Hip joint and muscle loading for persons with bilateral transfemoral/through-knee amputations: biomechanical differences between full-length articulated and foreshortened non-articulated prostheses

BACKGROUND

Currently, there is little available in-depth analysis of the biomechanical effect of different prostheses on the musculoskeletal system function and residual limb internal loading for persons with bilateral transfemoral/through-knee amputations (BTF). Commercially available prostheses for BTF include full-length articulated prostheses (microprocessor-controlled prosthetic knees with dynamic response prosthetic feet) and foreshortened non-articulated stubby prostheses. This study aims to assess and compare the BTF musculoskeletal function and loading during gait with these two types of prostheses.

METHODS

Gait data were collected from four male traumatic military BTF and four able-bodied (AB) matched controls using a 10-camera motion capture system with two force plates. BTF completed level-ground walking trials with full-length articulated and foreshortened non-articulated stubby prostheses. Inverse kinematics, inverse dynamics and musculoskeletal modelling simulations were conducted.

RESULTS

Full-length articulated prostheses introduced larger stride length (by 0.5 m) and walking speed (by 0.3 m/s) than stubbies. BTF with articulated prostheses showed larger peak hip extension angles (by 10.1°), flexion moment (by 1.0 Nm/kg) and second peak hip contact force (by 3.8 bodyweight) than stubbies. There was no difference in the hip joint loading profile between BTF with stubbies and AB for one gait cycle. Full-length articulated prostheses introduced higher hip flexor muscle force impulse than stubbies.

CONCLUSIONS

Compared to stubbies, BTF with full-length articulated prostheses can achieve similar activity levels to persons without limb loss, but this may introduce detrimental muscle and hip joint loading, which may lead to reduced muscular endurance and joint degeneration. This study provides beneficial guidance in making informed decisions for prosthesis choice.

Bixa orellana ethyl acetate fraction and its isolated compound ellagic acid attenuate the progression of MIA-induced osteoarthritis in rat knees

Osteoarthritis (OA) is a pathology that is characterized by progressive erosion of articular cartilage. In this context, medicinal plants have become relevant tools regarding their potential role in the prevention and treatment of OA, being safe and effective. The aim of this work was investigate the therapeutic efficacy of the ethyl acetate fraction of Bixa orellana leaves (BoEA) and ellagic acid (ElAc) for the therapeutic treatment of OA induced by monosodium iodoacetate (MIA) in rats. The plant material was extracted via maceration with 70 % hydroalcoholic solvent (BoHE). The ethyl acetate (BoEA) fraction was by solvents in increasing order of polarity. The ElAc was identified and isolated in BoEA using high performance liquid chromatography (HPLC-DAD) and analytical curve. The OA was induced using MIA in the right knee at the knee joint. Doses of BoEA and ElAc were administered daily (every 24 h, orally) at concentrations of 50, 100 and 50 mg/kg, respectively, for 28 days after induced OA. We evaluated the animals through clinical and radiological examinations every 7 days and, on the 29th day, the animals were euthanized, the joints being removed for histopathological analysis and the serum for cytokine analysis. BoEA and ElAc compounds reduced inflammation and nociception in OA and were as effective as indomethacin in clinical parameters of joint discomfort and allodynia in rats, in addition to showing improvements in radiological and histopathological images, acting on the progress of cartilage deterioration, proving properties related to anti-inflammatory and analgesic processes, being important allies for new therapeutic interventions for the treatment of OA.

The impact of ligament tears on joint contact mechanics in progressive collapsing foot deformity: A finite element study

BACKGROUND

Patients with longstanding progressive collapsing foot deformity often develop osteoarthritis of the ankle, midfoot, or hindfoot joints, which can be symptomatic or lead to fixed deformities that complicate treatment. The development of deformity is likely caused by ligament degeneration and tears. However, the effect of individual ligament tears on changes in joint contact mechanics has not been investigated.

METHODS

A validated finite element model of the foot was used to compare joint contact areas, forces, and pressures between the intact and collapsed foot, and to evaluate the effect of individual ligament tears on joint contact mechanics.

FINDINGS

Collapsing the foot resulted in an increase in contact pressure in the subtalar, calcaneocuboid, tibiotalar, medial naviculocuneiform, and first tarsometatarsal joints but a decrease in contact pressure in the talonavicular joint. Rupture of the spring ligament was the main contributor to increased calcaneocuboid and subtalar joint contact pressures and decreased medial naviculocuneiform and first tarsometatarsal joint contact pressures, as well as talonavicular subluxation. Deltoid ligament rupture was the primary source of increased contact pressure in the medial naviculocuneiform, first tarsometatarsal, and tibiotalar joints.

INTERPRETATION

Degenerative tearing of the ligaments in flatfoot deformity leads to increased joint contact pressures, primarily in the calcaneocuboid, subtalar, and tibiotalar joints, which has been implicated in the development of osteoarthritis in these joints. An improved understanding of the relationship between ligament tears and joint contact pressures could provide support for the use of ligament reconstructions to prevent the development of arthrosis.

Arrabidaea chica Verlot fractions reduce MIA-induced osteoarthritis progression in rat knees

This study aims to investigate the activity of n-hexane, ethyl acetate and butanol fractions obtained from Arrabidaea chica Verlot against MIA-induced osteoarthritis (OA). The antinociceptive potentials of each fraction were evaluated through a cyclooxygenase (COX) 1 and 2 inhibition test and an in vivo OA-model. In addition, toxicity assessments in the liver, spleen and kidney, as well as radiographic and histopathological knee analyses, were performed. The chemical composition of the n-hexane fraction was elucidated, and a molecular docking protocol was carried out to identify which compounds are associated with the detected bioactivity. The n-hexane A. chica fraction preferentially inhibits COX-2, with 90% inhibition observed at 10 µg/mL. The fractions also produced significant improvements in OA incapacity, motor activity and hyperalgesia parameters and in radiological knee conditions. However, concerning the histopathological evaluations, these improvements were only significant in the hexane and ethyl acetate fraction treatments, which resulted in better average scores, suggesting that these fractions slow OA-promoted joint injury progression. Histopathological organ analyses indicate that the fractions are not toxic to animals. Twenty compounds were identified in the n-hexane fraction, comprising fatty acids, terpenes and phytosterols. In silico analyses indicate the presence of favourable interactions between some of the identified compounds and the COX-2 enzyme, mainly concerning alpha-tocopherol (Vitamin E), squalene and beta-sitosterol. The findings indicate that A. chica fractions display analgesic, anti-inflammatory properties, are non-toxic and are able to slow OA progression, and may, therefore, be prioritized as natural products in OA human clinical trials.

Intraosseous injections of platelet rich plasma for knee bone marrow lesions treatment: one year follow-up

PURPOSE

Cartilage lesions are usually accompanied by subchondral bone alterations or bone marrow lesions (BMLs). BML associated with joint degeneration and cartilage lesions are considered to be predictors of rapidly progressing OA. Currently no existing treatment can fully halt OA progression. One of the approaches is an autologous, biological treatment based on the use of platelet rich plasma (PRP) injections. The purpose of this study is to assess the short-term effectiveness of intraosseous PRP injections, within the BML of individuals affected by OA, in ameliorating pain and improving knee functionality.

MATERIALS AND METHODS

The study involved 17 patients with an average age of 41.7 ± 14.3 years old. OA stage was determined using the Kellgren-Lawrence grading system by performing radiographic scanning of the knee joint before surgical intervention. Patients with K-L grade 3 knee joint OA prevailed. Patient OA history varied between one and nine years (average 5.2 ± 4.5 years). Clinical and functional state of the knee were assessed by pain visual analogue scale (VAS) score, the Western Ontario and McMaster Universities Score (WOMAC), and the Knee Injury and Osteoarthritis Outcome Score (KOOS) which were filled out by patients previous to the surgical procedure at one, three, six and 12 months post-operatively. Before surgery, in addition to standard blood tests, serum cartilage oligomeric matrix protein (COMP) levels were tested for all patients.

RESULTS

Evaluation of preliminary results revealed a statistically significant reduction of pain based on the VAS score. A significant improvement was also observed in the patients' WOMAC score and in the overall KOOS score. Serum marker levels were initially elevated in our experimental patient group compared to the same marker in healthy control respondents, and continued to rise one month and three months following surgery, at six and 12 month the level was similar as at three months.

CONCLUSIONS

In our opinion, first COMP increasing can be caused by injection of platelet rich plasma. It is not adequate to interpret this growth in COMP levels as increased osteochondral degeneration. One year follow-up period showed good quality of life improvement, significant pain reduction, and essential MRI changes. The long-term observation of these cohort of patients combined with an analysis of MRI images is still ongoing.

Clinical outcomes of chondroblastoma treated using synthetic bone substitute: risk factors for developing radiographic joint degeneration

Background

Chondroblastoma (CB) is a rare locally aggressive bone tumor that commonly occurs in the epiphysis or apophysis of long bones. Although surgical treatment of CB carries potential risk for physeal or articular cartilage damage, risk factors for joint degeneration have not been well described. In addition, we have mainly used synthetic bone substitute (SBS) to fill the bone defect after intralesional curettage as treatment for CB. This study thus aimed to evaluate the incidence of and risk factors for adjacent-joint radiographic degeneration after SBS treatment for CB.

Methods

We retrospectively reviewed 48 patients treated for CB at our institutions between 1996 and 2017. Clinical data, radiographic images, treatments, and local recurrence were analyzed.

Results

We identified 40 patients [29 males and 11 females with a mean age of 19 years (range, 8–35 years)] who received SBS to fill the defect after curettage with a minimum follow-up of 1 year. The mean follow-up period was 71 months (range, 13–239 months). A total of 8 patients (20%) developed local recurrence. Radiographic analysis showed that 5 patients (16.7%) developed radiographic joint degeneration. Joint degeneration was significantly associated with the affected joint (p = 0.004).

Conclusions

Curettage and SBS filling had been found to be a reasonable treatment method for CB, which commonly occurs in the epiphysis or apophysis. Radiographic joint degeneration was not uncommon after CB treatment, especially in the talus and proximal humerus.

Comparison between cervical disc arthroplasty and conservative treatment for patients with single level cervical radiculopathy at C5/6

BACKGROUND

Cervical radiculopathy is a common disease that affects millions of people. Patients usually are managed by conservative therapy and surgical treatments.

OBJECTIVE

To compare the clinical outcomes between cervical disc arthroplasty (CDA) and conservative management for patients with single level cervical radiculopathy at C5/6.

METHODS

Seventy-two patients with cervical radiculopathy that only affect C5/6 joints were included and thirty-two of them received CDA surgery, and forty patients were treated with conservative management. All the patients were followed up around 4 years. Cervical curvature, cervical range of motion (CROM), horizontal displacement of cervical spine, and intervertebral gap were measured by radiological examination.

RESULTS

All the patients have comparable disease severity based on pre-surgical radiological assessments. At the 4-year follow-up examination, patients with CDA surgery had less CROM at C5/6 level, while greater CROM at C4/5 level, than control group. Similarly, the horizontal displacement in CDA group decreased at C5/6 vertebrae, and increased at C4/5 level at the 4-year follow-up examination. The intervertebral gaps of patients in CDA group were larger than control group at one-year and last follow-up examination.

CONCLUSION

CDA surgery stabilized C5/6 vertebrae and increased the CROM and horizontal displacement of upper adjacent C4/5 vertebrae.

Contrast enhanced μCT imaging of early articular changes in a pre-clinical model of osteoarthritis

OBJECTIVE

The objective of this study was to characterize early osteoarthritis (OA) development in cartilage and bone tissues in the rat medial meniscus transection (MMT) model using non-destructive equilibrium partitioning of an ionic contrast agent micro-computed tomography (EPIC-μCT) imaging. Cartilage fibrillation, one of the first physiological developments in OA, was quantified in the rat tibial plateau as three-dimensional (3D) cartilage surface roughness using a custom surface-rendering algorithm.

METHODS

Male Lewis rats underwent MMT or sham-operation in the left leg. At 1- and 3-weeks post-surgery, the animals (n = 7-8 per group) were euthanized and the left legs were scanned using EPIC-μCT imaging to quantify cartilage and bone parameters. In addition, a custom algorithm was developed to measure the roughness of 3D surfaces. This algorithm was validated and used to quantify cartilage surface roughness changes as a function of time post-surgery.

RESULTS

MMT surgery resulted in significantly greater cartilage damage and subchondral bone sclerosis with the damage increasing in both severity and area from 1- to 3-weeks post-surgery. Analysis of rendered 3D surfaces could accurately distinguish early changes in joints developing OA, detecting significant increases of 45% and 124% in surface roughness at 1- and 3-weeks post-surgery respectively.

CONCLUSION

Disease progression in the MMT model progresses sequentially through changes in the cartilage articular surface, extracellular matrix composition, and then osteophyte mineralization and subchondral bone sclerosis. Cartilage surface roughness is a quantitative, early indicator of degenerative joint disease in small animal OA models and can potentially be used to evaluate therapeutic strategies.

Evaluation of the Effect of Mega MSM on Improving Joint Function in Populations Experiencing Joint Degeneration

Joint degeneration has become a commonplace problem in aging populations. The main clinical manifestations include joint pain, joint stiffness and joint swelling with functional disorder. Mega MSM is a nutritional supplement that may provide potential relief for joint problems associated with joint degeneration. The current experiment performed was a 12-week, randomized, double-blind, controlled study conducted on populations in China experiencing joint degeneration. The objective of the study was to determine whether the daily use of Mega MSM capsules could improve joint function, relieve symptoms of joint degeneration and improve the quality of life in aging populations. A total of 100 male and female participants over 50 years old who had at least one of the related symptoms of joint degeneration (joint pain, joint stiffness, joint swelling, difficulty walking, difficulty getting up from bed and difficulty going down stairs) were recruited and their symptoms of joint degeneration before and after the intervention were recorded. In this study, Mega MSM shows positive effects in improving joint function, relieving symptoms associated with joint degeneration and improving the quality of life in aging populations.

Arthroscopic mosaicplasty: long-term outcome and joint degeneration progression

BACKGROUND

This study aims to document the long-term results in a group of patients treated with arthroscopic mosaicplasty for knee cartilage lesions, both in terms of clinical outcome and joint degeneration progression, evaluated by radiographs.

METHODS

26 patients (19 men and 7 women, mean age 29 years, mean BMI 23) treated arthroscopically with mosaicplasty for cartilage defects of the femoral condyles (mean/median/mode size 1.9 standard deviation, SD 0.6 cm(2)) were prospectively evaluated at 12 years follow-up. The clinical outcome was analyzed with IKDC and Tegner scores. Range of motion, transpatellar and suprapatellar circumferences were also measured. Radiographs with weight-bearing antero-posterior and Rosenberg projections were used for radiological evaluation in 18 patients, applying both Kellgren-Lawrence score and a direct joint line measurement to assess osteoarthritis.

RESULTS

A significant improvement in all clinical scores was obtained from the basal evaluation to the 12-year follow-up (IKDC subjective score from 36.8 standard deviation, SD 13.0 to 77.3 standard deviation, SD 20.6, P<0.0005; Tegner score from 2.9 standard deviation, SD 1.3 to 5.2 standard deviation, SD 2.5, P<0.0005), and better results in patients with a higher pre-injury activity level and those requiring fewer plugs. The radiographic evaluation showed significantly poorer Kellgren-Lawrence scores and a reduction of the joint line in the treated compartments. Knees with 3-4 plugs presented a significantly higher joint degeneration level with respect to those implanted with 1-2 plugs.

CONCLUSIONS

Mosaicplasty is an effective surgical option for small lesions of the femoral condyles. Although joint degeneration progression was present at 12 years, this did not affect significantly the clinical outcome which was satisfactory at long-term follow-up.

Intraoperative condyle positioning by sonographic monitoring in orthognathic surgery verified by MRI

OBJECTIVE

Repositioning of the jaw in orthognathic surgery must produce precise and stable long-term results; an effective and practical method of intraoperative condyle positioning is required to achieve this. Most traditional methods, such as manual positioning or positioning plates do not permit intraoperative monitoring of the temporomandibular joint (TMJ) position. This study evaluates the results of intraoperative, sonographically-monitored joint positioning, comparing preoperative and postoperative MRI scans.

PATIENTS AND METHODS

Of the 97 patients who were originally assessed (53 female, average age 29 ± 10.93; and 44 male, average age 28 ± 9.25), 21 had incomplete data sets and were excluded, leaving 76 evaluable patients. MRIs were performed preoperatively between 2 days and 100 weeks (median 30.5 days), and postoperatively between 12 and 96 weeks (median 150 days). Condyle positioning, intercondylar distance, and disc degeneration and dislocation were compared in preoperative and postoperative MRIs, and differentiated by Angle class on horizontal, axial and sagittal scans. Condyle to fossa distances were measured on parasagittal images from 0° (the vertical sagittal plane), 45° anteriorly and 45° posteriorly. The intercondylar distances between the condylar head midpoints were measured on axial sections. Two-sided t-tests (α < 0.05) were used for comparisons within classes; the interclass correlation was performed using univariate ANOVA and linear correlation for paired sample correlation settings.

RESULTS

In 27 Angle class II cases, the anterior distance of both condyles increased on average 0.3 ± 1.0 mm, the posterior position decreased 0.1 ± 1.2 mm, and the vertical position decreased 0.2 ± 1.1 mm postoperatively. In 47 Angle class III cases the anterior distance of both condyles increased on average 0.3 ± 0.8 mm, the posterior 0.1 ± 0.8 mm and the vertical distance 0.1 ± 0.8 mm postoperatively. All alterations of the condyle-fossa relation were non-significant except for the anterior distance in Angle class ІІІ (p = 0.02). Alterations of the disc position and disc degeneration were non-significant in class II. In class ІІІ, the disc degeneration deteriorated slightly on the left side (p = 0.02). Intercondylar distance increased 1 ± 5.5 mm in class ІІ and decreased by 1 ± 5.5 mm in class ІІІ postoperatively, alterations were non-significant.

CONCLUSION

Sonography is a non-invasive, comfortable, fast, economical and effective intraoperative method of condyle positioning. The results of the present study support this statement because the degree of disc degeneration and luxation remained unaltered and the condyle position did not change significantly. Prospective randomized comparison to manual positioning is in preparation and will be conducted in the near future.

Localized 3D analysis of cartilage composition and morphology in small animal models of joint degeneration

OBJECTIVE

Current histological scoring methods to evaluate efficacy of potential therapeutics for slowing or preventing joint degeneration are time-consuming and semi-quantitative in nature. Hence, there is a need to develop and standardize quantitative outcome measures to define sensitive metrics for studying potential therapeutics. The objectives of this study were to use equilibrium partitioning of an ionic contrast agent via Equilibrium Partitioning of an Ionic Contrast-Microcomputed tomography (EPIC-μCT) to quantitatively characterize morphological and compositional changes in the tibial articular cartilage in two distinct models of joint degeneration and define localized regions of interest to detect degenerative cartilage changes.

MATERIALS AND METHODS

The monosodium iodoacetate (MIA) and medial meniscal transection (MMT) rat models were used in this study. Three weeks post-surgery, tibiae were analyzed using EPIC-μCT and histology. EPIC-μCT allowed measurement of 3D morphological changes in cartilage thickness, volume and composition.

RESULTS

Extensive cartilage degeneration was observed throughout the joint in the MIA model after 3 weeks. In contrast, the MMT model showed more localized degeneration with regional thickening of the medial tibial plateau and a decrease in attenuation consistent with proteoglycan (PG) depletion. Focal lesions were also observed and 3D volume calculated as an additional outcome metric.

CONCLUSIONS

EPIC-μCT was used to quantitatively assess joint degeneration in two distinct preclinical models. The MMT model showed similar features to human Osteoarthritis (OA), including localized lesion formation and PG loss, while the MIA model displayed extensive cartilage degeneration throughout the joint. EPIC-μCT imaging provides a rapid and quantitative screening tool for preclinical evaluation of OA therapeutics.