Group Of Osteoarthritis Patients Research Articles

Effectiveness of Foam Rolling with Hip Strengthening versus Conventional Treatment in Iliotibial Band Tightness Among Osteoarthritis Patients

Background: The iliotibial band (ITB) tightness contributes to pain and functional limitations in osteoarthritis (OA) patients. The effectiveness of foam rolling (FR) combined with ITB stretching exercises versus conventional treatment methods targeting ITB tightness has not been thoroughly investigated. This study aimed to evaluate the impact of these modalities on passive range of motion (PROM) during hip adduction in OA patients. Methods: Three groups of OA patients (Foam Rolling alone-Group A, Conventional Exercises + Foam Rolling-Group B, and Hip strengthening + Foam Rolling-Group C) were assessed over 14 treatment sessions using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores and Ober's test for ITB tightness. Group A received foam rolling with hip strengthening, Group B underwent conventional treatment, and Group C was treated with a combination of methods. Results: All groups showed a marked decrease in WOMAC scores, indicating an improvement in pain and knee function. Group A exhibited a significant reduction in ITB tightness, with the mean Ober's test score initially increasing but then decreasing markedly by the 14th session. Group B and Group C also showed improvements, but Group A's protocol was the most effective in reducing ITB tightness. Conclusion: The study demonstrated that foam rolling with hip strengthening exercises is significantly effective in reducing ITB tightness and improving function in OA patients. This combination therapy may be considered a superior approach to conventional treatment methods for managing ITB-related symptoms in this population.

Identification of Osteoarthritis Inflamm-Aging Biomarkers by Integrating Bioinformatic Analysis and Machine Learning Strategies and the Clinical Validation

To identify inflamm-aging related biomarkers in osteoarthritis (OA). Microarray gene profiles of young and aging OA patients were obtained from the Gene Expression Omnibus (GEO) database and aging-related genes (ARGs) were obtained from the Human Aging Genome Resource (HAGR) database. The differentially expressed genes of young OA and older OA patients were screened and then intersected with ARGs to obtain the aging-related genes of OA. Enrichment analysis was performed to reveal the potential mechanisms of aging-related markers in OA. Three machine learning methods were used to identify core senescence markers of OA and the receiver operating characteristic (ROC) curve was used to assess their diagnostic performance. Peripheral blood mononuclear cells were collected from clinical OA patients to verify the expression of senescence-associated secretory phenotype (SASP) factors and senescence markers. A total of 45 senescence-related markers were obtained, which were mainly involved in the regulation of cellular senescence, the cell cycle, inflammatory response, etc. Through the screening with the three machine learning methods, 5 core senescence biomarkers, including FOXO3, MCL1, SIRT3, STAG1, and S100A13, were obtained. A total of 20 cases of normal controls and 40 cases of OA patients, including 20 cases in the young patient group and 20 in the elderly patient group, were enrolled. Compared with those of the young patient group, C-reactive protein (CRP), interleukin (IL)-6, and IL-1β levels increased and IL-4 levels decreased in the elderly OA patient group (P<0.01); FOXO3, MCL1, and SIRT3 mRNA expression decreased and STAG1 and S100A13 mRNA expression increased (P<0.01). Pearson correlation analysis demonstrated that the selected markers were associated with some indicators, including erythrocyte sedimentation rate (ESR), IL-1β, IL-4, CRP, and IL-6. The area under the ROC curve of the 5 core aging genes was always greater than 0.8 and the C-index of the calibration curve in the nomogram prediction model was 0.755, which suggested the good calibration ability of the model. FOXO3, MCL1, SIRT3, STAG1, and S100A13 may serve as novel diagnostic biomolecular markers and potential therapeutic targets for OA inflamm-aging.

Outcomes of the Surgical Treatment of Periprosthetic Fractures Around the Knee with Locking Plates: A Single Centre Experience.

Introduction:Surgical treatment options for periprosthetic fractures (PPF) include internal fixation with plate, intramedullary nailing and revision arthroplasty. We aimed at evaluating the surgical outcomes of patients who we had treated PPF with locking compression plates (LCP).Materials and methods:Twenty patients with PPF after primary total knee arthroplasty (TKA) between 2009 and 2016 were included in to the study. Knee Society Knee Scoring System (KSKSS) was used in the evaluation of radiologic and functional outcomes. There were periprosthetic supracondylar femoral fractures in 15 patients, and that of tibial fractures in 5 patients. For internal fixation, locking compression plate was preferred.Results:The mean age was 69 (range 61 to 78) years and the mean follow-up period was 72.25 (range 24 to 110) months. Union was achieved by 15.8 weeks in all the cases. Superficial infection and implant fracture were each seen in two patients. Revision operations were done to those patients with implant fracture. Mean KSKSS was 81.4 (75-87) and the mean functional score was 78.75 (75-85). Degenerative osteoarthritis patients were found to have higher age values than post-traumatic osteoarthritis patients (p = 0.001). When the union times were compared, it was found that the degenerative osteoarthritis patient group had a significantly shorter union than the post-traumatic osteoarthritis patient group (p = 0.036).Conclusion:Internal fixation with LCP is an effective treatment method in managing of PPF for patients with good bone stock. Rigid fixation should be done with the right surgical technique and an early movement must be initiated so that a good function can be achieved.

Results of shoulder resurfacing arthroplasty at medium-term follow-up

The main objective of this study was to evaluate the medium-term survival rate of Shoulder Resurfacing humeral Arthroplasties (SRA). The secondary objectives were to evaluate the clinical and radiological results and complications of this kind of arthroplasty. Sixty-five patients (75 shoulders) with a mean age of 69.1 years underwent shoulder resurfacing arthroplasty (Copeland Humeral Resurfacing Head, then Aequalis Resurfacing Humeral Head) between 2003 and 2017. Radiographic factors were evaluated pre- and postoperatively on AP and lateral views and on a preoperative CT-scan. At the last follow-up, functional results were evaluated using the Constant score, Disability Arm Shoulder and Hand score (DASH), pain on numeric scale and active range-of-motion measurement. At the mean follow-up of 7.5 years, we reviewed 52 shoulders (44 patients) with a survival rate of 85% for any revision and 87% regarding complications specific to SRA. Eight shoulders required surgical revision. Among the 36 shoulders (32 patients) seen in consultation, we obtained statistically significant improvement between preoperative and postoperative absolute Constant score, adjusted Constant score, active range of motion for antepulsion and abduction. The mean inclination angle of proximal humerus head after prothesis was + 4.2° varus, and the difference was statistically significant ( P = .02) compared with the preoperative measurement. A higher rate of complications was found in the post-traumatic osteonecrosis patient group while a lower rate of complications was found in the osteoarthritis patient group. This confirms that SRA is a good surgical option for shoulder arthroplasty with good survival rates and functional results, especially for patients with primary osteoarthritis. Level IV; Case Series, Therapeutic Study

The Relationship Between Primary Knee Osteoarthritis and Aortic Stiffness, Distensibility, and Valve Calcifications: A Case-Control Study.

The purpose of our study was to evaluate aortic stiffness and distensibility changes and the presence of aortic and mitral valve calcifications in patients with primary knee osteoarthritis (OA), using 2-dimensional and Doppler transthoracic echocardiography. This case-control study included 115 participants with OA and a control group between May 2019 and November 2019. The Kellgren-Lawrence classification was used for the diagnosis and classification of knee OA, based on radiological images. We compared the demographic data, 2-dimensional and Doppler transthoracic echocardiography results, and laboratory findings between the OA patient group and the control group. There was a significant difference between aortic strain, aortic distensibility, aortic stiffness, and C-reactive protein values between the OA patient group and the control group (p < 0.001 for all). Post hoc analyses revealed that aortic strain and aortic distensibility values were significantly lower, and aortic stiffness values were significantly higher in the grade 4 OA group than those of other groups (p < 0.05 for all). In addition, the C-reactive protein values of the grades 3 and 4 patients were significantly higher than those of other groups (p < 0.05 for all). No significant difference was observed between the groups in terms of aortic and mitral valve calcifications (p > 0.05 for all). Aortic strain and distensibility values were lower in the advanced grades of primary knee OA, whereas aortic stiffness values and the frequency of valve calcifications were higher.

Using the Systems Biology Approach and Molecular Method to Investigate the Role of the Dopaminergic Pathway in Osteoarthritis: A Case Control Study.

ObjectiveOsteoarthritis is the most common type of arthritis and one of the leading causes of job loss and motor disabilities. Recently, the involvement of dopaminergic pathways and dopamine receptor genes has been considered in this disease. Therefore, studying and comparing the expression pattern of these receptor genes can lead to a greater understanding of the pathogenesis of this disease.MethodsIn this research, we used the systems biology approach to investigate the role of the dopaminergic pathway in osteoarthritis. Then the gene expression pattern of dopamine receptor genes was examined in an osteoarthritis patientgroup in comparison with healthy individuals by Real-time PCR method.ResultsThe analysis of the transcriptome dataset of osteoarthritis identified some genes in the dopaminergic pathway and the six most important genes in this disease are in the network with a significant relationship to dopamine receptors which differentially expressed compared to health groups. Statistical analysis of the case control study showed a significant difference (P-value<0.05) in DRD1 and DRD2 family in the patients in comparison to healthy individuals.DiscussionWe attained the significant expression pattern of dopamine receptors in the blood of osteoarthritis patients which could be useful to identify new strategies for the diagnosis, management, or treatment of this disease.

State of intestinal microbiome in patients with osteoarthritis

Objective — to study the composition of intestinal microflora (CM) in patients with osteoarthritis (OA) against the background of administration of non-steroidal anti-inflammatory drugs (NSAIDs) and without them, as well as define difference in the CM of patients and healthy subjects.Materials and methods. The study involved 26 OA patients, who were divided into two groups: 16 subjects on NSAIDs (NSAID group) and 10 patients who did not take NSAIDs (non-NSAID group). Control group consisted of 23 healthy individuals. The state of intestinal microbiome was studied by real-time PCR, with the determination of the content of Bacteroides, Firmicutes, Actinobacteria, «other» types (total bacterial RNA with the exception of the above types) and the ratio of Firmicutes/Bacteroides.Results. It following significant differences have been established in QA patients in comparison with the healthy controls: Bacteroides levels was significantly higher, the median 19 % (interquartile range 8.05 — 27.39) % versus 7.36 (3.69 — 9.22) %, p &lt; 0.001; the Firmicutes and Actinobacteria levels were lower (51.47 (45.05 — 56.13) % versus 71.53 (58.57 — 74.098) %, p &lt; 0.01) and (6.95 (4.71 — 9.25) % versus 10.56 (7.07 — 14.64) %, p &lt; 0.05), respectively. The Firmicutes/Bacteroides ratio was almost five times lower in the OA group than in healthy control (2.81 (1.73 — 6.48) versus 9.898 (6.37 — 18.81), p &lt; 0.001), which makes it a very important diagnostic criterion. No significant difference was reveled in the CM compositions between the patients of NSAID group and non-NSAID group, as well as in the Firmicutes/Bacteroides ratio. However, Bacteroides levels differed form healthy controls in a higher extent in the group of OA patients from non-NSAID group, and they demonstrated more low Actinobacteria levels than healthy controls. Moreover, a middle-strength correlation has been established between the age and fecal Bacteroides content (positive, ρ = 0.595, p &lt; 0.001) and between age and fecal Firmicutes content (negative, ρ = –0.523, p &lt; 0.001). A positive correlation of the average strength was established between the «other» types of flora and age (ρ = 0.325, p &lt; 0.05)and body mass index (ρ = 0.464, p &lt; 0.05), which is consistent with the previous literature data.Conclusions. The significant difference has been established in the intestinal microflora composition between the group of OA patients and healthy subjects, and absence of such difference in case of subgroups comparison. The most significant difference was reveled in the levels of Bacteroides and Firmicutes: an increase of Bacteroides level and decrease in Firmicutes and Actinobacteria levels. The Firmicutes/Bacteroides ratio was the most sensitive indicator. In terms of Bacteroides levels, the non-NSAID group differed from the control group in more extension than the NSAID group, and they had the low Actinobacteria level.

The design of the cemented stem influences the risk of Vancouver type B fractures, but not of type C: an analysis of 82,837 Lubinus SPII and Exeter Polished stems

Background and purpose — In total hip replacements, stem design may affect the occurrence of periprosthetic femoral fracture. We studied risk factors for fractures around and distal to the 2 most used cemented femoral stems in Sweden.Patients and methods — This is a register study including all standard primary Lubinus SPII and Exeter Polished stems operated in Sweden between 2001 and 2009. The outcome was any kind of reoperation due to fracture around (Vancouver type B) or distal to the stem (Vancouver type C), with use of age, sex, diagnosis at primary THR, and year of index operation as covariates in a Cox regression analysis. A separate analysis of the primary osteoarthritis patient group was done in order to evaluate eventual influence of the surgical approach (lateral versus posterior) on the risk for Vancouver type B fractures.Results — The Exeter stem had a 10-times (95% CI 7–13) higher risk for type B fractures, compared with the Lubinus, while no statistically significant difference was noticed for type C fractures. The elderly, and patients with hip fracture or idiopathic femoral head necrosis, had a higher risk for both fracture types. Inflammatory arthritis was a risk factor only for type C fractures. Type B fractures were more common in men, and type C in women. A lateral approach was associated with decreased risk for Type B fracture.Interpretation — Stem design influenced the risk for type B, but not for type C fracture. The influence of surgical approach on the risk for periprosthetic femoral fracture should be studied further.

Probing The Relation Between Vitamin D Deficiency and Progression of Medial Femoro-tibial Osteoarthitis of the Knee.

To compare serum 25 OH vitamin D (25 (OH) D) levels between medial femoro-tibial knee osteoarthritis (OA) patients and controls, and to detect structural progression in patients with mild to moderate knee osteoarthritis in relation to baseline 25(OH) D levels in a oneyear longitudinal prospective cohort study. Thirty eight patients with medial femoro-tibial knee OA according to the ACR criteria and no knee malalignement, and 20 age, sex and BMI-matched pain free controls were included in the vitamin D study. All included OA patients had radiographic Kellgren and Lawrence grades 2 or 3. Baseline serum levels of 25(OH) D, and the "Benefiting from ultraviolet index "(BFUI) score were determined; serum parathormone, total alkaline phosphatase, calcium and phosphorus were measured. In the OA progression study, OA patients were divided into 2 groups according to 25 (OH) D level using a cutoff of 10 ng/ml to identify their status. MRIs were done at baseline and repeated after 12 months with scoring system according to Boston Leeds osteoarthritis knee score (BLOKS). During the study period, the patients were not supplemented with 25(OH)D. The mean values of Vitamin D were statistically lower in the OA patient group than in controls (8.64 ± 6.42 vs. 14.84±0.87 pg/mL, P =0.0295). The BFUI score overall correlated with 25 (OH) D status. Eight patients did not complete the study so only thirty OA patients underwent the 2 MRIs. Of those, 21 had 25(OH) D levels <10 ng/ml, while 9 had levels >10 ng/ml. A significant progression of the medial meniscal grading from baseline to 1 year was seen in the patients with 25(OH)D levels <10 ng/ml as compared to the others (Wilcoxon Z= -3.556 P<0.001). 25 (OH) D levels were significantly decreased in knee OA patients. Significant deterioration of the medial menisci was observed in OA patients with 25 (OH)D levels <10 ng/ml suggesting that Vit D deficiency may play a role in the progression of medial femoro-tibial OA.

Assessing sufficient capability: A new approach to economic evaluation

Amartya Sen's capability approach has been discussed widely in the health economics discipline. Although measures have been developed to assess capability in economic evaluation, there has been much less attention paid to the decision rules that might be applied alongside. Here, new methods, drawing on the multidimensional poverty and health economics literature, are developed for conducting economic evaluation within the capability approach and focusing on an objective of achieving “sufficient capability”. This objective more closely reflects the concern with equity that pervades the capability approach and the method has the advantage of retaining the longitudinal aspect of estimating outcome that is associated with quality-adjusted life years (QALYs), whilst also drawing on notions of shortfall associated with assessments of poverty. Economic evaluation from this perspective is illustrated in an osteoarthritis patient group undergoing joint replacement, with capability wellbeing assessed using ICECAP-O. Recommendations for taking the sufficient capability approach forward are provided.

High MMP-1, MMP-2, and MMP-9 protein levels in osteoarthritis.

Our study examined the relationship between the expression of matrix metalloproteinases (MMP)-1, MMP-2, and MMP-9 proteins and the pathogenesis of osteoarthritis (OA). We employed rigorous inclusion and exclusion criteria in computer-based bibliographic databases to extract published studies relevant to this investigation. The STATA 12.0 software was used for the statistical analyses. A total of 1408 studies were initially searched, and 10 studies with 458 OA patients and 295 healthy controls were included in this meta-analysis. The meta-analysis results suggested that the protein levels of MMP-1, MMP-2, and MMP-9 were higher in patients with OA than those in the control group. A subgroup analysis according to ethnicity showed that the protein levels of MMP-1 and MMP-2 were higher in Asian patients with OA than in controls. Caucasians showed no statistically significant differences in protein expression of MMP-1 and MMP-2 between the OA patient group and the control group. Interestingly, the protein levels of MMP-9 in patients with OA were higher than those in the control group in both Asians and Caucasians. A sample-source analysis suggested that the serum levels of MMP-2 and MMP-9 proteins were higher in patients with OA than in controls, while MMP-1 and MMP-9 protein expressions were higher in the synovial joint fluid of patients with OA than in controls. In conclusion, our meta-analysis results suggested that the increased expression of MMP-1, MMP-2, and MMP-9 proteins might be associated with the pathogenesis of OA.

Osteoarthritis pain has a significant neuropathic component: an exploratory in vivo patient model

Osteoarthritis is the most common form of arthritis and includes manifestations of both nociceptive and neuropathic mechanisms. Intravenous lignocaine, a sodium channel blocker and neuronal membrane stabiliser, has been shown in controlled trials to be effective in neuropathic pain; however, the outcome of intravenous lignocaine in osteoarthritis patients has not been assessed yet. The existence of a neuropathic component to the pain of osteoarthritis was investigated by examining possible benefits upon sensory aspects of pain in osteoarthritis patients receiving intravenous lignocaine therapy. Retrospective observational study was carried out using health data routinely collected for non-research purposes. Patients with generalised osteoarthritis who had not responded to more conservative treatments were recruited sequentially and scheduled for intravenous lignocaine therapy either in the rheumatology or pain relief departments. Assessment of efficacy was carried out through a questionnaire including sensory, psychological and social aspects of pain. The sample consisted of 17 women (60.7%) and 11 men (39.3%) with an average age at the time of treatment of 59 ± 11 years. The average pain relief calculated from the NRS scores was 30.2 ± 21.4%, and the mean duration of pain relief was 10 ± 6 weeks. Pain intensity (p < 0.001), pain relief (p < 0.003) and mobility (p < 0.003) were all significantly improved after administration of lignocaine intravenous infusion therapy. Pain was significantly reduced in a group of osteoarthritis patients after administration of intravenous lignocaine. This suggests that part of the pain mechanism in this patient group may be neuropathic, appears to contribute significantly to the patients' pain, and requires further investigation in studies designed specifically for the purpose.

Association of single nucleotide polymorphisms (SNPs) in leptin re-ceptor gene with knee osteoarthritis in the Ningxia Hui population

To investigate the association between primary knee osteoarthritis (OA) and single nucleotide polymorphism (SNP) (A668G) of leptin receptor gene (LEPR) in the Ningxia Hui population. A case-control association study has been adopted in this thesis. The polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP) analysis were performed to investigate the SNP of A668G site within LEPR from 148 patients with knee OA and 155 controls (asymptomatic and radiographically negative) with matched age and gender among Ningxia Hui population. In addition, genotypes of LEPR were verified by direct sequence analysis on PCR products. The result indicates that allele and genotype frequencies (P=0.024 and 0.008, respectively) in LEPR SNP A668G were significantly different in the knee OA patients group and control group, and in the knee OA patients group, the serum levels of leptin decreased significantly (P<0.001) and the serum levels of soluble leptin receptor increased significantly (P<0.001) compared with control group. Therefore, LEPR SNP A668G is associated with susceptibility to knee OA, which would be used as the genetic marker in predicting the risk of knee OA and would be one of the candidate genes in early prevention and control.

Evaluation of mean platelet volume (MPV) levels in patients with synovitis associated with knee osteoarthritis

Platelet count, C-reactive protein (CRP) and neutrophile countings are markers those reflect the inflammatory response. Mean platelet volume (MPV) is a simple indicator of platelet size and has been known to be a marker of platelet activity. Some platelet markers, including MPV, have been investigated to have relation with inflammation. MPV is inversely correlated with inflammation in inflammatory bowel diseases, rheumatoid arthritis, and ankylosing spondylitis, as shown in the previous studies. In this study, we aimed to investigate the levels of MPV in patients with synovitis of knee osteoarthritis. 147 patients diagnosed with synovitis associated to osteoarthritis, 191 patients with knee osteoarthritis, and 121 patients between the same age range who did not have joint complaints (control group), totally 459 participants were included to our study. MPV results of these groups were compared. We found a significant difference between the patient group with synovitis associated with osteoarthritis of knee and patients with knee osteoarthritis in MPV blood level (p < 0.0001), similarly a significant difference was found between the patient group with synovitis associated with osteoarthritis of knee and the control group (p < 0.0001). There was no significant difference between the knee osteoarthritis patient group and the control group (p = 0.78). We found a significant relation between MPV and ESR in the patient group with synovitis of osteoarthritis (p = 0.004). According to the Pearson correlation, it is found that there is a negative relationship between CRP and MPV variables in those of knee osteoarthritis patients. This correlation coefficient is statistically significant at the 10% level (p = 0.058). We could not find a relation between CRP and MPV in patients with the osteoarthritis group, but we found negative correlation (p = 0.65). Significant relationship was not found between ESR and MPV variables at the 10% level; the p value is 0.34. In the control group no correlation was found between CRP–MPV (p = 0.69) and ESR–MPV (p = 0.798). MPV levels may be beneficial in osteoarthritis with synovitis patients. MPV levels may be considered as a marker of inflammation but further comprehensive prospective trials are needed in osteoarthritis associated with synovitis patients.

Low osteocalcin/collagen type I bone gene expression ratio is associated with hip fragility fractures

IntroductionOsteocalcin (OC) is the most abundant non-collagenous bone protein and is determinant for bone mineralization.We aimed to compare OC bone expression and serum factors related to its carboxylation in hip fragility fracture and osteoarthritis patients. We also aimed to identify which of these factors were associated with worse mechanical behavior and with the hip fracture event. MethodsIn this case-control study, fragility fracture patients submitted to hip replacement surgery were evaluated and compared to a group of osteoarthritis patients submitted to the same procedure. Fasting blood samples were collected to assess apolipoproteinE (apoE) levels, total OC and undercarboxylated osteocalcin (ucOC), vitamin K, LDL cholesterol, triglycerides and bone turnover markers. The frequency of the apoε4 isoform was determined.Femoral epiphyses were collected and trabecular bone cylinders drilled in order to perform compression mechanical tests. Gene expression of bone matrix components was assessed by quantitative RT-PCR analysis. Results64 patients, 25 submitted to hip replacement surgery due to fragility fracture and 39 due to osteoarthritis, were evaluated. Bone OC/collagen expression (OC/COL1A1) ratio was significantly lower in hip fracture compared to osteoarthritis patients (p<0.017) adjusted for age, gender and body mass index. Moreover, OC/COL1A1 expression ratio was associated with the hip fracture event (OR ~0; p=0.003) independently of the group assigned, or the clinical characteristics. Apoε4 isoform was more frequent in the hip fracture group (p=0.029). ucOC levels were higher in the fracture group although not significantly (p=0.058). No differences were found regarding total OC (p=0.602), apoE (p=0.467) and Vitamin K (p=0.371).In hip fracture patients, multivariate analysis, adjusted for clinical characteristics, serum factors related to OC metabolism and gene expression of bone matrix proteins showed that low OC/COL1A1 expression ratio was significantly associated with worse trabecular strength (β=0.607; p=0.013) and stiffness (β=0.693; p=0.003). No association was found between ucOC and bone mechanics. Moreover, in osteoarthritis patients, the multivariate analysis revealed that serum total OC was negatively associated with strength (β=−0.411; p=0.030) and stiffness (β=−0.487; p=0.009). ConclusionWe demonstrated that low bone OC/COL1A1 expression ratio was an independent predictor of worse trabecular mechanical behavior and of the hip fracture event. These findings suggest that in hip fracture patients the imbalance of bone OC/COL1A1 expression ratio reflects disturbances in osteoblast activity leading to bone fragility.

Smoking is a predictor of worse trabecular mechanical performance in hip fragility fracture patients

Clinical risk factors (CRFs) are established predictors of fracture events. However, the influence of individual CRFs on trabecular mechanical fragility is still a subject of debate. In this study, we aimed to assess differences, adjusted for CRFs, between bone macrostructural parameters measured in ex-vivo specimens from hip fragility fracture patients and osteoarthritis patients, and to determine whether individual CRFs could predict trabecular bone mechanical behavior in hip fragility fractures. Additionally, we also looked for associations between the 10-year risk of major and hip fracture calculated by FRAX and trabecular bone mechanical performance. In this case-control study, a group of fragility fracture patients were compared with a group of osteoarthritis patients, both having undergone hip replacement surgery. A clinical protocol was applied in order to collect CRFs [body mass index (BMI), prior fragility fracture, parental history of hip fracture, long-term use of oral glucocorticoids, rheumatoid arthritis, current smoking, alcohol consumption, age and gender]. The 10-year probability of fracture was calculated. Serum bone turnover markers were determined and dual X-ray absorptiometry performed. Femoral head diameter was evaluated and trabecular bone cylinders were drilled for mechanical testing to determine bone strength, stiffness and toughness. We evaluated 40 hip fragility fracture and 52 osteoarthritis patients. Trabecular bone stiffness was significantly lower (p=0.042) in hip fragility fracture patients when compared to osteoarthritic individuals, adjusted for age, gender and BMI. No other macrostructural parameter was statistically different between the groups. In hip fragility fracture patients, smoking habits (β=-0.403; p=0.018) and female gender (β=-0.416; p=0.008) were independently associated with lower stiffness. In addition, smoking was also independently associated with worse trabecular strength (β=-0.323; p=0.045), and toughness (β=-0.403; p=0.018). In these patients, the 10-year risk of major (r=-0.550; p=0.012) and hip fracture (r=-0.513; p=0.021) calculated using only CRFs was strongly correlated with femoral neck bone mineral density but not with mechanical performance. Our data showed that among fragility fracture patients active smoking is a predictor of worse intrinsic trabecular mechanical performance, and female gender is also independently associated with lower stiffness. In this population, the 10-year risk of fracture using CRFs with different weights only reflects bone mass loss but not trabecular mechanical properties.

Comorbidades em pacientes com osteoartrite: frequência e impacto na dor e na função física

As the prevalence of osteoarthritis (OA) increases with age, the coexistence of other chronic diseases is common. To evaluate the frequency of comorbidities in OA patients and to measure their impact on pain and physical function of those patients. Cross-sectional study in OA patients of a public rheumatology clinic. Pain was measured by use of the Visual Analogue Scale (VAS) and physical function by use of the Lequesne's and SACRAH indices. A screening for depression was performed, as were the following measurements: anthropometric data; blood pressure; fasting glycemia; and lipid profile. The study assessed 91 patients (mean age 59.3 years; 91.4% female). The metabolic syndrome frequency was 54.9%. Hypertension occurred in 75.8% of the patients, dyslipidemia in 52.6%, and obesity in 57.1%. The screening for depression was positive in 61.3% of patients. When comparing the metabolic syndrome components individually, patients with hypertension had higher SACRAH scores, with statistically significant differences (P = 0.035). For the other variables, no differences among the Lequesne's, SACRAH and VAS scores were observed. This group of OA patients showed a high frequency of depression, metabolic syndrome and its components in isolation, which can impact the pain and physical function of those patients. Such results showed the need for investigating and treating those comorbidities in OA patients.

Prevalence of the Pro12Ala missense mutation in the PPARG2 gene in Kuwaiti patients with primary knee osteoarthritis

BACKGROUND AND OBJECTIVES:Peroxisome proliferator–activated receptors (PPARs) play an important role in a number of cellular and metabolic functions. This study was carried out to determine the prevalence of a missense mutation (Pro12Ala) in the PPARG2 gene in Kuwaiti Arab patients with primary knee osteoarthritis (OA) and healthy controls with the aim of identifying a possible association.DESIGN AND SETTING:A prospective cross-sectional study carried out at three major teaching hospitals (referral centers) in the country over a one-year period.PATIENTS AND METHODS:The prevalence of PPARG2 gene Pro12Ala missense mutation was determined in 104 Kuwaiti Arab patients with primary knee OA and 111 ethnically matched healthy controls. The prevalence of this Pro12Ala missense mutation was also determined in clinical subgroups of OA patients divided on the basis of age at onset, function and radiologic grading.RESULTSThe Pro-Pro genotype of the PPARG2 gene Pro12Ala missense mutation was detected in 95/104 (91.3%) cases compared to 111/111 (100%) in the control subjects. The heterozygous Pro-Ala genotype was detected in 9/104 (8.7%) of the OA patients, while it was not detected in any of the controls. The Ala-Ala genotype was not detected in any of the OA patients or the controls. No significant differences were detected in the PPARG2 gene Pro12Ala genotypes in the subgroups of patients classified on the basis of age at onset, functional assessment using Lequesne’s functional index, and radiological grading using Kellgren-Lawrence (K-L) grading.CONCLUSIONSThis study found no significant association between the PPARG2 gene Pro12Ala missense mutation and knee OA. However, the presence of the Pro-Pro genotype of the PPARG2 gene mutation has a protective effect against development of OA.

Popliteal artery–tibial plateau relationship before and after total knee replacement: a prospective ultrasound study

It seems to be a general belief that knee flexion releases the tension on the popliteal artery (PA) and displaces it posteriorly. Furthermore, there are opinions suggesting that previous surgery may result in fibrosis and rigidity of the vessels in the posterior knee region, which can lead to tethering of the PA, bringing it closer to the posterior tibia and making it more vulnerable during revision knee surgery. The aim of this study was to assess the distance between the PA and the tibial plateau in extension and flexion of the knee before and after surgery with total knee replacement (TKR). We studied 40 consecutive patients who were about to undergo TKR. The distance between the PA and tibial plateau was measured by ultrasound bilaterally in full knee extension without quadriceps contraction and in 90 degrees knee flexion, both preoperatively and 15 weeks postoperatively. The mean preoperative distances in flexion and in extension were 7 mm (3-12) and 8 mm (4-13), respectively (p < 0.05). Postoperatively, the distances were significantly increased both in flexion, 9 mm (4-14) (p < 0.001) and in extension 9 mm (3-15) (p < 0.01). Assessment of the contralateral legs where 14 previously had been operated with TKR showed no significant difference either between flexion and extension or between pre- and postoperative measurements. In conclusions, knee flexion does not increase the distance between the artery and the proximal tibia in this osteoarthritis patient group. At 15 weeks post-TKR, there was an increased distance from the PA to the posterior tibia and assessment of the contralateral knee where previous TKR had been performed showed equal distance to the ipsi-lateral preoperative knee, suggesting that the postoperative changes at 15 weeks were due to capsular swelling.

Knee joint kinematics, kinetics and muscle co-contraction in knee osteoarthritis patient gait

Background Compared to matched controls, knee osteoarthritis patients walk with altered, kinematics, kinetics and muscle activity. Studies of osteoarthritis patient gait have focused on individual measures, and findings from these studies differ due to differences in patient levels of disability and age. Therefore, aims of this study were to examine kinematic, kinetic and muscle co-contraction gait variables within a single osteoarthritis patient group, and to determine if alterations in these variables are related to pain, symptom and function measures. Methods Thirty asymptomatic controls and 54 patients with radiographic evidence of knee osteoarthritis participated. Self-perceived measures of pain and symptoms, and gait (knee joint angles, moments and muscle co-contraction) were analysed and compared. Findings Osteoarthritis patients had greater self-perceived pain and symptoms on the questionnaires. Gait differences in the knee osteoarthritis patients were greater knee flexion at heel strike and during early stance along with reductions in the peak external knee extension moment in late stance. Co-contraction ratios highlighted greater lateral muscle activation in osteoarthritis patients, which were correlated with the magnitude of their adduction moments. Larger adduction moments were related to lower self-perceived pain and symptoms. Interpretation Osteoarthritis patients use predominantly lateral muscle activation during stance which may aid in stabilising the external knee adduction moment. Kinematic alterations in knee osteoarthritis patient gait occur without alterations in knee joint moments. Our results also suggest that adduction moments are lowered to reduce the patients’ pain and symptoms.