Common Cause Of Osteoarthritis Research Articles

Iodinated gadolinium-gold nanomaterial as a multimodal contrast agent for cartilage tissue imaging.

Cartilage damage, a common cause of osteoarthritis, requires medical imaging for accurate diagnosis of pathological changes. However, current instruments can acquire limited imaging information due to sensitivity and resolution issues. Therefore, multimodal imaging is considered an alternative strategy to provide valuable images and analyzes from different perspectives. Among all biomaterials, gold nanomaterials not only exhibit outstanding benefits as drug carriers, in vitro diagnostics, and radiosensitizers, but are also widely used as contrast agents, particularly for tumors. However, their potential for imaging cartilage damage is rarely discussed. In this study, we developed a versatile iodinated gadolinium-gold nanomaterial, AuNC@BSA-Gd-I, and its radiolabeled derivative, AuNC@BSA-Gd-131I, for cartilage detection. With its small size, negative charge, and multimodal capacities, the probe can penetrate damaged cartilage and be detected or visualized by computed tomography, MRI, IVIS, and gamma counter. Additionally, the multimodal imaging potential of AuNC@BSA-Gd-I was compared to current multifunctional gold nanomaterials containing similar components, including anionic AuNC@BSA, AuNC@BSA-I, and AuNC@BSA-Gd as well as cationic AuNC@CBSA. Due to their high atomic numbers and fluorescent emission, AuNC@BSA nanomaterials could provide fundamental multifunctionality for imaging. By further modifying AuNC@BSA with additional imaging materials, their application could be extended to various types of medical imaging instruments. Nonetheless, our findings showed that each of the current nanomaterials exhibited excellent abilities for imaging cartilage with their predominant imaging modalities, but their versatility was not comparable to that of AuNC@BSA-Gd-I. Thus, AuNC@BSA-Gd-I could be served as a valuable tool in multimodal imaging strategies for cartilage assessment.

Intra-Articular Hyaluronic Acid for Osteoarthritis of the Hip, Shoulder, and Ankle

What Is the Issue?
 
 Osteoarthritis (OA) is a chronic disease of the joints, such as the hip, shoulder, and ankle. OA causes the joints to be painful, unstable, and less functional. In adults 55 years and younger, joint trauma is a common cause of OA.
 Hyaluronic acid (HA) is a naturally occurring molecule found in human cells that provides lubrication when injected into the joint. HA injections are a less invasive option than surgery, with potentially fewer complications.
 To support decision-making about treating hip, shoulder, or ankle OA in adults 55 years and younger, it is important to understand the potential benefits and harms of using HA in this population.
 
 What Did We Do?
 
 We reviewed the clinical effectiveness of high molecular weight (MW) injection of HA in adults between the ages of 18 and 55 years with OA of the hip, shoulder, or ankle joints to guide decisions on the use of high MW HA injection.
 An information specialist searched for peer-reviewed and grey literature sources published on January 1, 2013 to December 12, 2023. One reviewer screened citations and selected and critically appraised the included studies.
 
 What Did We Find?
 
 The evidence for this report was based on observational before-and-after studies. We found no relevant comparative studies examining the effect of high MW HA versus placebo or no treatment.
 While most studies reported post-treatment outcome improvements, it is uncertain whether high MW injection of HA improves pain, function, and disability in adults 55 years and under with hip, shoulder, or ankle OA. This is due to the low-quality evidence, small sample sizes, and methodological problems. Serious side effects of high MW HA were not reported.
 
 What Does This Mean?
 
 Due to the uncertainty of the clinical effectiveness evidence, health care providers and decision-makers may consider other factors when considering high MW IA-HA for patients with hip, shoulder, or ankle OA; these factors could include acceptability, feasibility, costs, health equity, and patient values and preferences.
 Future research from randomized studies in large populations is needed to understand the effectiveness and safety of high MW HA injections for hip, shoulder, and ankle OA.

Preoperative incipient osteoarthritis predicts failure after periacetabular osteotomy: 69 hips operated through the anterior intrapelvic approach.

Untreated developmental hip dysplasia may result in pain, loss of function and is a common cause of osteoarthritis (OA). The periacetabular osteotomy (PAO) was developed to relieve symptoms and postpone further degeneration of the hip. We aimed to assess preoperative clinical and radiographic prognostic factors and evaluate survivorship of PAO after medium-term follow-up of 7.4 (2-15) years. 59 patients (69 hips) operated with a PAO through an anterior intrapelvic approach from 1999 to 2011 were retrospectively identified. The patients were evaluated radiographically and clinically with Harris Hip Score, Western Ontario and McMaster Universities Osteoarthritis Index and 15D quality of life questionnaires. Survival analyses identified native hip joint survival predictors. 9 hips (9 patients) were converted to a total hip arthroplasty (THA). Of the 50 remaining patients (60 hips), 44 patients (54 hips) were examined at medium-term follow-up. 3 patients were lost to follow-up or declined participation and 3 were interviewed by telephone. Patient age at time of surgery was 32 (14-44) years. Survival analyses showed 84.3% (95% confidence interval [CI], 68.7-92.5%) survival of the native hip at 8 years follow-up (number at risk 32) (worst case scenario 80% survival at 8 years, 95% CI, 63.9-89.2%, number at risk 32). Cox regression with presence of preoperative OA (Tönnis ⩾1), showed a crude hazard ratio for conversion to THA with preoperative OA of 13.73, p < 0.001. Periacetabular osteotomy through the anterior intrapelvic approach can be performed safely and with satisfactory results at medium-term follow-up. The presence of preoperative incipient OA (Tönnis ⩾1) is the most important predictor for poor hip joint survival.

Delays in diagnosis are associated with poorer outcomes in adult hip dysplasia.

Background and Aims Developmental dysplasia of the hip is a common cause of osteoarthritis. Periacetabular osteotomy can restore femoral head coverage; however, it is reserved for patients with minimal articular degeneration. We examined the relationship between delays in diagnosis and outcomes. Methods We identified patients presenting to a hip specialist with a new diagnosis of hip dysplasia. The time taken between patients presenting to their general practitioner and attending the young adult hip clinic was established. Patients were stratified into Early, Moderate and Late Referral groups. Hip and SF-12 questionnaires were completed. Radiographs were graded according to the Tönnis classification system and the outcome following hip specialist review documented. Results Fifty-one patients were identified. Mean time from attending a general practitioner to review at the young adult hip clinic was 40.4 months. Lower hip and SF-12 scores, and higher radiological osteoarthritis grades were found in the Moderate and Late Referral groups. A higher proportion of the Moderate and Late Referral group underwent total hip arthroplasty rather than periacetabular osteotomy. Conclusion Delays in referring a patient to a hip specialist are associated with poorer outcomes. We propose pelvic radiographs are requested early by general practitioners to allow prompt diagnosis and referral to a hip specialist.

Scapholunate advanced collapse: a pictorial review

Teaching PointsScapholunate advanced collapse (SLAC) is the most common cause of osteoarthritis involving the wrist. Along with clinical investigation, radiological studies play a vital role in the diagnosis of SLAC wrist. Given that the osteoarthritic changes that are seen with SLAC occur in a predictable progressive pattern, it is important to understand the pathological evolution of SLAC to be able to recognise the associated progressive imaging findings seen with this disease process. Focusing on radiological findings, this article provides a pictorial review of the anatomy of the scapholunate interosseous ligament as well as the common terminology and biomechanical alterations seen in the pathway leading to the development of SLAC arthropathy. We will then discuss two additional common causes of SLAC wrist and their imaging findings, namely scaphoid non-union advanced collapse and calcium pyrophosphate dehydrate disease. In addition, we will provide a brief overview of the current treatment options of these pathological entities.• SLAC is the most common cause of osteoarthritis involving the wrist.• Arthritic changes of SLAC occur in a predictable progressive pathological and radiographic pattern.• Imaging is key for diagnosing, monitoring progression and assessing post-treatment changes of SLAC.

Growth factor treated tensioned synoviocyte neotissues: Towards meniscal bioscaffold tissue engineering

Meniscal injury is a common cause of osteoarthritis, pain, and disability in dogs and humans, but tissue-engineered bioscaffolds could be a treatment option for meniscal deficiency. The objective of this study was to compare meniscus-like matrix histology, composition, and biomechanical properties of autologous tensioned synoviocyte neotissues (TSN) treated with fetal bovine serum (TSNfbs) or three chondrogenic growth factors (TSNgf). Fourth passage canine synoviocytes from 10 dogs were grown in hyperconfluent monolayer culture, formed into TSN, and then cultured for 3weeks with 17.7% FBS or three human recombinant TSNgf (bFGF, TGF-β1, and IGF-1). Cell viability was determined with laser microscopy. Histological architecture and the composition of fibrocartilage matrix were evaluated in TSN by staining tissues for glycosaminoglycan (GAG), α-smooth muscle actin, and collagen 1 and 2; quantifying the content of GAG, DNA, and hydroxyproline; and measuring the gene expression of collagens type 1α and 2α, the GAG aggrecan, and transcription factor Sry-type Homeobox Protein-9 (SOX9). Biomechanical properties were determined by materials testing force–deformation curves.The TSN contained components and histological features of mensical fibrocartilage extracellular matrix. Growth factor-treated TSN had higher DNA content but lower cell viability than TSNfbs. TSNgf had greater fibrocartilage-like matrix content (collagen 2 and GAG content with increased collagen 2α and SOX9 gene expression). Additionally, TSNgf collagen was more organized histologically and so had greater tensile biomechanical properties. The results indicate the potential of TSN when cultured with growth factors as implantable bioscaffolds for the treatment of canine meniscal deficiency.

Results of arthrodiastasis in postraumatic ankle osteoarthritis in a young population: Prospective comparative study

IntroductionThe most common cause of osteoarthritis of the ankle is post-traumatic, and although tibiotalar arthrodesis remains the surgical gold standard, a number of techniques have been described to preserve joint mobility, such as joint distraction arthroplasty or arthrodiastasis. ObjectiveTo evaluate the functional outcome and changes in Visual Analog Scale (VAS) for pain after the application of the distraction arthroplasty for post-traumatic ankle osteoarthritis. Patients and methodsA prospective comparative study of a group of 10 young patients with post-traumatic ankle osteoarthritis treated by synovectomy and arthrodiastasis, compared to a control group of 10 patients treated by isolated synovectomy. Results were calculated using the AOFAS scale and the VAS for pain before and after treatment. ResultsAs regards the pain measured by VAS, no difference was observed between the two groups before surgery (P=.99), but there was a difference at 3 months (P<.001), 6 months (P=.005), and 12 months (P=.006). No differences were observed in the AOFAS scale between the two groups before surgery (P=.99), or at 3 months (P<.99), but there was a difference at 6 months (P<.001). ConclusionsAnkle arthrodiastasis is effective in reducing pain in post-traumatic ankle arthropathy, and is superior to isolated synovectomy.

Resultados de la artrodiastasis en la artropatía postraumática de tobillo en población joven: estudio prospectivo comparativo

IntroductionThe most common cause of osteoarthritis of the ankle is post-traumatic, and although tibiotalar arthrodesis remains the surgical gold standard, a number of techniques have been described to preserve joint mobility, such as joint distraction arthroplasty or arthrodiastasis. ObjectiveTo evaluate the functional outcome and changes in Visual Analogue Scale (VAS) for pain after the application of the distraction arthroplasty for post-traumatic ankle osteoarthritis. Patients and methodsA prospective comparative study of a group of 10 young patients with post-traumatic ankle osteoarthritis treated by synovectomy and arthrodiastasis, compared to a control group of 10 patients treated by isolated synovectomy. Results were calculated using the AOFAS scale and the VAS for pain before and after treatment. ResultsAs regards the pain measured by VAS, no difference was observed between the two groups before surgery (P=.99), but there was a difference at 3 months (P<.001), 6 months (P=.005), and 12 months (P=.006). No differences were observed in the AOFAS scale between the two groups before surgery (P=.99), or at 3 months (P<.99), but there was a difference at 6 months (P<.001). ConclusionsAnkle arthrodiastasis is effective in reducing pain in post-traumatic ankle arthropathy, and is superior to isolated synovectomy.

Increased thymosin β4 levels in the serum and SF of knee osteoarthritis patients correlate with disease severity

ObjectiveThymosin β4, a member of a large family of thymic proteins, plays an important role in the process of articular cartilage degeneration which is a common cause of osteoarthritis (OA). This study aims to determine thymosin β4 levels in the serum and synovial fluid (SF) of patients with knee OA and analyze the correlation of thymosin β4 levels with the radiographic severity of OA. MethodsThis study consisted of 216 patients with knee OA and 152 healthy controls. OA progression was classified based on Kellgren–Lawrence by evaluating x-ray changes observed in anteroposterior knee radiography. Thymosin β4 levels in the serum and SF were measured by enzyme-linked immunosorbent assay method. ResultsThe knee OA patients had higher levels of serum thymosin β4 than the healthy controls. Knee OA patients with KL grade 4 showed significantly elevated thymosin β4 levels in the serum and SF compared with those with KL grades 2 and 3. Knee OA patients with KL grade 3 had significantly higher SF levels of thymosin β4 than those with KL grade 2. Thymosin β4 levels in the serum and SF of knee OA patients were significantly correlated with disease severity according to KL grading criteria. ConclusionThe thymosin β4 levels in the serum and SF may serve as effective biomarkers for the severity of OA.

50 Years Ago in CORR: Slipping of the Upper Femoral Epiphysis Beckett Howorth MD CORR 1957;10:148–173

This month’s symposium reports various aspects of the diagnosis and treatment of femoroacetabular impingement, a condition recognized for well over a century but only recently emphasized, perhaps owing to the recognition of its occurrence in subtle and common forms. It was perhaps first recognized in 1898 a few years after the introduction of the roentgenogram in association with slipped capital femoral epiphysis [11]. According to Howorth, in the article highlighted here, Poland, in 1898, reported a case in which without reducing the displacement, “the projecting anterosuperior margin of the neck was trimmed away” [5]. He also noted that Whitman in 1909 [17] and Vulpius and Stoffel in 1913 [15] reported similar cases. Howorth suggested the earliest reference to slipped capital femoral epiphysis came from Ambroise Pare, whom he quotes, “The epiphysis of the head of the femur sometimes separates in such a way that the surgeon is misled, thinking there is a dislocation instead of a separation of the epiphysis” [5]. Howorth reviewed the work of many other authors who described slipped capital femoral epiphysis in the preradiographic days, although one wonders how these were identified unless they were observed at surgery (not all that common even in the late 1800s after the advent of general anesthesia) or autopsy. (Interested readers will find a large number of these early citations to slipped capital femoral epiphysis in Howorth’s article.) Howorth stated Poland, in 1898, found 31 cases in the literature and added his own [11]. In the first half of the 20th century the therapeutic emphasis in slipped capital femoral epiphysis was on the acute or chronic slip in adolescents, not the residuals in adults. Campbell, in the first edition of his book (1939) does not mention the treatment of adults with residuals [1]. However, the concept of impingement as a cause of hip pain in adults was certainly known in the 1930s. Smith-Petersen, in the Classic we reproduce in this issue, well described the entity [13]. Howorth only briefly notes a “residual stage,” following the acute slipped capital femoral epiphysis, in which “…some degree of osteoarthritis…may supervene.” In fact, he ventures, “Slipped epiphysis is probably the most common cause of osteoarthritis of the hip, often in the past called by the nonspecific term malum coxae senilis” (a term used in Smith-Peterson’s Classic in this issue). Nearly twenty years later, Stulberg et al. suggested unrecognized childhood diseases (primarily more or less subtle forms of slipped capital femoral epiphysis, developmental dysplasia, and Legg-Calve-Perthes disease) were likely a cause of many cases of presumably idiopathic osteoarthrosis [14]. Ganz and colleagues from Bern believed these conditions and others such as acetabular retroversion and femoral neck fractures caused impingement of the anterosuperior femoral neck against the labrum and acetabulum, resulting in labral and articular cartilage damage [2, 6, 7, 9, 12]. This theme has been recently amplified by Ganz and coworkers, suggesting osteoarthrosis occurs because of subtle forms of impingement not always readily detected on traditional forms of imaging [4, 16]. Many of the deformities of the femoral neck are consistent with mild, unrecognized slipped capital femoral epiphysis. The concepts about femoroacetabular impingement continue to be refined [3, 10], but the recent work of Loder et al. [8] suggests Howorth may be have been correct in surmising that subtle forms of slipped capital femoral epiphysis could be a common cause of osteoarthrosis.

Impingement of the Native Hip Joint

![Graphic][1] Impingement at the hip is a common cause of osteoarthritis. ![Graphic][2] Impingement is mostly due to morphologic changes as a consequence of in utero malformation or childhood hip disease such as Legg-Calve-Perthes disease or slipped capital femoral epiphysis. ![Graphic][3] On the basis of patterns and stages of labral and chondral injuries, impingement has been classified as cam type, pincer type, or mixed cam-pincer type. ![Graphic][4] The diagnosis is based on the medical history and the findings on physical examination and imaging studies. ![Graphic][5] Hip impingement is a mechanical problem, and nonoperative treatment will not correct the pathomechanics. Surgical correction should be considered prior to the onset of arthritis and must be designed to protect the vascularity of the femoral head. Impingement of the hip joint has been a hidden disease until the current decade. Femoroacetabular impingement was identified as a dynamic cause of osteoarthritis by Ganz et al.1-22, although Murray23 and Stulberg et al.24 had identified the so-called tilt deformity and pistol-grip deformity, respectively, as probable causes. Impingement within the hip joint is an abutment conflict between the bone of the femur and that of the pelvis. Impingement in young patients is a mechanical problem caused by biological structural patterns or by overuse, particularly in athletes or in very flexible hips. Leunig et al.14 observed evidence of impingement with aging in the acetabula of patients (sixty-nine to ninety-seven years of age) with a femoral neck fracture and not uncommonly in cadavers of donors who were sixty to ninety years old at the time of death. The cause of impingement in the osseous hip can be developmental, as a result of childhood conditions such as Legg-Calve-Perthes disease and slipped capital femoral epiphysis; it may also result from posttraumatic or post-osteotomy morphologic changes in inclination and anteversion angles1 … [1]: /embed/inline-graphic-1.gif [2]: /embed/inline-graphic-2.gif [3]: /embed/inline-graphic-3.gif [4]: /embed/inline-graphic-4.gif [5]: /embed/inline-graphic-5.gif

Comparison of predicted and measured contact pressures in normal and dysplastic hips

Hip dysplasia, a congenital and developmental deformity characterized by malorientation and a reduction of contact area between the femur and acetabulum, is the most common cause of osteoarthritis of the hip. According to current estimates, dysplasia accounts for nearly 76% of all cases of osteoarthritis, and many who are affected require a total hip replacement before the age of 50. It is theorized that in the poorly oriented and deformed pelvis, a reduction in contact area leads to an increase in contact pressure during normal activities. Currently, clinicians attempt to reposition the joint, assuming that improving the position of the existing contact surface will lead to decreased pressures. It is also assumed that improving certain geometric parameters correlates indirectly with decreased contact pressures. Neither these simple estimates nor other non-invasive models have ever been shown to be related to contact pressure. The purpose of this study was to evaluate a computerized method of predicting hip joint contact pressures, which applies known hip joint reaction forces to the three-dimensional surface of the hip joint. To this end, cadaveric and plastic pelvic models were developed to test whether the computer model could predict the magnitude and location of maximum pressure. Mechanical testing revealed that the computer model could be used to predict pressure in cadaveric pelves at prescribed locations ( r 2=0.64). The computerized model could also be used to predict the magnitude and location of maximum pressure in a series of plastic models where the load vector and the degree of dysplasia were parametrically varied ( r 2=0.7). These findings suggest that the computer model may be useful in identifying patients who will fail osteotomy or whether they can be used to select the best osteotomy for each patient.