Kellgren-Lawrence Stage Research Articles

Phenotypic variations in knee osteoarthritis: insights from MRI and radiographic comparisons.

To investigate the correlation between MRI-based phenotypes (cartilage-meniscus, subchondral bone, and inflammatory) and radiography-based atrophic and hypertrophic phenotypes, aiming to demonstrate MRI's diagnostic capability in identifying complex osteoarthritis phenotypes that radiography cannot fully capture. This single-center retrospective study examined knee radiographs and MRIs of patients from November 2021 to April 2023 to identify osteoarthritis phenotypes. Radiographs were staged by the Kellgren-Lawrence system, and both modalities were classified into atrophic or hypertrophic phenotypes. MRIs were further classified into three phenotypes: cartilage-meniscus, subchondral bone, and inflammatory. Associations between phenotypes, Kellgren-Lawrence stage, age, and gender were analyzed with Pearson chi-square test and student T-test. Reliability measurements were evaluated using kappa statistic. A total of 214 knees from 187 individuals (73.3% women, 26.7% men; mean age 57.1 ± 9.1years) were included. The hypertrophic MRI phenotype was significantly associated with cartilage-meniscus and subchondral bone phenotypes (p < 0.001). Cartilage-meniscus and subchondral bone phenotypes were less prevalent in Kellgren-Lawrence stage 2 than in stages 3 and 4 (p < 0.001 and p = 0.004, respectively). The subchondral bone phenotype was more common in men (p = 0.022), and the cartilage-meniscus phenotype in the elderly (p < 0.001). Radiography and MRI had substantial agreement (Kappa = 0.637, p < 0.001) in diagnosing hypertrophic and atrophic phenotypes. The hypertrophic phenotype was associated with cartilage-meniscus and subchondral bone phenotypes, with lower prevalences in Kellgren-Lawrence stage 2 knees. MRI offers enhanced phenotypic characterization, which facilitates more precise and individualized management in osteoarthritis care. Despite limitations compared to MRI, radiography remains valuable for the evaluation of hypertrophic and atrophic phenotypes.

Increased ankle pain after total knee arthroplasty is associated with a preoperative lateralized gait and talar tilt, but not with ankle laxity or the range of motion of the subtalar joint.

Total knee arthroplasty (TKA) may provoke ankle symptoms. The aim of this study was to validate the impact of the preoperative mechanical tibiofemoral angle (mTFA), the talar tilt (TT) on ankle symptoms after TKA, and assess changes in the range of motion (ROM) of the subtalar joint, foot posture, and ankle laxity. Patients who underwent TKA from September 2020 to September 2021 were prospectively included. Inclusion criteria were primary end-stage osteoarthritis (Kellgren-Lawrence stage IV) of the knee. Exclusion criteria were missed follow-up visit, post-traumatic pathologies of the foot, and neurological disorders. Radiological angles measured included the mTFA, hindfoot alignment view angle, and TT. The Foot Function Index (FFI) score was assessed. Gait analyses were conducted to measure mediolateral changes of the gait line and ankle laxity was tested using an ankle arthrometer. All parameters were acquired one week pre- and three months postoperatively. A total of 69 patients (varus n = 45; valgus n = 24) underwent TKA and completed the postoperative follow-up visit. Of these, 16 patients (23.2%) reported the onset or progression of ankle symptoms. Varus patients with increased ankle symptoms after TKA had a significantly higher pre- and postoperative TT. Valgus patients with ankle symptoms after TKA showed a pathologically lateralized gait line which could not be corrected through TKA. Patients who reported increased ankle pain neither had a decreased ROM of the subtalar joint nor increased ankle laxity following TKA. The preoperative mTFA did not correlate with the postoperative FFI (r = 0.037; p = 0.759). Approximately one-quarter of the patients developed ankle pain after TKA. If patients complain about ankle symptoms after TKA, standing radiographs of the ankle and a gait analysis could help in detecting a malaligned TT or a pathological gait.

Clinical evaluation and accuracy of mechanical axis alignment in robotic total knee arthroplasty

The first experience in robotic total knee arthroplasty (RoTKA) has been obtained resulting in the questions about clinical efficiency and accuracy of lower limb alignment.Objective To clarify clinical evaluation and accuracy of alignment of the mechanical axis of the lower limb in RoTKA.Materials and methods Twenty-nine patients with osteoarthritis of the knee of Kellgren-Lawrence stage 3-4 underwent RoTKA. The knee joint was assessed with VAS, WOMAC, FJS-12; the range of motion was measured. The changes in the axis of the lower limb were evaluated on the full limb length radiographs.Results Pain before the surgery according to VAS was 5.8 ± 1.5 points, on the first day after the surgery it was 8.5 ± 1.4, on day 3 – 5.9 ± 1.2, on day 12 – 2.9 ± 1.1. The range of motion on the first day after the surgery was 99.5° ± 1.4°, three months later – 115.1° ± 1.1°, six months later – 125.6 ± 1.5°, one year later– 127.5 ± 1.6°. The WOMAC score before the surgery was 32.7 ± 3.3, after the surgery 25.1 ± 2.1, three months later 7.3 ± 1.3, six months later 2.8 ± 0.2, and after one year – 1.3 ± 0.5. The FJS-12 score 3 months after the surgery was 68.2 ± 4.1, after 6 months 80.3 ± 2.9, after one year 94.0 ± 2.1. The analysis of postoperative full length roentgenograms in 72 % of cases (n = 21) did not reveal any deviation of the mechanical axis from the planned one and in 28 % of cases (n = 8) the deviation of the mechanical axis was up to 1° from the planned one.Discussion Neither technical difficulties nor complications inherent to RoTKA were found. According to the results of VAS, WOMAC and FJS‑12 questionnaires, and the assessment of the range of motion, a positive dynamics was observed. According to the results of tele-roentgenograms, there was alignment of the limb axis and the accuracy of the position of the endoprosthesis components.Conclusion The study of this technology has demonstrated safety, accuracy of alignment of the mechanical axis, validity of indications and contraindications, and stable early clinical results.

Changes in clinical outcomes and alignment of the ipsilateral knee and ankle after supramalleolar osteotomy in patients with varus osteoarthritis of the ankle: a short-term follow-up study.

The purpose of this study was to investigate the changes in clinical outcomes and alignment of the ipsilateral knee and ankle in patients with varus ankle osteoarthritis after supramalleolar osteotomy (SMO). We retrospectively reviewed 23 patients (24 ankles) with Takakura II, IIIa and IIIb ankle osteoarthritis treated with SMO between May 2017 and March 2022. The radiologic parameters of ankles contained medial distal tibial angle (TAS), tibiotalar angle (TT), tibial lateral surface (TLS), tibial plafond inclination (TPI) and talar inclination (TI). The radiologic parameters of knees contained medial proximal tibial angle (MPTA), joint line convergence angle (JLCA), the knee joint line orientation relative to ground (G-KJLO) and WBL. Hip-knee-ankle angle (HKA) was also collected. The Takakura system was used for evaluating the ankle osteoarthritis and the Kellgren-Lawrence (KL) system was used for evaluating the knee osteoarthritis. Clinical evaluation of the ankle joints contained American Orthopedic Foot and Ankle Society (AOFAS), range of motion (ROM) and visual analogue scale (VAS). Clinical evaluation of the knee joints contained Japanese Orthopaedic Association Scores (JOA), ROM, VAS. The mean follow-up times were 20.3 ± 7.3months (range 12-38). According to the radiologic evaluation, the TAS increased from preoperative 84.7° ± 2.0° to 91.2° ± 1.8° at the last follow-up (P < 0.001). The TPI and TI decreased from 4.4° ± 4.2° and 11.0° ± 5.2° to 0.1° ± 4.7° and 4.1° ± 4.8° (P < 0.001 for both). The TT angel improved from 9.5° ± 4.1° to 4.9° ± 3.3° (P < 0.001). No significant differences were found regarding MPTA, JLCA, G-KJLO, knee WBL and HKA (P > 0.05 for all). The Takakura stage improved after SMO (P < 0.001) whilst the KL stage maintains the similar lever (P > 0.05). According to the clinical evaluation, the AOFAS significantly increased from 67.5 ± 10.6 to 88.5 ± 9.3 and the VAS of the ankle decreased from 4.7 ± 1.6 to 1.2 ± 1.1, whilst there were no changes on VAS and even the JOA and knee ROM after SMO (P > 0.05 for all). SMO can alleviate the symptoms of varus ankle osteoarthritis and delay the time for ankle replacement or arthrodesis by redistributing the abnormal stress of the ankle and restoring the congruence of the tibiotalar joint. In addition, it did not induce the clinical symptoms of knee without compromising lower limb alignment or knee joint line orientation in the short term. Level IV case series.

Increased Medial Femoral Condyle Angle and Narrow Intercondylar Notch Are Associated With Medial Meniscus Posterior Root Tear

To investigate the correlation between nontraumatic medial meniscus posteriorroot tear (MMPRT) and bone morphology of the knee with a particular emphasis on MMPR impingement. Magnetic resonance imaging (MRI) findings were examined between January 2018 and December 2020. MRI findings of patients with traumatic MMPRT, Kellgren Lawrence stage 3-4 arthropathy on radiographs, single- or multiple-ligament injuries and/or those who underwent treatment for these diseases, and surgery in and around the knee were excluded from the study. MRI measurements included medial femoral condylar angle (MFCA), intercondylar distance (ICD), and intercondylar notch width (ICNW), distal/posterior medial femoral condylar offset ratio, notch shape, medial tibial slope (MTS) angle, and medial proximal tibial angle (MPTA) measurements and spur presence and were compared between groups. All measurements were performed by two board-certified orthopedic surgeons on a best agreement basis. MRI examinations of patients aged 40-60 were analyzed. MRI findings were divided into two groups: the study group of MRI findings of patients with MMPRT (n= 100) and the control group of MRI findings of patients without MMPRT (n= 100). MFCA was found to be significantly higher in the study group (mean: 46.5 ± 3.58) than in the control group (mean: 40.04 ± 4.61) (P < .001). In the study group, the ICD (study group mean: 76.26 ± 4.89; control group mean: 78.18 ± 6.1) was significantly narrower (P= .018), and the ICNW (study group mean: 17.19 ± 2.23; control group mean: 20.48 ± 2.13) was significantly shorter (P < .001). The ICNW/ICD ratio was significantly lower in patients in the study group (0.22 ± 0.02) than in the control group (0.25 ± 0.02) (P < .001). Bone spurs were present in 84% of the study group and only in 28% of those in the control group. In the study group, the most common notch type was A-type with 78%, while the least common was the U-type notch with 10%. However, in the control group, the most common notch type was A-type with 43%, and the least common was the W-type notch with 22%. The distal/posterior medial femoral condylar offset ratio was statistically lower in the study group (0.72 ± 0.07) than in the control group 0.78 ± 0.07) (P < .001). No significant intergroup differences were found in MTS (study group mean: 7.51 ±2.59; control group mean: 7.83 ± 2.57) (P= .390) and MPTA (study group mean: 86.92 ±2.15; control group mean: 87.48 ±1.8) measurements (P=.67). Increased medial femoral condylar angle, low distal/posterior femoral offset ratio, narrow intercondylar distance and intercondylar notch width, A-type notch shape, and spur presence are associated with MMPRT. Level III, retrospective cohort study.

Short-term comparison of intraarticular administration of IL-1 receptor antagonist and platelet-rich plasma for osteoarthritis treatment

Osteoarthritis (OA) is a prevalent joint condition that affects areas such as the knee, hip, hand, and spine. In treating mild to moderate cases of OA, treatment options such as intraarticular corticosteroids, viscosupplementation, glucosamine and chondroitin sulfate, PRP, and IL-1Ra are commonly used. This study aimed to compare the effects of IL-1 receptor antagonist (IL-1Ra) and platelet-rich plasma (PRP) on patients with Kellgren-Lawrence (KG) stage 2-3 knee osteoarthritis in terms of Visual Analog Scale (VAS) and Knee injury and osteoarthritis outcome score (KOOS). Ninety patients with KG stage 2-3 knee primary osteoarthritis were divided into two groups, with one group receiving three intraarticular IL-1Ra injections and the other group receiving three PRP injections. VAS and KOOS scores were recorded at the beginning and after six months to evaluate clinical improvement. Both the IL-1Ra and PRP groups showed statistically significant improvement in all scores, including the VAS and KOOS. After six months, the KOOS score in the IL-1Ra group was significantly higher than the PRP group, while the first-year VAS score after treatment in the IL-1Ra group was significantly lower compared to the PRP group. The mean KOOS scores increased from 44.1 to 87.8 and 46.04 to 84.43 at the end of six months in both groups, while the mean VAS scores decreased from 7.27 to 1.02 and 7.29 to 1.71 in the IL-1Ra and PRP groups, respectively. Administering intra-articular IL-1Ra once a week for three weeks can effectively improve function and reduce pain in patients with Kellgren-Lawrence stage 2-3 osteoarthritis. However, more research is necessary to validate the use of IL-1 receptor antagonists in OA treatment.

COVID-19 pandemisi sürecinde ileri evre gonartrozu olan hastalarda eklem içi enjeksiyonlar ağrı yönetiminde etkili midir? Tek merkez deneyimi.

Background: Primary gonarthrosis is a progressive disease that increases with age and leads to limitations in activities of daily living. Until surgery is performed, nonsteroidal anti-inflammatory drugs, intraarticular injections, and physical therapy methods are used.&#x0D; Purpose: This study aims to compare the clinical outcomes of intra- articular corticosteroid (CCS) and hyaluro nic acid (HA) injections for pain relief in primary gonartrhosis in COVID -19 pandemic period.&#x0D; Study Design: Retrospective Cohort Study.&#x0D; Methods: In this study, 88 patients who underwent intra-articular CCS and HA injection between August 2020 and March 2021 due to Kellgren-Lawrence stage 2 and higher gonarthrosis were investigated. Patients were divided into two groups. Group I represents the patients who received HA injections, and group II represents the patients who received CCS injection. Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Knee Society Score (KSS) scores were used for the preoperative and postoperative functional evaluations of the patients. &#x0D; Results: Group I included 40 patients and group II included 48 patients. The mean age was 59.4 ± 7.3 years, and the average follow-up period was 12 ± 2,6 months. The pre-intervention WOMAC scores were 13,5 in Group I and 13.6 in Group II, KSS scores were 26,5 in Group I and 25,2 in Group II. While there was a significant change in the control at month 1 in both groups, no difference was found between the groups. At the 6th month control, the improvement in group 1 continued at a significant level compared to the pre-injection period, while group 2 returned to the pre-injection level. (p

Paper 19: The Influence of Amniotic Suspension Allografts and Bone Marrow Aspirate Concentrate on Inflammation &amp; Cartilage Matrix Metabolism in Osteoarthritic Chondrocytes

Objectives:While bone marrow aspirate concentrate (BMAC) and amniotic suspension allografts (ASA) have all garnered clinical interest for the treatment of osteoarthritis, basic science evidence supporting their use is lacking. Specifically, there is a paucity of literature on the in vitro effects of BMAC and ASA on inflammation and cartilage matrix metabolism in OA chondrocytes and synoviocytes. The purpose of this study was to evaluate the effect of BMAC and ASA on inflammation and cartilage metabolism in a model that mimics the OA intra-articular environment: a co-culture of OA cartilage explants and synoviocytes.Methods:After institutional IRB approval, 17 patients were enrolled at the time of total knee arthroplasty for donation of cartilage, synovium, and bone marrow aspirate tissue samples. All patients had Kellgren-Lawrence Stage 2 or 3. The aspirate was then be prepared and centrifuged using a standard commercially available BMAC centrifuge system, typically yielding up to 3mL of BMAC. Synoviocyte and cartilage explant co-culture systems were created using 24-well culture plates containing 0.4mm filtered inserts. Four co-culture systems were established per patient to accommodate the 2 biologic treatment groups (BMAC and ASA), one control group at 96 hours, and one baseline control cartilage group. Multiplex ELISA was used to measure concentrations of pro-inflammatory mediators interleukin – 1b (IL-1b), interleukin – 6 (IL-6), and tumor necrosis factor – alpha (TNF–a) at 96 hours. Each sample was measured in duplicate to ensure accuracy. Additionally, both chondrocyte and synoviocyte RNA were assayed for collagen type I a1 (COL1A1), collagen type II a1 (COL2A1), collagen type III a1 (COL3A1), aggrecan (ACAN), and cartilage oligomeric matrix protein (COMP). All statistical analyses were performed on STATA v16.1. Normality of data was determined by Shapiro-Wilk test, and non-parametric or parametric tests were utilized where appropriate.Results:There were no significant differences in cytokine concentration between the 96-hr control group and the BMAC co-culture for any cytokine, although IL-6 was trending towards significance (Control: 856.3 ± 346.2 vs BMAC: 662.3 ± 346.8, p=.08). There was a significantly lower concentration of IL-1B in the ASA group compared to the control group (ASA: 11.2 ± 13.9 vs Control: 20.2 ± 39.5, p=.04) (Table 1). No significant differences in expression were observed for Col1A1, Col2A1, Col3A1, COMP or ACAN in either cartilage or synovium samples across the three groups.Conclusions:The early results from this study suggest that ASA may have anti-inflammatory properties and promote the expression of major extracellular matrix genes in both osteoarthritic chondrocytes and synoviocytes involved in cartilage matrix metabolism. Specifically, ASA was associated with decreased concentrations of IL-1ß. The use of intra-articular therapies as sources of growth factors, anti-inflammatory mediators, and potentially mesenchymal stem cells (MSCs) for OA is rapidly evolving. MSCs have garnered significant interest due to their chondrogenic potential and promise for tissue regeneration. Two commercially available sources of MSCs are bone marrow aspirate concentrate (BMAC) and amniotic membrane. As biologics garner more attention in the clinical setting, their underlying mechanisms and efficacy in in-vitro models become important to elucidate. The results from this study provide basic science support for further clinical trials comparing ASA and BMAC to current standard of care corticosteroid injections for OA.Table 1.Luminex Assay for Cytokine Concentrations in Media

Radiologically Guided Versus Blinded Intra-articular Injection in Patients With Hip Osteoarthritis: A Retrospective Comparative Study.

Objectives:The aim of this study was to present the clinical results of patients with Kellgren-Lawrence (KL) stage 2-4 hip osteoarthritis who were administered intra-articular corticosteroid (CS) or hyaluronic acid (HA), with or without fluoroscopy.Methods:This retrospective comparative study was conducted in the clinics where the authors worked between 2010 and 2018. Patients with stage 2-4 hip osteoarthritis according to KL criteria were included in the study. Age, body mass index, American Society of Anesthesiologists stages, and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores (3rd, 6th, and 12th months) were recorded. Two groups were created as patients who underwent injection with or without fluoroscopy guidance. In group 1, CS (triamnisolone) was administered, and in group 2, sodium hyaluronate 88 mg/4 mL was administered. Obtained parameters were compared.Results:The WOMAC scores at 3 months of both the CS and HA groups were statistically significantly better than before the application, with the improvement in the CS group found to be significantly better than in the HA group (P = .047). At 6 months, the mean WOMAC scores of the CS and HA groups were better than prior to the application, and there was a statistically significant difference (P < .001). No significant difference was found in either the CS or HA group in the comparison of 12-month WOMAC scores with the baseline scores (P = .744 and P = .054).Conclusion:In symptomatic hip OA patients, intra-articular administration of CS and HA was seen to be effective at 3 and 6 months after administration. However, the effectiveness was determined to have disappeared within 1 year. Furthermore, in hip OA intra-articular drug applications, it was determined that the blinded technique without radiological guidance performed in the outpatient clinic is as effective and safe as the radiologically guided technique administered in the operating room.

Proximal Fibular Osteotomy - A Novel Technique for Surgical Intervention in Knee Osteoarthritis and its Application in the Indian Scenario

Background: Knee osteoarthritis is a significant cause of functional restriction among the Indian population. In the initial stages when patients present with isolated medial compartment changes, the surgical options in the inventory are few. The scarcity of a simple yet cost-effective procedure has contributed to the growing popularity of isolated proximal fibular osteotomy (PFO) since its inception. This study aims to evaluate the outcome among patients who underwent PFO for symptomatic knee osteoarthritis. Materials and Methods: Fifty patients with medial unicompartmental osteoarthritis of the knee were treated with PFO from December 2017 to December 2020. Patient particulars and intra-operative parameters were recorded. The postintervention functional outcome was evaluated by comparing the preoperative Oxford Knee Score (OKS) with that reported postoperatively. Results: The mean age of the patients included in the study was 48.20 years, with a male: Female ratio of 1.8:1. Sixty-eight percent cases presented with Kellgren–Lawrence Stage III. The patients were followed for a mean of 18.18 months after the procedure. The preoperative, 1-month, 2-month, and 6-month OKS were 24.76 ± 2.63, 33.34 ± 3.84, 39.36 ± 4.65, and 43.02 ± 4.66, respectively. At 6 months postsurgery, 82% of patients were in the satisfactory functional score range (40–48). The most commonly observed complication was superficial peroneal nerve palsy. Conclusion: Despite the simple technique, PFO has been associated with good outcomes and lesser complications. Selection of patients and placement of the osteotomy site are crucial for the success of the procedure. The present study revealed that patients irrespective of their age, gender, or stage of the disease would benefit from the procedure.

Relationship of subchondral bone mineral density to progression of knee osteoarthritis

Purpose: to assess the relationship of bone mineral density (BMD) of the subchondral femoral and tibial bones with the progression of knee osteoarthritis (OA) during 1 year of follow-up. Methods: the prospective study included 185 women (40-75 y.o) with Kellgren-Lawrence stage II-III knee OA (ACR). The average age was 59.2±7.4 y.o, body mass index (BMI) 27.7±4.4 kg/m2, and disease duration 12±8.1 years. An individual map was filled out for each patient, including anthropometric indicators, anamnesis and clinical examination data, assessment of knee pain by VAS, concomitant diseases and therapy during the follow-up period. All patients underwent standard radiography of the knee joints, two-energy x-ray densitometry of the lumbar spine (L1-L4), femoral neck, and subchondral femoral and tibial bones. The method described by E. Murphy and C. Hulet was used to assess the BMD of the subchondral bone. Results: During the year of follow-up, the progression of knee OA was noted in 15 patients (group 1), in 170 - the stage of the disease remained the same (group 2). There were no differences in age, age of onset, and duration of the disease, when comparing the groups. However, group 1 had a higher BMI (31.9±5.8 and 27.3±4.1 kg/m2, p < 0.0001) and walking pain intensity (VAS) of 65.8±11.8 and 47.5±18.7 mm (p < 0.0003). More women from group 1 had concomitant diseases: arterial hypertension (93.3% and 71.8%, respectively, RR=1.3, 95% CI 1.1-1.53, p=0.05) and type 2 diabetes (33.3% and 12.9%, RR=2.57, 95% CI 1.14-5.82, p=0.04); they were more likely to receive intra-articular injections of glucocorticoids in the knee joints (57.1% and 30.8%, RR=1.85, 95% CI 1.09-3.14, p=0.05). There were no intergroup differences in absolute values of the axial skeleton BMD: in L1-L4 (0.95 [0.92;1.25] and 0.93 [0.81;1.03], p > 0.05) and in the femoral neck (0.83 [0.69;1.2] and 0.78 [0.71;0.89], p > 0.05). When assessing the BMD of the subchondral divisions of the lateral (0.79 [0.54;0.93] and 0.75 [0.64;0.88], p > 0,05) and medial (0.89 [0.76;1.01] and 0.82 [0.68;0.96], p > 0,05) tibial condyles, comparable data were also obtained, with a tendency to higher indicators in patients with progression of knee OA (group 1). Statistically significant higher BMD values of the subchondral femur were found in group 1. The BMD of the lateral femoral condyle in group 1 was 1.09 [0.74;1.26] and in group 2 - 0.87 [0.75;1.0], p=0.04. The BMD of the medial femoral condyle in group 1 was 1.03 [0.96;1.13] and in group 2 - 0.86 [0.73;1.07], p=0.03. Correlation analysis confirmed the relationship between radiological progression of OA and BMD in the subchondral bone of the lateral (r = 0.32 and p=0.002) and medial condyles of the femur (r = 0.28 and p=0.02). Conclusions: higher BMD values in the subchondral femur can be considered as predictors of rapid radiological progression of OA. However, further study of this issue is required in multicenter long-term prospective studies.

Association of Neutrophil to Lymphocyte Ratio with Patient Reported Outcomes in Knee Osteoarthritis

Background: Determining the association of neutrophil to lymphocyte ratio (NLR) and clinical disease severity in patients with mild and advanced stage knee osteoarthritis (OA).Method: We analyzed clinical scores and routine hematology panels of 111 subjects with symptomatic knee degeneration: mild OA (66) who underwent knee arthroscopy and advanced OA (45) who had total replacement. Results: Compared to the advanced OA group, the mild OA group was younger (54/67), had fewer females (1.75/5.43), and better scores: Euroqol EQ5D Index (0.50/0.25), VAS (visual analog scale) (65/44); International knee documentation committee subjective knee evaluation form—IKDC (31.6/20.24); Knee disability and osteoarthritis outcome score for joint replacement—KOOSJR (15.5/18.3); and better Kellgren–Lawrence stage (1.3/3.8). Patients with advanced disease had higher NLRs compared to mild OA group and controls: 2.82 versus 1.99 (p = 0.004) and 1.98 (p = 0.002). In the multiple regression model, NLR was only influenced by age (p &lt; 0.001). In the subgroup analysis, for the early OA cases, NLR was significantly dependent to VAS (p = 0.006), IKDC (p = 0.001) and KOOSJR (p &lt; 0.001). Conclusion: NLR was not associated with symptomatic knee OA, as determined by commonly used patient reported outcomes. However, for patients with mild degenerative modifications, EQ5D, VAS, and IKDC were independent predictors of NLR.

Postoperative Functional and Radiological Outcome Comparison of Computer-assisted and Conventional Total Knee Arthroplasty at 6 Months Follow-up: A Cross Sectional Study

Background. Computer-assisted navigation TKA has just been adapted in Indonesia for the last decade. The method is aiming to achieve more precise mechanical alignment in TKA. However, controversies still exist especially in terms of functional outcome and radiological outcome.Method. Fifty elderly patients aged more than 50 years old with severe knee osteoarthritis (Kellgren Lawrence stage III or IV) who scheduled for TKA surgery in the first half of 2019 were consecutively sampled. All patients were measured for objective functional status with Western Ontario Mac Master University Index (WOMAC) and Oxford Knee Score (OKS). Weight-bearing, long-leg follow-up radiographs of both lower limbs were taken, and coronal tibiofemoral angle (CTFA), coronal femoral component angle (CFCA) and coronal tibial component angle (CTCA) were measured.Results. Group of computer-assisted navigation TKA surgery was found to have significantly lower WOMAC score (p0.05) and higher OKS score (p0.05). Although not statistically significant, greater angle of deviation is observed in the conventional TKA surgery group. Proportions with deviation of less than 3º were found more in the group using computer navigation.Discussion. The results of this study indicate the advantage of using a computer assisted system in TKA procedure, in terms of better functional outcome. However, our study only measures mechanical alignment from coronal plane and short term follow up time. Other parameter measurement, such as mechanical alignment on sagittal plane, rotational alignment, and soft tissue balance are also important to determine the success rate of TKA procedure.Conclusion. Patients who had TKA surgery under computer-assisted navigation would benefit a better functional outcome if compared with conventional TKA surgery, as measured with WOMAC and OKS. However, there is no significant difference in terms of radiographic value of coronal-plane mechanical deviation on both methods.

The influence of different concentration of proFLEX® INTRA on clinical progression and dynamics of laboratory test values in different age patients with knee osteoarthrosis

Introduction: application of hyaluronic acid gel for intraarticular administration is actual topic of modern orthopaedic concerning to its therapeutical efficacy. Objective: to assess the influence of different concentrations of proFLEX® INTRA on the synovial fluid and biochemical blood markers in patients with the 2nd knee osteoarthritis stage in the different age groups. Materials and methods: 30 patients with Kellgren–Lawrence stage II knee osteoarthritis were examined. The first group consisted of 15 patients aged 40–50 years, in the second group the average age of patients was 50–70 years. Each group was divided into 3 subgroups (a, b, c) of 5 patients. In each group the first subgroup of patients received intra-articular 1 injection of proFLEX® INTRA 10 mg/ml 2.0 ml, І-b, ІІ-b — 12 mg/ml 2.5 ml, І-с, ІІ-с — 20 mg/ml 3.0 ml. Results: an inflammatory-dystrophic process in the knee joint of patients was found in both groups, which was more expressed in elderly patients. The dynamics of blood markers in patients of the 1st and 2nd groups after the treatment showed a decreasing the level of inflammatory and dystrophic processes in the knee joints. In the 1st group 1 month after intra-articular injection, the content of glycoproteins and chondroitin sulfates (CS) decreased, did not reach the normative values. In subgroup II-c the level of glycoproteins and CS decreased, the concentration of interleukin-6 (IL-6) remained elevated comparing to subgroups II-a and II-b. Conclusions: it was found that patients with stage II knee osteoarthritis had increased CS and lower levels of hyaluronic acid in their synovial fluid. Markers of inflammation (glycoproteins and IL-6) and destruction markers (CS) in the blood serum changed unidirectionally and indicated a decreasing in the activity of inflammatory process after the injection of hyaluronic acid gel, which was clinically confirmed 1 month after intra-articular injection. In this case, the results after the reexamination of blood biomarkers of patients aged 40–50 years indicated a higher efficiency of hyaluronic acid gel injection with a concentration of 10 and 12 mg/ml, aged 50–70 years — a concentration of 20 mg/ml was confirmed by a decrease in the level of glycoproteins, CS and IL-6 in the blood of patients.

Platelet Rich STROMA, the Combination of PRP and tSVF and Its Potential Effect on Osteoarthritis of the Knee

(1) Background: osteoarthritis (OA) of the knee is a degenerative disease accompanied by pain, reduced mobility and subsequent decrease in quality of life. Many studies on OA of the knee have reported that using an intercellular acting-derivate like platelet-rich plasma (PRP) results in a limited effect or none at all. Authors hypothesized that adding tissue-Stromal Vascular Fraction (tSVF) to PRP (Platelet Rich Stroma (PRS)) would reduce pain and improve functionality in osteoarthritis of the knee. (2) Methods: a consecutive case series of fifteen patients (aged 43–75 years) suffering from OA of the knee (Kellgren–Lawrence stage two to three) were treated with a single injection of autologous PRS. tSVF was mechanically isolated by means of the fractionation of adipose tissue (FAT) procedure. Clinical evaluation was done using a visual analogue score (VAS) score, an adapted Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) and Lysholm score at fixed time points: pre-injection as well as three, six and twelve months post injection. (3) Results: VAS and WOMAC scores improved significantly after twelve months (p &lt; 0.01 and p &lt; 0.05). Lysholm instability scores were also improved at twelve months (p &gt; 0.05) in comparison to pre-injection measurements. No complications were seen in any of the patients. One patient was excluded due to a total knee arthroplasty. (4) Conclusions: a single injection with PRS for OA of the knee seems to lead to an improvement of function and simultaneous reduction of pain and joint stiffness for a period of twelve months. Further controlled trials are required to determine the optimal treatment regimen and evaluate long-term results.

Comparative clinical and economic analysis of the use of symptomatic slow-acting drugs containing glucosamine sulfate in patients with Stage II gonarthrosis during outpatient care

Objective : to carry out a comparative clinical and economic analysis of treatment regimens for primary gonarthrosis (GA) Stage II with a combination of dosage forms of Sustaguard ® Artro (ampoules) + Sustaguard ® Artro (powder for oral solution) and Dona ® (ampoules) + Dona ® (powder for oral solution) in outpatient practice. Patients and methods . A retrospective comparative study was conducted using data from medical records of outpatients with GA radiographically classified as Kellgren–Lawrence Stage II. The investigators made cost-effectiveness and budget impact analyses and missed opportunity calculation for pharmacoeconomic examination, by taking into account direct costs and treatment effectiveness on the basis of assessment of the dynamics of pain syndrome, joint functional ability by the Lequesne index, visual analogue scale, WOMAC index, knee joint ultrasound data, and quality of life according to the EuroQol-5D questionnaire. The materials from the medical records of 60 patients with stage II GA were systematized according to the inclusion/exclusion criteria. All the patients were divided into two groups: 1) 30 patients received therapy with intramuscular (IM) Sustaguard ® Artro 3 ml thrice weekly; the treatment cycle was 12 injections for 28 days + 1.5-g Sustaguard ® Artro powder in a package, dissolved in 200 ml of water, once daily; the treatment cycle was 40 days; the full therapy cycle was 68 days; 2) 30 patients had therapy with IM Dona ® 3 ml thrice weekly; the treatment cycle was 12 injections for 28 days + 1.5-g Dona ® powder, dissolved in 200 ml of water, once daily; the treatment cycle was 40 days; the full therapy cycle was 68 days. The patients of both groups had a cycle of therapy with a nonsteroidal anti-inflammatory drug (nimesulide) at a dose of 100 mg twice daily for 15 days. Results and discussion . Sustaguard ® Artro treatment for Stage II GA was shown to be more economically feasible in terms of the cost-effectiveness ratio compared to Dona ® therapy for 68 days, with the long-term results of treatment being maintained for 2 months after the start of therapy. The effective technology of Sustaguard ® Artro therapy makes it possible to save significant budgetary funds (as many as 1.2 million rubles) and to additionally treat 50 patients. Conclusion . The clinical and economic study has established that the use of Sustaguard ® Artro as a treatment for primary GA Stage II is more economically feasible in terms of cost-effectiveness ratio.

Hemofili A Hastalarındaki Diz Artropatisi ve Bilateral Total Diz Artroplastisi Oranı

Objective: This epidemiological study was co nducted in the joint haematology- orthopaedics clinic of a university hospital. The aim was to analyse the data in terms of age and radiolo gy of patients with moder ate or severe haemophilia A and knee involvement. Materials and Method: This was a retrospective stu dy 49 patients with knee problems out of 130 haemophilia A and musc u loskeletal problems . Kellgren-Lawrence (KL) classification was used for radiological assessments of osteoarthritis degree. Results: KL degree was 3 or 4 for most patients (27/39, 69.23%) in the group. There was statistically a meaningful correlation between KL degree and patients’ age (Spearman’s: r s = 0.512, p = 0.001). There were 7 patients with KL degree 4 at the age of 50 or younger (14.29%). 25 patients in 49 (51.0 2%) had total knee arthroplasty(TKA) and 10(40%) of those was bilateral . Mea n age for bilateral TKA (56.3 5 ) was higher than unilateral(49.87 ). There was a statistically mea ningful correlation between patient age and the patients with TKA (Spearman’s : r s = 0.338, p = 0.017 ). There were 2 revision surgeries out of 35 TKA (5.7 1 %). Most of the patients had prophyl actic factor treatment (43, 87.75 %). Conclusion: Our study signify the high ratio of bilateral knee replacements in haemophilia A patients and how early age they progressed to KL stage 4 comparing to normal population. These results show the importance of patient care in this group of patients, close follow-up and prophylactic treatment. They should be managed in experienced centres by an experience team to decrease the risks and complications.

The effectiveness of complex therapy using the injectable form of chondroitin sulfate and sodium hyaluronate with osteoarthritis of the knee joint

The study on the effectiveness of complex therapy for osteoarthritis (OA) of the knee joint was conducted in real clinical practice. The survey involved 125 patients aged fr om 50 to 70 years (25 men and 100 women) with a diagnosis of knee joint OA (the III roentgenologic Kellgren-Lawrence stage).The average age of the patients was 62±3.21, the average duration of the disease - 9.4±2.8 years. Patients were randomly assigned to three groups of 35 people, the control group had 20 patients. Group 1 patients received non - steroidal anti - inflammatory drugs (NSAIDs) + Injectran(Chondroitin sulfate) 200 mg intramuscularly (I.M.) every other day No. 25.In group 2, patients received NSAIDs + Fermatron 1% 2 ml with an interval of 7 days intra - articularly (I.A.) No. 3. In group 3 - NSAIDs + Injectran 200 mg (I.M.) every other day No. 25 + Fermatron 1% 2 ml with an interval of 7 days (I.A.) No. 3. In the control group (20 people), patients received only NSAIDs. Evaluation of the symptoms was carried out using the WOMAC index before the start of thetherapy, after 8 and 12 weeks of treatment. The intensity of pain while walking was estimated on a visual analogue scale. In the groups that received Injectran (I; group 1) or Fermatron (F; group 2), the dynamics of pain while walking reduction was comparable and had slightly more than 30% in both groups, the figures are reliable in comparison withinitial data (p.

03:00 PM Abstract No. 23 Geniculate artery embolization (GAE) for osteoarthritis (OA)-related knee pain: results from a multicenter US trial

Knee OA is a common cause of pain and disability, with many patients relying on chronic pain medications and/or joint injections. These options unfortunately result in short-term relief, or have associated increased morbidity, and knee replacement surgery may ultimately be performed. Researchers have postulated that synovial neovascularity develops as a result of inflammation and subsequently leads to knee pain. While previous overseas reports of success with GAE have been published, we present our final results from a prospective US multicenter clinical trial. 20 subjects with OA with pain greater than 50 mm (Visual Analog Scale 100mm) refractory to conservative therapy were enrolled in the study (clinicaltrials.gov NCT02850068). Subjects were excluded for: Kellgren Lawrence (KL) Stage 4, rheumatoid arthritis, infection, previous arthroplasty, renal insufficiency, or uncorrectable coagulopathy. GAE was performed using 75 or 100 um Embozene Microspheres (Boston Scientific, Marlborough, MA) in 20 subjects at 2 US centers. Subjects were assessed with MRI, Visual Analog (VAS) and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) pain and disability scales, before and after the procedure. Adverse events were also recorded at all time points. Median baseline OA was KL stage III and baseline VAS was 72 mm (SD 14). Neovascularity was identified in the area of pain in all cases by arteriography (n=20) and GAE was technically successful in all subjects (n=20). GAE significantly improved pain at primary endpoint of 6 months as measured by VAS and WOMAC (n=20, baseline VAS 76 mm, mean decrease -47 mm, p<0.01; baseline WOMAC 61, mean decrease 32, p<0.01). No major adverse events were seen related to the procedure, however transient cutaneous ischemia was noted in 14/20 and 2 subjects experienced transient plantar sensory parasthesias. GAE is a technically feasible and effective technique in the short term to reduce pain secondary to knee osteoarthritis.

When is indicated viscosupplementation in hip osteoarthritis?

Background and aim: The incidence of hip osteoarthritis (OA) is increasing in parallel with the aging of the population. The aim of this study is to report the efficacy of an ultrasound-guided intra-articular (IA) hip injection of a single dose of high-weight hyaluronic acid (HA) (2500 kDa) at a follow-up of 12 months. Materials and Methods: 226 patients older than 40 years of age affected by painful hip OA (Kellgren-Lawrence stage 1-2-3) were treated from January 2012 to December 2015 with viscosupplementation. Patients were clinically evaluated before injection (T0) and after 3 months (T3), 6 months (T6) and 1 year (T3) through the WOMAC scale and Harris Hip Score (HHS). Results: During the follow-up period no patients underwent to hip surgery or need adjunctive IA injection of HA. No adverse effects were registered. An improvement in WOMAC and HHS was observed in all patients after treatment. Results showed that patients with grade 2 of osteoarthritis had the higher delta of change in the scores. Discussion: Ultrasound-guided with high weight IA HA injection could be a possibility of treatment in the symptomatic osteoarthritic hip. Subjects with a moderate grade of osteoarthritis (Kellgren-Lawrence stage 2) represent the group that could report the maximum benefits from viscosupplementation. (www.actabiomedica.it)