Evidence Of Osteoarthritis Research Articles

Comorbidity clusters in generalized osteoarthritis among female patients: A cross-sectional study

ObjectivesTo investigate the prevalence of comorbidities among female patients with generalized osteoarthritis (GOA) in comparison to an age- and sex matched control group. To identify clusters of comorbidities in both groups. MethodsAn observational, cross-sectional study was conducted. Consecutive female patients with hand and knee osteoarthritis according to the American College of Rheumatology (ACR) classification criteria were invited to participate in the study. A control group of participants without musculoskeletal symptoms, history or evidence of osteoarthritis or inflammatory rheumatic disease were also included. Cardiovascular, obstructive pulmonary, gastrointestinal, endocrine, neurological, malignant diseases and depression were recorded in both groups. In both study groups comorbidity cluster and factor analysis was performed. ResultsThe study population included 200 GOA and 200 control participants. The following comorbidities were observed adjusted to Bonferroni correction with a significantly higher prevalence among individuals with GOA: hypertension, uterine leiomyoma, gastroesophageal reflux disease, diverticulosis, upper gastrointestinal tract ulcers, depression, diseases with vertigo (benign paroxysmal positional vertigo and vertebrobasilar insufficiency) and surgery due to otoclerosis. In the GOA group 5 clusters were identified with different comorbidity patterns. ConclusionWe report a high comorbidity rate in GOA. Cluster analysis allowed us to identify different comorbidity subsets for vascular, gastrointestinal and malignant gynaecological disorders. Further research is required to understand the links between GOA and non-musculoskeletal comorbidities.

Intraarticular corticosteroid injections in the management of osteoarthritis knee

Objective:- The aim of the study was to assess therapeutic efficacy, adverse events and patient satisfaction of intraarticular (IA) corticosteroid injections for knee osteoarthritis (OA).
 Methods:- Thirty-two (96) patients with OA of the knee participated in the present study. The inclusion criteria included (1) Resting visual analog scale pain >50 mm (2) Radiographic evidence for osteoarthritis (as per Kellgren-Lawrence scale) plus; age ≥50yrs, morning stiffness ≤ 30 min and crepitus on motion. Baseline Western Ontario and MacMaster University Osteoarthritis Index (WOMAC) and visual analogue score (VAS) were documented. Patients received intra-articular injections of triamcinolone acetonide 40 mg in the affected knee. The patients were reviewed at 1 weeks, 4 weeks and 8 weeks post-injection with final analysis at 3 months. Use of over the counter analgesia in the form of acetaminophen was allowed for concomitant analgesia.
 Results:- Ninety-six patients (male =45, female=51) with mean age of 50±5 years (range 45-55); duration of symptoms 5.7 ± 0.5 years and mean body mass index (BMI) 29.4kg/m2 were available at final follow-up. The VAS scores at baseline were:- at rest=71 and after 30 meter walk=80 and improved to 35 and 40, respectively. Improvement in pain and disability based on the WOMAC scores were significant. The overall efficacy “Knee Society Score” was judged as excellent in 56.25%, satisfactory in 21.87%, fair in 18.75%, and poor in 3.12%. The beneficial effects stayed till 4-6 weeks.
 Conclusion:- Intra-articular steroid injections for knee OA is safe and effective. The symptomatic relief is prompt, particularly in presence of inflammation (Effusion/synovitis). Proper patient selection and aseptic precautions yield satisfactory results. The need for concomitant analgesia is reduced.

Correlation between synovial fluid cytokine concentrations and limb function in normal dogs and in dogs with lameness from spontaneous osteoarthritis.

To determine the relationship between synovial biomarker concentrations and severity of lameness and to assess the ability to differentiate normal from osteoarthritic joints with synovial biomarker concentrations. Prospective clinical study. Twelve hounds with no evidence of osteoarthritis (OA) and 27 client-owned dogs with unilateral lameness and joint pain in a single joint from naturally occurring OA. Enrollment in the OA group required a history of lameness, radiographic evidence of OA on orthogonal joint radiographs, and ≥6% gait asymmetry between contralateral limbs. The concentrations of 14 synovial OA biomarkers in synovial samples obtained after gait analysis were measured with enzyme-linked immunosorbent assays and compared between normal and OA joints. Concentrations of monocyte chemoattractant protein (MCP)-1, substance P, interleukin (IL)-6, IL-8, KC-like, matrix metalloproteinase (MMP)-1, and MMP-3 were greater (P ≤ .05) in OA than in normal joints. The concentrations of bradykinin and tissue inhibitors of metalloproteinase-4 were decreased in OA compared with normal joints. Monocyte chemoattractant protein 1 was identified as the most accurate marker to distinguish OA from normal joints. No correlation was detected between any OA biomarker concentration, individually or in combination, and severity of gait asymmetry at the walk. Differences in proinflammatory and anti-inflammatory biomarkers were detected between OA and normal joints, but no relationship was identified between biomarker concentrations and gait asymmetry in dogs with OA. This information will help guide future studies to elucidate how factors such as disease chronicity, severity, and etiology affect these relationships.

Midterm Outcomes of Arthroscopic Reduction and Internal Fixation of Anterior Cruciate Ligament Tibial Eminence Avulsion Fractures With K-Wire Fixation

To determine the clinical and radiological outcomes of patients who underwent arthroscopic reduction and internal fixation of a tibial eminence avulsion fracture with Kirshner wires (K-wires) at a mean of 8years following surgery. This was a retrospective study with prospectively collected data. Inclusion criteria consisted of patients who underwent arthroscopic reduction and internal fixation of tibial eminence fracture with K-wires between 1989 and 2015 at a minimum of 18months follow-up. Assessment included the International Knee Documentation Committee Ligament Evaluation, Lysholm Knee Score, and clinical outcomes. Magnetic resonance imaging (MRI) was performed to evaluate the anterior cruciate ligament (ACL) and evidence of osteoarthritis. A total of 48 participants met the inclusion criteria, and 32 were reviewed at a mean of 8years (range, 18-260months) after surgery. The mean age at the time of surgery was 24.5years (10-55years). Subsequent ACL injury occurred in 5 participants (10.4%) on the index knee and in 1 participant also on the contralateral knee; 86% had a normal examination, and no patients had >5-mm side-to-side difference on instrumented testing. The mean International Knee Documentation Committee subjective score at 8years was 86 (range, 40-100). On MRI scan assessment for osteoarthritic changes at final follow-up, 82% of participants had no evidence of chondral wear on the medial compartment and 73% had no changes in the lateral compartment according to Magnetic Resonance Image Osteoarthritis Knee Score classification. On MRI scan qualitative assessment of ACL and tibial eminence, 7 participants (32%) were found to have high signal at the fracture site. The mean medial tibial eminence height was 9.2mm (range, 6.3mm to 1.31cm) and the lateral tibial eminence height was an average of 6.7mm (range, 0.38-0.97mm). Significant kneeling pain was reported by 8 participants (25%). This study indicates that internal fixation with K-wires is an acceptable approach to reduce tibial eminence avulsion fractures, providing excellent clinical and radiological outcomes at a minimum of 18months of follow-up. Level IV, therapeutic case series.

Association Between Bone Marrow Lesions, Chondral Lesions, and Pain in Patients Without Radiographic Evidence of Degenerative Joint Disease Who Underwent Arthroscopic Partial Meniscectomy.

Background:Bone marrow lesions (BMLs) have been found on magnetic resonance imaging in patients with meniscal tears.Purpose:We sought to determine the prevalence and location of BMLs, the association between BMLs and chondral lesions, and the association between BMLs and pain in patients without radiographic evidence of degenerative joint disease who underwent arthroscopic partial meniscectomy (APM).Study Design:Cohort study; Level of evidence, 2.Methods:We performed a secondary analysis of the Chondral Lesions And Meniscus Procedures (ChAMP) randomized controlled trial. BMLs were assessed on preoperative magnetic resonance imaging, and chondral lesions were documented at the time of surgery. Pain was assessed preoperatively and at 1 year after APM using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Knee injury and Osteoarthritis Outcome Score (KOOS). The chi-square test was used to examine the association between BMLs and chondral lesions, and the F test was used to examine the association between BMLs and pain.Results:Of 241 patients, 58.9% had ≥1 BMLs, and most were located on the medial tibial plateau (MTP; 74.6%) and/or medial femoral condyle (MFC; 28.9%). Most MTP BMLs were submeniscal (56%), and most MFC BMLs extended beyond the meniscus (73%). There were more MFC chondral lesions for patients with any MFC BMLs (P = .01) and submeniscal MFC BMLs (P = .02) versus those without BMLs, and there was no association between BMLs and chondral lesions on the MTP. There was also no association between BMLs and preoperative or postoperative pain scores.Conclusion:In patients without radiographic evidence of degenerative joint disease who underwent APM, BMLs were found in 58.9% of knees and were primarily located in the medial compartment. There was a borderline statistically significant association between BMLs and chondral lesions for the MFC; however, BMLs were not associated with pain scores preoperatively or at 1 year after surgery.

Clinical and radiographic outcomes in patients operated for complex open tibial pilon fractures

AimTo report clinical and radiographic results of treatment of patients with complex open tibial pilon fractures. MethodsA retrospective analysis in 14 patients with complex open pilon fractures treated between 2010 and 2015 was conducted. The injuries were graded according to AO Classification and the Gustillo-Anderson system. Routine follow-up was performed at 1, 3, 6, 12 month with an annual evaluation thereafter. All patients were included for the assessment of the rate of infection, wound and fracture-healing. Functional outcome assessment was performed in all patients according to the American Orthopedic Foot and Ankle Score (AOFAS) at 12 months after the injury. The radiological outcome was evaluated through standard XR using the criteria proposed by Burwell and Charnley. ResultsAnalysis were conducted in 12 men and 2 women, with a mean age of 50.4 years (20–77) who were followed up for an average 34 months (range: 9–60 months). All patients had a AO type 43C fracture. There were three Gustilo Type IIIA injuries, seven Type III B and four Type III C. The mean time to fracture healing was 6.3 months. 4 patients underwent definitive treatment with external fixation at the time of the initial irrigation and debridement. 10 patients underwent delayed definitive surgery: in 10 patients ORIF was used. Soft-tissue coverage by vascularized muscle flap was necessary in 4 patients (28%) and was typically performed on the day of definitive fixation. One patient required iliac crest bone-grafting. 4 patients (28%) had a deep infection.6 patients (43%) had a superficial pin infection or cellulitis. 6 patients (43%) presented delayed union. The average AOFAS score was 71.5 (40–95). According to the Burwell-Charnley score, the anatomical reduction of the fracture was obtained in 50% of patients and a good reduction in 86% of cases. 5 patients (35.7%) had loss of joint congruity and evidence of osteoarthritis on radiographs at final follow-up. No patient needed arthrodesis or amputation. ConclusionThe results of our study suggest that open tibial pilon fractures can be safely managed with low rate of complications using intensive debridement, antibiotics, adequate devices and patient-tailored timing of definitive surgical treatment.

Crowned dens syndrome: a case report followed by an update on differential diagnosis and treatment

Introduction Crowned dens syndrome (CDS) is a rare clinical presentation of chondrocalcinosis or calcium pyrophosphate crystal deposition (CPPD) disease, characterized by fever, neck pain and stiffness, associated with increased biological markers of inflammation. Diagnosis is made mainly via imaging, and the best modality remains the magnetic resonance imaging (MRI) of the neck showing calcification and calcium pyrophosphate crystals deposition around the odontoid process (1). The aim of this report is to increase awareness of this rare and ill-known clinical tableau and to review its complications and the latest modalities of its diagnosis and treatment. Clinical case: An 83-year-old female patient presented to the emergency department (ED) of the Middle East Institute of Health (MEIH) with severe acute onset neck stiffness and pain of 10/10 intensity, radiating to the submandibular area and reaching the occipital part of the head, associated with nausea and 2 episodes of chills one day prior to presentation. Patient denied any recent history of trauma or surgery of the head and neck. Physical exam at that time was only remarkable for marked limitation of neck motion, and positive Kernig and Brudzinski signs. No skin changes, facial sinuses tenderness, cervical lymphadenopathies or neck swellings were noted. Vital signs at ED were within normal range except for a low grade fever. Laboratory work-up upon presentation showed hyperleukocytosis (WBC = 14000/mm3) with left shift and a C-reactive protein (CRP) of 189 mg/L (0-5 mg/L). Chest X-Ray only showed degenerative osteoarthritis of the thoracic spinal vertebrae. CT-scan of the brain without IV contrast done urgently showed no acute changes. As Clinical and biological features were suggestive of acute meningitis, cultures were taken including blood, urine and CSF fluid from lumbar puncture. The patient was admitted to the hospital for IV antibiotic treatment with a large spectrum carbapenem and close observation. On next 2 days, the patient continued to develop low grade fever with a fluctuating pattern, and levofloxacin and amikacin shots were added for maximal bacterial coverage. Urine and blood culture yielded positive for Escherichia Coli only resistant to penicillin. CSF fluid analysis and culture was unremarkable. So, the patient continued to receive IV antibiotics for urinary tract infection and bacteremia. And although the cultures were sensitive to the antibiotics given, the patient continued to suffer from fever, headache, neck stiffness with minimal improvement and response to IV acetaminophen. Laboratory markers continued to increase and CRP reached 325. The patient then underwent a series of imaging and laboratory tests to determine the cause of fever, including CT-scan of the chest, abdomen and pelvis with IV contrast, widal, wright, Rose Bengal, stool analysis, stool culture, clostridium difficile toxins, transthoracic and transesophageal cardiac ultrasound that were all negative. Finally, neck MRI was done to rule out spondylodiscitis or a cervical abscess and showed evidence of osteoarthritis on multiple cervical spinal levels, calcification of the odontoid process of C2, and thickening of the synovium and posterior ligaments (Fig C – D). Those results were compatible with a CT-scan of the neck then done and was in favor of a corona of calcification around the odontoid process suggesting a crowned dens syndrome (Fig A – B). The patient was put on colchicine therapy, and started to improve slowly, then corticosteroids were added and yielded a faster improvement. The C-reactive protein finally started to drop until reaching 23 mg/L upon the discharge. The patient was finally discharged on NSAIDs and colchicine. And after 1 month, the patient was seen in an outpatient setting where she reported dramatic improvement of her symptoms.

Posteromedial release combined with arthrodesis of the talocalcaneal and calcaneocuboid joints for equinovarus associated with myelodysplasia: Clinical outcomes assessment preliminary report

BackgroundWhether arthrodesis is necessary to correct equinovarus associated with myelodysplasia in children, possibly preventing its recurrence, is controversial. At our hospital, patients >4 years of age with equinovarus associated with myelodysplasia are treated with posteromedial release combined with arthrodesis of the talocalcaneal and calcaneocuboid joints. This retrospective study aimed to reinvestigate the postoperative outcomes of this surgery. MethodsThe outcomes were evaluated by clinically assessing patients' records according to de Carvalho Neto and Machida, focusing on related complications, union rate after arthrodesis in talocalcaneal and calcaneocuboid joints, evidence of osteoarthritis in the talocrural joint, and the angle of the ankle joint on plain radiographs at the final follow-up >1 year postoperatively. ResultsWe evaluated 12 feet from nine patients. The mean age at the time of surgery was 5 years, and the mean follow-up was 78 months. The clinical assessment according to de Carvalho Neto et al. was “good” in 10 cases and “fair” in 2 cases. The Machida et al. assessment was “excellent” in 5 cases, “good” in 2 cases, and “fair” in 5 cases. One fracture occurred in a single proximal tibia (8%). Union rate after arthrodesis was 83% in the talocalcaneal joint and 42% in the calcaneocuboid joint. There was no evidence of osteoarthritis in the talocrural joint. Postoperative tibiocalcaneal (TiCa) and tibiotalor (TiTa) angles, measured in maximum dorsiflexion, were significantly smaller than the preoperative angles (p = 0.01 for both). Postoperative TiCa and TiTa angles measured in maximum plantar flexion minus the TiCa and TiTa angles measured in maximum dorsiflexion were not significantly less than the preoperative angles (p = 0.23 and 0.62, respectively). ConclusionOur surgical outcomes were generally good. However, we must monitor the patients for recurrence because of the relatively low 42% union rate of the calcaneocuboid joint.

Celecoxib-mediated reduction of prostanoid release in Hoffa's fat pad from donors with cartilage pathology results in an attenuated inflammatory phenotype

The Hoffa's fat pad (HFP) is an intra-articular adipose tissue which is situated under and behind the patella. It contains immune cells next to adipocytes and secretes inflammatory factors during osteoarthritis (OA). In this study, we compared the release profile of prostanoids, which are involved in inflammation, of HFP from OA patients vs patients with a focal cartilage defect (CD) without evidence for OA on MRI and investigated the prostanoid modulatory anti-inflammatory action of celecoxib on HFP. Prostanoid release was analyzed in conditioned medium of HFP explant cultures from 17 osteoarthritic patients and 12 CD patients, in the presence or absence of celecoxib. Furthermore, gene expression of COX enzymes and expression of genes indicative of a pro-inflammatory or anti-inflammatory phenotype of HFP was analyzed. Prostanoid release by HFP from knee OA patients clustered in two subgroups with high and low prostanoid producers. HFP from high prostanoid producers released higher amounts of PGE2, PGF2α and PGD2 compared to HFP from CD patients. PGE2 release by OA HFP was positively associated with expression of genes known to be expressed by M1 macrophages, indicating a role for macrophages. Celecoxib modulated prostanoid release by HFP, and also modulated the inflammation ratio towards a more favorable anti-inflammatory M2 phenotype, most effectively in patients with higher prostanoid release profiles. In knee OA patients with inflamed HFP's, celecoxib may exert positive effects in the knee joint via decreasing the release of prostanoids produced by the HFP and by favorably modulating the anti-inflammatory marker expression in HFP.

Symptomatic tarsometatarsal osteoarthritis after open reduction and screwing of Lisfranc injuries

Objective To explore the outcomes of open reduction and internal fixation (ORIF) with transarticular screws for Lisfranc injuries and the postoperative incidence of symptomatic tarsometatarsal osteoarthritis (OA). Methods This retrospective study involved 28 patients who had been treated surgically at our institution between January 2009 and January 2015 for Lisfranc injuries. They were 18 males and 10 females, with an average age of 36.1 years (from 19 to 54 years). According to the Quenu-Kuss classification, 5 patients had type-A injury, 10 type-B injury (4 cases of type-B1 and 6 ones of type-B2), and 13 type-C injury (8 cases of type-C1 and 5 ones of type-C2). The patients underwent ORIF with screws for the 1st to the 3rd tarsometatarsal joints and ORIF with Kirschner wires for the 4th to the 5th tarsometatarsal joints within 2 weeks. After the Kirschner wires were removed 8 to 10 weeks postoperatively, progressive weight-bearing began. Functional outcomes were assessed according to the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot scores and visual analog scale (VAS) at final follow-ups. Results The mean duration of follow-up was 29.9 months (from 26 to 72 months). AOFAS scores revealed one excellent case, 22 good ones and 5 poor ones with an excellent to good rate of 82.1%. The mean VAS score was 2.8. Radiographic evidence of OA was noted in 20 patients (71.4%, 20/28), in 18 of whom (90.0%) symptomatic OA was observed. There was no significant difference (P=0.399) in the incidence of symptomatic OA either between the patients with anatomic reduction (60.9%, 14/23) and those without anatomical reduction (80.0%, 4/5). Conclusions ORIF with transarticular screws can lead to good therapeutic outcomes for Lisfranc injuries. The incidence of symptomatic OA may not be related to the injury type or reduction quality. Key words: Foot injuries; Bone nails; Osteoarthritis; Open reduction

Osteoarthritis: Pathophysiology, Prevalence, Risk Factors, and Exercise for Reducing Pain and Disability.

Osteoarthritis (OA) is a disorder involving deterioration of articular cartilage and underlying bone and is associated with symptoms of pain and disability. The incidence of OA in the military increased over the period 2000 to 2012 and was the first or second leading cause of medical separations in this period. Risk factors for OA include older age, black race, genetics, higher body mass index, prior knee injury, and excessive joint loading. Animal studies indicate that moderate exercise can assist in maintaining normal cartilage, and individuals performing moderate levels of exercise show little evidence of OA. There is considerable evidence that among individuals who develop OA, moderate and regular exercise can reduce pain and disability. There is no firm evidence that any particular mode of exercise (e.g., aerobic training, resistance exercise) is more effective than another for reducing OA-related pain and disability, but limited research suggests that exercise should be lifelong and conducted at least three times per week for optimal effects.

Evidence of osteoarthritis in the Tiwanaku Colony, Moquegua, Peru (AD 500–1100)

AbstractThe Tiwanaku (AD 500–1100) colonized ecologically diverse, lower elevation areas to produce goods not easily grown in the high altitude heartland (3,800 m a.s.l.). One colony near present‐day Moquegua, Peru (900–1,500 m a.s.l.) was composed of multiple Tiwanaku settlements. Colonists farmed products like maize and coca and transported goods via llama caravan between the colony and heartland. Two subsistence groups emerged in terms of settlement, those of “Chen Chen‐style” affiliation associated with an agrarian lifestyle and those of “Omo‐style” representing more of a pastoralist lifeway. Considering Tiwanaku people likely began light chores around 5 years of age (e.g., babysitting siblings), with heavier labour beginning at approximately 8 years of age, we questioned if these social and occupational differences translated into skeletal changes associated with osteoarthritis (i.e., porosity, lipping, osteophyte formation, and/or eburnation). Individuals from 5 sites, 2 that represent the Omo‐style (M16 and M70) and 3 that are in the Chen Chen‐style (M1, M10, and M43), were evaluated for osteoarthritis while controlling for age‐at‐death and sex using 25 total joint surfaces in the shoulder, elbow, wrist, hip, knee, ankle, and sacroiliac. Overall, our comparisons show no combined significant differences between the Omo‐style and Chen Chen‐style groups. Instead, distinctions in osteoarthritis evidence by age‐at‐death and sex emerged, reflecting the likelihood of specific age‐ or sex‐related tasks. Arthropathy evidence among children in elbow and ankle joints also supported the cultural legacy in the Andes that work begins at a relatively young age and would show up in patterns of adult osteoarthritis.

Recurrent Labral Tearing on Magnetic Resonance Imaging Is Not Predictive of Diminished Participation Among National Football League Athletes

To investigate the prevalence of shoulder labral repair and utility of magnetic resonance imaging (MRI) in determining the risks of recurrent labral tearing and impact on future participation in the National Football League (NFL). Athletes invited to the NFL Combine between 2012 and 2015 were retrospectively reviewed. Athletes with a history of labral repair and MRI of the operative shoulder at the Combine were included in the study for further analysis, excluding athletes without a history of labral repair, labral repair without MRI at the Combine, additional procedure to the operative shoulder, or athletes still undergoing rehabilitation at the time of the Combine after labral repair. All MRIs were reviewed to determine initial labral repair location, the presence of recurrent tearing, and any concomitant shoulder pathology. Prospective information on future NFL participation in regard to draft status, games played, and games started in the athlete's first NFL season after the Combine was compared between athletes with a history of labral repair with and without recurrent tearing versus all other athletes participating in the Combine. A total of 132 (10.1%) athletes underwent 146 shoulder labral repair procedures before the NFL Combine, of whom 32% (n= 39 athletes, n= 46 shoulders) had recurrent labral tears on MRI. Athletes with recurrent tears were more likely to have undergone bilateral labral repairs (P= .048) and possess concomitant shoulder pathology (P < .001). Recurrent labral tearing was significantly more common in the posterior labrum in athletes with a history of posterior labral repairs (P= .032). Prospective participation in the NFL in terms of games played (P= .38) or started (P= .98) was not significantly reduced in athletes with a history of labral repair compared with those without repair. Participation was not diminished in athletes with recurrent labral tears compared with those with intact repairs or those with evidence of degenerative joint disease. Athletes invited to the NFL Scouting Combine with a history of bilateral repair, posterior labral repair, and concomitant shoulder pathology are at high risk of recurrent labral tearing on MRI. No significant reduction in NFL participation the year after the Combine was seen in athletes with a history of labral repair, recurrent labral tearing, or degenerative joint disease who were successfully drafted into the NFL. In athletes with a history of labral repair, assessment of labral integrity on MRI alone is not predictive of future short-term participation. Level IV, prognostic study-case series.

The Effect of Body Mass Index on Clinical Outcomes in Patients Without Radiographic Evidence of Degenerative Joint Disease After Arthroscopic Partial Meniscectomy

To examine the effect of obesity on clinical outcomes at 1year after arthroscopic partial meniscectomy. We conducted a secondary analysis of the ChAMP (Chondral Lesions and Meniscus Procedures) randomized controlled trial (N= 256). The visual analog scale for pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), range of motion, and presence of effusion were assessed preoperatively and at 1year after arthroscopic partial meniscectomy. Body mass index was categorized as normal weight, 24.99 or less; overweight, 25 to 29.99; or obese, 30 or greater. Analysis of variance or the Cochran-Mantel-Haenszel test was used to examine differences in clinical outcomes between body mass index categories, and mean ± standard deviation or number (percentage) is reported. Preoperatively, obese patients had worse WOMAC pain (56.2 ± 17.2 vs 61.3 ± 17.2, P= .02), WOMAC physical function (55.8 ± 17.1 vs 62.8 ± 17.1, P= .004), pain visual analog scale (4.9 ± 2.1 vs 4.2 ± 1.9, P= .01), KOOS pain (49.5 ± 14.9 vs 54.0 ± 15.1, P= .02), and KOOS quality-of-life (27.9 ± 18.3 vs 36.9 ± 17.0, P= .001) scores, as well as decreased flexion (121.8° ± 22.6° vs 132.3° ± 16.5°, P= .003), compared with normal-weight patients. Overweight patients (n= 51 [51.5%], P= .03) and obese patients (n= 56 [52.8%], P= .002) were more likely to have knee effusion before surgery than normal-weight patients (n= 17 [34%]). At 1year after surgery, overweight (130.2° ± 7.7°, P= .03) and obese (128.1° ± 7.1°, P= .003) patients had decreased flexion compared with normal-weight patients (134.5° ± 8.3°). Obese patients had worse pain, physical functioning, and quality-of-life scores, as well as decreased flexion, compared with normal-weight patients before arthroscopic partial meniscectomy. At 1year after arthroscopic partial meniscectomy, there were no statistically significant differences in clinical outcomes but obesity was associated with decreased knee flexion. Level II, prospective comparative trial.

Role of platelet rich plasma in osteoarthritis knee

Worldwide osteoarthritis is the most common joint disorder. It results from mechanical and biological events that destabilize the normal processes of degradation and synthesis of articular cartilage chondrocytes, extracellular matrix and subchondral bone. These changes include increased water content, decreased proteoglycan content and altered collagen matrix, leading to the degeneration of articular cartilage. There is trend on rise to use platelet rich plasma to promote healing of the degenerated cartilage. The aim of the study was to evaluate whether the newer method i.e platelet rich plasma has any significant advantage. The study included a total of 50 cases with individuals ageing greater than 40 years. Patients without evidence of degenerative arthritis and with KL grade 3 and grade 4 were excluded from the study. At 1 month only 14% cases showed excellent, 68% cases showed and. 18% cases showed fair results. At 3 months follow up 16% cases showed excellent, 82% cases showed good and fair results were seen in 2% cases. No case had poor results. At 6 months follow up 16% cases showed excellent, 86% cases showed good and 6% cases showed fair results and no case had poor results. Platlet rich plasma is an excellent method of treatment in early osteoarthritis of knee.

Transforming growth factor activating kinase 1 regulates extracellular matrix degrading enzymes and pain-related molecule expression following tumor necrosis factor-\u03b1 stimulation of synovial cells: an in vitro study

BackgroundRecent studies have suggested that the tumor necrosis factor-α (TNF-α) pathway is a potential target for the management of osteoarthritis (OA). Transforming growth factor (TGF)-β-activated kinase 1 (TAK1) is essential in several cytokine-mediated cascades, including the TNF-α, interleukin-1 (IL-1), and TGF-β pathways. The role of TAK1 in synovial tissue in OA is not fully understood. Using synovial cells harvested from OA patients during surgery, we investigated whether TAK1 inhibition suppresses production of TNF-α-induced extracellular matrix degrading enzymes and expression of pain-related molecules.MethodsSynovial tissues were harvested from ten subjects with radiographic evidence of osteoarthritis (OA) during total knee arthroplasty. Synovial cells were cultured and stimulated with control (culture media), 10 ng/mL human recombinant TNF-α, or 10 ng/mL TNF-α and 10 μM of the TAK1 inhibitor (5Z)-7-oxozeaenol for 24 h. Real-time polymerase chain reaction (PCR) analysis was used to monitor expression of mRNA of the extracellular matrix degrading enzymes matrix metalloproteinase-3 (MMP-3) and a disintegrin-like and metalloprotease (reprolysin type) with thrombospondin type 1 motif, 4 (ADAMTS-4); and of the pain-related molecules cyclooxygenase-2 (COX-2), microsomal prostaglandin E synthase-1 (mPGES-1), and nerve growth factor (NGF). MMP-3 and NGF protein concentrations in cell supernatant were measured by enzyme-linked immunosorbent assay (ELISA). COX-2, mPGES-1 and ADAMTS-4 protein expression was also evaluated by western blotting.ResultsTNF-α stimulated increases in ADAMTS-4 and MMP3 mRNA (2.0-fold and 1.6-fold, respectively, p < 0.05) and protein expression (21.5-fold and 2.0-fold, respectively). Treatment with the TAK1 inihibitor (5Z)-7-oxozeaenol reduced ADAMTS-4 and MMP3 mRNA (0.5-fold and 0.6-fold, respectively) and protein expression (1.4-fold and 0.5-fold, respectively) in OA synovial cells. COX-2, mPGES-1 and NGF mRNA (11.2-fold, 3.1-fold and 2.7-fold, respectively) and protein expression (3.0-fold, 2.7-fold and 2.2-fold, respectively) were increased by TNF-α. (5Z)-7-oxozeaenol treatment reduced mPGES1 and NGF mRNA (1.5-fold and 0.8-fold, respectively) and protein (1.5-fold and 0.5-fold, respectively).ConclusionTAK1 plays an important role in the regulation of TNF-α induced extracellular matrix degrading enzymes and pain-related molecule expression. TAK1 may be a potential target for therapeutic strategies aimed at preventing osteoarthritis progression and pain.

Cam versus pincer femoroacetabular impingement. Which type is associated with more hip structural damage? An exploratory cross-sectional study

Background: Femoroacetabular impingement (FAI) occurs as a conflict between the proximal femur and the acetabular rim. The purpose of this study was to evaluate MRI findings and look for correlations with pain intensity and duration in each type of FAI separately in an attempt to identify which type is associated with more structural damage. Methods: Forty-four patients (78 hips) diagnosed with either cam or pincer FAI were consecutively recruited in a prospective cohort study. None of our patients had evidence of osteoarthritis (OA) on the initial plain radiography. All patients had contrast-enhanced MRI and CT scans of the hips. All patients filled in a visual analogue scale (VAS) for pain. Results: The frequency of bone marrow edema (BME) was 37% in cam FAI and 20.8% in pincer FAI. In cam FAI, BME positively correlated with pain severity as measured by VAS (P&lt;0.0001), cartilage degradation (P=0.001), pseudocysts (P&lt;0.0001), hip effusion (P=0.013) and reactive synovitis (P&lt;0.0001). However, in pincer FAI, BME only correlated with pain severity (P=0.004) and duration (P=0.011) and did not correlate with other MRI signs of structural hip damage. Conclusions: In cam FAI, BME of the femoral head and neck on MRI positively correlated with chondral damage and synovitis, but not in pincer FAI. This correlation suggests that cam FAI might be associated with a worse long-term prognosis. This finding might have an impact on clinical practice and decision making as it would encourage surgeons to intervene early in cases of cam FAI, thus preventing the possible development of irreversible, established hip OA.

Can hip arthroscopy in the presence of arthritis delay the need for hip arthroplasty?

Hip arthroscopy for joint preservation surgery has grown immensely over the last two decades. There is now an increasing trend to try and expand the role of hip arthroscopy to include patients of an older age or perhaps even with signs of arthritis, instead of the established patient group of young adults with mechanical symptoms or serious athletes. But how much of this growth is really justified? Once arthritis is apparent, the arthroscopic procedures needed to try and limit progression of the disease are likely to be different to those needed in young adult non-arthritic hips. Similarly, the expectation of results following an arthroscopic procedure in an older adult with arthritis must also be different. With an almost 5-fold increase in conversion rate from arthroscopy to arthroplasty in the over 50s population, arthroscopy in arthritis is a different procedure, with a different outcome, to arthroscopy in young adults with no evidence of osteoarthritis. This article takes a closer inspection at outcomes following hip arthroscopy in the older population particularly in those with evidence of early arthritis. This paper does not attempt to make recommendations in other diagnoses such as inflammatory arthritis or other secondary arthritides. It must be considered that hip arthroscopy is not a benign intervention: as well as the surgical risks, the lengthy rehabilitation period should be factored into the equation. Although the nature of surgeons is to find new techniques and push boundaries, we highlight the need for caution in undertaking arthroscopic intervention when arthritis is already apparent at presentation.

Inter-segmental motions of the foot: differences between younger and older healthy adult females

BackgroundAlthough accumulative evidence exists that support the applicability of multi-segmental foot models (MFMs) in evaluating foot motion in various pathologic conditions, little is known of the effect of aging on inter-segmental foot motion. The objective of this study was to evaluate differences in inter-segmental motion of the foot between older and younger adult healthy females during gait using a MFM with 15-marker set.MethodsOne hundred symptom-free females, who had no radiographic evidence of osteoarthritis, were evaluated using MFM with 15-marker set. They were divided into young (n = 50, 20–35 years old) and old (n = 50, 60–69 years old) groups. Coefficients of multiple correlations were evaluated to assess the similarity of kinematic curve. Inter-segmental angles (hindfoot, forefoot, and hallux) were calculated at each gait phase. To evaluate the effect of gait speed on intersegmental foot motion, subgroup analysis was performed according to the similar speed of walking.ResultsKinematic curves showed good or excellent similarity in most parameters. Range of motion in the sagittal (p < 0.001) and transverse (p = 0.001) plane of the hallux, and sagittal (p = 0.023) plane of the forefoot was lower in older females. The dorsiflexion (p = 0.001) of the hallux at terminal stance and pre-swing phases was significantly lower in older females. When we compared young and older females with similar speed, these differences remained.ConclusionsAlthough the overall kinematic pattern was similar between young and older females, reduced range of inter-segmental motion was observed in the older group. Our results suggest that age-related changes need to be considered in studies evaluating inter-segmental motion of the foot.

Articular sagittal and medial parasagittal patellar fracture repair using lag screws in two mature horses

SummaryThis report describes the clinical experience with internal fixation of a sagittal and a medial parasagittal patellar fracture using lag screws. Severely displaced sagittal and medial parasagittal fractures of the patella were diagnosed in 2 horses (a 10‐year‐old Thoroughbred gelding and a 5‐year‐old Thoroughbred mare) and were repaired using internal fixation. A direct approach through the fascia latae was used. In both cases, the leg was placed in full extension and the fracture was corrected by a combination of digital manipulation and application of bone reduction forceps. Articular congruency was assured by arthrotomy and digital assessment, and radiographic skyline projection. Then, the leg was placed in flexion and two 5.5 mm cortical screws with washers were inserted in lag fashion, under radiographic guidance (skyline projection). In one case, an additional 6.5 mm cancellous screw was used. Both fractures healed without evidence of degenerative joint disease. However, the first horse's wound dehisced, then healed by second intention uneventfully. The second horse was put in a sling in order to prevent lying down. Both horses were able to be used for their intended purpose. In these clinical cases, sagittal and medial parasagittal patellar fractures were treated successfully by open reduction and internal fixation. Post‐operative management in a sling was used successfully in the second case to prevent wound dehiscence.