Abstract

Objective: This study aimed to investigate the brain functional alterations with resting-state functional magnetic resonance imaging (rs-fMRI) in older patients with knee osteoarthritis (KOA) before and after total knee arthroplasty (TKA) and to assess the causal relationship of the brain function and neuropsychological changes.Methods: We performed rs-fMRI to investigate brain function of 23 patients aged ≥65 with KOA and 23 healthy matched controls. Of the KOA patients, 15 completed postoperative rs-fMRI examinations. Analyzes of the amplitude of low-frequency fluctuation (ALFF) and functional connectivity (FC) were used to estimate differences in brain functional parameters between KOA patients, postoperative patients, and the controls. The relationship between changes of pre- and post-surgical status in ALFF and neuropsychological test results was analyzed.Results: Compared with the controls, all patients with KOA exhibited decreased ALFF in the default mode network (bilateral angular gyrus, precuneus gyrus, medial superior frontal gyrus) and increased ALFF in the bilateral amygdala and cerebellum posterior lobe before surgery (P < 0.001). Altered ALFF persisted in the same brain regions 1 week postoperatively. The decreased ALFF in the left precuneus gyrus and middle temporal gyrus was found after surgery when compared with preoperative data (P < 0.01). Preoperatively, the KOA patients exhibited increased FC between the left precuneus gyrus and the right supplementary motor area compared to the controls (P < 0.001), but this connectivity became no significant difference after TKA. The left Cerebelum_9 was found to have decreased FC with the right precuneus gyrus postoperatively (P < 0.001) although this was not significantly different before surgery. The significantly altered ALFF values were not correlated with changes in cognitive assessment scores.Conclusion: In older patients with end-stage KOA, functional alterations in important brain regions were detected with the persistence and further changes observed at an early stage after knee replacement. Our data further our understanding of brain functional abnormalities and cognitive impairment in older patients following knee replacement, which may provide therapeutic targets for preventive/treatment strategy to be developed.Trial registration: Clinical Trial Registration: http://www.chictr.org.cn/index.aspx, ChiCTR1800016437; Registered June 1, 2018.

Highlights

  • Knee osteoarthritis (KOA) is a common disease in elderly people worldwide; chronic pain and movement limitation caused by the disease seriously negate their quality of life [1]

  • This study aimed to investigate the brain functional alterations with resting-state functional magnetic resonance imaging in older patients with knee osteoarthritis (KOA) before and after total knee arthroplasty (TKA) and to assess the causal relationship of the brain function and neuropsychological changes

  • Compared with the controls, all patients with KOA exhibited decreased amplitude of low-frequency fluctuation (ALFF) in the default mode network and increased ALFF in the bilateral amygdala and cerebellum posterior lobe before surgery (P < 0.001)

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Summary

Introduction

Knee osteoarthritis (KOA) is a common disease in elderly people worldwide; chronic pain and movement limitation caused by the disease seriously negate their quality of life [1]. It has been suggested that KOA is associated with an increased risk of cognitive decline and dementia [2]. The exact mechanism is still unclear [3], peripheral inflammatory mediators associated with osteoarthritis travel to the central nervous system to subsequently cause neuroinflammation and trigger cognitive decline or even dementia/Alzheimer’s disease development [4]. Patients at end-stage KOA normally receive total knee arthroplasty (TKA), and surgery can relieve chronic pain through removal of diseased cartilage and synovium, which causes chronic peripheral inflammation. Wide-ranging incidence of cognitive dysfunction has been reported in different patient populations, and it is likely related to the different type of neuropsychological test battery used, the variety of statistical analysis, and a lack of controls. The incidence of cognitive impairment can be overestimated or underestimated when the neuropsychological battery test itself is improperly used [7]

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