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Xi Y, Chhabra A. We may be closer to automated Kellgren-Lawrence grading for knee osteoarthritis than we thought. Eur Radiol 2025; 35:2296-2297. [PMID: 39297949 DOI: 10.1007/s00330-024-11064-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 06/26/2024] [Accepted: 07/16/2024] [Indexed: 09/21/2024]
Affiliation(s)
- Yin Xi
- The Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA.
| | - Avneesh Chhabra
- The Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA
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Beynon RA, Saunders FR, Ebsim R, Faber BG, Jung M, Gregory JS, Lindner C, Aspden RM, Harvey NC, Cootes T, Tobias JH. A novel classifier of radiographic knee osteoarthritis for use on knee DXA images is predictive of joint replacement in UK Biobank. Rheumatol Adv Pract 2025; 9:rkaf009. [PMID: 39991690 PMCID: PMC11846665 DOI: 10.1093/rap/rkaf009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2024] [Accepted: 12/17/2024] [Indexed: 02/25/2025] Open
Abstract
Objectives DXA scans may offer a novel means of evaluating radiographic knee OA (rKOA) in large population studies and through opportunistic screening. We aimed to develop and apply a semi-automated method for assessing rKOA using ≈20 000 knee DXA images from UK Biobank (UKB) and assess its face validity by checking for expected relationships with clinical outcomes. Methods Right knee DXA scans were manually annotated for osteophytes to derive corresponding grades. Joint space narrowing (JSN) grades in the medial joint compartment were determined from automatically measured minimum joint space width. Overall rKOA grade (0-4) was determined by combining osteophyte and JSN grades. Logistic regression was employed to investigate the associations of osteophyte, JSN and rKOA grades with knee pain and hospital-diagnosed KOA. Cox proportional hazards modelling was used to examine the associations of these variables with risk of subsequent total knee replacement (TKR). Results Of the 19 595 participants included (mean age 63.7 years), 19.5% had rKOA grade ≥1 (26.1% female, 12.5% male). Grade ≥1 osteophytes and grade ≥1 JSN were associated with knee pain, hospital-diagnosed KOA and TKR. Higher rKOA grades were linked to stronger associations with these clinical outcomes, with the most pronounced effects observed for TKR. Hazard ratios for the association of rKOA grades with TKR were 3.28, 8.75 and 28.63 for grades 1, 2 and 3-4, respectively. Conclusions Our DXA-derived measure of rKOA demonstrated a progressive relationship with clinical outcomes. These findings support the use of DXA for classifying rKOA in large epidemiological studies and in future population-based screening.
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Affiliation(s)
- Rhona A Beynon
- Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Bristol, UK
| | - Fiona R Saunders
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Raja Ebsim
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, University of Manchester, Manchester, UK
| | - Benjamin G Faber
- Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Bristol, UK
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Mijin Jung
- Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jennifer S Gregory
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Claudia Lindner
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, University of Manchester, Manchester, UK
| | - Richard M Aspden
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Nicholas C Harvey
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Timothy Cootes
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, University of Manchester, Manchester, UK
| | - Jonathan H Tobias
- Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Bristol, UK
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
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Takiyama K, Kubota K, Yokoyama H, Kanemura N. Speed-dependent modulations of muscle modules in the gait of people with radiographical and asymptomatic knee osteoarthritis and elderly controls: Case-control pilot study. J Biomech 2024; 171:112194. [PMID: 38901294 DOI: 10.1016/j.jbiomech.2024.112194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 06/04/2024] [Accepted: 06/10/2024] [Indexed: 06/22/2024]
Abstract
This study investigates the muscle modules involved in the increase of walking speed in radiographical and asymptomatic knee osteoarthritis (KOA) patients using tensor decomposition. The human body possesses redundancy, which is the property to achieve desired movements with more degrees of freedom than necessary. The muscle module hypothesis is a proposed solution to this redundancy. While previous studies have examined the pathological muscle activity modulations in musculoskeletal diseases such as KOA, they have focused on single muscles rather than muscle modules. Moreover, most studies have only examined the gait of KOA patients at a single speed, leaving the way in which gait speed affects gait parameters in KOA patients unclear. Assessing this influence is crucial for determining appropriate gait speed and understanding why preferred gait speed decreases in KOA patients. In this study, we apply tensor decomposition to muscle activity data to extract muscle modules in KOA patients and elderly controls during walking at different speeds. We found a muscle module comprising hip adductors and back muscles that activate bimodally in a gait cycle, specific to KOA patients when they increase their walking speed. These findings may provide valuable insights for rehabilitation for KOA patients.
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Affiliation(s)
- Ken Takiyama
- Tokyo University of Agriculture and Technology, Department of Electrical Engineering and Computer Science, Nakacho, Koganei, Tokyo, Japan.
| | - Keisuke Kubota
- Research Development Center, Saitama Prefectural University, Saitama, Japan
| | - Hikaru Yokoyama
- Tokyo University of Agriculture and Technology, Division of Advanced Health Science, Nakacho, Koganei, Tokyo, Japan
| | - Naohiko Kanemura
- Graduate Course of Health and Social Services, Saitama Prefectural University, Saitama, Japan
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Kubota K, Yokoyama M, Onitsuka K, Kanemura N. The investigation of an analysis method for co-activation of knee osteoarthritis utilizing normalization of peak dynamic method. Gait Posture 2023; 101:48-54. [PMID: 36724656 DOI: 10.1016/j.gaitpost.2023.01.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 01/14/2023] [Accepted: 01/26/2023] [Indexed: 01/29/2023]
Abstract
BACKGROUND Assessing co-activation characteristics in knee osteoarthritis (knee OA) using method of quantification of the activity ratio (such as the co-contraction index (CCI) or the directed co-activation ratios (DCAR)) for surface electromyography (EMG) has been reported. However, no studies have discussed the differences in results between non-negative matrix factorization (NNMF) and the DCAR. RESEARCH QUESTION Does DCAR or NNMF reflect the characteristic co-activation pattern of knee OA while using EMG normalized by the peak dynamic method? METHODS Ten elderly control participants (EC) and ten knee OA patients (KOA) volunteered to participate in this study. EMG data from 20 participants were obtained from our previous study. Patients with knee OA were recruited from a local orthopedic clinic. The DCAR of agonist and antagonist muscles and the number of modules using NNMF were calculated to evaluate multiple muscle co-activations. An independent t-test statistical parametric mapping approach was used to compare the DCAR between the two groups. The difference in the number of modules between EC and KOA was evaluated using the Wilcoxon rank-sum test. RESULTS There was no significant difference in the DCAR between the two groups. However, NNMF had significantly fewer modules with KOA than with EC. SIGNIFICANCE The NNMF with the ratio of the amplitude of each muscle and duration of activity as variables reflected the co-activation of KOA, characterized by the high synchronous and prolonged activity of each muscle. Therefore, the NNMF is suitable for extracting characteristic muscle activity patterns of knee OA independent of the normalization method.
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Affiliation(s)
- Keisuke Kubota
- Research Development Center, Saitama Prefectural University, Saitama 343-8540, Japan.
| | - Moeka Yokoyama
- Sportology Center, Graduate School of Medicine, Juntendo University, Tokyo 113-8421, Japan
| | - Katsuya Onitsuka
- Graduate Course of Health and Social Services, Saitama Prefectural University, Saitama 343-8540, Japan
| | - Naohiko Kanemura
- Graduate Course of Health and Social Services, Saitama Prefectural University, Saitama 343-8540, Japan
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Osman AE, El-Gafary KA, Khalifa AA, El-Adly W, Fadle AA, Abubeih H. Medial displacement calcaneal osteotomy versus lateral column lengthening to treat stage II tibialis posterior tendon dysfunction, a prospective randomized controlled study. Foot (Edinb) 2021; 47:101798. [PMID: 33957531 DOI: 10.1016/j.foot.2021.101798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 03/29/2021] [Accepted: 04/03/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE Adult-acquired flatfoot deformity (AAFD) requires optimum planning that often requires several procedures for deformity correction. The objective of this study was to detect the difference between MDCO versus LCL in the management of AAFD with stage II tibialis posterior tendon dysfunction regarding functional, radiographic outcomes, efficacy in correction maintenance, and the incidence of complications. PATIENT AND METHODS 42 Patients (21 males and 21 females) with a mean age of 49.6 years (range 43-55), 22 patients had MDCO while 20 had LCL. Strayer procedure, spring ligament plication, and FDL transfer were done in all patients. Pre- and Postoperative (at 3 and 12 months) clinical assessment was done using AOFAS and FFI questionnaire. Six radiographic parameters were analyzed, Talo-navicular coverage and Talo-calcaneal angle in the AP view, Talo- first metatarsus angle, Talo-calcaneal angle and calcaneal inclination angle in lateral view and tibio-calcaneal angle in the axial view, complications were reported. RESULTS At 12 months, significant improvement in AOFAS and FFI scores from preoperative values with no significant difference between both groups. Postoperative significant improvements in all radiographic measurements in both groups were maintained at 12 months. However, the calcaneal pitch angle and the TNCA were better in the LCL at 12 months than MDCO, 17̊±2.8 versus 13.95̊±2.2 (p=0.001) and 13.70̊±2.2 versus 19.05̊±3.2 (p<0.001) respectively. 11 patients (26.2%) had metal removal, seven (16.6%) in the MDCO, and four (9.6%) in the LCL. Three (7.1%) in the LCL group had subtalar arthritis, only one required subtalar fusion. CONCLUSION LCL produced a greater change in the realignment of AAFD, maintained more of their initial correction, and were associated with a lower incidence of additional surgery than MDCO, however, a higher incidence of degenerative change in the hindfoot was observed with LCL.
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Affiliation(s)
- Ahmed E Osman
- Orthopedic Department, Assiut University Hospital, Assiut, Egypt.
| | | | - Ahmed A Khalifa
- Orthopedic Department, Qena Faculty of Medicine and University Hospital, South Valley University, Qena, Egypt.
| | - Wael El-Adly
- Orthopedic Department, Assiut University Hospital, Assiut, Egypt.
| | - Amr A Fadle
- Orthopedic Department, Assiut University Hospital, Assiut, Egypt.
| | - Hossam Abubeih
- Orthopedic Department, Assiut University Hospital, Assiut, Egypt.
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Ito H, Ichihara K, Tamari K, Amano T, Tanaka S, Uchida S, Morikawa S. Determination of reference intervals for knee motor functions specific to patients undergoing knee arthroplasty. PLoS One 2021; 16:e0249564. [PMID: 33852606 PMCID: PMC8046200 DOI: 10.1371/journal.pone.0249564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 03/19/2021] [Indexed: 11/24/2022] Open
Abstract
Background In patients with knee osteoarthritis (KOA) undergoing knee arthroplasty (KA), lower-limb motor function tests are commonly measured during peri-surgical rehabilitation. To clarify their sources of variation and determine reference intervals (RIs), a multicenter study was performed in Japan. Methods We enrolled 545 KOA patients (127 men; 418 women; mean age 74.2 years) who underwent KA and followed a normal recovery course. The surgical modes included total KA (TKA), minimally invasive TKA (MIS-TKA), and unicompartmental KA (UKA). Motor functions measured twice before and two weeks after surgery included timed up-and-go (TUG), maximum walking speed (MWS), extensor and flexor muscle strength (MS), and knee range of motion (ROM). Multiple regression analysis was performed to evaluate their sources of variation including sex, age, BMI, and surgical mode. Magnitude of between-subgroup differences was expressed as SD ratio (SDR) based on 3-level nested ANOVA. SDR≥0.4 was set as the threshold for requiring RIs specific for each subgroup. Results Before surgery, age-related changes exceeding the threshold were observed for TUG and MWS. Between-sex difference was noted for extensor and flexor MS, but extension and flexion ROMs were not influenced by sex or age. After surgery, in addition to similar influences of sex and age on test results, surgical modes of UKA and MIS-TKA generally had a favorable influence on MWS, extensor MS, and flexion ROM. All motor function test results showed a variable degree of skewness in distribution, and thus RIs were basically derived by the parametric method after Gaussian transformation of test results. Conclusions This is the first study to determine RIs for knee motor functions specific to KOA patients after careful consideration of their sources of variation and distribution shapes. These RIs facilitate objective implementation of peri-surgical rehabilitation and allow detection of patients who deviate from the normal course of recovery.
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Affiliation(s)
- Hideyuki Ito
- Department of Rehabilitation, Faculty of Wakayama Health Care Sciences, Takarazuka University of Medical and Health Care, Wakayama, Japan
| | - Kiyoshi Ichihara
- Faculty of Health Sciences, Yamaguchi University Graduate School of Medicine, Ube, Japan
- * E-mail:
| | - Kotaro Tamari
- Department of Physical Therapy, Faculty of Health and Medical Science Teikyo Heisei University, Tokyo, Japan
| | - Tetsuya Amano
- Department of Physical Therapy, Faculty of Health and Medical Sciences, Tokoha University, Hamamatsu, Japan
| | - Shigeharu Tanaka
- Division of Physical Therapy, School of Rehabilitation, Faculty of Health and Social Services, Kanagawa University of Human Services, Yokosuka, Japan
| | - Shigehiro Uchida
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Higashihiroshima, Japan
| | - Shinya Morikawa
- Department of Rehabilitation, Hoshasen Daiichi Hospital, Imabari, Japan
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Ito H, Ichihara K, Tamari K, Amano T, Tanaka S, Uchida S. Factors characterizing gait performance of patients before and soon after knee arthroplasty. J Phys Ther Sci 2021; 33:274-282. [PMID: 33814716 PMCID: PMC8012181 DOI: 10.1589/jpts.33.274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 12/15/2020] [Indexed: 11/24/2022] Open
Abstract
[Purpose] For monitoring patients with knee osteoarthritis undergoing knee arthroplasty,
the Timed Up and Go and maximum walking speed tests are commonly used. To provide
appropriate peri-surgical rehabilitation, we evaluated the factors associated with
postsurgical changes in Timed Up and Go and maximum walking speed results. [Participants
and Methods] We enrolled 545 knee osteoarthritis patients undergoing either of the
following knee arthroplasties: conventional total knee arthroplasty, minimally invasive
total knee arthroplasty, and unicompartmental knee arthroplasty. Comfortable Timed Up and
Go, maximum Timed Up and Go, and maximum walking speed were measured 2 weeks before and
soon after surgery. Factors (gender, age, and surgical mode) that might influence changes
in test results were evaluated by multiple regression analysis and a two-factor
stratification diagram. [Results] Multiple regression analysis revealed that postsurgical
changes in comfortable/maximum Timed Up and Go and maximum walking speed results were
associated with age and surgical mode after adjustment for preoperative values. Two-factor
diagrams showed that the older the patient, the greater was the slowdown in the Timed Up
and Go test performed postoperatively. The levels of slowdown in the postoperative Timed
Up and Go and maximum walking speed tests were the smallest in those who underwent
conventional total knee arthroplasty, followed by those who underwent minimally invasive
and unicompartmental knee arthroplasty. Among patients whose preoperative Timed Up and Go
and maximum walking speed were slow, slowdown in Timed Up and Go was pronounced with age,
and slowdown in maximum walking speed was higher in conventional total knee arthroplasty.
[Conclusion] The changes in Timed Up and Go and maximum walking speed results 2 weeks
after knee arthroplasty depended on age and surgical modes. These findings are relevant
for the implementation of appropriate peri-surgical rehabilitation.
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Affiliation(s)
- Hideyuki Ito
- Department of Rehabilitation, Faculty of Wakayama Health Care Sciences, Takarazuka University of Medical and Health Care: 2252 Nakanoshima, Wakayama, Wakayama 640-8392, Japan.,Department of Clinical Laboratory Sciences, Faculty of Health Sciences, Yamaguchi University Graduate School of Medicine, Japan
| | - Kiyoshi Ichihara
- Department of Clinical Laboratory Sciences, Faculty of Health Sciences, Yamaguchi University Graduate School of Medicine, Japan
| | - Kotaro Tamari
- Department of Physical Therapy, Faculty of Health and Medical Science, Teikyo Heisei University, Japan
| | - Tetsuya Amano
- Department of Physical Therapy, Faculty of Health and Medical Sciences, Tokoha University, Japan
| | - Shigeharu Tanaka
- School of Rehabilitation, Faculty of Health and Social Services, Kanagawa University of Human Services, Japan
| | - Shigehiro Uchida
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Japan
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Kubota K, Hanawa H, Yokoyama M, Kita S, Hirata K, Fujino T, Kokubun T, Ishibashi T, Kanemura N. Usefulness of Muscle Synergy Analysis in Individuals With Knee Osteoarthritis During Gait. IEEE Trans Neural Syst Rehabil Eng 2020; 29:239-248. [PMID: 33301406 DOI: 10.1109/tnsre.2020.3043831] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To clarify whether there are any muscle synergy changes in individuals with knee osteoarthritis, and to determine whether muscle synergy analysis could be applied to other musculoskeletal diseases. METHODS Subjects in this study included 11 young controls (YC), 10 elderly controls (EC), and 10 knee osteoarthritis patients (KOA). Gait was assessed on a split-belt treadmill at 3 km/h. A non-negative matrix factorization (NNMF) was applied to the electromyogram data matrix to extract muscle synergies. To assess the similarity of each module, we performed the NNMF analysis assuming four modules for all of the participants. Further, we calculated joint angles to compare the kinematic data between the module groups. RESULTS The number of muscle modules was significantly lower in the EC (2-3) and KOA (2-3) groups than in the YC group (3-4), which reflects the merging of late swing and early stance modules. The EC and KOA groups also showed greater knee flexion angles in the early stance phase. Contrarily, by focusing on the module structure, we found that the merging of early and late stance modules is characteristic in KOA. CONCLUSION The lower number of modules in the EC and KOA groups was due to the muscle co-contraction with increased knee flexion angle. Contrarily, the merging of early and late stance modules are modular structures specific to KOA and may be biomarkers for detecting KOA. SIGNIFICANCE Describing the changes in multiple muscle control associated with musculoskeletal degeneration can serve as a fundamental biomarker in joint disease.
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Brisson NM, Gatti AA, Maly MR. Association of Pain and Steps Per Day in Persons With Mild-to-Moderate, Symptomatic Knee Osteoarthritis: A Mixed-Effects Models Analysis of Multiple Measurements Over Three Years. Arthritis Care Res (Hoboken) 2020; 72:114-121. [PMID: 30838814 DOI: 10.1002/acr.23842] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 01/29/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Pain is a consistently reported barrier to physical activity by persons with knee osteoarthritis (OA). Nonetheless, few studies of knee OA have investigated the association of pain with daily walking levels. The current study assessed the relationship of 2 distinct measures of knee pain with objectively measured physical activity in adults with knee OA. METHODS This was a longitudinal, observational investigation of 59 individuals (48 women; mean ± SD age 61.1 ± 6.4 years, mean ± SD body mass index 28.1 ± 5.6 kg/m2 ) with clinical knee OA. Data were collected every 3 months for up to 3 years. Physical activity was characterized as the average steps per day taken over at least 3 days, mea-sured by accelerometry. Pain was measured using 2 patient-administered questionnaires: the pain subscale of the Knee Injury and Osteoarthritis Outcome Score (KOOS-pain) and the P4 pain scale (P4-pain). Mixed-effects models determined the association between pain and physical activity levels (over covariates) among adults with knee OA (α = 0.05). RESULTS All covariates (age [β = -3.65, P < 0.001], body mass index [β = -3.06, P < 0.001], season [spring/fall β = -6.91, P = 0.002; winter β = -14.92, P < 0.001]) were predictors of physical activity. Neither the inverted KOOS-pain (β = 0.04, P = 0.717) nor P4-pain (β = -0.37, P = 0.264) was associated with physical activity. CONCLUSION Knee pain is not associated with daily walking levels in persons with mild-to-moderate, symptomatic knee OA. While pain management remains an important target of interventions, strategies to increase steps per day in this population should focus on overcoming potentially more crucial barriers to activity participation.
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Affiliation(s)
- Nicholas M Brisson
- McMaster University, Hamilton, Ontario, Canada, and Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Monica R Maly
- McMaster University, Hamilton, Ontario, Canada, and University of Waterloo, Waterloo, Ontario, Canada
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Thomas KA, Kidziński Ł, Halilaj E, Fleming SL, Venkataraman GR, Oei EHG, Gold GE, Delp SL. Automated Classification of Radiographic Knee Osteoarthritis Severity Using Deep Neural Networks. Radiol Artif Intell 2020; 2:e190065. [PMID: 32280948 DOI: 10.1148/ryai.2020190065] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 10/30/2019] [Accepted: 11/06/2019] [Indexed: 11/11/2022]
Abstract
Purpose To develop an automated model for staging knee osteoarthritis severity from radiographs and to compare its performance to that of musculoskeletal radiologists. Materials and Methods Radiographs from the Osteoarthritis Initiative staged by a radiologist committee using the Kellgren-Lawrence (KL) system were used. Before using the images as input to a convolutional neural network model, they were standardized and augmented automatically. The model was trained with 32 116 images, tuned with 4074 images, evaluated with a 4090-image test set, and compared to two individual radiologists using a 50-image test subset. Saliency maps were generated to reveal features used by the model to determine KL grades. Results With committee scores used as ground truth, the model had an average F1 score of 0.70 and an accuracy of 0.71 for the full test set. For the 50-image subset, the best individual radiologist had an average F1 score of 0.60 and an accuracy of 0.60; the model had an average F1 score of 0.64 and an accuracy of 0.66. Cohen weighted κ between the committee and model was 0.86, comparable to intraexpert repeatability. Saliency maps identified sites of osteophyte formation as influential to predictions. Conclusion An end-to-end interpretable model that takes full radiographs as input and predicts KL scores with state-of-the-art accuracy, performs as well as musculoskeletal radiologists, and does not require manual image preprocessing was developed. Saliency maps suggest the model's predictions were based on clinically relevant information. Supplemental material is available for this article. © RSNA, 2020.
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Affiliation(s)
- Kevin A Thomas
- Departments of Biomedical Data Science (K.A.T., S.L.F., G.R.V.), Bioengineering (Ł.K., S.L.D.), and Radiology (G.E.G.), Stanford University, Clark Center, 318 Campus Dr, Room S321, Stanford, CA 94305; Department of Radiology, Erasmus University Rotterdam, Rotterdam, the Netherlands (E.H.G.O.); and Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, Pa (E.H.)
| | - Łukasz Kidziński
- Departments of Biomedical Data Science (K.A.T., S.L.F., G.R.V.), Bioengineering (Ł.K., S.L.D.), and Radiology (G.E.G.), Stanford University, Clark Center, 318 Campus Dr, Room S321, Stanford, CA 94305; Department of Radiology, Erasmus University Rotterdam, Rotterdam, the Netherlands (E.H.G.O.); and Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, Pa (E.H.)
| | - Eni Halilaj
- Departments of Biomedical Data Science (K.A.T., S.L.F., G.R.V.), Bioengineering (Ł.K., S.L.D.), and Radiology (G.E.G.), Stanford University, Clark Center, 318 Campus Dr, Room S321, Stanford, CA 94305; Department of Radiology, Erasmus University Rotterdam, Rotterdam, the Netherlands (E.H.G.O.); and Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, Pa (E.H.)
| | - Scott L Fleming
- Departments of Biomedical Data Science (K.A.T., S.L.F., G.R.V.), Bioengineering (Ł.K., S.L.D.), and Radiology (G.E.G.), Stanford University, Clark Center, 318 Campus Dr, Room S321, Stanford, CA 94305; Department of Radiology, Erasmus University Rotterdam, Rotterdam, the Netherlands (E.H.G.O.); and Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, Pa (E.H.)
| | - Guhan R Venkataraman
- Departments of Biomedical Data Science (K.A.T., S.L.F., G.R.V.), Bioengineering (Ł.K., S.L.D.), and Radiology (G.E.G.), Stanford University, Clark Center, 318 Campus Dr, Room S321, Stanford, CA 94305; Department of Radiology, Erasmus University Rotterdam, Rotterdam, the Netherlands (E.H.G.O.); and Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, Pa (E.H.)
| | - Edwin H G Oei
- Departments of Biomedical Data Science (K.A.T., S.L.F., G.R.V.), Bioengineering (Ł.K., S.L.D.), and Radiology (G.E.G.), Stanford University, Clark Center, 318 Campus Dr, Room S321, Stanford, CA 94305; Department of Radiology, Erasmus University Rotterdam, Rotterdam, the Netherlands (E.H.G.O.); and Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, Pa (E.H.)
| | - Garry E Gold
- Departments of Biomedical Data Science (K.A.T., S.L.F., G.R.V.), Bioengineering (Ł.K., S.L.D.), and Radiology (G.E.G.), Stanford University, Clark Center, 318 Campus Dr, Room S321, Stanford, CA 94305; Department of Radiology, Erasmus University Rotterdam, Rotterdam, the Netherlands (E.H.G.O.); and Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, Pa (E.H.)
| | - Scott L Delp
- Departments of Biomedical Data Science (K.A.T., S.L.F., G.R.V.), Bioengineering (Ł.K., S.L.D.), and Radiology (G.E.G.), Stanford University, Clark Center, 318 Campus Dr, Room S321, Stanford, CA 94305; Department of Radiology, Erasmus University Rotterdam, Rotterdam, the Netherlands (E.H.G.O.); and Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, Pa (E.H.)
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Suzuki Y, Iijima H, Tashiro Y, Kajiwara Y, Zeidan H, Shimoura K, Nishida Y, Bito T, Nakai K, Tatsumi M, Yoshimi S, Tsuboyama T, Aoyama T. Development of a questionnaire survey to evaluate lower limb function of patients with knee osteoarthritis. Clin Rheumatol 2018; 37:3115-3123. [PMID: 30091087 DOI: 10.1007/s10067-018-4229-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 07/12/2018] [Accepted: 07/20/2018] [Indexed: 11/27/2022]
Abstract
This study aimed to develop a self-questionnaire index relevant to lower limb functional assessment reflecting clinical symptoms and activity restrictions associated with activities of daily living (ADL) for patients with knee osteoarthritis. This cross-sectional study enrolled patients with knee osteoarthritis (Kellgren/Lawrence grade ≥ 1). Participants evaluated clinical symptoms and activity restrictions using self-reported questionnaires. Radiographic evaluation, knee joint range of motion (ROM), and lower limb muscle strength were assessed. Associations between clinical symptoms, activity restrictions, and knee and hip joint function were evaluated using multiple and logistic regression analysis. Overall, 142 participants were included in the final analysis. Patients with knee pain while rising from a chair had lower knee and hip extension strength (knee extension β = - 0.28; 95% confidence interval (CI), - 0.41 to - 0.14; P < 0.0001; hip extension β = - 0.26; 95% CI, - 0.42 to - 0.08; P = 0.0034), and restricted knee extension ROM (odds ratio [OR] = 2.17; 95% CI, 1.02-4.63; P = 0.041). Patients with knee pain during stair climbing, turning or who were unable to stand on one leg without external support had reduced hip abduction muscle strength (β = - 0.17; 95% CI, - 0.27 to - 0.07; P = 0.0008). Patients with knee pain while rising from a chair or stepping showed more severe knee joint degeneration on radiographic evaluation (OR = 3.26; 95% CI, 1.11-10.91; P = 0.03). The self-questionnaire index reflected clinical symptoms and activity restrictions associated with ADL and was significantly associated with lower limb function in individuals with knee osteoarthritis.
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Affiliation(s)
- Yusuke Suzuki
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Hirotaka Iijima
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
- Department of System Design Engineering, Keio University, Yokohama, Japan
| | - Yuto Tashiro
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yuu Kajiwara
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Hala Zeidan
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Kanako Shimoura
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yuichi Nishida
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Tsubasa Bito
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Kengo Nakai
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Masataka Tatsumi
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Soyoka Yoshimi
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Tadao Tsuboyama
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Tomoki Aoyama
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
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Stone OD, Duckworth AD, Curran DP, Ballantyne JA, Brenkel IJ. Severe arthritis predicts greater improvements in function following total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2017; 25:2573-2579. [PMID: 26441252 DOI: 10.1007/s00167-015-3806-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 09/22/2015] [Indexed: 12/27/2022]
Abstract
PURPOSE Although excellent outcomes are routinely reported following total knee replacement, up to 20 % of patients remain dissatisfied. The aim of this study was to determine whether pre-operative radiographic classification was associated with functional outcomes following surgery. METHODS A retrospective review of a prospective arthroplasty database identified 256 patients that fulfilled the inclusion criteria over an 18-month period. Baseline demographic data on all patients were collected prospectively. All pre-operative radiographs were assessed using the Kellgren and Lawrence (K&L) classification system. Patients were prospectively assessed using the American Knee Society Score pre-operatively and at 1, 3 and 5 years post-surgery. RESULTS An association was found between the pre-operative radiographic severity of arthritis and the pre-operative American Knee Society Knee (AKSK) scores, with worsening radiographic grade corresponding to worsening AKSK scores (p = 0.020). There was an association between K&L classification and improvement in AKSK scores from pre-operative to 1 year (p = 0.003) and 3 years (p = 0.04), with K&L grades 3 and 4 demonstrating the most significant improvements. On multivariate regression analysis, K&L classification was the only significant predictor of improvement in AKSK at 1 year (p = 0.009). No correlation was found between K&L grade and the American Knee Society Functional Scores at any stage. CONCLUSIONS The results of this study may help to improve satisfaction rates in total knee replacement by targeting treatment. Patients can be counselled that although radiographic severity of arthritic changes can predict knee-specific functional improvement, the extent of their global functional improvement cannot. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- O D Stone
- Edinburgh Royal Infirmary, Edinburgh, Scotland, UK.
| | | | - D P Curran
- Victoria Hospital Kirkcaldy, Fife, Scotland, UK
| | | | - I J Brenkel
- Victoria Hospital Kirkcaldy, Fife, Scotland, UK
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Nakagawa K, Maeda M. Associations of knee muscle force, bone malalignment, and knee-joint laxity with osteoarthritis in elderly people. J Phys Ther Sci 2017; 29:461-464. [PMID: 28356631 PMCID: PMC5361010 DOI: 10.1589/jpts.29.461] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 11/29/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] From the viewpoint of prevention of knee osteoarthritis, the aim of this study was to verify how muscle strength and joint laxity are related to knee osteoarthritis. [Subjects and Methods] The study subjects consisted of 90 community-dwelling elderly people aged more than 60 years (22 males, 68 females). Femorotibial angle alignment, knee joint laxity, knee extensors and flexor muscle strengths were measured in all subjects. In addition, the subjects were divided into four groups based on the presence of laxity and knee joint deformation, and the muscle strength values were compared. [Results] There was no significant difference in knee extensor muscle strength among the four groups. However, there was significant weakness of the knee flexor muscle in the group with deformation and laxity was compared with the group without deformation and laxity. [Conclusion] Decreased knee flexor muscle strengths may be involved in knee joint deformation. The importance of muscle strength balance was also considered.
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Affiliation(s)
- Kazumasa Nakagawa
- Department of Physiotherapy, Takasaki University of Health and Welfare, Japan
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Jawhar A, Hutter K, Scharf HP. Outcome in total knee arthroplasty with a medial-lateral balanced versus unbalanced gap. J Orthop Surg (Hong Kong) 2016; 24:298-301. [PMID: 28031494 DOI: 10.1177/1602400305] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To evaluate the clinical outcome in 108 total knee arthroplasty (TKA) patients with a medial-lateral balanced versus unbalanced gap after a mean follow-up of 34 months. METHODS 64 women and 44 men (mean age, 69.5 years) underwent computer-assisted TKA for osteoarthritis using a cemented fixed-bearing cruciate-retaining prosthesis. The medial-lateral gap difference (measured with the prosthesis in situ and the patella reduced) was balanced (≤2 mm) in 81 patients and unbalanced (>2 mm) in 27 patients. After a mean follow-up of 34 months, patients were assessed using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire for pain, stiffness, and physical function. Scores were normalised to 0% (worst) to 100% (best). RESULTS The balanced and unbalanced gap groups were comparable in terms of age, severity of osteoarthritis, and proportion of pre- and post-operative mechanical alignment. Compared with the balanced gap group, the unbalanced gap group had a larger medial-lateral extension gap difference (0.75±0.57 vs. 2.02±1.15 mm, p=0.001) and medial-lateral flexion gap difference (0.79±0.63 vs. 2.98±2.13 mm, p=0.001) and lower normalised total WOMAC score (84.9±18 vs. 74.8±20.8, p=0.017). CONCLUSION WOMAC score is better in TKAs with a medial-lateral balanced (<2 mm) gap.
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Affiliation(s)
- Ahmed Jawhar
- Orthopaedic and Trauma Surgery Center, University Medical Center Mannheim of University Heidelberg, Germany
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15
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Multiplexed mass spectrometry monitoring of biomarker candidates for osteoarthritis. J Proteomics 2016; 152:216-225. [PMID: 27865793 DOI: 10.1016/j.jprot.2016.11.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 11/10/2016] [Accepted: 11/14/2016] [Indexed: 12/22/2022]
Abstract
The methods currently available for the diagnosis and monitoring of osteoarthritis (OA) are very limited and lack sensitivity. Being the most prevalent rheumatic disease, one of the most disabling pathologies worldwide and currently untreatable, there is a considerable interest pointed in the verification of specific biological markers for improving its diagnosis and disease progression studies. Considering the remarkable development of targeted proteomics methodologies in the frame of the Human Proteome Project, the aim of this work was to develop and apply a MRM-based method for the multiplexed analysis of a panel of 6 biomarker candidates for OA encoded by the Chromosome 16, and another 8 proteins identified in previous shotgun studies as related with this pathology, in specimens derived from the human joint and serum. The method, targeting 35 different peptides, was applied to samples from human articular chondrocytes, healthy and osteoarthritic cartilage, synovial fluid and serum. Subsequently, a verification analysis of the biomarker value of these proteins was performed by single point measurements on a set of 116 serum samples, leading to the identification of increased amounts of Haptoglobin and von Willebrand Factor in OA patients. Altogether, the present work provides a tool for the multiplexed monitoring of 14 biomarker candidates for OA, and verifies for the first time the increased amount of two of these circulating markers in patients diagnosed with this disease. SIGNIFICANCE We have developed an MRM method for the identification and relative quantification of a panel of 14 protein biomarker candidates for osteoarthritis. This method has been applied to analyze human articular chondrocytes, articular cartilage, synovial fluid, and finally a collection of 116 serum samples from healthy controls and patients suffering different degrees of osteoarthritis, in order to verify the biomarker usefulness of the candidates. HPT and VWF were validated as increased in OA patients.
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16
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Gracitelli GC, Moraes VY, Franciozi CES, Luzo MV, Belloti JC. Surgical interventions (microfracture, drilling, mosaicplasty, and allograft transplantation) for treating isolated cartilage defects of the knee in adults. Cochrane Database Syst Rev 2016; 9:CD010675. [PMID: 27590275 PMCID: PMC6457623 DOI: 10.1002/14651858.cd010675.pub2] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Cartilage defects of the knee are often debilitating and predispose to osteoarthritis. Microfracture, drilling, mosaicplasty, and allograft transplantation are four surgical treatment options that are increasingly performed worldwide. We set out to examine the relative effects of these different methods. OBJECTIVES To assess the relative effects (benefits and harms) of different surgical interventions (microfracture, drilling, mosaicplasty, and allograft transplantation) for treating isolated cartilage defects of the knee in adults. SEARCH METHODS We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, CENTRAL, EMBASE, MEDLINE, SPORTDiscus, LILACS, trial registers and conference proceedings up to February 2016. SELECTION CRITERIA Any randomised or quasi-randomised trials that evaluated surgical interventions (microfracture, drilling, mosaicplasty, and allograft transplantation) for treating isolated cartilage defects of the knee in adults. DATA COLLECTION AND ANALYSIS At least two review authors independently selected studies, assessed risk of bias and extracted data. Intervention effects were assessed using risk ratios (RR) for dichotomous data and mean differences (MD) for continuous data, with 95% confidence intervals (CI). Data were pooled using the fixed-effect model, where possible. MAIN RESULTS We included three randomised controlled trials comparing mosaicplasty versus microfracture for isolated cartilage defects in adults. Two trials were single-centre trials and one involved three centres. These small trials reported results for a total of 133 participants, of whom 79 (59%) were male. Mean participant age in the three trials ranged from 24.4 years to 32.3 years. All studies included grade 3 or 4 cartilage lesions (International Cartilage Repair Society (ICRS) classification). The defect area ranged from 1.0 cm² to 6.0 cm²; the mean area in all three trials was 2.8 cm². No trials of allograft transplantation or drilling were identified.All trials were judged as being at high or unclear risk of performance and reporting bias. We judged that the quality of evidence was very low for all outcomes. For individual outcomes, we downgraded the quality of evidence by one or two levels for risk of bias, one level for indirectness where there were data from a single-centre trial only, one or two levels for imprecision where there were wide confidence intervals and an insufficient number of events, and one level for inconsistency reflecting heterogeneity. This means that we are very uncertain about the estimates for all outcomes.There is very low quality evidence from one single-centre trial (57 participants), which included athletes only, that mosaicplasty resulted in higher patient-reported function scores (probably the IKDC 2000 subjective knee evaluation score) compared with microfracture (range 0 to 100; higher score = better function) at one year follow-up (MD 10.29 favouring mosaicplasty, 95% CI 7.87 to 12.71). Very low quality evidence from the same trial showed that this effect persisted in the long term at 10 years follow-up. However, there is very low quality evidence from the two other trials (72 participants) of little difference in patient-reported function, assessed via the Lysholm score (range 0 to 100; higher score = better function), between the two groups at long-term follow-up (MD -1.10 favouring microfracture, 95% CI -4.54 to 2.33). One trial (25 participants) provided very low quality evidence of no significant difference between the two groups in quality of life or pain at long-term follow-up. Pooled results for treatment failure - primarily symptom recurrence - reported at long-term follow-up (means ranging from 6.3 to 1.4 years) in the three trials (129 participants) favoured mosaicplasty (10/64 versus 20/65; RR 0.47, 95% CI 0.24 to 0.90). Based on an illustrative risk of 379 treatment failures per 1000 patients treated with microfracture, there is very low quality evidence that 201 fewer patients (95% CI 38 to 288 fewer) would have treatment failure after mosaicplasty. All three trials reported activity scores but due to clear statistical and clinical heterogeneity, we did not pool the long term Tegner score results. There was very low quality evidence from one study (57 participants) of higher Tegner scores - indicating greater activity - at intermediate-term and long-term follow-up in the mosaicplasty group; however, the between-group difference may not be clinically important. The other two trials provided very low quality evidence of no significant difference between the two groups in activity scores. AUTHORS' CONCLUSIONS We found no evidence from randomised controlled trials on allograft transplantation or drilling. The very low quality evidence from RCTs comparing mosaicplasty with microfracture is insufficient to draw conclusions on the relative effects of these two interventions for treating isolated cartilage defects of the knee in adults. Of note is that treatment failure, with recurrence of symptoms, occurred with both procedures. Further research is needed to define the best surgical option for treating isolated cartilage defects. We suggest the greatest need is for multi-centre RCTs comparing reconstructive procedures (mosaicplasty versus allograft transplantation) for large osteochondral lesions and reparative procedures (microfracture versus drilling) for small chondral lesions.
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Affiliation(s)
- Guilherme C Gracitelli
- Universidade Federal de São PauloDepartment of Orthopaedics and TraumatologyRua Borges Lagoa, 778São PauloSão PauloBrazil040450001
| | - Vinícius Y Moraes
- Universidade Federal de São PauloDepartment of Orthopaedics and TraumatologyRua Borges Lagoa, 778São PauloSão PauloBrazil040450001
| | - Carlos ES Franciozi
- Universidade Federal de São PauloDepartment of Orthopaedics and TraumatologyRua Borges Lagoa, 778São PauloSão PauloBrazil040450001
| | - Marcus V Luzo
- Universidade Federal de São PauloDepartment of Orthopaedics and TraumatologyRua Borges Lagoa, 778São PauloSão PauloBrazil040450001
| | - João Carlos Belloti
- Universidade Federal de São PauloDepartment of Orthopaedics and TraumatologyRua Borges Lagoa, 778São PauloSão PauloBrazil040450001
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Higano Y, Hayami T, Omori G, Koga Y, Endo K, Endo N. The varus alignment and morphologic alterations of proximal tibia affect the onset of medial knee osteoarthritis in rural Japanese women: Case control study from the longitudinal evaluation of Matsudai Knee Osteoarthritis Survey. J Orthop Sci 2016; 21:166-71. [PMID: 26778626 DOI: 10.1016/j.jos.2015.12.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 11/02/2015] [Accepted: 11/03/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Relationship malalignment of the knee and the onset of knee OA are unclear. Moreover, it has not been clarified whether malalignment of the knee affects the morphological change of the proximal tibia. The purpose of current study was to investigate whether varus knee alignment and morphological change of the proximal medial tibia influence the onset of medial knee OA and to clarify the relationship between them. METHODS The subjects comprised 736 knees from 390 women that went under both the first survey in 1979 and the fourth survey in 2000 in the Matsudai district in Niigata Prefecture in Japan. None of the subjects demonstrated radiographic knee OA at the first survey. OA was graded according to the Kellgren-Lawrence classification and the subjects were divided according to the OA grades in the forth survey into the 3 groups (non-OA, early OA, and advanced OA). Age, BMI, Femorotibial angle (FTA), the tibial plateau angle and medial tibial cortical bone thickness (MTCBT) were measured. We performed multivariate logistic regression analysis using the stepwise method to identified the risk factors regarding onset of knee OA and calculated the odds ratio (OR) and 95% confidence intervals (95% CI). RESULTS Advanced OA had a significantly higher OR compared to non-OA in 1979 with the tibial plateau angle (OR: 1.15) and MTCBT (OR: 2.11). And also advanced OA had a significantly higher OR compared to early-OA in 1979 with the tibial plateau angle (OR: 1.17) and MTCBT (OR: 1.62). CONCLUSIONS In the advanced OA, varus alignment of the proximal tibia had already existed before the onset of knee OA. In addition, we thought that varus alignment due to the proximal tibia had influenced the morphologic alterations of proximal medial tibia.
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Affiliation(s)
- Yukimasa Higano
- Department of Orthopedic Surgery, Tsuruoka Municipal Shonai Hospital, Yamagata, Japan; Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medicine and Dental Science, Niigata, Japan.
| | - Tadashi Hayami
- Department of Orthopedic Surgery, Saiseikai Niigata Daini Hospital, Niigata, Japan
| | - Go Omori
- Center of Transdisciplinary Research, Niigata University, Niigata, Japan
| | - Yoshio Koga
- Department of Orthopedic Surgery, Niigata Medical Center, Nigata, Japan
| | - Kazuo Endo
- Department of Physical Therapy, Niigata University of Health and Welfare, School of Medical Technology, Niigata, Japan
| | - Naoto Endo
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medicine and Dental Science, Niigata, Japan
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Sheehy L, Cooke TDV. Radiographic assessment of leg alignment and grading of knee osteoarthritis: A critical review. World J Rheumatol 2015; 5:69-81. [DOI: 10.5499/wjr.v5.i2.69] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 02/25/2015] [Accepted: 05/06/2015] [Indexed: 02/06/2023] Open
Abstract
Knee osteoarthritis (OA) is a progressive joint disease hallmarked by cartilage and bone breakdown and associated with changes to all of the tissues in the joint, ultimately causing pain, stiffness, deformity and disability in many people. Radiographs are commonly used for the clinical assessment of knee OA incidence and progression, and to assess for risk factors. One risk factor for the incidence and progression of knee OA is malalignment of the lower extremities (LE). The hip-knee-ankle (HKA) angle, assessed from a full-length LE radiograph, is ideally used to assess LE alignment. Careful attention to LE positioning is necessary to obtain the most accurate measurement of the HKA angle. Since full-length LE radiographs are not always available, the femoral shaft - tibial shaft (FS-TS) angle may be calculated from a knee radiograph instead. However, the FS-TS angle is more variable than the HKA angle and it should be used with caution. Knee radiographs are used to assess the severity of knee OA and its progression. There are three types of ordinal grading scales for knee OA: global, composite and individual feature scales. Each grade on a global scale describes one or more features of knee OA. The entire description must be met for a specific grade to be assigned. The Kellgren-Lawrence scale is the most commonly-used global scale. Composite scales grade several features of knee OA individually and sum the grades to create a total score. One example is the compartmental grading scale for knee OA. Composite scales can respond to change in a variety of presentations of knee OA. Individual feature scales assess one or more OA features individually and do not calculate a total score. They are most often used to monitor change in one OA feature, commonly joint space narrowing. The most commonly-used individual feature scale is the OA Research Society International atlas. Each type of scale has its advantages; however, composite scales may offer greater content validity. Responsiveness to change is unknown for most scales and deserves further evaluation.
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Lourido L, Calamia V, Fernández-Puente P, Mateos J, Oreiro N, Blanco FJ, Ruiz-Romero C. Secretome analysis of human articular chondrocytes unravels catabolic effects of nicotine on the joint. Proteomics Clin Appl 2015; 10:671-80. [DOI: 10.1002/prca.201400186] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 03/24/2015] [Accepted: 04/23/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Lucía Lourido
- Proteomics Group-PBR2-ProteoRed/ISCIII; Rheumatology Division, Instituto de Investigación Biomédica de A Coruña (INIBIC); Complexo Hospitalario Universitario de A Coruña (CHUAC); Sergas, Universidade da Coruña (UDC); A Coruña Spain
| | - Valentina Calamia
- Proteomics Group-PBR2-ProteoRed/ISCIII; Rheumatology Division, Instituto de Investigación Biomédica de A Coruña (INIBIC); Complexo Hospitalario Universitario de A Coruña (CHUAC); Sergas, Universidade da Coruña (UDC); A Coruña Spain
| | - Patricia Fernández-Puente
- Proteomics Group-PBR2-ProteoRed/ISCIII; Rheumatology Division, Instituto de Investigación Biomédica de A Coruña (INIBIC); Complexo Hospitalario Universitario de A Coruña (CHUAC); Sergas, Universidade da Coruña (UDC); A Coruña Spain
| | - Jesús Mateos
- Proteomics Group-PBR2-ProteoRed/ISCIII; Rheumatology Division, Instituto de Investigación Biomédica de A Coruña (INIBIC); Complexo Hospitalario Universitario de A Coruña (CHUAC); Sergas, Universidade da Coruña (UDC); A Coruña Spain
| | - Natividad Oreiro
- Proteomics Group-PBR2-ProteoRed/ISCIII; Rheumatology Division, Instituto de Investigación Biomédica de A Coruña (INIBIC); Complexo Hospitalario Universitario de A Coruña (CHUAC); Sergas, Universidade da Coruña (UDC); A Coruña Spain
| | - Francisco J. Blanco
- Proteomics Group-PBR2-ProteoRed/ISCIII; Rheumatology Division, Instituto de Investigación Biomédica de A Coruña (INIBIC); Complexo Hospitalario Universitario de A Coruña (CHUAC); Sergas, Universidade da Coruña (UDC); A Coruña Spain
- RIER-RED de Inflamación y Enfermedades Reumáticas; Instituto de Investigación Biomédica de A Coruña (INIBIC); Complexo Hospitalario Universitario de A Coruña (CHUAC); A Coruña Spain
| | - Cristina Ruiz-Romero
- Proteomics Group-PBR2-ProteoRed/ISCIII; Rheumatology Division, Instituto de Investigación Biomédica de A Coruña (INIBIC); Complexo Hospitalario Universitario de A Coruña (CHUAC); Sergas, Universidade da Coruña (UDC); A Coruña Spain
- CIBER-BBN Instituto de Salud Carlos III; Instituto de Investigación Biomédica de A Coruña (INIBIC); Complexo Hospitalario Universitario de A Coruña (CHUAC); A Coruña Spain
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Groen VA, van de Graaf VA, Scholtes VAB, Sprague S, van Wagensveld BA, Poolman RW. Effects of bariatric surgery for knee complaints in (morbidly) obese adult patients: a systematic review. Obes Rev 2015; 16:161-70. [PMID: 25487972 DOI: 10.1111/obr.12236] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 09/29/2014] [Indexed: 12/12/2022]
Abstract
Obesity is a major risk factor for the development of knee osteoarthritis, and over the past 30 years the prevalence of obesity has more than doubled. In an advanced-stage knee osteoarthritis is treated with total knee arthroplasty, and the demand for primary total knee arthroplasties is expected to grow exponentially. However, total knee arthroplasty in obese patients is associated with more complications, longer hospital stay and higher costs. We aimed to determine the effects of bariatric surgery on knee complaints in (morbidly) obese (body mass index >30 kg m(-2) ) adult patients. The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, TRIP, BIOSIS-Previews and reference lists of retrieved publications were systematically searched from earliest available up to 20 April 2014 for any English, German, French and Dutch studies. There was no restriction on study design. We included studies on the effect of surgically induced weight reduction on knee complaints in (morbidly) obese adult patients, with a minimal follow-up of 3 months. Studies on the effects of lipectomy or liposuction and studies in which patients had already received a total knee arthroplasty were excluded. Thirteen studies were included in this systematic review with a total of 3,837 patients. Although different assessment tools were used, an overall significant improvement in knee pain was seen in 73% out of the used assessments. All studies measuring intensity of knee pain, knee physical function and knee stiffness showed a significant improvement after bariatric surgery. The quality of evidence was very low or too low for most of the included studies and moderate for one study. Bariatric surgery with subsequent marked weight loss is likely to improve knee pain, physical function and stiffness in (morbidly) obese adult patients. However, with the current available evidence, there is need for high-quality studies.
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Affiliation(s)
- V A Groen
- Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
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Jawhar A, Hutter K, Scharf HP. Are joint line changes after primary navigated total knee arthroplasty predictable? J Orthop Sci 2015; 20:93-100. [PMID: 25217136 DOI: 10.1007/s00776-014-0647-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 09/01/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Navigation systems have been successful in reducing the outlier of leg alignment after total knee arthroplasty (TKA). Less is known about the restoration of the anatomical joint line with computer-assisted knee replacement. The aim of this study was to determine whether joint line changes <3 or ≥3 mm are predictable with several pre- and intraoperative parameters. METHODS The study included a total of 180 cases of primary computer-assisted TKA performed using the gap-balancing/tibia-first technique. The final shift of the joint line was calculated using computer verification of proximal tibial and distal femoral cuts. In consideration of the clinical relevance of a 3-mm joint line shift, patients were stratified into two groups: Group I, with joint line change <3 mm, and Group II, with joint line change ≥3 mm. Between groups, variables such as demographics, Kellgren & Lawrence degree of osteoarthritis, preoperative flexion contracture, pre-/intraoperative mechanical leg alignment, flexion/extension gaps, and implant design/sizes were compared statistically. RESULTS The absolute joint line shift averaged 1.6 ± 1.3 mm (range 0-6 mm). A joint line shift ≥3 mm was observed in 28 cases (15 %). A statistically significant difference between groups was not identified for any of the parameters. Shift of the joint line did not correlate with the analyzed variables. CONCLUSIONS Joint line was adequately restored when computer navigation was carefully applied as a measuring tool for primary TKA. Knee joint deformity, leg alignment, gap balance, and implant type did not aid in predicting the joint line shift.
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Affiliation(s)
- Ahmed Jawhar
- Orthopaedic and Trauma Surgery Center, University Medical Center Mannheim of University Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany,
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Abstract
BACKGROUND Osteoarthritis of the knee is commonly diagnosed and monitored with radiography. However, the reliability of radiographic classification systems for osteoarthritis and the correlation of these classifications with the actual degree of confirmed degeneration of the articular cartilage of the tibiofemoral joint have not been adequately studied. METHODS As the Multicenter ACL (anterior cruciate ligament) Revision Study (MARS) Group, we conducted a multicenter, prospective longitudinal cohort study of patients undergoing revision surgery after anterior cruciate ligament reconstruction. We followed 632 patients who underwent radiographic evaluation of the knee (an anteroposterior weight-bearing radiograph, a posteroanterior weight-bearing radiograph made with the knee in 45° of flexion [Rosenberg radiograph], or both) and arthroscopic evaluation of the articular surfaces. Three blinded examiners independently graded radiographic findings according to six commonly used systems-the Kellgren-Lawrence, International Knee Documentation Committee, Fairbank, Brandt et al., Ahlbäck, and Jäger-Wirth classifications. Interobserver reliability was assessed with use of the intraclass correlation coefficient. The association between radiographic classification and arthroscopic findings of tibiofemoral chondral disease was assessed with use of the Spearman correlation coefficient. RESULTS Overall, 45° posteroanterior flexion weight-bearing radiographs had higher interobserver reliability (intraclass correlation coefficient = 0.63; 95% confidence interval, 0.61 to 0.65) compared with anteroposterior radiographs (intraclass correlation coefficient = 0.55; 95% confidence interval, 0.53 to 0.56). Similarly, the 45° posteroanterior flexion weight-bearing radiographs had higher correlation with arthroscopic findings of chondral disease (Spearman rho = 0.36; 95% confidence interval, 0.32 to 0.39) compared with anteroposterior radiographs (Spearman rho = 0.29; 95% confidence interval, 0.26 to 0.32). With respect to standards for the magnitude of the reliability coefficient and correlation coefficient (Spearman rho), the International Knee Documentation Committee classification demonstrated the best combination of good interobserver reliability and medium correlation with arthroscopic findings. CONCLUSIONS The overall estimates with the six radiographic classification systems demonstrated moderate (anteroposterior radiographs) to good (45° posteroanterior flexion weight-bearing radiographs) interobserver reliability and medium correlation with arthroscopic findings. The International Knee Documentation Committee classification assessed with use of 45° posteroanterior flexion weight-bearing radiographs had the most favorable combination of reliability and correlation. LEVEL OF EVIDENCE Diagnostic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Rick W Wright
- MARS Group Principal Investigator, Department of Orthopaedic Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8233, St. Louis, MO 63110. E-mail address:
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Damen J, Schiphof D, Wolde ST, Cats HA, Bierma-Zeinstra SMA, Oei EHG. Inter-observer reliability for radiographic assessment of early osteoarthritis features: the CHECK (cohort hip and cohort knee) study. Osteoarthritis Cartilage 2014; 22:969-74. [PMID: 24857977 DOI: 10.1016/j.joca.2014.05.007] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 04/18/2014] [Accepted: 05/07/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To calculate inter-observer reliability between four different trained readers and an experienced reader on early radiographic osteoarthritis (OA) features in our early OA cohort hip and cohort knee (CHECK) cohort. METHODS Four readers were trained by a radiologist and experienced reader to score radiographic OA features. After this training they scored the CHECK cohort. Of the 1002 participants, 38 were scored by all readers. Five different angle radiographs (three for the knee, two for the hip) at three different time points were scored and compared. Inter-observer reliability was evaluated between each of the four trained readers and the experienced reader. Separate radiographic OA features and of overall Kellgren & Lawrence (K&L) scores. In addition, reliability of progression of radiographic was determined in K&L scores and joint space narrowing (JSN). RESULTS For hip and knee there was substantial inter-observer reliability on overall K&L scores. In the knee, JSN was scored with fair to moderate reliability, osteophytes with moderate to nearly perfect reliability, and other features with fair to substantial reliability. In the hip, reliability ranged from substantial to nearly perfect. Moderate inter-observer reliability was found for progression of OA in both knee and hip, with slightly better reliability for progression based on K&L scores than on separate features. CONCLUSION Good inter-observer reliability can be achieved between trained readers and an experienced reader. Although JSN in the knee is scored with lower inter-observer reliability than osteophytes, this does not seem to influence overall K&L scoring. In the hip all features showed good reliability.
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Affiliation(s)
- J Damen
- Department of General Practice, Erasmus MC, Rotterdam, The Netherlands.
| | - D Schiphof
- Department of General Practice, Erasmus MC, Rotterdam, The Netherlands
| | - S Ten Wolde
- Department of Rheumatology, Kennemer Gasthuis Haarlem, Haarlem, The Netherlands
| | - H A Cats
- Department of Rheumatology, St. Maartenskliniek, Nijmegen, The Netherlands
| | - S M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC, Rotterdam, The Netherlands; Department of Orthopaedics, Erasmus MC, Rotterdam, The Netherlands
| | - E H G Oei
- Department of Radiology, Erasmus MC, Rotterdam, The Netherlands
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Hirschmann MT, Schön S, Afifi FK, Amsler F, Rasch H, Friederich NF, Arnold MP. Assessment of loading history of compartments in the knee using bone SPECT/CT: a study combining alignment and 99mTc-HDP tracer uptake/distribution patterns. J Orthop Res 2013; 31:268-74. [PMID: 22886713 DOI: 10.1002/jor.22206] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Accepted: 07/10/2012] [Indexed: 02/04/2023]
Abstract
This study investigates if the mechanical/anatomical alignment influences the intensity values as well as the distribution pattern of SPECT/CT tracer uptake. Eighty-five knees (mean age 48 ± 16) undergoing 99mTc-HDP-SPECT/CT due to pain were prospectively included. SPECT/CTs were analyzed using a previously validated localization method. The maximum intensities in each femoral, tibial, and patellar joint compartment (medial, lateral, central, superior, and inferior) were noted using a color-coded grading scale (0-10). The Kellgren-Lawrence osteoarthritis score (KL) was assessed on standardized radiographs. Long leg radiographs were used to assess the mechanical/anatomical leg alignment, which was classified as varus, valgus, or neutral. The alignment and KL was correlated with the intensity of tracer uptake in each area of interest (p < 0.05). The intensity of SPECT/CT tracer uptake in the medial and lateral knee compartment significantly correlated with varus or valgus alignment of the knee. A higher degree of osteoarthritis was significantly related to higher tracer uptake in the corresponding joint compartments. SPECT/CT reflects the specific loading pattern of the knee with regard to its alignment. It is also related to the degree of osteoarthritis. Hence, SPECT/CT should be considered for follow-up of patients after realignment treatments, osteotomies, deloader devices, or insoles.
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Affiliation(s)
- Michael T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland-Bruderholz, CH-4101 Bruderholz, Switzerland.
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Baert IAC, Jonkers I, Staes F, Luyten FP, Truijen S, Verschueren SMP. Gait characteristics and lower limb muscle strength in women with early and established knee osteoarthritis. Clin Biomech (Bristol, Avon) 2013; 28:40-7. [PMID: 23159192 DOI: 10.1016/j.clinbiomech.2012.10.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Revised: 10/19/2012] [Accepted: 10/22/2012] [Indexed: 02/06/2023]
Abstract
BACKGROUND Based on novel classification criteria using magnetic resonance imaging, a subpopulation of "early knee osteoarthritis patients" was clearly defined recently. This study assessed whether these early osteoarthritis patients already exhibit gait adaptations (knee joint loading in particular) and changes in muscle strength compared to control subjects and established knee osteoarthritis patients. METHODS Fourteen female patients with early knee joint degeneration, defined by magnetic resonance imaging (early osteoarthritis), 12 female patients with established osteoarthritis and 14 female control subjects participated. Specific gait parameters and lower limb muscle strength were analyzed and compared between groups. Within the osteoarthritis groups, association between muscle strength and dynamic knee joint loading was also evaluated. FINDINGS Early osteoarthritis patients presented no altered gait pattern, no significant increase in knee joint loading and no significant decrease in hamstring muscle strength compared to controls, while established osteoarthritis patients did. In contrast, early osteoarthritis patients experienced significant quadriceps weakness, comparable to established osteoarthritis patients. Within the osteoarthritis groups, muscle strength was not correlated with knee joint loading during gait. INTERPRETATION The results suggest that gait changes reflect mechanical overload and are most likely the consequence of structural degeneration in knee osteoarthritis. Quadriceps weakness might however contribute to the onset and progression of the disease. This study supports the relevance of classification of early osteoarthritis patients and assists in identifying their functional characteristics. This helps to understand the trajectory of disease onset and progression and further develop more targeted strategies for prevention and treatment of knee osteoarthritis.
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Affiliation(s)
- Isabel A C Baert
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Tervuursevest 101, Heverlee, Belgium
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Gudas R, Gudaite A, Pocius A, Gudiene A, Cekanauskas E, Monastyreckiene E, Basevicius A. Ten-year follow-up of a prospective, randomized clinical study of mosaic osteochondral autologous transplantation versus microfracture for the treatment of osteochondral defects in the knee joint of athletes. Am J Sports Med 2012; 40:2499-508. [PMID: 23024150 DOI: 10.1177/0363546512458763] [Citation(s) in RCA: 234] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Various techniques have proven to be effective for treating articular cartilage defect (ACD) and osteochondral defect (OCD) of the knee joint, but knowledge regarding which method is best still remains uncertain. PURPOSE To evaluate and compare the outcomes of mosaic-type osteochondral autologous transplantation (OAT) and microfracture (MF) procedures for the treatment of articular cartilage defects of the knee joint in young active athletes. This article represents an update of the clinical results at 10 years. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS Between 1998 and 2002, a total of 60 athletes with a mean age of 24.3 years (range, 15-40 years) and with a symptomatic ACD or OCD in the knee were randomized to undergo either OAT or MF. Patients were then evaluated postoperatively using the International Cartilage Repair Society (ICRS) score, Tegner activity score, radiographs, and magnetic resonance imaging. The mean follow-up time was 10.4 years (range, 9-11 years). RESULTS Three to 10 years after the OAT and MF procedures, patients had lower ICRS and Tegner scores (P < .05), but both groups still had significant clinical improvement over presurgery scores according to ICRS scores at 10-year follow-up. Statistically significantly better results were detected in patients in the OAT group compared with those in the MF group at 10 years (P < .005). At 10-year follow-up, there were 15 failures (26%), including 4 failures (14%) of the OAT and 11 failures (38%) of MF treatment (P < .05). Seven patients (25%) from the OAT group and 14 patients (48%) from the MF group had radiographic evidence of Kellgren-Lawrence grade I osteoarthritis at 10 years, but these differences were not significant (P = .083) or related to the clinical results. The ICRS and Tegner scores of younger athletes (<25 years at the time of primary surgery) remained significantly higher after 10 years compared with older patients (P < .05); 15 of 20 patients (75%) in the OAT group and 8 of 22 patients (37%) in the MF group maintained the same physical activity level. CONCLUSION The OAT technique for ACD or OCD repair in the athletic population allows for a higher rate of return to and maintenance of sports at the preinjury level compared with MF.
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Affiliation(s)
- Rimtautas Gudas
- Sports Traumatology and Arthroscopy Unit and Sport Institute, Department of Orthopaedic Surgery, Lithuanian University of Health Sciences, Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania.
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Teut M, Kaiser S, Ortiz M, Roll S, Binting S, Willich SN, Brinkhaus B. Pulsatile dry cupping in patients with osteoarthritis of the knee - a randomized controlled exploratory trial. Altern Ther Health Med 2012; 12:184. [PMID: 23057611 PMCID: PMC3527288 DOI: 10.1186/1472-6882-12-184] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 10/04/2012] [Indexed: 01/22/2023]
Abstract
Introduction Cupping is used in various traditional medicine forms to relieve pain in musculoskeletal diseases. The aim of this study was to investigate the effectiveness of cupping in relieving the symptoms of knee osteoarthritis (OA). Methods In a two-group, randomized controlled exploratory pilot study patients with a clinically and radiological confirmed knee OA (Kellgren-Lawrence Grading Scale: 2-4) and a pain intensity > 40 mm on a 100 mm visual analogue scale (VAS) were included. 40 Patients were randomized to either 8 sessions of pulsatile dry cupping within 4 weeks or no intervention (control). Paracetamol was allowed on demand for both groups. Outcomes were the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) score, the pain intensity on a VAS (0 mm = no pain to 100 mm = maximum intensity) and Quality of Life (SF-36) 4 and 12 weeks after randomization. Use of Paracetamol was documented within the 4-week treatment period. Analyses were performed by analysis of covariance adjusting for the baseline value for each outcome. Results 21 patients were allocated to the cupping group (5 male; mean age 68 ± SD 7.2) and 19 to the control group (8 male; 69 ± 6.8). After 4 weeks the WOMAC global score improved significantly more in the cupping group with a mean of 27.7 (95% confidence interval 22.1; 33.3) compared to 42.2 (36.3; 48.1) in the control group (p = 0.001). After 12 weeks the WOMAC global score were still significantly different in favor for cupping (31.0 (24.9; 37.2) vs. 40.8 (34.4; 47.3) p = 0.032), however the WOMAC subscores for pain and stiffness were not significant anymore. Significantly better outcomes in the cupping group were also observed for pain intensity on VAS and for the SF-36 Physical Component Scale compared to the control group after 4 and 12 weeks. No significant difference was observed for the SF-36 Mental Component Scale and the total number of consumed Paracetamol tablets between both groups (mean 9.1, SD ± 20.0 vs. 11.5 ± 15.9). Conclusion In this exploratory study dry cupping with a pulsatile cupping device relieved symptoms of knee OA compared to no intervention. Further studies comparing cupping with active treatments are needed. Trial registration Clinicaltrials.gov Identifier: NCT01057043
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Fernández-Costa C, Calamia V, Fernández-Puente P, Capelo-Martínez JL, Ruiz-Romero C, Blanco FJ. Sequential depletion of human serum for the search of osteoarthritis biomarkers. Proteome Sci 2012; 10:55. [PMID: 22971006 PMCID: PMC3515479 DOI: 10.1186/1477-5956-10-55] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 09/06/2012] [Indexed: 12/20/2022] Open
Abstract
Background The field of biomarker discovery, development and application has been the subject of intense interest and activity, especially with the recent emergence of new technologies, such as proteomics-based approaches. In proteomics, search for biomarkers in biological fluids such as human serum is a challenging issue, mainly due to the high dynamic range of proteins present in these types of samples. Methods for reducing the content of most highly abundant proteins have been developed, including immunodepletion or protein equalization. In this work, we report for the first time the combination of a chemical sequential depletion method based in two protein precipitations with acetonitrile and DTT, with a subsequent two-dimensional difference in-gel electrophoresis (2D-DIGE) analysis for the search of osteoarthritis (OA) biomarkers in human serum. The depletion method proposed is non-expensive, of easy implementation and allows fast sample throughput. Results Following this workflow, we have compared sample pools of human serum obtained from 20 OA patients and 20 healthy controls. The DIGE study led to the identification of 16 protein forms (corresponding to 14 different proteins) that were significantly (p < 0.05) altered in OA when compared to controls (8 increased and 7 decreased). Immunoblot analyses confirmed for the first time the increase of an isoform of Haptoglobin beta chain (HPT) in sera from OA patients. Conclusions Altogether, these data demonstrate the utility of the proposed chemical sequential depletion for the analysis of sera in protein biomarker discovery approaches, exhibit the usefulness of quantitative 2D gel-based strategies for the characterization of disease-specific patterns of protein modifications, and also provide a list of OA biomarker candidates for validation.
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Affiliation(s)
- Carolina Fernández-Costa
- Rheumatology Division, ProteoRed/ISCIII Proteomics Group, INIBIC - Hospital Universitario de A Coruña, 15006, A Coruña, Spain.
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Lübbeke A, Salvo D, Stern R, Hoffmeyer P, Holzer N, Assal M. Risk factors for post-traumatic osteoarthritis of the ankle: an eighteen year follow-up study. INTERNATIONAL ORTHOPAEDICS 2012; 36:1403-10. [PMID: 22249843 PMCID: PMC3385887 DOI: 10.1007/s00264-011-1472-7] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Accepted: 12/19/2011] [Indexed: 01/16/2023]
Abstract
PURPOSE Long-term studies evaluating risk factors for development of ankle osteoarthritis (OA) following malleolar fractures are sparse. METHODS We conducted a retrospective cohort study including consecutive patients treated by open reduction and internal fixation for malleolar fracture between January 1988 and December 1997. Perioperative information was obtained retrospectively. Patients were evaluated clinically and radiographically 12-22 years postoperatively. Radiographic ankle OA was determined on standardised radiographs using the Kellgren and Lawrence scale (grade 3-4=advanced OA). Uni- and multivariate regression analyses were performed to determine risk factors for OA. RESULTS During the inclusion period, 373 fractures (372 patients; 9% Weber A, 58% Weber B, 33% Weber C) were operated upon. The mean age at operation was 42.9 years. There were 102 patients seen at follow-up (mean follow-up 17.9 years). Those not available did not differ in demographics and fracture type from those seen. Advanced radiographic OA was present in 37 patients (36.3%). Significant risk factors were: Weber C fracture, associated medial malleolar fracture, fracture-dislocation, increasing body mass index, age 30 years or more and length of time since surgery. CONCLUSIONS Advanced radiographic OA was common 12-22 years after malleolar fracture. The probability of developing post-traumatic OA among patients having three or more risk factors was 60-70%.
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Affiliation(s)
- Anne Lübbeke
- Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, 4, rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland.
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Fickert S, Jawhar A, Sunil P, Scharf HP. Precision of Ci-navigated extension and flexion gap balancing in total knee arthroplasty and analysis of potential predictive variables. Arch Orthop Trauma Surg 2012; 132:565-74. [PMID: 22072193 DOI: 10.1007/s00402-011-1419-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Indexed: 10/15/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate the accuracy of final limb alignment and flexion-extension and medial-lateral gap balancing in computer navigated total knee arthroplasty and to analyze various possible predictive variables that may affect the gaps in computer navigated knee arthroplasty. MATERIALS AND METHODS The DePuy Ci system, a nonimage-based passive optical computer navigation system, was used in 225 patients with knee osteoarthritis to assist for the total knee arthroplasty. From the raw data the Ci-verified pre- and postoperative leg axis in extension, angle of tibia and femur resection, the flexion and extension angle, the medial and lateral extension and flexion gaps were extracted; and differences in gaps were calculated and subjected to statistical analysis. Leg alignment and implant position were determined only by the navigation system. Preoperative variables were evaluated for their impact on the final flexion/extension and medial/lateral gaps achieved. RESULTS Though the preoperative femoro-tibial coronal alignment had a large variance, postoperatively 98.22% of the knee was found to be between -3° and +3° in the coronal limb alignment axis. The Ci-verified femoral and tibial cuts in the coronal plane showed a good accuracy. The sagittal alignment of the femoral cut ranged from 8.20° flexion to 3.20° of extension. Rectangular extension and flexion gaps were achieved with ≤3 mm of difference in gaps on medial and lateral sides in 98 and 93% of knees, respectively. Difference between extension and flexion gaps on the medial side was ≤3 mm in 83% and on the lateral side in 84% of the knees. Of all the possible predictive variables analyzed, Pearson correlation and multiple regression analysis showed significant correlation only between the medial-lateral gap difference in extension and the Ci-verified femoral cut, tibial cut and limb axis, all in the coronal plane. CONCLUSION Computer-assisted navigated total knee replacement allows for accurate gap balancing that is not dependent on the various pre- and intraoperative factors mentioned, including age, sex, Range of motion preoperative deformity and grade of osteoarthritis. The Ci-calculated and verified tibial, and femoral cuts are the only possible factors affecting the extension gap.
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Affiliation(s)
- S Fickert
- Orthopedic and Trauma Surgery Center, University Medical Center Mannheim, Germany
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Elbaz A, Mor A, Segal O, Agar G, Halperin N, Haim A, Debbi E, Segal G, Debi R. Can single limb support objectively assess the functional severity of knee osteoarthritis? Knee 2012; 19:32-5. [PMID: 21269835 DOI: 10.1016/j.knee.2010.12.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2010] [Revised: 11/29/2010] [Accepted: 12/13/2010] [Indexed: 02/02/2023]
Abstract
There is a lack in objective measurements that can assess the symptoms of knee osteoarthritis (KOA). In a previous study it was shown that pain and function are in higher correlation with the single-limb support gait parameter than with radiographic KOA stage. Single limb support represents a phase in the gait cycle when the body weight is entirely supported by one limb, while the contra-lateral limb swings forward. The purpose of this study was to further examine the relationship between single-limb support and the level of pain and function in patients with KOA. 125 adults with bilateral KOA underwent a physical and radiographic evaluation, and completed the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the SF-36 health survey. Patients walked barefoot at a self-selected speed on a computerized mat. Statistical analysis was used to divide the patients into quintiles based on single-limb support phase value and determine the differences in WOMAC and SF-36 scores between quintiles. Significant differences were found in WOMAC and SF-36 sub-category scores between the single-limb support quintiles. The means of the WOMAC-pain and WOMAC-function sub-categories decreased gradually over single-limb support quintiles (P<0.001), and the means of the SF-36 sub-categories increased gradually over the quintiles (P<0.001). Results show that single-limb support quintiles can help determine the level of pain, function and quality of life in patients with KOA. These results suggest that single-limb support quintiles may be added as an additional scale for generally assessing the symptomatic stage of KOA.
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Affiliation(s)
- Avi Elbaz
- AposTherapy Research Group, Herzliya, Israel
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Fernández-Puente P, Mateos J, Fernández-Costa C, Oreiro N, Fernández-López C, Ruiz-Romero C, Blanco FJ. Identification of a panel of novel serum osteoarthritis biomarkers. J Proteome Res 2011; 10:5095-101. [PMID: 21973172 DOI: 10.1021/pr200695p] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Osteoarthritis (OA) is the most common rheumatic pathology. Because currently available diagnostic methods are limited and lack sensitivity, the identification of new specific biological markers for OA has become a focus. The purpose of this study was to identify novel protein biomarkers for moderate and severe OA in serum. Sera were obtained from 50 moderate OA patients, 50 severe OA patients, and 50 nonsymptomatic controls. Serum protein levels were analyzed using isobaric tags for relative and absolute quantitation (iTRAQ) and matrix-assisted laser desorption/ionization (MALDI)-TOF/TOF mass spectrometry. We identified 349 different proteins in the sera, 262 of which could be quantified by calculation of their iTRAQ ratios. Three sets of proteins were significantly (p < 0.05) changed in OA samples compared to controls. Of these, 6 were modulated only in moderate OA, 13 only in severe OA and 7 in both degrees. Although some of these proteins, such as cartilage oligomeric matrix protein, have a previously reported putative biomarker value for OA, most are novel biomarker candidates for the disease. These include some complement components, lipoproteins, von Willebrand factor, tetranectin, and lumican. The specificity and selectivity of these candidates need to be validated before new molecular diagnostic or prognostic tests for OA can be developed.
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Hart JM, Turman KA, Diduch DR, Hart JA, Miller MD. Quadriceps muscle activation and radiographic osteoarthritis following ACL revision. Knee Surg Sports Traumatol Arthrosc 2011; 19:634-40. [PMID: 21110004 DOI: 10.1007/s00167-010-1321-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Accepted: 10/25/2010] [Indexed: 01/11/2023]
Abstract
PURPOSE Quadriceps strength and activation may play an important role in the recovery from ACL revision surgery. The purpose of this study was to describe quadriceps strength and central activation ratio (CAR) and correlate with radiographic findings in patients with ACL revision surgery. METHODS Twenty-one patients who were on average 47.5 ± 21.1 months [range: 14-85 months] post-revision ACL reconstruction. We performed knee joint physical examination and radiographic evaluation. Quadriceps strength testing consisted of maximal voluntary isometric contractions (MVIC) with the knee bent to 90-degrees bilaterally. We calculated quadriceps central activation ratio using the superimposed burst technique. Radiographs (bilateral standing antero-posterior in knee flexion and lateral in full extension) were evaluated by a fellowship-trained orthopedic surgeon using the International Knee Documentation Committee (IKDC) grading system. RESULTS Mean CAR was 83.9 ± 12.0% on the reconstructed limb and 85.5 ± 9.5% on the contralateral limb. Average, normalized MVIC torque was 2.5 ± 1.0 Nm/kg on the reconstructed limb and 2.7 ± 1.0 N m/kg for the contralateral limb. Patient age at the time of follow-up evaluation was related to severity of knee joint degeneration, particularly the medial, anterior and patellofemoral compartments. Younger patients with lower CARs tended to have more severe degeneration in the patellofemoral joint. Older patients with lower normalized MVIC torque values tended to exhibit more severely graded degeneration in the patellofemoral joint. CONCLUSION Bilateral quadriceps central activation deficits and radiographic osteoarthritis are evident in patients with revision ACL reconstruction.
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Affiliation(s)
- Joseph M Hart
- Department of Orthopaedic Surgery, University of Virginia, 400 Ray C. Hunt Drive, Suite 330, PO Box 800159, Charlottesville, VA 22908, USA.
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Prevalence of radiographic primary hip and knee osteoarthritis in a representative Central European population. INTERNATIONAL ORTHOPAEDICS 2010; 35:971-5. [PMID: 20556380 DOI: 10.1007/s00264-010-1069-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2010] [Revised: 05/24/2010] [Accepted: 05/26/2010] [Indexed: 10/19/2022]
Abstract
The aim of our study was to determine the radiographic prevalence of hip and knee osteoarthritis and compare our results with prevalence data reported by other studies, as no similar study had been performed in Hungary previously. Our aim was also to investigate the usefulness of the different radiological scoring methods for the definition of osteoarthritis. Patients who earlier reported complaints and gave written consent were asked to participate in a clinical follow-up. In the 682 participants Harris hip score, visual analogue pain scale values for both joints, Knee Society score and knee functional score were calculated. Weight-bearing radiographs were taken of both joints. Kellgren-Lawrence radiological evaluation was performed and osteoarthritis prevalence was defined. Hip osteoarthritis was found in 109 cases (16.49%), and knee osteoarthritis was found in 111 cases (16.54%). Harris hip score, Knee Society score, functional score and visual analogue scale values were significantly worse in people with radiographically proven osteoarthritis compared to the control group (p < 0.05). Significantly higher osteoarthritis prevalence of both joints was found in those with increased body mass index values. Age also plays a significant role in the development of both hip and knee osteoarthritis. No significant difference was observed between male and female participants regarding osteoarthritis prevalence. The Kellgren-Lawrence score with a cut-off value of 2 or more is a useful evaluation method for the detection of osteoarthritis prevalence in epidemiological studies; according to our observations, in clinical practice a cut-off value of three or more is more relevant.
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Horváth G, Koroknai G, Ács B, Than P, Bellyei Á, Illés T. Prevalence of knee osteoarthritis in Hungary. Study conducted in a representative Hungarian population. Orv Hetil 2010; 151:140-3. [DOI: 10.1556/oh.2010.28727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A szerzők korábbi közleményükben beszámoltak reprezentatív magyarországi mintán végzett felmérésükről, amelyben a degeneratív ízületi panaszok, így a térdpanaszok gyakoriságát vizsgálták.
Célkitűzés:
ezt követően, e közlemény tárgyát képezve, céljuk ambuláns klinikai és radiológiai vizsgálat keretén belül, nemzetközileg elfogadott standard pontrendszerek felhasználásával a betegek panaszainak objektivizálása, és a térdízületi arthrosis előfordulási gyakoriságának meghatározása.
Módszer:
korábbi kérdőíves felmérésük mozgásszervi panaszokkal bíró és felülvizsgálatba beleegyezését adó 2422 fős beteganyagot alapul véve megkeresésükre 682-en (244 férfi, 438 nő) jelentek meg klinikai felülvizsgálatra. Az anamnézis, az antropometriai paraméterek és a mozgásszervi státus felmérésen túlmenően a térdízületre vonatkozóan a szerzők meghatározták a knee society score-t, a vizuális analóg fájdalomskála értékét, a kétirányú térdröntgenfelvételeken az ízületi rés szélességét mérték, Kellgren–Lawrence szerinti radiológiai kiértékelést végeztek, majd ennek kritériumrendszerét figyelembe véve meghatározták a térdízületi arthrosis előfordulási gyakoriságát.
Eredmények:
a fent említett 682 főnél 676 esetben volt radiológiai kiértékelés lehetséges. Térdízületi arthrosist 91 esetben (13,3%), előrehaladott arthrosist 20 esetben (2,9%) állapítottak meg. Ezt követően a negatív és az arthrosis által érintett betegek funkcionális paramétereit hasonlították össze. Mind a knee society score, mind a vizuális analóg fájdalomskála értékei szignifikánsan rosszabb értékeket mutattak ez utóbbi csoportban (p<0,05). A testtömegindexet vizsgálva szintén szignifikánsan magasabb értékeket találtak az arthrosisos csoportban.
Következtetések:
a szerzők a hazai irodalomban első alkalommal számolnak be radiológiailag is igazolt térdízületi arthrosisprevalenciáról. Az életkor és az emelkedett BMI térdízületi arthrosisban játszott szerepe vizsgálataik alapján bizonyított. A felmerés részleteinek ismertetésen túl a szerzők áttekintik a téma hazai és nemzetközi irodalmát.
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Affiliation(s)
- Gábor Horváth
- 1 Ortopédiai Klinikai Tanszék, Pécsi Tudományegyetem, Általános Orvostudományi Kar Mozgásszervi Sebészeti Intézet Pécs Ifjúság út 13. 7624
| | - Gabriella Koroknai
- 2 Pécsi Tudományegyetem, Egészségtudományi Kar Fizioterápiás és Táplálkozástudományi Intézet Pécs
| | - Barnabás Ács
- 3 Pécsi Tudományegyetem, Közgazdaságtudományi Kar Gazdaság-módszertani Intézet Pécs
| | - Péter Than
- 1 Ortopédiai Klinikai Tanszék, Pécsi Tudományegyetem, Általános Orvostudományi Kar Mozgásszervi Sebészeti Intézet Pécs Ifjúság út 13. 7624
| | - Árpád Bellyei
- 1 Ortopédiai Klinikai Tanszék, Pécsi Tudományegyetem, Általános Orvostudományi Kar Mozgásszervi Sebészeti Intézet Pécs Ifjúság út 13. 7624
| | - Tamás Illés
- 1 Ortopédiai Klinikai Tanszék, Pécsi Tudományegyetem, Általános Orvostudományi Kar Mozgásszervi Sebészeti Intézet Pécs Ifjúság út 13. 7624
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Outcome after knee dislocations: a 2-9 years follow-up of 85 consecutive patients. Knee Surg Sports Traumatol Arthrosc 2009; 17:1013-26. [PMID: 19609504 DOI: 10.1007/s00167-009-0869-y] [Citation(s) in RCA: 112] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Accepted: 06/24/2009] [Indexed: 02/07/2023]
Abstract
Dislocation of the knee is a relatively rare injury with modern arthroscopic techniques, operative reconstruction has become the standard of care. The primary aim of this study was to prospectively follow a large, consecutive series of patients with knee dislocation to document associated injuries, surgical treatment, knee function, and knee osteoarthritis (OA) at a minimum of 2 years follow-up. Hundred and twenty-two consecutive patients with a traumatic knee dislocation (Schenck II-IV) were treated at the Oslo University Hospital, Ulleval, between May 1996 and December 2004. Follow-up evaluation of 85 patients consisted of evaluation of knee joint laxity using the KT1000, the Lachman test, the pivot shift test, the reversed pivot shift, the posterior drawer test, the dial test, and the varus-valgus tests compared to the uninjured knee. Knee function was evaluated using the Lysholm score, the Tegner activity level score, the IKDC2000 score, and four single leg hop tests. Radiographic evaluation was performed using the Kellgren & Lawrence classification grade 0-4. Knee function at a minimum of 2 years after surgery disclosed a Lysholm score of a median of 83, a Tegner activity score of 5, and above 83% on all single leg hop tests compared to the uninjured side. Knee function was lower in the patients with a knee dislocation caused by high-energy trauma compared to low energy trauma. Eighty-seven percent had Kellgren & Lawrence grade 2 or higher for the injured knee compared to 35% for the uninjured knee.
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[Determining the indication for primary total hip and knee replacement. Results of external quality assurance of over 270,000 primary total hip and knee replacements]. DER ORTHOPADE 2009; 37:1016-26. [PMID: 18806998 DOI: 10.1007/s00132-008-1341-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The German mandatory quality assurance programme collects data from all primary total hip and knee replacements. The quality of the indication is measured by clinical and radiological criteria. The results were analysed in terms of differences in establishing the indication subject to patient and hospital characteristics. MATERIALS AND METHODS Data on more than 270,000 primary total hip and knee replacements that were operated in 2006 in Germany were analysed concerning differences in the quality of the indication subject to age, gender, hospital volume and density of population and hospitals (metropolitan vs rural areas). The statistical analysis was done by exact Fisher's test. RESULTS The quality of the indication was statistically significantly better in men, patients 60 and older, in rural areas and in high volume hospitals (50 and more joint replacements per year). DISCUSSION Data of this mandatory German quality assurance programme are useful to describe differences in medical care. The results are valid and complete. An exact analysis of the reasons for these differences is difficult though. Data focus is on quality assurance and represent only in-hospital results. CONCLUSION Further analyses are necessary to ascertain whether the differences in quality of care are deficits or only variances in medical care.
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Vignon E, Valat JP, Rossignol M, Avouac B, Rozenberg S, Thoumie P, Avouac J, Nordin M, Hilliquin P. Osteoarthritis of the knee and hip and activity: a systematic international review and synthesis (OASIS). Joint Bone Spine 2006; 73:442-55. [PMID: 16777458 DOI: 10.1016/j.jbspin.2006.03.001] [Citation(s) in RCA: 184] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2005] [Accepted: 03/01/2006] [Indexed: 12/12/2022]
Abstract
UNLABELLED The goal of this study was to determine which activities in four domains, daily life, exercises, sports and occupational activities, should be recommended, in favor or against, for the patient suffering from knee or hip OA. METHODS Scientific literature was searched in Medline, Embase and Cochrane databases for articles in French or English, reporting original data. The articles were evaluated with standardized epidemiological criteria. Seventy-two articles were retained. Recommendations were graded according to the level of scientific evidence (A high, B moderate, C clinical consensus) and were formulated for primary care. CONCLUSIONS AND RECOMMENDATIONS For activity of daily life (ADL), the OASIS group states with a moderate level of scientific evidence, that ADL are a risk factor for knee OA and that risk increases with intensity and duration of activity. The group concludes that healthy subjects as well as OA patients in general can pursue a high level of physical activity, provided the activity is not painful and does not predispose to trauma (grade B). Radiographic or clinical OA is not a contraindication to promoting activity in patients who have a sedentary lifestyle (grade C). For exercises and other structured activities pursued with a goal of health improvement, the group states with a high level of scientific evidence that they have a favourable effect on pain and function in the sedentary knee OA patient. The OASIS group recommends the practice of exercises and other structured activities for the sedentary patient with knee OA (grade A). Static exercises are not favored over dynamic exercises, availability, preference and tolerance being the criteria for the choice of an exercise (grade A). As results deteriorate when exercises are stopped, they should be performed at a frequency of between one and three times per week (grade B). Professional assistance can be useful in improving initial compliance and perseverance (grade B). There is no scientific argument to support halting exercise in case of an OA flare-up (grade C). For sports and recreational activity, the group states with a high degree of scientific evidence, that these activities are a risk factor for knee and hip OA and that the risk correlates with intensity and duration of exposure. The group also states, with a high degree of scientific evidence, that the risk of OA associated with sport is lesser than that associated with a history of trauma and overweight. No firm conclusion could be drawn about the possible protective role of sports such as cycling, swimming or golf. The OASIS group recommends that athletes should be informed that joint trauma is a greater risk factor than the practice of sport (Grade A). The high level athlete should be informed that the risk of OA is associated with the duration and intensity of exposure (Grade B). The OA patient can continue to engage regularly in recreational sports as long as the activity does not cause pain (Grade C). The OA patient who practices a sport at risk for joint trauma should be encouraged to change sport (Grade C). For occupational activity, the OASIS group states with a high level of scientific evidence that there is a relationship between occupational activity and OA of the knee and hip. The precise nature of biomechanical stresses leading to OA remains unclear but factors such as high loads on the joint, unnatural body position, heavy lifting, climbing and jumping may contribute to knee and hip OA. The group recommends that taking an occupational history should always be part of managing the OA patient (Grade B). In the knee or hip OA patient, work-related activity that produces or maintains pain should be avoided (Grade B). Physicians should be alerted by the early knee and hip signs and symptoms in workers exposed to stresses that are known or supposed to favour knee or hip OA (Grade C).
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Witt C, Brinkhaus B, Jena S, Linde K, Streng A, Wagenpfeil S, Hummelsberger J, Walther HU, Melchart D, Willich SN. Acupuncture in patients with osteoarthritis of the knee: a randomised trial. Lancet 2005; 366:136-43. [PMID: 16005336 DOI: 10.1016/s0140-6736(05)66871-7] [Citation(s) in RCA: 403] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Acupuncture is widely used by patients with chronic pain although there is little evidence of its effectiveness. We investigated the efficacy of acupuncture compared with minimal acupuncture and with no acupuncture in patients with osteoarthritis of the knee. METHODS Patients with chronic osteoarthritis of the knee (Kellgren grade < or =2) were randomly assigned to acupuncture (n=150), minimal acupuncture (superficial needling at non-acupuncture points; n=76), or a waiting list control (n=74). Specialised physicians, in 28 outpatient centres, administered acupuncture and minimal acupuncture in 12 sessions over 8 weeks. Patients completed standard questionnaires at baseline and after 8 weeks, 26 weeks, and 52 weeks. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index at the end of week 8 (adjusted for baseline score). All main analyses were by intention to treat. RESULTS 294 patients were enrolled from March 6, 2002, to January 17, 2003; eight patients were lost to follow-up after randomisation, but were included in the final analysis. The mean baseline-adjusted WOMAC index at week 8 was 26.9 (SE 1.4) in the acupuncture group, 35.8 (1.9) in the minimal acupuncture group, and 49.6 (2.0) in the waiting list group (treatment difference acupuncture vs minimal acupuncture -8.8, [95% CI -13.5 to -4.2], p=0.0002; acupuncture vs waiting list -22.7 [-27.5 to -17.9], p<0.0001). After 52 weeks the difference between the acupuncture and minimal acupuncture groups was no longer significant (p=0.08). INTERPRETATION After 8 weeks of treatment, pain and joint function are improved more with acupuncture than with minimal acupuncture or no acupuncture in patients with osteoarthritis of the knee. However, this benefit decreases over time.
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Affiliation(s)
- C Witt
- Institute of Social Medicine, Epidemiology, and Health Economics, Charité University Medical Centre, Berlin, Germany.
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Brander VA, Stulberg SD, Adams AD, Harden RN, Bruehl S, Stanos SP, Houle T. Predicting total knee replacement pain: a prospective, observational study. Clin Orthop Relat Res 2003:27-36. [PMID: 14646737 DOI: 10.1097/01.blo.0000092983.12414.e9] [Citation(s) in RCA: 425] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
To describe the natural history of pain after total knee arthroplasty and to identify factors predicting excessive postoperative pain, we used a prospective, observational study assessing clinical and radiographic variables preoperatively and at 1, 3, 6, and 12 months after knee replacement. Data sources included the visual analog pain scale and other measures of patient health, psychologic state, and component reliability. Regression analyses were conducted to identify specific factors predictive of postoperative pain, controlling for inequality of variables, and confirmed using regression diagnostics. For 116 patients (149 knees; mean age, 66 years; 55.2% women), significant pain was reported by 72.3%, 44.4%, 22.6%, 18.4%, and 13.1%, respectively. No intergroup differences existed for anesthesia, weight, age, or gender. Patients with greater preoperative pain had more postoperative pain, used more home therapy, and postoperative manipulations. Preoperative depression and anxiety were associated with heightened pain at 1 year. Pain after knee replacement resolves quickly, declining to approximately (1/2) by 3 months. However, one in eight patients report moderate to severe pain 1 year after surgery despite an absence of clinical or radiographic abnormalities. Development of office-based preoperative screening tools and interventions for these patients may reduce postoperative costs and improve patient-perceived outcomes.
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Affiliation(s)
- Victoria A Brander
- Northwestern University, Orthopedic Institute, Memorial Hospital Joint Reconstruction and Implant Service, and Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Chicago, IL 60611, USA.
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