Osteoarthritis Research Articles

Management of knee osteoarthritis using bone marrow aspirate concentrate: a systematic review.

Knee osteoarthritis (OA) is a common degenerative joint condition and a major cause of disability in the general population. Recent published literature identified from PubMed, EMBASE, Google Scholar, and Scopus. Orthobiological therapies try to regenerate articular cartilage and stop the progression of the degenerative lesion. Intra-articular injections of biological derivates have been increasingly used in the last decade. The indications for the use of bone marrow aspirate concentrate (BMAC) are still unclear. We systematically reviewed the current literature on BMAC in the management of knee OA, giving an update on the current indications for the selection of the ideal patient and the preparations and efficacy of BMAC compared to other biological alternatives. BMAC is a valuable source of mesenchymal stem cells, offering potential benefits in attenuating the inflammatory pathway associated with knee OA. Intra-articular injection of BMAC has shown effectiveness in clinical trials improving functional outcomes of knee OA patients. The superiority of BMAC over other orthobiological treatments cannot be assessed because of conflicting results.

High- versus low-intensity resistance exercise in the treatment of pain in patients with knee osteoarthritis

High- versus low-intensity resistance exercise in the treatment of pain in patients with knee osteoarthritis

Changes in Muscle Mass and Bone Density and Their Relationship After Total Knee Arthroplasty

Purpose: To investigate the effects of total knee arthroplasty (TKA) on muscle mass and bone density in end-stage knee osteoarthritis (OA). Methods: This prospective study was conducted on 111 patients with Kellgren–Lawrence grade 4 knee OA who underwent TKA after failing to respond to conservative treatment for more than 3 months at a single institution from June 2022 to May 2023. Appendicular lean mass index (ALMI) and bone mineral density (BMD) were measured using dual-energy X-ray absorptiometry before and every 6 months after surgery. The average follow-up period was 15.5 ± 2.31 months (range, 11.6–24 months). Results: During the follow-up period after TKA, the ALMI increased relatively continuously and consistently. The BMD of the L-spine and proximal femur did not change significantly until 12 months after TKA surgery but began to increase steeply after 12 months and slowed down after 18 months. The increase in muscle mass showed a significant positive correlation with the increase in BMD. Conclusions: Muscle mass gradually increased after TKA for end-stage knee OA, whereas bone density also increased but not until 12 months after surgery. The significant positive correlation between the increase in muscle mass and bone density suggests that the increase in muscle mass after TKA may be one of the causes of the increase in bone density.

Association of neighborhood-level disadvantage beyond individual sociodemographic factors in patients with or at risk of knee osteoarthritis

ObjectiveLower socioeconomic status (SES) is a risk factor for poorer pain-related outcomes. Further, the neighborhood environments of disadvantaged communities can create a milieu of increased stress and deprivation that adversely affects pain-related and other health outcomes. Socioenvironmental variables such as the Area Deprivation Index, which ranks neighborhoods based on socioeconomic factors could be used to capture environmental aspects associated with poor pain outcomes. However, it is unclear whether the ADI could be used as a risk assessment tool in addition to individual-level SES.MethodsThe current study investigated whether neighborhood-level disadvantage impacts knee pain-related outcomes above sociodemographic measures. Participants were 188 community-dwelling adults who self-identified as non-Hispanic Black or non-Hispanic White and reported knee pain. Area Deprivation Index (ADI; measure of neighborhood-level disadvantage) state deciles were derived for each participant. Participants reported educational attainment and annual household income as measures of SES, and completed several measures of pain and function: Short-form McGill Pain Questionnaire, Western Ontario and McMaster Universities Osteoarthritis Index, and Graded Chronic Pain Scale were completed, and movement-evoked pain was assessed following the Short Physical Performance Battery. Hierarchical linear regression analyses were used to assess whether environmental and sociodemographic measures (i.e., ADI 80/20 [80% least disadvantaged and 20% most disadvantaged]; education/income, race) were associated with pain-related clinical outcomes.ResultsLiving in the most deprived neighborhood was associated with poorer clinical knee pain-related outcomes compared to living in less deprived neighborhoods (ps < 0.05). Study site, age, BMI, education, and income explained 11.3–28.5% of the variance across all of the individual pain-related outcomes. However, the ADI accounted for 2.5–4.2% additional variance across multiple pain-related outcomes.ConclusionThe ADI accounted for a significant amount of variance in pain-related outcomes beyond the control variables including education and income. Further, the effect of ADI was similar to or higher than the effect of age and BMI. While the effect of neighborhood environment was modest, a neighborhood-level socioenvironmental variable like ADI might be used by clinicians and researchers to improve the characterization of patients’ risk profile for chronic pain outcomes.

Grading of Knee Osteoarthritis Based on Kellgren-Lawrence Classification and Finding an Association Between Radiographic Features and Pain: A Cross-Sectional Study at a Tertiary Health Care Hospital

Grading of Knee Osteoarthritis Based on Kellgren-Lawrence Classification and Finding an Association Between Radiographic Features and Pain: A Cross-Sectional Study at a Tertiary Health Care Hospital

Analgesic use may not decrease in the first postoperative year in patients underwent total knee arthroplasty due to advanced osteoarthritis

BackgroundTotal knee arthroplasty (TKA) is expected to relieve pain and reduce the use of analgesics in patients with advanced knee osteoarthritis. However, in some cases, there is no relief in the pain of the patients and the use of analgesics continues. The aim of this study was to compare analgesic consumption one year before and after TKA in the same patient group and to evaluate whether there is a decrease in analgesic consumption after TKA. MethodThe cumulative amounts of analgesia used by the patients in the one-year periods before and after the operation were checked from the automated patient records system and the national systems showing drug prescriptions. The dosages of all the analgesics used in the one-year periods before and after the operation were calculated and converted to oral morphine equivalents (OME). The demographic data of the patients, cumulative OME and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were used in the assessment. ResultsIt was observed that there was a statistically significant improvement in Womac scores after the treatment compared to the pre-treatment. Although the mean amount of analgesics decreased compared to pre-treatment, it was not statistically significant. Also, age and preoperative analgesic use were found to be the two most important factors in relation to total postoperative analgesic consumption. ConclusionThe results of this study indicate that there may not be a substantial reduction in the use of analgesic by patients within the first year after TKA. Furthermore, the age and preoperative analgesic use were identified as the two primary factors influencing postoperative analgesic consumption. Level of evidenceRetrospective Cohort Study.

Impact of Knee Osteoarthritis and Arthroplasty on Full Body Sagittal Alignment in Adult Spinal Deformity Patients.

Retrospective analysis of prospectively collected data. This study evaluates the impact of knee osteoarthritis (OA) and knee arthroplasty on alignments and patient-reported outcomes measures (PROMS) of patients undergoing adult spinal deformity (ASD) corrective surgery. The relationship between knee OA and spinal alignment in patients with ASD is incompletely understood. It is also unknown how patients with knee arthroplasty and ASD compare to ASD patients with native knees. Baseline full-body radiographs were used, and hip and knee OA were graded by two independent reviewers using the KL classification. Spinopelvic parameters and PROMs were compared across the different knee OA groups and compared between patients with knee replacement and native knees. 199 patients with bilateral non severe OA (G1), 31 patients with unilateral severe knee OA (G2), and 60 patients with bilateral severe knee OA (G3). Patients with severe knee OA presented with worse spinopelvic parameters. However, after multivariable regression analysis controlling for age, frailty, PI, T1PA, knee OA was an independent predictor of knee flexion (G1:-0.02±7.3, G2: 7.8±9.4, G3: 4.5±8.7, P<0.001), and ankle dorsiflexion (G1: 2.3±4.0, G2: 6.6±4.5, G3: 5.1±4.1, P<0.001). There was no difference in PROMs (P>0.05). Secondary analysis included 96 patients: 48 patients (50%) with non-severe knee OA, and 48 patients (50%) with knee replacement. There was no difference in radiographic parameters or PROMs between the groups. In this study of complex ASD patients, patients with worse spinal deformity were more likely to have concomitant knee OA. Knee OA was shown to be a predictor of knee flexion and ankle dorsiflexion angles, but was not associated with worse PROMs in this study population. Patients with knee arthroplasty, however, had comparable spinal alignment and PROMs relative to those with mild OA.

Predictive analysis of osteoarthritis and chronic pancreatitis comorbidity: complications and risk factors

BackgroundThe comorbidity of chronic pancreatitis (CP) in patients with osteoarthritis (OA) is insufficiently studied, and the reciprocal impact of these conditions remains poorly understood. This study aimed to investigate potential predictors for the development of CP in OA patients, as well as associated complications.MethodsA cohort of 181 patients was categorized into four groups: a control group (n=30), patients with OA (n=68), patients with CP (n=31), and patients with OA and comorbid CP (n=52). All four groups had no statistical differences in age and gender. The study utilized the WOMAC index, Visual Analog Scale (VAS), Lequesne index, biochemical assays, and advanced statistical methods to assess joint status in OA patients with comorbid CP. It explored potential predictors of comorbidity development and associated complications.ResultsThe study revealed that concurrent CP in OA exacerbates progression and contributes to malnutrition. Body Mass Index (BMI) emerged as a potential predictor for CP comorbidity development in OA patients. Factors such as the WOMAC total score, fecal elastase-1, C-reactive protein (CRP), ferritin, retinol, tocopherol, 25-hydroxyvitamin D3, and BMI were found to influence the development of comorbidity of CP in OA. Additionally, Gastrointestinal Symptom Rating Scale-Diarrhea Syndrome (GSRS-DS), Gastrointestinal Symptom Rating Scale-Constipation Syndrome (GSRS-CS), Qualitative Assessment of the Symptoms and Impact of Pancreatic Exocrine Insufficiency Domain A (PEI-Q-A), retinol, tocopherol, and iron were identified as potential predictors comorbidity CP with exocrine pancreatic insufficiency in OA patients.ConclusionThe presence of CP in OA patients exacerbates disease progression and complications, necessitating further investigation.

Effect of low-intensity muscle strength training on postoperative rehabilitation and adverse events in patients with knee osteoarthritis over 55 years of age: a meta-analysis

BackgroundThis study aimed to study the effect of low-intensity muscle strength training on postoperative rehabilitation of patients with knee osteoarthritis over 55 years of age and the incidence of adverse events by a meta-analysis.MethodsWe searched China National Knowledge Infrastructure (CNKI), WanFang, China Science and Technology Journal Database (VIP), PubMed, Web of science, and Embase databases for articles on the effect of low-intensity muscle strength training on the recovery of patients with knee arthritis. And meta-analysis combined effect was performed in R 4.2.2 software. Quantitative analysis and risk of bias were assessed by Begg’s and Eegger’s test.ResultsMeta-analysis showed that the effect of low-intensity muscle strength training on postoperative knee range of motion in patients with knee arthritis was mean difference (MD) = 5.20, 95% CI=[4.00, 6.40], τ2 = 0.43, P = 0.34; the effect on postoperative muscle strength was standard mean difference (SMD) = 1.24, 95% CI=[0.86, 1.61], τ2 = 0.07, P < 0.01; the effect on postoperative knee joint score was MD = 5.88, 95%CI=[2.09, 9.67], τ2 = 16.60, P < 0.01; the effect on postoperative knee visual analogue scale (VAS) score was MD=-1.12, 95%CI =[-1.43, -0.81], τ2 = 0.09, P < 0.001; the effect on the incidence of adverse events was RR = 0.85, 95%CI= [0.52 1.39], τ2 = 0.79, P = 0.04.ConclusionLow-intensity muscle strength training can improve the muscle strength of the affected limb and knee joint score, reduce the VAS score and the incidence of adverse events in patients with knee osteoarthritis over 55 years of age after surgery, but it has no effect on the postoperative knee range of motion, so it can be considered as appropriate in clinical selection.

Protective mechanism of Prim-O-glucosylcimifugin in the treatment of osteoarthritis: Based on lncRNA XIST regulation of Nav1.7

LncRNA XIST and Nav1.7 have been identified to be significantly associated with the onset of osteoarthritis. Prim-O-glucosylcimifugin (POG) has antiinflammatory and analgesic effects in treating osteoarthritis (OA). However, its molecular mechanism of action remains unclear. This research investigated whether POG inhibits OA cartilage degeneration by regulating Nav1.7 through lncRNA XIST. We observed the relationship between lncRNA XIST and Nav1.7 through in vivo and in vitro experiments, and utilized lentiviral plasmids for XIST overexpression to further validate the protective effect of POG against OA. In vivo experiments revealed the close association of improving OA cartilage morphological changes by POG with lncRNA XIST and Nav1.7 downregulation and related proteins expression. In vitro experiments demonstrated significantly up-regulated lncRNA XIST and Nav1.7 expression in IL1β-induced chondrocytes, and their levels and related protein expression decreased after POG intervention. FISH indicated that POG attenuated the fluorescence intensity of lncRNA XIST in chondrocytes. RT-PCR and Western blot assays revealed the positive correlation of lncRNA XIST and Nav1.7 expression in chondrocytes. Additionally, flow cytometry results revealed that POG intervention reduced OA chondrocyte apoptosis. Therefore, we conclude that POG can mediate lncRNA XIST to regulate Nav1.7 to delay cartilage degeneration, which is an effective way to treat OA. However, lncRNA XIST is not the only target for regulation, and further discussion is needed.

Total Knee Arthroplasty in Patients With Ankle Osteoarthritis Affects Contralateral Ankle Alignment and Postoperative Outcome of Total Knee Arthroplasty.

This study investigated the impact of total knee arthroplasty (TKA) on the alignment of the ankle joint, focusing on changes in coronal alignment of both ankles. This retrospective study, conducted at our hospital, included 64 patients older than 70 years who underwent TKA for varus knee osteoarthritis (OA). Using full-length standing radiographs of both lower extremities taken preoperatively and 6 months postoperatively, we assessed ankle OA grading based on the Takakura-Tanaka classification and measured mechanical hip-knee-ankle (mHKA) and the tibiotalar angle (TTA) on both the surgical and contralateral side. Additionally, we examined the impact of ankle OA on postoperative clinical scores, the Knee injury and Osteoarthritis Outcome Score, following TKA. Based on the classification, ankle OA stage 2 or higher was present in 13 cases on the surgical side and 13 cases on the contralateral side. On the surgical side, mHKA changed from 12.2 to 1.8 degrees varus (P < .001) and TTA from 1.7 to 1.0 degrees varus (P = .002). On the contralateral side, mHKA changed from 4.0 to 5.4 degrees varus (P = .04), and TTA from 2.7 to 3.0 degrees varus (P < .001). In ankle OA stage 2 or higher patients, contralateral TTA changed from 5.2 to 6.5 degrees varus (P < .001) and unchanged in stage 1 patients. Ankle OA stage 2 or higher patients had worse ADL outcomes than stage 1 patients (score: 67.2 and 78.3, respectively, P = .03). This study suggests an apparent interrelationship between knee and ankle OA and the potential negative influence of TKA on ankle OA.

Interconnected Pathways: Exploring Inflammation, Pain, and Cognitive Decline in Osteoarthritis

The relationship among inflammation, pain, and cognitive decline in osteoarthritis (OA) patients is complex and has not been sufficiently explored; therefore, we undertook this research to evaluate how OA-related inflammation and pain affect cognitive functions, as well as to examine the potential of urinary markers as indicators of these conditions. This study examined fifty OA patients through clinical and cognitive assessments, morphological analyses, urinary biomarkers, and bioinformatics. Morphologically, 24% of patients had moderate to high synovial inflammation, which was significantly correlated with depressive symptoms, pain intensity, and self-reported anxiety. The Montreal Cognitive Assessment indicated minimal decline in most patients but showed negative correlations with age and inflammation severity. Urinary TNF-α and TGF-β1 levels positively correlated with body mass index and pain and synovitis score and immune cell infiltration, respectively. In contrast, cartilage oligomeric matrix protein and C-telopeptides of type II collagen showed inverse correlations with pain duration and cognitive function, respectively. Distinct patient clusters with higher inflammation were identified and were associated with reported pain and depressive symptoms. Urinary TNF-α and TGF-β1 can serve as biomarkers reflecting inflammation and disease severity in OA. This study suggests that synovial inflammation may be linked to mental and cognitive health in some patient cohorts.

Evaluation of three acetabular measurement methods for total hip replacement in dogs.

To compare three measurement methods for acetabular sizing and evaluate the influence of osteoarthritis (OA) on the accuracy of measurements. Observational study. Radiographic images of 73 hip joints from 60 dogs with cementless cups. Radiographs were anonymized and measured independently by three observers. One observer measured 12 sets of radiographs three times. A best-fit acetabular circle (AC) and cranial-caudal acetabular line (AL) were measured on ventral-dorsal (VD) radiographic view and open leg lateral (OLL) view. A best-fit femoral head circle (FHC) was measured on VD, OLL, and craniocaudal horizontal beam (CCHB) views. Two observers scored the OA in each hip joint. Intra- and interobserver consistency and repeatability and bias relative to implanted cup size were calculated and analyzed. Intraobserver consistency and repeatability were excellent for all measurements. Interobserver consistency was excellent (ICC > 0.9) for ACVD and ACOLL and was good (0.75 < ICC ≤ 0.9) for all other methods. Bias was small for AC and AL measurements (range, -0.46 to 0.45 mm) and large for FHC measurements (-3.58 to -2.42 mm). OA score significantly influenced bias for all acetabular measurement methods (p < 0.05). All acetabular measurement methods were highly consistent within an observer. Interobserver consistency was highest for ACVD and ACOLL. FHC measurements underestimated cup size. Higher OA scores decreased the accuracy of all acetabular measurement methods. Superimposing a circle on the acetabulum seen on VD radiographic view accurately measures the acetabulum before cementless cup placement.

Efficacy of Autologous Micrografting Technology in Managing Osteoarthritis Pain: A Pilot Study

Osteoarthritis (OA) is one of the most common joint diseases worldwide, predominantly present in elderly people. Being a major source of pain for patients, it is debilitating and leads inevitably to a reduction in quality of life. The management of OA needs a personalized and multidimensional approach, resulting in the emergence of new regenerative and non-invasive methods, such as the use of micrografts. In this pilot study, Rigenera® Technology was employed to obtain micrografts of cartilage tissue to be injected into the knees of 10 patients with osteoarthritic pain. To assess the efficacy of the treatment concerning pain reduction at this site, patients were asked to complete KOOS and WOMAC questionnaire and a VAS test before and after the procedure. The results presented in this article show how Rigenera® treatment can potentially improve OA symptoms, alleviating pain in patients.

Artemisinin emulgel ameliorates cartilage degradation in knee osteoarthritis: in vitro and in vivo studies.

Aim: Laboratory scale-up of artemisinin-loaded emulgel (ART-emulgel) was carried out and characterized for therapeutic performance in osteoarthritis (OA).Materials & methods: The solubility of ART in various oils, surfactants and co-surfactants were screened for construction of pseudo ternary phase diagram (TPD), followed by scale-up of artemisinin loaded nanoemulsion (ART-NE). ART-NE was amalgamated with Carbopol Ultrez 10-NF to prepare ART-emulgel that was later characterized invitro and invivo to analyze therapeutic efficacy in monosodium-iodoacetate (MIA) induced knee OA.Results: The droplet diameter of ART-NE was estimated to be 104.3±2.593nm with a polydispersity index of 0.245±0.019 in addition to ζ-potential of 0.434±0.028mV. Steady-state flux and permeability coefficient for ART-emulgel were estimated to be 0.651±0.031 µg.cm2/h and 0.245±0.011cm/h, respectively. ART-emulgel demonstrated 43.18% reduction in COX-2 level; 52.28% drop in IL-1β, and 88.78% alleviation of Tumor Necrosis Factor-α (TNF-α) level when compared with monosodium-iodoacetate induced OA rats. ART-emulgel and injectable ART (intra-articular; I.A) portrayed minor synovial erosion compared with blank and diclofenac emulgel. Histopathological evidences indicated restoration of cartilage integrity followed by reduction of OARSI scores in ART-emulgel when compared with disease control animals.Conclusion: ART-emulgel is a potential dosage form for translating into a clinically viable product for the management of OA.

Effect of femoral prosthesis flexion angle on unicompartmental knee arthroplasty with mobile platform

ObjectiveTo investigate the effect of the flexion angle of a femoral prosthesis on the postoperative clinical outcome of patients with knee osteoarthritis who are undergoing unicompartmental knee arthroplasty.MethodsPatients were divided into three groups according to the flexion angle of the femoral prosthesis following unicompartmental knee arthroplasty. Group A comprised patients with a flexion angle of the femur prosthesis of less than 5°, Group B included those with a flexion angle of 5° to 10°, and Group C consisted of patients with a flexion angle of the femur prosthesis greater than 10°. The basic clinical data, visual analog scale (VAS) score, Hospital for Special Surgery (HSS) score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score and knee range of motion (ROM) were subjected to statistical analysis and comparison between the groups.ResultsNo significant differences were observed in the basic data of the patients in each group. The ROM and VAS scores for the knee in the first month following unicompartmental knee arthroplasty in groups B and C were significantly greater than those in group A. The HSS scores for the knee joint in Group B indicated superior outcomes in the initial postoperative month and the third postoperative month, as evidenced by the WOMAC scores, which demonstrated a statistically significant difference between Group B and the other two groups within the six-month postoperative period.ConclusionThe short-term recovery of patients in Group B was the fastest. These results provide a new reference for the installation of femoral prostheses in unicompartmental knee arthroplasty.

The effects of pre-operative anti-osteoporotic use on total joint arthroplasty complications: A national database study

BackgroundThe current study aims to analyze the effect of pre-operative non-bisphosphonate anti-osteoporotic drugs on complication and revision rates following total joint arthroplasty (TJA). MethodsA retrospective cohort analysis of the PearlDiver (PearlDiver Technologies, Colorado Springs, CO) database was performed. The database was queried to identify all patients who underwent total hip arthroplasty (THA) or total knee arthroplasty (TKA) with history of hip or knee osteoarthritis and either osteopenia or osteoporosis. The treatment groups consisted of patients prescribed non-bisphosphonate and bisphosphonate osteomodulatory agents for 1 year prior to and following surgery. The treatment groups were matched to control cohorts by age, gender, and comorbidities. Chi-square analyses were used to compare outcomes between paired cohorts. ResultsThere were no statistically significant differences (p ≤ 0.05) in risk of aseptic loosening, broken prosthesis, dislocation of prosthetic joint, periprosthetic fracture, periprosthetic osteolysis, postoperative infection, full or partial revision, or stress fracture between both the non-bisphosphonate and bisphosphonate groups following THA or TKA. Comparisons between both groups and control cohort also yielded no significant differences. ConclusionThe current study detected no significant differences in early post-operative complications following TJA between patients treated with different classes of anti-osteoporotic medications versus untreated osteopenic/osteoporotic patients. Further research is required to fully understand the impact of osteomodulatory medications on TJA outcomes. Analysis should continue to ensure a high-quality standard of care and aim to better understand outcomes for such patients requiring TJA.

Portable Gait Analysis of Patients With Rotating Hinge Knee Megaprosthesis Compared With Total Knee Arthroplasty.

The gait analysis of patients after surgery for tumors around the knee joint relies on the use of a three-dimensional motion capture system. However, obtaining long-term, free-standing, real-world gait data with three-dimensional gait analysis is challenging. In this study, we utilized a portable gait analyzer to collect gait data from patients who underwent rotating hinge knee megaprosthesis (RHK) and total knee arthroplasty (TKA), this study aims to compare via gait analysis patients who underwent megaprosthesis with patients with TKA. A retrospective study was conducted on eight patients with knee bone tumors (RHK group) and ten patients with knee osteoarthritis who underwent standard TKA (TKA group) from January 2018 to January 2022. Gait analysis, was conducted using the Intelligent Device for Energy Expenditure and Activity (IDEEA), and the results were compared with those of a healthy control group. The lower limb alignment of the RHK and TKA groups was evaluated, and the KSS scores of the two groups were collected and compared. Energy consumption during a 20-m walk was measured and compared among the RHK, TKA, and healthy control groups using one-way ANOVA. Paired t-tests were used to compare the operated and nonoperated limbs within groups. All patients exhibited slower walking speeds and cadence than the healthy control participants (p < 0.01), While no significant differences were found between the RHK and TKA groups. The single support time (521.15 ± 94.56 ms) of the RHK-operated limb was significantly shorter than that of the nonoperated limb (576.53 ± 77.40 ms, p = 0.004). The pulling acceleration of the RHK group (0.71 ± 0.27 G) was lower than that of the TKA group (1.04 ± 0.31 G, p = 0.029). The push-off angle in the RHK group (24.91° ± 10.91°) was significantly greater than that in the TKA group (10.64° ± 5.41°, p = 0.007). The RHK group showed significant differences between the operated and nonoperated limbs in terms of swing power, ground impact, footfall, and push-off. The RHK (0.03 ± 0.01 kcal/min/kg) and TKA (0.029 ± 0.01 kcal/min/kg) groups had significantly greater energy expenditures than did the healthy control group (0.02 ± 0.00 kcal/min/kg, p < 0.05). The comparison of HKA angles and KSS scores between the TKA and RHK groups showed statistically significant differences. A portable gait analyzer appears to be suitable for evaluating the effects of RHK. RHK patients demonstrate more pronounced gait abnormalities than TKA patients, reflected in greater energy expenditure, implying reduced walking efficiency. This suggests the need for increased energy expenditure in RHK patients to compensate for abnormal knee joint conditions during walking and maintain body balance.

Added value of pre-procedural magnetic resonance angiography in transarterial embolization for refractory musculoskeletal pain

BackgroundTransarterial microembolization (TAME) is a minimally invasive treatment for chronic musculoskeletal disorders. Identifying angiogenesis and the supplying vessels of the target joint is important but challenging. Although magnetic resonance imaging (MRI) is commonly used to diagnose musculoskeletal diseases, it typically excludes vascular imaging. Dynamic contrast-enhanced magnetic resonance angiography (DCE-MRA) has the ability to visualize lesion angiogenesis, identify supplying vessels, and evaluate the vasculature anatomy. We propose that incorporating DCE-MRA into pre-procedural assessments can help identify the culprit vessels, arterial anatomy, and variant assessment of the target joint before TAME.Materials and methodsWe investigated six cases, each presenting pain in different body parts: shoulder adhesive capsulitis, trapezius myalgia, combined tennis and golf elbow, knee osteoarthritis, refractory knee pain after osteotomy, and plantar fasciitis. All patients underwent MRI with DCE-MRA before undergoing TAME. DCE-MRA was performed using either 1.5 T or 3 T MRI scanners, employing 3D-TRICKS or 4D-TRAK XD techniques. The numerical rating scale for pain was evaluated at one, three, and six months after the procedure, and any adverse events were recorded over the entire six-month follow-up period.ResultsPre-procedural DCE-MRA helped to visualize angiogenesis at the lesion site in all patients and identify the supplying vessels, arterial vasculature anatomy, and branching variants. These findings corroborated the subsequent digital subtraction angiography (DSA) findings obtained during TAME. All patients experienced pain reduction and functional improvement after TAME without any complications. The average pain score reduced significantly after TAME treatment (p &amp;lt; 0.05). Two patients underwent a second MRI and DCE-MRA at the six-month follow-up and showed a significant reduction in angiogenesis.ConclusionDCE-MRA offers a valuable pre-procedural assessment tool for TAME procedures by facilitating the visualization of angiogenesis at the lesion site, supplying vessels, and arterial anatomic variants, including the variable orifice of the supplying branches. This information can potentially improve patient selection and pre-procedural planning, leading to better outcomes and reduced risk of complications.

Interrater reliability of RheuMetric checklist scales for Physician Global Assessment, inflammation, damage and patient distress

Abstract Objective To analyze interrater reliability of four RheuMetric checklist 0–10 visual numerical scales (VNS) of physician global assessment (DOCGL), inflammation or reversible findings (DOCINF), organ damage or irreversible findings (DOCDAM), and patient distress or findings explained by fibromyalgia and/or depression (DOCDIS). Methods A retrospective study was performed of data from a rheumatology fellows’ continuity clinic at Rush University. Each rheumatology patient with any diagnosis seen in routine care completed a multidimensional health assessment questionnaire (MDHAQ). Both the rheumatology fellow and attending rheumatologist independently completed RheuMetric estimates at the same visit for DOCGL, DOCINF, DOCDAM, DOCDIS, and the proportion of DOCGL explained by each subglobal estimate (totaling 100%). Agreement between the two assessors was compared using paired t-tests, Spearman correlation coefficients, intraclass correlation coefficients (ICC), Lin’s concordance correlation coefficients (LCCC), and Bland-Altman plots. Results In 112 patients, mean levels of DOCINF were highest in inflammatory diseases, DOCDAM in osteoarthritis (OA), and DOCDIS in primary fibromyalgia (FM). However, mean DOCDAM was as high as DOCINF in inflammatory diseases. No statistically significant differences were seen between scores from attending rheumatologists and fellows. Agreement within 2/10 units ranged from 60% for DOCGL to 71% for DOICINF and DOCDAM. Spearman correlations were 0.49-0.65, ICCs were 0.46-0.63, LCCC were 0.46-0.62 between rheumatologist and fellow, indicating moderate agreement; reliability was slightly higher for each sub-global VNS than DOCGL. Conclusion RheuMetric 0–10DOCGL, DOCINF, DOCDAM, and DOCDIS have moderate interrater reliability and are feasible in routine care to estimate patient status beyond DOCGL for improved management decisions.