Joint Status Research Articles

Characterizing Osteophyte Formation in Knee Osteoarthritis: Application of Machine Learning Quantification of a Computerized Tomography Cohort: Implications for Treatment

BackgroundOsteophytes are commonly used to diagnose and guide knee osteoarthritis (OA) treatment, but their causes are unclear. Although they are not typically the focus of knee arthroplasty surgeons, they can predict case difficulty and length. Furthermore, their extent and location may yield much information about the knee joint status. The aims of this computed tomography–based study in patients awaiting total or partial knee arthroplasty were to: (1) measure osteophyte volume in anatomical subregions and relative change as total volume increases; (2) determine whether medial and/or lateral OA affects osteophyte distribution; and (3) explore relationships between osteophytes and OA severity. MethodsData were obtained from 4,928 computed tomography scans. Machine-learning-based imaging analyses enabled osteophyte segmentation and quantification, divided into anatomical regions. Mean three-dimensional joint space narrowing was assessed in medial and lateral compartments. A Bayesian model assessed the uniformity of osteophyte distribution. We correlated femoral osteophyte volumes with B-scores, a validated OA status measure. ResultsTotal tibial (25%) and femoral osteophyte volumes (75%) within each knee correlated strongly (R2 = 0.85). Medial osteophytes (65.3%) were larger than lateral osteophytes (34.6%), with similar proportions in both the femur and tibia. Osteophyte growth was found in all compartments, and as total osteophyte volume increased, the relative distribution of osteophytes between compartments did not markedly change. No evidence of variation was found in the regional distribution of osteophyte volume between knees with medial, lateral, both, or no three-dimensional joint space narrowing in the femur or tibia. There was a direct relationship between osteophyte volume and OA severity. ConclusionsOsteophyte volume increased in both medial and lateral compartments proportionally with total osteophyte volume, regardless of OA location. The peripheral position of femoral osteophytes does not appear to contribute to load-bearing. This suggests that osteophytic growth represents a ‘whole-knee’/global response. This work may have broad applications for knee OA, both surgically and nonoperatively.

EARLY RESULTS OF SHOULDER ARTHRODESIS WITH 3D-TITANIUM IMPLANTS FOR TREATMENT OF SEVERE GUNSHOT WOUNDS OF THE SHOULDER GIRDLE

As a result of large-scale war in Ukraine, the frequency of gunshot wounds of the upper extremities has increased dramatically, accompanied by massive damage to soft tissue, neurovascular plexuses, and significant bone deficiency, so their treatment with traditional methods is risky. This leads to the development of new treatment methods, in particular, techniques for shoulder arthrodesis. Objective. To investigate the effectiveness of shoulder arthrodesis using an individual 3D-titanium implant and or a locked compression plate (LCP) with bone autoplasty for the treatment of severe combat trauma of the upper extremity. Methods. In 2022–2023, 19 men aged 36.2 (24–52) years with severe combat trauma of the upper extremity underwent shoulder arthrodesis using individual 3D-titanium implants (n = 9) or LCP with bone autoplasty (n = 10). The follow-up period was 18 months. Individual 3D-implants were created in the CAD program Autodesk Fusion 360 and made of Ti6AI4V alloy by three- dimensional metal 3D-printing. The functional status of the shoulder joint was assessed by the Oxford Shoulder Score, VAS at 6 and 12 months after surgery. Fusion was checked radiographically at 1, 3, 6 and 12 months. Results. The average follow-up period was 12 months. Ankylosis of the shoulder joint was formed in 18 (95 %) patients, and clinical consolidation without final restructuring with a positive tendency to bone fusion was detected in one patient (5 %). Radiologically confirmed fusion in 8.5 months (6–12). After 12 months, a decrease in pain (VAS: 5 to 1 points; p < 0.001) and improvement in the condition of the shoulder (Oxford Shoulder Score: 25 to 40 points, p < 0.001) were found compared with 6 months. Conclusions. Treatment of severe combat trauma of the upper extremity by shoulder arthrodesis allows to eliminate pain and restore sufficient function to perform daily tasks one year after surgery. The combination of shoulder arthrodesis with individual 3D-implants resulted in the restoration of upper limb function in all 9 patients with massive bone and muscle defects.

A post hoc comparative real-world analysis of HEAD-US score for joint health assessment of patients with severe haemophilia A and B in Spain.

Joint damage due to haemarthrosis can be effectively monitored with point-of care ultrasound using the Haemophilia Early Arthropathy Detection with US (HEAD-US) scoring system. A post hoc comparative analysis of the joint status of patients with severe haemophilia A (HA) or B (HB) was performed. The databases of two observational, cross-sectional studies that recruited patients with HA or HB from 12 Spanish centres were analysed to compare the status of the elbows, knees and ankles in patients with severe disease according to treatment modality. The HEAD-US score was calculated in both studies by the same trained operators. Overall, 95 HA and 41 HB severe patients were included, with a mean age of 35.2±11.8 and 32.7±14.2 years, respectively. The percentage of patients who received prophylaxis, over on-demand (OD) treatment, was much higher in HA (91.6%) than in HB (65.8%) patients. With a similar number of target joints, the HEAD-US score was zero in 6.3% HA and 22.0% HB patients (p<.01), respectively. The HA population showed significantly worse HEAD-US scores. Whilst osteochondral damage occurred more frequently in patients OD or tertiary prophylaxis, our data suggest that articular damage is less prominent in primary/secondary prophylaxis, regardless of the type of haemophilia. These latter treatment modalities were also associated with a lower prevalence of synovial hypertrophy, particularly in HB patients. This post hoc analysis indicates that joint status seems to be significantly influenced by haemophilia type (HA or HB) and treatment modality in these severe Spanish populations with severe disease. Continuing HEAD-US monitoring for the early detection and management of intra-articular abnormalities, as well as more efficiently tailored therapies should be warranted.

Sanmiao wan alleviates inflammation and exhibits hypouricemic effect in an acute gouty arthritis rat model

Ethnopharmacological relevanceSanmiao wan (SMW), a classical traditional Chinese medicine (TCM) formula, has been employed to treat gouty diseases in clinic as early as Yuan dynasty. It shows remarkably therapeutic effects in acute gouty arthritis (GA). However, the potential mechanisms of SMW are still not fully revealed. Aim of the studyThe objective of this project is to evaluate the pharmacological effects and possible mechanisms of SMW in a rat model of acute GA. Materials and methodsMonosodium urate (MSU) suspension was injected into the ankle joint of rats to establish acute GA model. The inflammation was evaluated by measuring the posterior ankle diameter. The pathological status of synovial tissue was assessed by hematoxylin eosin (HE), Masson, and picrosirius red staining. The level of IL-6 was measured using ELISA kit. The levels of blood urea nitrogen (BUN), creatinine (CR), UA (uric acid), and xanthine oxidase (XOD) in the serum were measured using standard diagnostic kits. The percentage of Th17 cells in blood samples was performed using flow cytometry. Moreover, RT-qPCR was performed to examine the mRNA level of RANK, RORγt, RANKL, and STAT3 in the synovial tissue. Furthermore, immunofluorescence was carried out to assess the expression of STAT3 in the synovial tissue. ResultsSMW effectively alleviated the inflammation and improved the pathological status of the ankle joint in rats with acute GA. It significantly suppressed the release of proinflammatory cytokine (IL-6). Meanwhile, the levels of UA, BUN, and CR were markedly reduced after SMW treatment. A remarkable reduction of XOD activity was observed in the study. Importantly, SMW treatment significantly reduced the frequency of Th17 cells, decreased the mRNA levels of RANK, RORγt, RANKL, and STAT3 in the synovial tissue. Furthermore, the suppression of STAT3 was also demonstrated using immunofluorescence in SMW-treated group. ConclusionSMW showed significant anti-inflammatory and hypouricemic effects in a rat model of GA. It is an effective TCM formula for GA therapy.

Complications of Patients Who Underwent Total Hip Replacement Surgery According to Their Severity, Type, And Ct Findings

Background: Total hip replacement surgery can be defined as the most performed and successful surgeries in recent times. The use of computed tomography technology has greatly improved the accuracy of determining the condition of the hip joint. Objective: This study was aimed to determine and assess the complications and CT scan outcomes related to patients with total hip replacement surgery. Patients and methods: A cross-sectional study was conducted which occurred in different hospitals in Iraq, recruiting 106 patients who had undergone total hip replacement surgery through February 8th, 2022, and August 16th, 2023. Clinical data were collected into patients who diagnosed under CT imaging where it was determined the status of the hip joint. The clinical and demographic characteristics were determined into male and female patients aged between 20 and over 50. Postoperative complications were diagnosed using CT scans.&#x0D; Additionally, this study was assessed the pain levels of patients through ten days after total hip surgery by (NRS) scale, which ranged between (0 – 10) where 0 can indicate no pain while 10 can indicate severe pain. Results: clinical results can indicate that most of the patients (41) with total hip replacement surgery were over 50 years old. The number of male patients was higher than that of female patients, with 70 and 36 patients, respectively. Osteoporosis was present in 34 patients, while fractures or dislocations of the hip joint were observed in 28 patients. In this study, 51.89% of participants were smokers. The most common symptoms reported were stiffness (27 cases), pain (20 cases), and limping (24 cases). The most prevalent concomitant diseases were hypertension (42 patients) and diabetes (32 patients). The study found that the most common complications after surgery, as recorded by a CT scan, were infections (5 cases), blood clots (3 cases), and bleeding (3 cases), with a mortality rate of only 4 cases. Pain scores of patients were assessed within ten days after surgery, and the success of the surgery technique in controlling patients was examined. The study concluded that the NRS scale reached a score of 1 in the last few days. Conclusions: This study demonstrates the effectiveness of total hip replacement surgery in improving patients' quality of life, as determined by their ability to move with better performance, lower pain levels, and fewer complications associated with the surgery, as shown by CT scans.

Сравнение эффективности внутрисуставного введения препаратов гиалуроновой кислоты с разной кратностью введения после артроскопических операций на коленном суставе

This study was conducted to evaluate the efficacy of various hyaluronic acid (HA) preparations in patients with knee joint injuries in the postoperative period after knee arthroscopy. Ninety patients with grade I–II gonarthrosis and concomitant meniscus damage who underwent knee arthroscopy were included in the study. Patients were divided into three groups of 30 patients: in the 1st group no HA preparations were administered, in the 2nd group threefold administration of HA with the concentration of 1.6% was performed with the volume of 2 ml, in the 3rd group a single injection of HA with the concentration of 2.2% mixed with mannitol was performed with the total volume of 5 ml. After 1, 6 and 12 months, the dynamics of the mean score on the visual analog scale (VAS) of pain, WOMAC index and Leken's algo-functional index were evaluated. According to the results of observation after 6 and 12 months, the most pronounced dynamics of pain syndrome intensity reduction was observed in groups 2 and 3, where HA preparations were administered after knee arthroscopy. No statistically significant differences in the efficacy of the compared HA preparations were found. According to the results of observation after 6 and 12 months, the most pronounced dynamics of pain syndrome intensity reduction was observed in groups 2 and 3, where HA preparations were used after knee arthroscopy. No statistically significant differences in the efficacy of the compared HA preparations were revealed. HA administration after arthroscopic lavage causes persistent regression of pain syndrome and improvement of functional status of the knee joint.

The Effect of Different Degrees of Ankle Dorsiflexion Restriction on the Biomechanics of the Lower Extremity in Stop‐Jumping

Purpose. The functional status of the ankle joint is critical during dynamic movements in high‐intensity sports like basketball and volleyball, particularly when performing actions such as stopping jumps. Limited ankle dorsiflexion is associated with increased injury risk and biomechanical changes during stop‐jump tasks. Therefore, this study aims to investigate how restricting ankle dorsiflexion affects lower extremity biomechanics during the stop‐jump phase, with a focus on the adaptive changes that occur in response to this restriction. Initially, 18 participants during stop‐jumping with no wedge plate (NW), 10° wedge plate (10 W), and 20° wedge plate (20 W) using dominant leg data were collected to explore the relationship between limiting ankle mobility and lower extremity biomechanics. Following this, a musculoskeletal model was developed to simulate and calculate biomechanical data. Finally, one‐dimensional parametric statistical mapping (SPM1D) was utilized to evaluate between‐group variation in outcome variables using a one‐way repeated measures analysis of variance (ANOVA). Results. As the ankle restriction angle increased, knee external rotation angles, knee extension angular velocities, hip extension angle, and angular velocity increased and were significantly different at different ankle restriction angles (p &lt; 0.001 and p = 0.001), coactivation of the peripatellar muscles (BF/RF and BF/VM) increased progressively, and patellofemoral joint contact force (PTF) increased progressively during the 3%–8% phase (p = 0.015). These results highlight the influence of ankle joint restriction on lower limb kinematics and patellofemoral joint loading during the stop‐jump maneuver. Conclusion. As the angle of ankle restriction increased, there was an increase in coactivation of the peripatellar muscles and an increase in PTF, possibly because a person is unable to adequately adjust their body for balance when the ankle valgus angle is restricted. The increased coactivation of the peripatellar muscles and increased patellofemoral contact force may be a compensatory response to the body’s adaptation to balance adjustments.

Midterm Results after Tibiotalar or Tibiotalocalcaneal Fusion Using an Ilizarov External Fixator.

Ankle fusion is considered a treatment of choice for end-stage ankle arthritis when a total ankle replacement procedure is not indicated. However, the potential risk of secondary arthritis in the adjacent joint after ankle fusion raises arguments on whether preserving the adjacent joint during an isolated tibiotalar (TT) fusion brings about any future benefits with regard to pain and gait discomfort. In this study, we intended to present midterm results following TT or tibiotalocalcaneal (TTC) fusion using an Ilizarov external fixator and to investigate whether spontaneous fusion occurred in the subtalar or midtarsal joint. This is a retrospective observational study. Medical records of patients who underwent TT or TTC fusion using an Ilizarov external fixator for substantial bone defects around the ankle joint between 1994 and 2018 were manually searched. Forty-one patients were included and the status of the joints adjacent to the fusion site was evaluated in radiographic examinations. Of the 34 patients who underwent TT fusion, 30 patients (88.3%) had a spontaneous fusion in the adjacent joints. Specifically, 11 patients (29.4%) had subtalar joint fusion and 19 patients (55.9%) had both midtarsal joint and subtalar joint fusion. In TTC fusion, the midtarsal joint was spontaneously fused in all 7 patients. In this study, we observed spontaneous adjacent joint fusion following TT or TTC fusion using an Ilizarov external fixator for substantial bone defects around the ankle joint. Although a careful approach should be made since patients treated in this study may not represent typical candidates that need primary joint-sacrificing procedures, we believe that this study may draw attention from surgeons concerned about the fate of the adjacent joint status after TT or TTC fusion.

The Correlation of Muscle Mass and Walking Distance with Joint Health and Functional Status in Hemophilic Arthropathy Among People with Hemophilia a (PwHA)

Introduction: Hemophilic arthropathy resulting from repeat joint bleeding is a common complication for people with hemophilia (PWH), despite the current prophylaxis therapy. Monitoring the status of musculoskeletal health for PWH is necessary. Muscle plays a critical role in maintaining and promoting the joint health. Muscle atrophy is one of the key features of haemophilic arthropathy. Up to date, there are more studies focusing on joint health of PWH but few having attention on the impact of limbs muscles on joint status of PWH. Clinical assessments such as muscle circumference and manual muscle strength tests fail to detect subtle muscle changes. The study aimed to evaluate the ultrasound measurement of muscle thickness in people with hemophilia A (PwHA) and its correlation to joint health and functional impairments. Methods and Materials: In the observational cross-sectional study, 29 PwHA (median age 35 years; range 13-63) were enrolled, including 27 severe-type diseases on prophylaxis therapy and 2 moderate-type diseases on episodic treatment. Muscle thickness of quadriceps and medial gastrocnemius were measured by ultrasound. Joint health and functional capacity were assessed using Haemophilia Joint Health Score (HJHS), Haemophilia Early Arthropathy Detection with Ultrasound (HEAD-US), Haemophilia Quality of Life Questionnaire for Adults (Haemo-A-QoL), and Haemophilia Activities List (HAL). 6-Minute Walking Test (6MWT) for global functional evaluation. Results: At the time when the 29 patients receiving this survey of joint health, there were 28 on rFVIIIFc treatment for an average of 31.2 months (mean: 33.5, range 19.5－43), among whom 26 severe-type patients had rFVIIIFc prophylaxis and 2 moderate-type patients had on-demand therapy with rFVIIIFc. Only one severe-type patient had received non-rFVIIFc product prophylaxis for &amp;gt; 3 years. Totally 174 joints were examined. By correlation analysis, a significant correlation was found between both quadriceps and calf muscle thickness and the HJHS knee and ankle scores, respectively, with a negative correlation ( r= -0.45, p=0.015*, right quadriceps; r= -0.60, p&amp;lt;0.001***, left quadriceps; r= -0.39, p=0.039*, right calf; r= -0.58, p&amp;lt;0.001***, left calf). A significant correlation between muscle thickness and HEAD-US was observed between quadriceps muscle and knee score, with a negative correlation ( r= -0.56, p=0.017*, right quadriceps; r= -0.36, p=0.0048**, left quadriceps). Therefore, Quadriceps muscle thickness significantly correlated with HJHS knee, HEAD-US knee, and HAL. Calf muscle thickness significantly correlated with the HJHS ankle. After adjusted age and BMI, calf muscle thickness was significantly associated with the HJHS ankle. Muscle thickness was also observed to correlate with Haem-A-QoL and HAL. 6MWT was found to significantly correlated with HJHS total, HEAD-US total, Haem-A-QoL, and HAL ( r= -0.42, p=0.0231*, HJHS; r= -0.52, p=0.0037**, HEAD-US; r= -0.60, p&amp;lt;0.0001***, Haem-A-QoL; r= 0.64, p&amp;lt;0.001***, HAL). Conclusion: For the first time, limbs muscle thickness and the distance of 6MWT were linked to assessment of joint health, quality of life and activity participation in PwHA. Ultrasound measurement of muscle thickness appears to be a reliable tool for the assessment of muscle mass in PwHA.The 6MWT also appears to be useful tool for assessment of physical capacity and endurance in PwHA. Disclosures: No relevant conflicts of interest to declare.

Physical Activity, Bleedings and Quality of Life in Patients with Haemophilia a without Inhibitors - a Multicenter, Observational Italian Study with a Wearable Device

Introduction: Haemophilia A (HA) is characterized by spontaneous or traumatic recurrent bleedings, especially in joints and muscles, which can cause haemophilic arthropathy, impaired function, and in turn, reduce physical and social activities and negatively impact the quality of life (Franchini M at al., Semin Thromb Hemost, 2022 Nov; Mannucci PM et al., N Engl J Med, 2001 Jun). Despite regular physical activity (PA) being strongly recommended by guidelines as a key element to improve well-being and mental health, the perception of an associated increased risk of bleeding and bleed-related issues discourage people with hemophilia A (PWHA) (Makris M at al, Haemophilia, 2013 Jan; Matlary RED at al., Haemophilia, 2022 Nov; Srivastava A et al., Haemophilia, 2020 Aug 1) Methods: This cohort study (NCT04165135 - POWER) is a multicenter study conducted in 18 investigational Italian sites aimed at gathering data on activity status, bleeding, QoL, and health status, through the use of a wearable device and an ePRO app, in individuals with moderate or severe HA without inhibitors receiving standard of care (SoC) treatment. This population was observed for 12 months or up to 18 months if the therapy with a newly approved product was initiated during the study. The study started in January 2020 and has been completed in April 2022 with the last data collection. Results: A total of 103 male patients represented the Intention To Treat Population (ITT). Of them, 97 (94.2%) had severe (FVIII &amp;lt;1%) and 6 (5.8%) moderate (FVIII 1-2%) HA without inhibitors. They were aged 12-50 years (17, 16.5% aged 12-17 years [adolescents]; 46, 44.7% aged 18-30 years [young], and 40, 38.8% aged 31-50 years [adults]); 21 subjects switched to a newly approved agent for HA during the study and were followed for additional six months after the switch. Eighty-eight (85%) completed the study. The primary outcome measures included the duration and type of PA, distance covered, calories burned, body weight, heart rate, sleep data, active minutes, metabolic equivalents for tasks (METs), and step counts. The secondary measurements included the documentation of PA by type and intensity, the description of the population in terms of adherence to WHO Guidelines, disease severity, and treatment regimen for HA, health status, joint health status, and BMI. PA data were collected continuously through a fitness tracker worn by the patient. HRQoL questionnaires, joint health assessments, intensity of pain and bleeding episodes were recorded by the patient through an ePRO app (Petracca F. at al., JMIR Form Res 2021) Only 54/103 subjects (52.4%), which represented the Evaluable Population (EVL), were using the fitness tracker for at least 10 hours in 50% of their days for a period of at least 6 months in the study; adolescents were the least compliant age group. The fitness tracker's analysis of the type of activity collected showed low weekly rates for all activities (no differences in the different physical activities). High-intensity physical activities were poorly represented in all the subgroups. Approximately 51% of the subjects (including all adolescents) had sedentary behavior (Figure1). The mean METs per day were lower in adults. The EQ-5D utility score did not change during the observational period. The mean EQ-5D VAS progressively worsened, indicating a situation of discomfort and pain during the study. The results of HRQoL showed that a sedentary condition was associated with a worse quality of life, a higher risk of hospitalization, and a worse joint status compared to active patients. At least one bleeding (mean 2.9; median 2.0) was reported in 43.7% of the subjects (Figure 2), with a higher proportion in sedentary than active subjects. The physical activity in the 2 days preceding the bleeding was comparable to the one observed in the overall observational period. Adherence to the treatment regimen was quite poor overall (mean 55%) and only 26.2% of the subjects had an adherence ≥ 80%. Conclusion: The results from this study show that patients with HA without inhibitors have a lower-than-expected physical activity. Despite the poor PA, around half of the subjects reported bleeds, especially in the sedentary population. This suggests that other causes than PA, such as treatment adherence and type of treatment, might affect the number, frequency, and severity of bleedings. This study has been sponsored and financially supported by Roche Italy.

Physicochemical and Cytological Analysis of Synovial Fluid in Young and Adult Dogs

Background: Synovial fluid is a complex viscous fluid which provides lubrication to the articulating joints to avoid friction and wearing of cartilages. It is also an indicator of health status of joint, but a comparison of its composition between young and adult dogs is lacking. Methods: Present study was conducted to evaluate physical, biochemical and cytological analysis of synovial fluid in apparently healthy stifle joint of young and adult non-descript dogs. Twelve non-descript dogs irrespective of sex were divided into two groups (6 dogs in each group) i.e., group I (2-8 months of age) and group II (1-8 years of age). Dogs died in the OPDs of Veterinary Clinical Complex, Jabalpur were acquired with the consent of pet parent. The duration of study was one year, i.e., from September 2021 to August 2022. Immediately after collection of synovial fluid; volume, colour, viscosity, pH, specific gravity and refractive index were recorded, smear on slides were prepared. Protein and glucose were estimated within one hour using biochemical semi-autoanalyzer. Result: Volume of fluid collected in a single attempt varied from one drop to 0.5 ml. Mean pH values in group I and II were 7.33±0.17 and 7.67±0.25 respectively. Mean values of refractive index and specific gravity were 1.34 and 1.02 respectively in both the groups. Observations of mucin clot test of synovial fluid in group I and II exhibited a tight ropy clot in a clear solution. Turbidity was not observed in any case. Mean protein concentration was 1.29±0.18 g/dl and 2.74±0.84 g/dl in group I and II respectively. The concentration of glucose in group I and II was 102.79±3.66 mg/dl and 105.47±4.19 mg/dl respectively, that was around normal blood plasma level. Cytological observation revealed 1-3 cells per field at 1000x magnification. Mean neutrophil count in both the groups was about 6% of total nucleated cell count. Small mononuclear cells and large mononuclear cells were 19±3.79, 74.33±4.24 and 12.17±2.33, 81.83±2.54 in group I and II respectively. Biochemically and cytologically no significant difference was observed between the group I and II. Vacuolated large mononuclear cells contributed about 6-6.5% of total large mononuclear cells in both the groups. No significant difference was observed in most physical and biochemical parameters of synovial fluid in young and adult dogs, except a higher concentration of protein content in adults.

The Principles of Knee Joint Preservation

The 3 primary factors involved with preservation of the knee joint include joint alignment, meniscal status, and ligament stability (in particular that of the anterior cruciate ligament [ACL]). These factors are interdependent and result in knee joint homeostasis when all factors are stable. When a deficiency exists in one of the factors, it will affect the others. For example, the ACL and posterior horn of the medial meniscus both act as restraints to anterior tibial translation. Thus, medial meniscal deficiency increases the risk for failure of ACL reconstruction, and chronic ACL insufficiency increases the risk for medial meniscus tears. Furthermore, all 3 of the factors of joint preservation have an impact on the articular cartilage status of the knee joint. Studies have shown that cartilage-preservation procedures do not result in optimal outcomes if there is joint malalignment, meniscal deficiency, or ligament deficiency. When evaluating patients with knee cartilage pathology, surgeons should be aware of the various factors involved in knee joint preservation and, if surgery is indicated, all factors should be addressed in order to support a successful result.

Changes in Health-Related Quality of Life, Pain and Functional Parameters in People with Hemophilia and People with Osteoarthritis - a Comparative Follow-up of Physiotherapeutic Training (Physio-FUN Study)

Background: Spontaneous joint bleeding is common in people with hemophilia (PWH). These bleeds lead to reduced physical activity and thus to a weakening of the musculature. Common sequelae of this are synovitis and cartilage damage. In the long term, secondary osteoarthritis, so-called hemophilic arthropathy, occurs with changes and progressive destruction of joint structures (Lafeber et al., 2008). Hemophilic arthropathy is age-independent and can lead to severe movement restrictions and significant limitations in health-related quality of life (HRQoL) of affected PWH (Varaklioti et al., 2018). To prevent advanced stages of arthropathy not only regular assessment of musculoskeletal status and early detection of symptoms, but also daily rehabilitation exercises at home, and implementation of appropriate physiotherapy and medical training are important (Bossard et al., 2008). Home exercises and manual therapy can be used without causing bleeding or pain to improve pain, HRQoL and functionality (Tat et al., 2021). The primary aim of the Physio-FUN study was to assess the subjective (Hemophilia Exercise Project Test-Questionnaire [HEP-Test-Q]) and objective physical functioning (Hemophilia Joint Health Score [HJHS]) during the course of 1-year applied physiotherapy comparing PWH with arthropathy and patients with osteoarthritis (PWO). Methods: In this prospevtive, controlled monocentric cohort study it was planned to enroll 20 adult PWH A or B compared to 20 gender-matched adult PWO without a bleeding disorder. Patients with a blood pressure ≥ 180/110 mmHg were excluded. A positive ethical approval for the study was obtained by the Ethics Committee North Rhine, Germany. After informed consent had been obtained, the study participants underwent examinations based on clinician-reported outcomes (ClinRO) and performance outcomes (PerfO) and completed different patient-reported outcomes (PROs). ClinROs included ultrasound, functional movement screen (FMS) and the collection of anthropometric and clinical data; PerfOs included cardiopulmonary performance, 6-minute walk test (6MWT), blood pressure measurement before and after 6MWT, joint mobility (neutral-zero method) and Functional Movement Screen (FMS) to evaluate movement pattern quality; PROs included the assessment of sociodemographic data, HRQoL (SF-12), Physical Activity Questions (EPIC - Simple Index), pain sensation scale (SES) and Borg Rating of Perceived Exertion (RPE) measuring physical activity intensity level. All patients took part in regular physiotherapy (once a week) at the ARZD as prescribed by a physician. During the study, PWH continued to receive their usual hemophilia treatment regimen without study-related changes. Over a period of 12 months, ClinROs, PerfOs and PROs were collected repeatedly on a quarterly basis. Each patient was supposed to participate in 5 measure points (baseline, every 12 weeks over a one-year period). Ultrasound examinations were performed at baseline and at the conclusion at MZP5 in all patients. Results: At baseline 17 PWH (mean age 43.29±13.1 years) and 12 PWO (mean age 61.42±8.5 years) were enrolled; most PWH had HA (88.2%) were severely affected (58.8%) and 6/17 had a knee endoprosthesis. 88.2% of PWH had a disabled card (most with a disability degree of ≥ 80) compared to 45.5% of PWO (most with a disability degree of 50). PWH had a significant worse orthopaedic joint status ( p&amp;lt;.002) and subjective physical functioning ( p&amp;lt;.001) compared to PWO; PWH had a mean HJHS of 26.76±18.0 vs. 11.0±5.7 and a mean HEP-Test-Q of 48.12±16.4 vs. 67.08±9.1. PWO reported highest impairments in the domain ‘mobility’, while PWH suffered mainly under reduced ‘endurance’. With respect to their age, height and weight most of the PWH were below the predicted lower limit of the 6MWD compared to the PWO who all were above the lower limit of the 6MWD. No difference was found between the groups regarding FMS (11.34±3.8) and RPE before (11.5±3.3) after 6MWT (11.5±3.3). Conclusions: Our study took place during the Corona pandemic and was quite time consuming for the participants, resulting in a failure to reach the desired number of cases and lead to a high drop-out rate over the duration of the project. Although PWH were significantly younger than PWO, they had a significantly worse subjective (HEP-Test-Q) and objective physical functioning (HJHS).

A Comparison of Health-Related Quality of Life, Pain and Functional Parameters between People with Hemophilia and People with Osteoarthritis - Preliminary Results of the Physio-FUN Study

Background: Spontaneous joint bleeding is common in people with hemophilia (PWH) leading to reduced physical activity and weakening of the musculature. Common sequelae of this are synovitis and cartilage damage. Following, secondary osteoarthritis, so-called hemophilic arthropathy, occurs with changes and progressive destruction of joint structures (Lafeber et al., 2008). Hemophilic arthropathy can lead to severe movement restrictions and significant limitations in health-related quality of life (HRQoL) (Varaklioti et al., 2018). To prevent advanced stages of arthropathy not only regular assessment of musculoskeletal status and early detection of symptoms, but also daily rehabilitation exercises at home, and implementation of appropriate physiotherapy and medical training are important (Bossard et al., 2008). Home exercises and manual therapy can be used without causing bleeding or pain to improve pain, HRQoL and functionality (Tat et al., 2021). The primary aim of the Physio-FUN study was to assess subjective (HEP-Test-Q]) and objective physical functioning (HJHS]) during the course of 1-year applied physiotherapy comparing PWH with arthropathy and patients with osteoarthritis (PWO). Methods: In this prospective, controlled monocentric cohort study it was planned to enroll 20 adult PWH A or B compared to 20 matched adult PWO without a bleeding disorder. Patients with a blood pressure ≥ 180/110 mmHg were excluded. A positive ethical approval for the study was obtained by the Ethics Committee North Rhine, Germany. After informed consent had been obtained, the study participants underwent examinations and completed questionnaires for Clinical Outcome Assessments (COAs) (see table 1); clinical, anthropometric and socio-demographic data were collected. All patients took part in regular physiotherapy (once a week) at the ARZD as prescribed by a physician. During the study, PWH continued to receive their usual hemophilia treatment regimen without study-related changes. Over a period of 12 months, Clinical Outcome Assessment (COAs) were collected repeatedly on a quarterly basis. Each patient was supposed to participate in 5 measure points (baseline, every 12 weeks over a one-year period). Ultrasound examinations were performed at baseline and at the conclusion at MZP5 in all patients. Results: At baseline 17 PWH (mean age 43.29±13.1 years) and 12 PWO (mean age 61.42±8.5 years) were enrolled; most PWH had HA (88.2%), were severely affected (58.8%), had a target joint (52.6%) and 6/17 had a knee endoprosthesis. 88.2% of PWH had a disabled card (most with a disability degree of ≥ 80) compared to 45.5% of PWO (most with a disability degree of 50). PWH had a significant worse orthopaedic joint status ( p&amp;lt;.003) and subjective physical functioning ( p&amp;lt;.001) compared to PWO; PWH had a mean HJHS of 26.76±18.0 vs. 11.0±5.7 and a mean HEP-Test-Q of 48.12±16.4 vs. 67.08±9.1. PWO reported highest impairments in the HEP-Test-Q domain ‘mobility’, while PWH suffered mainly under reduced ‘endurance’. The NNM showed a significant impairment in the mobility of the left ( p&amp;lt;.001) and right ( p&amp;lt;.013) ankle, 58.3% PWO had no impairments compared to 58.9-76.5% of PWH with moderate-severe impairments. This was confirmed by the ultrasound showing a worse progression of their disease ( p&amp;lt;.001) compared to PWO (mean HEAD-US 11.41±6.5 vs. 3.75±3.3). PWH had a worse HRQoL ( p&amp;lt;.001) (mean PCS of 37.51±8.3 vs. 49.45±7.2) and reported a significant higher ( p&amp;lt;.001) emotional distress due to pain (mean SES affective 30.0±12.8, SES sensory 20.94±6.2 vs. SES affective 16.75±2.6, SES sensory 12.08±2.5). Compared to PWO, PWH had a significant lower PAL-value ( p&amp;lt;.045) describing the level of physical activity over the period of 24 hours, most had a sedentary job (87.5% vs. 50%). Most of the PWH were below the predicted lower limit of the 6MWD compared to the PWO who all were above the lower limit. No difference was found between the groups regarding FMS and RPE before and after 6MWT and in the MCS. Conclusions: Although PWH were significantly younger than PWO, they had a significantly worse subjective and objective physical functioning; in addition they had a worse HRQoL, HEAD-US, NNM, PAL and a higher pain experience. Our study took place during the Corona pandemic and was quite time consuming for the participants, resulting in a failure to reach the desired number of cases and led to a high drop-out rate over the duration of the project.

Analysis of the functional state of the hip joints before total hip replacement in patients with ankylosing spondylitis: Data from a retrospective study

Coxitis belongs to the extraaxial manifestations of ankylosing spondylitis (AS) and is considered as an unfavorable prognostic factor that may play a significant role in the development of functional limitations. The aim of the study – to evaluate the functional status of the hip joints (HJ) before total hip replacement (THR) in AS patients. Materials and methods. The retrospective study included 170 patients with AS who met the modified New York criteria of 1984, who were hospitalized in the traumatology and orthopedics department of the V.A. Nasonova Research Institute of Rheumatology from 1998 to 2020, and all patients underwent scheduled THR. Most of them were males (80.6%). The average age of the patients was 38,1±11,3 years, duration of the disease from the moment of the first symptoms appearance – 17,0±8,5 years, duration of pain in HJ before THR – 7,4±4,8 years. Disability was established in 80% of cases: in 14,1% – group 1, in 50% – group 2, in 15,9% – group 3. Did not work due to the disease – 64% of patients. The preoperative functional state of HJ was determined using the modified Harris scale. Results and discussion. The preoperative total Harris score averaged 38.0±15.4 points and the pain score averaged 15.6±8.4 points. In the vast majority (82.9%) of patients it ranged from 10–20 points (“severe” and “moderate constantly”). The intensity of pain according to VAS was 72,3±14,0 mm. The median severity of lameness in the HJ was 5 [0; 5] points. Claudication was absent in 2.4% of patients, moderate in 42.9% of cases, severe in another 42.9%, and mild in 11.8%. Additional support was needed in the majority of patients (69.4%). One (29.4%) or two (26.5%) crutches were more frequently required. There was no need for additional support in 30.6% of patients. In 68.8% of cases, there were varying degrees of limitation in distance walking. Climbing stairs caused difficulties in 167 (98.2%) patients, only 3 (1.8%) of them did not use a handrail. Only 1 in 4 patients could use public transportation. Various anatomical deformities were determined in 88.8% of cases. Almost all patients were found to have pronounced restrictions in the volume of movements in the HJ. Conclusion. The result of function assessment according to the Harris scale, as well as the presence of deformities and significant limitation of the range of motion indicate a high degree of severity of the HJ lesion in patients with AS before THR.

Joint status, pain and quality of life in elderly people with haemophilia: A case-control study.

Elderly people with haemophilia (PwH) develop haemophilic arthropathy, pain, and reduced health-related quality of life (HR-QoL). The condition of elderly mild haemophilia patients have rarely been evaluated. This study aimed to compare joint status, pain, and HR-QoL between elderly with mild, moderate/severe haemophilia and healthy elderlies. Knee/ankle abnormalities were assessed by ultrasound (HEAD-US) and physical examination (HJHS 2.1). Pain severity and pain interference were investigated using the Brief Pain Inventory. Pressure pain thresholds (PPTs) were obtained at knees/ankles and forehead. Functional limitations were evaluated using the 2-Minute-Walking-Test, Timed-Up-and-Go and HAL. The EQ-5D-5L questionnaire evaluated HR-QoL. Healthy controls (HCs) and elderly individuals with moderate/severe and mild haemophilia were compared using Kruskal-Wallis and Mann-Whitney U tests. From the 46 elderly PwH approached, 40 individuals (≥60 years) with haemophilia A/B (17 moderate/severe; 23 mild) and 20 age-matched HCs were recruited. Moderate/severe PwH displayed worse joint status, lower PPTs, and poorer HR-QoL than mild PwH and HCs (p-value=.010-<.001). HEAD-US abnormalities were observed in 100% of knees and 94% of ankles in moderate/severe PwH, versus 50% of knees and 61% of ankles in mild PwH. Pain was reported by 80% and 57% of moderate/severe and mild PwH, respectively. Low PPTs, functional limitations, and poor HR-QoL scores were likewise observed in some mild PwH, yet without significantly differing from HCs. This study highlights poor joint/functional status, pain, and HR-QoL outcomes in elderly with moderate/severe haemophilia. A few mild haemophilia subjects presented joint abnormalities, pain, functional limitations, and poor HR-QoL, without significantly differing from HCs. Elderly individuals with mild haemophilia have not yet been extensively studied, whereas moderate/severe haemophilia individuals have proven to suffer from haemophilic arthropathy, pain, and poor health-related quality of life (HR-QoL). Using a case-control design, joint status, pain, and HR-QoL outcomes were examined in elderly haemophilia individuals and compared with those of healthy controls (HCs). Elderly moderate/severe haemophilia individuals exhibited worse joint status, increased joint pain sensitivity, and reduced HR-QoL compared with both mild haemophilia subjects and HCs. A subset of mild haemophilia subjects exhibited poor joint status, pain, and HR-QoL outcomes, without any differences noted when compared with HCs.

Patients with moderate hemophilia A and B with a severe bleeding phenotype have an increased burden of disease

BackgroundPatients with moderate hemophilia express varying bleeding phenotypes. ObjectivesTo assess the burden of disease in patients with moderate hemophilia and a mild or severe phenotype incorporating the thrombin generation profile. MethodsThis sub-study of the 6th Hemophilia in the Netherlands study, analyzed data of adults with moderate hemophilia A or B. Patient characteristics and information on bleeding tendency, joint status, and quality of life were obtained from electronic patient files and self-reported questionnaires. A severe bleeding phenotype was defined as an annual bleeding rate ≥5, an annual joint bleeding rate ≥3, and/or the use of secondary/tertiary prophylaxis, and a mild phenotype vice versa. TG was measured with the Nijmegen Hemostasis Assay. ResultsThis study included 116 patients: 21% had a severe phenotype of whom 46% used prophylaxis. Patients with a severe phenotype treated on demand reported a higher median annual bleeding rate (7), annual joint bleeding rate (3), and more frequently an impaired joint (77%) than patients with a severe phenotype on prophylaxis (2; 0; 70%) or patients with a mild phenotype (0; 0; 47%). Furthermore, patients with a severe phenotype treated on demand experienced a more decreased quality of life. Despite similar factor activity levels, patients with a severe phenotype had a lower thrombin peak height and thrombin potential (0.7%; 0.06%) than patients with a mild phenotype (21.3%; 46.8%). ConclusionPatients with moderate hemophilia and a severe phenotype treated on demand displayed a high burden of disease as well as a low thrombin generation profile advocating them toward more intensive prophylactic treatment.

Impact of autologous platelet-rich plasma therapy vs. hyaluronic acid on synovial fluid biomarkers in knee osteoarthritis: a randomized controlled clinical trial.

Observe the effects of platelet-rich plasma (PRP) therapy on inflammatory cytokines in the synovial fluid of the knee joint of patients with KOA, and explore the effects of PRP intra-articular injection on the inflammation of the knee joint environment and the possible mechanism of action. Seventy patients were randomized to undergo three blinded weekly intra-articular injections of PRP or hyaluronic acid (HA). The concentrations of inflammatory cytokines, including interleukin (IL)-6, IL-1β, tumor necrosis factor (TNF)-α, IL-8, IL-17A, IL-17F, IL-4, IL-5, and IL-10, in the synovial fluid were evaluated before the intervention and 1 month after the third injection. The Western Ontario and McMaster University (WOMAC) and visual analog scale (VAS) scores were used to assess pain and functional status of the knee joints in both groups before the intervention, immediately post-intervention, and 1, 3, 6, and 12 months after the intervention. Baseline characteristics were similar in both groups with no statistical difference. The IL-6, IL-1β, TNF-α, IL-17A, and IL-10 levels in the synovial fluid of the observation group decreased significantly after, vs. before, the intervention (p < 0.05), whereas the IL-8, IL-17F, and IL-4 levels decreased (p > 0.05) and IL-5 levels increased (p > 0.05). There was no statistically significant difference between inflammatory cytokine levels in the synovial fluid of the samples from the control group before and after the intervention (p > 0.05). There were no statistically significant differences between the two groups immediately after intervention (p > 0.05). At 1, 3, 6, and 12 months after intervention, the WOMAC and VAS scores were significantly better in the observation group than in the control group (p < 0.05). Platelet plasma therapy can reduce the concentrations of inflammatory cytokines IL-6, IL-1β, TNF-α, IL-17A, and IL-10 in the synovial fluid of KOA patients, reduce the expression levels of IL-8, IL-17F, and IL-4, clear the pro-inflammatory factors, improve the inflammatory environment of the affected knee joint, and alleviate pain caused by inflammation. Thus, alleviating pain and improving knee function in patients with KOA.

Neuroinflammatory markers in patients with haemophilia and healthy controls: Where are the differences?

People with haemophilia (PwH) suffer from haemophilic arthropathy which is accompanied by acute and chronic inflammation. The aim of this study was to examine the neuroinflammatory network operative in PwH and to compare it to healthy controls. Blood samples were collected from 41 PwH (age 54.7±11.7 years) and 33 healthy controls (age 50.9±10.5 years) and the levels of 13 neuroinflammatory markers were analyzed by applying an antibody-based detection kit in a flow cytometer. From 13 analyzed markers, three-ß-nerve growth factor (ß-NGF), soluble receptor for advanced glycation endproducts (sRAGE) and Interleukin-18 (IL-18) differed significantly between the groups (ß-NGF p=.045; sRAGE p=.003; IL-18 p=.007). While ß-NGF was downregulated in PwH, sRAGE and IL-18 were upregulated. None of the analyzed markers corelated to the joint status of PwH while CCL2 (C-C motif ligand 2 chemokine) correlated to HIV infections in PwH (r=.313, p=.007). Correlation analyses of the markers studied also revealed many differences between PwH and controls suggesting a number of deregulations in PwH. The altered levels of sRAGE and ß-NGF in PwH, which have not been analyzed in PwH before, may help to understand the neuroinflammatory network operative in PwH. The general inflammatory processes in PwH and the involved biomarkers in PwH remain poorly understood. PwH could benefit from new therapies against neuroinflammation which may help to reduce inflammation or also chronic pain.

Effectiveness of antibiotic-loaded bone cement in total joint arthroplasty at a tertiary medical center: A retrospective cohort study

BackgroundData regarding the effectiveness of antibiotic-loaded bone cement (ALBC) in preventing prosthetic joint infections (PJI) after total joint arthroplasty (TJA) is inconsistent. The objective of this study was to evaluate if the routine use of ALBC influenced the risk of revision surgery due to PJI. MethodsThis is a retrospective cohort study performed between January 2018 and September 2020. Adult patients aged ≥ 18 years who underwent TJA (knee or hip) and received either ALBC or plain cement (PC) were included. The outcome of this study was the rate of revision due to PJI. Multivariate analysis using logistic regression was used to identify factors that may be associated with increased risk of PJI, using STATA 15.1 (StataCorp LP, College Station, Texas, USA). ResultsA total of 844 patients were screened and 319 patients were included. There were 247 patients in ALBC group and 72 patients in the PC group. Only vancomycin powder was used in all ALBC cases, with a 2 g dose in 50% of the cases (dose ranged between 1 g and 8 g). The status of the prosthetic joint was assessed and recorded up to 2 years of the TJA. Overall, the difference in the rates of PJI between the two groups after primary arthroplasty was not statistically significant (5.6% vs 1.4%; p = 0.173; OR, 4.2; 95% CI, 0.5–33). ConclusionALBC was not associated with a reduction in PJI rates after primary TJA. More research is needed to further evaluate the effectiveness of ALBC in preventing PJI.