Knee Osteoarthritis Disease Research Articles

Cell and transcriptomic diversity of infrapatellar fat pad during knee osteoarthritis

ObjectivesIn this study, we employ a multiomic approach to identify major cell types and subsets, and their transcriptomic profiles within the infrapatellar fat pad (IFP), and to determine differences in...

Sex Differences in Ambulatory Biomechanics: A Meta-Analysis Providinga Mechanistic Insight into Knee Osteoarthritis.

Females typically present with a higher prevalence of knee osteoarthritis (KOA), and such a higher prevalence may be due to unique knee biomechanics during walking. However, the sex-dependent ambulatory mechanics has been yet to be clarified. To address this critical knowledge gap, this study implemented a series of computational approaches (1) to identify sex-related knee joint biomechanics during ambulation in persons with KOA and (2) to compare these biomechanical measures between individuals with vs. without KOA, stratified by sex. We searched five electronic databases for studies reporting sex-specific knee biomechanics in persons with and/or without KOA. Summary estimates were computed using random-effects meta-analysis and stratified by sex. The systematic review identified eighteen studies (308 males and 383 females with KOA; 740 males and 995 females without KOA). A series of meta-analyses identified female-specific knee biomechanics in a disease-dependent manner. Females with KOA had lower first peak knee adduction moment and peak knee adduction compared to male counterparts. On the other hand, healthy females had lower peak knee flexion moment than male counterparts. Effect estimate in each meta-analysis display poor quality of evidence according to the GRADE approach. The current study is the first to consider sex as a biological variable into ambulatory mechanics in the development of KOA. We discovered that sex-dependent alterations in knee biomechanics is a function of the presence of KOA, indicating that KOA disease may be a driver of the sex-dependent biomechanical alterations or vice versa. Although no strong conclusion can be drawn because of the low quality of evidence, these findings provide new insight into the sex differences in ambulatory knee biomechanics and progression of KOA.

Time to Total Knee Arthroplasty (TKA) Post Intra-Articular Injection.

Background: Disease-modifying treatments are not currently developed to target the underlying causes of knee osteoarthritis (KOA). Corticosteroids (CS), hyaluronic acid (HA), and platelet-rich plasma (PRP) intra-articular (IA) injections are commonly used for patients that do not respond to non-pharmacological treatments, oral nonsteroidal anti-inflammatory, or pain medications to address solely KOA symptoms. Utilizing TKA as an endpoint in the KOA disease progression provides a basis to determine efficacy of this treatment pathway. The primary objective is to evaluate a large national database to determine the time between first injection and total knee arthroplasty in patients solely administered intra-articular IA, CS, and HA. Methods: A retrospective query was performed on a national, all-payer claims database (PearlDiver, Colorado Springs, CO, USA), a composite of over 160 million Health Insurance Portability and Accountability Act compliant orthopedic records across all states and territories of the United States spanning 2016 to 2022. The database was queried to produce three distinct cohorts for analysis (PRP, HA, and CS). A 4:1 case match was conducted to compare cohorts receiving a subsequent TKA. Kaplan-Meier survival analysis analyzed the TKA-free survival of patients within each group at 6 months and 1 to 4 years. The log-rank test was performed for comparisons between survival cohorts. Results: The PRP cohort had a total population of 3240 patients, of which 71 (2.2%) received a subsequent TKA. The corticosteroid cohort had a total population of 1,382,572, of which 81,271 (5.9%) received a subsequent TKA. The HA cohort had a total population of 164,000, of which 13,044 (8.0%) received a subsequent TKA. Due to the low population within the PRP group, this group was excluded from comparison. The mean time to TKA from first injection in the HA group was 377.8 days, while in the corticosteroid group it was 370.0 days. The proportions of TKA-free survival for CS and HA when compared at 4 years post-injection was similar between groups (p = 0.05). Discussion and Conclusion: Patients that received only IA-corticosteroids or IA-hyaluronic acid had a similar length of time between the first injection and the total knee arthroplasty associated with the injected joint. This evidence provides information for clinicians and patients alike when contemplating these non-surgical injection modalities for KOA. The similarity observed between these treatments supports the need for future research to determine whether there is any potential for reduction in healthcare costs for KOA treatment prior to TKA.

The burden of knee osteoarthritis worldwide, regionally, and nationally from 1990 to 2019, along with an analysis of cross-national inequalities.

To describe the disease burden of knee osteoarthritis (KOA) globally, regionally, and in 204 countries by age, sex, and sociodemographic index (SDI) from 1990 to 2019, and to explore cross-national inequalities across SDI. The Global Burden of Disease (GBD) 2019 database collected data on KOA worldwide from 1990 to 2019, including prevalence, incidence, years lived with disability (YLDs). The average annual percentage change (AAPC) was used to measure temporal trends. In addition, the inequality slope index and the health concentration index were calculated to quantify the unequal distribution of the burden of KOA across 204 countries worldwide. In 2019, the global age-standardized prevalence rate increased by 7.5% compared with 1990, and the age-standardized incidence rate increased by about 6.2%; The age-standardized YLDs rate increased by about 7.8%. In addition to the Republic of Korea and the United States of America, the disease burden of KOA has increased year by year in other countries around the world. The incidence of KOA was highest at ages 50-59, while the prevalence and rates of YLDs were highest at ages 75-84. The burden of KOA was higher in women than in men. Cross-country inequality suggests that the inequality in the burden of KOA between high SDI and low SDI countries becomes greater, and that countries with high SDI bear a disproportionately high burden. The global KOA burden has risen steadily between 1990 and 2019, and cross-national inequality gaps remain large. Targeted measures must therefore be taken to address this inequality and the increasing global KOA disease burden.

Simulation of Lower Limb Muscle Moment and Total Muscle Fiber Force Using OpenSim for Knee Osteoarthritis

Computational modelling is a tool that provide accurate readings and simulation by using a combination of trusted and tested mathematical models of materials and system dynamics. Existing study in gait analysis mostly focus on extrinsic parameter such as kinetics and kinematics measures. The analysis of gait especially for disease such as knee osteoarthritis (OA) can provides insight into muscle properties, activation pattern and potential impact on the knee stability and function. This study aims to simulate and compare muscle activation properties in normal individual and individuals with knee osteoarthritis (OA) during gait phases. This study used musculoskeletal modeling software, OpenSim, to analyze the total fiber force and moment of several key muscles (such as medial gastrocnemius, vastus lateralis, and rectus femoris) relative to knee flexion moments. The motion analysis data of three subjects (one normal subject and two knee OA patients) were used in this study. The results shows that total muscle fiber force and muscle moment for medial gastrocnemius and vastus lateralis muscle were higher among individual with knee osteoarthritis. Meanwhile, rectus femoris muscle behaved differently where both parameters were smaller among knee OA patient. These simulated findings suggest that muscle mechanism changed due to knee osteoarthritis disease. The muscles force and moment were observed in this study gave some insight on the devastating effect of the disease on the lower limb joint muscle. Thus, further study is still warranted to investigate the risk of muscle injury and alteration of gait on individual with knee osteoarthritis. It is highly recommended to repeat this study with larger number of subjects for a better data interpretation.

A Robust Framework for Severity Detection of Knee Osteoarthritis Using an Efficient Deep Learning Model

With the changing lifestyle, a large population suffers from a bone disease known as an osteoarthritis affecting the knee, spine, and hip. Therefore, timely detection and classification of the disease are necessary to minimize the loss, however, it is a time-consuming task and requires various tests and physicians’ in-depth analysis. Thus, an accurate automated technique, timely detection and classification are needed to cope with the aforementioned challenges. This study proposes a technique based on an efficient DenseNet that uses the knee image’ features to identify the Knee Osteoarthritis (KOA) and determine its severity level according to the KL grading system such as Grade-I, Grade-II, Grade-III, and Grade-IV. We introduced the reweighted cross-entropy loss function which makes our proposed algorithm more robust as the training data is imbalanced. The dense connections of efficient DenseNet with regularization power help to reduce the overfitting during the training of small knee sample training sets. The proposed algorithm is an efficient approach that can identify the early symptoms of KOA and classify the severity level of the disease for better decision making by orthopedics. The algorithm is a pre-trained network that does not require a huge training set, therefore, the existing dataset i.e. Mendeley VI has been utilized for the training and testing. Additionally, cross-validation has been employed using the OAI dataset to assess the performance of the proposed model. The algorithm achieved 98.22% accuracy over the testing set and 98.08% accuracy over cross-validation. Various experiments have been performed to confirm that our proposed algorithm is more consistent and capable of detecting and classifying the KOA disease than existing state of the art.

A joint multi-modal learning method for early-stage knee osteoarthritis disease classification

Osteoarthritis (OA) is a progressive and chronic disease. Identifying the early stages of OA disease is important for the treatment and care of patients. However, most state-of-the-art methods only use single-modal data to predict disease status, so that these methods usually ignore complementary information in multi-modal data. In this study, we develop an integrated multi-modal learning method (MMLM) that uses an interpretable strategy to select and fuse clinical, imaging, and demographic features to classify the grade of early-stage knee OA disease. MMLM applies XGboost and ResNet50 to extract two heterogeneous features from the clinical data and imaging data, respectively. And then we integrate these extracted features with demographic data. To avoid the negative effects of redundant features in a direct integration of multiple features, we propose a L1-norm-based optimization method (MMLM) to regularize the inter-correlations among the multiple features. MMLM was assessed using the Osteoarthritis Initiative (OAI) data set with machine learning classifiers. Extensive experiments demonstrate that MMLM improves the performance of the classifiers. Furthermore, a visual analysis of the important features in the multimodal data verified the relations among the modalities when classifying the grade of knee OA disease.

Automatic Detection of Knee Osteoarthritis Disease with the Developed CNN, NCA and SVM Based Hybrid Model

Automatic Detection of Knee Osteoarthritis Disease with the Developed CNN, NCA and SVM Based Hybrid Model

The Correlation Between Age and Body Mass Index and The Incidence of Osteoarthritis in The Elderly at Outpatient Unit of PKU Muhammadiyah Sekapuk Hospital

Aging is often considered as a factor in the occurrence of osteoarthritis because of weakness increased around the joints, cartilage calcification, joint flexibility and chondrocyte function decreased. Osteoarthritis can also be caused by obesity or overweight that occurs in a person with excessive or abnormal amount fat which can be detrimental to health. The aim of this study is to analyze the correlation between age also BMI and the incidence of knee osteoarthritis disease in the elderly at the outpatient unit of PKU Muhammadiyah Sekapuk Hospital.The design was used cross sectional approach, sampling using random sampling method and the number of samples as many as 31 respondents. The analysis used the Chi Square Test with a significant value of < 0.05. The results showed that p-value was 0.025 in the correlation between age and the incidence of osteoarthritis also p-value was 0.023 in the correlation between BMI and the incidence of osteoarthritis which means that there was correlation between age and body mass index and the incidence of osteoarthritis in the elderly at outpatient unit of PKU Muhammadiyah Sekapuk Hospital.

Correlation between osteopontin and cartilage oligomeric matrix protein levels in joint synovial fluid of patients with knee osteoarthritis and disease severity

To investigate the correlation between osteopontin(OPN) and cartilage oligomeric matrix protein (COMP) levels in synovial fluid of patients with knee osteoarthritis(KOA) and the severity of the disease. A total of 59 patients with KOA admitted to our hospital from February 2018 to May 2020 were selected as the KOA group, including 25 males and 34 females, age ranged 60 to 75 years old with an average of(65.57±1.56) years old, the body mass index(BMI) ranged 21.4 to 30.7(26.12±1.54) kg/m2. After admission, X-ray examination was performed, and Kellgren-Lawrence(K-L) grading system was used to evaluate the X-ray examination results. There were 14 cases in gradeⅡ(K-L2 group), 27 cases in grade Ⅲ(K-L3 group), and 18 cases in grade Ⅳ(K-L4 group). Eighteen patients who underwent arthroscopy for ligament or meniscus disease without cartilage damage were selected as control group, including 7 males and 11 females, age ranged 61 to 78 years old with an average of (64.88±1.60) years old, BMI ranged 22.8 to 29.9(25.89±1.49) kg/m2. Before treatment, synovial fluid samples of subjects were collected, and the OPN and COMP levels of synovial fluid were detected by Elisa. The OPN and COMP levels of synovial fluid in KOA group and control group were compared. The clinical data of KOA patients with different K-L grades were collected, including gender, age and BMI. The biochemical indices of interleukin-1 β(IL-1β), OPN, COMP and matrix metalloproteinase 3(MMP-3) in synovitic fluid were detected by enzyme-linked immunoassay, and the clinical data and biochemical indices of KOA patients with different K-L grades were compared. Logistic regression was used to analyze the factors affecting the K-L classification of KOA patients, and the area under the ROC curve(AUC) was used to predict the severity of KOA. All the 59 patients were followed up for 8 to 27(15.75±3.27) months. The levels of OPN and COMP in synovial fluid in KOA group were significantly higher than those in control group (t=16.991, 17.387, P<0.001). The levels of IL-1β, OPN, COMP and MMP-3 in synovitic fluid were significantly different among those in different K-L grade KOA patients(P<0.001). Compared with the K-L2 group, the levels of IL-1β, OPN, COMP, and MMP-3 in the synovial fluid of K-L3 and K-L4 were increased (P<0.05). Compared with the K-L3 group, the levels of IL-1β, OPN, COMP, and MMP-3 in the K-L4 joint were increased (P<0.05). Multivariate Logistic regression analysis showed that the levels of OPN, COMP and MMP-3 were independent risk factors for K-L grading of KOA patients(OR=6.653, 4.229, 1.579, P<0.001). AUC of OPN in synovial fluid predicting K-L4 KOA was 0.720[95%CI(0.588-0.851)], and the sensitivity was 94.4%. the specificity was 65.9%. The AUC of COMP in synoviac fluid predicting K-L4 KOA was 0.731[95%CI(0.592-0.870)], the sensitivity was 88.9%, the specificity was 63.4%. The AUC of OPN combined with COMP in synoviac fluid predicting K-L4 KOA was 0.839 [95%CI(0.724-0.953)], the sensitivity was 94.4%, and the specificity was 51.2%. The AUC of OPN combined with COMP in synoviac fluid predicting K-L4 grade KOA was greater than that of OPN and COMP alone(Z=4.037, 3.540, P<0.05). The levels of OPN and COMP in synovial fluid increase in patients with KOA, and they increase with the increase of K-L grade. Synovitic fluid OPN and COMP are independent risk factors affecting K-L grade of KOA patients, and they have high AUC, sensitivity and specificity in predicting of K-L4 KOA, and can be used to evaluate the progression of KOA disease.

Cross-Tissue Analysis Using Machine Learning to Identify Novel Biomarkers for Knee Osteoarthritis.

Background Knee osteoarthritis (KOA) is a common degenerative joint disease. In this study, we aimed to identify new biomarkers of KOA to improve the accuracy of diagnosis and treatment. Methods GSE98918 and GSE51588 were downloaded from the Gene Expression Omnibus database as training sets, with a total of 74 samples. Gene differences were analyzed by Gene Ontology, Kyoto Encyclopedia of Genes and Genomes pathway, and Disease Ontology enrichment analyses for the differentially expressed genes (DEGs), and GSEA enrichment analysis was carried out for the training gene set. Through least absolute shrinkage and selection operator regression analysis, the support vector machine recursive feature elimination algorithm, and gene expression screening, the range of DEGs was further reduced. Immune infiltration analysis was carried out, and the prediction results of the combined biomarker logistic regression model were verified with GSE55457. Results In total, 84 DEGs were identified through differential gene expression analysis. The five biomarkers that were screened further showed significant differences in cartilage, subchondral bone, and synovial tissue. The diagnostic accuracy of the model synthesized using five biomarkers through logistic regression was better than that of a single biomarker and significantly better than that of a single clinical trait. Conclusions CX3CR1, SLC7A5, ARL4C, TLR7, and MTHFD2 might be used as novel biomarkers to improve the accuracy of KOA disease diagnosis, monitor disease progression, and improve the efficacy of clinical treatment.

Evaluation and Relation Between Inflammatory Marker (Leptin) Level and Knee Osteoarthritis (KOA) Disease

Subject :Knee Osteoarthritis (KOA) is know as degenerative cartilage cell disease in joint association with generation various inflammatory responses . This disease is more common in geriatric and effected by many factors such as obesity . Leptin is hormones secreted of fatty tissue involve as mediators in many pathophysiology process , and support inflammation at cartilage of knee joint . Objective of the Study: Role of leptin concentration level in progression of knee Osteoarthritis . Materials and Methods: This study was done on 60 patients with KOA disease and 60 healthy persons (control ), the all subjects age within this study were more than 60 years of both genders .After obtained serum , immediately used quantity method (immunoassay) for measured level of leptin concentration . Results: This study shows elevation of serum leptin concentration level in KOA group compare with healthy control group . Conclusion: This study confirms that serum leptin concentration level can act as support KOA disease progression

Mechanism of Wuwei Ganlu in treatment of knee osteoarthritis:a study based on network pharmacology and molecular docking

Wuwei Ganlu, a formula for medicated bath, consists of medicinal materials of Ephedra sinica, Platycladus orientalis, Myricaria squamosa, Artemisia carvifolia, and Rhododendron anthopogonoides, which is effective in inducing perspiration, resisting inflammation, relieving pain, regulating yellow water disease, and activating blood circulation. On this basis, a variety of formulas for Tibetan medicated bath have been derived for the treatment of diseases in internal organs, joints, nerves, etc. Modern studies have confirmed that Wuwei Ganlu has a good therapeutic efficacy on knee osteoarthritis(KOA). The present study explored the mechanism of Wuwei Ganlu in treating KOA based on network pharmacology and molecular docking. Firstly, the chemical components of Wuwei Ganlu were obtained through literature mining and database retrieval, and corresponding potential targets were predicted according to the BATMAN-TCM database. The protein-protein interaction(PPI) network was obtained after the potential targets were input into the STRING database. The network function modules were analyzed by the Molecular Complex Detection(MCODE) algorithm, and the functions of the modules were annotated to analyze the action mode of Wuwei Ganlu. Secondly, the related targets of KOA were collected through the DisGeNET database, and the overlapping targets were confirmed to analyze the mechanism of Wuwei Ganlu in treating KOA. Finally, the key targets were selected for molecular docking with the main components of Wuwei Ganlu to verify the component-target interaction. A total of 550 chemical components and 1 365 potential targets of Wuwei Ganlu were obtained. PPI analysis indicated that this formula could exert the effects of oxidation-reduction, inflammation resistance, bone absorption, bone mineralization, etc. Nineteen common targets were obtained from the intersection of potential targets of Wuwei Ganlu and KOA disease targets. It was found that the Wuwei Ganlu mainly acts on nuclear factor-κB(NF-κB), interleukin-1 beta(IL1β), tumor necrosis factor(TNF), IL6, IL1 receptor antagonist(IL1 RN), and prostaglandin-endoperoxide synthase-2(PTGS2) to treat KOA. Among the 550 chemical components of Wuwei Ganlu, 252 potential active components were docked with TNF and 163 with PTGS2, indicating good binding of the components with potential key targets. The study preliminarily explored the mechanism of Wuwei Ganlu in treating KOA to provide a reference for the further development and utilization of Tibetan medicated bath that has been included in the UN Intangible Cultural Heritage.

PMS29 Qualitative Study to Understand the Patient Experience of Knee Osteoarthritis (OA) and Assess the Content Validity of the Knee Injury and Osteoarthritis Outcome Score (KOOS) and HIP Disability and Osteoarthritis Outcome Score (HOOS) Measures

Osteoarthritis (OA) affects 30-million people in the USA, more commonly affecting women. Despite available treatments focusing on symptomatic relief, most patients report inadequate pain management and reduced health-related quality of life. This study aimed to understand knee OA disease burden and to confirm content validity of the Knee injury and Osteoarthritis Outcome Score (KOOS) and Hip Disability and Osteoarthritis Outcome Score (HOOS) in a population that included older patients. A draft conceptual framework was development from reviews of literature and online OA-patient forums. Existing knee OA patient-reported outcome (PRO) measures were also reviewed. Concept elicitation (CE) interviews were conducted with knee OA patients (with/without hip/hand OA), exploring patients’ symptoms, treatments, and impacts. The conceptual model was refined and used to assess coverage of the PRO measures. The KOOS and HOOS were selected for interviews to further confirm their content validity. Three clinicians and a patient advocate provided expert input throughout this study. Thirty patients participated in the CE interviews (age 40-78 years; 60% female). A multitude of symptoms characterized knee OA, markedly pain, stiffness, and swelling. Pain was considered most bothersome and important to treat, with substantial impact on functioning. Treatment symptom relief was partial and/or short-lived. Thirty patients participated in the cognitive interviews (age 40-76 years; 60% female) where 20 and 10 patients were debriefed the KOOS and HOOS, respectively. Most patients confirmed that the items were relevant, well understood and interpreted as intended, although with reports of some unfamiliar phrases such as ‘knee catch/hang up,’ ‘straightening hip fully’ and ‘twisting/pivoting on loaded leg’. Pain, stiffness and swelling are defining knee OA symptoms, which substantially impact functioning, and are only partially relieved by current treatments. The KOOS and HOOS demonstrated strong content validity but may benefit from minor modification (or patient training) to ensure that items are interpreted consistently.

Correlation between Vascular Endothelial Cell Growth Factor (VEGF) and Muscular Ultrasonography Finding in Knee Osteoarthritis

Background: Osteoarthritis (OA) is a degenerative joint disorder affecting articular cartilage that may be associated with synovial inflammation. The vascular endothelial growth factor is implicated in the pathogenesis of OA. This study aimed to assess man serum vascular endothelial growth factor (VEGF) levels in patients with primary knee osteoarthritis (KOA) and to evaluate their correlation with clinical manifestations, physical function and musculoskeletal-ultrasonography findings. Results: This is a case control study conducted on 50 subjects, thirty patients with primary Knee OA recruited from the outpatients’ clinic of the Rheumatology, Rehabilitation and Physical Medicine Department Benha University Hospitals, from November 2018 to November 2019. Twenty age and sex matched apparently healthy adult individuals were also included as a control group. The present study showed a highly statically significant difference (p < 0.0001) between the mean serum levels of VEGF in the patients’ and the control groups being higher in the patients group compared to the control group (<0.001). The current study revealed a strong significant positive correlations of VEGF levels with the presence of Baker’s cysts, cartilage thickness index and color Doppler US grading (p < 0.0001). Significant positive correlations were also reported between VEGA levels (p=<0.001) and WOMAC total and WOMAC sub scores. Conclusions: VEGF serum levels are highly correlated with clinical, functional and musculoskeletal ultrasound severity of KOA. Thus it could be used as a potential biomarker for estimating Knee OA disease status

Determining individual trajectories of joint space loss: improved statistical methods for monitoring knee osteoarthritis disease progression

Knee osteoarthritis (KOA) progression is frequently monitored by calculating the change in knee joint space width (JSW) measurements. Such differences are small and sensitive to measurement error. We aimed to assess the utility of two alternative statistical modelling methods for monitoring KOA. We used JSW on radiographs from both the control arm of the Strontium Ranelate Efficacy in Knee Osteoarthritis trial (SEKOIA), a 3-year multicentre, double-blind, placebo-controlled phase three trial, and the Osteoarthritis Initiative (OAI), an open-access longitudinal dataset from the USA comprising participants followed over 8 years. Individual estimates of annualised change obtained from frequentist linear mixed effect (LME) and Bayesian hierarchical modelling, were compared with annualised crude change, and the association of these parameters with change in WOMAC pain was examined. Mean annualised JSW changes were comparable for all estimates, a reduction of around 0.14mm/y in SEKOIA and 0.08mm/y in OAI. The standard deviation (SD) of change estimates was lower with LME and Bayesian modelling than crude change (SEKOIA SD=0.12, 0.12 and 0.21 respectively; OAI SD=0.08, 0.08 and 0.11 respectively). Estimates from LME and Bayesian modelling were statistically significant predictors of change in pain in SEKOIA (LME P-value=0.04, Bayes P-value=0.04), while crude change did not predict change in pain (P-value=0.10). Implementation of LME or Bayesian modelling in clinical trials and epidemiological studies, would reduce sample sizes by enabling all study participants to be included in analysis regardless of incomplete follow up, and precision of change estimates would improve. They provide increased power to detect associations with other measures.

Comparing walking biomechanics of older females in maximal, minimal, and traditional shoes

BackgroundKnee osteoarthritis (OA) is a degenerative joint disease that affects millions of individuals each year. Several biomechanical variables during walking have been identified as risk factors for developing knee OA, including the peak external knee adduction moment (KAM) and the knee flexion angle at initial contact. Many interventions have been studied to help mitigate these risk factors, including footwear. However, it is largely unknown how varying shoe cushioning may affect walking biomechanics related to knee OA risk. Research QuestionWhat is the effect of maximally and minimally cushioned shoes on walking biomechanics compared to a traditionally cushioned shoe in older females? MethodsWalking biomechanics in three shoes (maximal, traditional, minimal) were collected on 16 healthy females ages 50–70 using an 8-camera 3D motion capture system and two embedded force plates. Key biomechanical variables related to knee OA disease risk were compared between shoes using repeated measures ANOVAs. ResultsThe KAM was significantly larger in the maximal shoe (p = 0.005), while the knee flexion angle at initial contact was significantly larger in both the maximal and minimal shoe compared to the traditional shoe (p = .000). Additionally, the peak knee flexion angle (p = .000) and the loading rates of the vertical ground reaction force were (instantaneous: p = 0.001; average: p = .010) were significantly higher in the minimal shoe. SignificanceWhile these results are specific to the shoes used in this study, clinicians should exercise caution in prescribing maximal or minimal shoes to females in this age group who may be at risk of knee OA given these results. Research is needed on the effect of these shoes in patients with knee OA.

Responsiveness of Pain and Associated Health Issues of Patients with Knee Osteoarthritis to the Revulsive Compresses

Background: Osteoarthritis disease (OA) is a major public health problem globally, affecting the cartilage of joint and contributing to reduced function that affects the quality of life. Knee Osteoarthritis disease (KOA) is considered the most frequent reason for knee pain in both adult and elder people. Although pain is the main and most common disabling symptom for KOA patients; however, knee stiffness, oedema, disfigurement, and decreased functional ability such as walking, are widespread associated health issues of those patients. Since there is no cure for OA, the aim of therapy is generally to reduce pain, manage symptoms, improve joint function, and minimize disability. Revulsive compresses are a hydrotherapy procedure commonly used to eliminate or reduce pain and related KOA effects. Study aim: evaluate the responsiveness of pain and associated health issues of patients with knee osteoarthritis to the revulsive compresses. Study Design: a quasi-experimental design. Setting: Orthopedic and Rheumatology Outpatient clinics at Zagazig University Hospitals, Egypt. Subject: a purposive sample included 60 adult patients with knee osteoarthritis. Tools: A structured interview questionnaire; 0-10 Numeric pain rating scale; and Knee Injury and Osteoarthritis Outcome Score were used to collect data. Results: there was a statistically significant reducing and improving the pain intensity level and knee OA associated health issues as pain; other symptoms; difficulty in performing activities of daily living functions, activities of sports and recreational functions and quality of life-related to the knee after applying of revulsive compresses compared to before applying it. Conclusions: the pain and associated health issues of patients with knee osteoarthritis have positive responsiveness to Revulsive compresses, this leads us to conclude that the Revulsive compresses are effective in reducing and improving both pain and associated health issues of those patients. Recommendations: The early strategies for managing patients with knee osteoarthritis should include revulsive compresses to reduce pain and improve the associated health issues for those patients.

Sex- and osteoarthritis-related differences in muscle co-activation during weight-bearing tasks

BackgroundIndividuals with knee osteoarthritis (OA) demonstrate impairments in muscle function (i.e. muscle weakness, high muscle co-activation believed to have detrimental effects on joint integrity). Women with knee OA exhibit poorer health outcomes than men. Sex and muscle function are known risk factors for knee OA. It is unclear how these risk factors are associated with muscle function in knee OA and the implications for disease aetiology. Research questionHow does sex and knee osteoarthritis disease status relate to muscle function, specifically strength and muscle co-activation, during walking, stair negotiation and sit-to-walk activities. MethodsA cross-sectional study assessed muscle co-activation in 77 individuals with knee OA (mean[SD], 62.5[8.1] years; 48/29 women/men) and 18 age-matched controls (62.5[10.4] years; 9/9 women/men), during a series of walking, stair ascent and descent and sit-to-walk activities. Muscle strength of the knee extensors and flexors was assessed using maximal voluntary isometric contractions (MVIC). Electromyography was recorded from the vastus lateralis/medalis, rectus femoris, biceps femoris, semitendinosus, medial/lateral gastrocnemius normalised to MVIC. Multiple regression assessed the relationship between sex, disease status, and muscle strength on muscle co-activation. ResultsIndividuals with knee OA were weaker than controls, had higher hamstrings-quadriceps and medial-lateral co-activation for specific phases of gait. Women were weaker than men with higher muscle co-activation across all activities. Sex and muscle weakness, but not age or disease status predicted high muscle co-activation. SignificanceHigh muscle co-activation was associated with female sex and muscle weakness regardless of disease status and age. High muscle co-activation is believed to be a compensatory mechanism for muscle weakness to maintain a certain level of function. High muscle co-activation is also thought to have detrimental effects on cartilage and joint integrity this may explain high muscle co-activation in women with muscle weakness and contribute to increased risk of incidence and progression of knee OA in women.

Association of IL-6, IL-8, MMP-13 gene polymorphisms with knee osteoarthritis susceptibility in the Chinese Han population.

Objective: To identify the association between the interleukin (IL) 6 (IL-6) rs1800795 (-174 G>C), IL-8 rs4073 (-251T>A), and matrix metalloproteinase-13 (MMP-13) rs2252070 (-77G>A) gene polymorphisms and knee osteoarthritis (KOA) susceptibility in the Chinese Han population. Methods: Genomic DNA was extracted from a total of 400 KOA patients and 400 healthy subjects. Sanger sequencing was performed to determine the genotypes of the IL-6 rs1800795 (-174 G/C), IL-8 rs4073 (-251A/T), and MMP-13 rs2252070 (-77A/G) loci. The mRNA expression levels of IL-6, IL-8, and MMP-13 in osteoblasts and the protein expression levels of IL-6, IL-8, and MMP-13 in the synovial fluids of KOA patients were analyzed. Results: The recessive model of IL-6 rs1800795 locus was found to be associated with KOA risk (adjusted odds ratio (OR) = 1.657, 95% confidence interval (CI) = 1.396–1.866, P<0.001). The IL-8 rs4073 locus dominant and recessive model showed no significant association with KOA risk (P>0.05). The dominant and recessive models of the MMP-13 rs2252070 locus showed higher risk for developing KOA (dominant model: adjusted OR = 1.271, 95%CI = 1.095–1.480, P=0.001; recessive model: adjusted OR = 1.361 95%CI = 1.151–1.569, P<0.001). The G>C mutation in IL-6 rs1800795 and the G>A mutation in MMP-13 rs2252070 were associated with significantly higher KOA disease severity. The G>C mutation in the IL-6 rs1800795 locus was associated with up-regulation of IL-6 expression. The G>A mutation in the MMP-13 rs2252070 locus was associated with up-regulation of MMP-13 expression. Conclusion: The IL-8 rs4073 (-251T>A) mutation was not associated with KOA susceptibility. The IL-6 rs1800795 (-174 G>C) and MMP-13 rs2252070 (-77G>A) mutations were associated with KOA susceptibility, increased disease severity, and up-regulation of IL-6 and MMP-13 expression levels.