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Journal articles on the topic 'Grading knee OA'
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Phalswal, Uma, Vandna Pandey, Ashok Kumar, and Abhay Elhence. "Correlation of Ahlback grading and knee society score in patients with moderate to severe osteoarthritis of the knee." International Journal of Research in Orthopaedics 7, no. 3 (April 26, 2021): 606. http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20211617.
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<p class="abstract"><strong>Background:</strong> Knee osteoarthritis (OA) is a most common rheumatological disorder that causes functional limitation and disability. The most common problem in knee OA are joint pain and stiffness. It will lead to decreased quality of life and it have a serious economic burden on any country due to effect of disability and treatment.</p><p class="abstract"><strong>Methods:</strong> A correlational study was conducted to find out correlation between Ahlback grading and knee society score (KSS) on a sample of 100 moderate to severe knee OA patients and 142 OA knees. Data was collected at orthopedics OPD, for a period of 3 months by purposive sampling.</p><p class="abstract"><strong>Results:</strong> On evaluation, mean age of the participants was 60.19±1.01. Out of 100 patients, 42 patients had bilateral knee OA, therefore total 142 knees included in the analysis. More than half (51%) participants were overweight. Only 34% subjects had compliament to physiotherapy. Around 76% subjects taking analgesics and massage therapy to reduce knee pain. Maximum 82.4% subjects had a poor knee condition in KSS and mean score is 49.07±1.06. Ahlback grading in X-ray had negative correlation -0.610 with KSS. Hence it is evaluated, both the scales have approximately same result as it is analyzed that both scales are moderately correlated. There is significant association of age, occupation and physiotherapy with Ahlback grading followed with KSS significant associated with BMI, occupation and physiotherapy.</p><p class="abstract"><strong>Conclusions:</strong> The study concluded that there is a moderate correlation found between Ahlback X-ray grading and knee society scoring. X-ray and knee society scoring (clinical evaluation) both are essential for effective treatment of OA.</p>
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Oikonomidis, Stergios A., Yannis V. Simos, Ioannis K. Toliopoulos, Ioannis I. Verginadis, Alexandros S. Oikonomidis, Vasilios N. Ragos, Spyridon Ch Karkabounas, Angelos M. Evangelou, and Dimitrios Peschos. "OXIDATIVE STRESS INCIDENCE ON THE SEVERITY OF KNEE OSTEOARTHRITIS." Journal of Musculoskeletal Research 20, no. 02 (June 2017): 1750008. http://dx.doi.org/10.1142/s0218957717500087.
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The aim of the study was to examine the incidence of oxidative stress on the severity of knee osteoarthritis (OA). Data were obtained from a previous pilot controlled trial among patients, diagnosed with OA in one or both knees, that were randomly assigned into two different treatment groups and were either supplemented with ascorbic acid and Vitamin E daily per os or treated with meloxicam. The following markers were estimated: A. Clinical markers: functionality of the knee (WOMAC index), pain (using a pain visual analogue scale) and severity of OA (Kellgren–Lawrence grading scale) B. Laboratory markers: total antioxidant capacity (TAC) and malonyldialdehyde (MDA) levels in the synovial fluid. The TAC of the knees was moderately correlated with the severity of OA and the level of pain whilst MDA concentration was weekly correlated. An average change of 5[Formula: see text]mM of a-tocopherol in TAC (4.6–5.5[Formula: see text]mM of a-tocopherol) defines the shift among stages of OA and the level of pain experienced by the patients. Neither TAC nor MDA were correlated with the Kellgren–Lawrence grading scale. Alleviation of oxidative stress should be a key objective for the therapeutic interventions (pharmacological and nonpharmacological) in knee OA. Even small improvements in antioxidant capacity of the synovial fluid may contribute to the patient’s quality of life and to the deceleration of the disease progression.
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Naorem, Ajit Singh, Jugindro Singh Ningthoujam, K. Wangjam, and RK Rajesh. "Does Radiologic Grading Predict Severity of Osteo-arthritis Knee." Indian Journal of Physical Medicine and Rehabilitation 27, no. 3 (2016): 73–77. http://dx.doi.org/10.5005/ijopmr-27-3-73.
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Abstract Objective Evaluation of association between pain and functional limitation of osteo-arthritis knee with radiographic features. Methods Total of 123 knee OA patients diagnosed on the basis of American College of Rheumatology Classification (ACR) Criteria for knee OA, attended in Physical Medicine and Rehabilitation (PMR) OPD, JNIMS, were included. Pain and disability were measured using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and radiological grading by Kellgren-Lawrence (KL) grading from x-ray of weight bearing antero-posterior and lateral views. Correlation between WOMAC score and KL grading analysed. Results Sex distribution M:F=9:32, mean age 59.48 (+ 9.8), mean disease duration 4.79 (+ 0.41) months. Correlations of WOMAC pain and KL grading and WOMAC disability and KL grading were insignificant (p > 0.05). Conclusions There is discordance between radiographic findings and clinical features of OA knee and we should not plan treatment on the basis of radiologic grading rather on the functional status and symptoms.
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Li, Bei, Yi-Li Zhang, and Shou-Yi Yu. "Synovial Fluid Eotaxin-1 Levels May Reflect Disease Progression in Primary Knee Osteoarthritis Among Elderly Han Chinese: A Cross-Sectional Study." CARTILAGE 10, no. 4 (March 22, 2018): 408–16. http://dx.doi.org/10.1177/1947603518764280.
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Objective The CC chemokine family member eotaxin-1, also named chemokine C-C motif ligand 11 (CCL11), has been detected in knee osteoarthritis (OA) and could induce breakdown of cartilage matrix. This study was performed to investigate the plasma and synovial fluid eotaxin-1 levels with the disease progression in elderly Han Chinese with primary knee OA. Design A total of 143 elderly primary knee OA patients and 135 healthy controls were enrolled in the study. The Western Ontario and McMaster Universities Arthritis Index (WOMAC) was performed to evaluate the clinical severity. The radiographic severity was assessed by Kellgren-Lawrence (K-L) grading. Plasma and synovial fluid (SF) eotaxin-1 levels were explored using enzyme-linked immunosorbent assay. The SF levels of matrix metalloproteinase–3 (MMP-3) and interleukin-6 (IL-6) were also examined. Results Elevated plasma eotaxin-1 levels were found in knee OA patients compared with healthy controls. Eotaxin-1 levels in SF of knee OA patients with K-L grade 4 were significantly elevated compared with those with K-L grades 2 and 3. Meanwhile, knee OA patients with K-L grade 3 had significantly increased SF levels of eotaxin-1 compared with those with K-L grade 2. Plasma eotaxin-1 levels in different K-L grading did not reach significant difference. Eotaxin-1 levels in SF of knee OA patients were significantly associated with disease severity evaluated by KL grading criteria. In addition, eotaxin-1 levels in SF were positively related to clinical severity illustrated by WOMAC as well as biochemical markers MMP-3 and IL-6. Conclusions Eotaxin-1 levels in SF instead of plasma, were independently and positively related to the disease severity in elderly knee OA patients. The inhibition of eotaxin-1 and its related signaling pathways may serve as a novel therapeutic approach for OA progression.
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Hariyanto, Hori, John Butar Butar, Gatot Susilo Lawrence, FX Budhianto Suhadi, and Andi Husni Tanra. "Association Between Plasma Beta-endorphin and WOMAC Score in Female Patients with Knee Osteoarthritis." Indonesian Biomedical Journal 4, no. 2 (August 1, 2012): 107. http://dx.doi.org/10.18585/inabj.v4i2.169.
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BACKGROUND: β-endorphin plays a role in the descending pain control in the central nervous system. Central sensitization may be involved in the generating and maintenance of osteoarthritis (OA) pain. However, the correlation between β-endorphin and pain severity in OA has shown conflicting results. The aim of this study was to investigate the association between plasma β-endorphin and the severity of the disease. METHODS: This study was an observational cross-sectional study carried out on 60 female subjects with knee OA who fulfilled the inclusion criteria. Plasma β-endorphin was measured by a commercial enzyme-linked immunosorbent assay (ELISA) kit. Osteoarthritis knees were classified by the Kellegren-Lawrence (KL) grading (1-4) criteria. The Western Ontario McMaster University Osteoarthritis (WOMAC) scoring method was used to assess self-reported physical function, pain and stiffness. RESULTS: The mean of the participants' ages was 58 years old, ranging from 42 to 83 years. Overall, more than 70% of the participants were overweight with a mean of body mass index (BMI) of 27.59. More than 54% of the participants were diagnosed of having KL grading 3 or 4. Plasma β-endorphin was correlated inversely with the WOMAC subscale of stiffness (r=-0.286, p=0.0311), but no correlation was noted with the WOMAC subscale of pain and physical activity. There was no significant difference of the mean of plasma β-endorphin among the KL gradings. CONCLUSIONS: Plasma β-endorphin is associated with better WOMAC total score and stiffness subscale, but not associated with KL grading of OA. KEYWORDS: knee osteoarthritis, female, β-endorphin, WOMAC, Kellgren-Lawrence
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Widhiyanto, Lukas, Andre Triadi Desnantyo, Lilik Djuari, and Maynura Kharismansha. "CORRELATION BETWEEN KNEE OSTEOARTHRITIS (OA) GRADE AND BODY MASS INDEX (BMI) IN OUTPATIENTS OF ORTHOPAEDIC AND TRAUMATOLOGY DEPARTMENT RSUD DR. SOETOMO." (JOINTS) Journal Orthopaedi and Traumatology Surabaya 6, no. 2 (December 9, 2019): 71. http://dx.doi.org/10.20473/joints.v6i2.2017.71-79.
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Osteoarthritis (OA) is the number eight disease causes Years of Disability in developing countries. OA worsen life quality, from movement limitation until inability to perform normal daily routines. Obesity is one of the risk factor of OA. The doubles increasing trend of obesity from 1980, might possibly causes the escalation of OA case. However, there is still no study that explains the correlation between OA grade, especially knee OA, with Body Mass Index (BMI). The purpose of this study was to determine whether there is correlation between knee osteoarthritis (OA) grade with Body Mass Index (BMI) in outpatients of Orthopaedic and Traumatology department RSUD Dr. Soetomo. This study was cross-sectional study with analitical observational design and survey was the method to determine whether there is correlation between knee OA grade and BMI. Height and weight measurement and also knee x-ray reading were performed to determine the BMI and knee OA grade. The BMI categories that were used were based on standard from Health Department of Republic of Indonesia, while the grading system that were used were based on Kellgren-Lawrence’s grading system. Populations in this study were taken from the outpatients of Orthopaedic and Traumatology Department RSUD Dr. Soetomo during August until November 2015. After statistic test using Spearman correlation test was done, the result was p=0,822. It can be concluded that there was no significant correlation between knee OA grade and BMI. Furthermore, knee OA grade was not affected by BMI only, but also other risk factors as well.
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Tiulpin, Aleksei, and Simo Saarakkala. "Automatic Grading of Individual Knee Osteoarthritis Features in Plain Radiographs Using Deep Convolutional Neural Networks." Diagnostics 10, no. 11 (November 10, 2020): 932. http://dx.doi.org/10.3390/diagnostics10110932.
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Knee osteoarthritis (OA) is the most common musculoskeletal disease in the world. In primary healthcare, knee OA is diagnosed using clinical examination and radiographic assessment. Osteoarthritis Research Society International (OARSI) atlas of OA radiographic features allows performing independent assessment of knee osteophytes, joint space narrowing and other knee features. This provides a fine-grained OA severity assessment of the knee, compared to the gold standard and most commonly used Kellgren–Lawrence (KL) composite score. In this study, we developed an automatic method to predict KL and OARSI grades from knee radiographs. Our method is based on Deep Learning and leverages an ensemble of residual networks with 50 layers. We used transfer learning from ImageNet with a fine-tuning on the Osteoarthritis Initiative (OAI) dataset. An independent testing of our model was performed on the Multicenter Osteoarthritis Study (MOST) dataset. Our method yielded Cohen’s kappa coefficients of 0.82 for KL-grade and 0.79, 0.84, 0.94, 0.83, 0.84 and 0.90 for femoral osteophytes, tibial osteophytes and joint space narrowing for lateral and medial compartments, respectively. Furthermore, our method yielded area under the ROC curve of 0.98 and average precision of 0.98 for detecting the presence of radiographic OA, which is better than the current state-of-the-art.
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Cubukcu, Duygu, Ayse Sarsan, and Hakan Alkan. "Relationships between Pain, Function and Radiographic Findings in Osteoarthritis of the Knee: A Cross-Sectional Study." Arthritis 2012 (November 19, 2012): 1–5. http://dx.doi.org/10.1155/2012/984060.
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Objectives. The aim of this study was to investigate the relationships between pain, disability, and radiographic findings in patients with knee osteoarthritis (OA). Patients and Methods. A total of 114 patients with knee OA who attended the physical medicine and rehabilitation outpatient clinic were included in this study. The diagnosis was based on the American College of Rheumatology (ACR) criteria for knee OA. Age, duration of disease, and body mass index (BMI) of the patients were recorded. Radiographic features on the two-sided knee radiography were assessed with the Kellgren-Lawrence scale. The severity of knee pain, stiffness, and disability were measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Results. The mean age of the patients was 56.98 (±8.28) years and the mean disease duration was 4.14 (±4.15) years. Kellgren-Lawrence grading scale and age or disease duration were positively and significantly associated, whereas none of the WOMAC subscores were found to be related with Kellgren-Lawrence grading scale (). On the other hand, WOMAC disability scores were significantly associated with WOMAC pain and WOMAC stiffness (). Conclusions. Knee pain, stiffness, and duration of disease may affect the level of disability in the patients with knee OA. Therefore treatment of knee OA could be planned according to the clinical features and functional status instead of radiological findings.
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Zhao, Zhe, Enqi Li, Qing Cao, Jie Sun, and Baotong Ma. "Endothelin-1 concentrations are correlated with the severity of knee osteoarthritis." Journal of Investigative Medicine 64, no. 4 (February 25, 2016): 872–74. http://dx.doi.org/10.1136/jim-2015-000030.
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Endothelin-1, a potent vasoconstrictor regulator, contributes to articular cartilage destruction. Therefore, we aim to assess the correlation of endothelin-1 concentrations with the development and severity of knee osteoarthritis (OA). This study included a population of 209 patients with knee OA. Kellgren-Lawrence (KL) grading was utilized to score the severity of OA. The case group had higher serum endothelin-1 concentrations than controls. Patients with knee OA with a relatively higher grade showed significantly elevated serum and synovial fluid (SF) endothelin-1 concentrations compared with those with lower KL grades. A significant correlation was found between serum and SF endothelin-1 concentrations and KL grades. Serum and SF endothelin-1 concentrations are correlated with the development and progression of knee OA.
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Moniruzzaman, Mohammad, Muhammad Alamgir Mandal, Md Ariful Islam, Md Ashraful Haque, Md Ahsan Ullah, Syed Mozaffar Ahmed, Md Habibur Rahman, Md Zakir Hossain, and Md Masudur Rahman. "A study on knee osteoarthritis in physical medicine and rehabilitation department, Rangpur Medical College." KYAMC Journal 8, no. 2 (February 19, 2018): 18–23. http://dx.doi.org/10.3329/kyamcj.v8i2.35698.
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Background: Physical Medicine & Rehabilitation (PMR) Department has also been trying to provide services with specialized outdoor (referred patient only) set up for twenty million people of Rangpur division.Objectives: Study is to know the demographic study, clinical grading, examination findings and radiological changes of Knee osteoarthritis.Materials & Methods: It was an observational study. This study was done on referred patients of Knee osteoarthritis in PMR specialized outdoor of RpMCH from 20th September, 2012 to 20th October; 2012. The objective of this study is to know the demographic study, clinical grading, examination findings and radiological changes of knee osteoarthritis (OA). Consecutive sampling technique was adopted and total 34 samples were taken.Results: Among 30 study population, 4 (13.3%) were male, 26 (86.7%) were female and male: female ratio was 0.15 (Table I). The mean age was 52.20±9.572 (standard deviation) and P value was 0.000. Regarding Occupation, 18 (60%) were housewife, 10 (33.3%) were sedentary worker and 2 (6.7%) were businessmen (P value 0.002) (Table IV). Among the study population, 18 (60.0%) had both knee joint OA, 8 (26.7%) had right knee joint OA and 4 (13.3%) had left knee OA. The mean duration of knee joint pain was 25.33 ± 37.570 (standard deviation) month (P value 0.001) (Table VII). Among the study population, 4 (13.3%) had diabetes mellitus, 6 (20.0%) had hypertension, 2 (6.7%) had hypertension with ischemic heart disease and 2 (6.7%) had diabetes mellitus with hypertension with bronchial asthma and 16 (53.3%) were normotensive and nondiabetic (Figure 1). According to clinical grading of knee OA, 2 (6.7%) were in grade-1a, 6 (20%) were in grade-1b, 2 (6.7%) were in grade-2a, 4 (13.3%) were in grade-2b, 8 (26.7%) were in grade-3b, 8 (26.7%) were in grade-4 (P value 0.180 ) (Figure 2).Conclusion: This study reveals that clinically more advanced OA patients actually carrying early radiological changes.KYAMC Journal Vol. 8, No.-2, Jan 2018, Page 18-23
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Podlipská, Jana, Juhani M. Koski, Pasi Pulkkinen, and Simo Saarakkala. "In VivoQuantitative Ultrasound Image Analysis of Femoral Subchondral Bone in Knee Osteoarthritis." Scientific World Journal 2013 (2013): 1–8. http://dx.doi.org/10.1155/2013/182562.
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A potential of quantitative noninvasive knee ultrasonography (US) for detecting changes in femoral subchondral bone related to knee osteoarthritis (OA) was investigated. Thirty-nine patients referred to a knee arthroscopy underwent dynamic noninvasive US examination of the knee joint. The subchondral bone was semiautomatically segmented from representative US images of femoral medial and lateral condyles and intercondylar notch area. Subsequently, the normalized mean gray-level intensity profile, starting from the cartilage-bone interface and extending to the subchondral bone depth of ~1.7 mm, was calculated. The obtained profile was divided into 5 depth levels and the mean of each level, as well as the slope of the profile within the first two levels, was calculated. The US quantitative data were compared with the arthroscopic Noyes’ grading and radiographic Kellgren-Lawrence (K-L) grading. Qualitatively, an increase in relative subchondral bone US gray-level values was observed as OA progressed. Statistically significant correlations were observed between normalized US mean intensity or intensity slope especially in subchondral bone depth level 2 and K-L grading (r=0.600,P<0.001;r=0.486,P=0.006, resp.) or femoral arthroscopic scoring (r=0.332,P=0.039;r=0.335,P=0.037, resp.). This novel quantitative noninvasive US analysis technique is promising for detection of femoral subchondral bone changes in knee OA.
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Chen, Feihu, Hao Liu, Jie Xia, Xiaomin Ding, Jianbo Fan, Xinhui Zhu, Shengyu Cui, Hong Yi, Rufeng Gao, and Wei Liu. "Synovial fluid and plasma levels of milk fat globule–epidermal growth factor 8 are inversely correlated with radiographic severity of knee osteoarthritis." Journal of International Medical Research 47, no. 9 (July 25, 2019): 4422–30. http://dx.doi.org/10.1177/0300060519862460.
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Objective Mounting evidence demonstrates that inflammation plays an important role in the pathogenesis of osteoarthritis (OA). Milk fat globule–epidermal growth factor 8 (MFG-E8) is an important glycoprotein that is involved in anti-inflammatory responses. The present study was performed to assess the MFG-E8 levels in plasma and synovial fluid and explore the association between radiographic severity and MFG-E8 levels in patients with knee OA. Methods This study involved 138 healthy controls and 142 patients with knee OA. The MFG-E8 levels in plasma and synovial fluid were evaluated by enzyme-linked immunosorbent assay. The Kellgren and Lawrence classification was used for OA grading. Results The plasma MFG-E8 level was significantly lower in patients with knee OA than in healthy controls. The synovial fluid MFG-E8 level was significantly lower than the plasma level in patients with knee OA. More importantly, the MFG-E8 levels in synovial fluid and plasma were significantly and inversely associated with radiographic severity among patients with knee OA. Conclusions These results demonstrate that the levels of MFG-E8 in synovial fluid and plasma are inversely correlated with the radiographic severity of knee OA.
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Gregory, Jennifer S., Rebecca J. Barr, Kanako Yoshida, Salvatore Alesci, David M. Reid, and Richard M. Aspden. "Statistical shape modelling provides a responsive measure of morphological change in knee osteoarthritis over 12 months." Rheumatology 59, no. 9 (January 14, 2020): 2419–26. http://dx.doi.org/10.1093/rheumatology/kez610.
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Abstract Objectives Responsive biomarkers are needed to assess the progression of OA and their lack has hampered previous clinical trials. Statistical shape modelling (SSM) from radiographic images identifies those at greatest risk of fast-progression or joint replacement, but its sensitivity to change has not previously been measured. This study evaluates the responsiveness of SSM in knee OA in a 12-month observational study. Methods A total of 109 people were recruited who had undergone knee radiographs in the previous 12 months, and were grouped based on severity of radiographic OA (Kellgren–Lawrence grading). An SSM was built from three dual-energy X-ray absorptiometry scans at 6-month intervals. Change-over-time and OA were assessed using generalized estimating equations, standardized response means (SRM) and reliable change indices Results Mode 1 showed typical features of radiographic OA and had a strong link with Kellgren–Lawrence grading but did not change significantly during the study. Mode 3 showed asymmetrical changes consistent with medial cartilage loss, osteophytes and joint malalignment, and was responsive to change, with a 12-month SRM of 0.63. The greatest change was observed in the moderate radiographic OA group (SRM 0.92) compared with the controls (SRM 0.21), and the reliable change index identified 14% of this group whose progression was clinically significant. Conclusion Shape changes linked the progression of osteophytosis with increasing malalignment within the joint. Modelling of the whole joint enabled quantification of change beyond the point where bone-to-bone contact has been made. The knee SSM is, therefore, a responsive biomarker for radiographic change in knees over 12 months.
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Natalia Loekito, Tirza Z. Tamin, and I Nyoman Murdana. "Severe Degree of The Obesity Has More Comorbid Factors and more Severe of The Knee Osteoarthritis." Indonesian Journal of Physical Medicine & Rehabilitation 5, no. 02 (December 1, 2016): 1–8. http://dx.doi.org/10.36803/ijpmr.v5i02.211.
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Background : Obesity is a risk factor for knee osteoarthritis (OA). The major problem of OA are pain and decreased of knee muscle strength cause a decline of functional capacity, and lead to disability. Aim of this study is to describe the profile of obese patients with knee OA to prevent disability.
Methods : A descriptive study was conducted from September 2016 - March 2017. Subjects were obese patients with knee OA, age ranging from 40-80 years with sedentary lifestyle, with Physical level (PAL)<1.4.
Results : Most of the subjects have age>60 y.o(58.8%) anf were female (92.7%). The frequency of Obesity grade II (56.1%) and OA knee grade III (56.1%) were the most frequent. There were higher prevalence of comorbid factors on subjects with grade II of obesity i.e, hypertension, dyslipidemia, and diabetes mellitus (32 vs 27, 18 vs 5, 7 vs 2) respectively. THis study found 41 subjects has knee OA, consist grade II was 18 (43,9%), grade II was 23 (56,1%), Besides, there were higher prevalence of more severe knee OA on grade II than grade I of obesity subjects (29 vs 12).Conclusions : Higher grading of obesity has more prevalence of comorbid factors, as well as has more severe of knee OA
Keyword : obesity, comorbid factors, knee osteo arthritis
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Ngarmukos, Srihatach, Shaun Scaramuzza, Nipaporn Theerawattanapong, Aree Tanavalee, and Sittisak Honsawek. "Circulating and Synovial Fluid Heat Shock Protein 70 Are Correlated with Severity in Knee Osteoarthritis." CARTILAGE 11, no. 3 (July 19, 2018): 323–28. http://dx.doi.org/10.1177/1947603518790075.
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Objective Heat shock proteins are molecules rapidly produced under conditions of environmental stress, and involve in protecting the cells structural integrity and function. Osteoarthritis (OA) is a chronic destructive disorder of the joints manifested by the ongoing deterioration and loss of articular cartilage. The present study aimed to analyze circulating and synovial heat shock protein (Hsp70) values in knee osteoarthritis patients and healthy controls and to determine their relationship with the radiographic grading of the severity of knee OA. Design Seventy-two subjects with knee OA and 30 control participants were recruited. Circulating and joint fluid Hsp70 values were quantified by commercially available enzyme-linked immunosorbent assay. Results Circulating Hsp70 was markedly higher in knee OA patients compared with that of healthy volunteers ( P = 0.01). Correspondingly, synovial fluid Hsp70 was 3-fold greater than paired circulating Hsp70 samples ( P < 0.001). Further analysis revealed that circulating and joint fluid Hsp70 values were significantly related with the radiographic severity of knee OA ( r = 0.413, P < 0.001 and r = 0.658, P < 0.001, respectively). Subsequently, circulating Hsp70 value was directly associated with joint fluid Hsp70 value ( r = 0.704, P < 0.001). Conclusions Circulating and synovial Hsp70 levels were positively correlated with the radiographic severity of knee OA. Hsp70 could represent a potential biochemical marker for predicting the severity and may play a fundamental part in the pathogenic mechanism of knee OA.
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Sexana, Rahul, Ijen Bhattacharya, and Raj Sexana. "Susceptibility of knee osteoarthritis patients to develop cardiovascular disease - a clinical study." Asian Journal of Medical Sciences 4, no. 3 (June 20, 2013): 62–68. http://dx.doi.org/10.3126/ajms.v4i3.8169.
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Background: Osteoarthritis (OA) is a process of progressive destruction of articular cartilage which makes the OA patients physically inactive and increases the probability to develop cardiovascular disease (CVD). Aim: The objectives of present study were to estimate atherogenic index, markers of oxidative stress and inflammation in knee OA patients of different Kellegren- Lawrence (KL) grade and clarify the probability of knee OA patients to develop future CVD risk with disease severity. Methodology: Atherogenic index, plasma paraoxonase, C-reactive protein (CRP) and erythrocyte malondialdehyde (MDA) levels were estimated by using standard methods in 55 - 70 years aged 76 knee OA patients categorized into three groups (on the basis of KL grading scale) and 24 healthy subjects (control group). The obtained values were compared statistically by using student’s t-test. Result: A significant reduction in the plasma paraoxonase and serum HDL cholesterol levels were observed in (p<0.05) Group II & III knee OA patients. Similarly, erythrocyte MDA, Total cholesterol/HDL ratio and plasma CRP levels were increased significantly in (p<0.05) Group II and III knee OA patients. However, these levels were found to be altered insignificantly (p<0.01) in Group I knee OA subjects as compared to controls. Conclusion: Thus, the probability of KL grade III and IV knee OA patients to develop future risk of CVD are more as characterized by elevated antherogenic index, systemic inflammation and oxidative stress and reflect the need of antioxodants supplementation along with drug of choice to reduce CVD risk in knee OA patients. DOI: http://dx.doi.org/10.3126/ajms.v4i3.8169 Asian Journal of Medical Sciences 4(2013) 62-68
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Li, Zhan-Chun, Guang-Qi Cheng, Kong-Zu Hu, Mao-Qiang Li, Wei-Ping Zang, Yu-Qi Dong, Wei-Li Wang, and Zu-De Liu. "Correlation of synovial fluid HMGB-1 levels with radiographic severity of knee osteoarthritis." Clinical & Investigative Medicine 34, no. 5 (October 1, 2011): 298. http://dx.doi.org/10.25011/cim.v34i5.15673.
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Purpose: This study measured high-mobility group box 1 (HMGB-1) levels in serum and synovial fluid (SF) in patients with primary knee osteoarthritis (OA) and correlated these levels with radiographic disease severity. Methods: Seventy-eight OA patients and 30 controls were enrolled in this study. All OA patients were scored according to the Kellgren-Lawrence (KL) grading system. HMGB-1 levels were measured by enzyme-linked immunosorbent assay (ELISA). Results: SF HMGB-1 levels were significantly higher in knee OA patients, compared with controls (P < 0.01). Moreover, SF HMGB-1 levels were positively associated with KL scores (P < 0.01). Multinomial logistic regression demonstrated that the SF HMGB-1 level was an independent factor for radiographic severity of OA (P=0.002); however, serum HMGB-1 levels did not differ significantly between OA patients and controls and did not correlate with KL scores (P > 0.05). Conclusion: These results demonstrate that HMGB-1 levels in SF of knee OA patients are independently associated with radiographic disease severity.
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Shere, C., N. R. Fuggle, M. H. Edward, C. M. Parsons, K. A. Jameson, C. Cooper, E. M. Dennison, and K. A. Ward. "Jumping Joints: The Complex Relationship Between Osteoarthritis and Jumping Mechanography." Calcified Tissue International 106, no. 2 (October 26, 2019): 115–23. http://dx.doi.org/10.1007/s00223-019-00622-0.
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Abstract We investigated the relationship between lower limb osteoarthritis (OA) and muscle strength and power (assessed by jumping mechanography) in UK community-dwelling older adults. We recruited 249 older adults (144 males, 105 females). OA was assessed clinically at the knee according to ACR criteria and radiographically, at the knee and hip, using Kellgren and Lawrence grading. Two-footed jumping tests were performed using a Leonardo Mechanography Ground Reaction Force Platform to assess maximum muscle force, power and Esslinger Fitness Index. Linear regression was used to assess the relationship between OA and jumping outcomes. Results are presented as β (95% confidence interval). The mean age of participants was 75.2 years (SD 2.6). Males had a significantly higher maximum relative power during lift off (mean 25.7 W/kg vs. 19.9 W/kg) and maximum total force during lift off (mean 21.0 N/kg vs. 19.1 N/kg) than females. In adjusted models, we found significant associations in males between clinical knee OA and maximum relative power [− 6.00 (CI − 9.10, − 2.94)] and Esslinger Fitness Index [− 19.3 (− 29.0, − 9.7)]. In females, radiographic knee OA was associated with total maximum power [− 2.0 (− 3.9, − 0.1)] and Esslinger Fitness Index [− 8.2 (− 15.9, − 0.4)]. No significant associations were observed for maximum total force. We observed significant negative associations between maximum relative power and Esslinger Fitness Index and clinical knee OA in males and radiographic knee OA in females. We have used novel methodology to demonstrate relationships between muscle function and OA in older adults.
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Ahmed, Syed Mozaffar, Mohammed Emran, Md Israt Hasan, Fatema Newaz, Badrunnesa Ahmed, Md Nuruzzaman Khandaker, and Md Ali Emran. "Correlation of Pain, Physical Function and Radiography With Osteoarthritis of The knee." KYAMC Journal 10, no. 4 (March 1, 2020): 173–78. http://dx.doi.org/10.3329/kyamcj.v10i4.45714.
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Background: Osteoarthritis (OA) of the knee is a major public health issue. It is important to have a clear understanding about the relationship between clinical features (Pain, functional impairment) and radiographic findings to select appropriate treatment option.
Objectives: To investigate the relationship between pain, loss of physical function, and radiographic findings in OA of the knee joint.
Materials and Methods: A cross sectional study on 90 patients aged 40 years and above with OA of the knee joint selected randomly. Severity of the knee pain and functional impairment were measured using the Bangla version of WOMAC (Western Ontario and McMaster Universities Osteoarthritis index). Radiograph of the knee joint were assessed with the Kellgren- Lawrence grading scale.
Results: The mean of the age, BMI (body mass index) and duration of pain was respectively 54.2 (± 9.5) years, 26.0 (± 3.4) kg/m2 and 3.6 (± 2.8) years. Male female ratio was 1:1.6. 55% of the patients had the Visual Analogue Scale (VAS) score of 1-3. The Pain and physical function were associated with OA of the knee where the mean physical function score was 45.1 ± 4.2 in patients who had pain score of >10. However pain and physical function was not associated with the radiographic findings of the OA of the knee.
Conclusion: The treatment planning for the OA of the knee should be based on clinical presentation rather than radiographic findings.
KYAMC Journal Vol. 10, No.-4, January 2020, Page 173-178
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Minciullo, Luca, Matthew J. Parkes, David T. Felson, and Timothy F. Cootes. "Comparing image analysis approaches versus expert readers: the relation of knee radiograph features to knee pain." Annals of the Rheumatic Diseases 77, no. 11 (August 1, 2018): 1606–9. http://dx.doi.org/10.1136/annrheumdis-2018-213492.
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ObjectivesThe relationship between radiographic evidence of osteoarthritis and knee pain has been weak. This may be because features that best discriminate knees with pain have not been included in analyses. We tested the correlation between knee pain and radiographic features taking into account both image analysis features and manual scores.MethodsUsing data of the Multicentre Osteoarthritis Study, we tested in a cross-sectional design how well X-ray features discriminated those with frequent knee pain (one question at one time) or consistent frequent knee pain (three questions at three times during the 2 weeks prior to imaging) from those without it. We trained random forest models on features from two radiographic views for classification.ResultsX-rays were better at classifying those with pain using three questions compared with one. When we used all manual radiographic features, the area under the curve (AUC) was 73.9%. Using the best model from automated image analyses or a combination of these and manual grades, no improvement over manual grading was found.ConclusionsX-ray changes of OA are more strongly associated with repeated reports of knee pain than pain reported once. In addition, a fully automated system that assessed features not scored on X-ray performed no better than manual grading of features.
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Sandhar, Sandeep, Toby O. Smith, Kavanbir Toor, Franklyn Howe, and Nidhi Sofat. "Risk factors for pain and functional impairment in people with knee and hip osteoarthritis: a systematic review and meta-analysis." BMJ Open 10, no. 8 (August 2020): e038720. http://dx.doi.org/10.1136/bmjopen-2020-038720.
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ObjectiveTo identify risk factors for pain and functional deterioration in people with knee and hip osteoarthritis (OA) to form the basis of a future ‘stratification tool’ for OA development or progression.DesignSystematic review and meta-analysis.MethodsAn electronic search of the literature databases, Medline, Embase, CINAHL, and Web of Science (1990–February 2020), was conducted. Studies that identified risk factors for pain and functional deterioration to knee and hip OA were included. Where data and study heterogeneity permitted, meta-analyses presenting mean difference (MD) and ORs with corresponding 95% CIs were undertaken. Where this was not possible, a narrative analysis was undertaken. The Downs & Black tool assessed methodological quality of selected studies before data extraction. Pooled analysis outcomes were assessed and reported using the Grading of Reccomendation, Assessment, Development and Evaluation (GRADE) approach.Results82 studies (41 810 participants) were included. On meta-analysis: there was moderate quality evidence that knee OA pain was associated with factors including: Kellgren and Lawrence≥2 (MD: 2.04, 95% CI 1.48 to 2.81; p<0.01), increasing age (MD: 1.46, 95% CI 0.26 to 2.66; p=0.02) and whole-organ MRI scoring method (WORMS) knee effusion score ≥1 (OR: 1.35, 95% CI 0.99 to 1.83; p=0.05). On narrative analysis: knee OA pain was associated with factors including WORMS meniscal damage ≥1 (OR: 1.83). Predictors of joint pain in hip OA were large acetabular bone marrow lesions (BML; OR: 5.23), chronic widespread pain (OR: 5.02) and large hip BMLs (OR: 4.43).ConclusionsOur study identified risk factors for clinical pain in OA by imaging measures that can assist in predicting and stratifying people with knee/hip OA. A ‘stratification tool’ combining verified risk factors that we have identified would allow selective stratification based on pain and structural outcomes in OA.PROSPERO registration numberCRD42018117643.
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Sun, Jian-Min, Liang-Zhi Sun, Jun Liu, Bao-hui Su, and Lin Shi. "Serum Interleukin-15 Levels Are Associated with Severity of Pain in Patients with Knee Osteoarthritis." Disease Markers 35 (2013): 203–6. http://dx.doi.org/10.1155/2013/176278.
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Background.Inflammation plays a crucial role in the development and progression of osteoarthritis (OA). Interleukin-15 (IL-15) is a well-known proinflammatory cytokine.Objective.We aimed at evaluating the relationship between serum IL-15 levels and the severity of pain as well as radiographic progression in patients with knee OA.Methods.Two hundred and twenty-six OA patients and 106 controls were enrolled in this study. The symptomatic/radiological severity of OA was assessed by the Western Ontario McMaster University Osteoarthritis Index- (WOMAC-)pain scores/Kellgren-Lawrence (KL) grading system. Serum IL-15 levels were measured by enzyme-linked immunosorbent assay (ELISA).Results.Serum IL-15 levels were significantly higher in OA patients compared with controls. Serum IL-15 levels were independently and positively correlated with WOMAC-pain scores but not KL grades in OA patients.Conclusions.We demonstrated that increased serum IL-15 levels were independently correlated with self-reported greater pain in knee OA patients. These results suggest that IL-15 might play a crucial role in the pathogenesis of OA related pain and therapeutic interventions by blocking IL-15 signaling pathways to delay the degenerative process of OA related pain which warrants further investigations.
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Huang, Yu-Hao, Wen-Hui Fang, Dung-Jang Tsai, Yu-Hsuan Chen, Yu-Chiao Wang, Wen Su, Chung-Cheng Kao, Kevin Yi, Chih-Chien Wang, and Sui-Lung Su. "The Decisive Case-Control Study Elaborates the Null Association between ESR1 XbaI and Osteoarthritis in Asians: A Case–Control Study and Meta-Analysis." Genes 12, no. 3 (March 12, 2021): 404. http://dx.doi.org/10.3390/genes12030404.
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(1) Background: The prevalence of knee osteoarthritis (OA) in women is significantly higher than in men. The estrogen receptor α (ERα) has been considered to play a key role due to a large gender difference in its expression. ERα is encoded by the gene estrogen receptor 1 (ESR1), which is widely studied to explore the gender difference in knee OA. Several polymorphisms in ESR1 [PvuII (rs2234693) and BtgI (rs2228480)] were confirmed as the risk factors of OA. However, the evidence of the last widely investigated polymorphism, ESR1 Xbal (rs9340799), is still insufficient for concluding its effect on knee OA. (2) Objective: This study proposed a case–control study to investigate the association between ESR1 Xbal and knee OA. Moreover, a meta-analysis and trial sequential analysis (TSA) were conducted to enlarge the sample size for obtaining a conclusive evidence. (3) Methods: In total, 497 knee OA cases and 473 healthy controls were recruited between March 2015 and July 2018. The Kellgren–Lawrence grading system was used to identify the knee OA cases. To improve the evidence level of our study, we conducted a meta-analysis including the related studies published up until December 2018 from PubMed, Embase, and previous meta-analysis. The results are expressed as odds ratios (ORs) with corresponding 95% confidence intervals (CI) for evaluating the effect of this polymorphism on knee OA risk. TSA was used to estimate the sample sizes required in this issue. (4) Results: We found non-significant association between the G allele and knee OA [Crude-OR: 0.97 (95% CI: 0.78–1.20) and adjusted-OR: 0.90 (95% CI: 0.71–1.15) in allele model] in the present case–control study, and the analysis of other genetic models showed a similar trend. After including six published studies and our case–control studies, the current evidence with 3174 Asians showed the conclusively null association between ESR1 XbaI and knee OA [OR: 0.78 (95% CI: 0.59–1.04)] with a high heterogeneity (I2: 78%). The result of Caucasians also concluded the null association [OR: 1.05 (95% CI: 0.56–1.95), I2: 87%]. (5) Conclusions: The association between ESR1 XbaI and knee OA was not similar with other polymorphisms in ESR1, which is not a causal relationship. This study integrated all current evidence to elaborate this conclusion for suggesting no necessity of future studies.
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Köse, Özkan, Baver Acar, Fatif Çay, Ferhat Güler, Halil Yüksel, and Baris Yilmaz. "Inter- and Intraobserver Reliabilities of Four Different Radiographic Grading Scales of Osteoarthritis of the Knee Joint." Journal of Knee Surgery 31, no. 03 (May 1, 2017): 247–53. http://dx.doi.org/10.1055/s-0037-1602249.
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AbstractThe purpose of this study was to investigate the interobserver and intraobserver reliabilities of four different radiographic grading scale of osteoarthritis (OA) of the knee joint, namely, Kellgren–Lawrence (KL), Ahlback, Brandt, and OA Research Society International (OARSI). One consultant orthopaedic surgeon and one rheumatologist who were familiar with these OA grading scales participated in the study. Radiological assessments were performed in random order by each observer on two separate occasions, at least 2 weeks apart. K-statistics were used to establish a relative level of agreement between the observers for the two readings and between separate readings by the same observer. A total of 140 patients (53 males and 87 females) with a mean age of 61.2 years (range, 50–72 years) were included in the study. Intraobserver reliability for KL was substantial for observer A (κ: 0.753) and moderate for observer B (κ: 0.573). Interobserver reliability for KL was moderate for both observers (κ: 0.499 and 0.458, respectively). Intraobserver reliability for Ahlback was substantial for observer A (κ: 0.768) and moderate for observer B (κ: 0.561). Interobserver reliability for Ahlback was fair for both observers (κ: 0.365 and 0.204, respectively). Intraobserver reliability for Brandt was substantial for observer A (κ: 0.741) and moderate (κ: 0.425) for observer B. Interobserver reliability for Brandt was fair for both observers (κ: 0.308 and κ: 0.246, respectively). Intraobserver reliability for OARSI was substantial for observer A (κ: 0.792) and moderate for observer B (κ: 0.508). Interobserver reliability for OARSI was moderate for observer A (κ: 0.425) and slight for observer B (κ: 0.175). None of the studied OA grading scales showed acceptable reliability (κ > 0.80). The evaluation of patients with OA should not be dependent on radiographic findings alone; clinical findings should also guide the treatment and follow-up.
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Haberal, Bahtiyar, Ekin Kaya Şimşek, Hatice Pınar Baysan Çebi, Özer Tuç, Hasibe Verdi, and Fatma Belgin Ataç. "Lack of association between MMP13 (rs3819089), ADAM12 (rs3740199-rs1871054) and ADAMTS14 (rs4747096) genotypes and advanced-stage knee osteoarthritis." Joint Diseases and Related Surgery 32, no. 2 (June 11, 2021): 299–305. http://dx.doi.org/10.52312/jdrs.2021.64.
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Objectives: The aim of this study was to investigate the relationship between MMP13 rs3819089, ADAM12 rs3740199 and rs1871054, and ADAMTS14 rs4747096 genotypes in patients with radiologically diagnosed knee osteoarthritis (OA). Patients and methods: A total of 300 patients (68 males, 232 females; mean age: 61.6 years; range, 25 to 89 years) who were admitted to the orthopedics and traumatology clinic and diagnosed with knee OA according to the 2000 American College of Rheumatology (ACR) criteria between October 2018 and March 2019 were prospectively analyzed. Patients with Grades III-IV OA according to the Kellgren- Lawrence (K-L) grading system were included in the patient group (n=150) and those without radiological features of knee OA (K-L Grades I-II) were included in the control group (n=150) voluntarily. The presence of single nucleotide polymorphisms (SNPs) in the targeted genes in both groups was assessed by real-time polymerase chain reaction in the peripheral blood sample. Results: The most common nucleotides in both the control and patient groups were CG for rs3740199 and CT for rs1871054 in the ADAM12 gene, and the most common nucleotides in alleles were GG for MMP13 rs3819089 and AA for ADAMTS14 rs4747096. No statistically significant relationship was detected between the gene polymorphisms and advanced OA. Conclusion: The study results suggest that ADAM12 rs3740199 and rs1871054, MMP13 rs3819089, and ADAMTS14 rs4747096 polymorphisms have no relationship with knee OA susceptibility in the Turkish population. However, as this is the first study to investigate the relationship between the SNPs of ADAM12, ADAMTS14, and MMP13 genes and the development of OA in the Turkish population, it would contribute to our understanding of the molecular bases of OA.
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Denoble, Anna E., Norine Hall, Carl F. Pieper, and Virginia B. Kraus. "Patellar Skin Surface Temperature by Thermography Reflects Knee Osteoarthritis Severity." Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders 3 (January 2010): CMAMD.S5916. http://dx.doi.org/10.4137/cmamd.s5916.
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Background Digital infrared thermal imaging is a means of measuring the heat radiated from the skin surface. Our goal was to develop and assess the reproducibility of serial infrared measurements of the knee and to assess the association of knee temperature by region of interest with radiographic severity of knee Osteoarthritis (rOA). Methods A total of 30 women (15 Cases with symptomatic knee OA and 15 age-matched Controls without knee pain or knee OA) participated in this study. Infrared imaging was performed with a Meditherm Med2000™ Pro infrared camera. The reproducibility of infrared imaging of the knee was evaluated through determination of intraclass correlation coefficients (ICCs) for temperature measurements from two images performed 6 months apart in Controls whose knee status was not expected to change. The average cutaneous temperature for each of five knee regions of interest was extracted using WinTes software. Knee x-rays were scored for severity of rOA based on the global Kellgren-Lawrence grading scale. Results The knee infrared thermal imaging procedure used here demonstrated long-term reproducibility with high ICCs (0.50–0.72 for the various regions of interest) in Controls. Cutaneous temperature of the patella (knee cap) yielded a significant correlation with severity of knee rOA (R = 0.594, P = 0.02). Conclusion The skin temperature of the patellar region correlated with x-ray severity of knee OA. This method of infrared knee imaging is reliable and as an objective measure of a sign of inflammation, temperature, indicates an interrelationship of inflammation and structural knee rOA damage.
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Dawn, Indranil, Susmita Sarkar, and Chinmoy De. "A comparative study between Antioxidant vitamin and KellgrenLawrence grading scale in knee osteoarthritis patients." Bangladesh Journal of Medical Science 13, no. 1 (December 24, 2013): 30–35. http://dx.doi.org/10.3329/bjms.v13i1.14046.
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Osteoarthritis (OA) is a strongly age-related joint disorder that is defined as a gradual loss of articular cartilage. Current concepts of the pathogenic mechanisms of OA suggest that there isa shift in the homeostatic balance between the destruction and synthesis of bone and cartilage,with a net progressive destruction of these tissues. Recent studies of the biology of chondrocytes show that these cells actively produce reactive oxygen species (ROS). ROS are capable of inducing apoptotic cell death in chondrocytes, but more important, they can result in the degradation of aggrecan and collagen. Micronutrient antioxidants such as alpha- Tocopherol (Vitamin E) and Vitamin C also act to reduce the effects of ROS. A hospital based case control study was conducted in Burdwan Medical College, West Bengal, India on 76 postmenopausal women aged 4570 years suffering from Osteoarthritis (OA) of the knee joint, which was diagnosed from symptoms, clinical examinations and radiographic findings. The 151 controls were selected from the healthy persons .plasma vitamin C and serum vitamin E ware measured.. Knee joint radiographs were evaluated with the KellgrenLawrence grading scale .Furthermore both were correlated with KellgrenLawrence grading scale to find out possible association between the antioxidant vitamins and the disease progression. Results showed that there was a significant decrease in antioxidant vitamin levels in patients with knee joint osteoarthritis as compared to the controls suggests that treatment with antioxidants in the initial stages of the disease may be useful as secondary therapy. Both antioxidant vitamins showed negative correlation with KellgrenLawrence grading. Both vitamins decreased with increasing KellgrenLawrence grade. So antioxidant vitamin can be use to assess the disease severity. DOI: http://dx.doi.org/10.3329/bjms.v13i1.14046 Bangladesh Journal of Medical Science Vol. 13 No. 01 January2014: 30-35
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Øiestad, Britt Elin, Emily Quinn, Daniel White, Frank Roemer, Ali Guermazi, Michael Nevitt, Neil A. Segal, Cora E. Lewis, and David T. Felson. "No Association between Daily Walking and Knee Structural Changes in People at Risk of or with Mild Knee Osteoarthritis. Prospective Data from the Multicenter Osteoarthritis Study." Journal of Rheumatology 42, no. 9 (June 15, 2015): 1685–93. http://dx.doi.org/10.3899/jrheum.150071.
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Objective.We investigated the association between objectively measured daily walking and knee structural change, defined either as radiographic worsening or as cartilage loss, in people at risk of or with knee osteoarthritis (OA).Methods.Participants from the Multicenter Osteoarthritis Study (MOST) with Kellgren-Lawrence grades 0–2 and daily walking (measured with the StepWatch) at the 60-month visit were included. Participants had fixed-flexion, weight-bearing radiographs and knee magnetic resonance images (MRI) at 60 and 84 months. Radiographic worsening was read in both knees using the Osteoarthritis Research Society International grading, and MRI were read for 1 knee using the Whole-Organ MRI Score semiquantitative scoring. OR and 95% CI were calculated comparing those in the middle tertile against the lowest and highest tertiles of daily walking using logistic regression models and generalized estimating equations. Data on walking with moderate to vigorous intensity (min with > 100 steps/min/day) were associated to structural change using multivariate and logistic regression models.Results.The 1179 study participants (59% women) were 67.0 years old (± 7.6), with a mean (± SD) body mass index of 29.8 kg/m2 (± 5.3) who walked 6981 (± 2630) steps/day. After adjusting for confounders, we found no significant associations between daily walking and radiographic worsening or cartilage loss. More time spent walking at a moderate to vigorous intensity was not associated with either radiographic worsening or cartilage loss.Conclusion.Results from the MOST study indicated no association between daily walking and structural changes over 2 years in the knees of people at risk of or with mild knee OA.
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Saidapur, S. K., Rajendra B Uppin, Nitish K, Gangadhar Bhuti, and Satish Bachchu. "Effectiveness of intra-articular injection of platelet-rich plasma versus triamcinolone in osteoarthritis of knee – A hospital-based randomized clinical trial." IP International Journal of Orthopaedic Rheumatology 7, no. 1 (August 15, 2021): 6–11. http://dx.doi.org/10.18231/j.ijor.2021.003.
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Osteoarthritis of the knee is one of the most common conditions which clinicians have to deal with in their day-to-day practice. There are various pharmacologic therapies recommended for OA knee. Intra-articular Platelet Rich Plasma (PRP) and Intra-articular Triamcinolone have been shown to relieve pain and improve quality of life in patients with OA knee. This study is conducted to compare the effectiveness of PRP and Triamcinolone intra-articular injections in Grade 1 & 2 OA knee.We conducted a randomized control study including 70 patients with Grade 1 & 2 (Kellgrenn & Lawrence grading) OA knee. 35 patients each were divided into the PRP group and Triamcinolone group. Intra-articular PRP 5ml and Intra-articular Triamcinolone 80mg were injected twice 3 weeks apart. The effectiveness of the treatment was evaluated by using VAS, KOOS, and WOMAC scores at 3 weeks, 3 months, and 6 months of the follow-up period.At 3 weeks follow up both the groups showed similar results decreasing pain and improving quality of life. At 6 months follow-up, the PRP group showed better results, and the same effect was observed at 6 months of follow-up. Overall, the PRP group showed better VAS, KOOS, and WOMAC scores compared to the Triamcinolone group.In the present study both the groups showed improvement in function and reduction in pain in patients with Osteoarthritis of the knee but Triamcinolone had a short-term effect compared to PRP. The study showed the effect of intra-articular injection of platelet-rich plasma was better than triamcinolone in early osteoarthritis of the knee.
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Kim, Yong Sang, Dong Suk Suh, Dae Hyun Tak, Pill Ku Chung, and Yong Gon Koh. "Mesenchymal Stem Cell Implantation in Knee Osteoarthritis: Midterm Outcomes and Survival Analysis in 467 Patients." Orthopaedic Journal of Sports Medicine 8, no. 12 (December 1, 2020): 232596712096918. http://dx.doi.org/10.1177/2325967120969189.
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Background: A cell-based tissue engineering approach that uses mesenchymal stem cells (MSCs) has addressed the issue of articular cartilage repair in knees with osteoarthritis (OA). Purpose: To evaluate the midterm outcomes, analyze the survival rates, and identify the factors affecting the survival rate of MSC implantation to treat knee OA. Study Design: Case series; Level of evidence, 4. Methods: We retrospectively evaluated 467 patients (483 knees) who underwent MSC implantation on a fibrin glue scaffold for knee OA with a minimum 5-year follow-up. Clinical outcomes were determined based on the International Knee Documentation Committee (IKDC) and Tegner activity scale results measured preoperatively and during follow-up. Standard radiographs were evaluated using Kellgren-Lawrence grading. Statistical analyses were performed to determine the survival rate and the effect of different factors on the clinical outcomes. Results: The mean IKDC scores (baseline, 39.2 ± 7.2; 1 year, 66.6 ± 9.6; 3 years, 67.2 ± 9.9; 5 years, 66.1 ± 9.7; 9 years, 62.8 ± 8.5) and Tegner scores (baseline, 2.3 ± 1.0; 1 year, 3.4 ± 0.9; 3 years, 3.5 ± 0.9; 5 years, 3.4 ± 0.9; 9 years, 3.2 ± 0.9) were significantly improved until 3 years postoperatively and gradually decreased from 3- to 9-year follow-up ( P < .05 for all, except for Tegner score at 5 years vs 1 year [ P = .237]). Gradual deterioration of radiological outcomes according to the Kellgren-Lawrence grade was found during follow-up. Survival rates based on either a decrease in IKDC or an advancement of radiographic OA with Kellgren-Lawrence scores were 99.8%, 94.5%, and 74.5% at 5, 7, and 9 years, respectively. Based on multivariate analyses, older age and the presence of bipolar kissing lesion were associated with significantly worse outcomes ( P = .002 and .013, respectively), and a larger number of MSCs was associated with significantly better outcomes ( P < .001) after MSC implantation. Conclusion: MSC implantation provided encouraging outcomes with acceptable duration of symptom relief at midterm follow-up in patients with early knee OA. Patient age, presence of bipolar kissing lesion, and number of MSCs were independent factors associated with failure of MSC implantation.
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Li, Yusheng, Wenfeng Xiao, Minghua Sun, Zhenhan Deng, Chao Zeng, Hui Li, Tuo Yang, Liangjun Li, Wei Luo, and Guanghua Lei. "The Expression of Osteopontin and Wnt5a in Articular Cartilage of Patients with Knee Osteoarthritis and Its Correlation with Disease Severity." BioMed Research International 2016 (2016): 1–7. http://dx.doi.org/10.1155/2016/9561058.
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Objectives. This study is undertaken to investigate the relation between osteopontin (OPN) and Wnt5a expression in the progression and pathogenesis of osteoarthritis (OA).Methods. 50 cartilage tissues from knee OA patients and normal controls were divided into four groups of severe, moderate, minor, and normal lesions based on the modified grading system of Mankin. Immunohistochemistry and real-time PCR were utilized to analyze the OPN and Wnt5a expression in articular cartilage. Besides, the relations between OPN and Wnt5a expression and the severity of OA were explored.Results. OPN and Wnt5a could be identified in four groups’ tissues. Amongst the groups, the intercomparisons of OPN expression levels showed statistical differences (P<0.01). Besides, the intercomparisons of Wnt5a expression degrees showed statistical differences (P<0.05), except that between the minor and normal groups (P>0.05). The scores of Mankin were demonstrated to relate to OPN expression (r=-0.847,P<0.01) and Wnt5a expression in every group (r=-0.843,P<0.01). Also, a positive correlation can be observed between the OPN and Wnt5a expression (r=0.769,P<0.01).Conclusion. In articular cartilage, the expressions of OPN and Wnt5a are positively related to progressive damage of knee OA joint. The correlation between Wnt5a and OPN might be important to the progression and pathogenesis of knee OA.
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Wang, Yifan, Xianan Wang, Tianning Gao, Le Du, and Wei Liu. "An Automatic Knee Osteoarthritis Diagnosis Method Based on Deep Learning: Data from the Osteoarthritis Initiative." Journal of Healthcare Engineering 2021 (September 27, 2021): 1–10. http://dx.doi.org/10.1155/2021/5586529.
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Osteoarthritis (OA) is the most common form of arthritis. According to the evidence presented on both sides of the knee bones, radiologists assess the severity of OA based on the Kellgren–Lawrence (KL) grading system. Recently, computer-aided methods are proposed to improve the efficiency of OA diagnosis. However, the human interventions required by previous semiautomatic segmentation methods limit the application on large-scale datasets. Moreover, well-known CNN architectures applied to the OA severity assessment do not explore the relations between different local regions. In this work, by integrating the object detection model, YOLO, with the visual transformer into the diagnosis procedure, we reduce human intervention and provide an end-to-end approach to automatic osteoarthritis diagnosis. Our approach correctly segments 95.57% of data at the expense of training on 200 annotated images on a large dataset that contains more than 4500 samples. Furthermore, our classification result improves the accuracy by 2.5% compared to the traditional CNN architectures.
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Baki, Noha M. Abdel, Zeinab O. Nawito, Nehal M. S. Abdelsalam, Dina Sabry, Hossam Elashmawy, Nagy A. Seleem, Azza Ali Abdel-azeem Taha, and Mohamed El Ghobashy. "Does Intra-Articular Injection of Platelet-Rich Plasma Have an Effect on Cartilage Thickness in Patients with Primary Knee Osteoarthritis?" Current Rheumatology Reviews 17, no. 3 (August 30, 2021): 294–302. http://dx.doi.org/10.2174/1573397117666210114151701.
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Objectives: To determine the effect of intra-articular injection of platelet-rich plasma (PRP) in patients with primary knee osteoarthritis (OA) by clinical evaluation and ultrasonographic (US) assessment of cartilage thickness. Patients and Methods: A total of 100 patients with mild to severe primary knee OA using the Kellgren- Lawrence (K-L) grading scale were included and divided into two groups. Group I included 50 patients who were given two intra-articular knee injections of PRP, 1 week apart; Group II included 50 patients who received non-steroidal anti-inflammatory drugs (NSAIDs) and chondroprotective drugs. Functional assessment of all OA patients was done using the basal WOMAC score, at 2 and 6 months. US assessment of femoral condylar cartilage thickness was conducted basally and at 6 months. Results: Improvement of WOMAC score was observed at 2 and 6 months in Group I following PRP injection compared to Group II (p values<0.001), The improvement of WOMAC in Group I occurred in all severity degrees of OA (p<0.001). Moreover, a significant increase in cartilage thickness was found at the intercondylar area (ICA) at 6 months relative to baseline assessment by US in Group I (p = 0.041). Conclusion: Treatment with PRP injections can reduce pain and improve knee function in patients with various degrees of articular degeneration. Further studies are needed to clarify the anabolic effect of PRP on the articular cartilage.
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Vas, Dr Lakshmi. "Pulsed Radiofrequency of the Composite Nerve Supply to the Knee Joint as a New Technique for Relieving Osteoarthritic Pain: A Preliminary Report." Pain Physician 6;17, no. 6;12 (December 14, 2014): 494. http://dx.doi.org/10.36076/ppj.2014/17/494.
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We report a new technique for pulsed radiofrequency (PRF) of the entire nerve supply of the knee as an option in treating osteoarthritis (OA) of knee. We targeted both sensory and motor nerves supplying all the structures around the knee: joint, muscles, and skin to address the entire nociception and stiffness leading to peripheral and central sensitization in osteoarthritis. Ten patients with pain, stiffness, and loss of function in both knees were treated with ultrasonography (USG) guided PRF of saphenous, tibial, and common peroneal nerves along with subsartorial, peripatellar, and popliteal plexuses. USG guided PRF of the femoral nerve was also done to address the innervation of the quadriceps muscle. Assessment of pain (Numerical Rating Scale [NRS], pain DETECT, knee function [Western Ontario and McMaster Universities Osteoarthritis Index- WOMAC]) were documented pre and post PRF at 3 and 6 months. Knee radiographs (KellgrenLawrence [K-L] grading) were done before PRF and one week later. All the patients showed a sustained improvement of NRS, pain DETECT, and WOMAC at 3 and 6 months. The significant improvement of patellar position and tibio-femoral joint space was concordant with the patient’s reporting of improvement in stiffness and pain. The sustained pain relief and muscle relaxation enabled the patients to optimize physiotherapy thereby improving endurance training to include the daily activities of life. We conclude that OA knee pain is a product of neuromyopathy and that PRF of the sensory and motor nerves appeared to be a safe, effective, and minimally invasive technique. The reduction of pain and stiffness improved the knee function and probably reduced the peripheral and central sensitization. Key words: Osteoarthritis, knee pain, stiffness, knee innervation, femoral nerve supply, Hilton’s law, peripheral sensitization, pulsed radiofrequency treatment of nerves to knee joint
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Mortada, M. A., L. I. Kotb, and Y. A. Amer. "Impact of ultrasonography detected quadriceps calcific tendinopathy on pain and function in patients with primary knee osteoarthritis." Reumatismo 73, no. 2 (August 3, 2021): 111–16. http://dx.doi.org/10.4081/reumatismo.2021.1381.
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Calcific tendinopathy is most commonly seen around the shoulder joint. Only a few cases of quadriceps calcific tendinopathy (QCT) were reported. This study compares pain, function, clinical examination results, and ultrasonographic findings among primary knee osteoarthritis (KOA) patients with or without ultrasonography-detected QCT. A cross-sectional study was conducted on 214 patients with knee OA. Ultrasonography (US) of knee joints was performed according to the EULAR guidelines. Kellgren-Lawrence radiographic grading was used to score OA. Pain and functional status were assessed using the visual analog scale (VAS), the Health Assessment Questionnaire-II (HAQ-II), and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). QCT was detected in 50 out of 428 knees (11.6%), i.e. in 46 out of 214 patients (21.49%). Most cases of QCT were detected in the following sites: 36 in the vastus lateralis (72%), 10 in the vastus intermedius (20%), and only 4 in the vastus medialis (8%). QCT was found mainly in advanced KOA stages: 44 cases of QCT were found in patients with grade 4 KOA and 6 cases in grade 3 KOA. The presence of QCT showed a statistically significant association (p<0.05) with VAS, HAQ-II, WOMAC subscales, synovitis, and effusion detected by US. In knees with ultrasound-detected QCT, ultrasonographic features of CPPD were found in 31 knees (62%). QCT was found in cases with advanced KOA and mainly with ultrasonographic findings of CPPD disease. QCT could be considered an independent poor prognostic finding regarding pain, functional activity, and response to NSAIDs.
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Meyer, Maximilian A., Timothy S. Leroux, David M. Levy, Annemarie K. Tilton, Paul B. Lewis, Adam B. Yanke, and Brian J. Cole. "Flexion Posteroanterior Radiographs Affect Both Enrollment for and Outcomes After Injection Therapy for Knee Osteoarthritis." Orthopaedic Journal of Sports Medicine 5, no. 5 (May 1, 2017): 232596711770669. http://dx.doi.org/10.1177/2325967117706692.
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Background: Knee injection therapy is less effective for severe osteoarthritis (OA), specifically Kellgren-Lawrence (KL) grade 4. Patient selection for knee injection trials has historically been based on extension anteroposterior (AP) radiographic evaluation; however, emerging evidence suggests that KL grading using a flexion posteroanterior (PA) radiograph more accurately and reproducibly predicts disease severity. The impact of radiographic view on patient selection and outcome after knee injection therapy remains unknown. Hypothesis: A 45° flexion PA radiograph will reveal more advanced knee OA in certain patients. These patients will report worse pre- and postinjection outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: Four raters independently graded extension AP and flexion PA radiographs from 91 patients previously enrolled in a knee injection trial. Patients determined to have KL grade 4 OA by any rater on extension AP radiographs were excluded. Among included patients, those upgraded to KL grade 4 on flexion PA radiographs by at least 2 raters constituted group 2, while all remaining patients constituted group 1. Demographic data and patient-reported outcome scores before injection and at 6 weeks, 3 months, 6 months, and 12 months postinjection were compared between groups. Results: Overall, 64 patients met the inclusion criteria, of which 19 patients (30%) constituted group 2. Compared with group 1, patients in group 2 were older (58.7 vs 52.3 years, P = .02), had worse visual analog scale pain scores before (6.6 vs 5.3, P = .03) and 6 months after injection (5.3 vs 3.5, P = .01), had less improvement in both Lysholm (8.5 vs 20.5, P = .02) and Short Form–12 physical component (–2.2 vs 1.7, P = .03) scores from preinjection to 6 months postinjection, and had less improvement in both Lysholm (1.6 vs 13.1, P = .03) and Knee injury and Osteoarthritis Outcome Score sport subscale (–2.1 vs 16, P = .01) scores from preinjection to 12 months postinjection. Conclusion: One in 3 patients considered to have mild to moderate knee OA on extension AP radiography is upgraded to severe knee OA (KL grade 4) on flexion PA radiography. These patients report worse preinjection outcomes, worse pain scores at short-term follow-up, and decreased improvement in knee function scores between 6 months and 1 year postinjection.
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Kohno, Motonori, Yuichi Iwamura, Riki Inasaka, Gosuke Akiyama, Shota Higashihira, Takuya Kawai, Takanori Niimura, and Yutaka Inaba. "Influence of comorbid knee osteoarthritis on surgical outcome and sagittal spinopelvic/lower-extremity alignment in elderly patients with degenerative lumbar spondylolisthesis undergoing transforaminal lumbar interbody fusion." Journal of Neurosurgery: Spine 32, no. 6 (June 2020): 850–58. http://dx.doi.org/10.3171/2019.11.spine19978.
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OBJECTIVEThis retrospective study aimed to clarify the influence of comorbid severe knee osteoarthritis (KOA) on surgical outcome in terms of sagittal spinopelvic/lower-extremity alignment in elderly patients with degenerative lumbar spondylolisthesis (DLS).METHODSIn total, 110 patients aged at least 65 years (27 men, 83 women; mean age 74.0 years) who underwent short-segment lumbar fusion were included in the present study. Using the Kellgren-Lawrence (KL) grading system, patients were categorized into those with no to mild KOA (the mild-OA group: KL grades 0–2), moderate KOA (moderate-OA group: KL grade 3), or severe KOA (severe-OA group: KL grade 4). Surgical results were assessed using the Japanese Orthopaedic Association (JOA) scoring system, and spinopelvic/lower-extremity parameters were compared among the 3 groups. Adjacent-segment disease (ASD) was assessed over a mean follow-up period of 4.7 years (range 2–8.1 years).RESULTSThe study cohort was split into the mild-OA group (42 patients), the moderate-OA group (28 patients), and the severe-OA group (40 patients). The severe-OA group contained significantly more women (p = 0.037) and patients with double-level listhesis (p = 0.012) compared with the other groups. No significant differences were found in mean postoperative JOA scores or recovery rate among the 3 groups. The mean postoperative JOA subscore for restriction of activities of daily living was only significantly lower in the severe-OA group compared with the other groups (p = 0.010). The severe-OA group exhibited significantly greater pelvic incidence, pelvic tilt, and knee flexion angle (KFA), along with a smaller degree of lumbar lordosis than the mild-OA group both pre- and postoperatively (all p < 0.05). Overall, the rate of radiographic ASD was observed to be higher in the severe-OA group than in the mild-OA group (p = 0.015). Patients with ASD in the severe-OA group exhibited significantly greater pelvic tilt, pre- and postoperatively, along with less lumbar lordosis, than the patients without ASD postoperatively (all p < 0.05).CONCLUSIONSA lack of lumbar lordosis caused by double-level listhesis and knee flexion contracture compensated for by far greater pelvic retroversion is experienced by elderly patients with DLS and severe KOA. Therefore, corrective lumbar surgery and knee arthroplasty may be considered to improve sagittal alignment, which may contribute to the prevention of ASD, resulting in favorable long-term surgical outcomes.
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Ruano, Jennifer S., Michael R. Sitler, and Jeffrey B. Driban. "Prevalence of Radiographic Knee Osteoarthritis After Anterior Cruciate Ligament Reconstruction, With or Without Meniscectomy: An Evidence-Based Practice Article." Journal of Athletic Training 52, no. 6 (June 1, 2017): 606–9. http://dx.doi.org/10.4085/1062-6050-51.2.14.
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Reference: Claes S, Hermie L, Verdonk R, Bellemans J, Verdonk P. Is osteoarthritis an inevitable consequence of anterior cruciate ligament reconstruction? A meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2013;21(9):1967–1976. Clinical Question: What is the prevalence of radiographic knee osteoarthritis (OA) at a mean follow-up equal to or greater than 10 years after autologous anterior cruciate ligament (ACL) reconstruction, with or without meniscectomy? Data Sources: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines were used to conduct this meta-analysis. Studies were identified by searching PubMed, MEDLINE, EMBASE, and Cochrane Library dating from their earliest file until October 2010. Key terms applied for searching were anterior cruciate ligament or ACL, autologous, follow-up, long-term, outcome, reconstruction, results, treatment, and (osteo)arthritis or osteoarthrosis. The reference lists of included studies were also manually checked to ensure that relevant articles were not omitted. Study Selection: The authors limited their search to English- and French-language journals. Included studies provided radiographic outcomes after autologous ACL reconstruction and had a mean follow-up of ≥10 years. Excluded studies evaluated ACL reconstruction with major concomitant surgical procedures (eg, meniscal allograft transplantation, high tibial osteotomy). In addition, data from 2 studies completed by the same research team with identical patient populations were limited to the article with the longest follow-up. Finally, manuscripts with inaccurate or incomplete data were excluded. Data Extraction: The following key characteristics of each study were extracted: type of study (prospective or retrospective); ACL surgical procedure (eg, open or arthroscopic bone-patellar tendon-bone graft); time frame of surgery; mean follow-up (in years) post–ACL reconstruction; total number of participants with radiographs; total number of participants with radiographic OA at follow-up; and number of participants with meniscectomy before, during, or after ACL reconstruction. Although the OA diagnosis was based on radiographic criteria, the included studies used 4 OA classifications and grading scales: Ahlbäck, Fairbanks, Kellgren and Lawrence, and International Knee Documentation Committee. Regardless of classification or grading scale, OA was defined as the presence of joint-space narrowing: Ahlbäck grades 1 through 5, modified Fairbanks grades 2 and 3, Kellgren and Lawrence ≥2, and International Knee Documentation Committee grades C and D. Tibiofemoral and patellofemoral OA data were collapsed due to the lack of reporting specificity among the studies. Participants were categorized into a meniscectomy or nonmeniscectomy group if this information was reported. Partial or total meniscectomies before, during, or after ACL reconstruction were collapsed regardless of location (medial or lateral compartment), and those patients who underwent a meniscal repair were grouped into the nonmeniscectomy group. Data were analyzed using odds ratios, the Cochran χ2 test, and a random-effects meta-regression analysis. The DerSimonian and Laird approach was used to assess study heterogeneity. P values below .05 were considered statistically significant. Main Results: The initial computerized database search resulted in 211 possible studies. However, after the authors applied the inclusionary and exclusionary criteria, only 16 studies were relevant. A total of 1554 participants were available at the follow-up period. Mean follow-up ranged from 10 to 24.5 years; 11 of the 16 articles had a mean follow-up between 10 and 12 years. Heterogeneity was large (I2 = 96%), which indicated that the included studies generated a wide range of knee OA prevalence (2%–79%). Almost 28% (95% confidence interval [CI] = 16.3%, 43.5%) of participants had radiographic knee OA. A total of 1264 participants were involved in studies that evaluated meniscectomies (n = 11). Among the 614 participants with either partial or total meniscectomies, 50.4% had radiographic knee OA (95% CI = 27.4%, 73.1%). In contrast, only 16.4% (95% CI = 7.0%, 33.9%) of those without a meniscectomy had radiographic knee OA. Conclusions: The findings of Claes et al reflected a radiographic knee OA prevalence at a minimum average of 10 years' postautologous ACL reconstruction that was lower than commonly perceived (up to 79%). In addition, meniscectomy was an important risk factor (3.54-fold increase) for developing OA after ACL reconstruction.
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Anitua, Eduardo, Mikel Sánchez, Maria de la Fuente, Juan Azofra, Mar Zalduendo, Jose J. Aguirre, and Isabel Andía. "Relationship between Investigative Biomarkers and Radiographic Grading in Patients with Knee Osteoarthritis." International Journal of Rheumatology 2009 (2009): 1–4. http://dx.doi.org/10.1155/2009/747432.
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Objective. To examine new investigative biomarkers and their relevance for radiographic severity in knee osteoarthritis.Methods. The group comprised 63 patients with 73 knees examined. Patients were divided according to radiographic severity to allow for comparison of biomarker levels. Hyaluronic acid (HA), matrix metalloproteases (MMP-1, MMP-3 and MMP-13), tissue inhibitors of metalloproteases (TIMP-1 and TIMP-2), platelet-derived growth factor (PDGF-AB), transformed growth factor (TGF-β), vascular endothelial growth factor (VEGF), hepatocyte growth factor (HGF) and insulin-like growth factor (IGF-I) were measured on synovial fluid and in plasma releasate at a single time point. Principal component analysis (PCA) followed by analysis of covariance were applied to evaluate data.Results. Four different groups of biomarker were identified in plasma releasates. The first (platelet number, PDGF-AB and TGF-β) and second groups (HA and IGF-I) were related to radiographic severity,P=.005andP=.022, respectively. The third (MMP-1 and TIMP-2) and fourth groups (MMP-3 and TIMP-1) represented the catabolic balance, but were not associated to radiographic grading. Three different clusters of biomarkers were found in synovial fluid but did not show any significant association to radiographic grading.Conclusions. New imaging approaches to assess structural deterioration and correlation with biomarker levels are warranted to advance in OA research.
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Letaeva, M. V., M. V. Koroleva, T. A. Raskina, O. S. Malyshenko, Yu V. Averkieva, and E. V. Usova. "Results of a prospective 6-year observational study of the efficacy and safety of a bioactive concentrate of small marine fish in senile patients with knee osteoarthritis and multimorbidity." Modern Rheumatology Journal 15, no. 4 (August 15, 2021): 56–62. http://dx.doi.org/10.14412/1996-7012-2021-4-56-62.
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Objective: to evaluate the efficacy and safety of Alflutop therapy in elderly patients (75–90 years old) with knee osteoarthritis (OA) and multimorbidity based on the results of a prospective 6-year follow-up.Patients and methods. The study included 38 elderly women with knee OA (according to ACR criteria, 1986) stage II–III by Kellgren–Lawrence grading system, with pain ≥40 mm by visual analogue scale (VAS), who needed to take non-steroidal anti-inflammatory drugs (NSAIDs). Alflutop was administered as 1 ml intramuscular injections 20 consecutive days with a 6-month interval (12 courses). The effectiveness of therapy was assessed by VAS, WOMAC index and EQ-5D questionnaire. The safety of therapy was monitored throughout the observation period. The duration of the study was 6 years.Results and discussion. The full course of treatment with Alflutop was completed by 29 (76.3%) patients. Nine (23.7%) patients discontinued the study due to their inability to visit the treatment center (for reasons unrelated to the study).In elderly patients with knee OA, high level of multimorbidity was revealed, 5 comorbidities on average.There was a significant decrease in pain according to VAS (≥20%): by visit (V) 1 – in 76.3%, by V2 – in 71.0%, by V3 – in 68.4%, by V4 – in 63.1% and by V5 – in 55.2% of patients. By the 21st day of Alflutop therapy, a statistically significant decrease in the total WOMAC index (p<0.001) and an improvement in the quality of life according to the EQ-5D questionnaire (p=0.016) were found. These indicators remained relatively stable throughout the follow-up. By the 12th month, a decrease of the need of NSAIDs was registered (p=0.005).X-ray progression of OA stage ≥1 according to Kellgren–Lawrence on Alflutop therapy after 36 months of observation was recorded in 10.5% of patients, after 72 months – in 50.0%. No serious adverse events were registered during entire observation period.Conclusion. The results of a 6-year prospective study demonstrate the high efficacy of Alflutop in elderly patients with knee OA. The obtained data confirm the safety of long-term treatment with this drug in elderly patients with high multimorbidity, which makes it the first-line drug in the complex therapy of OA.
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Everhart, Josh S., Morgan H. Jones, Sercan Yalcin, Emily K. Reinke, Laura J. Huston, Jack T. Andrish, Charles L. Cox, et al. "The Clinical Radiographic Incidence of Posttraumatic Osteoarthritis 10 Years After Anterior Cruciate Ligament Reconstruction: Data From the MOON Nested Cohort." American Journal of Sports Medicine 49, no. 5 (April 2021): 1251–61. http://dx.doi.org/10.1177/0363546521995182.
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Background: The incidence of posttraumatic osteoarthritis (PTOA) based on clinical radiographic grading criteria at 10 years after anterior cruciate ligament (ACL) reconstruction (ACLR) has not been well-defined in a prospective cohort of young athletic patients. Hypothesis: Among young athletic patients, there is a high incidence of clinical radiographic PTOA at 10 years after ACLR. Additionally, there is a significant difference in clinical radiographic osteoarthritis (OA) changes (joint space narrowing and osteophyte formation) between ACL-reconstructed and contralateral knees at 10 years. Study Design: Case series; Level of evidence, 4. Methods: The first 146 patients in an ongoing nested cohort study of the Multicenter Orthopaedic Outcomes Network (MOON) prospective cohort presented for a minimum 10-year follow-up. Included patients had a sports-related ACL injury, were aged <33 years at the time of ACLR, had no history of ipsilateral or contralateral knee surgery, and did not undergo revision ACLR before follow-up. Bilateral knee metatarsophalangeal view radiographs were obtained and graded according to International Knee Documentation Committee (IKDC), Osteoarthritis Research Society International (OARSI), and modified Kellgren-Lawrence (KL) criteria by 2 blinded reviewers. The incidence and severity of ipsilateral and contralateral radiographic OA were determined among patients without a contralateral ACL injury before 10-year follow-up (N = 133). Results: Interrater reliability was substantial for the IKDC (Gwet Agreement Coefficient [AC] 1 = 0.71), moderate for the KL (0.48), and almost perfect for the OARSI (0.84) grading systems. Among patients with a contralateral radiographically normal knee, the 10-year incidence of clinical radiographic PTOA after ACLR was 37% as defined by osteophytes and 23% as defined by joint space narrowing. The maximum side-to-side difference in the OARSI osteophyte grade in the medial or lateral compartment was 0 in 65% of patients, 1 in 20%, and ≥2 in 15%. The maximum side-to-side difference in the OARSI joint space narrowing grade was 0 in 77% of patients, 1 in 19%, and ≥2 in 4%. Conclusion: In young active patients, the 10-year incidence of clinical radiographic PTOA after ACLR was 37% as defined by osteophytes and 23% as defined by joint space narrowing. The mean difference in the degree of osteophyte formation (≤1 grade in 85%) and joint space narrowing (≤1 grade in 96%) between the ACL-reconstructed and contralateral knees was small. Registration: NCT02717559 (ClinicalTrials.gov identifier)
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Cakar, Murat, Semih Ayanoglu, Haluk Cabuk, Metin Seyran, Suleyman Semih Dedeoglu, and Hakan Gurbuz. "Association between vitamin D concentrations and knee pain in patients with osteoarthritis." PeerJ 6 (April 24, 2018): e4670. http://dx.doi.org/10.7717/peerj.4670.
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Objectives Osteoarthritis (OA) and vitamin D deficiency are common health conditions in older people. Whether vitamin D concentration is associated with knee OA is controversial. In this study, we aimed to determine the association between serum concentrations of vitamin D and osteoarthritic knee pain. Subjects and Methods Vitamin D concentrations were measured with the 25 hydroxyvitamin D test in patients presenting with clinical symptoms of primary knee osteoarthritis. Osteoarthritis was graded on the Kellgren-Lawrence grading scale from anteroposterior and lateral radiographs. Height, weight, and body mass index (BMI) were recorded. Patients completed a 10-cm visual analogue scale (VAS) for indicating pain and the Western Ontario and McMaster Universities Arthritis Index (WOMAC). Vitamin D concentration was defined as severely deficient (<10 ng/mL), insufficient (10 to 19 ng/mL), or normal (20 to 50 ng/mL). Results Of 149 patients (133 women), the mean age was 63.6 years. Mean vitamin D concentration was 11.53 ng/mL, and 90% patients were vitamin D deficient. Mean WOMAC score was 57.2, and VAS pain score was 7.5. Kellgren-Lawrence grade was 2 for 10 patients, grade 3 for 61, and grade 4 for 88. Mean BMI was 33.4. Mean values of VAS, WOMAC, and BMI did not differ by vitamin D status. Conclusion Serum vitamin D concentration is not associated with knee pain in patients with osteoarthritis.
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Çakar, Murat, Semih Ayanoğlu, Haluk Çabuk, Metin Seyran, Süleyman Semih Dedeoğlu, and Hakan Gürbüz. "Association between Vitamin D Concentrations and Knee Pain in Patients with Osteoarthritis." Orthopaedic Journal of Sports Medicine 5, no. 2_suppl2 (February 1, 2017): 2325967117S0008. http://dx.doi.org/10.1177/2325967117s00083.
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Objectives: Osteoarthritis (OA) and vitamin D deficiency are common health conditions in older people. Whether vitamin D concentration is associated with knee OA is controversial. In this study, we aimed to determine the association between serum concentrations of vitamin D and osteoarthritic knee pain. Subjects and Methods: Vitamin D concentrations were measured with the 25 hydroxyvitamin D test in patients presenting with clinical symptoms of primary knee osteoarthritis. Osteoarthritis was graded on the Kellgren-Lawrence grading scale from anteroposterior and lateral radiographs. Height, weight, and body mass index (BMI) were recorded. Patients completed a 10-cm visual analogue scale (VAS) for indicating pain and the Western Ontario and McMaster Universities Arthritis Index (WOMAC). Vitamin D concentration was defined as severely deficient (<10 ng/mL), insufficient (10 to 19 ng/mL), or normal (20 to 50ng/mL). Results: Of 149 patients (133 women) the mean age was 63.6 years. Mean vitamin D concentration was 11.53 ng/mL, and 90% patients were Vitamin D deficient. Mean WOMAC score was 57.2, and VAS pain score was 7.5. Kellgren-Lawrence grade was 2 for 10 patients grade 3 for 61, and grade 4 for 88. Mean BMI was 33.4. Mean values of VAS, WOMAC, and BMI did not differ by vitamin D status. Conclusion: Serum vitamin D concentration is not associated with knee pain in patients with osteoarthritis.
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Kang, J. H., S. E. Choi, H. Xu, D. J. Park, and S. S. Lee. "AB0867 INCREASED ADIPONECTIN LEVELS ARE ASSOCIATED WITH HIGHER RADIOGRAPHIC SCORES IN THE KNEE JOINT, BUT NOT IN THE HAND JOINT: THE DONG-GU STUDY." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 1740.1–1740. http://dx.doi.org/10.1136/annrheumdis-2020-eular.1677.
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Background:Several studies have evaluated the association between serum adiponectin levels and knee and hand osteoarthritis (OA), with mixed results.Objectives:The aim of this study was to investigate the relationship between OA and serum adiponectin levels according to the radiographic features of knee and hand OA.Methods:A total of 2,402 subjects were recruited from the Dong-gu Study. Baseline characteristics were collected via a questionnaire, and X-rays of knee and hand joints were scored by a semi-quantitative grading system. The relationship between serum adiponectin levels and radiographic severity was evaluated by linear regression analysis.Results:Subjects with higher tertiles of serum adiponectin were older and had a lower body mass index than those with lower tertiles. In the knee joint scores, serum adiponectin levels were positively associated with the total score (P<0.001), osteophyte score (P=0.003), and joint space narrowing (JSN) score (P<0.001) among the three tertiles after adjustment for age, sex, body mass index, smoking, alcohol consumption, education, and physical activity. In the hand joint scores, no association was found between serum adiponectin levels and the total score, osteophyte score, JSN score, subchondral cyst score, sclerosis score, erosion score, and malalignment score among the three tertiles after adjustment.Conclusion:In this study, we found that increased adiponectin levels were associated with higher radiographic scores in the knee joint, but not in the hand joint, suggesting different pathophysiologic mechanisms in the development of OA.Disclosure of Interests:None declared
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Apinun, Jirun, Panjana Sengprasert, Pongsak Yuktanandana, Srihatach Ngarmukos, Aree Tanavalee, and Rangsima Reantragoon. "Immune Mediators in Osteoarthritis: Infrapatellar Fat Pad-Infiltrating CD8+ T Cells Are Increased in Osteoarthritic Patients with Higher Clinical Radiographic Grading." International Journal of Rheumatology 2016 (2016): 1–8. http://dx.doi.org/10.1155/2016/9525724.
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Osteoarthritis is a condition of joint failure characterized by many pathologic changes of joint-surrounding tissues. Many evidences suggest the role of both innate and adaptive immunity that interplay, resulting either in initiation or in progression of osteoarthritis. Adaptive immune cells, in particular T cells, have been demonstrated to play a role in the development of OA in animal models. However, the underlying mechanism is yet unclear. Our aim was to correlate the frequency and phenotype of tissue-infiltrating T cells in the synovial tissue and infrapatellar fat pad with radiographic grading. Our results show that CD8+ T cells are increased in osteoarthritic patients with higher radiographic grading. When peripheral blood CD8+ T cells were examined, we show that CD8+ T cells possess a significantly higher level of activation than its CD4+ T cell counterpart (P<0.0001). Our results suggest a role for CD8+ T cells and recruitment of these activated circulating peripheral blood CD8+ T cells to the knee triggering local inflammation within the knee joint.
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Wesseling, Janet, Alex N. Bastick, Saskia ten Wolde, Margreet Kloppenburg, Floris P. J. G. Lafeber, Sita M. A. Bierma-Zeinstra, and Johannes W. J. Bijlsma. "Identifying Trajectories of Pain Severity in Early Symptomatic Knee Osteoarthritis: A 5-year Followup of the Cohort Hip and Cohort Knee (CHECK) Study." Journal of Rheumatology 42, no. 8 (July 1, 2015): 1470–77. http://dx.doi.org/10.3899/jrheum.141036.
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Objective.To identify subgroups of pain trajectories in patients with symptomatic knee osteoarthritis (OA), and to explain these different trajectories by patient characteristics, lifestyle, and coping factors, as well as radiographic features.Methods.Longitudinal data of pain severity (0–10) from 5 years of followup of the CHECK (Cohort Hip and Cohort Knee) study was used. Latent class growth analysis identified homogeneous subgroups with distinct trajectories of pain. Multinomial regression analysis was used to examine different lifestyle and coping characteristics between the trajectories.Results.In longitudinal pain data of 5 years of followup in 705 participants, 3 pain trajectories were identified: marginal, mild, and moderate pain trajectories. Compared with the marginal pain trajectory, the mild and moderate pain trajectories can be characterized by the following baseline variables: body mass index (BMI) > 25, additional hip pain, low education level, using the coping strategy “worrying,” and having ≥ 3 comorbidities. Moderate pain trajectory can be supplemented with the Kellgren-Lawrence grading scale grade ≥ 2 radiological change.Conclusion.Three trajectories of pain were identified. Participants with a BMI > 25, secondary school as highest education level, having at least 3 comorbidities, additional hip pain, and/or whose coping style is worrying are more likely to develop a moderate or mild pain trajectory compared with those without these characteristics. In the management of knee pain in people with early symptomatic OA, attention should also be given to additional factors such as hip pain, other comorbidities, passive coping strategy, and obesity.
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Brem, M. H., P. M. Schlechtweg, J. Bhagwat, M. Genovese, M. F. Dillingham, H. Yoshioka, and P. Lang. "Longitudinal evaluation of the occurrence of MRI-detectable bone marrow edema in osteoarthritis of the knee." Acta Radiologica 49, no. 9 (November 2008): 1031–37. http://dx.doi.org/10.1080/02841850802339413.
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Background: Bone marrow edema (BME) is a condition detectable with magnetic resonance imaging (MRI) and is present in different stages of osteoarthritis (OA). Its pathogenesis is still not completely known. Purpose: To evaluate the longitudinal occurrence and persistence of BME in early OA of the knee. Material and Methods: Twenty-three patients (eight females, 15 males; mean age 55.5±10.3 years) were scanned with a 1.5T MR imaging unit (sagittal fat-suppressed intermediate-weighted fast spin echo; 4-mm section thickness, 1-mm intersection gap, 256x192 matrix, 120-mm field of view). Images were obtained in all 23 patients at two time points (TPs) and in 12 patients at three TPs. Images were evaluated by two readers independently; discrepancies in image grading were reviewed and evaluated in consensus. A four-point image-grading scale was used (absence of BME to severe BME). Four main anatomical regions were evaluated (medial femur, lateral femur, medial tibia, lateral tibia), which were subcategorized into anterior, central, and posterior regions. Results: One hundred five areas of BME in the 23 patients were found at all three TPs. In 16 areas, the BME was consistent at the same location over time, in seven locations the BME became larger, in six areas the BME became smaller, and in 16 locations it could not be detected in follow-up MRIs. In one case, the BME was smaller at TP2 but increased at TP3. In eight cases, only at the last time point could a BME be detected. Conclusion: BME is not a static phenomenon but changes over time. Correlation to physical activity and local inflammatory reaction should be evaluated.
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Minas, Tom, Takahiro Ogura, Jeff Headrick, and Tim Bryant. "Autologous Chondrocyte Implantation “Sandwich” Technique Compared With Autologous Bone Grafting for Deep Osteochondral Lesions in the Knee." American Journal of Sports Medicine 46, no. 2 (November 10, 2017): 322–32. http://dx.doi.org/10.1177/0363546517738000.
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Background: Treating symptomatic osteochondral defects is challenging, especially in young adults with deep (>8-10 mm) empty defects after osteochondritis dissecans (OCD) or collapsed condyles secondary to avascular necrosis (AVN). For this population, osteoarthritis (OA) is inevitable if articular congruence is not restored. Purpose: To describe the autologous chondrocyte implantation (ACI) “sandwich” technique with autologous bone grafting (ABG) and compare it with ABG alone for restoration of the osteochondral unit. The midterm to long-term outcomes in patients after the treatment for OCD and AVN will be reported and compared. Study Design: Cohort study; Level of evidence, 3. Methods: The outcomes for a consecutive cohort of 24 patients who underwent combined ABG with the ACI sandwich technique between 2001 and 2013 (ACI sandwich group) was compared with a historical control group of 17 consecutive patients who underwent ABG alone between 1995 and 2002 (ABG group) by a single surgeon for symptomatic deep (>8 mm) osteochondral lesions. Patients who were followed up with a minimum of 2 years were included in this study. The modified Cincinnati Knee Rating System, the Western Ontario and McMaster Universities Osteoarthritis Index, a visual analog scale (VAS), the Short Form–36, and a patient satisfaction survey were used to evaluate clinical outcomes. Survival analysis was performed using the Kaplan-Meier method, with no clinical improvement, graft failure, or conversion to prosthetic arthroplasty as the endpoint (failure). Kellgren-Lawrence (K-L) grading to assess OA progression was also performed. Results: In the ABG group, 13 of 17 patients (76%) were available with a mean follow-up of 15.7 years postoperatively (range, 5-21 years). In the ACI sandwich group, all 24 patients were available with a mean follow-up of 7.8 years postoperatively (range, 2-15 years). No significant differences were observed between the groups in terms of age, sex, side of the operated knee, body mass index, lesion type, lesion size, lesion depth, lesion location, or the need for realignment osteotomy. Eight patients (62%) were considered failures in the ABG group, while 3 patients (13%) were considered failures in the ACI sandwich group. The survival rate was significantly better in the ACI sandwich group than the ABG group (87% vs 54% at 5 years, respectively; P = .0025). All functional scores in patients with retained grafts significantly improved in the ACI sandwich group, whereas only the VAS score showed significant improvement in the ABG group. The patient satisfaction survey showed a very high satisfaction rate in the ACI sandwich group, with over 90% of patients reporting their knees as good or excellent and being satisfied with the procedure. In the ACI sandwich group, K-L grading demonstrated no significant OA progression from preoperatively to a mean 5.1 years postoperatively. Conclusion: Our study showed that the ACI sandwich technique provided excellent and superior survival rates compared to ABG alone and significant improvements over midterm to long-term follow-up. This unique treatment offers native joint preservation for conditions that naturally will progress to OA and eventually require prosthetic arthroplasty.
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Bai, Hui, Zhiheng Zhang, Yue Li, Xiaopeng Song, Tianwen Ma, Chunpeng Liu, Lin Liu, Rui Yuan, Xinyu Wang, and Li Gao. "L-Theanine Reduced the Development of Knee Osteoarthritis in Rats via Its Anti-Inflammation and Anti-Matrix Degradation Actions: In Vivo and In Vitro Study." Nutrients 12, no. 7 (July 3, 2020): 1988. http://dx.doi.org/10.3390/nu12071988.
Full textAbstract:
The etiology of osteoarthritis (OA) is multifactorial, with no effective disease-modifying-drugs. L-theanine has been reported to inhibit inflammatory responses in some diseases and this study aimed to investigate the effect of L-theanine on Interleukin-1(IL-1)β-stimulated chondrocytes, and in an injury-induced OA rat model. Primary chondrocytes were stimulated by IL-1β (10 ng/mL) for 24 h and then co-cultured with L-theanine for 24 h. The effects of L-theanine on IL-1β-stimulated expression of pro-inflammatory cytokines and hydrolytic enzyme were analyzed using Western blotting, quantitative polymerase chain reaction (q-PCR) and enzyme-linked immunosorbent assay (ELISA) kits. An immunofluorescence assay was used to detect nuclear factor kappa B (NF-κB) phosphorylation. OA was induced by anterior cruciate ligament transection (ACLT) surgery in rats and celecoxib was used as a positive control. OA severity was measured using the Osteoarthritis Research Society International (OARSI) grading system to describe histological changes. The results showed that L-theanine decreased the expression of pro-inflammatory mediators, including cyclooxygenase-2 (COX-2), prostaglandin E2 (PGE-2), inducible nitric oxide synthase (iNOS), and nitric oxide (NO), both in vivo and in vitro. L-theanine treatment inhibited IL-1β-induced upregulation of matrix metalloproteinases (MMP)-3 and MMP-13, as well as inhibited NF-κB p65 activation. In vivo animal model showed that L-theanine administration (200 mg/kg) significantly alleviated OA lesions and decreased OARSI score. Our data indicated that L-theanine decreased inflammatory cytokines and protected extracellular matrix degradation through inhibition of the NF-κB pathway, and L-theanine may be considered a promising therapeutic strategy in OA prevention.
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Kim, Man Soo, In Jun Koh, Keun Young Choi, Yong Gyu Sung, Dong Chul Park, Hyo Jin Lee, and Yong In. "The Minimal Clinically Important Difference (MCID) for the WOMAC and Factors Related to Achievement of the MCID After Medial Opening Wedge High Tibial Osteotomy for Knee Osteoarthritis." American Journal of Sports Medicine 49, no. 9 (June 11, 2021): 2406–15. http://dx.doi.org/10.1177/03635465211016853.
Full textAbstract:
Background: Many approaches have been used to determine the minimal clinically important difference (MCID) in patients undergoing total knee arthroplasty, but the MCID for outcome measures after medial opening wedge high tibial osteotomy (MOWHTO) for the treatment of medial compartment knee osteoarthritis (OA) has not been reported. Purpose: To define the MCID for the Western Ontario and McMaster Universities Arthritis Index (WOMAC) after MOWHTO and to identify risk factors for not achieving the MCID. Study Design: Case-control study; Level of evidence, 3. Methods: Among patients with medial compartment knee OA who underwent MOWHTO, 174 patients who were followed for 2 years were included in the study. The MCID and substantial clinical benefit (SCB) for the WOMAC were determined using the anchor-based method with a 15-item questionnaire. Preoperative OA severity was measured by the Kellgren-Lawrence (K-L) grading system, and the acceptable range of the postoperative weightbearing line ratio was 50% to 70%. Patients were divided into 2 groups based on whether the MCID and SCB were achieved, and then factors related to failure to achieve the MCID and SCB were analyzed using multivariate logistic regression analysis. Results: The MCID for the WOMAC was 4.2 points for the pain subscale, 1.9 points for the stiffness subscale, 10.1 points for the function subscale, and 16.1 points for the total. Additionally, the SCB for the WOMAC was 6.4 for pain, 2.6 for stiffness, 16.4 for function, and 25.3 for the total. Overall, 116 (66.7%), 99 (56.9%), 127 (73.0%), and 128 (73.6%) patients achieved the MCID for the WOMAC pain, stiffness, function, and total, respectively, after MOWHTO. The odds of not achieving the MCID for the WOMAC total were 1.09 times greater (95% CI, 1.05-1.13; P < .001) in patients with a low preoperative WOMAC total score (cutoff values: 10.5 for pain, 3.5 for stiffness, 34.5 for function, and 51.0 for the total), 11.77 times greater (95% CI, 3.68-37.70; P < .001) in patients with K-L grade 4 OA compared with K-L grades 2 or 3 OA, and 8.39 times greater (95% CI, 2.98-23.63; P < .001) in patients with undercorrection or overcorrection. A low preoperative WOMAC score, K-L grade 4 OA, and undercorrection or overcorrection were also associated with not achieving the SCB for the WOMAC total (all P < .05). Conclusion: Patients treated with a MOWHTO require a 16.1-point improvement in the WOMAC total score to achieve a MCID from the procedure. Low preoperative WOMAC scores, severe OA, and undercorrection or overcorrection were related to failure to achieve the MCID.