Joint Osteoarthritis Research Articles

Correlation between severity of knee joint osteoarthritis and alignment of patellofemoral and patellar height on radiographs

Correlation between severity of knee joint osteoarthritis and alignment of patellofemoral and patellar height on radiographs

Foreign body giant cell reaction due to Durolane (hyaluronic acid derivative) injection - A case report.

Osteoarthritis can be treated with hyaluronic acid derivatives, such as Durolane manufactured by Bioventus (Hill, 2017), particularly when conventional treatments prove ineffective. In osteoarthritic joints, the synovial fluid has a lower concentration of hyaluronic acid compared to healthy joints. Intra-articular therapy with exogenous hyaluronic acid can improve viscoelastic properties, enhance chondrocyte synthesis, reduce cartilage degradation, and alleviate pain associated with osteoarthritis (Migliore and Procopio in Clin Cases Miner Bone Metab. 12:31-3, 2015). This report describes a unique case where a patient, following Durolane administration, presented with an intraosseous foreign body giant cell reaction. A 2.5-cm lesion was identified on MRI, initially raising concerns for metastatic disease or multiple myeloma. Subsequent IR CT-guided biopsy confirmed a diagnosis of "foreign body giant cell reaction to gel," linked to the Durolane injection. This case presents a contribution to the literature due to the scarcity of documented instances where Durolane injection leads to an intraosseous foreign body giant cell reaction resembling metastatic disease. While a solitary intraosseous pseudotumor, reportedly due to viscosupplement injection, has been published, it differs in both location (hip vs. knee) and imaging characteristics from the presented case. The manifestation of a foreign body giant cell reaction after Durolane injection, mimicking malignant osseous lesions, merits attention among practitioners. This case underscores the necessity for further research into potential adverse reactions associated with hyaluronic acid derivatives.

Characteristics of Temporomandibular Joint Osteoarthritis Patients With Condylar Erosion: A Retrospective Cross-Sectional Study.

Condylar erosion (CE) may indicate an active progressive stage of temporomandibular joint osteoarthritis (TMJOA), but no studies have analysed the characteristics of this population. This cross-sectional study analysed the characteristics of TMJOA patients with CE. A total of 267 patients were included. The severity of CE of all joints was evaluated using cone beam computed tomography (CBCT) and scored using a four-point rating scale (0-III). Patients were categorised into mild (grade I), moderate (grade II) and severe (grade III) groups. Demographic and clinical characteristics were summarised and stratified by age and erosion severity. Univariate and multivariate logistic regression analyses were performed based on the assignment of the variables. The proportion of patients under 30 years old is much higher than other age groups. Compared to adults (≥ 20 years old), a higher proportion of adolescent patients (10-19 years old) choose orthodontics department for their first consultation (p < 0.01). And adolescent patients have a higher proportion of temporomandibular joint (TMJ) noise (p < 0.05) and a lower proportion of arthralgia (p < 0.001). Significant differences exist in CE severity between adolescents and adults (p < 0.001). The severe group had the youngest patients (p < 0.05) and the highest proportion of mandibular deviation and abnormal postural habits. Patients under 30 years of age constitute a significant proportion of TMJOA cases with CE. Compared to adults, adolescent patients have more severe CE and less arthralgia. Due to obvious dental and maxillofacial deformities and milder TMJ symptoms, adolescent patients may not be aware that they have TMJ disease, potentially leading to delayed treatment.

HE ROLE OF PHYSICAL THERAPY IN MANAGING SYMPTOMS OF TEMPOROMANDIBULAR JOINT DYSFUNCTION SECONDARY TO OSTEOARTHRITIS

The purpose of the study is to evaluate the effectiveness of the physical therapy in managing symptoms of temporomandibular joint dysfunction in patients with osteoarthritis. Materials and methods. 48 people with diagnosis of osteoarthritis of the temporomandibular joints were examined. In Group 1 (23 participants), correction involved wearing customized relieving splints. In addition to splint therapy, Group 2 received a course of physical therapy, which included therapeutic exercises targeting the masticatory muscles, facial muscles, tongue, and anterior neck muscles, as well as a course of transcutaneous electrical nerve stimulation (TENS) using the unipolar method on the masticatory and temporal muscles. The correction period for both groups was 1 month. Outcomes were evaluated using the Hamburg Test, the Helkimo Index, and the Jaw Functional Limitation Scale. Results. After the application of relaxing splints and the implementation of the physical therapy program, the total score of the "Hamburg test" decreased by 39.6% in group 1, and by 59.4% in group 2 (p&lt;0.05). The positive dynamics of the Helkimo index was 34.5% in group 1, 48.6% in group 2 (р&lt;0.05), passing within the parameters of moderate temporomandibular joint dysfunction. When re-evaluating the functional state of the temporomandibular region according to the Jaw Functional Limitation Scale, the improvement of chewing in group 1 was 28.8%, in group 2 – 62.3%, the mobility of the lower jaw was 21.9% and 44.3%, respectively, verbal and emotional communication – 26% and 41.7%, the total score – by 26.2% and 49.6%. The developed program of physical therapy against the background of wearing individual relief splints demonstrated a statistically significantly better effect (p&lt;0.05) on all the studied indicators of the functioning of the orofacial zone compared to the initial data and the results of the group that corrected the dysfunction of the temporomandibular joint with talc splints. Conclusion. Use the means of physical therapy can be recommended to increase the effectiveness of dental orthopedic correction in patients with osteoarthritis of the temporomandibular joint.

Adipose tissue-derived injectable products combined with platelet-rich plasma for the treatment of osteoarthritis: the promising preclinical results are not confirmed by the clinical evidence.

The association of adipose tissue-derived injectable products with platelet-rich plasma (PRP) has been promoted for osteoarthritis (OA) treatment. The aim of this study was to investigate the preclinical and clinical evidence supporting the potential of this combined approach to treat OA. A systematic review was performed in January 2024 on five databases (PubMed, Embase, Scopus, Cochrane, and Web-of-Science) to identify preclinical in vivo and clinical studies. Safety, OA biomarker changes, and outcomes in terms of clinical and imaging results were analyzed. The quality of studies was assessed with the SYRCLE's tool for preclinical studies and the Downs and Black checklist for clinical studies. Ten preclinical studies (223 animals) and 14 clinical studies (594 patients) were included. Preclinical results documented improvements at the cartilage histological and immunohistochemical evaluation and at the biomarkers level. Clinical studies confirmed the procedure's safety, and the case series suggested satisfactory results in different joints in terms of symptoms and function improvement, with positive findings at the biomarker level. However, the randomized controlled trials did not document any clinical benefit, nor any changes in the imaging analysis. A large heterogeneity and overall poor quality were documented in both preclinical and clinical studies. There is an increasing interest in the use of adipose tissue-derived injectable products associated with PRP for the treatment of OA joints, with preclinical studies showing promising results with this combined approach. However, clinical studies did not confirm the benefits offered by PRP augmentation to adipose tissue-derived injectable products in patients affected by OA.

Early Improvement in Postoperative Clinical Outcomes without Patellar Resurfacing in Patella-Friendly Design of Medial Pivot TKA.

There is continued debate about the efficacy and indications for patellar resurfacing in total knee arthroplasty (TKA), especially with the emergence of patella-friendly designs. This study aimed to compare the postoperative outcomes in patients undergoing TKA with or without patellar resurfacing using the same implant design. This is a retrospective cohort study of patients who underwent TKA including those with patellar resurfacing (PR group) and those without (NPR group). Demographic data included age, gender, side of surgery, operative time, and body mass index (BMI). Outcomes included preoperative, 2-week, 6-week, and 1-year postoperative Knee Injury and Osteoarthritis Outcome Score and Joint Replacement (KOOS, JR) values along with knee range of motion (ROM). Postoperative complications were recorded. The power analysis with a large effect size indicated that a minimum sample size of 54 was required for Student's t-test and 34 for the paired t-test. A total of 90 medial pivot (MP) TKA were included in this study. There were 30 knees in the PR group and 60 in the NPR group. There was no significant difference between the groups for all demographic data, preoperative and postoperative ROM, and KOOS, JR values at all time points (p > 0.05 for all variables). The KOOS, JR significantly improved in the NPR groups at 2 weeks, 6 weeks, and 1 year postoperatively when compared with the preoperative score and at 6 weeks and 1 year postoperatively in the PR group (p < 0.01). No revisions related to the patellofemoral joint were observed in patients initially undergoing patellar resurfacing. One patient in the NPR group required secondary patellar resurfacing. The patella-friendly MP TKA yielded favorable postoperative outcomes, with or without patellar resurfacing. Improvements in KOOS, JR were observed earlier in the NPR group when compared with the PR group, suggesting that patellar resurfacing may not always be necessary for modern TKA designs. LEVEL OF EVIDENCE: Retrospective cohort study, Level III.

Population-based in silico modeling of anatomical shape variation of the knee and its impact on joint loading in knee osteoarthritis.

Anatomical knee joint features and osteoarthritis (OA) severity are associated, however confirming causals link to altered knee loading is challenging. This study leverages statistical shape models (SSM) to investigate the relationship between joint shape/alignment and knee loading during gait in knee OA(KOA) patients to understand their contribution to elevated medial knee loading in OA. Musculoskeletal (MSK) models were created for the mean as well as the first eightSSM principal modes of variation (-3,-2,-1, +1, +2, +3 standard deviations for each mode) and used as input to a MSK modeling framework. Using an identical KOA gait pattern (i.e., joint kinematics and ground reaction forces), we ran simulations for each MSK model and evaluated medial compartment loading magnitude and contact distribution at the instant of first and second peak of knee joint loading. An increase in external rotation, posterior tibia translation and a decrease in medial joint space and medial femoral condylar size predisposed the medial compartment knee joint to overloading during gait. This was coupled with an anterior and medial shift in contact location with increasing external rotated tibial position and increasing posterior tibial translation with respect to the femur. Next, results also highlighted a posterior shift of the medial compartment loading location with decreasing medial joint space. This study provides important population-based insights on how knee shape and alignment predispose individuals with KOA to elevated medial compartmental knee loading. This information can be crucial in assessing the risk for medial KOA development and progression.

AI and radiologist assessments on the prevalence of TMJ osteoarthritis using radiographic images: A comparative study

Objectives: This study aims to address the significant discomfort and functional impairment associated with temporomandibular joint osteoarthritis (TMJ OA), which negatively impacts the quality of life. It emphasizes the importance of prompt diagnosis and explores the potential of an Artificial Intelligence (AI) system to enhance TMJ OA diagnosis. Methods: The prevalence of TMJ OA was evaluated using 3 diagnostic tools: the gold standard, the AI model, and an examiner. In total, 132 patients who performed 190 cone-beam computed tomography (CBCT) images were included. Results: The prevalence of TMJ OA was 62.11% using the gold standard, 63.68% using the AI model, and 58.42% when assessed by the examiner. No gender variation in TMJ OA diagnosis was reported (p-value&gt;0.05). Age variations were reported with the gold standard and the examiner diagnosis. When compared to the gold standard, the AI model had remarkable sensitivity (97.46%) and specificity (91.67%). Conclusions: The AI model shows promise in enhancing the accuracy of TMJ OA diagnosis, offering potential benefits for early detection and improved patient outcomes.

Early signs of osteoarthritis in differing rat osteochondral defects.

Preclinical models of osteochondral defects (OCDs) are fundamental test beds to evaluate treatment modalities before clinical translation. To increase the rigor and reproducibility of translational science for a robust "go or no-go," we evaluated disease progression and pain phenotypes within the whole joint for two OCD rat models with same defect size (1.5x 0.8 mm) placed either in the trochlea or medial condyle of femur. Remarkably, we only found subtle transitory changes to gaits of rats with trochlear defect without any discernible effect to allodynia. At 8-weeks post-surgery, anatomical evaluations of joint showed early signs of osteoarthritis with EPIC-microCT. For the trochlear defect, cartilage attenuation was increased in trochlear, medial, and lateral compartments of the femur. For condylar defect, increased cartilage attenuation was isolated to the medial condyle of the femur. Further, the medial ossicle showed signs of deterioration as indicated with decreased bone mineral density and increased bone surface area to volume ratio. Thus, OCD in a weight-bearing region of the femur gave rise to more advanced osteoarthritis phenotype within a unilateral joint compartment. Subchondral bone remodeling was evident in both models without any indication of closure of the articular cartilage surface. We conclude that rat OCD, placed in the trochlear or condylar region of the femur, leads to differing severity of osteoarthritis progression. As found herein, repair of the defect with fibrous tissue and subchondral bone is insufficient to alleviate onset of osteoarthritis. Future therapies using rat OCD model should address joint osteoarthritis in addition to repair itself.

Why is therapeutic exercise the best treatment for knee osteoarthritis?

Osteoarthritis (OA) of the knee joints (KJ) has a high social significance and is therefore a relevant pathology for scientific research. The authors have proposed an original hydraulic theory for the pathogenesis of OA in KJ. This approach is based on the notion of primary mechanical damage to the internal ligamentous structures and synovial membrane accompanied by posttraumatic edema, synovial hypervolemia, and hypertension. The authors demonstrated that regular physical activity at all stages of the disease is pathogenetically justified and allows the patient to improve lymphatic and venous outflow and thus resist increasing fibrosis. Improved arterial blood flow will reduce tissue hypoxia. Any type of symptom-modifying therapy can be harmful because it reduces the protective role of pain reflexes in protecting the KJ from excessive loads, leading to injury. The necessity of maintaining a walking speed of more than 4.3 km/h with an increase in cadence is emphasized from the perspective of reducing static stress during walking and extending life expectancy.

The Role of Cartilage Tissue Engineering in Osteoarthritis Treatment: The Bench to Bedside Translation

ABSTRACTCartilage tissue engineering holds huge promise for joint defects and osteoarthritis (OA) conditions which otherwise have limited treatment options due to cartilage's inherent inability to self‐repair. Chemical cues play a pivotal role in regulating chondrocyte behavior and matrix synthesis. Strategies utilizing growth factors, small molecules, and biomaterial‐based delivery systems aim to modulate chondrogenic differentiation, proliferation, and matrix deposition, while recent insights emphasize the significance of mimicking native tissue gradients for optimal regeneration outcomes. Mechanical stimuli profoundly influence chondrocyte phenotype and function, necessitating precise control of the mechanical microenvironment in tissue engineering strategies. Advances in biomaterial design, scaffold fabrication, and bioreactor systems facilitate the tailored modulation of mechanical cues, including substrate stiffness, topography, and dynamic loading regimes. This review showcases the latest advancements in engineering both the chemical and mechanical microenvironment to enhance chondrocyte regeneration. Furthermore, exploring the synergistic effects of combining chemical and mechanical cues underscores the importance of multifaceted approaches in promoting robust chondrocyte regeneration. The review also addresses challenges and future directions in the field, such as achieving spatially organized tissue architecture and integrating patient‐specific factors, to propel advancements in cartilage tissue engineering. We also conducted a comprehensive enlistment for the clinical trials and tissue engineering‐based marketed products for OA therapy.

Targeting long non-coding RNA H19 in Subchondral Bone Osteocytes Alleviates Cartilage Degradation in Osteoarthritis.

Emerging evidence suggests long non-coding RNA (lncRNA) H19 is associated with osteoarthritis (OA) pathology. However, how H19 contributes to OA has not been reported. This study aims to investigate the biological function of H19 in OA subchondral bone remodeling and OA progression. Clinical joint samples and OA animal models induced by medial meniscus destabilization (DMM) surgery were used to verify the causal relationship between osteocyte H19 and OA subchondral bone and cartilage changes. MLO-Y4 osteocyte cells subjected to fluid shear stress were used to verify the mechanism underlying H19-mediated mechano-response. Finally, the antisense oligonucleotide (ASO) against H19 was delivered to mice knee joints by magnetic metal-organic framework (MMOF) nanoparticles in order to develop a site-specific delivery method for targeting osteocyte H19 for OA treatment. Both clinical OA subchondral bone and wildtype mice with DMM-induced OA exhibit aberrant higher subchondral bone mass with more H19 expressing osteocytes. On the contrary, osteocyte-specific deletion of H19 mice is less vulnerable to DMM-induced OA phenotype. In MLO-Y4 cells, H19-mediated osteocyte mechano-response through PI3K/AKT/GSK3 signals activation by EZH2-induced H3K27me3 regulation on PP2A inhibition. Targeted inhibition of H19 (using ASO-loaded MMOF) substantially alleviates subchondral bone remodeling and OA phenotype. In summary, our results provide new evidence that the elevated H19 expression in osteocytes may contribute to aberrant subchondral bone remodeling and OA progression. H19 appears to be required for the osteocyte response to mechanical stimulation, and targeting H19 represents a new promising approach for OA treatment.

FTO in oral diseases: Functions, mechanisms, and therapeutic potential.

Fat mass and obesity-associated protein (FTO) is the first identified N6-methyladenosine (m6A) demethylase widely distributed in various tissues in adults and children. It plays an essential role in diverse mRNA-associated processes including transcriptional stability, selective splicing, mRNA translocation, and also protein translation. Recently, emerging studies have shown that FTO is involved in the genesis and development of oral diseases. However, the correlation between FTO and oral diseases and its specific regulatory mechanism still needs further study. In this review, we will summarize the discovery, distribution, gene expression, protein structure, biological functions, inhibitors, and quantifying methods of FTO, as well as its regulatory role and mechanism in oral diseases. Notably, FTO genetic variants are strongly associated with periodontal diseases (PDs), temporomandibular joint osteoarthritis (TMJOA), and obstructive sleep apnea (OSA). Besides, the latest studies that describe the relationship between FTO and PDs, head and neck squamous cell carcinoma (HNSCCs), TMJOA, and OSA will be discussed. We elaborate on the regulatory roles of FTO in PDs, HNSCCs, and TMJOA, which are modulated through cell proliferation, cell migration, apoptosis, bone metabolism, and immune response. The review will enrich our understanding of RNA epigenetic modifications in oral diseases and present a solid theoretical foundation for FTO to serve as a novel diagnosis and prognostic biomarker for oral diseases.

Automatic detection of temporomandibular joint osteoarthritis radiographic features using deep learning artificial intelligence. A Diagnostic accuracy study

ObjectiveThe purpose of this study was to investigate the diagnostic performance of a neural network Artificial Intelligence model for the radiographic confirmation of Temporomandibular Joint Osteoarthritis in reference to an experienced radiologist. Materials and MethodsThe diagnostic performance of an AI model in identifying radiographic features in patients with TMJ-OA was evaluated in a diagnostic accuracy cohort study. Adult patients elected for radiographic examination by the Diagnostic Criteria for Temporomandibular Disorders decision tree were included. Cone-beam computed Tomography images were evaluated by object detection YOLO deep learning model. The diagnostic performance was verified against examiner radiographic evaluation. ResultsThe differences between the AI model and examiner were non-significant statistically, except in the subcortical cyst (P=0.049*). AI model showed substantial to near-perfect levels of agreement when compared to those of the examiner data. Regarding each radiographic phenotype, the AI model reported favorable sensitivity, specificity, accuracy, and highly statistically significant Receiver Operating Characteristic (ROC) analysis (p < 0.001). Area Under Curve ranged from 0.872, for surface erosion, to 0.911 for subcortical cyst. ConclusionAI object detection model could open the horizon for a valid, automated, and convenient modality for TMJ-OA radiographic confirmation and radiomic features identification with a significant diagnostic power.

Walking biomechanics in women with patellofemoral osteoarthritis differ compared to men with and women without patellofemoral osteoarthritis

BackgroundDifferences in walking biomechanics between women and men with patellofemoral joint (PF) osteoarthritis (OA) may contribute to the development or progression of persistent symptoms in people with PFJ OA. ObjectiveEvaluate how walking biomechanics of women with PF OA differ from: (i) men with PFJ OA; and (ii) women without PF OA. Second, explore the relationship between knee-related symptoms/function and walking biomechanics in individuals with PF OA, and whether these are modified by sex. MethodsSixty-seven individuals with PF OA (43 women) and 14 women without PF OA were included. Biomechanics data were recorded during walking. Patient-reported symptoms and function were obtained using the Knee injury and Osteoarthritis Outcome Score. Differences in continuous biomechanical data were assessed using statistical parametric mapping, with discrete data and relationships evaluated using linear models. ResultsWomen with PF OA walked with a greater hip adduction angle throughout stance (t > 2.757) and lower impulses for the hip flexion, knee flexion, and ankle dorsiflexion moments (adjusted mean differences [95 % CI]:3.3 × 10–2 [-4.9 × 10–2, -1.6 × 10–2], -2.9 × 10–2 [-5.3 × 10–2, -0.4 × 10–2], -5.1 × 10–2 [-8.2 × 10–2, -2.0 × 10–2] Nms/kg, respectively) compared to men with PF OA. Compared to their asymptomatic peers, women with PF OA displayed a 5° offset towards greater hip flexion. Higher knee adduction moment impulse correlated with worse KOOS-ADL scores in men, not women. ConclusionObserved biomechanical differences were small in nature with moderate to weak relationship observed with the KOOS. Findings were not limited to the knee, indicating that women with PF OA display unique biomechanical features across the kinetic-chain.

Alginate Use in Orthopedics and Peripheral Nerve Repair: A Systematic Review.

The use of alginate, a derivative of seaweed, has been proposed for multiple orthopedic indications. We aimed to review the current use of alginate in orthopedics and to focus on the future applications of alginate for peripheral nerve repair. A comprehensive literature search was performed to identify biomechanical, laboratory, animal, and human studies where alginate has been utilized for orthopedic or nerve repair indications. A systematic review of orthopedic indications was conducted for safety and efficacy, and a specific focus was placed on alginate for use in peripheral nerve repair and reconstruction. Thirty-two studies were identified. Alginate has a strong history and safety profile for usage in orthopedic surgery. Its primary usage has been for the repair of articular cartilage, although it has also been used for disc regeneration of the lumbar spine and for cushioning joints in osteoarthritis. The primary indication in peripheral nerve repair is to create an environment that encourages Schwann cell migration and repair in nerve injuries while blocking fibrotic scar tissue formation by inhibiting the activity of fibroblasts. Alginate hydrogel may serve as a potential conduit for nerve regeneration in nerve injuries with small to medium-sized gaps.

The interplay between osteoarthritis and osteoporosis: Mechanisms, implications, and treatment considerations – A narrative review

This comprehensive review examines the relationship between osteoarthritis (OA) and osteoporosis (OP), two common disorders in the elderly. OA involves joint cartilage degeneration and pain, while OP leads to fractures due to reduced bone mass. Despite different pathologies, both conditions share risk factors such as age and genetics. Studies reveal mixed results: some show higher bone mineral density (BMD) in OA patients, suggesting an inverse relationship, while others find no significant link. Proposed mechanisms include mechanical loading, bone remodeling, and inflammation. Clinical strategies focus on maintaining bone health in OA and monitoring joint health in OP, with treatments like bisphosphonates and exercise. Understanding these interactions is crucial for developing integrated treatments to improve patient outcomes and quality of life. Further research is needed to clarify these complex mechanisms.

Identification of potential immune-related genes and infiltrations in temporomandibular joint osteoarthritis

Objective: The aim of this study was to investigate the potential inflammatory cytokines and chemokines markers for temporomandibular joint osteoarthritis (TMJOA) diagnosis using a bioinformatics analysis. Methods: The differentially expressed genes of mRNA (DEGs) and transcripts of lncRNA (DETs) were identified between TMJOA samples and normal controls curated from GSE205389 by the “DESeq. 2” R package. KEGG and GO were conducted using the R package “ggplot2” and “clusterProfiler”. A PPI network was constructed to identify hub genes by using the STRING and Cytoscape. The co-expression network was constructed between mRNA and lncRNA to check the potential regulation and function of lncRNA on protein coding genes. Finally, the immune cell infiltration analysis was conducted with CIBERSORTx and confirmed with xCells. Results: We identified 171 DEGs and DETs, of which the DEGs were closely related to immune response, T cell activation, cytokine-cytokine-receptor interaction, and the muscle system process. PPI network of the DEGs screened the top 10 hub genes, including IL6, IL1B, IL10, CCL2, CCL5, CXCL1, CXCL10, ICAM1, CSF1 and MMP1. Additionally, the immune cell infiltration analysis showed that CD8+ T cells, M1 macrophage and B cells infiltration were increased in TMJOA samples. Finally, we demonstrated that the co-expression between mRNA and lncRNA was mainly enriched in inflammatory and muscle related pathways. Conclusions: We found that immune and muscle system related pathways as well as the immune infiltration played a significant role in the TMJOA development. Additionally, inflammatory cytokines and chemokines could be crucial markers for early-stage TMJOA diagnosis and personalized treatment strategies.

Arthrodesis of the Distal Interphalangeal Joint of the Finger Using an Intramedullary Implant

Osteoarthritis (OA) of the joints of the hand is one of the most common musculoskeletal disorders in the elderly population. It is a complex, degenerative disease affecting all components of the joint. Surgical treatment is indicated when conservative therapy fails. The ultimate solution is arthrodesis of the distal interphalangeal (DIP) joint. Various methods of arthrodesis have been described, ranging from the use of K-wires or compression screw to different types of intra-articular (intramedullary) implants. The aim of this study is to evaluate the surgical outcomes of arthrodesis of the distal interphalangeal (DIP) joint of the fingers using intramedullary implants. Since 2011, arthrodesis of the distal interphalangeal joint using an intramedullary implant has been performed at our department 97 times in total, in 59 patients. 9 patients (15 cases of arthrodesis) were excluded from the study group due to their failure to complete the questionnaire, 1 female patient died. In the final group, 82 cases of arthrodesis in 49 patients (47 women, 2 men) were evaluated. In 72% of cases, the surgery was performed on the dominant hand. The mean age at the time of surgery was 58 years (median 59 years). The patients were indicated for surgery after the failure of all conservative treatment options. In addition to radiographs, also the hand function and pain were assessed based on the preand postoperative DASH score questionnaires. The surgical outcomes for all implants are satisfactory. In all 82 patients, the surgical wounds healed per primam. In one case, implant extraction was performed due to infection. Another complication was an unhealed fusion and formation of a non-union with minimum pathological mobility (the patient is satisfied with the outcome). In three patients, a fracture at the base of the distal phalanx was observed on postoperative radiographs, which fully healed within 3 months after surgery. The mean DASH score decreased from 41.95 preoperatively to 14.93 postoperatively. The mean time to healing of the arthrodesis observed on radiographs was 9.1 weeks. Currently, there are many different types of arthrodesis of the distal interphalangeal joint of the hand. Each method has its pros and cons. Arthrodesis using an intramedullary implant has the advantages of the older methods while minimizing postoperative complications. Our results are comparable to those reported in the foreign literature. Based on the evaluated outcomes, arthrodesis of the distal interphalangeal joint using an intramedullary implant can be considered valid. It definitely deserves to be included in the portfolio of surgical treatment of osteoarthritis of the DIP joints of the hand. According to our observation, the differences between various types of implants are minimal and their outcomes are comparable to those reported in foreign publications. The pain relief, restored finger function and fusion rate are comparable to, if not better than, those achieved by the older surgical methods. The advantage of this method is mainly easier implantation, fewer complications, and the possibility of implantation without the use of an X-ray image intensifier, which ultimately reduces the cost of surgery. The main disadvantage is the higher purchase price of the implant. osteoarthritis, distal interphalangeal joint, arthrodesis.

Characterization of the single cell landscape in normal and osteoarthritic equine joints.

Osteoarthritis (OA) is a major source of pain and disability worldwide. Understanding of disease progression is evolving, but OA is increasingly thought to be a multifactorial disease in which the innate immune system plays a role in regulating and perpetuating low-grade inflammation. The aim of this study was to enhance our understanding of OA immunopathogenesis through characterization of the transcriptomic responses in OA joints, with the goal to facilitate the development of targeted therapies. Single-cell RNA sequencing (scRNA-seq) was completed on cells isolated from the synovial fluid of three normal and three OA equine joints. In addition to synovial fluid, scRNA-seq was also performed on synovium from one normal joint and one OA joint. Characterization of 28,639 cells isolated from normal and OA-affected equine synovial fluid revealed the composition to be entirely immune cells (CD45+) with 8 major populations and 26 subpopulations identified. In synovial fluid, we found myeloid cells (macrophage and dendritic cells) to be overrepresented and T cells (CD4 and CD8) to be underrepresented in OA relative to normal joints. Through subcluster and differential abundance analysis of T cells we further identified a relative overrepresentation of IL23R+ gamma-delta (γδ) T cells in OA-affected joints (a cell type we report to be enriched in gene signatures associated with T helper 17 mediated immunity). Analysis of an additional 17,690 cells (11 distinct cell type clusters) obtained from synovium of one horse led to the identification of an OA-associated reduction in the relative abundance of synovial macrophages, which contrasts with the increased relative abundance of macrophages in synovial fluid. Completion of cell-cell interaction analysis implicated myeloid cells in disease progression, suggesting that the myeloid-myeloid interactions were increased in OA-affected joints. Overall, this work provides key insights into the composition of equine synovial fluid and synovium in health and OA. The data generated in this study provides equine-specific cell type gene signatures which can be applied to future investigations. Furthermore, our analysis highlights the potential role of macrophages and IL23R+ γδ T cells in OA immunopathogenesis.