through the medial compartment. CONCLUSION Performing an osteotomy at a more distal location along the humerus and increasing the angle of the induced change increased the effectiveness of load-shifting humeral osteotomies.
Collapse
Affiliation(s)
- Ed Crystal
- Small Animal Teaching Hospital, Institute of Veterinary Science, University of Liverpool, Liverpool, United Kingdom
- Northwest Veterinary Specialists, Delamere House, Sutton Weaver, United Kingdom
| | - Alice Brettle
- Fusion Implants, Harrison Hughes Building of Engineering, University of Liverpool, Liverpool, United Kingdom
| | - Thomas W Maddox
- Small Animal Teaching Hospital, Institute of Veterinary Science, University of Liverpool, Liverpool, United Kingdom
- Department of Musculoskeletal and Ageing Sciences, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Dan Jones
- Fusion Implants, Harrison Hughes Building of Engineering, University of Liverpool, Liverpool, United Kingdom
| | - Myles Benjamin Walton
- Fusion Implants, Harrison Hughes Building of Engineering, University of Liverpool, Liverpool, United Kingdom
- Movement Referrals, 3 Abbots Park, Preston Brook, Runcorn, United Kingdom
| |
Collapse
|
3
|
Ten Noever de Brauw GV, Bayoumi T, Ruderman LV, Kerkhoffs GMMJ, Zuiderbaan HA, Pearle AD. Knees with isolated lateral compartment osteoarthritis show a substantial variability in functional knee phenotypes with demographic-specific variations: Phenotypic analysis of 305 knees. Knee 2024; 48:265-278. [PMID: 38820655 DOI: 10.1016/j.knee.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 04/03/2024] [Accepted: 05/01/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND The primary aim of this study was to assess and describe the phenotypic variation in the coronal plane of knees affected by isolated lateral compartment osteoarthritis (OA). The secondary aim was to investigate the potential gender-specific and age-related differences in functional knee phenotypes among knees with isolated lateral compartment OA. METHODS A comprehensive classification system was used to categorize 305 knees with isolated lateral compartment OA based on their mechanical hip-knee-ankle angle (HKA), femoral mechanical angle (FMA), and tibial mechanical angle (TMA). The phenotypic variation of functional knee phenotypes was assessed for the entire cohort and stratified by gender and age category. RESULTS Among knees with isolated lateral compartment OA, a total of 60 distinct functional knee phenotypes were identified, with phenotype VALHKA6°NEUFMA0°VALTMA3° being the most prevalent (10.8 %). Gender-specific differences were evident, with females exhibiting significantly greater valgus alignment in both mean HKA and TMA values compared with males (HKA: -6.4° vs. -5.4°, respectively; P = 0.02 and TMA 94.4° vs. 89.0°, respectively; P = 0.005). Age-related variations included younger patients predominantly displaying femoral deformities, while older patients primarily exhibited isolated tibial- or combined femoral and tibial deformities. CONCLUSIONS There is a broad variation of functional knee phenotypes among knees affected by isolated lateral compartment OA, with gender-specific and age-related differences. Recognizing this inherent phenotypic diversity during preoperative planning may facilitate the implementation of tailored approaches that account for the unique characteristics and bony deformities of the individual knee.
Collapse
Affiliation(s)
- G V Ten Noever de Brauw
- Hospital for Special Surgery, Department of Orthopaedic Surgery, Computer Assisted Surgery Center & Sports Medicine, Weill Medical College of Cornell University, New York, NY, USA; Amsterdam UMC location University of Amsterdam, Department of Orthopaedic Surgery, Amsterdam, the Netherlands.
| | - T Bayoumi
- Hospital for Special Surgery, Department of Orthopaedic Surgery, Computer Assisted Surgery Center & Sports Medicine, Weill Medical College of Cornell University, New York, NY, USA; Amsterdam UMC location University of Amsterdam, Department of Orthopaedic Surgery, Amsterdam, the Netherlands
| | - L V Ruderman
- Hospital for Special Surgery, Department of Orthopaedic Surgery, Computer Assisted Surgery Center & Sports Medicine, Weill Medical College of Cornell University, New York, NY, USA
| | - G M M J Kerkhoffs
- Amsterdam UMC location University of Amsterdam, Department of Orthopaedic Surgery, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Sports, Amsterdam, the Netherlands
| | - H A Zuiderbaan
- Medische Kliniek Velsen, Department of Orthopaedic Surgery, Velsen-Noord, the Netherlands
| | - A D Pearle
- Hospital for Special Surgery, Department of Orthopaedic Surgery, Computer Assisted Surgery Center & Sports Medicine, Weill Medical College of Cornell University, New York, NY, USA
| |
Collapse
|
4
|
Hodge PE, Rabak OJ, Perriman DM, Scarvell JM, Smith PN, Lynch JT. Are Kinematics an Indicator of Outcome After Total Knee Arthroplasty? J Arthroplasty 2024; 39:343-349.e1. [PMID: 37572724 DOI: 10.1016/j.arth.2023.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND A proportion of total knee arthroplasty (TKA) patients are dissatisfied postoperatively, particularly with their ability to perform higher-demand activities including deep-kneeling and step-up where kinematic parameters are more demanding. The purpose of this study was to examine the relationship between knee kinematics of step-up and deep-kneeling and patient-reported outcome measures following TKA. METHODS Sixty-four patients were included at minimum 1-year follow-up. Participants performed a step-up and deep-kneeling task which was imaged via single-plane fluoroscopy. 3-dimensional prosthesis computer-aided design models were registered to the fluoroscopy, yielding in-vivo kinematic data. Associations between kinematics and patient-reported outcome measures, including Oxford Knee Score, American Knee Society Score, surgical satisfaction, and pain were assessed using log-transformed step-wise linear regressions. RESULTS A higher total Oxford Knee Score was associated with more external rotation and more adduction at maximal flexion during kneeling and more external rotation and minimum flexion during step-up. Improved American Knee Society Score was associated with increased internal-external rotation during step-up. Improved surgical satisfaction was associated with greater maximum flexion and more external rotation at maximal flexion during deep-kneeling and more femoral internal rotation at terminal extension during step-up. An improved pain score was associated with greater maximum flexion and more femoral external rotation during deep-kneeling, as well as greater internal femoral rotation during step-up. CONCLUSION The ability to move through full flexion/extension range and end-of-range rotation is important kinematic parameters that influence patient-reported outcome measures. Implant designs and postoperative rehabilitation should continue to focus on achieving these kinematic targets for enhanced outcomes after TKA.
Collapse
Affiliation(s)
- Phillipa E Hodge
- The Trauma and Orthopaedic Research Unit, Canberra Hospital, Canberra, ACT, Australia; Medical School, Australian National University, Canberra, ACT, Australia
| | - Owen J Rabak
- The Trauma and Orthopaedic Research Unit, Canberra Hospital, Canberra, ACT, Australia; Medical School, Australian National University, Canberra, ACT, Australia
| | - Diana M Perriman
- The Trauma and Orthopaedic Research Unit, Canberra Hospital, Canberra, ACT, Australia; Medical School, Australian National University, Canberra, ACT, Australia
| | - Jennie M Scarvell
- The Trauma and Orthopaedic Research Unit, Canberra Hospital, Canberra, ACT, Australia; Faculty of Health, University of Canberra, Canberra, ACT, Australia
| | - Paul N Smith
- The Trauma and Orthopaedic Research Unit, Canberra Hospital, Canberra, ACT, Australia; Medical School, Australian National University, Canberra, ACT, Australia
| | - Joseph T Lynch
- The Trauma and Orthopaedic Research Unit, Canberra Hospital, Canberra, ACT, Australia; Medical School, Australian National University, Canberra, ACT, Australia
| |
Collapse
|
5
|
Ahsan P, Ezaz MS, Jahan I, Asma NS, Anjoom M. Total Knee Replacement in a Young Patient with Valgus Knee Osteoarthritis: A Case Report. J Orthop Case Rep 2024; 14:48-53. [PMID: 38292095 PMCID: PMC10823812 DOI: 10.13107/jocr.2024.v14.i01.4144] [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: 10/25/2023] [Revised: 11/19/2023] [Indexed: 02/01/2024] Open
Abstract
Introduction Valgus deformity is characterized by an outward angulation of the knee joint. The most common cause of valgus deformity is osteoarthritis (OA), a prevalent progressive joint disease that causes chronic pain and functional limitations. Total knee replacement (TKR) is rarely done in patients with grade-I valgus deformity and young age. To the best of our knowledge, this is the first case report of its kind. Case Report A 34-year-old man presented to us with 15 years of persistent, progressively worsening right knee pain that was interfering with his daily activities. No non-operative treatment could alleviate his severe pain. Physical examination revealed a positive valgus stress test, limited knee extension, and an asymmetrical gait. He was diagnosed with a grade-I valgus deformity of the right osteoarthritic knee. History, physical examination, and radiological findings confirmed the diagnosis. In consideration of severe pain and impaired quality of life, we opted to perform TKR using a medial parapatellar approach. Regular follow-ups were done after the procedure. He experienced no pain or recurrence of deformity. He was very satisfied with the result. His Western Ontario and McMaster Universities OA Index score at 12 months following surgery was 5, indicating a favorable outcome. Conclusion This case exhibits the effectiveness of TKR in treating grade-I valgus deformity of the osteoarthritic knee with severe pain in a young adult, resulting in improved pain alleviation, mobility, joint alignment, and overall quality of life.
Collapse
Affiliation(s)
- Pervez Ahsan
- Department of Orthopedic Surgery, Ibn Sina Medical College, Dhaka, Bangladesh
| | - Md. Shafiul Ezaz
- Department of Orthopedic Surgery, Ibn Sina Medical College, Dhaka, Bangladesh
| | - Israt Jahan
- Department of Orthopedic Surgery, Ibn Sina Medical College, Dhaka, Bangladesh
| | - Nusrat Sharmin Asma
- Department of Orthopedic Surgery, Ibn Sina Medical College, Dhaka, Bangladesh
| | - Maliha Anjoom
- Department of Orthopedic Surgery, Ibn Sina Medical College, Dhaka, Bangladesh
| |
Collapse
|
6
|
Annapareddy A, Mulpur P, Prakash M, Suhas Masilamani AB, Eachempati KK, Gurava Reddy AV. Partial versus total knee arthroplasty for isolated antero-medial osteoarthritis - An analysis of PROMs and satisfaction. SICOT J 2023; 9:11. [PMID: 37094284 PMCID: PMC10125017 DOI: 10.1051/sicotj/2023006] [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: 10/19/2022] [Accepted: 03/12/2023] [Indexed: 04/26/2023] Open
Abstract
AIM This study aimed to compare the patient-reported functional outcomes and patient satisfaction after medial Unicompartmental Knee Arthroplasty (UKA) versus Total Knee Arthroplasty (TKA), performed for anteromedial osteoarthritis (AMOA) of the knee in patients from an Indian population, at a minimum 3-year follow-up. METHODS This is a prospective matched cohort study (1:2 ratio). One hundred and one UKA cases were matched to 206 TKA cases by propensity score matching for age, body mass index (BMI), gender distribution, and the Charlson Comorbidity Index (CCI). The primary outcome (Oxford knee score, OKS) was assessed at a 3-year follow-up, along with secondary outcomes (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] Score, Forgotten Joint Score (FJS), Anterior Knee Pain (Kujala) score, patient satisfaction, and revision rate at the final follow-up). RESULTS The UKA group was superior to the TKA group in patient-reported functional outcomes based on the OKS (p = 0.004). Using the FJS score, UKA was more likely to be a forgotten joint compared to TKA (p < 0.001). However, differences in the OKS and FJS did not meet the reported minimal clinically important difference (MCID) thresholds. Quality of life (EuroQol-5D VAS scale) was found to be significantly higher in the UKA group (p < 0.001). Patients in the UKA group were more likely to be very satisfied (75.2%) versus the TKA group (62.1%, p = 0.023). CONCLUSION For AMOA, UKA was associated with improved patient satisfaction compared to TKA. Although patient-reported outcome measures were statistically in favour of UKA over TKA, the differences were not clinically significant. Multicenter and randomized studies comparing the two procedures are warranted. EVIDENCE Level-II Therapeutic.
Collapse
Affiliation(s)
- Adarsh Annapareddy
- Consultant Orthopaedic and Joint Replacement Surgeon, Sunshine Bone and Joint Institute, KIMS-Sunshine Hospitals, 500003 Hyderabad, India
| | - Praharsha Mulpur
- Consultant Orthopaedic and Joint Replacement Surgeon, Sunshine Bone and Joint Institute, KIMS-Sunshine Hospitals, 500003 Hyderabad, India
| | - Mrinal Prakash
- Research Fellow, Joint Replacement Surgery, Sunshine Bone and Joint Institute, KIMS-Sunshine Hospitals, 500003 Hyderabad, India
| | - A B Suhas Masilamani
- Consultant Orthopaedic and Joint Replacement Surgeon, Sunshine Bone and Joint Institute, KIMS-Sunshine Hospitals, 500003 Hyderabad, India
| | - Krishna Kiran Eachempati
- Consultant Orthopaedic and Joint Replacement Surgeon, Department of Orthopaedics, Medicover Hospitals, 524002 Hyderabad, India
| | - A V Gurava Reddy
- Consultant Orthopaedic and Joint Replacement Surgeon, Sunshine Bone and Joint Institute, KIMS-Sunshine Hospitals, 500003 Hyderabad, India
| |
Collapse
|
7
|
A Computer-Assisted Approach Regarding the Optimization of the Geometrical Planning of Medial Opening Wedge High Tibial Osteotomy. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12136636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Opening wedge high tibial osteotomy (OWHTO) is a surgical procedure often used to eliminate the effects of knee osteoarthritis, a disease that is becoming more widespread worldwide. Optimizing the geometric planning of this operation is a very important preparatory step for the success of the intervention and rapid postoperative recovery. This optimization is performed in two main directions. The first direction evaluates the intraoperative behavior of the tibia during the osteotomy by optimizing four geometric parameters that characterize geometric planning. The second direction aims at a postoperative evaluation of the flat tibia-osteosynthesis assembly taking into account the optimal position on the medial–lateral articular line through which the corrected mechanical axis of the tongue passes and implicitly offloads the transfer from the medial area to the side of the knee. The research methods used are exclusively computer-assisted such as: computer-aided design (hereinafter CAD) for geometric modeling of the tibia taking into account the real bone structure, the finite element method (hereinafter FEM) for performing numerical analyses and design of the experiment (hereinafter DOE) for the design of the research. The results obtained are eloquent and clearly presented and can be important elements for orthopedic doctors at the geometric planning stage of the OWHTO.
Collapse
|
8
|
Total knee arthroplasty versus unicompartmental knee arthroplasty in management of anteromedial knee osteoarthritis: a randomized clinical trial. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1097/bco.0000000000001128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
9
|
Govil G, Tomar L, Dhawan P. Knee-Spine Syndrome: Management Dilemma When Knee Osteoarthritis Coexists With Spine Degeneration. Cureus 2022; 14:e24939. [DOI: 10.7759/cureus.24939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2022] [Indexed: 11/05/2022] Open
|
10
|
Geometrical Planning of the Medial Opening Wedge High Tibial Osteotomy—An Experimental Approach. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12052475] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This article presents an experimental approach to the geometrical planning of the medial opening wedge high tibial osteotomy surgery which, as it is known, is an efficient surgical strategy quite widely used in treating knee osteoarthritis. While most of the published papers focus on analyzing this surgery from a medical point of view, we suggest a postoperative experimental evaluation of the intervention from a biomechanical point of view. The geometrical planning and, more specifically, the determination of the point of intersection between the corrected mechanical axis and the medial-lateral articular line of the knee, is a problem quite often debated in literature. This paper aims to experimentally investigate the behavior of the tibia with an open wedge osteotomy fixed with a locking plate, TomoFix (DE Puy Synthes), taking into account two positions of the mechanical axis of the leg on the width of the tibial plateau, measured from medial to lateral at 50% and 62.5% (Fujisawa point), respectively. The variations of the force relative to the deformation, strains, and displacements resulting from the progressive loading of the tibial plateau are studied. The research results reveal that using the Fujisawa point is better for conducting the correction not only for medical reasons, but also from a mechanical point of view.
Collapse
|
11
|
Han Y, Wu J, Gong Z, Zhou Y, Li H, Chen Y, Qian Q. Identification and development of the novel 7-genes diagnostic signature by integrating multi cohorts based on osteoarthritis. Hereditas 2022; 159:10. [PMID: 35093162 PMCID: PMC8801091 DOI: 10.1186/s41065-022-00226-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 12/29/2021] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
A chronic progressive degenerative joint disease, such as osteoarthritis (OA) is positively related to age. The medical economy is facing a major burden, because of the high disability rate seen in patients with OA. Therefore, to prevent and treat OA, exploring the diagnostic biomarkers of OA will be of great significance.
Methods
Differentially expressed genes (DEGs) were obtained from the Gene Expression Omnibus database using the RobustRankAggreg R package, and a protein–protein interaction network was constructed. The module was obtained from Cytoscape, and the four algorithms of degree, MNC, closeness, and MCC in CytoHubba were used to identify the hub genes. A diagnostic model was constructed using Support Vector Machines (SVM), and the ability of the model to predict was evaluated by other cohorts.
Results
From normal and OA samples, 136 DEGs were identified, out of which 45 were downregulated in the normal group and 91 were upregulated in the OA group. These genes were associated with the extracellular matrix-receptor interactions, the PI3K-Akt signaling pathway, and the protein digestion and absorption pathway, as per a functional enrichment analysis. Finally, we identified the 7 hub genes (COL6A3, COL1A2, COL1A1, MMP2, COL3A1, POST, and FN1). These genes have important roles and are widely involved in the immune response, apoptosis, inflammation, and bone development. These 7 genes were used to construct a diagnostic model by SVM, and it performed well in different cohorts. Additionally, we verified the methylation expression of these hub genes.
Conclusions
The 7-genes signature can be used for the diagnosis of OA and can provide new ideas in the clinical decision-making for patients with OA.
Collapse
|
12
|
Lawande M, Daftary A, Ahuja A, Sabnis B. Role of imaging in surgical decision making in young knee osteoarthrosis. Eur J Radiol Open 2022; 9:100436. [PMID: 36061258 PMCID: PMC9429574 DOI: 10.1016/j.ejro.2022.100436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 07/31/2022] [Accepted: 08/16/2022] [Indexed: 11/28/2022] Open
Abstract
Osteoarthrosis is the most common form of knee arthritis, characterized by pain and discomfort from primarily articular cartilage wear. Traditionally in its end stage, it has been treated with total knee arthroplasty, a permanent process with a life span of ten to fifteen years and challenges with revision. With an increasing longevity and epidemic of obesity that the population is facing, naturally, we are seeing more and more patients with osteoarthrosis at a younger age. This makes it imperative to extend the life of the native knee by conservative measures, injections of steroid, hyaluronic acid, or biologicals and finally a slew of surgical alternatives ranging from joint realignment to partial and total joint replacement. Besides the clinical presentation, decisions are made based on joint alignment, extent and degree of cartilage wear and the status of the subchondral bone. Imaging plays an invaluable role in surgical decision making. In this article, we will discuss how imaging is used in our practice during decision making for the management of the young osteoarthritic knee. Prevalence of knee osteoarthrosis is increasing in younger population. Surgical treatment of osteoarthrosis at a younger age has its own challenges of need to return to higher levels of physical activity and longer life expectancy. Osteoarthrosis is now considered a whole organ dynamic disease. Imaging plays an important role in decision making in treatment and management of osteoarthrosis.
Collapse
Affiliation(s)
- Malini Lawande
- Innovision Imaging, Sportsmed, 2nd Floor, Parel premises, Junction of Gokhale and Sayani road, Parel west, Mumbai 400025, Maharashtra, India
- Corresponding author.
| | - Aditya Daftary
- Innovision Imaging, Sportsmed, 2nd Floor, Parel premises, Junction of Gokhale and Sayani road, Parel west, Mumbai 400025, Maharashtra, India
| | - Ankita Ahuja
- Innovision Imaging, Sportsmed, 2nd Floor, Parel premises, Junction of Gokhale and Sayani road, Parel west, Mumbai 400025, Maharashtra, India
| | - Bhushan Sabnis
- Department of Orthopaedics, Sportsmed, 2nd Floor, Parel premises, Junction of Gokhale and Sayani road, Parel west, Mumbai 400025, Maharashtra, India
| |
Collapse
|
13
|
Wang KK, Munoz Pareja JC, Mondello S, Diaz-Arrastia R, Wellington C, Kenney K, Puccio AM, Hutchison J, McKinnon N, Okonkwo DO, Yang Z, Kobeissy F, Tyndall JA, Büki A, Czeiter E, Pareja Zabala MC, Gandham N, Berman R. Blood-based traumatic brain injury biomarkers - Clinical utilities and regulatory pathways in the United States, Europe and Canada. Expert Rev Mol Diagn 2021; 21:1303-1321. [PMID: 34783274 DOI: 10.1080/14737159.2021.2005583] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Traumatic brain injury (TBI) is a major global health issue, resulting in debilitating consequences to families, communities, and health-care systems. Prior research has found that biomarkers aid in the pathophysiological characterization and diagnosis of TBI. Significantly, the FDA has recently cleared both a bench-top assay and a rapid point-of-care assays of tandem biomarker (UCH-L1/GFAP)-based blood test to aid in the diagnosis mTBI patients. With the global necessity of TBI biomarkers research, several major consortium multicenter observational studies with biosample collection and biomarker analysis have been created in the USA, Europe, and Canada. As each geographical region regulates its data and findings, the International Initiative for Traumatic Brain Injury Research (InTBIR) was formed to facilitate data integration and dissemination across these consortia. AREAS COVERED This paper covers heavily investigated TBI biomarkers and emerging non-protein markers. Finally, we analyze the regulatory pathways for converting promising TBI biomarkers into approved in-vitro diagnostic tests in the United States, European Union, and Canada. EXPERT OPINION TBI biomarker research has significantly advanced in the last decade. The recent approval of an iSTAT point of care test to detect mild TBI has paved the way for future biomarker clearance and appropriate clinical use across the globe.
Collapse
Affiliation(s)
- Kevin K Wang
- Program for Neurotrauma, Neuroprotoemics & Biomarker Research, Department of Emergency Medicine, University of Florida College of Medicine, Gainesville, Florida, USA.,Brain Rehabilitation Research Center (BRRC), Malcom Randall Veterans Affairs Medical Center, Gainesville, Florida, USA
| | - Jennifer C Munoz Pareja
- Department of Pediatric Critical Care, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Stefania Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Ramon Diaz-Arrastia
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Cheryl Wellington
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Canada
| | - Kimbra Kenney
- Department of Neurology, Uniformed Service University, Bethesda, Maryland, USA
| | - Ava M Puccio
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jamie Hutchison
- The Hospital for Sick Children, Department of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nicole McKinnon
- The Hospital for Sick Children, Department of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - David O Okonkwo
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Zhihui Yang
- Program for Neurotrauma, Neuroprotoemics & Biomarker Research, Department of Emergency Medicine, University of Florida College of Medicine, Gainesville, Florida, USA.,Brain Rehabilitation Research Center (BRRC), Malcom Randall Veterans Affairs Medical Center, Gainesville, Florida, USA
| | - Firas Kobeissy
- Program for Neurotrauma, Neuroprotoemics & Biomarker Research, Department of Emergency Medicine, University of Florida College of Medicine, Gainesville, Florida, USA.,Brain Rehabilitation Research Center (BRRC), Malcom Randall Veterans Affairs Medical Center, Gainesville, Florida, USA
| | - J Adrian Tyndall
- Program for Neurotrauma, Neuroprotoemics & Biomarker Research, Department of Emergency Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | | | - Endre Czeiter
- Department of Neurosurgery, Pecs University, Pecs, Hungary
| | | | - Nithya Gandham
- Program for Neurotrauma, Neuroprotoemics & Biomarker Research, Department of Emergency Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Rebecca Berman
- National Institute of Neurological Disorders and Stroke, National Institute of Health, Bethesda, MD, USA
| | | |
Collapse
|
14
|
Biomechanical Changes in Gait Patterns of Patients with Grade II Medial Gonarthritis. Diagnostics (Basel) 2021; 11:diagnostics11071242. [PMID: 34359325 PMCID: PMC8305118 DOI: 10.3390/diagnostics11071242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/06/2021] [Accepted: 07/06/2021] [Indexed: 11/17/2022] Open
Abstract
Deforming osteoarthritis (OA) of the knee is a progressive disease associated with pain and compromised function of the joint. Typical biomechanical modifications in the gait of subjects with medial knee OA are characterized by decreased gait speed and overload on the affected limb. The borderline stage for conservative versus surgical management is Grade II OA. The aim of this research was to study preoperatively the specific features of gait, knee, and hip function in patients with Grade II medial OA. We examined 26 patients with Grade II unilateral gonarthritis with varus deformity and 20 healthy adults. Biomechanical parameters of gait were recorded using an inertial sensor system. The gait cycle (GC) slightly increased both for the affected and for the intact limb. The hip joint movements showed significant symmetrical reduction in the first flexion amplitude, as well as a symmetrical delay in full hip extension at the end of the stance phase. In the knee, the first flexion amplitude was significantly reduced on the affected side compared to healthy control. The extension amplitude in the single support phase was significantly increased in both the affected and the intact lower limbs. The swing amplitude was significantly reduced on the affected side. On the affected side, the changes were more pronounced, both in incidence and in severity. The affected knee showed a syndrome of three reduced amplitudes. In patients, walking is characterized by several groups of symptoms: those of unloading of the affected limb, those of limiting the load on the affected joint and the musculoskeletal system as a whole, and those of gait harmonization. The symptoms of unloading the affected side and those of harmonization are the common symptoms of adaptation, typical for several pathological conditions with a relatively preserved function. The intensity of the observed symptoms can help assess changes in the subject’s functional condition over time and during the treatment.
Collapse
|
15
|
Malahias MA, Manolopoulos PP, Mancino F, Jang SJ, Gu A, Giotis D, Denti M, Nikolaou VS, Sculco PK. Safety and outcome of simultaneous bilateral unicompartmental knee arthroplasty: A systematic review. J Orthop 2021; 24:58-64. [PMID: 33679029 DOI: 10.1016/j.jor.2021.02.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 02/14/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose Simultaneous bilateral unicompartmentsl knee arthroplasty (BUKA) is considered safe and effective. We performed a systematic review to assess the postoperative outcomes. Methods The US National Library of Medicine (PubMed/MEDLINE), Google Scholar, and the Cochrane Database of Systematic Reviews were queried for publications. Results Ten articles were included with 765 simultaneous BUKA. Overall complication rate was 7.0%, survivorship was 97.6% at mean 17 months follow-up. No differences were reported between simultaneous and staged BUKA. Conclusion Simultaneous BUKA is as safe as staged BUKA, it is associated with decreased length of stay and operative time, although it has an increased rate of blood transfusion.
Collapse
Affiliation(s)
- Michael-Alexander Malahias
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Philip P Manolopoulos
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
- School of Medicine, European University of Cyprus, Diogenis Str 6 Nicosia CY, 2404, Cyprus
| | - Fabio Mancino
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
- Division of Orthopaedics and Traumatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Seong J Jang
- Weill Cornell Medical College, 1300 York Ave, New York, NY, 10065, USA
| | - Alex Gu
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
- Department of Orthopedic Surgery, George Washington School of Medicine and Health Sciences, 2300 M St NW, Washington, DC, 20037, USA
| | - Dimitrios Giotis
- Department of Orthopaedic Surgery, General Hospital of Grevena, Grevena, Greece
| | - Matteo Denti
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| | - Vasileios S Nikolaou
- 2nd Orthopaedic Department, National & Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Peter K Sculco
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| |
Collapse
|
16
|
Alves CJ, Couto M, Sousa DM, Magalhães A, Neto E, Leitão L, Conceição F, Monteiro AC, Ribeiro-da-Silva M, Lamghari M. Nociceptive mechanisms driving pain in a post-traumatic osteoarthritis mouse model. Sci Rep 2020; 10:15271. [PMID: 32943744 PMCID: PMC7499425 DOI: 10.1038/s41598-020-72227-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 08/20/2020] [Indexed: 11/29/2022] Open
Abstract
In osteoarthritis (OA), pain is the dominant clinical symptom, yet the therapeutic approaches remain inadequate. The knowledge of the nociceptive mechanisms in OA, which will allow to develop effective therapies for OA pain, is of utmost need. In this study, we investigated the nociceptive mechanisms involved in post-traumatic OA pain, using the destabilization of the medial meniscus (DMM) mouse model. Our results revealed the development of peripheral pain sensitization, reflected by augmented mechanical allodynia. Along with the development of pain behaviour, we observed an increase in the expression of calcitonin gene-related peptide (CGRP) in both the sensory nerve fibers of the periosteum and the dorsal root ganglia. Interestingly, we also observed that other nociceptive mechanisms commonly described in non-traumatic OA phenotypes, such as infiltration of the synovium by immune cells, neuropathic mechanisms and also central sensitization were not present. Overall, our results suggest that CGRP in the sensory nervous system is underlying the peripheral sensitization observed after traumatic knee injury in the DMM model, highlighting the CGRP as a putative therapeutic target to treat pain in post-traumatic OA. Moreover, our findings suggest that the nociceptive mechanisms involved in driving pain in post-traumatic OA are considerably different from those in non-traumatic OA.
Collapse
Affiliation(s)
- C J Alves
- Neuro-Skeletal Circuits Group, Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Rua Alfredo Allen, 208, 4200-135, Porto, Portugal. .,Instituto de Engenharia Biomédica (INEB), Universidade do Porto, Porto, Portugal.
| | - M Couto
- Neuro-Skeletal Circuits Group, Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Rua Alfredo Allen, 208, 4200-135, Porto, Portugal.,Instituto de Engenharia Biomédica (INEB), Universidade do Porto, Porto, Portugal
| | - D M Sousa
- Neuro-Skeletal Circuits Group, Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Rua Alfredo Allen, 208, 4200-135, Porto, Portugal.,Instituto de Engenharia Biomédica (INEB), Universidade do Porto, Porto, Portugal
| | - A Magalhães
- Neuro-Skeletal Circuits Group, Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Rua Alfredo Allen, 208, 4200-135, Porto, Portugal.,Instituto de Biologia Molecular e Celular (IBMC), Universidade do Porto, Porto, Portugal
| | - E Neto
- Neuro-Skeletal Circuits Group, Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Rua Alfredo Allen, 208, 4200-135, Porto, Portugal.,Instituto de Engenharia Biomédica (INEB), Universidade do Porto, Porto, Portugal
| | - L Leitão
- Neuro-Skeletal Circuits Group, Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Rua Alfredo Allen, 208, 4200-135, Porto, Portugal.,Instituto de Engenharia Biomédica (INEB), Universidade do Porto, Porto, Portugal.,Instituto Ciências Biomédicas Abel Salazar (ICBAS), Universidade de Porto, Porto, Portugal
| | - F Conceição
- Neuro-Skeletal Circuits Group, Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Rua Alfredo Allen, 208, 4200-135, Porto, Portugal.,Instituto de Engenharia Biomédica (INEB), Universidade do Porto, Porto, Portugal.,Instituto Ciências Biomédicas Abel Salazar (ICBAS), Universidade de Porto, Porto, Portugal
| | - A C Monteiro
- Neuro-Skeletal Circuits Group, Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Rua Alfredo Allen, 208, 4200-135, Porto, Portugal.,Instituto de Engenharia Biomédica (INEB), Universidade do Porto, Porto, Portugal
| | - M Ribeiro-da-Silva
- Neuro-Skeletal Circuits Group, Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Rua Alfredo Allen, 208, 4200-135, Porto, Portugal.,Instituto de Engenharia Biomédica (INEB), Universidade do Porto, Porto, Portugal.,Faculdade de Medicina, Universidade do Porto (FMUP), Porto, Portugal.,Serviço de Ortopedia e Traumatologia, Centro Hospitalar São João, Porto, Portugal
| | - M Lamghari
- Neuro-Skeletal Circuits Group, Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Rua Alfredo Allen, 208, 4200-135, Porto, Portugal.,Instituto de Engenharia Biomédica (INEB), Universidade do Porto, Porto, Portugal.,Instituto Ciências Biomédicas Abel Salazar (ICBAS), Universidade de Porto, Porto, Portugal
| |
Collapse
|
17
|
Pande H, Thakur K, Dubey R, Singh C. Changes in lower limb alignment and their effect on the functional outcome after treatment of varus degenerative OA knee by hemicallotasis using modular dynamic HTO fixator. J Clin Orthop Trauma 2020; 14:85-93. [PMID: 33717901 PMCID: PMC7920100 DOI: 10.1016/j.jcot.2020.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/07/2020] [Accepted: 09/09/2020] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE High tibial osteotomy (HTO) is an established procedure to treat medial compartmental osteoarthritis (OA) knee associated with varus deformity. It is well documented that precise correction of deformity and maintenance of correction achieved is important to ensure long term good results. This study was undertaken to record changes in radiological parameters and its effect on the functional outcomes in first two years following HTO done for varus degenerative OA kneeby hemicallotasis technique using HTO fixator. METHODS 31 patients meeting our inclusion-exclusion criteria who underwent HTO by hemicallotasis method using self-adjusting unilateral HTO fixator were included in the study. Their femoro tibial angle (FTA), mechanical axis %, Insall- Salvati ratio, proximal tibial antero-posterior slope and knee injury and osteoarthritis outcome Score (KOOS) were recorded preoperatively, postoperatively at the time of removal of fixator, at 1 year and at 2 years. RESULTS The FTA and mechanical axis significantly improved from a mean of 183.12⁰ and -3.26% respectively preoperatively to 173.38⁰ and 61.81% at the time of removal of fixator but subsequently showed significant deterioration to 176.06⁰ and 57.96% at 1 year and further insignificant deterioration to 176.16⁰ and 57.74 at 2 years. The KOOS improved from mean 56.61 preoperatively to 70.48 at the time of fixator removal and further improved significantly to 85.68 at 1 year but significantly deteriorated to 84.54 at 2 years. The Insall-Salvati ratio, tibial slope showed no significant change throughout the study. Conclusion: Though desired alignment can be achieved by using the fixator, we found a significant deterioration in achieved radiological parameters after removal of fixator adversely affecting the functional outcome which is a matter of concern.
Collapse
Affiliation(s)
- Hrishikesh Pande
- Command Hospital, Lucknow, India,Corresponding author. Department of Orthopaedics, Command Hospital Lucknow, 226002, India.
| | | | - Rajiv Dubey
- Department of Orthopaedics, AFMC, Pune, India
| | | |
Collapse
|
18
|
Marie-Hardy L, O'Loughlin P, Bonnin M, Ait Si Selmi T. Two cases of deliberate implant mismatch in knee arthroplasty. SICOT J 2020; 6:19. [PMID: 32553102 PMCID: PMC7301637 DOI: 10.1051/sicotj/2020016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 05/27/2020] [Indexed: 11/29/2022] Open
Abstract
Cases: Knee arthroplasty is increasingly common with good clinical results. However, there is a cohort of patients whose native knee anatomy may not marry well with standard implants. The current authors describe two cases (one unicompartmental knee arthroplasty (UKA), one total knee arthroplasty (TKA)), during which deliberately implanting an implant designed for the contra-lateral distal femur (TKA) or contralateral femoral condyle (UKA) respectively, led to a better fit than correct-sided implants. Conclusion: The authors share their experience to raise awareness of a potential solution to such an intra-operative challenge and suggest that implant customisation may ultimately address challenges with grossly abnormal native anatomy.
Collapse
Affiliation(s)
- Laura Marie-Hardy
- Service de Chirurgie Orthopédique, Hôpital de la Pitié-Salpétrière, Sorbonne Université, 47, Bd de l'Hôpital, 75013 Paris, France
| | - Padhraig O'Loughlin
- Department of Orthopaedic Surgery, Cork University Hospital, Wilton, T12 DFK4 Cork, Ireland
| | - Michel Bonnin
- Service de Chirurgie Orthopédique, Clinique Mermoz-Paul Santy, 24 Avenue Paul Santy, 69008 Lyon, France
| | - Tarik Ait Si Selmi
- Service de Chirurgie Orthopédique, Clinique Mermoz-Paul Santy, 24 Avenue Paul Santy, 69008 Lyon, France
| |
Collapse
|
19
|
Burchard R, Huflage H, Soost C, Richter O, Bouillon B, Graw JA. Efficiency of platelet-rich plasma therapy in knee osteoarthritis does not depend on level of cartilage damage. J Orthop Surg Res 2019; 14:153. [PMID: 31126348 PMCID: PMC6534904 DOI: 10.1186/s13018-019-1203-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 05/17/2019] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Osteoarthritis of the knee is common and often leads to significant physical disability. While classic conservative therapeutic approaches aim for symptoms like pain and inflammation, procedures like the intraarticular application of hyaluronic acids (HA) or platelet-rich plasma (PRP) are thought to stimulate the endogenous HA production, stop catabolism of cartilage tissue, and promote tissue regeneration. To analyse whether the positive effects of PRP injections are associated with the level of cartilage damage, patient satisfaction with the treatment was correlated with the level of knee joint osteoarthritis quantified by MRI. METHODS PRP was performed with a low-leukocyte autologous conditioned plasma (ACP) system in 59 patients. A pre-treatment MRI was performed and a Whole-Organ MRI Score (WORMS) was used to score the level of knee osteoarthritis by 14 features: integrity of the cartilage, affection of the bone marrow, subcortical cysts, bone attrition, osteophytes, integrity of the menisci and ligaments, presence of synovitis, loose bodies, and periarticular cysts. A multivariate analysis with ordinary least squares regressions was used. RESULTS Although pain symptoms and severity of clinical osteoarthritis symptoms decreased, regression analysis could not detect a correlation between the degree of cartilage damage measured by the WORMS score and a positive response to PRP therapy. CONCLUSION This study suggests that intraarticular injection of PRP might improve osteoarthritis symptoms and reduces the pain in patients suffering from osteoarthritis of the knee joint independent from the level of cartilage damages quantified by the whole-organ MRI scoring method WORMS.
Collapse
Affiliation(s)
- Rene Burchard
- Department of Health, University of Witten/Herdecke, Witten, Germany. .,Department of Trauma- and Orthopaedic Surgery, Kreisklinikum Siegen, Siegen, Germany. .,School of Science and Technology, University of Siegen, Siegen, Germany.
| | - Hanno Huflage
- Department of Health, University of Witten/Herdecke, Witten, Germany
| | - Christian Soost
- Department of Statistics an Econometrics, University of Siegen, Siegen, Germany
| | - Oliver Richter
- Institute of Diagnostic Radiology at Kreisklinikum Siegen, Siegen, Germany
| | - Bertil Bouillon
- Department of Health, University of Witten/Herdecke, Witten, Germany.,Department of Orthopaedics, Trauma Surgery and Sports Traumatology, Kliniken der Stadt Köln, Köln, Germany
| | - Jan Adriaan Graw
- Department of Anaesthesiology and Operative Intensive Care Medicine (CCM, CVK) Charité, Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| |
Collapse
|
20
|
Hermans J, Bierma-Zeinstra SMA, Bos PK, Niesten DD, Verhaar JAN, Reijman M. The effectiveness of high molecular weight hyaluronic acid for knee osteoarthritis in patients in the working age: a randomised controlled trial. BMC Musculoskelet Disord 2019; 20:196. [PMID: 31064359 PMCID: PMC6503549 DOI: 10.1186/s12891-019-2546-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 03/28/2019] [Indexed: 01/27/2023] Open
Abstract
Background High molecular weight (HMW) hyaluronic acid (HA) is a treatment option for knee osteoarthritis (OA). The efficacy of HMW-HA in knee OA is investigated extensively, but the effectiveness in patients in the working age is unknown. Nevertheless, the number knee OA patients in the working age is increasing. Surgical treatment options are less eligible in these patients and productivity losses are high. In this study the effectiveness of intra-articular HMW-HA added to regular non-surgical usual care in everyday clinical practice (UC) compared to UC over 52 weeks in symptomatic knee OA patients in the working age was investigated. Methods In this open labelled randomized controlled trial, subjects aged between 18 and 65 years with symptomatic knee OA (Kellgren and Lawrence I-III) were enrolled and randomized to UC + 3 weekly injections with HMW-HA (intervention) or UC only (control). The primary outcome was the between group difference in responders to therapy according to OMERACT-OARSI criteria after 52 weeks. These criteria include the domains pain, knee related function and patient’s global assessment (PGA). Function was evaluated with the KOOS questionnaire. Pain was assessed with the Numeric Rating Scale. Secondary outcome comprised the between group difference on the individual responder domains, as analysed with a random effects model. Odds Ratios (OR) were calculated by logistic regression analysis. Sensitivity analyses were performed. Results In total, 156 subjects were included (intervention group 77, control group 79). Subjects in the intervention group (HMW-HA + UC) were more often responder compared to the controls (UC). Depending on whether pain during rest or pain during activity was included in the responder domains, 57.1% versus 34.2% (p = 0.006) and 54.5% versus 34.2% (p = 0.015) was responder to therapy respectively. The results of the secondary outcome analyses show that scores on individual responder domains over all follow-up moments were statistically significant in favour of the intervention group in the domains pain during rest (δ 0.8, 95%CI 0.2; 1.4, p = 0.010), knee related function (δ − 6.8, 95%CI -11.9; − 1.7, p = 0.010) and PGA (δ − 0.7, 95%CI -0.9; − 0.4, p < 0.0001). Conclusions Intra-articular HMW-HA added to usual care is effective for knee OA in patients in the working age. Trial registration www.trialregister.nl, NTR1651, registered 2009-3-3. Electronic supplementary material The online version of this article (10.1186/s12891-019-2546-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Job Hermans
- Department of Orthopaedic Surgery, Erasmus University Medical Centre Rotterdam, PO Box 2040, 3000, CA, Rotterdam, The Netherlands.
| | - Sita M A Bierma-Zeinstra
- Department of Orthopaedic Surgery, Erasmus University Medical Centre Rotterdam, PO Box 2040, 3000, CA, Rotterdam, The Netherlands.,Department of General Practice, Erasmus University Medical Centre, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Pieter K Bos
- Department of Orthopaedic Surgery, Erasmus University Medical Centre Rotterdam, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Dieu Donne Niesten
- Department of Orthopaedic Surgery, Reinier de Graaf Hospital, PO Box 5011 2600, GA, Delft, The Netherlands
| | - Jan A N Verhaar
- Department of Orthopaedic Surgery, Erasmus University Medical Centre Rotterdam, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Max Reijman
- Department of Orthopaedic Surgery, Erasmus University Medical Centre Rotterdam, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
| |
Collapse
|
21
|
High Tibial Osteotomy: Review of Techniques and Biomechanics. JOURNAL OF HEALTHCARE ENGINEERING 2019; 2019:8363128. [PMID: 31191853 PMCID: PMC6525872 DOI: 10.1155/2019/8363128] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 04/15/2019] [Indexed: 12/15/2022]
Abstract
High tibial osteotomy becomes increasingly important in the treatment of cartilage damage or osteoarthritis of the medial compartment with concurrent varus deformity. HTO produces a postoperative valgus limb alignment with shifting the load-bearing axis of the lower limb laterally. However, maximizing procedural success and postoperative knee function still possess many difficulties. The key to improve the postoperative satisfaction and long-term survival is the understanding of the vital biomechanics of HTO in essence. This review article discussed the alignment principles, surgical technique, and fixation plate of HTO as well as the postoperative gait, musculoskeletal dynamics, and contact mechanics of the knee joint. We aimed to highlight the recent findings and progresses on the biomechanics of HTO. The biomechanical studies on HTO are still insufficient in the areas of gait analysis, joint kinematics, and joint contact mechanics. Combining musculoskeletal dynamics modelling and finite element analysis will help comprehensively understand in vivo patient-specific biomechanics after HTO.
Collapse
|
22
|
Indelli PF, Giuntoli M. Early osteoarthritis of the knee: from conservative to surgical management. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:398. [PMID: 30499567 DOI: 10.21037/atm.2018.08.18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Pier Francesco Indelli
- Department of Orthopaedic Surgery and Bioengineering, Stanford University School of Medicine, Stanford, USA and PAVAHCS, Palo Alto, CA, USA
| | - Michele Giuntoli
- Department of Orthopaedic Surgery and Bioengineering, Stanford University School of Medicine, Stanford, USA and PAVAHCS, Palo Alto, CA, USA
| |
Collapse
|
23
|
Witjes S, Wanlin S, Litchfield R, van Geenen RCI, Kerkhoffs GMMJ, Getgood A. Realignment osteotomy of the knee allows for return to work and sport activities in the young athletic population. J ISAKOS 2018. [DOI: 10.1136/jisakos-2018-000212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
24
|
Harms A, Heredia-Rizo AM, Moseley GL, Hau R, Stanton TR. A feasibility study of brain-targeted treatment for people with painful knee osteoarthritis in tertiary care. Physiother Theory Pract 2018; 36:142-156. [PMID: 29889597 DOI: 10.1080/09593985.2018.1482391] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Purpose: To assess the feasibility and clinical impact of brain-targeted treatment (BT; aiming to target sensorimotor processing) in knee osteoarthritis patients attending tertiary care. Methods: Randomized replicated case series. The study involved three phases, each of 2 weeks duration: (1) no-treatment phase; (2) BT phase (left/right judgments and touch discrimination training); and (3) usual care (education, strengthening, and stretching training). Primary outcomes were: timely recruitment; number of participants completing the interventions; treatment compliance and barriers; follow-up rates; and treatment impact on pain and function. Fear-avoidance beliefs and clinical measures of cortical body representation (tactile acuity and left/right judgment performance) were secondary outcomes. Results: A total of 5% (19/355) of all assessed patients were eligible to participate and of these, 58% (11/19) agreed to participate. Ten patients completed the study, and 9 were successfully followed up, with treatment compliance varying between interventions. Compliance was poor for the touch discrimination component of BT. No significant effects were observed for pain relief or knee function after any treatment. A positive impact of treatment was found for fear-avoidance beliefs (usual care vs. washout, p = 0.007; BT vs. washout, p = 0.029) and left/right judgment accuracy (usual care vs. washout; p = 0.006). Conclusions: Clear barriers were identified to implementing BT in tertiary care for knee osteoarthritis. Access to all available services (especially the use of interpreters), and treatment options that do not require additional assistance to perform (e.g., touch discrimination training) represent the main lessons learned.
Collapse
Affiliation(s)
- Anton Harms
- Department of Physiotherapy, Northern Hospital, Epping, Victoria, Australia
| | - Alberto M Heredia-Rizo
- Physiotherapy Department, Faculty of Nursing, Physiotherapy and Podiatry, Universidad de Sevilla, Sevilla, Spain.,School of Health Sciences, University of South Australia, Adelaide, South Australia
| | - G Lorimer Moseley
- School of Health Sciences, University of South Australia, Adelaide, South Australia.,Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Raphael Hau
- Northern Clinical School of Melbourne Medical School, Northern Hospital, Epping, Victoria, Australia
| | - Tasha R Stanton
- School of Health Sciences, University of South Australia, Adelaide, South Australia.,Neuroscience Research Australia, Randwick, New South Wales, Australia
| |
Collapse
|
25
|
Gohal C, Shanmugaraj A, Tate P, Horner NS, Bedi A, Adili A, Khan M. Effectiveness of Valgus Offloading Knee Braces in the Treatment of Medial Compartment Knee Osteoarthritis: A Systematic Review. Sports Health 2018. [PMID: 29543576 PMCID: PMC6204633 DOI: 10.1177/1941738118763913] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
CONTEXT: Knee osteoarthritis affects 9.3 million adults over age 45 years in the United States. There is significant disability associated with this condition. Given the potential complications and the significant cost to the health care system with the dramatic increase in total knee arthroplasties performed for this condition, assessment of the efficacy of nonoperative modalities, such as offloading knee braces, is essential as part of optimizing nonoperative treatment for this condition. OBJECTIVE: To determine the effectiveness of valgus offloader braces in improving clinical outcomes for patients with medial compartment knee osteoarthritis. DATA SOURCES: Three databases (PubMed, MEDLINE, and EMBASE) were searched from database inception through July 28, 2017. STUDY SELECTION: Studies reporting outcomes of valgus offloader knee braces in the treatment of medial compartment knee osteoarthritis were included. STUDY DESIGN: Systematic review. LEVEL OF EVIDENCE: Level 4. DATA EXTRACTION: Data pertaining to demographics, descriptive statistics, and clinical outcomes were extracted from the included studies. The methodological quality of included studies was evaluated. RESULTS: A total of 31 studies were included, with a total of 619 patients. The majority of studies reported improved pain outcomes using valgus offloader braces. However, variable results were reported as to whether valgus offloader braces significantly improved functional outcomes and stiffness. Offloader bracing was more effective at reducing pain when compared with neutral braces or neoprene sleeves. CONCLUSION: Valgus offloader bracing is an effective treatment for improving pain secondary to medial compartment knee osteoarthritis. The literature remains unclear on the effectiveness of valgus offloader braces with regard to functional outcomes and stiffness. Larger prospective randomized trials with consistent outcome assessment tools and consideration of patient compliance would be beneficial to more accurately determine treatment effects of valgus offloader bracing.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Moin Khan
- Moin Khan, MD, MSc, FRCSC, St Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, Ontario L8N 4A6, Canada () (Twitter: @moinkhan_md)
| |
Collapse
|
26
|
Intramedullary nailing in opening wedge high tibial osteotomy-in vitro test for validation of a method of fixation. INTERNATIONAL ORTHOPAEDICS 2018; 42:1835-1843. [PMID: 29392383 DOI: 10.1007/s00264-018-3790-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 01/18/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE Opening wedge high tibial osteotomy (HTO) as a treatment in unicompartimental osteoarthritis of the knee can significantly relieve pain and prevent or at least delay an early joint replacement. The fixation of the osteotomy has undergone development and refinements during the last years. The angle-stable plate fixator is currently one of the most commonly used plates in HTOs. The angular stable fixation between screws and the plate offers a high primary stability to retain the correction with early weight-bearing protocols. This surgical technique is performed as a standard of care and generally well tolerated by the patients. Nevertheless, some studies observed that many patients complained about discomfort related to the implant. METHODS Therefore, the stability of two different intramedullary nails, a short implant used in humeral fractures and a long device used in tibial fractures for stabilization in valgus HTOs, was investigated as an alternative fixation technique. The plate fixator was defined as reference standard. Nine synthetic tibia models were standardly osteotomized and stabilized by one of the fixation devices. Axial compression was realized using a special testing machine and two protocols were performed: a multi-step fatigue test and a load-to-failure test. RESULTS Overall motion, medial, and lateral displacements were documented. Fractures always occurred at the lateral cortex. Axial cyclic loading up to 800 N was tolerated by all implants without failure. The tibia nail provided highest fatigue strength under the load-to-failure conditions. CONCLUSIONS The results suggest that intramedullary nailing might be used as an alternative concept in HTO.
Collapse
|
27
|
Ge DH, Anoushiravani AA, Kester BS, Vigdorchik JM, Schwarzkopf R. Preoperative Diagnosis Can Predict Conversion Total Knee Arthroplasty Outcomes. J Arthroplasty 2018; 33:124-129.e1. [PMID: 28939032 DOI: 10.1016/j.arth.2017.08.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 07/27/2017] [Accepted: 08/14/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Compared to total knee arthroplasty (TKA) for primary osteoarthritis, conversion TKAs in the post-traumatic setting are associated with increased operative times, infection rates, and readmissions. We aim at determining how post-traumatic osteoarthritis and previous knee surgery influence postoperative outcomes in conversion TKA. METHODS Seventy-two conversion TKA procedures with prior knee trauma at a single institution between April 2012 and 2016 were examined. Twenty-seven (37.5%) cases had a preoperative site-specific diagnosis such as fracture of the proximal tibia, distal femur, or patella whereas 45 (62.5%) cases had a preoperative diagnosis of significant soft-tissue trauma. These 2 groups were compared in terms of total implant cost, length of stay, complications, and readmission and reoperation rates. A subanalysis was conducted to evaluate the effects of previous knee surgery on surgical outcomes. RESULTS The postfracture TKA cohort suffered significantly higher early surgical site complications (22% vs 4.4%, P = .02) and 90-day readmissions (14.8% vs 2.2%, P = .042) compared to the soft-tissue trauma cohort. Operative time, total implant costs, length of stay, medical complications, 30-day readmissions, and 90-day reoperation rates did not significantly differ. It was also found that patients with multiple prior knee surgeries compared to one prior knee surgery are younger (53.0 vs 63.1, P = .003), healthier, and receive significantly more expensive implants (1.72 vs 1.07, P = .026). In addition, patients with previous open reduction internal fixations experience more surgical site complications than patients with previous arthroscopies (31% vs 3.3%, P = .042). CONCLUSION Patients with previous site-specific fracture are more likely to experience surgical site complications and 90-day readmissions after conversion TKA than patients with previous soft-tissue knee trauma. Multiple previous knee surgeries appear to serve as an independent factor in the selection of costlier implants irrespective of preoperative diagnosis.
Collapse
Affiliation(s)
- David H Ge
- Division of Adult Reconstruction, Department of Orthopaedic Surgery, NYU Langone Medical Center, Hospital for Joint Diseases, New York, NY
| | - Afshin A Anoushiravani
- Division of Adult Reconstruction, Department of Orthopaedic Surgery, NYU Langone Medical Center, Hospital for Joint Diseases, New York, NY
| | - Benjamin S Kester
- Division of Adult Reconstruction, Department of Orthopaedic Surgery, NYU Langone Medical Center, Hospital for Joint Diseases, New York, NY
| | - Jonathan M Vigdorchik
- Division of Adult Reconstruction, Department of Orthopaedic Surgery, NYU Langone Medical Center, Hospital for Joint Diseases, New York, NY
| | - Ran Schwarzkopf
- Division of Adult Reconstruction, Department of Orthopaedic Surgery, NYU Langone Medical Center, Hospital for Joint Diseases, New York, NY
| |
Collapse
|
28
|
Effects of an over-ground exoskeleton on external knee moments during stance phase of gait in healthy adults. Knee 2017; 24:977-993. [PMID: 28760608 DOI: 10.1016/j.knee.2017.04.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 02/10/2017] [Accepted: 04/04/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Physical activity and exercise is central to conservative management of knee osteoarthritis (KOA), but is often difficult for patients with KOA to maintain over the decade or more prior to surgical management. Better approaches are needed for maintaining physical function and health in this population that can also address the patho-biomechanics of the osteoarthritic knee. The objective of the study is to quantify how a lower-extremity robotic exoskeleton (dermoskeleton) modifies the external knee moments during over-ground walking in a sample of healthy adults, and to evaluate these biomechanical modifications in the context of the osteoarthritic knee. METHOD Motion analysis data was acquired for 13 participants walking with and without the dermoskeleton. Force plate data, external knee moment arms, and knee moments in the laboratory and tibia frames of reference were computed, as well as time-distance parameters of walking, and compared between the two conditions. RESULTS Although gait speed was not different, users took shorter and wider steps when walking with the dermoskeleton. Ground reaction forces and early-stance knee moment increased due to the added mass of the dermoskeleton, but the knee adduction moment was significantly reduced in late stance phase of gait. There was no effect on the knee torsional moment when measured in the anatomical frame of reference, and the late-stance knee flexion moment was invariant. CONCLUSIONS The dermoskeleton demonstrated favorable biomechanical modifications at the knee in healthy adults while walking. Studies are warranted to explore this technology for enabling physical activity-based interventions in patients with KOA.
Collapse
|
29
|
Moorman CT, Kirwan T, Share J, Vannabouathong C. Patient Preferences Regarding Surgical Interventions for Knee Osteoarthritis. CLINICAL MEDICINE INSIGHTS-ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2017; 10:1179544117732039. [PMID: 28974919 PMCID: PMC5613842 DOI: 10.1177/1179544117732039] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 08/16/2017] [Indexed: 11/17/2022]
Abstract
Surgical interventions for knee osteoarthritis (OA) have markedly different procedure attributes and may have dramatic differences in patient desirability. A total of 323 patients with knee OA were included in a dual response, choice-based conjoint analysis to identify the relative preference of 9 different procedure attributes. A model was also developed to simulate how patients might respond if presented with the real-world knee OA procedures, based on conservative assumptions regarding their attributes. The “amount of cutting and removal of the existing bone” required for a procedure had the highest preference score, indicating that these patients considered it the most important attribute. More specifically, a procedure that requires the least amount of bone cutting or removal would be expected to be the most preferred surgical alternative. The model also suggested that patients who are younger and report the highest pain levels and greatest functional limitations would be more likely to opt for surgical intervention.
Collapse
Affiliation(s)
- Claude T Moorman
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Tom Kirwan
- Bruno and Ridgway Research Associates, Inc., Lawrenceville, NJ, USA
| | - Jennifer Share
- Bruno and Ridgway Research Associates, Inc., Lawrenceville, NJ, USA
| | | |
Collapse
|
30
|
Hylkema TH, Stevens M, Van Beveren J, Rijk PC, van Jonbergen HP, Brouwer RW, Bulstra SK, Brouwer S. Preoperative characteristics of working-age patients undergoing total knee arthroplasty. PLoS One 2017; 12:e0183550. [PMID: 28841709 PMCID: PMC5571908 DOI: 10.1371/journal.pone.0183550] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 08/07/2017] [Indexed: 11/27/2022] Open
Abstract
Objective Total Knee Arthroplasty (TKA) is performed more in working-age (<65 years) patients. Until now, research in this patient population has been conducted mainly among retired (≥65 years) patients. Aim of this study was therefore to describe demographic, physical, psychological and social characteristics of working TKA patients and to subsequently compare these characteristics with retired TKA patients and the general population. Methods A cross-sectional analysis. Preoperative data of 152 working TKA patients was used. These data were compared with existing data of retired TKA patients in hospital registers and with normative values from literature on the general population. Demographic, physical, psychological and social (including work) characteristics were analyzed. Results The majority (83.8%) of working TKA patients was overweight (42.6%) or obese (41.2%), a majority (72.4%) was dealing with two or more comorbidities, and most (90%) had few depressive symptoms. Mean physical activity level was 2950 minutes per week. Compared to the retired TKA population, working TKA patients perceived significantly more stiffness and better physical functioning and vitality, were more physically active, and perceived better mental health. Compared to the general population working TKA patients perceived worse physical functioning, worse physical health and better mental health, and worked fewer hours. Conclusion This study shows that a majority of working TKA patients are overweight/obese, have multiple comorbidities, but are highly active in light-intensity activities and have few depressive symptoms. Working patients scored overall better on preoperative characteristics than retired patients, and except for physical activity scored overall worse than the general population.
Collapse
Affiliation(s)
- Tjerk H. Hylkema
- Department of Orthopedics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Health Sciences, Division of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- * E-mail:
| | - Martin Stevens
- Department of Orthopedics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jan Van Beveren
- Department of Orthopedics, Röpcke-Zweers Hospital Hardenberg, Hardenberg, The Netherlands
| | - Paul C. Rijk
- Department of Orthopedics, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | | | - Reinoud W. Brouwer
- Department of Orthopedics, Martini Hospital Groningen, Groningen, The Netherlands
| | - Sjoerd K. Bulstra
- Department of Orthopedics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sandra Brouwer
- Department of Health Sciences, Division of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| |
Collapse
|
31
|
Kulshrestha V, Datta B, Kumar S, Mittal G. Outcome of Unicondylar Knee Arthroplasty vs Total Knee Arthroplasty for Early Medial Compartment Arthritis: A Randomized Study. J Arthroplasty 2017; 32:1460-1469. [PMID: 28065624 DOI: 10.1016/j.arth.2016.12.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 12/01/2016] [Accepted: 12/12/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND With increasing number of patients with early osteoarthritis of knee opting for total knee arthroplasty (TKA), there has been increase in patients dissatisfied with surgical outcomes. It is being presumed that offering unicondylar knee arthroplasty (UKA) to them would improve outcomes. METHODS Primary objective of our study was to look for any difference in patient-reported outcome and function at 2-year follow-up in patients undergoing UKA as compared to TKA. Our study was a randomized study with parallel assignment conducted at a high-volume specialized arthroplasty center. Eighty patients with bilateral isolated medial compartment knee arthritis were randomized into simultaneous 2-team bilateral TKA (n = 40) and UKA (n = 40) group. We finally analyzed 36 patients in each group. Main outcome measure was improvement in Knee Outcome Survey-Activities of Daily Living Scale (KOS-ADLS) and High Activity Arthroplasty Score (HAAS) obtained at 2-year follow-up. RESULTS Improvement in KOS-ADLS and HAAS at 2 years was similar (P = .2143 and .2010) in both groups. Performance as assessed with Delaware index was also similar. Length of hospital stay was less in UKA group (6.6 days as against 5.4 days). Complications and readmission rates were more in TKA group (nil in UKA group; 08 in TKA group). CONCLUSION At 2-year follow-up, UKA provides similar improvement in patient-reported outcomes, function, and performance as compared to TKA when performed in patients with early arthritis. However, UKA patients have shorter hospital stay and fewer complications.
Collapse
Affiliation(s)
- Vikas Kulshrestha
- Joint Replacement Centre, Army Hospital Research & Referral, New Delhi, India
| | - Barun Datta
- Joint Replacement Centre, Army Hospital Research & Referral, New Delhi, India
| | - Santhosh Kumar
- Department Of Orthopaedics, Air Force Hospital, Jorhat, India
| | - Gaurav Mittal
- Joint Replacement Centre, Army Hospital Research & Referral, New Delhi, India
| |
Collapse
|
32
|
Adravanti P, Budhiparama NC, Berend KR, Thienpont E. ACL-deficient knee and unicompartmental OA: state of the art. J ISAKOS 2017. [DOI: 10.1136/jisakos-2016-000066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
33
|
Minimally invasive Oxford medial unicompartmental knee arthroplasty in young patients. Knee Surg Sports Traumatol Arthrosc 2017; 25:660-668. [PMID: 25957605 DOI: 10.1007/s00167-015-3620-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 04/27/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Advanced knee arthritis in young patients is a challenging problem that may necessitate surgical treatment. There are few published studies of mobile-bearing unicompartmental knee arthroplasty (UKA) in young patients, while indications have expanded to its use in this demanding patient group. METHODS The clinical and radiographic results of the first 118 consecutive Oxford medial UKAs (OUKA) using a minimally invasive technique (phase 3) in 101 patients 60 years of age or younger at the time of surgery were evaluated. Median age at surgery was 57 (25-60) years. Kaplan-Meier survivorship analysis was used to estimate implant survival. RESULTS Mean time of follow-up evaluation was five (SD 1.6) years. At final follow-up, three patients (three knees) had died, and two patients (three knees) were lost to follow-up. Five knees were revised: three for unexplained pain, one for early infection and one for bearing fracture. There was one impending revision for progression of osteoarthritis in the lateral compartment. The radiographic review demonstrated that 5 % of the knees had progressive arthritis in the lateral knee compartment, of those 2 % with full joint space loss and pain. The Kaplan-Meier survival analysis, using revision for any reason as the endpoint, estimated the five-year survival rate at 97 % (95 % CI 91-99). Ninety-six per cent of the non-revised patients were satisfied with the outcome, and 4 % were dissatisfied. The mean Oxford knee score was 41 (SD 7), with 6 % of the knees having a poor result. The mean AKSS was 89 (SD 14), mean flexion was 129° (SD 13) and the mean UCLA score was 6.8 (SD 1.5). CONCLUSION Minimally invasive Oxford medial UKA was reliable and effective in this young and active patient cohort providing high patient satisfaction at mid-term follow-up. Progressive arthritis in the lateral knee compartment was a relevant failure mode in this age group. Most revisions were performed for unexplained pain, while we did not find loosening or wear in any patient. LEVEL OF EVIDENCE IV.
Collapse
|
34
|
Abstract
Synopsis Although osteoarthritis (OA) has traditionally been considered a disease of older age, hip and knee OA can and does affect younger adults, with a profound impact on psychosocial well-being and work capacity. Obesity and a history of traumatic knee injury (eg, anterior cruciate ligament rupture and/or meniscal tear) are key risk factors for the accelerated development of knee OA, while structural hip deformities (including those contributing to femoroacetabular impingement syndrome) are strong predictors of early-onset hip OA. In view of these associations, rising rates of obesity and sports injuries are concerning, and may signal a future surge in OA incidence among younger people. Assessment of hip and knee OA in younger people should focus on a patient-centered history, comprehensive physical examination, performance-based measures, and patient-reported outcome measures to enable monitoring of symptoms and function over time. Referral for imaging should be reserved for people presenting with atypical signs or symptoms that may indicate diagnoses other than OA. Nonpharmacological approaches are core strategies for the management of hip and knee OA in younger people, and these include appropriate disease-related education, activity modification (including for work-related tasks), physical therapist- prescribed exercise programs to address identified physical impairments, and weight control or weight loss. High-quality evidence has shown no benefit of arthroscopy for knee OA, and there are no published clinical trials to support the use of hip arthroscopy for OA. Referral for joint-conserving or joint replacement surgery should be considered when nonpharmacological and pharmacological management strategies are no longer effective. J Orthop Sports Phys Ther 2017;47(2):67-79. doi:10.2519/jospt.2017.7286.
Collapse
|
35
|
Jacobs HN, Rathod S, Wolf MT, Elisseeff JH. Intra-articular Injection of Urinary Bladder Matrix Reduces Osteoarthritis Development. AAPS JOURNAL 2016; 19:141-149. [PMID: 27778194 DOI: 10.1208/s12248-016-9999-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 09/28/2016] [Indexed: 11/30/2022]
Abstract
Micronized porcine urinary bladder matrix (UBM) is an extracellular matrix biomaterial that has immunomodulatory and pro-regenerative properties. The objective of this study was to assess the ability of UBM to alter disease progression in a mouse model of post-traumatic osteoarthritis (OA). Ten-week-old wild-type C57BL/6 male mice underwent anterior cruciate ligament transection (ACLT) to induce OA. Two weeks after ACLT, UBM (50 mg/mL) or saline was injected into the mouse joint. At 4 and 8 weeks post-ACLT, cartilage integrity was assessed using OARSI scoring of histology, pain was evaluated, and joints were harvested for quantitative RT-PCR analysis of cartilage-specific and inflammatory gene expression. UBM-treated animals showed improved cartilage integrity at 4 and 8 weeks and reduced pain at 4 weeks compared to saline-injected mice. Animals injected with UBM expressed higher levels of genes encoding structural cartilage proteins, such as collagen2α1 and aggrecan, as well as anti-inflammatory cytokines, including interleukins 10 and 4. UBM decreased cartilage degeneration in the murine ACLT model of OA, which may be due to reduced inflammation in the joint and maintenance of high expression levels of proteoglycans.
Collapse
Affiliation(s)
- Heather N Jacobs
- Translational Tissue Engineering Center, Wilmer Eye Institute and Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, 21287, USA
| | - Sona Rathod
- Translational Tissue Engineering Center, Wilmer Eye Institute and Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, 21287, USA
| | - Matthew T Wolf
- Translational Tissue Engineering Center, Wilmer Eye Institute and Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, 21287, USA
| | - Jennifer H Elisseeff
- Translational Tissue Engineering Center, Wilmer Eye Institute and Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, 21287, USA. .,, 400N Broadway, Baltimore, Maryland, 21232, USA.
| |
Collapse
|
36
|
|
37
|
Peck J. Long-term sequelae and management following anterior cruciate ligament injury. BMJ Case Rep 2014; 2014:bcr-2014-204239. [PMID: 25320251 DOI: 10.1136/bcr-2014-204239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This article discusses a case in which a patient who sustained an anterior cruciate ligament (ACL) injury returned with anterior knee pain in the same knee approximately 20 years later. He underwent reconstruction at the time of the injury and had a revision reconstruction performed 10 years later. The case highlights the long-term consequences of ACL injury and subsequent reconstruction for the knee joint, as this patient has developed anterior knee pain during his mid-40s. Additionally, non-operative management of knee osteoarthritis is discussed.
Collapse
|
38
|
Plancher KD, Dunn ASM, Petterson SC. The anterior cruciate ligament-deficient knee and unicompartmental arthritis. Clin Sports Med 2014; 33:43-55. [PMID: 24274844 DOI: 10.1016/j.csm.2013.08.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Treatment of medial and lateral compartment arthritis in the anterior cruciate ligament (ACL)-deficient knee remains a topic of debate among orthopedic surgeons. This article discusses the treatment options for the ACL-deficient knee with unicompartmental arthritis and provides a rationale for clinical decision making in this difficult group of patients. Unicondylar knee arthroplasty (UKA) is a viable option in a select group of patients to decrease pain and maintain an active lifestyle. When performing a UKA in an ACL-deficient knee, it is important to manage appropriate expectations for a successful outcome.
Collapse
Affiliation(s)
- Kevin D Plancher
- Plancher Orthopaedics & Sports Medicine, 1160 Park Avenue, New York, NY 10128, USA; Orthopaedic Foundation for Active Lifestyles, Greenwich, CT, USA; Department of Orthopaedics, Albert Einstein College of Medicine, New York, NY, USA.
| | | | | |
Collapse
|