Severe Knee Pain Research Articles

Peripheral Nerve Stimulation for Knee Pain

Peripheral nerve stimulation (PNS) is a drug free pain management procedure that uses electrical impulses to target specific nerve and block pain signals. PNS helps decrease perception of pain, providing real answers to patients dealing with chronic knee pain. The case study discussed in this presentation is of use of PNS targeting the superior lateral genicular nerve and the saphenous nerve for a patient with severe knee pain from osteoarthritis. The patient discussed is a 49-year-old female with a history of chronic pain related to osteoarthritis of the left knee. Her BMI was 68, due to which she was not a surgical candidate. She had exhausted all other interventions including steroid injections, hyaluronic acid injections, genicular nerve blocks, radio frequency ablation (RFA) with temporary relief. The PNS trail was conducted from 5/18/22 through 5/25/22, patient was assessed everyday for pain. She verbalized she did not have any pain during the trail. She also verbalized that she was able to walk better, stand longer and sleep without pain. She is planned to have perm implant for PNS completed on 6/29/22. I plan to include the findings of permanent implant in the poster presentation. I can conclude based on the trial results that the results from this case study are encouraging, and we believe that PNS may be a viable option for patients who do not qualify for surgical intervention, refuse surgery, or have failed other conservative and pharmacological methods of treatment. We plan to continue to use PNS for patients with knee pain and failed other non-invasive options. However, we agree that further studies are needed to explore and implement PNS successfully clinically for knee pain.

Higher Body Weight Is Associated With Greater Knee Pain Severity

Higher Body Weight Is Associated With Greater Knee Pain Severity

Relation of pain sensitization to self-reported and performance-based measures of physical functioning: the Multicenter Osteoarthritis (MOST) study

It is unclear if alterations in nociceptive signaling contribute to poor physical functioning in persons with knee osteoarthritis (OA). We aimed to characterize the relation of pain sensitization to physical functioning in persons with or at risk for knee OA, and determine if knee pain severity mediates these relationships. We used cross-sectional data from the Multicenter Osteoarthritis Study, a cohort study of persons with or at risk for knee OA. Pressure pain thresholds (PPTs) and temporal summation (TS) were assessed with quantitative sensory testing. Self-reported function was quantified with the Western Ontario and McMaster Universities Arthritis Index function subscale (WOMAC-F). Walking speed was determined during a 20-mwalk. Knee extension strength was assessed with dynamometry. Relations of PPTs and TS to functional outcomes were examined with linear regression. The mediating role of knee pain severity was assessed with mediation analyses. Among 1560 participants (60.5% female, mean age (SD) 67 (8), body mass index (BMI) 30.2 (5.5) kg/m2), lower PPTs and the presence of TS were associated with worse WOMAC-F scores, slower walking speeds, and weaker knee extension. The extent of mediation by knee pain severity was mixed, with the greatest mediation observed for self-report function and only minimally for performance-based function. Heightened pain sensitivity appears to be meaningfully associated with weaker knee extension in individuals with or at risk for knee OA. Relations to self-reported physical function and walking speed do not seem clinically meaningful. Knee pain severity differentially mediated these relationships.

Arthroscopic popliteal tenotomy grants satisfactory outcomes in total knee arthroplasty with persistent localised posterolateral pain and popliteus tendon impingement.

The purpose was to estimate the prevalence of popliteus tendon impingement following TKA, and to describe the characteristics and the differential diagnosis protocol for this rare condition. The hypothesis was that arthroscopic popliteal tenotomy in TKA patients with suspected popliteus tendon impingement would relieve pain and improve satisfaction. Of 741 TKAs performed over three years, eight (1.1%, all women) had suspected popliteus tendon impingement, of which seven had severe localised posterolateral knee pain and one global knee pain. Upon confirmation of popliteus tendon impingement, arthroscopic popliteal tenotomy was performed, and outcomes (Pain on visual analogue scale (pVAS; best, 0; worst, 10), Oxford Knee Score (OKS; best, 48; worst, 0) and satisfaction (best, 100%; worst, 0%) assessed at mean 18-month follow-up. At four to 30months after TKA, arthroscopic exploration revealed popliteus tendon impingement in all eight knees. Six reported complete pain relief (pVAS, 0) the day following arthroscopic popliteal tenotomy, whilst one reported some residual pain (pVAS, 2). The remaining patient with global pain reported no pain relief, and required revision TKA at 12months. Excluding the revised TKA, OKS was between 19 and 43, and satisfaction was rated ≥ 80% in five of the remaining seven patients. Arthroscopic popliteal tenotomy relieved symptoms in TKA patients with persistentlocalised posterolateral pain and a positive popliteus test. These findings suggest that the popliteus test is reliable to diagnose popliteus tendon impingement following TKA, which could be treated by arthroscopic popliteal tenotomy. Level IV, Small case series.

Novel Arthrometer for Quantifying In Vivo Knee Laxity in Three Planes Following Total Knee Arthroplasty

BackgroundKnee instability is a leading cause of dissatisfaction following total knee arthroplasty (TKA). Instability can involve abnormal laxity in multiple directions including varus-valgus (VV) angulation, anterior-posterior (AP) translation, and internal-external rotation (IER). No existing arthrometer objectively quantifies knee laxity in all three of these directions. The study objectives were to verify the safety and assess reliability of a novel multiplanar arthrometer. MethodsThe arthrometer utilized a five degree-of-freedom instrumented linkage. Two examiners each conducted two tests on the leg that had received a TKA of 20 patients (mean age 65 years (range, 53-75); 9 men, 11 women), with nine and eleven distinct patients tested at 3-month and 1-year postoperative time points, respectively. AP forces from −10 to 30 Newtons, VV moments of ±3 Newton-meters, and IER moments of ±2.5 Newton-meters were applied to each subject’s replaced knee. Severity and location of knee pain during testing were assessed using a visual analog scale. Intraexaminer and interexaminer reliabilities were characterized using intraclass correlation coefficients. ResultsAll subjects successfully completed testing. Pain during testing averaged 0.7 (out of possible 10; range, 0-2.5). Intraexaminer reliability was >0.77 for all loading directions and examiners. Interexaminer reliability and 95% confidence intervals were 0.85 (0.66-0.94), 0.67 (0.35-0.85), and 0.54 (0.16-0.79) in the VV, IER, and AP directions, respectively. ConclusionThe novel arthrometer was safe for evaluating AP, VV, and IER laxities in subjects who had received TKA. This device could be used to examine relationships between laxity and patient perceptions of knee instability.

Woman With a Painful Knee.

A 67-year-old woman presented to the emergency department with sudden onset of severe left knee pain after long-distance walking. She complained of locked hyperextension and inability to bend her knee. Several years previously, she had undergone bilateral high tibial osteotomy and arthroscopic debridement surgery for knee osteoarthritis. Additionally, she denied any history of trauma to her left knee before the accident. On examination, there was a hyperextended knee with a superiorly displaced patella and a palpable skin dimple inferior to the patella (Figure 1).

Potential surrogate outcomes in individuals at high risk for incident knee osteoarthritis

To study potential surrogate outcomes for osteoarthritis (OA) incidence by evaluating the association of short-term changes in clinical and imaging biomarkers with long-term clinical knee OA incidence. Middle-aged women with overweight/obesity, but free of knee symptoms were recruited through their general practitioners. At baseline, after 2.5 years, and after 6.5 years, questionnaires, physical examination, radiographs, and Magnetic resonance imaging (MRI) scans were obtained. The percentage of knees with a minimal clinically important difference for knee pain severity, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain/stiffness/function, and joint space narrowing, and of those with progression/regression of medial knee alignment, chronic knee pain, radiographic osteophytes, and cartilage defects, bone marrow lesions, osteophytes, and effusion/synovitis on MRI were determined. For each of these potential surrogate outcomes with ≥10% improvement or progression in the population over 2.5 years, the association with incident clinical knee OA, defined using the combined ACR-criteria, after 6.5 years was determined. Most pre-defined potential surrogate outcomes showed ≥10% change in the population over 2.5 years, but only worsening of TF cartilage defects, worsening of TF osteophytes on MRI, and an increase in pain severity were significantly associated with greater clinical knee OA incidence after 6.5 years. These potential surrogate outcomes had high specificity and negative predictive value (89-91%) and low sensitivity and positive predictive value (20-28%) CONCLUSIONS: Worsening of TF cartilage defects and TF osteophytes on MRI, and increased pain severity could be seen as surrogate outcomes for long-term OA incidence. However, higher positive predictive values seem warranted for the applicability of these factors in future preventive trials.

Knee Pain and Functional Outcomes after Retrograde Femoral Nailing: A Retrospective Review.

To investigate the incidence and severity of knee pain following retrograde intramedullary nailing of femur fractures and to better understand functional outcomes using validated patient-reported outcome measures. Fifty-three patients with OTA 32 or 33 fractures treated by retrograde nail at a single academic Level 1 trauma center between 2009 and 2020 were retrospectively reviewed. Patients verbally completed the Oxford Knee Score (OKS) and Patient-Reported Outcome Measurement Information System (PROMIS) Short Form 6b, minimum one year postoperatively. Thirty-four (64%) patients reported the presence of pain. Of those reporting pain, 16 (47.1%) reported their pain as mild. Compared to those without pain, patients with knee pain had lower OKS (30.38 +/- 10.65, versus 41.95 +/- 6.87; P <0.001) and higher PROMIS scores (14.65 +/- 6.76 versus 10.95 +/- 7.09; P=0.066). The increasing severity of pain was inversely correlated with functional status as measured by patient-reported measures. At present, the reliability, high union rates, and otherwise low complication rates associated with retrograde femoral nailing justify its continued use. However, knee pain and functional outcomes should remain an integral part of the preoperative discussion with the patient.

Potential influencing factor on health-related quality of life in Japanese with knee osteoarthritis: the Locomotive syndrome and Health outcome in Aizu cohort Study (LOHAS)

PurposeSeveral studies have investigated the factors that influence health-related quality of life in patients with knee osteoarthritis (KOA). This study aimed to identify and investigate the degree of involvement of potential factors influencing health-related quality of life (HRQOL) in an aged population with or without KOA.MethodsThis multi-centered study included 651 participants who underwent health checkups in rural areas of Japan in 2010. The association between three component summary score of short-form 12 (physical component summary; PCS, mental component summary; MCS, and role-social component summary; RCS) and covariates were investigated using multiple linear regression model and calculated the scaled estimated regression coefficient.ResultsDecreasing mobility, severity of knee pain, high pain-related self-efficacy (PSE), older age, high functional self-efficacy (FSE), and female gender had significant effect on PCS (p < 0.05). However, radiographic KOA had no influence on PCS. Presence of depression and body mass index had a significant influence on the MCS (p < 0.05). Decreasing mobility, presence of depression, PSE and older age had significant influence on the RCS (p < 0.05).ConclusionOur study results showed that physical, mental, and role/social QOL were affected by different influencing factors. Physical QOL was strongly influenced by subjective pain, physical performance, and self-efficacy, whereas radiographic KOA had no such effect. Depressive mood is associated with both mental and role/social QOL. The role/social QOL was predominantly affected by physical function and pain-related self-efficacy. Taking measure to improving functional ability and mental status might be the key factor to improve HRQOL in patient with KOA.Level of evidenceLevel 3: Epidemiologic cross-sectional study (prognostic study)

The prevalence of foot pain and association with baseline characteristics in people participating in education and supervised exercise for knee or hip osteoarthritis: a cross-sectional study of 26,003 participants from the GLA:D® registry

BackgroundOsteoarthritis (OA) affecting the knee or hip is highly prevalent in the general population and has associated high disease burden. Early identification of modifiable risk factors that prevent, limit, or resolve disease symptoms is critical. Foot pain may represent a potentially modifiable factor however little is known about the prevalence of foot pain in people with knee or hip OA nor whether foot pain is associated with clinical characteristics. The main aim of this study was therefore to determine the prevalence of foot pain in people with knee or hip OA attending an education and supervised exercise-based intervention in Denmark (GLA:D®) and determine if baseline demographic or clinical characteristics are associated with foot pain.MethodsAnalysis was conducted on baseline data of 26,003 people with symptomatic knee or hip OA completing a pain mannequin as part of the Good Life with osteoArthritis in Denmark (GLA:D®) primary care programme. Odds Ratios (OR) and 95% confidence intervals (CI) were calculated to estimate the strength of association between baseline clinical characteristics (including pain severity in worst knee/hip joint, number of painful knee/hip joints, pain medication use and physical activity level) and the presence of baseline foot pain.ResultsTwelve percent of participants (n = 3,049) reported foot pain. In those people with index knee OA (n = 19,391), knee pain severity (OR 1.01 CI 1.00, 1.01), number of painful knee/hip joints (OR 1.67 CI 1.58, 1.79), and use of pain medication (OR 1.23 CI 1.12, 1.36) were statistically associated with foot pain. Excluding use of pain medication, similar associations were seen in those with index hip OA.ConclusionTwelve percent of people with knee or hip OA participating in GLA:D® had foot pain. Those with worse knee/hip pain, and greater number of painful joints were more likely to report foot pain. This study is the first to demonstrate a significant relationship between clinical characteristics and foot pain in people with knee or hip OA participating in education and supervised exercise. Future investigation should consider the role that foot pain may play on knee and hip related outcomes following therapeutic intervention.

DYNAMIC CONTRAST-ENHANCED MRI OF THE SYNOVIUM IN KNEE OSTEOARTHRITIS: SEMI-AUTOMATIC SEGMENTATION OF SYNOVIAL SUBREGIONS AND TEST-RETEST REPEATABILITY

Inflammation of the joint lining (synovitis) is often seen in OA, and is strongly associated with both knee pain severity and disease progression. Dynamic contrast-enhanced MRI (DCE-MRI) can be used to visualize the uptake and washout of gadolinium-based contrast, and enables quantification of blood perfusion as a surrogate measure of inflammation. DCE-MRI could therefore be used to characterize the extent of synovitis and serve as a biomarker for response to treatment in clinical trials. However, (semi)-automatic segmentation methods and thorough technical and clinical validation are needed to fully adopt DCE-MRI in this setting. We aim to evaluate semi-automatic segmentation of synovial subregions and test-retest repeatability of DCE-MRI to measure synovial perfusion in patients with knee OA. Patients with mild-to-moderate knee OA (KLG 1-3) who were allocated to the control group in a prospective randomized controlled trial of genicular artery embolization were included. Patients underwent MRI at 3T (GE Healthcare) at baseline and after 1 month. Image acquisition consisted of native T1 mapping with variable flip angle, followed by a dual-echo SPGR sequence (DISCO; DIfferential Sub-sampling with Cartesian Ordering), in which the spatial resolution was optimized to allow for visualization of small vessels. After the initial phase, 0.1 ml/kg gadovist was injected and subsequently 34 dynamic phases were acquired, with a temporal resolution of 10.2 seconds. Segmentation of the synovium comprised an initial rough manual segmentation followed by selection of enhancing voxels using a shuffle transform method. Synovial subregions were created by semi-automatic vessel mapping using MeVisLab and mathematically assigning synovial voxels to the corresponding closest genicular artery. Motion compensation was performed using Elastix (Elastix, version 5.0.1), and native T1 mapping and pharmacokinetic modelling was done using open source software for DCE analysis (MADYM, version 4.21.1). The commonly used combination of the Parker literature arterial input function, and the Extended Toft's model pharmacokinetic model was implemented. Voxelwise perfusion parameters were calculated, after which median Ktrans values were extracted for the whole synovium and separately for each synovial subregion. Agreement was visualized with a Bland-Altman plot, and test-retest repeatability was evaluated using intraclass correlation coefficients (ICC; single rating random sample) and within-subject coefficients of variation (CV). 30 patients were included, of which two patients were lost to follow-up and one patient was excluded due to errors during image acquisition. For the remaining 27 participants, median Ktrans values ranged from 0.017 to 0.121. ICC of Ktrans for the whole synovium was 0.51, and CV was 0.14. Sensitivity analysis by exclusion of two statistical outliers yielded an ICC of 0.66 and a CV of 0.11. For the individual synovial regions, ICCs ranged between 0.27 and 0.58 while CVs ranged between 0.13 and 0.25. Semi-automatic segmentation of the synovium and synovial subregions through vessel mapping on DCE-MRI in knee OA is feasible. Perfusion parameters determined through pharmacokinetic modeling have moderate repeatability and should be interpreted with caution. Stichting Coolsingel, Cook Medical, Erasmus MRace Doelmatigheid E.H.G. Oei has received research support from GE Healthcare. The University of Wisconsin receives research support from Bracco Diagnostics. CORRESPONDENCE ADDRESS: [email protected]

The natural history of end-stage knee osteoarthritis: Data from the osteoarthritis initiative

ObjectiveWe aimed to describe the natural history leading to end-stage knee osteoarthritis (esKOA), focusing on knee symptoms, radiographic severity, and the presence of limited mobility or instability. MethodsWe performed knee-based analyses of Osteoarthritis Initiative data from 7691 knees (4165 participants). We used a validated definition of esKOA that relied on meeting one of two criteria: (1) severe radiographic knee osteoarthritis (Kellgren-Lawrence [KL] grade=4) with moderate-to-intense pain (Likert WOMAC pain+function>11/88) or (2) KL grade<4 with intense or severe pain (WOMAC pain+function>22) and limited mobility (flexion contracture≥5°) or instability (based on a varus and valgus stress test). We also introduced an alternate definition of esKOA that relied on meeting one of two criteria that omitted physical exam findings:(1) severe radiographic knee osteoarthritis (KL grade=4) with at least moderate symptoms or (2) KL grade=2 or 3 with intense or severe symptoms and persistent knee pain (frequent knee pain during three or more months in the past year). We used descriptive statistics to explore the frequency of components of esKOA at the index visit when they had incident esKOA, at the annual visit before developing esKOA, and the interval change between those visits. ResultsOur analytic sample was mostly female (58%), without radiographic knee osteoarthritis (KL grade=0 or 1; 60%), without stability or mobility concerns (91%), and without persistent knee pain (77%). At the visit before incident esKOA, most knees already had moderate-to-severe radiographic osteoarthritis using the original (62%) or alternate (50%) definition (versus <15% for either definition of no esKOA). Over 80% of knees that reached the criteria for esKOA achieved this based on increased knee symptom severity – typically without worsening radiographic severity (80%). ConclusionRadiographic severity predisposed a knee to esKOA. However, worsening knee symptoms led to the development of incident esKOA. If investigators want to increase the chance of identifying incident esKOA as an outcome, they should enrich their study samples with people with moderate-to-severe radiographic osteoarthritis. Our findings also highlight the potential reversibility of esKOA (a knee that is classified with esKOA but later is not classified with esKOA). Reversibility is not a flaw of an outcome defining esKOA but rather a desirable clinical outcome to demonstrate a therapeutic intervention can help people with esKOA improve their knee symptoms and delay a knee replacement.

How to Use Biomechanical Job Exposure Matrices with Job History to Access Work Exposure for Musculoskeletal Disorders? Application of Mathematical Modeling in Severe Knee Pain in the Constances Cohort.

Musculoskeletal disorders related to work might be caused by the cumulative effect of occupational exposures during working life. We aimed to develop a new model which allows to compare the accuracy of duration of work and intensity/frequency associations in application to severe knee pain. From the CONSTANCES cohort, 62,620 subjects who were working at inclusion and coded were included in the study. The biomechanical job exposure matrix "JEM Constances" was used to assess the intensity/frequency of heavy lifting and kneeling/squatting at work together with work history to characterize the association between occupational exposure and severe knee pain. An innovative model G was developed and evaluated, allowing to compare the accuracy of duration of work and intensity/frequency associations. The mean age was 49 years at inception with 46 percent of women. The G model developed was slightly better than regular models. Among the men subgroup, odds ratios of the highest quartile for the duration and low intensity were not significant for both exposures, whereas intensity/duration were for every duration. Results in women were less interpretable. Though higher duration increased strength of association with severe knee pain, intensity/frequency were important predictors among men. Exposure estimation along working history should have emphasis on such parameters, though other outcomes should be studied and have a focus on women.

Assessment of Severity of Knee Pain and its Relationship with Serum and Urine Biomarkers in Individuals with Osteoarthritis Knee

<h3>Research Objectives</h3> To assess the severity of knee pain in persons with primary osteoarthritis (OA) knee and find out the possible association between severity of knee pain and (serum and urine) biomarkers. <h3>Design</h3> A cross-sectional study. <h3>Setting</h3> A tertiary care teaching hospital in India. <h3>Participants</h3> Persons presenting with knee pain, with diagnosis of primary osteoarthritis Knee (unilateral/ bilateral) with a Kellgren-Lawrence score of 3. <h3>Interventions</h3> Nil. <h3>Main Outcome Measures</h3> The severity of knee pain was assessed with a visual analog scale (VAS). Among biomarkers, C-telopeptide type-II Collagen (CTX-II) and N-telopeptide- type-I Collagen (NTX-I) were assessed from urine. From serum, cartilage oligomeric matrix protein (COMP), N-terminal propeptide of collagen type-IIA (PIIANP), and hyaluronic acid (HA) were assessed. Besides these, erythrocyte sedimentation rate (ESR) and C-reactive Protein were assessed. In this study, we calculated the correlation coefficients between pain (VAS) scores and individual biomarkers. <h3>Results</h3> A total of 96 persons (47% were female) with OA knee grade III participated in the study. The mean age and body mass index (BMI) of the participants was 59 years and 26.6 kg/m2. None of the participants were using any walking aids or any orthosis/ knee brace. The mean ESR and uric acids were 14.05 mm/hour and 5.40 mg/dL. Using spearman's correlation coefficient, the study found a correlation among VAS pain and ESR (p<0.001, r=0.51), CRP (p=0.002, r=0.31) and HA (p=0.024, r=0.23). However, the study failed to demonstrate any association between the intensity of knee pain and bony biomarkers- CTX-II (p=0.14, r=0.15), NTX-I (p=0.67, r=0.43), COMP (p=0.06, r=-0.20) and PIIANP (p=0.26, r=0.12). <h3>Conclusions</h3> The study confirmed the relationship between the intensity of knee pain and inflammatory markers- ESR, C-reactive protein and HA. <h3>Author(s) Disclosures</h3> The study was supported by extramural research grant (ICMR).

Identification of Early Knee Osteoarthritis Based on Knee Joint Trajectory during Stair Climbing.

Patients with knee osteoarthritis show low stair climbing ability, but a diagnosis of stair performance time is not enough to identify the early stages of knee osteoarthritis. Therefore, we developed an indicator named range of the knee joint trajectory (RKJT) as a kinematic parameter to express more detailed characteristics than stair performance time. To achieve this, we used our developed "IR-Locomotion", a markerless measurement system that can track the knee joint trajectory when climbing stairs. This study aimed to test whether the RKJT effectively identifies patients with early knee osteoarthritis even after controlling stair performance time. Forty-seven adults with moderate to severe knee pain (mean age 59.2 years; 68.1% women) underwent the radiographic examination (Kellgren and Lawrence grade) of both knees and a stair climbing test on 11 stairs. The RKJT during the stair climbing test was calculated by "IR-Locomotion". A generalized linear mixed model was used to evaluate the discriminative capability of RKJT on early knee osteoarthritis (i.e., Kellgren and Lawrence grade of 1). As expected, patients with early knee osteoarthritis showed larger RKJT than non-radiographic controls (95% confidence interval: 1.007, 1.076). Notably, this finding was consistent even after adjusting stair performance time.

PSAT223 A Delayed Diagnosis of Oncogenic Osteomalacia Presenting with Bone Pain, Muscle Weakness and Elevated Alkaline Phosphatase

Abstract Background Tumor-induced osteomalacia (TIO) is a rare bone disease caused by excess production of FGF23 by a phosphaturic mesenchymal tumor, resulting in severe hypophosphatemia, bone demineralization, insufficiency fractures, bone pain and muscle weakness. The Fibroblast Growth Factor-23 (FGF23) is a phosphaturic hormone produced by osteocytes, whose primary effect is to decrease serum phosphate by suppressing proximal tubular phosphate reabsorption and intestinal phosphate absorption (via diminished 1,25D production). Clinical case A 65-year-old male was referred to endocrinology clinic for a second opinion due to severe rib pain and elevated alkaline phosphatase levels. His first endocrinologist diagnosed Paget's disease of the bone based on symptoms of rib pain, an elevated alkaline phosphatase level, and abnormal Tc99 bone scintigraphy demonstrating uptake in multiple areas, including bilateral humeri, ribs, knees, ankles, and L4 vertebral body. He received 5 mg IV zoledronate for treatment of Paget's disease, and immediately post-infusion reported worsening of severe rib pain. Upon presentation to our institution, he reported ongoing severe rib pain and bilateral knee pain. On exam, he had extreme difficulty rising from a seated position. Laboratories revealed calcium 9.0 mg/dL, albumin 5.0 g/dL, alkaline phosphatase 116 U/L, 25D 43 ng/dL, PTH 66 pg/mL and serum phosphorous 1.5 mg/dL. Tubular Reabsorption of Phosphate (TRP) was 59%, based on a spot second morning void with corresponding fasting morning blood draw. 1,25D was 13 pg/mL (19-79 pg/mL). Intact FGF23 was 346 pg/mL (&amp;lt;59 pg/nL). CT revealed bilateral tibial plateau insufficiency fractures. When asked if he noticed any "lumps or bumps", the patient reported a lump under his left second toe. MRI showed a 1.8 cm soft tissue mass. A GA68-DOTA-TATE PET CT revealed a 2.3 cm soft tissue mass plantar to the 2nd left proximal phalanx with intense activity mass (SUVmax 39.8). This mass was surgically excised. Post-operative FGF23 levels were as follows: 38 pg/mL → 15 pg/mL → &amp;lt;14 pg/mL. Within 14 days, the patient's ability to rise from a seated position was markedly improved. His severe rib pain persisted for three weeks but was significantly improved by six weeks post-op. Despite treatment with 1 mcg calcitriol daily and 5000 IU vitamin D daily, he developed evidence of post-operative hungry bone syndrome with calcium 8.3 mg/dL, PTH 64 pg/mL, and alk phos 157 U/L. Conclusion Tumor-induced osteomalacia is a rare but treatable condition, presenting with severe hypophosphatemia, bone pain, bone demineralization, insufficiency fractures, and muscle weakness. Due to the nonspecific nature of the presenting symptoms, delays in diagnosis are common. Serum phosphorous should be obtained in all patients presenting with unexplained elevations in alkaline phosphatase. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

VGG16 Based Knee Osteoarthritis Grading Using X-Ray Images

Abstract: In older citizens, Osteoarthritis (OA) in the knees is a frequent cause of restriction in movement and significant decline in their overall wellbeing. Early OA evaluation and treatment can prevent further progression. The accurate evaluation of a visual examination by a doctor is subject to different interpretations and heavily reliant on the degree of expertise that the doctor has. In this study, we use a method called deep learning (VGG16) to determine the severity of knee pain immediately. Simple Xray pictures collected from Kaggle are evaluated and divided into five grades. This model successfully reached a mean precision of 0.858 and a recall of 92.2 percent for knee osteoarthritis grading.

Unilateral Strength Training Imparts a Cross-Education Effect in Unilateral Knee Osteoarthritis Patients.

Background: Worldwide, 86 million individuals over the age of 20 were diagnosed with knee osteoarthritis (KOA) in 2020. Hallmark features of KOA are the loss in knee extensor strength, increasing knee pain severity, and deficits in functional performance. There is a critical need for the investigation into potential cost-effective therapeutic interventions in the treatment of KOA. A potential therapeutic option is the cross-education phenomenon. Methods: This was a non-blinded randomized control trial, with a 4-week intervention, with a pre, post and follow-up assessment (3 months post intervention). Outcome measures of isometric knee extensor strength, rectus femoris muscle thickness and neuromuscular activation were assessed at all-time points. Results: Compared to age-matched KOA controls, 4 weeks of unilateral strength training in end-stage KOA patients increased strength of the untrained affected KOA limb by 20% (p < 0.05) and reduced bilateral hamstring co-activation in the KOA intervention group compared to the KOA control group (p < 0.05). Conclusions: A 4-week-long knee extensor strength training intervention of the contralateral limb in a cohort with diagnosed unilateral KOA resulted in significant improvements to knee extensor strength and improved neuromuscular function of the KOA limb. Importantly, these results were maintained for 3 months following the intervention.

Exercise adherence Mobile app for Knee Osteoarthritis: protocol for the MappKO randomised controlled trial

BackgroundIn people with knee osteoarthritis (OA), ongoing exercise participation, particularly with strengthening exercises, is central to management. Patient adherence to prescribed exercise typically declines once consultations with a clinician have ceased. Mobile applications (apps) can incorporate behaviour change techniques that may assist adherence, potentially optimising clinical outcomes.MethodsThis is a two-arm, pragmatic, superiority randomised trial. One hundred and eighty two Australians with chronic knee pain (clinical knee OA) and who have at least a mild level of physical dysfunction are being recruited. Participants are randomly allocated i) exercise (physiotherapist-prescribed exercise) or; ii) exercise plus app (physiotherapist-prescribed exercise plus access to the ‘My Exercise Messages’ mobile app). Exercise care comprises two videoconferencing consultations with a physiotherapist over two weeks (30 min each) for a strengthening exercise program, which is then conducted independently at home for 24 weeks without any further physiotherapist consultations. Participants are also provided with exercise resources to facilitate home-based exercise. Those randomised to exercise plus app will download the app after completing the two weeks of physiotherapy consultations and will be instructed by research staff to use the app for the 24 weeks of unsupervised home-based exercises. The app works by tracking completion of weekly exercise sessions, providing regular messages to facilitate weekly exercise and providing personalised messages to help overcome individual barriers to exercise participation. The two primary outcomes are i) self-reported physical function; and ii) number of days strengthening exercises were performed (previous fortnight), with a primary endpoint of 26 weeks and a secondary endpoint of 14 weeks. Secondary outcomes include knee pain severity; knee-related quality of life; global change; exercise program satisfaction; exercise self-efficacy; physical activity; sport and recreation function; another measure of exercise adherence; and willingness to undergo joint replacement. Process measures are also included.DiscussionFindings will determine if a theory-informed mobile app improves exercise adherence and physical function in people with knee OA who have received a home-based strengthening program.Trial RegistrationAustralian New Zealand Clinical Trials Registry, ACTRN12621000724875. Prospectively registered 9/06/2021.

Multiple Intraarticular Osteochondromas of the Knee

Osteochondroma is the most common benign growing bone tumor that usually affects the knee joint area. It often involves the long bone metaphysis, which occurs extraarticularly. Despite this, single intraarticular osteochondroma is rarely reported in the literature, but multiple knee osteochondromas is very rare and has not been reported so far. The patient who is introduced is a 30-year-old woman who has undergone two arthrotomy surgeries of the left knee, in which intraarticular osteochondroma was reported in the pathology. In the second operation, due to the size of the lesion and the involvement of the patella, the surgeon had to perform a patellectomy. The patient was referred with severe knee pain and inability to flexion and extension the knee and was unable to walk without a walker. Due to severe osteoarthritis and lack of extensor mechanism and condition of multiple intraarticular osteochondromas of the knee, complete excision of multiple osteochondroma lesions was performed for the patient and Rotating Hinge Knee (RHK) prosthesis was implanted. During two years of treatment follow-up, there is no recurrence of the lesion and the patient walks without a walker and is able to flex the knee 100 degrees. Her knee pain was also relieved.