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1
Ozaki, Yusuke, Ryota Hara, Kensuke Okamura, et al. "Correlation between varus-type knee osteoarthritis severity and hindfoot alignment: Analysis of radiographs in the long-leg weight-bearing anteroposterior view." PLOS One 20, no. 6 (2025): e0324974. https://doi.org/10.1371/journal.pone.0324974.
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Background In knee osteoarthritis, the subtalar joint undergoes valgus and varus contractions to compensate for deformities in the knee joint. In this cross-sectional study, we investigated the relationship between varus-type knee osteoarthritis severity and hindfoot alignment severity by concurrently assessing varus-type knee osteoarthritis severity and hindfoot alignment using radiographs in the long-leg weight-bearing anteroposterior view. Patients and methods A total of 114 patients with knee osteoarthritis graded Kellgren–Lawrence II or higher (128 knees) and 30 healthy controls (31 knees) underwent long-leg weight-bearing anteroposterior imaging for 1 year. Four angles were measured on radiographs in the long-leg weight-bearing anteroposterior view: the femorotibial angle; tibial calcaneal angle; tibial anterior surface angle; and talocrural joint angle between the tibial plafond and talar dome on weight-bearing. Group comparisons were conducted for each Kellgren–Lawrence classification, which was used to classify the severity of knee osteoarthritis at each measured angle. One-way analysis of variance was used to test the results. Results The mean tibial calcaneal angles were 9.7°, 11.3°, 8.8°, and 9.8° in controls and in patients with Kellgren–Lawrence grades II, III, and IV, respectively (p < 0.05). The mean femorotibial angles were 175.6°, 176.8°, 180.3°, and 186.2° in controls and in patients with Kellgren–Lawrence grades II, III, and IV, respectively (p < 0.05). On weight-bearing, the tibial anterior surface angle and the talocrural joint angle between the tibial plafond and talar dome varied according to severity level. Conclusion In varus-type knee osteoarthritis cases, defined in accordance with the Kellgren–Lawrence classification, hindfoot alignment leaned toward valgus. As the severity of knee osteoarthritis progressed, the valgus of the hindfoot alignment reduced. While future longitudinal analyses are necessary, these observations indicate both potential compensatory changes and their limitations in varus-type knee osteoarthritis.
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Moon, Ki-Ho. "New View on the Initial Development Site and Radiographic Classification System of Osteoarthritis of the Knee Based on Radiographic Analysis." International Journal of Biomedical Science 8, no. 4 (2012): 233–43. http://dx.doi.org/10.59566/ijbs.2012.8233.
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ntroduction: Radiographic pathology of severe osteoarthritis of the knee (OAK) such as severe osteophyte at tibial spine (TS), compartment narrowing, marginal osteophyte, and subchondral sclerosis is well known. Kellgren-Lawrence grading system, which is widely used to diagnose OAK, describes narrowing-marginal osteophyte in 4-grades but uses osteophyte at TS only as evidence of OAK without detailed-grading. However, kinematically the knee employs medial TS as an axis while medial and lateral compartments carry the load, suggesting that early OAK would occur sooner at TS than at compartment. Then, Kellgren-Lawrence system may be inadequate to diagnose early-stage OAK manifested as a subtle osteophyte at TS without narrowing-marginal osteophyte. This undiagnosed-OAK will deteriorate becoming a contributing factor in an increasing incidence of OAK. Methods: This study developed a radiographic OAK-marker based on both osteophyte at TS and compartment narrowing-marginal osteophyte and graded as normal, mild, moderate, and severe. With this marker, both knee radiographs of 1,728 patients with knee pain were analyzed.Results: Among 611 early-stage mild OAK, 562 or 92% started at TS and 49 or 8% at compartment. It suggests the initial development site of OAK, helping develop new site-specific radiographic classification system of OAK accurately to diagnose all severity of OAK at early, intermediate, or late-stage. It showed that Kellgren-Lawrence system missed 92.0% of early-stage mild OAK from diagnosis. Conclusions: A subtle osteophyte at TS is the earliest radiographic sign of OAK. A new radiographic classification system of OAK was suggested for accurate diagnosis of all OAK in severity and at stage.
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Mahum, Rabbia, Saeed Ur Rehman, Talha Meraj, et al. "A Novel Hybrid Approach Based on Deep CNN Features to Detect Knee Osteoarthritis." Sensors 21, no. 18 (2021): 6189. http://dx.doi.org/10.3390/s21186189.
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In the recent era, various diseases have severely affected the lifestyle of individuals, especially adults. Among these, bone diseases, including Knee Osteoarthritis (KOA), have a great impact on quality of life. KOA is a knee joint problem mainly produced due to decreased Articular Cartilage between femur and tibia bones, producing severe joint pain, effusion, joint movement constraints and gait anomalies. To address these issues, this study presents a novel KOA detection at early stages using deep learning-based feature extraction and classification. Firstly, the input X-ray images are preprocessed, and then the Region of Interest (ROI) is extracted through segmentation. Secondly, features are extracted from preprocessed X-ray images containing knee joint space width using hybrid feature descriptors such as Convolutional Neural Network (CNN) through Local Binary Patterns (LBP) and CNN using Histogram of oriented gradient (HOG). Low-level features are computed by HOG, while texture features are computed employing the LBP descriptor. Lastly, multi-class classifiers, that is, Support Vector Machine (SVM), Random Forest (RF), and K-Nearest Neighbour (KNN), are used for the classification of KOA according to the Kellgren–Lawrence (KL) system. The Kellgren–Lawrence system consists of Grade I, Grade II, Grade III, and Grade IV. Experimental evaluation is performed on various combinations of the proposed framework. The experimental results show that the HOG features descriptor provides approximately 97% accuracy for the early detection and classification of KOA for all four grades of KL.
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Umesh, Hengaju. "Classification of Knee Osteoarthritis using CNN." Advancement in Image Processing and Pattern Recognition 5, no. 1 (2022): 1–14. https://doi.org/10.5281/zenodo.6491218.
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<em>Knee osteoarthritis (OA) is a joint disease which is globally common in elder people. It is typically the result of wear and tear and progressive loss of articular cartilage. It has no cure. Despite of its high prevalence, there is a lack of diagnostic tools and approaches that detects and classifies the different stages of Knee OA severalties with better precision. This paper presents the approaches to automatically quantify the severity of knee OA using X-ray images. Two of the CNN classifiers namely, VGG-15 and ResNet-32 have been used for classifying the knee OA severity into one of the 5 Kellgren-Lawrence classification grades (normal, doubtful, mild, moderate and severe). These models have been trained using loss function: ‘categorical cross entropy’ and optimizer ‘Adam’. The datasets used in this work has been collected from Bhaktapur Hospital. About 350 X-ray images were collected and manually classified into their KL grades and then they were used for testing as well as training the models. The test results shows that the accuracy of classifying knee OA severities with VGG-16 and ResNet-32 were 59% and 57% respectively. It seemed that the accuracy of VGG-16 model is better than ResNet-32 in quantifying knee OA severity. </em>
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Yamada, Junichi, Koji Akeda, Norihiko Takegami, Tatsuhiko Fujiwara, Akinobu Nishimura, and Akihiro Sudo. "Novel elemental grading system for radiographic lumbar spondylosis in a population based-cohort study of a Japanese mountain village." PLOS ONE 17, no. 6 (2022): e0270282. http://dx.doi.org/10.1371/journal.pone.0270282.
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Purpose Lumbar radiography is a primary screening tool for lumbar spondylosis (LS). Kellgren-Lawrence (KL) classification is widely used to evaluate LS; however, it cannot individually evaluate each radiographic feature. The purpose of this study was to 1) evaluate radiographic LS using a novel elemental grading system and 2) investigate the relationship between the grades of radiographic LS and low back pain (LBP) in a population-based cohort study. Methods A total of 260 (75 men, 185 women; mean age, 71.5 ± 8.7 years) participants were included in this study. Participants were divided into two groups according to the presence of LBP (LBP- and LBP+ groups). Radiographic features, including osteophyte (OP), disc height narrowing (DHN), vertebral sclerosis (VS), and spondylolisthesis (SL), were classified between grades of 0–2 grades according to the extent of radiographic changes. The sum of grades at each intervertebral level was designated as the intervertebral grade (IG). Results Intra- and inter-observer reliability (kappa coefficient) of OP, DHN, VS, and SL were 0.82–0.92. OP, DHN, VS, and IG grades were significantly higher in the LBP+ group than in the LBP- group. There were no significant differences in KL grades between the LBP- and LBP+ groups. Logistic regression analysis demonstrated that VS grade was a significant independent factor associated with LBP. Conclusion The novel elemental grading system of LS would reflect LBP more accurately than the KL classification by individually evaluating each radiographic feature.
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Bhateja, Vikrant, Yatndeep Dubey, Navaneet Maurya, et al. "Ensemble CNN Model for Computer-Aided Knee Osteoarthritis Diagnosis." International Journal of Service Science, Management, Engineering, and Technology 15, no. 1 (2024): 1–17. http://dx.doi.org/10.4018/ijssmet.349913.
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Osteoarthritis (OA) is a multifaceted ailment posing challenges in its diagnosis and treatment due to the intricate nature of the disease. Particularly, Knee Osteoarthritis (KOA) significantly impacts the knee joint, manifesting through symptoms such as pain, stiffness, and limited movement. Despite its prevalence and debilitating effects, early detection of KOA remains elusive, often hindered by subjective diagnostic methods and the absence of reliable biomarkers. This research aims to address these challenges by leveraging deep learning techniques and ensemble methodologies for accurate KOA classification using knee X-ray images. This paper utilized a dataset sourced from the Osteoarthritis Initiative (OAI), comprising a large collection of knee X-ray images graded according to the Kellgren-Lawrence (KL) grading system. The proposed design methodology involves preprocessing the input X-ray images and training multiple pre-trained Convolutional Neural Network (CNN) models, including ResNet50, InceptionResNetV2, and Xception to classify KOA severity grades. Additionally, this work introduced an ensemble model by combining predictions from these base models to improve overall performance of the Computer-Aided Diagnosis (CAD) system. The obtained results demonstrate the effectiveness of the ensemble approach, outperforming individual algorithms in terms of accuracy, precision, recall, F1-score, and balanced accuracy. However, challenges persist in accurately distinguishing between adjacent KL grades, particularly grades#1 and #2, highlighting the need for further refinement. Notably, the proposed CAD model showcases superior predictive accuracy compared to various state-of-art methods, offering a promising avenue for early KOA diagnosis and personalized treatment strategies.
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Boldbayar, Tuvshinjargal, Baatarjav Sosor, Otgonbayar Maidar, Sergelen Orgoi, and Munkhbaatar Dagvasumberel. "Mid-Term Results of High Tibial Osteotomy Regarding From Grades of Knee Osteoarthritis." Central Asian Journal of Medical Sciences 8, no. 2 (2022): 90–101. http://dx.doi.org/10.24079/cajms.2022.06.003.
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Objectives: The number of high tibial osteotomy (HTO) has significantly increased in Mongolia, however, researchers are still debating about the impact of severity of knee osteoarthritis on the outcome of high tibial osteotomy. The purpose of our study is to report the mid-term results of HTO for knee osteoarthritis according to the Kellgren Lawrence classification. Methods: A total of 100 patients who underwent high tibial osteotomy for knee osteoarthritis from October 2019 to June 2020 at the Joint Center of the First Central Hospital of Mongolia participated in this study. Outcome evaluation of the participants was accomplished at baseline, at 2 months, 6 months, 8 months and 18 months post-operatively. Results: Lateral closing wedge HTO was performed in 54.2 % of patients who had 1st grade deformity and 55.9 % of patients who had 2nd grade deformity. On the other hand, medial opening wedge HTO was performed in 3rd grade patients compared to other grades. WBL was 11.43 ± 8.22 at preoperative, and increased to 56.31 ± 4.52 after 12 months of the surgery in 3rd grade. The total WBL was improved from 20.54 ± 12.57 to 57.24 ± 3.69 after two months of surgery and 57.89 ± 4.17 after 12 months. Conclusion: Our study showed that the severity of knee osteoarthritis had impact on outcome of high tibial osteotomy.
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Tsukamoto, Hiroaki, Kimio Saito, Hidetomo Saito, et al. "A Novel Classification of Coronal Plane Knee Joint Instability Using Nine-Axis Inertial Measurement Units in Patients with Medial Knee Osteoarthritis." Sensors 23, no. 5 (2023): 2797. http://dx.doi.org/10.3390/s23052797.
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The purpose of this study was to propose a novel classification of varus thrust based on gait analysis with inertial motion sensor units (IMUs) in patients with medial knee osteoarthritis (MKOA). We investigated thigh and shank acceleration using a nine-axis IMU in 69 knees with MKOA and 24 (control) knees. We classified varus thrust into four phenotypes according to the relative medial–lateral acceleration vector patterns of the thigh and shank segments: pattern A (thigh medial, shank medial), pattern B (medial, lateral), pattern C (lateral, medial), and pattern D (lateral, lateral). Quantitative varus thrust was calculated using an extended Kalman filter-based algorithm. We compared the differences between our proposed IMU classification and the Kellgren–Lawrence (KL) grades for quantitative varus thrust and visible varus thrust. Most of the varus thrust was not visually perceptible in early-stage OA. In advanced MKOA, increased proportions of patterns C and D with lateral thigh acceleration were observed. Quantitative varus thrust was significantly increased stepwise from patterns A to D. This novel IMU classification has better clinical utility due to its ability to detect subtle kinematic changes that cannot be captured with conventional motion analysis even in the early stage of MKOA.
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Mohammed, Abdul Sami, Ahmed Abul Hasanaath, Ghazanfar Latif, and Abul Bashar. "Knee Osteoarthritis Detection and Severity Classification Using Residual Neural Networks on Preprocessed X-ray Images." Diagnostics 13, no. 8 (2023): 1380. http://dx.doi.org/10.3390/diagnostics13081380.
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One of the most common and challenging medical conditions to deal with in old-aged people is the occurrence of knee osteoarthritis (KOA). Manual diagnosis of this disease involves observing X-ray images of the knee area and classifying it under five grades using the Kellgren–Lawrence (KL) system. This requires the physician’s expertise, suitable experience, and a lot of time, and even after that the diagnosis can be prone to errors. Therefore, researchers in the ML/DL domain have employed the capabilities of deep neural network (DNN) models to identify and classify KOA images in an automated, faster, and accurate manner. To this end, we propose the application of six pretrained DNN models, namely, VGG16, VGG19, ResNet101, MobileNetV2, InceptionResNetV2, and DenseNet121 for KOA diagnosis using images obtained from the Osteoarthritis Initiative (OAI) dataset. More specifically, we perform two types of classification, namely, a binary classification, which detects the presence or absence of KOA and secondly, classifying the severity of KOA in a three-class classification. For a comparative analysis, we experiment on three datasets (Dataset I, Dataset II, and Dataset III) with five, two, and three classes of KOA images, respectively. We achieved maximum classification accuracies of 69%, 83%, and 89%, respectively, with the ResNet101 DNN model. Our results show an improved performance from the existing work in the literature.
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Ishii, Yoshinori, Hideo Noguchi, Junko Sato, Hana Ishii, Ryo Ishii, and Shin-ichi Toyabe. "Knee Osteoarthritis Grade Does Not Correlate with Quadriceps Muscle Strength or Bone Properties of the Calcaneus in Men Aged 80 Years or More Who Can Walk Independently." International Journal of Environmental Research and Public Health 17, no. 5 (2020): 1709. http://dx.doi.org/10.3390/ijerph17051709.
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Purpose: Muscle weakness and bone deterioration in the elderly are related to falls and fractures, resulting in decreased mobility. Knee osteoarthritis also may contribute to falls and fractures and thereby affect mortality rates. The Kellgren–Lawrence (KL) classification is widely used in the radiographic evaluation of knee osteoarthritis. Aims: This study aimed to evaluate the quadriceps strength and bone properties of the calcaneus for each KL grade, and to clarify the impact of knee osteoarthritis grade on quadriceps strength and bone properties. Methods: This prospective cross-sectional study included data on 108 male patients (213 knees), aged ≥80 years, who could walk independently. A handheld dynamometer was used to measure quadriceps strength. Bone properties were evaluated using broadband ultrasound attenuation with a portable bone densitometer. Weight-bearing standing knee radiographs were evaluated using KL classification. Quadriceps strength and bone properties were evaluated for each KL grade and the correlations between the grade and quadriceps strength and bone properties were assessed simultaneously. Results: The numbers of participants in KL grades I–IV were 46, 102, 45, and 20, respectively. There were no differences among grades for either quadriceps strength or bone properties. Conclusions: Participants exhibited good quadriceps strength and bone properties regardless of their KL grade. Relatively high mechanical loading of muscle and bone incurred while walking independently, likely explaining this result. Clinically, this study demonstrated the absence of correlations between KL grade and quadriceps strength and bone properties, as was previously reported in studies showing the absence of a correlation between KL grade and pain.
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Choi, Joo Chan, Min Young Jeong, Young Jae Kim, and Kwang Gi Kim. "Artificial Intelligence Model Assists Knee Osteoarthritis Diagnosis via Determination of K-L Grade." Diagnostics 15, no. 10 (2025): 1220. https://doi.org/10.3390/diagnostics15101220.
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Background: Knee osteoarthritis (KOA) affects 37% of individuals aged ≥ 60 years in the national health survey, causing pain, discomfort, and reduced functional independence. Methods: This study aims to automate the assessment of KOA severity by training deep learning models using the Kellgren–Lawrence grading system (class 0~4). A total of 15,000 images were used, with 3000 images collected for each grade. The learning models utilized were DenseNet201, ResNet101, and EfficientNetV2, and their performance in lesion classification was evaluated and compared. Statistical metrics, including accuracy, precision, recall, and F1-score, were employed to assess the feasibility of applying deep learning models for KOA classification. Results: Among these four metrics, DenseNet201 achieved the highest performance, while the ResNet101 model recorded the lowest. DenseNet201 demonstrated the best performance with an overall accuracy of 73%. The model’s accuracy by K-L grade was 80.7% for K-L Grade 0, 53.7% for K-L Grade 1, 72.7% for K-L Grade 2, 75.3% for K-L Grade 3, and 82.7% for K-L Grade 4. The model achieved a precision of 73.2%, a recall of 73%, and an F1-score of 72.7%. Conclusions: These results highlight the potential of deep learning models for assisting specialists in diagnosing the severity of KOA by automatically assigning K-L grades to patient data.
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Ravindra D. Kale. "A Robust Pre-processing Framework for ROI Extraction in Knee Osteoarthritis X-Ray Analysis." Communications on Applied Nonlinear Analysis 32, no. 5s (2024): 401–17. https://doi.org/10.52783/cana.v32.3110.
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Medical image processing depends much on pre-processing, particularly in cases of precise categorisation and prediction—like those involving the diagnosis of osteoarthritis (OA) in the knee. This work presents a rapid and simple approach to get the area of interest (ROI) from knee X-ray images such that the Kellgren and Lawrence (KL) technique may be used for accurate grading. By means of a planned approach including Gaussian blurring, thresholding, and sophisticated statistical and wavelet-based algorithms for finetuning characteristics, the system addresses issues like noise, poor contrast, and uneven illumination. The recommended approach divides the knee joint, eliminates regions not required, and enhances the view of crucial diagnostic elements like the gap between the upper and lower knee bones. It makes separating ROIs for all five KL grades—from healthy knees to severe OA cases—simple. With more than 8,000 X-ray images in the Kaggle knee OA dataset, the research ensures system dependability and applicability in various contexts. The method significantly increases the precision of ROI segmentation, thereby enhancing the feature extraction for next classification projects. While eliminating uncertainty, the separated ROIs maintain crucial characteristics and help to distinctly differentiate KL grades. Though it might function even better with future developments like adding more sophisticated brightness control and noise reduction techniques, the framework performs effectively in many different image settings. The foundation for automated OA detection is laid by this study. It closes the distance between the limitations of imaging and clinical requirements. It also guides the direction of medical image processing forward.
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Karaman, Nazlı, Aslıhan Ulusoy, and Mehmet Karaman. "Is there a relationship between blood inflammation markers and the severity of knee osteoarthritis?" Turkish Journal of Physical Medicine and Rehabilitation 71, no. 1 (2024): 102–8. https://doi.org/10.5606/tftrd.2024.14862.
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Objectives: This study aims to evaluate the monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR), plateletto-lymphocyte ratio (PLR), and C-reactive protein (CRP)-to-albumin ratio levels between individuals with mild to moderate knee osteoarthritis (OA) and those with severe knee OA. Patients and methods: One hundred eighty-two participants (131 females, 51 males; mean age: 67.7±10.2 years; range, 43 to 91 years) affected by knee OA were involved in the cross-sectional retrospective study between January 2018 and January 2021. Kellgren and Lawrence (K-L) classification was performed in accordance with two-view (lateral and anteroposterior) plain radiograph examinations of each knee. The patients were grouped as follows: 98 patients had mild to moderate knee OA (K-L Grades 1-2), and 84 had severe knee OA (K-L Grades 3-4). Demographic data, neutrophil, monocyte, platelet, and lymphocyte levels, erythrocyte sedimentation rate, albumin, and CRP levels were documented. C-reactive protein-to-albumin ratio, NLR, MLR, and PLR levels were calculated. Results: The MLR was significantly elevated in the severe knee OA group (p=0.047). A significant positive relationship was found with disease stage, MLR (r=0.206; p=0.005), and NLR levels (r=0.158; p=0.033). Receiver operating characteristic curve analyses for blood MLR demonstrated a sensitivity of 57% and specificity of 60%. Conclusion: The study results suggest that while MLR and NLR may reflect the inflammatory response in knee OA, they are not highly diagnostic inflammatory markers that can be used to evaluate the severity or prognosis of the disease.
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Abraham, Paul F., Nathan H. Varady, Kirstin M. Small, et al. "Safety of Intra-articular Hip Corticosteroid Injections: A Matched-Pair Cohort Study." Orthopaedic Journal of Sports Medicine 9, no. 10 (2021): 232596712110350. http://dx.doi.org/10.1177/23259671211035099.
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Background: Recent studies have suggested there is an increased risk of avascular necrosis (AVN), subchondral insufficiency fracture (SIF), femoral head collapse, and osteoarthritis (OA) progression in the 12-month period after hip corticosteroid/anesthetic injection (CSI); however, these studies have failed to account for preinjection OA severity or preexisting AVN/SIF. Purpose: To compare these complication rates in patients treated with versus without hip CSI, while minimizing the aforementioned forms of selection bias present in previous investigations. Study Design: Cohort study; Level of evidence, 3. Methods: For all patients who had undergone a single hip CSI and hip magnetic resonance imaging (MRI) within the preceding 12 months at a single institution (CSI cohort), 2 musculoskeletal radiologists retrospectively graded OA severity (modified Kellgren-Lawrence classification) and femoral head collapse on hip radiographs taken within 12 months before, and 1 to 12 months after, CSI. Using identical methodology, radiographs from a control cohort (composed of hips that had never undergone CSI and had undergone hip MRI with hip radiographs taken within 12 months before, and 1-12 months after, MRI) were also graded. The cohorts were matched for age, sex, body mass index, and OA severity. Readers were blinded to cohort and time point. OA progression was defined as an increase in modified Kellgren-Lawrence grade ≥1 between radiographs. Results: Included were 141 matched pairs. After exclusion of 48 matched pairs with at least 1 incidence of preexisting AVN or SIF on index MRI, CSI (n = 93; mean time between CSI and final hip radiograph, 5.43 months) and control (n = 93; mean time between MRI and final hip radiograph, 4.87 months), groups did not significantly differ in rates of OA progression (3.2% vs 3.2%) or new femoral head collapse (3.2% vs 2.2%). Conclusion: In contrast to the findings of recent retrospective investigations, we did not find that patients treated with hip CSI had significantly higher rates of short-term OA progression or femoral head articular surface collapse after controlling for baseline OA severity and preexisting AVN or SIF. Future randomized trials investigating safety of hip CSI are needed to determine its exact short-term risk profile.
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Saraf, Amit, Prakhar Agarwal, and Abhinav Kush. "To Analyze the Effect of Platelet Count of Platelet-rich Plasma on Clinical Outcomes in Patients of Osteoarthritis of Knee." Journal of Orthopedics, Traumatology and Rehabilitation 15, no. 2 (2023): 155–59. http://dx.doi.org/10.4103/jotr.jotr_27_23.
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Abstract Purpose: The purpose of this study was to find the association between the platelet (PLT) count in PLT-rich plasma (PRP) injection and clinical response in knee osteoarthritis (KOA) patients. Materials and Methods: Fifty patients of Kellgren–Lawrence Grade 2 and 3 KOA were given single intra-articular PRP injection. Baseline PLT count was documented and PLT concentration of each PRP was documented and was classified as P1, P2, and P3 (as per PAW classification). This was compared to clinical results using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Visual Analog Scale (VAS) score at baseline, followed by 3, 6, and 9 months of follow-up. Results: There was a significant decrease in VAS score between the P1 and P2 and P1 and P3 groups at 9-month follow-up, with P = 0.028 (<0.05) and P = 0.01 (<0.05), respectively. Moreover, the WOMAC score significantly dropped among the P1 and P2 and P1 and P3 groups at 9-month follow-up, with P = 0.016 (<0.05) and P = 0.036 (<0.05), respectively. Conclusion: Both the VAS score and the WOMAC score have significantly decreased at 9-month follow-up period when the P1 group is compared to both P2 and P3 but not between P2 and P3, so it is concluded that for proper efficacy of PRP injection in OA knee Grades 2 and 3, concentration of platelets in prepared PRP should be more than baseline PLT concentration.
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Steenkamp, Wynand, Pududu Archie Rachuene, Roopam Dey, Nkosiphendule Lindani Mzayiya, and Brian Emmanuel Ramasuvha. "The correlation between clinical and radiological severity of osteoarthritis of the knee." SICOT-J 8 (2022): 14. http://dx.doi.org/10.1051/sicotj/2022014.
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Introduction: Primary osteoarthritis (OA) is a common cause of knee pain. Appropriate management of knee OA is based on clinical and radiological findings. Pain, deformity, and functional impairments are major clinical factors considered along with radiological findings when making management decisions. Differences in management strategies might exist due to clinical and radiological factors. This study aims at finding possible associations between clinical and radiological observations. Methods: A prospective cross-sectional study of 52 patients with primary osteoarthritis of the knee managed conservatively at a tertiary hospital arthroplasty clinic was conducted for three months. English speaking patients with primary OA were identified and included in this study. Pain and functional impairment were assessed using Wong-Baker Faces pain scale, The Knee Society Score (KSS), and Western Ontario and McMaster Osteoarthritis Index (WOMAC). The Body Mass Index (BMI) of all participants was measured. Standard two views plain radiographs were used for radiographic grading of the OA. Anonymized radiographs were presented to two senior consultant orthopaedic surgeons who graded the OA using Kellgren and Lawrence (KL) and Ahlbäck classification systems. The severity of the functional impairment and pain score was then compared to the radiological grading. Results: The average age of our participants was 63 ± 9 years. Their average BMI was 34.9 ± 8.4 kg/m2, median self-reported pain, total WOMAC, and pain WOMAC scores were 8, 60, and 13, respectively. We observed no significant correlation between BMI and pain scores. Inter-rater reliability for KL and Ahlbäck grading was strong. There was no significant correlation between WOMAC scores and the radiological grades. Conclusion: There was no correlation between pain and functional scores, patient factors and radiological severity of OA of the knee.
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Momenpour, Thomures, and Arafat Abu Mallouh. "Optimizing CNN-Based Diagnosis of Knee Osteoarthritis: Enhancing Model Accuracy with CleanLab Relabeling." Diagnostics 15, no. 11 (2025): 1332. https://doi.org/10.3390/diagnostics15111332.
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Background: Knee Osteoarthritis (KOA) is a prevalent and debilitating joint disorder that significantly impacts quality of life, particularly in aging populations. Accurate and consistent classification of KOA severity, typically using the Kellgren-Lawrence (KL) grading system, is crucial for effective diagnosis, treatment planning, and monitoring disease progression. However, traditional KL grading is known for its inherent subjectivity and inter-rater variability, which underscores the pressing need for objective, automated, and reliable classification methods. Methods: This study investigates the performance of an EfficientNetB5 deep learning model, enhanced with transfer learning from the ImageNet dataset, for the task of classifying KOA severity into five distinct KL grades (0–4). We utilized a publicly available Kaggle dataset comprising 9786 knee X-ray images. A key aspect of our methodology was a comprehensive data-centric preprocessing pipeline, which involved an initial phase of outlier removal to reduce noise, followed by systematic label correction using the Cleanlab framework to identify and rectify potential inconsistencies within the original dataset labels. Results: The final EfficientNetB5 model, trained on the preprocessed and Cleanlab-remediated data, achieved an overall accuracy of 82.07% on the test set. This performance represents a significant improvement over previously reported benchmarks for five-class KOA classification on this dataset, such as ResNet-101 which achieved 69% accuracy. The substantial enhancement in model performance is primarily attributed to Cleanlab’s robust ability to detect and correct mislabeled instances, thereby improving the overall quality and reliability of the training data and enabling the model to better learn and capture complex radiographic patterns associated with KOA. Class-wise performance analysis indicated strong differentiation between healthy (KL Grade 0) and severe (KL Grade 4) cases. However, the “Doubtful” (KL Grade 1) class presented ongoing challenges, exhibiting lower recall and precision compared to other grades. When evaluated against other architectures like MobileNetV3 and Xception for multi-class tasks, our EfficientNetB5 demonstrated highly competitive results. Conclusions: The integration of an EfficientNetB5 model with a rigorous data-centric preprocessing approach, particularly Cleanlab-based label correction and outlier removal, provides a robust and significantly more accurate method for five-class KOA severity classification. While limitations in handling inherently ambiguous cases (such as KL Grade 1) and the small sample size for severe KOA warrant further investigation, this study demonstrates a promising pathway to enhance diagnostic precision. The developed pipeline shows considerable potential for future clinical applications, aiding in more objective and reliable KOA assessment.
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Deo, Arpit, Manish Korde, Amit Khatri, Aman Jain, Ashish Kumawat, and Vineeta Rathore. "Comparative analysis of machine learning classifiers and deep learning models for categorization of Knee Osteoarthritis." EPJ Web of Conferences 328 (2025): 01023. https://doi.org/10.1051/epjconf/202532801023.
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Knee Osteoarthritis also known as KOA is a disease in which there is so much pain, stiffness and it also limits the mobility of patient, if not cured at right time it can lead to disablement due to degeneration of articular cartilage in knee joint. Due to limited mobility , its treatment and diagnosis are very challenging, especially when there is lack of devices and technologies for precise identification and tracking of this disease’s progression at right time. There is a very common method known as “Kellgren-Lawrence (KL) grading” by which degree of Osteoarthritis is determined. The scale of KL grading ranges from ‘0’ to ‘4’ where 0 is ‘no osteoarthritis’ and 4 is ‘severe osteoarthritis. By using machine learning and deep learning, this work presented a approach that improves the accuracy of classification of KOA and its level diagnosis by using X-ray images. In this research work, feature extraction techniques such Global Average Pooling, Min–Max scaling, Histogram of Oriented Gradients (HOG) along with another technique called Linear Discriminant Analysis (LDA) applied on Xray dataset. The study evaluates two Machine Learning classifiers which were Support Vector Machine (SVM) and XGBoost which both are optimized through GridSearchCV for hyperparameter tuning and two deep learning models EfficientNetB6 and EfficientNetB7 which both were fine tuned. The proposed approach evaluates the knee X-ray images and assigns them to one of 0, 1, 2, 3, or 4 grades in order to automate KL grading. From the experimental results, it is concluded that the XGBoost classifier performed the best with 97.00 % accuracy.
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Lopez, Alejandro Alvarez. "Knee arthroscopy in patients over 64 years suffering from primary gonarthrosis." Orthopaedic Journal of Sports Medicine 9, no. 7_suppl3 (2021): 2325967121S0017. http://dx.doi.org/10.1177/2325967121s00177.
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Objectives: to evaluate the results of the arthroscopic surgical techniques in patients with primary gonarthrosis older than 64 years. Methods: an analytical observational study was carried out in 40 patients older than 64 years treated arthroscopically with the diagnosis of primary gonarthrosis, at the Manuel Ascunce Domenech University Hospital in the city of Camagüey from October 2012 to May 2019. The research has a level of evidence IV recommendation D. Results: the average age of the 40 patients studied was 69,6 years, with a predominance of female to male, with a ratio of 3 to 1. Tricompartmental disease predominated in most patients as well as grade IV according to the Outerbridge RE classification. The cartilage and associated meniscus injuries predominate. Grades III and IV of the Kellgram JH and Lawrence JS classification were the most found. The most commonly used arthroscopic treatments were debridement and partial meniscectomy. Statistical significance between a before and after was detected. Conclusion: the results of the investigation show that the procedures performed through the arthroscopic route for patients with primary gonarthrosis over 64 years of age are effective in more than half of the patients.
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Wera, Glenn D., Mark W. Dwyer, Daniel R. Verhotz, Matthew A. Popa, and Randall E. Marcus. "Custom Cementless Femoral Stems in Total Hip Arthroplasty." Journal of Hip Surgery 03, no. 02 (2019): 068–72. http://dx.doi.org/10.1055/s-0039-1679953.
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AbstractObtaining appropriate prosthetic fit in cementless total hip arthroplasty can be challenging in cases with disparity between the femoral and metaphyseal diameters of the femur or cases of complex deformity. One solution has been to utilize a custom femoral component in total hip arthroplasty. The long-term results of this option with respect to femoral morphology are limited. This cohort was analyzed to determine the survivorship, functional results using Harris Hip Scores (HHSs), and complication rates using these implants. Survivorship and complications were evaluated based on the proximal femoral anatomy and severity of arthritis. The authors retrospectively reviewed 73 cases of custom femoral implants in total hip arthroplasties by a single surgeon. The average age of patients at index surgery was 58.06 years (range, 36.00–73.75 years). The mean follow-up was 8.59 years (range, 0.17–20.33 years) with a minimum of 2-year follow-up required for analysis of HHS data. There were 8 failures at a mean of 67.68 months (range, 2.04–135 months). The reasons for revision were infection (2), osteolysis (1), periprosthetic fracture (3), osteolysis and aseptic loosening (1), and polyethylene wear (1). The mean preoperative HHS was 55.38 (range, 31–90). The mean follow-up HHS was 93.10 (range, 38–100) with a mean improvement of 37.44 (p < 0.0001). Complications included infection (3), fracture (6), and dislocation (3). Preoperative Dorr classification A (n = 44), B (n = 24), and C (n = 1) and Kellgren–Lawrence grades I (n = 0), II (n = 2), III (n = 7), and IV (n = 60) were not predictive of failure or revision (p = 0.45, p = 0.6). There was a near significant association between Dorr classification B femur fractures requiring revision (p < 0.053). Kaplan–Meier predicted survivorship was 20.33 years with revision for any reason as the endpoint and total overall survivorship of 81.7%. Custom cementless femoral stems provide satisfactory survivorship and improvement in hip scores in a variety of patients undergoing cementless total hip arthroplasty. Fracture rates are higher in Dorr class B femurs. The level of evidence was IV.
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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 (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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Keenan, Oisin J. F., George Holland, Julian F. Maempel, John F. Keating, and Chloe E. H. Scott. "Correlations between radiological classification systems and confirmed cartilage loss in severe knee osteoarthritis." Bone & Joint Journal 102-B, no. 3 (2020): 301–9. http://dx.doi.org/10.1302/0301-620x.102b3.bjj-2019-0337.r1.
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Aims Although knee osteoarthritis (OA) is diagnosed and monitored radiologically, actual full-thickness cartilage loss (FTCL) has rarely been correlated with radiological classification. This study aims to analyze which classification system correlates best with FTCL and to assess their reliability. Methods A prospective study of 300 consecutive patients undergoing unilateral total knee arthroplasty (TKA) for OA (mean age 69 years (44 to 91; standard deviation (SD) 9.5), 178 (59%) female). Two blinded examiners independently graded preoperative radiographs using five common systems: Kellgren-Lawrence (KL); International Knee Documentation Committee (IKDC); Fairbank; Brandt; and Ahlbäck. Interobserver agreement was assessed using the intraclass correlation coefficient (ICC). Intraoperatively, anterior cruciate ligament (ACL) status and the presence of FTCL in 16 regions of interest were recorded. Radiological classification and FTCL were correlated using the Spearman correlation coefficient. Results Knees had a mean of 6.8 regions of FTCL (SD 3.1), most common medially. The commonest patterns of FTCL were medial ± patellofemoral (143/300, 48%) and tricompartmental (89/300, 30%). ACL status was associated with pattern of FTCL (p = 0.023). All radiological classification systems demonstrated moderate ICC, but this was highest for the IKDC: whole knee 0.68 (95% confidence interval (CI) 0.60 to 0.74); medial compartment 0.84 (95% CI 0.80 to 0.87); and lateral compartment 0.79 (95% CI 0.73 to 0.83). Correlation with actual FTCL was strongest for Ahlbäck (Spearman rho 0.27 to 0.39) and KL (0.30 to 0.33) systems, although all systems demonstrated medium correlation. The Ahlbäck score was the most discriminating in severe knee OA. Osteophyte presence in the medial compartment had high positive predictive value (PPV) for FTCL, but not in the lateral compartment. Conclusion The Ahlbäck and KL systems had the highest correlation with confirmed cartilage loss at TKA. However, the IKDC system displayed the best interobserver reliability, with favourable correlation with FTCL in medial and lateral compartments, although it was less discriminating in more severe disease. Cite this article: Bone Joint J 2020;102-B(3):301–309
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Kuo, C. F., K. Zheng, S. Miao, et al. "OP0062 PREDICTIVE VALUE OF BONE TEXTURE FEATURES EXTRACTED BY DEEP LEARNING MODELS FOR THE DETECTION OF OSTEOARTHRITIS: DATA FROM THE OSTEOARTHRITIS INITIATIVE." Annals of the Rheumatic Diseases 79, Suppl 1 (2020): 41.2–42. http://dx.doi.org/10.1136/annrheumdis-2020-eular.2858.
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Background:Osteoarthritis is a degenerative disorder characterized by radiographic features of asymmetric loss of joint space, subchondral sclerosis, and osteophyte formation. Conventional plain films are essential to detect structural changes in osteoarthritis. Recent evidence suggests that fractal- and entropy-based bone texture parameters may improve the prediction of radiographic osteoarthritis.1In contrast to the fixed texture features, deep learning models allow the comprehensive texture feature extraction and recognition relevant to osteoarthritis.Objectives:To assess the predictive value of deep learning-extracted bone texture features in the detection of radiographic osteoarthritis.Methods:We used data from the Osteoarthritis Initiative, which is a longitudinal study with 4,796 patients followed up and assessed for osteoarthritis. We used a training set of 25,978 images from 3,086 patients to develop the textual model. We use the BoneFinder software2to do the segmentation of distal femur and proximal tibia. We used the Deep Texture Encoding Network (Deep-TEN)3to encode the bone texture features into a vector, which is fed to a 5-way linear classifier for Kellgren and Lawrence grading for osteoarthritis classification. We also developed a Residual Network with 18 layers (ResNet18) for comparison since it deals with contours as well. Spearman’s correlation coefficient was used to assess the correlation between predicted and reference KL grades. We also test the performance of the model to identify osteoarthritis (KL grade≥2).Results:We obtained 6,490 knee radiographs from 446 female and 326 male patients who were not in the training sets to validate the performance of the models. The distribution of the KL grades in the training and testing sets were shown in Table 1. The Spearman’s correlation coefficient was 0.60 for the Deep-TEN and 0.67 for the ResNet18 model. Table 2 shows the performance of the models to detect osteoarthritis. The positive predictive value for Deep-TEN and ResNet18 model classification for OA was 81.37% and 87.46%, respectively.Table 1Distribution of KL grades in the training and testing sets.KL grades01234TotalTraining set1089341.9%458218.7%611423.5%332012.8%7993.1%25,978Testing set247238.1%135320.8%169626.1%77511.9%1943.0%6,490Table 2Performance matrices of the Deep-Ten and ResNet18 models to detect osteoarthritisDeep-TENResNet18Sensitivity62.29%(95% CI, 60.42%–64.13%)59.14%(95% CI, 57.24%–61.01%)Specificity90.07%(95% CI, 89.07%–91.00%)94.09%(95% CI, 93.30%–94.82%)Positive predictive value81.37%(95% CI, 79.81%–82.84%)87.46%(95% CI, 85.96%–88.82%)Negative predictive value77.42%(95% CI, 77.64%–79.65%)76.77%(95% CI, 75.93%–77.59%)Conclusion:This study demonstrates that the bone texture model performs reasonably well to detect radiographic osteoarthritis with a similar performance to the bone contour model.References:[1]Bertalan Z, Ljuhar R, Norman B, et al. Combining fractal- and entropy-based bone texture analysis for the prediction of osteoarthritis: data from the multicenter osteoarthritis study (MOST). Osteoarthritis Cartilage 2018;26:S49.[2]Lindner C, Wang CW, Huang CT, et al. Fully Automatic System for Accurate Localisation and Analysis of Cephalometric Landmarks in Lateral Cephalograms. Sci Rep 2016;6:33581.[3]Zhang H, Xue J, Dana K. Deep TEN: Texture Encoding Network. The IEEE Conference on Computer Vision and Pattern Recognition (CVPR) 2017:708-17.Disclosure of Interests:None declared
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Holguin, Esteban. "Platelet-rich plasma injection is more effective than hyaluronic acid in the treatment of knee osteoarthritis." Orthopaedic Journal of Sports Medicine 2, no. 12_suppl4 (2014): 2325967114S0024. http://dx.doi.org/10.1177/2325967114s00240.
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Objectives: To determine and compare the effects of autologous platelet rich plasma (PRP) and hyaluronic acid (HA) for the treatment of osteoarthritis of the knee. Methods: This prospective study included 150 patients affected by severe osteoarthritis of the knee. Gonarthrosis was graded using the Kellgren-Lawrence and Albhack radiographic classification scale. 150 patients were randomized into 2 study groups .In the PRP group (n=55) three intraarticular injection were applied andthe control group (n=55) received 3 intra-articular injections of high molecular weight HA. An unblinded physician performed infiltration once a week for 3 weeks into the knee affected by clinically relevant gonarthrosis (in both groups). All patients were evaluated with the Western Ontario and McMaster (WOMAC) score and visual pain scale before the infiltration and at 3, 6, and 12 months after the first injection. Results: No severe adverse events was observed. Statistically significant better results in the WOMAC score and visual pain scale was determined in PRP group than HA group at 3 months and 6 months follow up. The cost of the application for the PRP group was lower than that of the HA group.At 12 months' of follow-up, PRP and HA treatments offered similar results. Conclusion: The results of this study have shown the application of autologousPRP to be a safe, effective and low-cost method for treating OA tan HA. However, further studies are required for a more clear result
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Wang, Dean, Vivek Kalia, Claire D. Eliasberg, et al. "Osteochondral Allograft Transplantation of the Knee in Patients Aged 40 Years and Older." American Journal of Sports Medicine 46, no. 3 (2017): 581–89. http://dx.doi.org/10.1177/0363546517741465.
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Background: Treatment of large chondral defects of the knee among patients aged ≥40 years remains a difficult clinical challenge owing to preexisting joint degeneration and the lack of treatment options short of arthroplasty. Purpose: To characterize the survivorship, predictors of failure, and clinical outcomes of osteochondral allograft transplantation (OCA) of the knee among patients aged ≥40 years. Study Design: Case series; Level of evidence, 4. Methods: Prospectively collected data were reviewed for 54 consecutive patients aged ≥40 years who were treated with OCA. Preoperative levels of osteoarthritis (according to Kellgren-Lawrence classification) and meniscal volume and quality were graded from review of radiographs and magnetic resonance imaging. Complications, reoperations, and patient responses to validated outcome measures were reviewed. A minimum follow-up of 2 years was required for analysis. Failure was defined by any removal or revision of the allograft or conversion to arthroplasty. Results: Among 51 patients (mean age, 48 years; range, 40-63 years; 65% male), a total of 52 knees had symptomatic focal cartilage lesions (up to 2 affected areas) that were classified as Outerbridge grade 4 at the time of OCA and did not involve substantial bone loss requiring shell allografts or additional bone grafting. Mean duration of follow-up was 3.6 years (range, 2-11 years). After OCA, 21 knees (40%) underwent reoperation, including 14 failures (27%) consisting of revision OCA (n = 1), unicompartmental knee arthroplasty (n = 5), and total knee arthroplasty (n = 8). Mean time to failure was 33 months, and 2- and 4-year survivorship rates were 88% and 73%, respectively. Male sex (hazard ratio = 4.18, 95% CI = 1.12-27.13) and a higher number of previous ipsilateral knee operations (hazard ratio = 1.70 per increase in 1 surgical procedure, 95% CI = 1.03-2.83) were predictors of failure. A higher Kellgren-Lawrence osteoarthritis grade on preoperative radiographs was associated with higher failure rates in the Kaplan-Meier analysis but not the multivariate model. At final follow-up, clinically significant improvements were noted in the pain (mean score, 47.8 to 67.6) and physical functioning (56.8 to 79.1) subscales of the Short Form-36, as well as the International Knee Documentation Committee subjective form (45.0 to 63.6), Knee Outcome Survey–Activities of Daily Living (64.5 to 80.1), and overall condition statement (4.5 to 6.8) ( P < .001). No significant changes were noted for the Marx Activity Rating Scale (5.1 to 3.9, P = .789). Conclusion: A higher failure rate was found in this series of patients aged ≥40 years who were treated with OCA as compared with other studies of younger populations. However, for select older patients, OCA can be a good midterm treatment option for cartilage defects of the knee.
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Senga, Yoshiyuki, Akinobu Nishimura, and Akihiro Sudo. "The Prevalence of Hallux Rigidus and its Risk Factors." Foot & Ankle Orthopaedics 4, no. 4 (2019): 2473011419S0037. http://dx.doi.org/10.1177/2473011419s00377.
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Category: Midfoot/Forefoot Introduction/Purpose: Hallux rigidus (HR) is known as osteoarthritis of the first metatarsophalangeal joint (MPJ). The radiographical findings of HR are characterized by joint space narrowing, osteophytic lipping of the metatarsal head and proximal phalanx and sesamoid hypertrophy. HR is not so rare in daily medical practice, but its prevalence and risk factors are not completely understood. The purpose of this cross-sectional study, using a population-sample from Japan, is to investigate the prevalence of HR and its risk factors among Japanese community dwellers. Methods: In this study, we analyzed the cohort studies in 2009, 2011, 2013 and 2015 covering the elderly (=50 years). We excluded the participants with hallux valgus (HV) because it is difficult to distinguish HR from HV completely. Knee osteoarthritis (KOA) was scored according to the Kellgren-Lawrence grading system and was defined as grade=2. HR was scored according to the Hattrup and Johnson classification and was defined as grade=1. Continuous and categorical variables were compared using the t-test and chi-square test, respectively. The logistic regression model was used to examine the relationship between predictor variables and HR. The Cochran-Armitage trend test was used to examine the relationships between the presence or absence of HR and the severity of KOA in a linear trend. All p values presented are two-sided and p values < 0.05 were considered statistically significant. Results: A total of 416 (171 men, 245 women) participants fulfilled this study criterion. The prevalence of HR was 17.8%. The rate of grade0, grade1, grade2, and grade3 of HR were 82.2%, 10.1%, 6.7%, and 0.96%, respectively. Univariate analysis revealed age (=65), KOA, and Gout Attack (GA) were significantly associated with HR (Table 1). In addition, they were confirmed as independent risk factors of HR in the multivariate analysis. All parameters were significantly associated with HR. The odds ratio of age, KOA, and GA were 2.46, 1.83, and 4.87, respectively (p <0.05). KOA severity is significantly associated with the presence or absence of HR (p <0.05). Conclusion: While previous reports have demonstrated a higher prevalence of HR (27.2-44.4%), HV was not excluded in that study. To achieve the accurate evaluation, we examined the epidemiology and prevalence of HR among participants without HV. HR prevalence in the elderly (=50 years) was 17.8%. Although multifactorial risk factors have been proposed in the literature, our study revealed that age (=65), KOA, and GA were the independent risk factors for HR. KOA severity was associated with the presence or absence of HR.
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Lamplot, Joseph D., Muhammad Farooq Rai, William P. Tompkins, et al. "Gene Expression in Meniscal Tears at the Time of Arthroscopic Partial Meniscectomy Predicts the Progression of Osteoarthritis Within 6 Years of Surgery." Orthopaedic Journal of Sports Medicine 8, no. 8 (2020): 232596712093627. http://dx.doi.org/10.1177/2325967120936275.
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Background: While knees with meniscal tears are associated with a heightened risk of developing osteoarthritis (OA), it is difficult to predict which patients are at the greatest risk for OA. Gene signatures in menisci that are resected during arthroscopic partial meniscectomy (APM) may provide insight into the risk of OA progression. Hypothesis: Meniscal gene signatures at the time of APM will predict radiographic OA progression. Study Design: Case series; Level of evidence, 4. Methods: Meniscal fragments were collected from 38 patients without OA during clinically indicated APM of the medial meniscus. The expression of 28 candidate genes with known roles in cartilage homeostasis, OA, extracellular matrix degradation, and obesity was assessed by quantitative real-time polymerase chain reaction. Weightbearing radiographs obtained before surgery and at final follow-up were graded by a musculoskeletal radiologist using the Kellgren-Lawrence classification of OA. The association of meniscal gene expression at baseline with the progression of radiographic OA was determined. Results: Gene expression and baseline and follow-up radiographic data were available from 31 patients (81.6%) at a mean follow-up of 6.2 ± 1.3 years. Patients without OA progression had significantly higher expression of 7 genes: MMP9 (5.1-fold; P = .002), IL8 (2.9-fold; P = .016), CCL3 (3.7-fold; P = .032), CCL3L1 (4.5-fold; P = .008), CXCL6 (6.2-fold; P = .010), LEP (5.2-fold; P = .004), and RETN (46-fold; P = .008). Conclusion: Gene expression in the meniscus at the time of APM may be associated with the risk for progression of OA after surgery. Elevated expression of the aforementioned genes may reflect a chondroprotective response. Stratifying the risk for OA progression after APM could facilitate targeted interventions to delay or prevent the development of OA. Further studies in a larger cohort with an extended follow-up, and inclusion of additional genes, are warranted to better characterize this association.
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Abraham, Paul, Nathan Varady, Kirstin Small, et al. "Hip Corticosteroid/Anesthetic Injections—Are the reported rates of osteoarthritis progression and femoral head collapse real?" Orthopaedic Journal of Sports Medicine 9, no. 7_suppl4 (2021): 2325967121S0024. http://dx.doi.org/10.1177/2325967121s00243.
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Objectives: In the absence of definitive Level I evidence regarding the safety of hip CSI, there have been an increasing number of retrospective case series studying outcomes after hip corticosteroid injection (CSI). Recent studies have suggested that hip CSI may be associated with increased rates of avascular necrosis (AVN), subchondral insufficiency fracture (SIF), femoral head articular surface collapse, and accelerated progression of osteoarthritis (OA), but these studies do not compare against a control arm matched for baseline OA severity or exclude patients with pre-injection AVN or SIF from analysis, causing selection bias. The purpose of this study was to compare complication rates in patients treated with and without CSI, while minimizing the aforementioned selection bias. Methods: For all patients at our institution who had undergone hip CSI between 2007 and 2019 and hip magnetic resonance imaging (MRI) within the preceding 12 months (CSI cohort), two musculoskeletal radiologists retrospectively reviewed hip radiographs taken within 12 months prior to and after CSI and graded OA severity (modified Kellgren-Lawrence classification) and femoral head collapse, blinded to cohort and timepoint. The same was done for a hip control cohort (matched for age, sex, BMI, and OA severity on baseline radiograph reports) that had undergone hip MRI and pre- and post-MRI hip radiographs within 12 months. A third reader arbitrated discrepant reads. OA progression was defined as an increase in modified Kellgren-Lawrence grade ≥1 between radiographs. Matched pairs with at least one incidence of pre-existing AVN or SIF on index MRI were excluded for analysis. Results: 186 hips in the CSI group [mean ±95% CI age: 55.8±2.1, mean±95% CI BMI: 27.5±0.8, 69 (37.1%) males, 100 (53.8%) right hips] and 186 hips in the control group [mean ±95% CI age: 55.7±2.3, mean±95% CI BMI: 28.0±0.8, 69 (37.1%) males, 96 (51.6%) right hips] were included in this study. There were no significant differences between groups in age, gender, BMI, laterality, baseline OA severity, or baseline AVN/SIF on index MRI. Analysis of adjudicated radiographic outcomes were performed after exclusion of 61 matched pairs with at least 1 instance of pre-existing AVN or SI (Table 1). Rates of OA progression (5.6% vs. 2.4%; p=0.33), new AVN or SIF (1.6% vs. 0.0%; p=0.50), and new femoral head collapse (3.2% vs. 2.4%; p=1.000) were all similar between groups. Of the 4 cases of new femoral head collapse in the CSI group, 2 were classified as femoral head remodeling secondary to OA, leaving only two (1.6%) definitive femoral head collapses secondary to AVN or SIF. Of the 3 cases of new femoral head collapse in the control group, 2 were classified as femoral head remodeling due to an unknown etiology, leaving only one (0.8%) definitive femoral head collapses secondary to AVN or SIF. (Tables 1, 2, 3) Conclusions: When controlling for baseline OA severity and pre-existing AVN or SIF, patients treated by CSI in our study showed OA progression in only 6% of cases and new femoral head collapse in only 3% of cases, which was not significantly greater than control and similar to the expected progression of natural disease. Future multicenter, randomized, double-blind, placebo-controlled trials investigating safety of hip CSI are needed. [Table: see text][Table: see text][Table: see text]
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Klasan, Antonio, David A. Rice, Michal T. Kluger, et al. "A combination of high preoperative pain and low radiological grade of arthritis is associated with a greater intensity of persistent pain 12 months after total knee arthroplasty." Bone & Joint Journal 104-B, no. 11 (2022): 1202–8. http://dx.doi.org/10.1302/0301-620x.104b11.bjj-2022-0630.r1.
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Aims Despite new technologies for total knee arthroplasty (TKA), approximately 20% of patients are dissatisfied. A major reason for dissatisfaction and revision surgery after TKA is persistent pain. The radiological grade of osteoarthritis (OA) preoperatively has been investigated as a predictor of the outcome after TKA, with conflicting results. The aim of this study was to determine if there is a difference in the intensity of pain 12 months after TKA in relation to the preoperative radiological grade of OA alone, and the combination of the intensity of preoperative pain and radiological grade of OA. Methods The preoperative data of 300 patients who underwent primary TKA were collected, including clinical information (age, sex, preoperative pain), psychological variables (depression, anxiety, pain catastrophizing, anticipated pain), and quantitative sensory testing (temporal summation, pressure pain thresholds, conditioned pain modulation). The preoperative radiological severity of OA was graded according to the Kellgren-Lawrence (KL) classification. Persistent pain in the knee was recorded 12 months postoperatively. Generalized linear models explored differences in postoperative pain according to the KL grade, and combined preoperative pain and KL grade. Relative risk models explored which preoperative variables were associated with the high preoperative pain/low KL grade group. Results Pain 12 months after TKA was not associated with the preoperative KL grade alone. Significantly increased pain 12 months after TKA was found in patients with a combination of high preoperative pain and a low KL grade (p = 0.012). Patients in this group were significantly more likely to be male, younger, and have higher preoperative pain catastrophizing, higher depression, and lower anxiety (all p ≤ 0.05). Conclusion Combined high preoperative pain and low radiological grade of OA, but not the radiological grade alone, was associated with a higher intensity of pain 12 months after primary TKA. This group may have a more complex cause of pain that requires additional psychological interventions in order to optimize the outcome of TKA. Cite this article: Bone Joint J 2022;104-B(11):1202–1208.
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Al-Rawi, Ziad S., Faiq I. Gorial, and Wafi H. Ali. "Fibromyalgia Syndrome among Iraqi Patients with Knee Osteoarthritis." Journal of the Faculty of Medicine Baghdad 56, no. 1 (2014): 45–48. http://dx.doi.org/10.32007/jfacmedbagdad.561424.
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Back ground: Fibromyalgia syndrome (FMS) is a common chronic musculo-skeletal disorder resulting in chronic widespread pain impacting on quality life.Objectives: To assess the relationship between FMS and knee osteoarthritis (KOA) and to evaluate the predictors of this relationship if present.Patients and Methods: One hundred Iraqi KOA patients and 100 healthy controls were included in this cross-sectional study. Full history was taken and complete clinical examination was done for all patients. Baseline characteristics [age, sex, duration, body mass index (BMI), waist circumference, family history (Hx) of KOA, smoking history, and drug history.] were also documented. Laboratory analysis included complete blood count, erythrocyte sedimentation rate (ESR), thyroid stimulation hormone, serum calcium, serum alkaline phosphatase, serum phosphate, and anti-nuclear antibody were done for all patients. X-rays of both Knees was taken for patients and was graded according Kellgren and Lawrence scale. The American College of Rheumatology (ACR) criteria for classification and reporting osteoarthritis of the knees were applied on both groups. Individuals in both groups were assessed for FMS and the American College of Rheumatology 1990 Criteria for fibromyalgia were applied for both groups. Comparative statistics were done using Chi square test for categorical variables and students' independent 2 samples (t) test for continuous variables.Results: FMS was present in 26 of 100(26%) KOA patients compared to 7(75%) of 100 of controls [odd ratio (OR)=4.6(95% CI(1.92-11.35),p=0.001]. Frequencies of associated features (headache, sleep disturbances, fatigue, depression, anxiety, and parasthesia) were significantly more in patients than that of controls (P<0.05). Longer duration of KOA, higher waist circumference, and positive family Hx of FMS were significant associates with FMS in the patient group (P<0.05). However no significant association was found with age, sex, BMI, grade of KOA, drugs taken marital status, and increased ESR.Conclusions: FMS was significantly increased in Iraqi patients with KOA compared to controls. Longer disease duration of KOA, large waist circumference and family history of FMS were significant predictors.
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Korochina, K., T. Chernysheva, I. Korochina, V. Klementeva, and G. Kuznetsov. "AB0582 KNEE OSTEOARTHRITIS PHENOTYPES STRATIFICATION." Annals of the Rheumatic Diseases 80, Suppl 1 (2021): 1328.1–1329. http://dx.doi.org/10.1136/annrheumdis-2021-eular.36.
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Background:Osteoarthritis (OA) relevance is determined by its record prevalence with progredient growth throughout the world [1]. Clinical and pathogenic heterogeneity of disease actualizes problem of its stratification [2]. Lack of unified understanding of OA and its phenotype determination results in incredible number of attempts to group OA, using of different classification criteria in last decade.Objectives:To analyze and systematize available OA classifications, proposals and phenotypes, to highlight the most promising of them.Methods:We studied publications from MEDLINE / PubMed and Google Scholar databases found by the keywords “osteoarthritis”, “phenotypes”, “subphenotypes”, “classification”, “subtypes”, “subsets”, “subgroups”, “subpopulations”, “profiles” and “endotypes” in various combinations in English and Russian. We did not set a time frame, but aimed to include as many different methods as possible in order to reflect evolution of scientists’ views on structuring of this disease.Results:A total of 55 OA grouping methods were covered so that OA was structured by different determinants into 6 big boxes.First OA classifications were characterized by complex etiopathogenetic approach, while subsequent studies differed in joint-mediated approach, and the knee joint was undisputed “champion” in this “race”. One of the first attempts to group OA was division into primary, or idiopathic, and secondary, due to known causes. It is now obvious that it is becoming obsolete, and criteria for OA primacy are difficult to determining. Genomic highly specialized studies based on isolation of “favorable” and “unfavorable” genes develops prerequisites to genetic OA classifying. Clinical variants occupy central place as they are the most fully consistent with modern phenotype conception [3], considerating as subtypes of disease shared by underlying pathobiological and pain mechanisms and their structural and functional consequences. Trajectories of OA progression are distinguished by longitudinal design, that is, the determinants for grouping here are disease characteristics in dynamics. The ancestor of structural OA trajectories can be considered Kellgren-Lawrence grades; subsequent studies identified complex of clinical, laboratory and morphological factors contributing to development of trajectories. Structural OA variants are diverse depending on visualization methods, and many of them can be naturally considered phenotypes, since they drive certain clinical OA manifestations. Morphological changes were described at macro- and microscopic levels; it is interesting to note the absence of histopathological norm in patients without OA. Laboratory profiles of patients are determined by content of systemic (serum, urinary) or local, “proximal” (in synovial fluid) biomarkers, which seem to be more precise. Metabolomic analysis is perspective new direction of laboratory studies based on joint metabolic products identification in the synovial fluid. New trend in OA research is molecular phenotyping. The specific molecular pathway explaining observed phenotype properties is called “endotype”. Endotype is related to certain pathobiological scenario, and laboratory markers are potentially effective for its diagnosis.Conclusion:Thus, a large amount of accumulated information and its diversity soon will probably lead to qualitatively new knowledge level with deep understanding of phenotype-associated strategy for managing OA patients.References:[1]Wallace IJ, Worthington S, Felson DT, et al. Knee osteoarthritis has doubled in prevalence since the mid-20th century. Proc Natl Acad Sci USA. 2017 Aug 29;114(35): 9332-9336. doi: 10.1073/pnas.1703856114 Epub 2017 Aug 14.[2]Deveza LA, Nelson AE, Loeser RF. Phenotypes of osteoarthritis: current state and future implications. Clin Exp Rheumatol 37 Suppl 2019;120(5):64-72.[3]Van Spil WE, Bierma-Zeinstra SMA, Deveza LA, et al. A consensus-based framework for conducting and reporting osteoarthritis phenotype research. Arthritis Res Ther. 2020;22(1):54. doi:10.1186/s13075-020-2143-0Disclosure of Interests:None declared.
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Salama, Ahmed, Kamel Rahouma, and Fatma Elzahraa Mansour. "Knee osteoarthritis automatic detection using U-Net." IAES International Journal of Artificial Intelligence (IJ-AI) 13, no. 2 (2024): 2122. http://dx.doi.org/10.11591/ijai.v13.i2.pp2122-2130.
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Knee osteoarthritis or OA is one of the most common diseases that can affect the elderly and overweight people. OA is occur as the result of wear and tear and progressive loss of articular cartilage. Kellgren-Lawrence system is a common method of classifying the severity of osteoarthritis depends on knee joint width. According to Kellgren-Lawrence, knee osteoarthritis is divided into five classes; one class represents a normal knee and the others represent four levels of knee osteoarthritis. In this work, we aim to automatically detect knee OA according to the Kellgren-Lawrence classification. The proposed system uses the U-Net architecture. The overall system yielded an accuracy of 96.3% during training.
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Ahmed, Salama Abdellatif, Hussien Rahouma Kamel, and E. Mansour Fatma. "Knee osteoarthritis automatic detection using U-Net." IAES International Journal of Artificial Intelligence (IJ-AI) 13, no. 2 (2024): 2122–30. https://doi.org/10.11591/ijai.v13.i2.pp2122-2130.
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Knee osteoarthritis or OA is one of the most common diseases that can affect the elderly and overweight people. OA is occurred as the result of wear, tear, and progressive loss of articular cartilage. Kellgren-Lawrence system is a common method of classifying the severity of osteoarthritis depends on knee joint width. According to Kellgren-Lawrence, knee OA is divided into five classes; one class represents a normal knee and the others represent four levels of knee OA. In this work, we aim to automatically detect knee OA according to the Kellgren-Lawrence classification. The proposed system uses the U-Net architecture. The overall system yielded an accuracy of 96.3% during training.
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Choi, J. H., and W. Jeong. "AB1180 THE CHANGES OVER TIME OF KNEE STRENGTH AND FUNCTIONAL OUTCOMES BEFORE AND AFTER BILATERAL TOTAL KNEE ARTHROPLASTY." Annals of the Rheumatic Diseases 82, Suppl 1 (2023): 1820.1–1820. http://dx.doi.org/10.1136/annrheumdis-2023-eular.1245.
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BackgroundKnee osteoarthritis is the most common joint disorder and is associated with functional disability and pain. Total knee arthroplasty (TKA) is considered as an effective treatment for patients with end-stage knee osteoarthritis. However, most patients experienced deterioration in knee strength and functional outcomes immediately after surgery.ObjectivesThe overall aim of this study was to investigate the change over time of knee strength and functional outcomes before and after bilateral total knee arthroplasty.MethodsRetrospective cohort data of 308 patients who underwent primary bilateral TKA were analyzed. Patients underwent home-based preoperative rehabilitation program (3 times per week for 3 or 4 weeks) including strengthening and resistance training. After TKA, standard rehabilitation program was applied to all patients. Outcome measures were assessed 3 times, preoperatively and at 6 weeks and 3 months after surgery which included performance-based physical function test and self-reported physical function questionnaires. Assessment were included the isometric knee extensor and flexor strength of both knees, timed up-and-go (TUG) test, timed stair climbing test (SCT), 6-minute walk test, isometric knee extensor and flexor strength of both knees, knee flexion and extension range of motion, Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) for pain, stiffness, and functional levels. The knee flexion and extension range of motion (ROM) was assessed 5 times including at the beginning and end of standard rehabilitation.ResultsThe knee extensor strength and ROM, and SCT of ascending were worsened at the 6 weeks after surgery, and these measures significantly improved following the 6 weeks. The ROM of knee flexion improved earlier than other physical functions and ROM of knee extension worsened after 6 weeks postoperatively. However, the result of self-reported physical function and other performance-based physical functions continued to improve significantly at 6 weeks and 3 months after surgery.ConclusionThis study demonstrated that the patients who underwent bilateral TKA surpassed most of their physical functions in the 3 months before surgery. However, the recovery of performance-based physical function and self-reported physical function occurred at different times after surgery. Therefore, a rehabilitation treatment strategy according to these changes of physical functions is needed.References[1]Peat G, McCarney R, Croft P. Knee pain and osteoarthritis in older adults: a review of community burden and current use of primary health care. Annals of the rheumatic diseases. 2001;60(2):91-7.[2]Cross III WW, Saleh KJ, Wilt TJ, Kane RL. Agreement about indications for total knee arthroplasty. Clinical Orthopaedics and Related Research (1976-2007). 2006;446:34-9.[3]Nilsdotter AK, Toksvig-Larsen S, Roos EM. Knee arthroplasty: are patients’ expectations fulfilled? A prospective study of pain and function in 102 patients with 5-year follow-up. Acta orthopaedica. 2009;80(1):55-61.[4]Stevens JE, Mizner RL, Snyder-Mackler L. Quadriceps strength and volitional activation before and after total knee arthroplasty for osteoarthritis. Journal of Orthopaedic Research. 2003;21(5):775-9.Table 1.Demographic and Disease-Related Characteristics of the Subjects (N=308)VariablesValuesAge (years)69.3 ± 4.5Sex, males/females39 (12.7)/ 269 (87.3)BMI (kg/m2)26.5 ± 3.2K-L grades (Grade 3/Grade 4)* Right42 (13.6)/ 266 (86.4) Left52 (16.9)/ 256 (83.1)ComorbiditiesDiabetes mellitus47 (15.3) Hypertension184 (59.7) Cerebrovascular disease20 (6.5)Dyslipidemia66 (21.4)ASA PS Classification Class I98 (31.8) Class II204 (66.2) Class III6 (1.9)Values represent mean ± standard deviation or number (%) of casesAbbreviations: BMI, Body Mass Index; K-L, Kellgren-Lawrence; ASA PS, American Society of Anesthesiologists Classification Physical StatusAcknowledgements:NIL.Disclosure of InterestsNone Declared.
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Ben Tekaya, A., L. Rouached, A. Slimi, et al. "AB0879 DOES BODY WEIGHT INFLUENCE THE KNEE INJURY AND OSTEOARTHRITIS OUTCOME SCORE IN PERSONS WITH SYMPTOMATIC KNEE OSTEOARTHRITIS?" Annals of the Rheumatic Diseases 79, Suppl 1 (2020): 1745.2–1745. http://dx.doi.org/10.1136/annrheumdis-2020-eular.5643.
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Background:Overweight is a major risk factor for the development and progression of knee osteoarthritis (OA). Weight loss for patients with knee OA has been associated with improvement in self-reported pain and function and is recommended by EULAR as part of the therapeutic management.Objectives:The aim of the study was to evaluate the relation between overweight and functional impairment in adults with knee OA.Methods:It was a prospective study conducted in a rheumatologic department over a 4 months period. Patients with symptomatic knee OA based on the ACR criteria, were included. A screening of body mass index (BMI) was carried out for all patients. It was categorized following the WHO classification into: normal (<25 kg/m2), overweight (25 to <30), obese (up to 30).Pain level was evaluated using the Visual Analogue Scale (VAS). Function was assessed by the short form of the Knee injury and Osteoarthritis Outcome Score (KOOS-PS) (KOOS-PS scores to 0 representing no difficulty and 100 representing extreme difficulty). The patients’ knee radiographies were graded according to Kellgren Lawrence criteria (KL). The patients were allocated in two groups; as grade I-II KL (Group 1) and grade III-IV KL (Group 2).Results:We included 143 patients with a mean age of 65.17± 10.7 years and 88.1% of women. Patients were from low socio-economic class in 30.8% of cases. Mean disease duration of the KOA was 5.4 years [3months-20 years] and mean BMI was 31.8±5.6kg/m2. Patients were with normal weight in 16.1%, overweight in 19.6% and obese in 64.3%.Knee OA was bilateral in 85.3% and other OA sites were associated in 37.8% of patients. Mean VAS pain of knee OA was 6.6±1.5 and KOOS-PS was 48.8±16.5/100. Concerning the radiographic damage; we found grade I-II (KL) in 22.6% and grade III-IV (KL) in 77.4%.High BMI (BMI≥25 kg/m2was not significantly associated with worse KOOS score (p=0.9), more pain (p=0.5) or an increasing severity of radiological knee osteoarthritis (p=0.14). Moreover, the level BMI was not associated with the presence of other OA sites (p=0.9) or a bilateral KOA (p=0.07).Conclusion:These data, from a subset of participants with symptomatic radiographic knee OA, demonstrate no correlation between obesity and pain, functional impairment and radiographic severity.Acknowledgments:noneDisclosure of Interests:None declared
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Kohn, Mark D., Adam A. Sassoon, and Navin D. Fernando. "Classifications in Brief: Kellgren-Lawrence Classification of Osteoarthritis." Clinical Orthopaedics and Related Research® 474, no. 8 (2016): 1886–93. http://dx.doi.org/10.1007/s11999-016-4732-4.
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Schiphof, D., M. Boers, and S. M. A. Bierma-Zeinstra. "Differences in descriptions of Kellgren and Lawrence grades of knee osteoarthritis." Annals of the Rheumatic Diseases 67, no. 7 (2008): 1034–36. http://dx.doi.org/10.1136/ard.2007.079020.
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Roemer, Frank W., Ali Guermazi, C. Kent Kwoh, Shadpour Demehri, David J. Hunter, and Jamie E. Collins. "Diagnostic performance of MRI-defined simulated Kellgren-Lawrence grades using ordinal grading." Osteoarthritis and Cartilage 33 (April 2025): S278. https://doi.org/10.1016/j.joca.2025.02.398.
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Mikhaylichenko, А. A., and Y. М. Demyanenko. "Using squeeze-and-excitation blocks to improve an accuracy of automatically grading knee osteoarthritis severity using convolutional neural networks." Computer Optics 46, no. 2 (2022): 317–25. http://dx.doi.org/10.18287/2412-6179-co-897.
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In this paper, we investigate the effect of squeeze-and-excitation blocks on improving the classification quality of osteoarthritis using convolutional neural networks of the ResNet and DenseNet families. We show that the use of these blocks improves the quality of osteoarthritis classification according to the Kellgren-Lawrence scale by 1–3 % without a significant modifi-cation of the model structure. We also demonstrate that combining the 0 and 1 classes of the Kellgren-Lawrence scale into one class allows one to increase the accuracy of osteoarthritis grading by 12.74 %, without losing significant information about the disease. The best final ac-curacy attained was 84.66 % when using an ensemble of three convolutional networks with the DenseNet-121 architecture using squeeze-and-excitation blocks, which significantly exceeds the performance of the existing state-of-the-art. The obtained results can be used both for a prelimi-nary automatic diagnosis and as an auxiliary tool.
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Fishchenko, Ia V., A. A. Vladimirov, I. V. Roy, L. D. Kravchuk, and S. P. Chornobai. "Treatment of coxalgia in patients with grades 3–4 hip osteoarthritis." Genij Ortopedii 27, no. 2 (2021): 209–13. http://dx.doi.org/10.18019/1028-4427-2021-27-2-209-213.
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Hip osteoarthritis (OA) is an important public health issue. Nonsurgical treatments including changes in lifestyle, physiotherapy, pharmacological therapy can be effective for patients with coxalgia at early stages of hip osteoarthritis. Objective To evaluate the effectiveness of percutaneous radiofrequency (RF) denervation (neuroablation) of articular sensory nerves of the hip joint for pain relief in patients with chronic hip pain. Material and methods The review included 46 patients (47 joints) with hip OA who were classified as Kellgren-Lawrence grade 3 (n = 37) and Kellgren-Lawrence grade 4 (n = 9). Quantitative and qualitative assessment of pain was produced with VAS scale. The Harris Hip Score (HHS) was used to measure functionality. All patients underwent radiofrequency ablation of the articular branches of the femoral and obturator nerves. The results of treatment were evaluated at 2 weeks, 1, 3, 6 and 12 months. Results VAS scores showed significant pain relief immediately after the procedure that persisted in 69.5 % of patients at 6 months and in 56.5 % at 12 months with 43.5% of patients reporting dissatisfaction. HHS scores demonstrated improved quality of life in 85.2 % of patients at 6 months, with patient satisfaction recorded in 58.6 % at 12 months, and 41.3 % reported significant deterioration. Conclusions Percutaneous RF denervation of articular sensory nerves of the hip joint was shown to be effective for pain relief in patients with severe hip OA at a short term (up to 6 months). The technique can be recommended for patients who have contraindications to hip replacement surgery.
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Battu, Maheswara Reddy, Muddamsetti Nagesh, G. Raghava Naidu Y, and Venkateswara Prasad Saya. "Evaluation of Final Outcomes after High Tibial Osteotomies in the Treatment of Osteoarthritis." International Journal of Pharmaceutical and Clinical Research 16, no. 12 (2024): 605–9. https://doi.org/10.5281/zenodo.14590238.
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<strong>Background: </strong>High tibial osteotomy (HTO) and uni-compartmental knee arthroplasty are both treatment options for isolated uni-compartmental osteoarthritis (OA) of the knee and Knee joint instability. Before the advent of knee arthroplasties, HTO was the most commonly performed surgical procedure for knee OA. HTO is a well-established procedure used to treat uni-compartmental conditions like overload or osteoarthritis by shifting the mechanical axis of the knee, thereby realigning the load distribution. This realignment can help reduce pain, improve function, and potentially slow the progression of osteoarthritis. <strong>Aim of the Study:</strong> To analyse the final outcome of the High Osteotomy in Osteoarthritis patients after a follow up of 2 years. <strong>Materials: </strong>29 consecutive patients with Osteoarthritis patients attending the Department of Orthopedics, from May 2022 to August 2024 were included in a prospective case series study. All the patients were graded according to Kellgren Lawrence classification with radiological evidence of Osteoarthritis with valgus and/or varus deformities and medial compartmental osteoarthritis (OA). Patients aged between 45 years and 65 years were included. Patients with high-demand activity levels without running or jumping were included. Patients with varus mal-alignment less than 15° were included. Patients with metaphyseal varus of the tibia greater than 5° were included. Patients with full range of motion and normal lateral and patella-femoral compartments were included. Deformity analysis was based on full-leg weight-bearing radiographs, either digitally or on paper. Arthroscopy was done initially to assess the status of the cartilage and menisci, especially in the lateral compartment. Wherever necessary, medial meniscus was resected, smoothing of the cartilage done and ablation of osteophytes were done to address any extension deficits. All the patients were followed up for 2 years. <strong>Results: </strong>29 patients were treated with HTO, with an average age of 45.62±5.35 years. The average osteotomy opening was 10.8 mm, and no cases of secondary loss of correction occurred. One patient required a reoperation shortly after the initial procedure due to overcorrection, which was corrected by removing distal locking screws, adjusting the leg axis, and securing the plate with bi-cortical locking screws. Two patients experienced late infection and soft-tissue irritation 4 months postoperatively, but after plate removal and antibiotic treatment, the further clinical course was complication-free. <strong>Conclusions: </strong>Realignment osteotomy remains a critical treatment option for early to medium-grade varus medial compartment osteoarthritis (OA). Open-wedge high tibial osteotomy (HTO) utilizing optimal surgical techniques (including bi-planar metaphyseal osteotomy) and fixation with the TomoFix internal plate fixator has proven to be effective in treating uni-compartmental gonarthrosis, even in the absence of bone grafts or substitutes. The complication rate is low, patients achieve full weight-bearing quickly, and the medium-term results are promising.
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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 (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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Ponce, Y., O. Rillo, A. Brigante, O. Leonardi, E. Raad, and M. C. Lunic. "POS1486-HPR DETECTION OF ASSOCIATED FIBROMYALGIA IN PATIENTS WITH OSTEOARTHRITIS OF THE KNEE ACCORDING TO THE MULTIDIMENSIONAL HEALTH ASSESSMENT QUESTIONNAIRE/ FIBROMYALGIA ASSESSMENT SCREENING TOOLS (MDHAQ/FAST4)." Annals of the Rheumatic Diseases 81, Suppl 1 (2022): 1089.1–1089. http://dx.doi.org/10.1136/annrheumdis-2022-eular.4217.
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BackgroundOsteoarthritis is the most prevalent joint pathology. knee Osteoarthritis is one of the most frequent locations and has the greatest impact on the health of patients. It can be associated up to 11% with depression and 23% with neuropathic pain. It has also been reported that it can coincide with fibromyalgia (FM) between 6% and 22.83%. This difference may be attributed to some factors, e.g., sample size and/or socioeconomic status. Therefore, the clinical interpretation of symptoms in knee osteoarthritis may be overestimated by the presence of FM. Pincus T. et al. used the FAST4 to identify the coexistence of FM in patients with various rheumatic pathologies. The FAST4 consists of using the MDHAQ (symptom checklist, painful joint count, fatigue and pain). A FAST4 score ≥ 3 allows the association of FM to be considered. The authors demonstrated good concordance with the 2011 FM criteria according to the ACR (with a sensitivity of 70.4% and a specificity of 97.1%)ObjectivesTo detect the presence of associated FM in patients with early and established knee osteoarthritis employing the MDHAQ/FAST4MethodsPatients ≥18 years, of both sexes, from our community with early and established knee osteoarthritis (Luyten, FP 2018 and Altman, R 1986 Classification Criteria respectively). All answered the MDHAQ/FAST3-F questionnaire, in addition to the Patient Health Questionnaire (PHQ9) and the Neuropathic Pain 4 Questions (DN4). Depression was considered respectively with a score ≥3 of the PHQ9 and neuropathic pain with 4 points of the DN4Results100 patients (96 with a diagnosis of early knee osteoarthritis and 4 with established knee osteoarthritis [Luyten - ACR]) with a median age of 58 (RIC 16) and female sex were included 72%.We observed associated FM (FAST4-F) in 31% of patients (27 with early knee osteoarthritis and 4 with established knee osteoarthritis). Median VAS pain, patient and physician global assessment of the disease was higher in patients with FM (p<0.0001). Disease activity by RAPID 3 was low in 4%, moderate in 38% and high in 58% of patients. The cohort had a median pain score of 60 (RIC 60) with absence of neuropathic pain (DN4) in 90% of patients. Depression (PHQ9) was observed in 29% of cases.OA evolution time in months in patients with FM 48 (RIC 12) vs. 36 (RIC 24) without FM (p< 0.0001).Binary logistic regression was performed. In the bivariate analysis, it was observed that the presence of early OA by Luyten’s criteria (p=0.002), the presence of depression by PHQ9 (p=0.001), patients of white ethnicity (p=0.03), sobrepeso (p=0.002), low RAPID 3 disease activity (p=0.001), kellgren and lawrence grades II and III (p=0.001), were significant in the bivariate model, although none were statistically significant in the multivariate modelConclusionThe evaluation of knee osteoarthritis can be complicated in those patients who coexist with FM. In our study 31% met criteria for this entity according to MDHAQ/FAST4. We consider this questionnaire to be single and practical for detecting associated FM. The results obtained give hierarchy to the use of PROMs (Patient Reported Outcomes Measures) that can recognize clues of associated diseases such as FM and/or depression. And thus be able to establish a timely and appropriate treatment when these pathologies are overlapping, in order to change the patient’s prognosis and improve their quality of lifeReferences[1]Pincus T, Schmukler J, Castrejon I. Patient questionnaires in osteoarthritis: what patients teach doctors about their osteoarthritis on a multidimensional health assessment questionnaire (MDHAQ) in clinical trials and clinical care. Clin Exp Rheumatol 2019; 37(Suppl. 120): S100-S111.[2]Gibson K, Castrejon I, Descallar J, et al. Fibromyalgia Assessment Screening Tool: Clues to Fibromyalgia on a Multidimensional Health Assessment Questionnaire for Routine Care. J Rheumatol. 2020;47(5):761-69AcknowledgementsUnidad de investigación de la Sociedad Argentina de Reumatología(UNISAR)Disclosure of InterestsNone declared
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Kurniawati, Wensri Sevni, Muhammad Ilyas, Mirna Muis, Andi Alfian Z, Faridin Faridin, and Sri Asriyani. "Correlation between Osteoarthritis Knee Damage Based on Ultrasound with Kellgren-Lawrence Classification." Mutiara Medika: Jurnal Kedokteran dan Kesehatan 21, no. 1 (2021): 50–58. http://dx.doi.org/10.18196/mmjkk.v21i1.7225.
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The classic standard criteria to diagnose osteoarthritis (OA) of the knee is the conventional radiological imaging. Ultrasonography could assess the osteoarthritis early and show invisible joint structures in osteoarthritis. This study aimed to compare the cartilage changes of trochlear femur and osteophytes (femur and tibia) through ultrasound examination with the radiological imaging in stages to Kellgren-Lawrence (KL) classification. This is an observational study using cross-sectional design, involved 33 patients with knee OA who underwent conventional photo examination and ultrasonography at dr. Wahidin Sudirohusodo Makassar Hospital in the period of June - August 2019. Spearman's test showed that there is a significant correlation between the stage of OA by KL and the stage of femoral trochlear cartilage damage (p 0.001) with strong correlation (r 0.828). Significant correlation is also between the stage of OA and the stage of osteophytes on the femur-lateral condylus both medial and lateral sides (p 0.001) with strong correlation (r 0.823; 0.79; 0.816, and 0.818). It concluded that the higher grade of femoral trochlear cartilage damage will result in the higher the stage of OA. The higher grade of osteophytes in knee joints will also result in the higher the stage of OA.
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Naseem, Sajid, Muhammad Sajid Rafiq Abbasi, Jahangir Anjum, Nadeem Afzal, Zia Kakar, and Komal Aqeel Safdar. "Association between Pain, Functional Impairment and Radiographic Findings in Patients with Osteoarthritis of Knee." Pakistan Journal of Medical and Health Sciences 15, no. 9 (2021): 2544–46. http://dx.doi.org/10.53350/pjmhs211592544.
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Objective: To explore the relationship between pain, functional impairment (disability) and the radiographic findings in patients with osteoarthritis of the knee. Study Design: Cross sectional study Place and Duration of Study: Department of Rhematology, Pakistan Air Force Hospital Islamabad from 1st September 2020 to 28th February 2021 Methodology: One hundred and thirty eight patients of knee joint osteoarthritis were included. Weight bearing antero-posterior and lateral views X-ray for both knees were performed on each patient and Kellgren-Lawrence (KL) system was used to grade the severity of OA. We used Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for assessment of pain, stiffness and functional impairment. Results: The mean age was 53.76±7.14 years and females were 92 (67 %) and males were 46 (33 %). Average duration of disease was 3.7 years and mean body mass index was 26.78±2.25 Kg/m2. There was no statistically significant association of pain, stiffness and functional impairment with Kellgren-Lawrence radiographic grades. Conclusion: Functional impairment is more associated with level of pain, stiffness in joint and body mass index of patient than the severity of radiographic changes on knee X-ray. Therefore, we would recommend considering functional status of patient alongside radiological findings while planning treatment for patient with knee osteoarthritis. Key words: Osteoarthritis, Pain, function, Radiography
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Barbari, Cody, Sarah Pastoriza, Jianli Niu, Elvis Guzman, Sophia Artamendi, and Jackson Cohen. "A REVIEW OF BONE MARROW ASPIRATE CONCENTRATE THERAPY IN THE TREATMENT OF KNEE OSTEOARTHRITIS." Biologic Orthopedics Journal 6, no. 1 (2024): e21-e33. http://dx.doi.org/10.22374/boj.v6i1.71.
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Purpose: Bone marrow aspirate concentrate (BMAC) provides a novel therapeutic option for knee osteoarthritis. The authors aim to systematically evaluate functional and clinical outcomes after BMAC injection treatment for knee osteoarthritis. Methods: We used articles found in PubMed and Google Scholar using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies published from January 2018 through November 2023 on patients treated with a bone marrow aspirate concentrate injection with a focus on grades I-IV Kellgren-Lawrence osteoarthritis of the knee. Reports contained functional and clinical outcomes. Results: Eleven articles were used in the extraction of data. Eight hundred seventy-six patients were injected with BMAC and 1,010 knees with osteoarthritis were included in this literature review. For studies that passed inclusion and exclusion criteria, reported outcomes included improved pain, function, and quality of life post-procedure. Conclusion: The literature reviewed indicates that the intraarticular injection of BMAC warrants additional investigation in treating mild to severe osteoarthritis (classified under Kellgren-Lawrence I-IV). Factors such as the preparation and concentration of BMAC remain subjects of ongoing debate and scrutiny. Consequently, further research is needed to determine the feasibility and effectiveness of BMAC as a treatment modality for knee osteoarthritis. Level of Evidence: IV.
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Nasef, Daniel, Demarcus Nasef, Viola Sawiris, Peter Girgis, and Milan Toma. "Deep Learning for Automated Kellgren–Lawrence Grading in Knee Osteoarthritis Severity Assessment." Surgeries 6, no. 1 (2024): 3. https://doi.org/10.3390/surgeries6010003.
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Background: This study evaluated the performance of machine learning models trained on two different datasets of knee X-ray images annotated with Kellgren–Lawrence grades. Methods: Learning curves indicated that one model experienced poor training, characterized by underfitting, while the other model demonstrated effective training with proper convergence. The poorly trained model appeared to perform adequately on its internal test set but failed to generalize to an external dataset, yielding suboptimal results. Results: In contrast, the well-trained model not only performed well on its internal validation but also showed adequate performance when tested on the external dataset. Conclusions: These findings highlight the importance of examining learning curves to assess model training quality and the critical necessity of external testing to evaluate generalizability. Most existing studies lack external validation, raising concerns about the reliability of their reported performance. This study emphasizes that without external testing, models may not perform as expected in real-world clinical settings, potentially impacting clinical decision-making for surgical interventions. The results advocate for the inclusion of external validation in model evaluation and the assessment of model convergence using learning curves to ensure the development of robust and generalizable tools for knee osteoarthritis severity assessment and other applications.
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Rodionova, S. S., N. A. Es’kin, N. Yu Matveeva, and N. S. Morozova. "Rational Choice of Treatment for Initial Stages of Gonarthrosis in Patients with Systemic Osteoporosis." N.N. Priorov Journal of Traumatology and Orthopedics 21, no. 2 (2014): 52–56. http://dx.doi.org/10.17816/vto20140252-56.
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Results of open controlled study of 60 outpatients aged 45-70 years, with systemic osteoporosis (postmenopausal and idiopathic) and I-II stages of gonarthrosis by Kellgren - Lawrence classification are presented. All patients were divided into 2 groups: study group (n=30) and control group (n=30). Additional treatment for gonarthrosis (Artra drug for 3 months) was prescribed only to patients from the study group. It was shown that study drug decreased significantly (p
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Mishra, Abhishek Kumar, Sudhir Kushwaha, Sundip Hemant Charmode, and Vishwa Chauhan. "Revisiting the Existing Grading Systems of Glenohumeral Joint Arthropathy and Proposing a Modified Classification." Journal of Surgical Specialties and Rural Practice 5, no. 3 (2024): 98–99. https://doi.org/10.4103/jssrp.jssrp_14_24.
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Abstract Osteoarthritis (OA) of the glenohumeral joint may affect up to 20% of the elderly population. The glenohumeral joint OA is classified in several ways based on different criteria. The notable ones include the Samilson and Prieto classification, Modified Samilson and Prieto classification by Allain, Modified Samilson and Prieto classification by Gerber, Guyette classification, and Kellgren and Lawrence classification. Through this letter, the authors wish to bring it to esteemed editors that a more comprehensive radiological classification is needed to study and categorize the patient and to predict the severity of glenohumeral arthritis. We suggest that X-ray views in anatomical position as well as 45° external rotation and 45° internal rotation will be best suited to plain radiographic classification, which is needed to classify glenohumeral arthritis.
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Safarli, Aytan, Berkay Kirnaz, Derin Kumcuoglu, Vusal Mahmudov, Ziya Karimov, and Afig Berdeli. "Retrospective evaluation of the short-term effectiveness of non-enzymatically isolated stromal vascular fraction cells in patients with knee osteoarthritis." Journal of Orthopaedics, Trauma and Rehabilitation, July 25, 2024. http://dx.doi.org/10.1177/22104917241258237.
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Background Knee osteoarthritis (KOA) is the most common degenerative joint disease. Adipose-derived stromal vascular fraction cell therapy slows the progression of knee osteoarthritis and prevents hyaline cartilage degeneration without serious side effects. This study aims to present retrospectively the effectiveness of stromal vascular fraction cells isolated from adipose tissue by the non-enzymatic method applied to 55 osteoarthritis patients of different age groups and Kellgren-Lawrence grades on the recovery of the disease. Material and Methods Fifty-five patients with knee osteoarthritis, treated with stromal vascular fraction cells at the International Medical Centre (Azerbaijan) between 2020 and 2021, were included in the study to be evaluated retrospectively. Patients aged 32–67 years, Grades I–IV according to Kellgren-Lawrence classification, were included in this study. Pain and functional limitations were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaires before treatment, at the 5th month, and 12th month after stromal vascular fraction injection. Results At the fifth and 12th months post-treatment, it was observed that the WOMAC scores were significantly improved compared with pre-treatment scores. It was also observed that stromal vascular fraction therapy was effective for Kellgren-Lawrence Grades I and II at 12 months. The most significant decrease in the WOMAC score after stromal vascular fraction treatment was observed in patients aged 45–60 years, and it was also found that there was no meaningful relationship between stromal vascular fraction efficiency and gender. Conclusion According to our results, non-enzymatically stromal vascular fraction treatment is more effective for longer in osteoarthritis patients with early age and low Kellgren-Lawrence grades (I and II). Moreover, our finding is that the stromal vascular fraction cells could be used safely in osteoarthritis treatments and significantly benefit patients’ quality of life.