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Vea-Huerta M, Salazar-López JN, Flores-Bautista P. [Pressure digit sign in patients with knee osteoarthritis]. Acta Ortop Mex 2024; 38:101-104. [PMID: 38782475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
INTRODUCTION it is estimated that 302 million people worldwide are affected by osteoarthritis, corresponding to 60% osteoarthritis (OA) of the knee, which responsible 80% of disability in older adults, hence the importance of the association of the sign with the early inflammatory process in OA. OBJECTIVE to determine the association of digital pressure sign in patients with and without osteoarthritis of the knee. MATERIAL AND METHODS this was an observational, comparative cross-sectional study, carried out in patients with and without a diagnosis of knee OA, to whom the digital pressure sign was determined. The sample was calculated with the formula for two proportions, obtaining a total of 40 participants per group, obtained by non-probabilistic sampling for convenience. The statistical analysis included frequencies, percentages, 2 and OR. The bioethics regulations in force were respected. RESULTS the study included 80 participants, with a median age of 48.9 years (RQI 46-53.7), 73.1% were predominantly female sex (38), and a statistically significant association was found between patients with OA and the presence of digital pressure sign, 2 4.62 and p value = 0.41, OR of 2.65. CONCLUSIONS the presence of digital pressure sign increases the probability of having OA 2.65 times more.
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Affiliation(s)
- M Vea-Huerta
- Coordinación Clínica de Educación e Investigación en Salud, Unidad de Medicina Familiar No. 16, Instituto Mexicano del Seguro Social (IMSS). Querétaro, Querétaro, México
| | - J N Salazar-López
- Hospital General Regional No. 1, Instituto Mexicano del Seguro Social (IMSS). Querétaro, Querétaro, México
| | - P Flores-Bautista
- Coordinación Clínica de Educación e Investigación en Salud, Unidad de Medicina Familiar No. 16, Instituto Mexicano del Seguro Social (IMSS). Querétaro, Querétaro, México
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Farì G, Megna M, Scacco S, Ranieri M, Raele MV, Noya EC, Macchiarola D, Bianchi FP, Carati D, Gnoni A, Inchingolo AD, Qorri E, Scarano A, Scacco A, Arrigoni R, Rapone B. Effects of Terpenes on the Osteoarthritis Cytokine Profile by Modulation of IL-6: Double Face versus Dark Knight? Biology (Basel) 2023; 12:1061. [PMID: 37626947 PMCID: PMC10452224 DOI: 10.3390/biology12081061] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/19/2023] [Accepted: 07/26/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Hemp seed oil and terpenes are emerging as a dietary supplement and complementary therapy for patients suffering from knee osteoarthritis (KOA). However, the mechanisms and effects induced by these molecules on inflammatory cytokines are not yet fully understood. The aim of this study was to evaluate the changes in the cytokine IL-1β, IL-1α, IL-2, IL-6, and TNF-α levels from two oral hemp seed oil-based dietary supplements, of which only one included the addition of terpenes, in a population of KOA patients. METHODS Sera from venous blood samples were collected from thirty-eight patients who were divided into two subgroups. The control group underwent a 45-day treatment with a dietary supplement containing only hemp seed oil, while the treatment group assumed a hemp seed oil and terpene-based dietary supplement for the same number of days. A Bio-Plex Human Cytokine assay was performed by a customized human cytokine five-plex panel for IL-1β, IL-1α, IL-2, IL-6, and TNF-α. Patients were evaluated before the beginning of the treatment (T0) and soon after it (T1). RESULTS No measurable levels of IL-2 and TNF-α were found in any of the subjects. Low levels of IL-1β were found, which were significantly decreased in the treatment group. No change in IL-1α levels was observed, while treated patients had a significant increase in IL-6 levels. CONCLUSIONS Hemp seed oil and terpene treatment modified the IL-1β and IL-6 levels, counteracting KOA inflammation in this way. In this study, IL-6 revealed its new and alternative action, since it is traditionally known as a pro-inflammatory factor, but it recently has been found to have anti-inflammatory activity in the muscle-derived form, which is the one it assumes as a myokine when activated by terpenes.
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Affiliation(s)
- Giacomo Farì
- Department of Translational Biomedicine and Neuroscience (DiBraiN), Aldo Moro University, 70121 Bari, Italy; (M.M.); (S.S.); (M.R.); (M.V.R.); (E.C.N.); (D.M.); (A.G.)
- Department of Biological and Environmental Science and Technologies (Di.S.Te.B.A.), University of Salento, Piazza Tancredi 7, 73100 Lecce, Italy
| | - Marisa Megna
- Department of Translational Biomedicine and Neuroscience (DiBraiN), Aldo Moro University, 70121 Bari, Italy; (M.M.); (S.S.); (M.R.); (M.V.R.); (E.C.N.); (D.M.); (A.G.)
| | - Salvatore Scacco
- Department of Translational Biomedicine and Neuroscience (DiBraiN), Aldo Moro University, 70121 Bari, Italy; (M.M.); (S.S.); (M.R.); (M.V.R.); (E.C.N.); (D.M.); (A.G.)
- Mater Dei Hospital C.B.H., 70125 Bari, Italy
| | - Maurizio Ranieri
- Department of Translational Biomedicine and Neuroscience (DiBraiN), Aldo Moro University, 70121 Bari, Italy; (M.M.); (S.S.); (M.R.); (M.V.R.); (E.C.N.); (D.M.); (A.G.)
| | - Maria Vittoria Raele
- Department of Translational Biomedicine and Neuroscience (DiBraiN), Aldo Moro University, 70121 Bari, Italy; (M.M.); (S.S.); (M.R.); (M.V.R.); (E.C.N.); (D.M.); (A.G.)
| | - Enrica Chiaia Noya
- Department of Translational Biomedicine and Neuroscience (DiBraiN), Aldo Moro University, 70121 Bari, Italy; (M.M.); (S.S.); (M.R.); (M.V.R.); (E.C.N.); (D.M.); (A.G.)
| | - Dario Macchiarola
- Department of Translational Biomedicine and Neuroscience (DiBraiN), Aldo Moro University, 70121 Bari, Italy; (M.M.); (S.S.); (M.R.); (M.V.R.); (E.C.N.); (D.M.); (A.G.)
- Istituti Clinici Scientifici Maugeri, IRCCS, 70124 Bari, Italy;
| | - Francesco Paolo Bianchi
- Department of Interdisciplinary Medicine, Aldo Moro University of Bari, 70121 Bari, Italy; (F.P.B.); (A.D.I.); (B.R.)
| | - Davide Carati
- Ansce Bio Generic, 73020 Carpignano Salentino, Italy;
| | - Antonio Gnoni
- Department of Translational Biomedicine and Neuroscience (DiBraiN), Aldo Moro University, 70121 Bari, Italy; (M.M.); (S.S.); (M.R.); (M.V.R.); (E.C.N.); (D.M.); (A.G.)
| | - Alessio Danilo Inchingolo
- Department of Interdisciplinary Medicine, Aldo Moro University of Bari, 70121 Bari, Italy; (F.P.B.); (A.D.I.); (B.R.)
| | - Erda Qorri
- Dean Faculty of Medical Sciences, Albanian University, Bulevardi Zogu I, 1001 Tirana, Albania;
| | - Antonio Scarano
- Department of Innovative Technologies in Medicine and Dentistry, University of Chieti-Pescara, 66100 Chieti, Italy;
| | - Antonio Scacco
- Istituti Clinici Scientifici Maugeri, IRCCS, 70124 Bari, Italy;
| | - Roberto Arrigoni
- CNR Institute of Biomembranes, Bioenergetics and Molecular Biotechnologies (IBIOM), 70125 Bari, Italy;
| | - Biagio Rapone
- Department of Interdisciplinary Medicine, Aldo Moro University of Bari, 70121 Bari, Italy; (F.P.B.); (A.D.I.); (B.R.)
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Lewis E, Merghani K, Robertson I, Mulford J, Prentice B, Mathew R, Van Winden P, Ogden K. The effectiveness of leucocyte-poor platelet-rich plasma injections on symptomatic early osteoarthritis of the knee: the PEAK randomized controlled trial. Bone Joint J 2022; 104-B:663-671. [PMID: 35638203 DOI: 10.1302/0301-620x.104b6.bjj-2021-1109.r2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
AIMS Platelet-rich plasma (PRP) intra-articular injections may provide a simple and minimally invasive treatment for early-stage knee osteoarthritis (OA). This has led to an increase in its adoption as a treatment for knee OA, although there is uncertainty about its efficacy and benefit. We hypothesized that patients with early-stage symptomatic knee OA who receive multiple PRP injections will have better clinical outcomes than those receiving single PRP or placebo injections. METHODS A double-blinded, randomized placebo-controlled trial was performed with three groups receiving either placebo injections (Normal Saline), one PRP injection followed by two placebo injections, or three PRP injections. Each injection was given one week apart. Outcomes were prospectively collected prior to intervention and then at six weeks, three months, six months, and 12 months post-intervention. Primary outcome measures were Knee Injury and Osteoarthritis Outcome Score (KOOS) and EuroQol five-dimension five-level index (EQ-5D-5L). Secondary outcomes included visual analogue scale for pain and patient subjective assessment of the injections. RESULTS A total of 102 patients were recruited. The follow-up period was 12 months, at intervals of six weeks, 12 weeks, six months, and 12 months. KOOS-Total significantly improved in all groups at these time intervals compared to pre-injection. There was an improvement in EQ-5D-5L index scores in saline and single injection groups, but not in the multiple injection group. Comparison of treatment groups showed no additional beneficial effect of single or multiple PRP injections above that displayed in the saline injection group. Subjective patient satisfaction and recommendation of treatment received demonstrated a similar pattern in all the groups. There was no indication of superiority of either single or multiple PRP injections compared to saline injections. CONCLUSION There is no evidence that single or multiple PRP had any additional beneficial effect compared to saline injection up to 12 months, follow-up after treatment of early stage symptomatic OA of the knee. Cite this article: Bone Joint J 2022;104-B(6):663-671.
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Affiliation(s)
- Emma Lewis
- Launceston General Hospital, Launceston, Australia
| | | | - Iain Robertson
- College of Health and Medicine, University of Tasmania, Launceston, Australia.,Clifford Craig Foundation, Launceston General Hospital, Launceston, Australia
| | | | - Ben Prentice
- Launceston General Hospital, Launceston, Australia
| | | | | | - Kathryn Ogden
- College of Health and Medicine, University of Tasmania, Launceston, Australia.,Clifford Craig Foundation, Launceston General Hospital, Launceston, Australia
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Banger MS, Doonan J, Jones BG, MacLean AD, Rowe PJ, Blyth MJG. Are there functional biomechanical differences in robotic arm-assisted bi-unicompartmental knee arthroplasty compared with conventional total knee arthroplasty? A prospective, randomized controlled trial. Bone Joint J 2022; 104-B:433-443. [PMID: 35360949 DOI: 10.1302/0301-620x.104b4.bjj-2021-0837.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this study was to compare any differences in the primary outcome (biphasic flexion knee moment during gait) of robotic arm-assisted bi-unicompartmental knee arthroplasty (bi-UKA) with conventional mechanically aligned total knee arthroplasty (TKA) at one year post-surgery. METHODS A total of 76 patients (34 bi-UKA and 42 TKA patients) were analyzed in a prospective, single-centre, randomized controlled trial. Flat ground shod gait analysis was performed preoperatively and one year postoperatively. Knee flexion moment was calculated from motion capture markers and force plates. The same setup determined proprioception outcomes during a joint position sense test and one-leg standing. Surgery allocation, surgeon, and secondary outcomes were analyzed for prediction of the primary outcome from a binary regression model. RESULTS Both interventions were shown to be effective treatment options, with no significant differences shown between interventions for the primary outcome of this study (18/35 (51.4%) biphasic TKA patients vs 20/31 (64.5%) biphasic bi-UKA patients; p = 0.558). All outcomes were compared to an age-matched, healthy cohort that outperformed both groups, indicating residual deficits exists following surgery. Logistic regression analysis of primary outcome with secondary outcomes indicated that the most significant predictor of postoperative biphasic knee moments was preoperative knee moment profile and trochlear degradation (Outerbridge) (R2 = 0.381; p = 0.002, p = 0.046). A separate regression of alignment against primary outcome indicated significant bi-UKA femoral and tibial axial alignment (R2 = 0.352; p = 0.029), and TKA femoral sagittal alignment (R2 = 0.252; p = 0.016). The bi-UKA group showed a significant increased ability in the proprioceptive joint position test, but no difference was found in more dynamic testing of proprioception. CONCLUSION Robotic arm-assisted bi-UKA demonstrated equivalence to TKA in achieving a biphasic gait pattern after surgery for osteoarthritis of the knee. Both treatments are successful at improving gait, but both leave the patients with a functional limitation that is not present in healthy age-matched controls. Cite this article: Bone Joint J 2022;103-B(4):433-443.
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Affiliation(s)
- Matthew S Banger
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | - James Doonan
- Department of Trauma and Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK
| | - Bryn G Jones
- Department of Trauma and Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK
| | - Angus D MacLean
- Department of Trauma and Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK
| | - Philip J Rowe
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | - Mark J G Blyth
- Department of Trauma and Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK
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Veronese N, Stefanac S, Koyanagi A, Al-Daghri NM, Sabico S, Cooper C, Rizzoli R, Reginster JY, Barbagallo M, Dominguez LJ, Smith L, Maggi S. Lower Limb Muscle Strength and Muscle Mass Are Associated With Incident Symptomatic Knee Osteoarthritis: A Longitudinal Cohort Study. Front Endocrinol (Lausanne) 2021; 12:804560. [PMID: 34975772 PMCID: PMC8716541 DOI: 10.3389/fendo.2021.804560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 11/26/2021] [Indexed: 11/25/2022] Open
Abstract
Recent literature suggests that sarcopenia, often represented by low lower limbs muscle mass and strength, can be considered a potential risk factor for knee osteoarthritis (OA), but the available literature is still limited. We therefore aimed to investigate whether sarcopenia is associated with a higher risk of radiographic (ROA) and symptomatic knee OA (SxOA) in a large cohort of North American people in the context of the OA initiative. Sarcopenia at baseline was diagnosed in case of low skeletal muscle mass (i.e., lower skeletal mass index) and poor performance in the chair stands test. The outcomes of interest for this study included ROA (radiographical osteoarthritis) if a knee developed a Kellgren and Lawrence (KL) grade ≥2 at follow-up, and SxOA (symptomatic osteoarthritis) defined as new onset of a combination of painful knee OA. Altogether, 2,492 older participants (mean age: 68.4 years, 61.4% females) were included. At baseline, sarcopenia was present in 6.1% of the population. No significant difference in ROA prevalence was observed between those with and without sarcopenia (p=0.76), whilst people with sarcopenia reported a significant higher prevalence of SxOA (p<0.0001). Using a logistic regression analysis, adjusting for potential confounders at baseline and the diagnosis of sarcopenia during follow-up, sarcopenia was associated with a higher incidence of knee SxOA (odds ratio, OR=2.29; 95%CI [confidence interval]: 1.42-3.71; p=0.001), but not knee ROA (OR=1.48; 95%CI: 0.53-4.10; p=0.45). In conclusion, sarcopenia could be associated with a higher risk of negative knee OA outcomes, in particular symptomatic forms.
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Affiliation(s)
- Nicola Veronese
- Department of Internal Medicine, Geriatric Section, University of Palermo, Palermo, Italy
- Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Sinisa Stefanac
- Institute of Outcomes Research, Centre for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Barcelona, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Nasser M. Al-Daghri
- Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Shaun Sabico
- Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Cyrus Cooper
- Oxford National Institute for Health Research (NIHR) Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, United Kingdom
- Medical Research Council (MRC) Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, United Kingdom
- National Institute for Health Research Nutrition Biomedical Research Centre, Southampton General Hospital, University of Southampton and University Hospital Southampton National Health System (NHS) Foundation Trust, Southampton, United Kingdom
| | - Renè Rizzoli
- Division of Bone Diseases, Department of Internal Medicine Specialties, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Jean-Yves Reginster
- Department of Public Health, Epidemiology and Health Economics, CHU Sart Tilman B23, University of Liege, Liège, Belgium
| | - Mario Barbagallo
- Department of Internal Medicine, Geriatric Section, University of Palermo, Palermo, Italy
| | - Ligia J. Dominguez
- Department of Internal Medicine, Geriatric Section, University of Palermo, Palermo, Italy
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Department of Life Sciences, Anglia Ruskin University, Cambridge, United Kingdom
| | - Stefania Maggi
- National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy
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Langworthy MJ, Hummer CD, Ngai W, Hao L, Webner D. Evaluation of Hylan G-F 20 Treatment with Opioid Prescriptions and Intraarticular Corticosteroid Injections in Patients with Osteoarthritis of the Knee Using a Claims Database. Cartilage 2021; 13:1586S-1597S. [PMID: 33095034 PMCID: PMC8808906 DOI: 10.1177/1947603520967076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE Assess how treatment with the viscosupplement hylan G-F 20 relates to opioid prescriptions and intraarticular corticosteroid injections (IACS) in patients with osteoarthritis of the knee (OAK). DESIGN Case-crossover; adult patients with OAK identified in a claims database were treated with hylan G-F 20 from July 1, 2007, to June 29, 2017. Opioid or IACS prescriptions in the 6 months before treatment were compared to the 6 months after. Patients with comorbid conditions requiring pain medications were excluded, resulting in a 29,395-patient cohort. Four subgroups were investigated: patients with (1) opioids before hylan G-F 20 (OB; n = 6,609); (2) opioids before and after hylan G-F 20 (OBF; n = 3,320); (3) IACS before hylan G-F 20 (CB; n = 11,162); and (4) IACS before and after hylan G-F 20 (CBF; n = 2,810). All opioids were converted to morphine milligram equivalents (MME). RESULTS OB subgroup patients had a significant decrease (P < 0.01) in total MME (-14.0%), MME per day (-14.2%) and opioid prescription days (-12.6%) after treatment versus before. Only 50.2% of patients prescribed opioids before hylan G-F 20 were prescribed an opioid after treatment. OBF subgroup patients had a significant increase (P < 0.01) in opioid prescription days (7.8%) before versus after treatment. There was a significant decrease (P < 0.01) in the number of IACS after versus before treatment for the Total Cohort (-56.1%), and subgroups CB (-72.6%) and CBF (-4.1%). A total of 74.8% of patients receiving an IACS before treatment did not receive an IACS after treatment. CONCLUSIONS Hylan G-F 20 is associated with a reduction in opioid prescriptions and IACS in OAK patients.
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Affiliation(s)
- Michael J. Langworthy
- Southcoast Health Systems, New Bedford,
MA, USA,Michael J. Langworthy, Southcoast Health
Systems, Saint Lukes Hospital, New Bedford, MA 02740, USA.
| | | | - Wilson Ngai
- Sanofi, U.S. Medical Affairs,
Bridgewater, NJ, USA
| | - Lichen Hao
- Sanofi, Real World Evidence,
Bridgewater, NJ, USA
| | - David Webner
- Crozer-Keystone Health System, Suburban
Philadelphia, PA, USA
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Schadler P, Lohberger B, Stündl N, Stradner MH, Glänzer D, Sadoghi P, Leithner A, Steinecker-Frohnwieser B. The Effect of Body Mass Index and Metformin on Matrix Gene Expression in Arthritic Primary Human Chondrocytes. Cartilage 2021; 13:1004S-1018S. [PMID: 33025801 PMCID: PMC8804722 DOI: 10.1177/1947603520962558] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Obesity is a known risk factor for knee osteoarthritis (OA). Diabetes has been associated with progression of OA and metformin is the first-line treatment in type 2 diabetes. The effect of the body mass index (BMI) and metformin on the expression of certain matrix genes in human chondrocytes is unclear. The purpose of this study was to investigate the effect of BMI and metformin on the expression of matrix genes in primary human chondrocytes. DESIGN Adult female patients undergoing knee arthroplasty for end-stage OA were enrolled. Primary chondrocytes were cultivated and stimulated with metformin. Matrix gene expression was analyzed using polymerase chain reaction. Clinical data were used in multivariable regression models to assess the influence of BMI and metformin stimulation on gene expression. RESULTS A total of 14 patients were analyzed. BMI was a predictor of increased expression in ADAMTS5 (β = -0.11, P = 0.03). Metformin slightly reduced expression in ADAMTS5 (β = 0.34, P = 0.04), HIF-1a (β = 0.39, P = 0.04), IL4 (β = 0.30, P = 0.02), MMP1 (β = 0.47, P < 0.01), and SOX9 (β = 0.37, P = 0.03). The hip-knee-ankle angle and proton pump inhibitors (PPIs) intake were associated with reduced SOX9 expression (β = 0.23, P < 0.01; β = 2.39, P < 0.01). Higher C-reactive protein (CRP) levels were associated with increased MMP1 expression (β = -0.16, P = 0.02). CONCLUSION We found that BMI exerts a destructive effect via induction of ADAMTS5. Metformin reduced the expression of catabolic genes ADAMTS5 and MMP1 and might play a role in disease prevention. Limb malalignment and PPI intake was associated with a reduced expression of SOX9, and higher CRP levels correlated with increased MMP1 expression, indicating a destructive process.
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Affiliation(s)
- Paul Schadler
- Department of Orthopaedics and Trauma,
Medical University of Graz, Graz, Austria,Paul Schadler, Department of Orthopaedics
and Trauma, Medical University of Graz, Auenbruggerplatz 5-7, Graz, 8036,
Austria.
| | - Birgit Lohberger
- Department of Orthopaedics and Trauma,
Medical University of Graz, Graz, Austria
| | - Nicole Stündl
- Department of Orthopaedics and Trauma,
Medical University of Graz, Graz, Austria,Department for Rehabilitation, Ludwig
Boltzmann Institute for Arthritis and Rehabilitation, Gröbming, Austria
| | - Martin Helmut Stradner
- Department for Rehabilitation, Ludwig
Boltzmann Institute for Arthritis and Rehabilitation, Gröbming, Austria
| | - Dietmar Glänzer
- Department of Orthopaedics and Trauma,
Medical University of Graz, Graz, Austria,Department for Rehabilitation, Ludwig
Boltzmann Institute for Arthritis and Rehabilitation, Gröbming, Austria
| | - Patrick Sadoghi
- Department of Orthopaedics and Trauma,
Medical University of Graz, Graz, Austria
| | - Andreas Leithner
- Department of Orthopaedics and Trauma,
Medical University of Graz, Graz, Austria
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Blyth MJG, Banger MS, Doonan J, Jones BG, MacLean AD, Rowe PJ. Early outcomes after robotic arm-assisted bi-unicompartmental knee arthroplasty compared with total knee arthroplasty: a prospective, randomized controlled trial. Bone Joint J 2021; 103-B:1561-1570. [PMID: 34587803 PMCID: PMC9948427 DOI: 10.1302/0301-620x.103b10.bjj-2020-1919.r2] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
AIMS The aim of this study was to compare the clinical outcomes of robotic arm-assisted bi-unicompartmental knee arthroplasty (bi-UKA) with conventional mechanically aligned total knee arthroplasty (TKA) during the first six weeks and at one year postoperatively. METHODS A per protocol analysis of 76 patients, 43 of whom underwent TKA and 34 of whom underwent bi-UKA, was performed from a prospective, single-centre, randomized controlled trial. Diaries kept by the patients recorded pain, function, and the use of analgesics daily throughout the first week and weekly between the second and sixth weeks. Patient-reported outcome measures (PROMs) were compared preoperatively, and at three months and one year postoperatively. Data were also compared longitudinally and a subgroup analysis was conducted, stratified by preoperative PROM status. RESULTS Both operations were shown to offer comparable outcomes, with no significant differences between the groups across all timepoints and outcome measures. Both groups also had similarly low rates of complications. Subgroup analysis for preoperative psychological state, activity levels, and BMI showed no difference in outcomes between the two groups. CONCLUSION Robotic arm-assisted, cruciate-sparing bi-UKA offered similar early clinical outcomes and rates of complications to a mechanically aligned TKA, both in the immediate postoperative period and up to one year following surgery. Further work is required to identify which patients with osteoarthritis of the knee will derive benefit from a cruciate-sparing bi-UKA. Cite this article: Bone Joint J 2021;103-B(10):1561-1570.
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Affiliation(s)
- Mark J. G. Blyth
- Department of Trauma and Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK,Correspondence should be sent to Mark J. G. Blyth. E-mail:
| | - Matthew S. Banger
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | - James Doonan
- Department of Trauma and Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK
| | - Bryn G. Jones
- Department of Trauma and Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK
| | - Angus D. MacLean
- Department of Trauma and Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK
| | - Philip J. Rowe
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
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Maehara M, Toyoda E, Takahashi T, Watanabe M, Sato M. Potential of Exosomes for Diagnosis and Treatment of Joint Disease: Towards a Point-of-Care Therapy for Osteoarthritis of the Knee. Int J Mol Sci 2021; 22:2666. [PMID: 33800860 DOI: 10.3390/ijms22052666] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/02/2021] [Accepted: 03/03/2021] [Indexed: 02/07/2023] Open
Abstract
In the knee joint, articular cartilage injury can often lead to osteoarthritis of the knee (OAK). Currently, no point-of-care treatment can completely address OAK symptoms and regenerate articular cartilage to restore original functions. While various cell-based therapies are being developed to address OAK, exosomes containing various components derived from their cells of origin have attracted attention as a cell-free alternative. The potential for exosomes as a novel point-of-care treatment for OAK has been studied extensively, especially in the context of intra-articular treatments. Specific exosomal microRNAs have been identified as possibly effective in treating cartilage defects. Additionally, exosomes have been studied as biomarkers through their differences in body fluid composition between joint disease patients and healthy subjects. Exosomes themselves can be utilized as a drug delivery system through their manipulation and encapsulation of specific contents to be delivered to specific cells. Through the combination of exosomes with tissue engineering, novel sustained release drug delivery systems are being developed. On the other hand, many of the functions and activities of exosomes are unknown and challenges remain for clinical applications. In this review, the possibilities of intra-articular treatments utilizing exosomes and the challenges in using exosomes in therapy are discussed.
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Yoshioka T, Kubota S, Sugaya H, Arai N, Hyodo K, Kanamori A, Yamazaki M. Feasibility and efficacy of knee extension training using a single-joint hybrid assistive limb, versus conventional rehabilitation during the early postoperative period after total knee arthroplasty. J Rural Med 2021; 16:22-28. [PMID: 33442431 PMCID: PMC7788304 DOI: 10.2185/jrm.2020-024] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 09/28/2020] [Indexed: 11/27/2022] Open
Abstract
Objectives: To evaluate the feasibility and efficacy of treatment for the
recovery of knee joint function after total knee arthroplasty (TKA) using a robotic
suit. Patients and Methods: Knee joint extension exercise sessions were started
with a robotic suit (single-joint hybrid assistive limb [HAL-SJ, Cyberdyne, Inc., Tsukuba,
Japan]) in one group of patients after TKA. Patients who underwent standard rehabilitation
were enrolled in the control group. To evaluate feasibility and safety, we assessed the
adverse events, the number of training sessions, and training time. We compared the
changes in knee joint pain and extension lag (°) between the groups. Results: The average age was 71.3 ± 6.2 years in the HAL-SJ group and 74.9 ±
8.7 years in the control group. There were no severe adverse events. In the HAL-SJ group,
training was performed 2.9 times, on average, and lasted 18.8 min. In the HAL-SJ group,
there was a reduction in the visual analog scale (VAS) for pain after training, which was
not significant. In the control group, the VAS score worsened after the sessions. The
extension lag significantly improved in the HAL-SJ group after the 2nd and 3rd sessions,
and this was more due to improvements in their active extension range of motion than their
passive extension range of motion. Conclusions: HAL-SJ-based training is safe and effective, and leads to
instantaneous improvement of extension lag, without worsening knee joint pain.
HAL-SJ-based knee extension training could represent a viable novel post-TKA
rehabilitation modality.
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Affiliation(s)
- Tomokazu Yoshioka
- Division of Regenerative Medicine for Musculoskeletal System, Faculty of Medicine, University of Tsukuba, Japan
| | - Shigeki Kubota
- Division of Regenerative Medicine for Musculoskeletal System, Faculty of Medicine, University of Tsukuba, Japan
| | - Hisashi Sugaya
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Norihito Arai
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Kojiro Hyodo
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Akihiro Kanamori
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Masashi Yamazaki
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
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Koppens D, Rytter S, Dalsgaard J, Sørensen OG, Hansen TB, Stilling M. The Effect of Bone Quality on Tibial Component Migration in Medial Cemented Unicompartmental Knee Arthroplasty. A Prospective Cohort Study Using Dual X-Ray Absorptiometry and Radiostereometric Analysis. J Arthroplasty 2020; 35:675-682.e2. [PMID: 31732369 DOI: 10.1016/j.arth.2019.10.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/10/2019] [Accepted: 10/15/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Periprosthetic bone mineral density (BMD) may influence implant fixation and subsequent loosening. Unicompartmental knee arthroplasty (UKA) restores normal knee kinematics and load distribution to the surrounding bone. We studied the influence of systemic and periprosthetic BMD of the proximal tibia on migration of the tibial component of cemented medial UKA. METHODS The cohort was dichotomized into a normal BMD group (T-score ≥ -1; n = 37) and a low BMD group (T-score < -1; n = 28) according to World Health Organization criteria. BMD of the proximal tibia and migration of the tibial component were measured with dual X-ray absorptiometry scans and stereoradiographs with 2-year follow-up. RESULTS Patients with normal systemic BMD had an 11% to15% higher BMD in all regions of interest (ROIs) compared to patients with low systemic BMD throughout follow-up. Over time, a decrease in periprosthetic BMD in ROI 1-3 was seen for both groups. The operated knees and contralateral knees showed a similar reduction in BMD in all ROIs between preoperative and 24 months. Between 12 and 24 months, the normal BMD group migrated (maximal total point motion) 0.03 mm (95% confidence interval, -0.01, 0.08) and the low BMD group migrated 0.02 mm (95% confidence interval, -0.03, 0.07). Migration over time was not influenced by change in periprosthetic BMD. CONCLUSION Migration of cemented medial tibial UKA was low until 24 months and was neither affected by preoperative systemic BMD nor affected by postoperative change in periprosthetic BMD. This suggests good long-term fixation despite an index difference in proximal tibial BMD.
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Affiliation(s)
- Daan Koppens
- Department of Orthopedic Surgery, University Clinic for Hand, Hip and Knee Surgery, Hospital Unit West, Holstebro, Denmark; Department of Clinical Medicine, Aarhus University, Incuba Skejby, Aarhus N, Denmark
| | - Søren Rytter
- Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus N, Denmark
| | - Jesper Dalsgaard
- Department of Orthopedic Surgery, University Clinic for Hand, Hip and Knee Surgery, Hospital Unit West, Holstebro, Denmark
| | - Ole G Sørensen
- Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus N, Denmark
| | - Torben B Hansen
- Department of Orthopedic Surgery, University Clinic for Hand, Hip and Knee Surgery, Hospital Unit West, Holstebro, Denmark; Department of Clinical Medicine, Aarhus University, Incuba Skejby, Aarhus N, Denmark
| | - Maiken Stilling
- Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Incuba Skejby, Aarhus N, Denmark
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12
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Springer B, Bechler U, Waldstein W, Rueckl K, Boettner F. Five Questions to Identify Patients With Osteoarthritis of the Knee. J Arthroplasty 2020; 35:52-56. [PMID: 31563394 DOI: 10.1016/j.arth.2019.08.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/07/2019] [Accepted: 08/26/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND To treat the increasing number of patients with osteoarthritis (OA) of the knee, high-volume institutions rely on central referral services as first contact point. Depending on the grading of arthritis, patients will be referred to a nonoperative or operative care provider. The present study reports on a simple 5-step questionnaire to identify patients with OA (Kellgren/Lawrence [KL] grade ≥2) of the knee to improve efficiency of referrals. METHODS We included 998 patients who contacted the physician referral service at the author's institution complaining of knee pain and divided them into 2 groups. The study group included patients with an appointment and consisted of 646 patients (345 women [53.4%] and 301 men [46.6%]). X-rays of the knee were graded according to the KL classification system. The control group of patients who did not make an appointment consisted of 352 patients (187 women [53.1%] and 165 men [46.9%]). These patients were contacted to evaluate whether they had been diagnosed with OA of the knee since their initial call, to assure that the study group was not exposed to a selection bias. RESULTS Logistic regression revealed 5 questions as significant predictors for OA of the knee (KL grade ≥2). When combining both groups, an 86.9% sensitivity, a 73.3% specificity, and an 84.3% overall accuracy were reached, when patients answered 3 or more questions positively. CONCLUSION The present study revealed a simple 5-step questionnaire to identify patients with OA of the knee. Implementation of the questionnaire has the potential to improve the accuracy of referral processes and streamline organization before the first appointment.
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Affiliation(s)
- Bernhard Springer
- Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, NY; Department of Orthopedics, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Ulrich Bechler
- Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, NY
| | - Wenzel Waldstein
- Department of Orthopedics, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Kilian Rueckl
- Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, NY
| | - Friedrich Boettner
- Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, NY
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13
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Lizis P, Kobza W, Manko G. Extracorporeal shockwave therapy vs. kinesiotherapy for osteoarthritis of the knee: A pilot randomized controlled trial. J Back Musculoskelet Rehabil 2017; 30:1121-1128. [PMID: 28946535 DOI: 10.3233/bmr-169781] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Osteoarthritis (OA) of the knee is a degenerative, painful pathology, needing conservative treatment for symptoms' relief. OBJECTIVE Comparing the effects of Extracorporeal shockwave therapy (ESWT) and Kinesiotherapy (KIN) on perceived health and range of motion (ROM) of the affected knee. METHOD A pilot randomized controlled trial with concealed allocation, assessor blinding, intention-to-treat analysis. Forty participants, aged 40-75 with OA of the knee were randomized to an ESWT and a KIN groups. The ESWT group completed 5 interventions for 5 weeks, the KIN group completed the same number of interventions. All evaluations were performed at baseline and after the treatment for: perceived health (Western Ontario and McMaster Universities questionnaire - WOMAC), range of motion (ROM). RESULTS After the intervention the statistical significant between groups differences favoring the ESWT were found in the WOMAC with regard to pain (p< 0.000), stiffness (p= 0.018), physical function (p< 0.000), total score (p< 0.000), extension and flexion of the affected knee (p= 0.015, p< 0.000) respectively. CONCLUSIONS ESWT improves WOMAC and ROM better then KIN on the affected knee in patients with OA of the knee.
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Affiliation(s)
- Paweł Lizis
- Department of Education and Health Protection, Holycross College of Kielce, Kielce, Poland
| | | | - Grzegorz Manko
- Department of Ergonomics and Physiology of Physical Effort, Jagiellonian University of Cracow, Cracow, Poland
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González-Huerta NC, Borgonio-Cuadra VM, Zenteno JC, Cortés-González S, Duarte-Salazar C, Miranda-Duarte A. D14 repeat polymorphism of the asporin gene is associated with primary osteoarthritis of the knee in a Mexican Mestizo population. Int J Rheum Dis 2015; 20:1935-1941. [PMID: 26620055 DOI: 10.1111/1756-185x.12797] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Asporin is a novel extracellular matrix protein (ECM) with an important role in the development of osteoarthritis (OA), because it has been reported that functional polymorphisms in the aspartic acid repeat (D) of the asporin gene (ASPN) are associated with susceptibility to OA. AIM This study was planned to investigate the association of the ASPN polymorphism with primary OA of the knee in a Mexican population, including several countryside regions. METHODS We conducted a case-control study in which 93 cases with primary OA of the knee and 118 controls were included. Cases included patients > 40 years of age, with a body mass index (BMI) ≤ 27 and a radiologic score for OA of the knee of ≥ 2. Controls were subjects > 40 years of age with a radiologic score of < 2. The D repeat polymorphism was genotyped and logistic regression was developed to evaluate risk magnitude. RESULTS The D14 allele was more common in our cases and was associated with an increased risk for developing OA, while the frequencies of the remaining alleles did not exhibit differences. CONCLUSION Our data suggest that the D14 allele of the ASPN polymorphism could exert an influence on primary OA of the knee etiology in a Mexican Mestizo population.
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Affiliation(s)
| | | | - Juan Carlos Zenteno
- Department of Biochemistry, Faculty of Medicine, Universidad Nacional Autónoma de México (UNAM), México City, México.,Department of Genetics, Instituto de Oftalmología "Conde de Valenciana", México City, México
| | - Socorro Cortés-González
- Department of Magnetic Resonance, Instituto Nacional de Rehabilitación (INR), México City, México
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15
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Marrin K, Wood F, Firth J, Kinsey K, Edwards A, Brain KE, Newcombe RG, Nye A, Pickles T, Hawthorne K, Elwyn G. Option Grids to facilitate shared decision making for patients with Osteoarthritis of the knee: protocol for a single site, efficacy trial. BMC Health Serv Res 2014; 14:160. [PMID: 24708747 PMCID: PMC3986464 DOI: 10.1186/1472-6963-14-160] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 03/27/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite policy interest, an ethical imperative, and evidence of the benefits of patient decision support tools, the adoption of shared decision making (SDM) in day-to-day clinical practice remains slow and is inhibited by barriers that include culture and attitudes; resources and time pressures. Patient decision support tools often require high levels of health and computer literacy. Option Grids are one-page evidence-based summaries of the available condition-specific treatment options, listing patients' frequently asked questions. They are designed to be sufficiently brief and accessible enough to support a better dialogue between patients and clinicians during routine consultations. This paper describes a study to assess whether an Option Grid for osteoarthritis of the knee (OA of the knee) facilitates SDM, and explores the use of Option Grids by patients disadvantaged by language or poor health literacy. METHODS/DESIGN This will be a stepped wedge exploratory trial involving 72 patients with OA of the knee referred from primary medical care to a specialist musculoskeletal service in Oldham. Six physiotherapists will sequentially join the trial and consult with six patients using usual care procedures. After a period of brief training in using the Option Grid, the same six physiotherapists will consult with six further patients using an Option Grid in the consultation. The primary outcome will be efficacy of the Option Grid in facilitating SDM as measured by observational scores using the OPTION scale. Comparisons will be made between patients who have received the Option Grid and those who received usual care. A Decision Quality Measure (DQM) will assess quality of decision making. The health literacy of patients will be measured using the REALM-R instrument. Consultations will be observed and audio-recorded. Interviews will be conducted with the physiotherapists, patients and any interpreters present to explore their views of using the Option Grid. DISCUSSION Option Grids offer a potential solution to the barriers to implementing traditional decision aids into routine clinical practice. The study will assess whether Option Grids can facilitate SDM in day-to-day clinical practice and explore their use with patients disadvantaged by language or poor health literacy. TRIAL REGISTRATION Current Controlled Trials ISRCTN94871417.
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Affiliation(s)
- Katy Marrin
- Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, CF14 4YS Cardiff, UK
| | - Fiona Wood
- Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, CF14 4YS Cardiff, UK
| | - Jill Firth
- Pennine MSK Partnership Ltd, Integrated Care Centre, New Radcliffe Street, Oldham OL1 1NL, UK
| | - Katharine Kinsey
- Pennine MSK Partnership Ltd, Integrated Care Centre, New Radcliffe Street, Oldham OL1 1NL, UK
| | - Adrian Edwards
- Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, CF14 4YS Cardiff, UK
| | - Kate E Brain
- Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, CF14 4YS Cardiff, UK
| | - Robert G Newcombe
- Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, CF14 4YS Cardiff, UK
| | - Alan Nye
- Pennine MSK Partnership Ltd, Integrated Care Centre, New Radcliffe Street, Oldham OL1 1NL, UK
| | - Timothy Pickles
- South East Wales Trials Unit, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK
| | - Kamila Hawthorne
- Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, CF14 4YS Cardiff, UK
| | - Glyn Elwyn
- The Dartmouth Center for Health Care Delivery Science, Dewey Field Road, Hanover, NH 03755, USA
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16
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Maricar N, Callaghan MJ, Felson DT, O'Neill TW. Predictors of response to intra-articular steroid injections in knee osteoarthritis--a systematic review. Rheumatology (Oxford) 2013; 52:1022-32. [PMID: 23264554 PMCID: PMC3651612 DOI: 10.1093/rheumatology/kes368] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 10/26/2012] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE IA steroid injections (IASIs) have been shown to relieve pain in knee OA and are widely used in clinical practice. There is, however, evidence of some variation in response. Knowledge of predictors of response could aid in the selection of patients for this therapy. The aim of this systematic review was to determine factors associated with response to IASI in knee OA. METHODS Medline, Embase, AMED, CINAHL, Web of Science and Cochrane Central Registers for Controlled Trials up to January 2012 were searched with additional hand searches of relevant articles. Studies included were those that involved adults diagnosed with knee OA in whom IASIs were administered and factors that predicted treatment response were investigated. RESULTS Eleven publications meeting these criteria were reviewed and relevant information extracted. It was not possible to pool the results because of the different predictors studied, variable outcome measures, different criteria for symptom change and missing data. Given the relative paucity of data and small heterogeneously designed studies, it was difficult to identify predictors of response. Data from individual publications, although not consistent across studies, suggest that the presence of effusion, withdrawal of fluid from the knee, severity of disease, absence of synovitis, injection delivery under US guidance and greater symptoms at baseline may all improve the likelihood of response to IASI. CONCLUSION Further larger-scale studies using standardized methods are required to characterize predictors of response and should focus on synovitis, effusion, pain and structural severity of disease. Such data would help in better targeting therapy to those most likely to benefit.
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Affiliation(s)
- Nasimah Maricar
- Arthritis Research UK Epidemiology Unit, Manchester Academic Health Science Centre, University of Manchester, Manchester M13 9PT, UK.
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17
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Moon KH. New view on the initial development site and radiographic classification system of osteoarthritis of the knee based on radiographic analysis. Int J Biomed Sci 2012; 8:233-43. [PMID: 23675278 PMCID: PMC3615296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 11/25/2012] [Indexed: 10/31/2022]
Abstract
INTRODUCTION Radiographic pathology of severe osteoarthritis of the knee (OAK) such as severe osteophyte at tibial spine (TS), compartment narrowing, marginal osteophyte, and subchondral sclerosis is well known. Kellgren-Lawrence grading system, which is widely used to diagnose OAK, describes narrowing-marginal osteophyte in 4-grades but uses osteophyte at TS only as evidence of OAK without detailed-grading. However, kinematically the knee employs medial TS as an axis while medial and lateral compartments carry the load, suggesting that early OAK would occur sooner at TS than at compartment. Then, Kellgren-Lawrence system may be inadequate to diagnose early-stage OAK manifested as a subtle osteophyte at TS without narrowing-marginal osteophyte. This undiagnosed-OAK will deteriorate becoming a contributing factor in an increasing incidence of OAK. METHODS This study developed a radiographic OAK-marker based on both osteophyte at TS and compartment narrowing-marginal osteophyte and graded as normal, mild, moderate, and severe. With this marker, both knee radiographs of 1,728 patients with knee pain were analyzed. RESULTS Among 611 early-stage mild OAK, 562 or 92% started at TS and 49 or 8% at compartment. It suggests the initial development site of OAK, helping develop new site-specific radiographic classification system of OAK accurately to diagnose all severity of OAK at early, intermediate, or late-stage. It showed that Kellgren-Lawrence system missed 92.0% of early-stage mild OAK from diagnosis. CONCLUSIONS A subtle osteophyte at TS is the earliest radiographic sign of OAK. A new radiographic classification system of OAK was suggested for accurate diagnosis of all OAK in severity and at stage.
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Affiliation(s)
- Ki-Ho Moon
- Department of Orthopedic Surgery, Interfaith Medical Center, 1545 Atlantic Ave, Brooklyn, NY, USA
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18
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Mody S, Jolly M, Kwasny MJ, Block JA. Patient reported outcomes and analgesia use in osteoarthritis of the knee. Osteoarthritis Cartilage 2008; 16:1294-9. [PMID: 18456521 PMCID: PMC2587259 DOI: 10.1016/j.joca.2008.03.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2007] [Accepted: 03/30/2008] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Non-opioid analgesics (NOAs) are widely used to palliate osteoarthritis (OA) pain, however, their role in health-related quality of life (HRQoL) in OA has not been well studied. Here, we assess the relationship of pain, physical function, and HRQoL to NOA use in symptomatic knee OA. METHODS NOA dose, pain, physical function, and HRQoL were evaluated longitudinally over 1 year in medial knee OA. Doses provided by subjects' weekly medication diaries were normalized to equi-analgesic ibuprofen-equivalents (IEs). Descriptive analyses at baseline, 1.5, and 12 months, and non-parametric comparisons of NOA with pain, physical function, and HRQoL at 1.5 months and over 12 months were performed. RESULTS Seventy-one subjects (19 males and 52 females; mean 57+/-10.5 years) used an overall median of 300 mg/week of IE. Twenty-five subjects reported no analgesic use during the study; of the 46 subjects that reported NOA use, the median intake was 1325 mg/week IE. Whereas age, Physical Functioning (PF) and HRQoL were predictive of NOA dose both at 1.5 months and during the entire study, pain level was not. The median NOA dose declined over 12 months (P=0.02), however, the change was not associated with changes in PF, HRQoL or pain. CONCLUSION Greater age and worse physical function and HRQoL, but not pain severity, are predictive of NOA use in symptomatic knee OA. Longitudinally, NOA use does not change as a function of pain. These data suggest that pain is not the primary determinant of NOA use over time among OA patients.
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19
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Tamari K, Tinley P, Aoyagi K. Gender and age-related differences in axial alignment of the lower limb among healthy Japanese volunteers: comparative and correlation study. J Jpn Phys Ther Assoc 2003; 6:25-34. [PMID: 25792930 PMCID: PMC4316508 DOI: 10.1298/jjpta.6.25] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2002] [Accepted: 12/14/2002] [Indexed: 11/23/2022]
Abstract
A cross-sectional study was designed for this investigation using a healthy Japanese population. The objectives of this study were to confirm gender and age-related differences in axial alignment of the lower limb, and to investigate the correlation between femorotibial angle and axial alignment of the lower limb among a healthy Japanese population. Although axial alignment of the lower limb has been defined as one of the associating factors for osteoarthritis of the knee along with varus and valgus deformity, the results in the literature are inconsistent. Since there is gender difference in femorotibial angle, axial alignment of the lower limb should show the difference if it is an associating factor for osteoarthritis of the knee. Few studies have been conducted to investigate gender difference in axial alignment of the lower limb. One hundred and forty four healthy Japanese subjects took part in the study. Reliable clinical methods of measuring femoral torsion, tibiofibular torsion, rotational range of motion of the hip and knee joints, and femorotibial angle were employed utilizing a digital inclinometer. Two way ANOVA and Pearson product-moment correlation analysis were used for statistical analyses. Axial alignment of the lower limb was different between genders (p<0.05). An age-related difference was also shown in hip rotation (p<0.05). Further, the femorotibial angle was significantly correlated with hip and knee joint rotation (p<0.05) in older males and younger females. This study implied that axial alignment of the lower limb may be related to deformity of the knee joint.
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Affiliation(s)
- Kotaro Tamari
- School of Physiotherapy, Curtin University of Technology, Kent Street, Bentley, 6102, Western Australia, Australia
| | - Paul Tinley
- Department of Podiatry, School of Community Health, Charles Start University, 2640, New South Wales, Australia
| | - Kiyoshi Aoyagi
- Department of Public Health, Nagasaki University School of Medicine, 1-12-4, Sakamoto, Nagasaki, 852-8523, Japan
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