Definite Joint Space Narrowing Research Articles

The effectiveness of Transcutaneous Electrical Nerve Stimulation and strengthening exercises on the functional ability of patients with osteoarthritis of the knee joints: A case report

Knee osteoarthritis (OA) is the most common musculoskeletal disease among elderly individuals. It affects the ability to sit on a chair, stand, walk, and climb stairs. Our objective was to evaluate the effectiveness of tens and strengthening exercises on functional ability in patients with OA of knee joints. We present a case of a 55-year-old female housewife with bilateral knee pain, which manifested suddenly as a dull ache exacerbated by walking and stair climbing and alleviated by rest. Clinical examination revealed crepitus, grade 1 tenderness, and reduced range of motion (ROM) in the left knee. The radiographic evaluation confirmed grade 3 osteoarthritis according to the Kellgren and Lawrence grading system, indicating moderate multiple osteophytes, definite joint space narrowing, some sclerosis, and potential bone deformity. The patient underwent a 4-week intervention comprising strengthening exercises and TENS. Pain intensity was assessed using the Numeric Pain Rating Scale (NPRS), knee ROM with a goniometer, and functional limitations with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Assessments were conducted weekly throughout the intervention. The findings suggest that the combined application of TENS and strengthening exercises effectively alleviates pain and improves functional ability in patients with knee osteoarthritis.

Automatic knee Kellgren Lawrence grading with artificial intelligence

Purpose: Osteoarthritis (OA) classification in the knee is most commonly done with radiographs using the 0–4 Kellgren Lawrence (KL) grading system where 0 is normal, 1 shows doubtful signs of OA with potential abnormality, 2 demonstrates definite osteophytes (mild OA), 3 shows definite joint space narrowing (moderate OA), and 4 is severe joint space narrowing with subchondral sclerosis and bony deformity (severe OA). KL grading is widely used for clinical assessment and diagnosis of OA, usually on a high volume of radiographs, making its automation highly relevant. We propose a fully automated algorithm for the detection of OA using KL gradings with a state-of-the-art neural network. Methods: 4,490 bilateral PA fixed flexion knee radiographs were collected from the Osteoarthritis Initiative dataset (age = 61.2 ± 9.2 years, BMI = 32.8 ± 15.9 Kg/m2, 42/58 male/female split). The left and right knee joints were separated using image thresholding to identify the edges of the bone. The knee joints for each side were localized using a weighted-template matching by passing a cropped knee joint radiograph over each image and selecting the region with the highest correlation to the template. This resulted in a total of 8980 unique left and right radiographs which were randomly divided with a 60/10/30% split into training, validation, and testing data. Due to the large imbalance in KL score classes and relatively small dataset size, random rotation and translation augmentations were applied to the training dataset to increase the sample size. Using the state-of-the-art neural network architecture called DenseNet, which utilizes dense connections to reduce the total number of learnable feature maps, the radiograph's KL scores were learned. KL scores of 0 and 1 were combined into one class since clinically they are not considered as definite OA. This also helped accelerate the learning of the neural network. The DenseNet's grading decisions were examined by looking at the sensitivity analysis heatmap created by calculating the gradient of the predicted output with respect to the input. Results: Through a manual quality check, 99% of the automatically localized knee joint images contained the correct region. For the classification of no OA, mild, moderate, and severe OA, testing accuracies of 70.36%, 66.18%, 73.51%, and 77.42% were achieved. The count confusion matrix can be viewed in Figure 1. A handful of the cases misclassified by the model were reviewed by a clinical radiologist to better understand why and if the model was incorrect. For the majority of these cases the radiologist agreed that there were features that represented the grading made by the algorithm (examples can be viewed in Figures 2A and 2B). There was even a case reviewed where the provided radiologist grading was incorrect and the artificial intelligence grading was correct (Figure 2C). A heatmap of the case examined in Figure 2A was created to confirm the intercondylar notch feature identified by the clinical radiologists that potentially led to the model’s misclassification (Figure 3). The bright partial derivative signals around the intercondylar notch confirmed that this feature did play a role in the neural networks decision to classify this case as mild OA. Conclusions: In this study we provide a proof of concept that a fully automated pipeline using artificial intelligence can identify varying stages of OA. This algorithm has the ability to quickly filter radiographs to classify subjects at a high risk of OA as well as identify relevant features that may play a role in the development and presence of OA.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Hip Osteoarthritis and the Risk of All-Cause and Disease-Specific Mortality in Older Women: A Population-Based Cohort Study.

To determine the risk of all-cause and disease-specific mortality among older women with hip osteoarthritis (OA) and to identify mediators in the causal pathway. Data were from the Study of Osteoporotic Fractures, a US population-based cohort study of 9,704 white women age ≥65 years. The analytic sample included women with hip radiographs at baseline (n = 7,889) and year 8 (n = 5,749). Mortality was confirmed through October 2013 by death certificates and hospital discharge summaries. Radiographic hip OA (RHOA) was defined as a Croft grade of ≥2 in at least 1 hip (definite joint space narrowing or osteophytes plus 1 other radiographic feature). The mean ± SD followup time was 16.1 ± 6.2 years. The baseline and year 8 prevalence of RHOA were 8.0% and 11.0%, respectively. The cumulative incidence (proportion of deaths during the study period) was 67.7% for all-cause mortality, 26.3% for cardiovascular disease (CVD) mortality, 11.7% for cancer mortality, 1.9% for gastrointestinal disease mortality, and 27.8% for all other mortality causes. RHOA was associated with an increased risk of all-cause mortality (hazard ratio 1.14 [95% confidence interval 1.05-1.24]) and CVD mortality (hazard ratio 1.24 [95% confidence interval 1.09-1.41]) adjusted for age, body mass index, education, smoking, health status, diabetes, and stroke. These associations were partially explained by the mediating variable of physical function. RHOA was associated with an increased risk of all-cause and CVD mortality among older white women followed up for 16 years. Dissemination of evidence-based physical activity and self-management interventions for hip OA in community and clinical settings can improve physical function and might also contribute to lower mortality.

AB1048 Does chondrocalcinosis associate with a different radiographic phenotype of osteoarthritis?

BackgroundSome studies suggest that the structural changes in joints with osteoarthritis (OA) and co-existing radiographic chondrocalcinosis (CC) are distinct from joints with OA alone. However, other studies suggest that there...

FRI0315 Patterns of femoral head migration in osteoarthritis of the hip

BackgroundVariations in the pattern of femoral head migration (FHM) in hip osteoarthritis (OA) was initially described by Resnick in 1975. The reasons for different patterns are unclear. Genetic and constitutional...

Recommendations for standardization and phenotype definitions in genetic studies of osteoarthritis: the TREAT-OA consortium

To address the need for standardization of osteoarthritis (OA) phenotypes by examining the effect of heterogeneity among symptomatic (SOA) and radiographic osteoarthritis (ROA) phenotypes. Descriptions of OA phenotypes of the 28 studies involved in the TREAT-OA consortium were collected. We investigated whether different OA definitions result in different association results by creating various hip OA definitions in one large population based cohort (the Rotterdam Study I (RSI)) and testing those for association with gender, age and body mass index using one-way ANOVA. For ROA, we standardized the hip-, knee- and hand ROA definitions and calculated prevalence's of ROA before and after standardization in nine cohort studies. This procedure could only be performed in cohort studies and standardization of SOA definitions was not feasible at this moment. In this consortium, all studies with SOA phenotypes (knee, hip and hand) used a different definition and/or assessment of OA status. For knee-, hip- and hand ROA five, four and seven different definitions were used, respectively. Different hip ROA definitions do lead to different association results. For example, we showed in the RSI that hip OA defined as "at least definite joint space narrowing (JSN) and one definite osteophyte" was not associated with gender (P =0.22), but defined as "at least one definite osteophyte" was significantly associated with gender (P=3×10(-9)). Therefore, a standardization process was undertaken for ROA definitions. Before standardization a wide range of ROA prevalence's was observed in the nine cohorts studied. After standardization the range in prevalence of knee- and hip ROA was small. Phenotype definitions influence the prevalence of OA and association with clinical variables. ROA phenotypes within the TREAT-OA consortium were standardized to reduce heterogeneity and improve power in future genetics studies.

Relation of regional articular cartilage morphometry and meniscal position by MRI to joint space width in knee radiographs

To ascertain the contribution of articular cartilage morphometry and meniscal position on MRI to joint space width (JSW) measured in the Lyon schuss radiograph of the knee. 62 obese women with knee OA and 99 non-obese female controls (mean age 56.6 years) were imaged using 3T MRI and coronal water excitation spoiled gradient echo sequences. Segmentation of femorotibial cartilage morphology and regional morphometric analysis was performed using custom software. Meniscal position was measured quantitatively in sagittal and coronal planes. Minimum space width (mJSW) was measured in the Lyon Schuss knee radiograph; Kellgren and Lawrence grades (KLG) were assigned on standing anteroposterior knee films. The relative contribution of regional cartilage thickness and meniscal position to mJSW was assessed initially in univariate models and subsequently with multivariable modelling. 65% of the variation in mJSW was explained by regional cartilage thickness measures, different KLG and meniscal coverage. Of these measures the medial tibia cartilage thickness measures and central region of the central medial femur (ccMF) play a consistent role in variations in mJSW observed across all KLG. Further ccMF and the addition of percent meniscal coverage to this model explains the remaining differences in mean mJSW found between those subjects with definite joint space narrowing (KLG3) and those without OA. The variation in radiographic mJSW is best described by five regional cartilage thickness measures and percent meniscal coverage. The magnitude of each measures contribution differs according to radiographic severity with more variability explained by cartilage thickness of ccMF cartilage thickness and percent meniscal coverage with more severe disease.

Serum vitamin D levels and incident changes of radiographic hip osteoarthritis: a longitudinal study. Study of Osteoporotic Fractures Research Group.

The purpose of this study was to determine the relationship of serum levels of 25-vitamin D and 1,25-vitamin D to incident changes of radiographic hip osteoarthritis (OA) among elderly white women. Baseline and followup hip radiographs of 237 subjects were obtained an average of 8 years apart. Hips were scored for individual radiographic features (IRF) and assigned a summary grade based on the number and type of IRF present. Serum 25- and 1,25-vitamin D levels from baseline samples were analyzed by radioimmunoassay. Logistic and linear regression were used to examine the association of 25- and 1,25-vitamin D levels with radiographic changes, adjusting for age, health status, physical activity, weight, vitamin D supplement use, and calcaneal bone mineral density. The risk of incident hip OA defined as the development of definite joint space narrowing was increased for subjects who were in the middle (odds ratio [OR] 3.21, 95% confidence interval [95% CI] 1.06, 9.68) and lowest (OR 3.34, 95% CI 1.13, 9.86) tertiles for 25-vitamin D compared with subjects in the highest tertile. Vitamin D levels were not associated with incident hip OA defined as the development of definite osteophytes or new disease according to the summary grade. No association between serum 1,25-vitamin D and changes in radiographic hip OA was found. Low serum levels of 25-vitamin D may be associated with incident changes of radiographic hip OA characterized by joint space narrowing.

Fractal signature analysis measures cancellous bone organisation in macroradiographs of patients with knee osteoarthritis.

To determine whether fractal signature analysis (FSA) of digitised macroradiographs of knees quantifies alterations in trabecular structure in the tibial cancellous bone of osteoarthritic patients with either early or definite joint space narrowing compared with non-arthritic subjects. 90 osteoarthritic knees had macroradiographs at x5 magnification. Joint space width and FSA of horizontal and vertical trabecular organisation in the tibial subarticular cancellous bone were measured in the medial and lateral tibio-femoral compartments and compared to reference values obtained from the knees of 14 healthy non-arthritic volunteers, and to the subject's age and weight. Compared to the non-arthritic joints, FSA of the trabecular structure of the medial diseased compartment of the tibia was significantly different and correlated with the degree of joint space narrowing (P < 0.003); FSA of horizontal trabecular structures decreased (P < 0.001) in knees with early osteoarthritis (joint space > 3 mm) and vertical trabecular FSA increased in knees with marked joint space narrowing (joint space < 3 mm). In the lateral compartment of the tibia, FSA did not show a difference between any of the categories. With increasing age of all subjects, the changes in FSA indicated a significant increase in the number of fine horizontal and vertical trabeculae. No correlation was found between the subjects' body weight and changes in the subarticular cancellous bone organisation. FSA quantifies changes in cancellous bone organisation in knee osteoarthritis. In the diseased compartment, increased horizontal trabecular thickness occurred early and preceded the later changes in the vertical structures.

The incidence and natural history of knee osteoarthritis in the elderly. The Framingham Osteoarthritis Study.

To determine the incidence of radiographic knee osteoarthritis (OA) and symptomatic OA (symptoms plus radiographic OA), as well as the rate of progression of preexisting radiographic OA in a population-based sample of elderly persons. Framingham Osteoarthritis Study subjects who had knee radiographs and had answered questions about knee symptoms in 1983-1985 were reexamined in 1992-1993 (mean 8.1-year interval) using the same protocol. Subjects were defined as having new (incident) radiographic OA if they developed grade > or = 2 OA (at least definite osteophytes or definite joint space narrowing). New symptomatic OA was present if subjects developed a combination of knee symptoms and grade > or = 2 OA. Progressive OA was diagnosed when radiographs showing grade 2 disease at baseline showed grade > or = 3 disease on followup. Of 1,438 participants in the original study, 387 (26.9%) died prior to followup. Of the 1,051 surviving subjects, 869 (82.7%) participated in the followup study (mean +/- SD age 70.8 +/- 5.0 at baseline). Rates of incident disease were 1.7 times higher in women than in men (95% confidence interval [CI] 1.0-2.7), and progressive disease occurred slightly more often in women (relative risk = 1.4; 95% CI 0.8-2.5) but rates did not vary by age in this sample. Among women, approximately 2% per year developed incident radiographic disease, 1% per year developed symptomatic knee OA, and about 4% per year experienced progressive knee OA. In elderly persons, the new onset of knee OA is frequent and is more common in women than men. However, among the elderly, age may not affect new disease occurrence or progression.