Minimum Joint Space Research Articles

Symptomatic (Pain and Inflammation) and Disease-Modifying Effect (Minimal Joint Space) of Intra-articular Ozone (O2-O3) in Osteoarthritis of the Knee: a Clinical Case

The objective of the clinical case is to report the symptomatic effect and, for the first time, the disease-modifying effect of ozone in a patient with osteoarthritis of the knee. A 67-year-old woman has been infiltrated with ozone 1 time/week for 4 weeks, using an oxygen-ozone volume of 20 ml, at a 20-µg/ml concentration. Another cycle of ozone treatment was boosted at 6 months follow-up. Clinical outcomes such as pain, function, and quality of life were measured by the Western Ontario and McMaster University Index for Osteoarthritis (WOMAC) scale. Biochemical markers of inflammation such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and uric acid were performed at the beginning and at the end of ozone (O2-O3) treatment protocol. Radiological outcome was evaluated as the change in minimal joint space at the medial compartment of joint space, at the beginning and at 12 months follow-up in both knees. In the first and second ozone cycles, clinical (pain, function, rigidity) and biochemical variables (CRP, ESR, uric acid) improved in our case report. Minimal joint space at medial compartment improved in both knees after 12 months follow-up. Intra-articular ozone (O2-O3) has shown a symptomatic effect and especially a disease-modifying effect in a patient with knee osteoarthritis, improving pain, function, and rigidity; decreasing inflammation biomarkers (CRP, ESR, and uric acid); and increasing the joint space of the medial component evidenced radiologically. The structural effect is reported for the first time in literature. No adverse effects have been observed after intra-articular ozone infiltrations.

Long-Term Outcomes of Eccentric Rotational Acetabular Osteotomy Combined With Femoral Osteotomy for Hip Dysplasia

BackgroundThis study aimed at investigating the clinical outcomes of eccentric rotational acetabular osteotomy (ERAO) combined with intertrochanteric valgus osteotomy (ITVO) over a period of more than 10 years. MethodsThis is a case-control study of 39 patients (40 hips) who underwent ERAO combined with ITVO for hip dysplasia (ITVO group). Patients were matched for age, sex, follow-up period, and preoperative joint stage to 78 patients (80 hips) who underwent ERAO alone (ERAO group). We compared the clinical and radiographic outcomes and the survival rates between the groups. ResultsThe Harris Hip Score at the final follow-up was significantly lower in the ITVO group than in the ERAO group. The postoperative center edge angle, acetabular head index, and minimum joint space were significantly smaller in the ITVO group than in the ERAO group. The survival rates for the conversion to total hip arthroplasty end point were not significantly different between groups. However, survival rates for the Harris Hip Score < 80 end point were significantly poorer in the ITVO group than in the ERAO group. ConclusionThe long-term results of ERAO combined with ITVO were not satisfactory from a hip function perspective. ERAO combined with ITVO should be indicated in only young active patients with pre-osteoarthritis and initial stages of osteoarthritis.

Predicting Severe Cartilage Damage in the Hip: A Model Using Patient-Specific Data From 2,396 Hip Arthroscopies

To determine patient-specific factors that can be used to predict the presence of severe articular cartilage damage in the hip in patients without osteoarthritis. The prevalence of severe (Outerbridge grade III or IV) cartilage damage to the acetabulum and femoral head was prospectively recorded at hip arthroscopy. Patients who underwent primary hip arthroscopic surgery between 2006 and 2016 performed by a single surgeon were included. Patients were excluded if they underwent previous hip surgery, had poor-quality radiographs, were younger than 16years at the time of surgery, or had a minimal joint space of 2mm or less. The relation between severe cartilage damage and preoperative patient characteristics was examined using multivariable logistic regression analysis with restricted cubic splines. Of the 2,396 hips presenting for hip arthroscopy, 995 (41%) had severe cartilage damage to the acetabulum and 257 (11%) had severe cartilage damage to the femoral head. Older age was a significant risk factor for severe cartilage damage both to the acetabulum (χ2= 69.5, P < .001) and to the femoral head (χ2= 53.9, P < .001). An age of 45years was associated with a 1.96 (95% confidence interval, 1.54-2.49) increase in the odds of severe acetabular cartilage damage and a 3.94 (95% confidence interval, 2.61-5.94) increase in the odds of severe femoral head cartilage damage relative to an age of 20years. Male sex was associated with severe cartilage damage to the acetabulum (χ2= 66.7, P < .001), and a lower center-edge angle was a significant risk factor for severe cartilage damage to the femoral head (χ2= 78.5, P < .001). Predictive nomograms were established for severe cartilage lesions. The primary risk factors for severe hip cartilage damage were older age for both the femoral head and acetabulum; a lower center-edge angle and larger Tönnis angle for the femoral head; and male sex, body mass index, alpha angle, and joint space for the acetabulum. The likelihood of cartilage damage to the hip can be estimated clinically using a prediction nomogram. Level III, cross-sectional study.

What Preoperative Factors are Associated With Not Achieving a Minimum Clinically Important Difference After THA? Findings from an International Multicenter Study.

AbstractBackgroundDespite innovations in THA, there remains a subgroup of patients who experience only modest pain relief and/or functional improvement after the procedure. Although several studies have previously sought to identify factors before surgery that were associated with achieving or not a

What Is the Prevalence of Cam Deformity After Prophylactic Pinning of the Contralateral Asymptomatic Hip in Unilateral Slipped Capital Femoral Epiphysis? A 10-year Minimum Followup Study.

Prophylactic pinning of the asymptomatic and normal-appearing contralateral hip in patients with unilateral slipped capital femoral epiphysis (SCFE) remains controversial. Understanding the minimal 10-year clinical, functional, and radiographic outcomes of the contralateral asymptomatic hip in unilateral SCFE may be helpful in the decision regarding whether the benefits associated with potentially preventing a SCFE are outweighed by the risk of additional surgery. Among patients with SCFE treated with prophylactic pinning of the asymptomatic and contralateral hip, we sought (1) to determine the complications and reoperations; (2) to evaluate the development of cam deformities and the frequency and severity of osteoarthritis progression; and (3) to characterize hip pain and function as measured by the Harris hip score (HHS) and the Hip Disability and Osteoarthritis Outcome Score (HOOS) at minimal 10-year followup. Between 1998 and 2005 all patients with SCFE seen at our institution were treated with the modified Dunn procedure and all were offered prophylactic pinning of the contralateral asymptomatic hip. Of the 41 patients who underwent the unilateral modified Dunn procedure and who had an asymptomatic contralateral hip, 37 patients (90%) underwent pinning of that contralateral hip. Of those, 33 patients (80%) were available for clinical and radiographic evaluation for this retrospective study at a minimum of 10 years (mean followup 12 ± 2 years) after surgery. Three patients of the 37 patients only had 10-year clinical followup, including questionnaires sent by mail and telephone, because they refused further radiographic followup and one patient was lost to followup. The group included 19 males and 17 females whose age at surgery was a mean of 13 ± 2 years. Medical charts were reviewed and patients were asked about complications and additional surgical procedures. Most recent postoperative radiographs were evaluated for measurement of the alpha angle, head-neck offset, epiphysis orientation, and osteoarthritis grading according to Tönnis classification and minimum joint space width. The presence of a cam deformity was defined by an alpha angle measurement > 60° on the AP radiograph and/or > 55° on the lateral radiograph. Hip function and pain were assessed by the HHS and HOOS outcome measures. No complications with prophylactic in situ pinning were recorded. Four of 36 (11%) patients underwent subsequent surgical treatment for cam-type femoroacetabular impingement (FAI), and hardware removal was performed in four hips (11%). The mean alpha angle was 53° ± 8° on the AP radiograph and 49° ± 8° on the lateral view at followup. In total, 10 of 33 hips (30%) had a cam morphology at the femoral head-neck junction and four (12%) were symptomatic and underwent FAI surgery. Six of 33 patients (18%) developed an asymptomatic cam morphology at the femoral head-neck junction; in three of 33 hips (9%), the cam deformity instead of lesion were visible only on the lateral projection, and 9% were visible on both the AP and lateral projections. The preoperative offset of the femoral head-neck junction was 10 ± 3 mm on the AP view and 11 ± 4 mm on the lateral view. At followup, the AP offset was 7 ± 3 mm and the lateral offset was 6 ± 3 mm, and on the lateral view, the offset was < 10 mm in eight hips (22%). No patient had radiographic signs of hip osteoarthritis (Tönnis Grade 0). The mean minimum joint space width was 4 ± 0.4 mm. The mean HHS for the 32 patients who did not undergo subsequent surgery was 97 ± 5 at latest followup. The mean postoperative HOOS was 94 ± 8 for the 32 patients at latest followup. At a minimum followup of 10 years after prophylactic pinning of a contralateral asymptomatic hip, most patients achieve excellent hip scores; however, a substantial proportion will develop a symptomatic cam deformity despite prophylactic pinning. No patient had signs of osteoarthritis at a minimum of 10 years, but almost one-third of the patients who underwent prophylactic pinning developed a cam deformity. Level IV, therapeutic study.

Patient satisfaction after total knee arthroplasty is better in patients with pre-operative complete joint space collapse

Aim of the studyTo determine if pre-operative radiologic minimal joint space width (mJSW) is related to the outcome of total knee arthroplasty (TKA) (primary hypothesis). Likewise, the aim was to test if pre-operative mJSW is related to prosthesis survival (secondary hypothesis).MethodsA retrospective comparative analysis was performed. Group 1 was comprised of patients with pre-operative mJSW 0–1 mm. Group 2 were patients with pre-operative mJSW ≥ 2 mm. The clinical outcome was determined with the Western Ontario and MacMaster Universities Osteoarthritis Index (WOMAC) score pre-operatively and one year after TKA. Only patients with pre-operative weight-bearing radiographs and complete WOMAC score data were accepted.ResultsAvailable for analysis were 377 patients, of whom 188 were allocated to Group 1 (118 female, 70 male, age 70 ± 11 years) and 189 to Group 2 (118 female, 71 male, age 70 ± 13 years). Pre-operative WOMAC total and WOMAC subscores showed no significant differences between groups. Post-operatively, the WOMAC total was significantly better in Group 1 than in Group 2, 10 ± 22 and 19 ± 31, respectively (p < 0.001, Power 97.5%). Similarly, the WOMAC subscores for pain, stiffness, and function were also significantly better in Group 1 than in Group 2. Five-year prosthesis survival was 94.2 and 91.6% in Groups 1 and 2, respectively (p = 0.07, Power 71%).DiscussionPatients with pre-operative complete joint space collapse (0 to 1 mm mJSW) achieve a significantly better WOMAC result from TKA than do those with a mJSW equal to or greater than 2 mm. From our findings, it is recommended that “complete joint space collapse” especially be used as an indication for TKA surgery.ConclusionOur study was underpowered to sufficiently show an effect of pre-operative mJSW on prosthesis survival.

Initial tissue repair predicts long-term clinical success of knee joint distraction as treatment for knee osteoarthritis

Knee joint distraction (KJD), a joint-preserving surgery for severe osteoarthritis (OA), provides clinical and structural improvement and postpones the need for total knee arthroplasty (TKA). This study evaluates 9-year treatment outcome and identifies characteristics predicting long-term treatment success. Patients with severe tibiofemoral OA (n=20; age<60 years) indicated for TKA were treated with KJD. Questionnaires, radiographs, and magnetic resonance imaging (MRI) were used for evaluation. Survival after treatment was analyzed, where 'failure' was defined by TKA over time. 9-year survival was 48%, and 72% for men (compared to 14% for women; P=0.035) and 73% for those with a first-year minimum joint space width (JSW) increase of >0.5mm (compared to 0% for <0.05mm; P=0.002). Survivors still reported clinical improvement compared to baseline (ΔWOMAC+29.9 points (95%CI 16.9-42.9; P=0.001), ΔVAS-46.8mm (-31.6-61.9; P<0.001)). Surprisingly, patients getting TKA years after KJD still reported clinical improvement although less pronounced (ΔWOMAC+20.5 points (-1.8-42.8; P=0.067), ΔVAS-25.4mm (-3.2-47.7; P=0.030)). Survivors showed long-lasting minimum JSW increase (baseline 0.3mm (IQR 1.9), follow-up 1.3mm (2.5); P=0.017) while 'failures' did not (baseline 0.4mm (1.8), follow-up 0.2mm (1.5); P=0.161). First-year minimum JSW on radiographs and cartilage thickness increase on MRI predict 9-year survival (HR 0.05 and 0.12, respectively; both P<0.026). Male gender was associated with survival (HR 0.24; P=0.050). KJD shows long-lasting clinical and structural improvement. In addition to a greater survival rate for males (>two out of three), the initial cartilage repair activity appears to be important for long-term clinical success.

Clinical and radiologic results after open-wedge high tibial osteotomy in haemophilic knee arthropathy with varus deformity.

The previous studies have described only closed-wedge high tibial osteotomy (HTO) in haemophilic arthropathy (HA). The purpose of this study was to evaluate clinical and radiographic results after open-wedge HTO in HA with varus knee deformity. We included 13 open-wedge HTOs in HA performed between 2005 and 2016. The mean age of patients was 28.9years. Visual analogue scale (VAS), Western Ontario and McMaster Universities (WOMAC), and range of motion (ROM) indices were assessed. Any complications or requirements for total knee arthroplasty (TKA) were investigated. Mechanical axis (MA), minimal joint space width (mJSW) and Pettersson score were measured. Bone union rates at 3 and 6months postoperative were evaluated. VAS improved from 5.1 to 2.4 (P<.001). WOMAC was 66.5 preoperatively, and 26.6 postoperatively (P<.001). Pre- and postoperative ROM did not differ significantly. There were no cases of HTO converted to TKA, but one case of HTO required TKA 152months postoperative. No complications were observed. The MA was corrected from varus 5.1° to valgus 1.2° (P<.001). Pre- and postoperative mJSW did not significantly differ. Pettersson score improved from 3.84 to 2.47 (P<.001). The bone union rates at the osteotomy gap were 45.2% and 67.8% at 3 and 6months postoperative. Open-wedge HTO should be considered in cases of HA with varus deformity in young haemophilic patients, even though inflammatory arthritis is not an optimal indication for this procedure. It can be an appropriate treatment with respect to the choice to postpone TKA.

The role of thigh muscle and adipose tissue in knee osteoarthritis progression in women: data from the Osteoarthritis Initiative

To determine whether loss in thigh muscle strength in women concurrent with knee osteoarthritis progression is associated with reductions of muscle anatomical cross-sectional area (ACSA) or specific-strength (i.e., isometric force÷ACSA), and to explore relationships with local adiposity. Female participants from the Osteoarthritis Initiative with Kellgren-Lawrence grade ≤3, thigh isometric strength measurements, and thigh magnetic resonance images at year-two (Y2) and year-four (Y4) (n=739, age 62±9 years; body mass index measurements (BMI) 28.8±5.9kg/m2) were grouped into: (1) those with vs without symptomatic progression (≥9 increase in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)-pain [scale: 0-100]); and (2) those with vs without radiographic progression (≥0.7mm reduction in minimum joint space width). The change in knee extensor and flexor ACSA and specific-strength, and subcutaneous and intermuscular fat (IMF) ACSAs were compared between progressors and non-progressors using analysis of covariance. Symptomatic progression was associated with a significantly greater loss (p<0.001) of knee extensor ACSA (-2.0%, 95%CI -2.5,-1.5) compared to those without progression (-0.7%, 95%CI -1.0,-0.4), and greater loss (p=0.020) of knee flexor specific-strength (-7.6%, 95%CI -11.5,-3.7; vs-2.4%, 95%CI -4.8, 0.0). Radiographic progression was associated with a significantly greater increase (p=0.023) in IMF (+1.7%, 95%CI -0.1,+3.6) compared to those without progression (-0.6%, 95%CI -1.6,+0.3). The significant reduction in thigh muscle strength concurrent with symptomatic progression in women appears to be associated with loss of extensor muscle ACSA and flexor specific-strength. In contrast, radiographic progression appears to be unrelated to muscle properties, but to be associated with local (intermuscular) adiposity gains.

Association of subchondral bone texture on magnetic resonance imaging with radiographic knee osteoarthritis progression: data from the Osteoarthritis Initiative Bone Ancillary Study

ObjectivesTo assess whether initial or 12–18-month change in magnetic resonance imaging (MRI) subchondral bone texture is predictive of radiographic knee osteoarthritis (OA) progression over 36 months.MethodsThis was a nested case-control study including 122 knees/122 participants in the Osteoarthritis Initiative (OAI) Bone Ancillary Study, who underwent MRI optimised for subchondral bone assessment at either the 30- or 36-month and 48-month OAI visits. Case knees (n = 61) had radiographic OA progression between the 36- and 72-month OAI visits, defined as ≥ 0.7 mm minimum medial tibiofemoral radiographic joint space (minJSW) loss. Control knees (n = 61) without radiographic OA progression were matched (1:1) to cases for age, sex, body mass index and initial medial minJSW. Texture analysis was performed on the medial femoral and tibial subchondral bone. We assessed the association of texture features with radiographic progression by creating a composite texture score using penalised logistic regression and calculating odds ratios. We evaluated the predictive performance of texture features for predicting radiographic progression using c-statistics.ResultsInitial (odds ratio [95% confidence interval] = 2.13 [1.41–3.40]) and 12– 18-month change (3.76 [2.04–7.82]) texture scores were significantly associated with radiographic OA progression. Combinations of texture features were significant predictors of radiographic progression using initial (c-statistic [95% confidence interval] = 0.65 [0.64–0.65], p = 0.003) and 12–18-month change (0.68 [0.68-0.68], p < 0.001) data.ConclusionsInitial and 12–18-month changes in MRI subchondral bone texture score were significantly associated with radiographic progression at 36 months, with better predictive performance for 12–18-month change in texture. These results suggest that texture analysis may be a useful biomarker of subchondral bone in OA.Key Points• Subchondral bone MRI texture analysis is a promising knee osteoarthritis imaging biomarker.• In this study, subchondral bone texture was associated with knee osteoarthritis progression.• This demonstrates predictive and concurrent validity of MRI subchondral bone texture analysis.• This method may be useful in clinical trials with interventions targeting bone.

Long-term benefit and survival of knee joint distraction as treatment of severe knee osteoarthritis

Purpose: In relatively young patients with end-stage knee osteoarthritis (OA), total knee arthroplasty (TKA) comes with the risk of future revision surgery. Knee joint distraction (KJD) is joint preserving surgery, which has been shown to provide clinical and structural improvement for at least five years. The aim of this study was to evaluate long-term clinical and structural results and identify characteristics predicting survival of the native knee joint. Methods: Patients (n = 20; age <60 years) with end-stage tibiofemoral OA indicated for TKA were treated with KJD. WOMAC questionnaires (100 being best) and VAS pain scores (0 being best) were used for clinical evaluation before treatment (baseline) and every year after treatment, up to nine years. The minimum and mean joint space width (JSW) were measured using KIDA software on standardized radiographs to evaluate structural changes at baseline and one, two, five and seven years after treatment. Survival after treatment was analyzed using the Kaplan-Meier estimator, where failure was defined by TKA. Paired t-tests were used to evaluate clinical and structural changes compared to baseline for survivors and non-survivors. Nine-year survival of KJD was predicted using logistic regression analyses. Results: Three patients withdrew consent during follow-up. Nine years after treatment, survival was 48% and survivors reported clinical improvement compared to baseline: ΔWOMAC +29.9 points (95%CI +16.9 to +42.9; P = 0.001; Fig. 1A), ΔVAS -46.8 mm (95%CI −31.6 to −61.9; P<0.001). Survivors showed a significant remained increase of the minimum JSW (+0.62 mm; 95%CI +0.13 to +1.11; P = 0.020; Fig. 1B) and non-significant increase in mean JSW (+0.31; 95%CI −0.91 to +1.55; P = 0.562) after seven years. In patients whose treatment failed, last reported clinical scores were still improved compared to baseline: ΔWOMAC +20.5 points (95%CI −1.8 to +42.8; P = 0.067; Fig. 1A), ΔVAS −25.4 mm (95%CI −3.2 to −47.7; P = 0.030). At last measurement, the minimum JSW was still significantly increased (+0.37; 95%CI +0.02 to +0.73; P = 0.042; Fig. 1B) while the mean JSW was similar compared to baseline (−0.06; 95%CI −0.85 to +0.72; P = 0.854). Survival analysis showed a difference in survival percentage nine years after treatment for gender (women 14%, men 70%; P = 0.035; Fig. 2A) and for amount of increase in minimum JSW in the first year after treatment (<0.5 mm increase 0%, >0.5 mm increase 72%; P = 0.002; Fig. 2B). Gender and increase in minimum JSW after one year were shown to predict survival of the native knee joint after nine years. Conclusions: Long-term results of joint distraction for end-stage knee OA show long-lasting clinical and structural improvement with a survival of 48% after nine years of follow-up. The last reported clinical scores in patients failing treatment were still improved compared to baseline and cannot fully explain the subsequent TKA surgery. Positive predicting factors for survival of the native knee after nine years are male gender and a larger initial increase in minimum joint space width. The differences between genders may relate to different subchondral bone characteristics between men and (postmenopausal) women.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Tibiofemoral joint space narrowing: can dynamic joint stiffness 2 years after anterior cruciate ligament injury years predict narrowing 5 years after injury?

Purpose: Patients with anterior cruciate ligament (ACL) injury experience higher rates of knee osteoarthritis (OA) compared with non-injured individuals. Changes in gait biomechanics are one proposed mechanism for OA development, as small changes in load bearing position shift cartilage loading to regions not adapted to ambulatory loading resulting in gradual degradation. Dynamic joint stiffness (DJS) is a biomechanical measure that captures contributions of both active muscle contraction and passive tissue tension. People with severe knee OA ambulate with higher DJS compared to healthy controls. It is unknown if DJS is predictive of radiographic changes in people after ACL injury. The purpose of this study was to evaluate if DJS measured 2 years after ACL injury predicts minimal joint space width (mJSW) 5 years after ACL injury. We hypothesized that higher DJS 2 years after injury will predict less joint space width (JSW) 5 years after injury. Methods: As part of a larger longitudinal study, 37 subjects (13 females, age 28.1 ± 11.9 yrs,) completed gait assessment 2 years after injury and radiographs at 5 years after injury. We analyzed participants' walking patterns using an eight-camera motion capture (VICON, Oxford, UK) at 120 Hz and embedded force platform (Bertec Corp, Columbus, OH) at 1080 Hz. We used 39 retroreflective markers on bilateral lower extremities and pelvis. Participants walked overground at a self-selected gait speed maintained ± 5% across trials. Data were processed using commercial software (Visual3D; C-Motion, Germantown, MD). DJS was analyzed during loading response, defined as from the first increase in external knee flexion moment to peak knee flexion. Knee flexion angle was plotted on the X-axis and an increase in the joint angle represents an increase in knee flexion. Knee extension joint moment was plotted along the Y-axis and an increase in moment represents an increase in the net external flexion moment. A larger positive slope indicates higher DJS. Weightbearing posteroanterior (PA) bent knee (30°) radiographs were read by one researcher (JLJ) for mJSW in each compartment. Tibiofemoral JSW in the medial compartment measured from plain radiographs has been shown to be a surrogate for articular cartilage thickness, of particular concern in knee OA. Linear regression was used to test if DJS at 2 years predicted mJSW at 5 years, adjusting for sex, body mass index (BMI), and meniscal involvement. Results: The median mJSW in this study was 4.6 mm and 5.7 mm in the medial and lateral compartment respectively. Using the IKDC scale for joint space narrowing, 8 subjects had mJSW of less than 4.0 mm, and 1 subject had mJSW less than 2.0 mm in the medial compartment. In the lateral compartment, 5 subjects had mJSW less than 4.0 mm and 1 subject had mJSW less than 2.0 mm. Average DJS of the involved limb at 2 years was 0.050 ± 0.009 and was not predictive of medial or lateral mJSW at 5 years, with unadjusted R2 = 0.033 and 0.022 respectively. Adjusting for sex, BMI, and meniscal involvement, the model remained not significant (R2 = 0.107 and 0.112). Conclusions: DJS was not a predictor of mJSW in subjects 5 years after ACL injury. Previous studies found a relationship only between severe OA and DJS; we had only 2 subjects with severe OA. Additionally, our cohort had a DJS range of 0.034–0.073, less stiff than previous literature. Limitations of this study included a lack of baseline DJS or JSW measurement. Additionally, our cohort had a very wide age range at time of initial injury (14.1–49.6 years old); previous research was on older adults. It is unknown what affect age has on DJS of the knee during gait. Further research at future time points (for OA progression) or with a more homogenous age sample may provide more insight to the relationship of DJS and JSW.

Association of Mucoid Degeneration of the Anterior Cruciate Ligament at MR Imaging with Medial Tibiofemoral Osteoarthritis Progression at Radiography: Data from the Osteoarthritis Initiative.

Purpose To determine whether anterior cruciate ligament (ACL) mucoid degeneration in participants with or at risk for osteoarthritis is associated with longitudinal risk of radiographic progression of medial tibiofemoral compartment joint space loss (JSL). Materials and Methods Baseline demographic, clinical, radiographic, and Magnetic Resonance (MR) Imaging Osteoarthritis Knee Score (MOAKS) data were evaluated in 600 participants from the Osteoarthritis Initiative database. Two blinded musculoskeletal radiologists independently evaluated baseline MR images for ACL mucoid degeneration. Multiple logistic regression was used to investigate the association between ACL mucoid degeneration at MR imaging and JSL progression at radiography, defined as a minimum joint space width decrease greater than 0.7 mm (48 months; cutoff according to mean and standard deviation of 1-year minimum joint space width changes in 90 knees of reference group). Stratified analysis was performed based on baseline cartilage surface damage. Results Knees with ACL mucoid degeneration showed a greater proportion of JSL progression compared with knees with a normal ACL (64% vs 47%; P = .004). After adjustment for all demographic, clinical, radiographic, and MOAKS variables, ACL mucoid degeneration was not statistically significantly associated with JSL progression in the entire cohort (adjusted odds ratio, 1.66; 95% confidence interval: 1.00, 2.77; P = .051). In subgroup analysis, ACL mucoid degeneration was statistically significantly associated with JSL progression in participants with less baseline cartilage surface damage (maximum cartilage surface loss of ≤75% in all subregions [P = .015] and ≤4 of involved subregions with cartilage surface loss [P = .028]). Conclusion ACL mucoid degeneration in participants with or at risk for osteoarthritis is associated with progression of medial tibiofemoral compartment JSL in knees with less baseline cartilage surface area damage. © RSNA, 2018 Online supplemental material is available for this article.

The posterior-anterior flexed view is better than the anterior-posterior view for assessing osteoarthritis of the knee.

The aim of this study is to determine whether the posterior-anterior (PA)-flexed view improves the radiographic assessment of patients with knee pain compared with the standard standing anterior-posterior radiograph. Three hundred and sixty-five patients with knee pain underwent anterior-posterior (AP), PA flexed, lateral, and Merchant radiographs of the knee. Knees were grouped as mild (Kellgren and Lawrence [K-L] 1-2) or severe (K-L 3-4) osteoarthritis (OA) and either varus (medial compartment), valgus (lateral compartment), or patellofemoral OA. In knees with mild valgus OA on AP view (K-L 1-2), the PA flexed view was more sensitive than the AP view. The measured lateral minimal joint space width (minJSW) decreased more than 2mm in 68% of the patients, resulting in an increase in K-L grade (3 or 4). In patients with severe valgus OA and in all patients with varus and patellofemoral OA, there was no difference between AP and PA flexed view with regard to radiographic measurements or KL grade. Based on the Medicare reimbursement rate using the PA flexed view alone instead of both views reduced imaging costs by 47%. The PA flexed view better classifies the severity of lateral compartment disease in patients with mild valgus OA and provides comparable diagnostic sensitivity for joint space narrowing in varus- and patellofemoral OA. Using the PA flexed view alone was more cost effective than using the combination of AP and PA flexed imaging.

Pelvic Tilt Displacement Before and After Artificial Hip Joint Replacement Surgery

BackgroundPrediction of pelvic displacement before total hip arthroplasty (THA) is important for accurate acetabular implant placement. This study aimed to evaluate the effect of contralateral joint conditions on pelvic displacement after THA. MethodsA total of 355 cases that underwent computed tomography before and after THA for osteoarthritis due to developmental dysplasia were assessed. The pelvic plane was based on preoperative and postoperative day 1 computed tomography images. The displacement in the anteversion direction was expressed as +. Subjects with a minimal joint space <2 mm in the contralateral hip joint were in group N; subjects with ≥2 mm were in group W; subjects with THA were in group P; and subjects who underwent THA simultaneously on both sides were in group B. The Bartlett test was used when conducting the equal variance test among the groups. The F test was used for pairwise comparison. A P value <.01 was considered statistically significant. ResultsGroups N, W, P, and B had 49, 227, 55, and 24 cases, respectively, and their displacements were −0.2° ± 2.7°, 0.8° ± 3.9°, 0.5° ± 2.6°, and 1.1° ± 4.0°, respectively; the variance between the groups was significantly different (P = .0001). The differences between groups W and N (P = .0020), between groups W and P (P = .0003), and between groups P and B (P = .0086) were statistically significant. ConclusionWhen the contralateral joint space is wide, the variance of the displacement is high. The contralateral joint affects pelvic displacement.

Statin use and knee osteoarthritis progression: Results from a post-hoc analysis of the SEKOIA trial

ObjectiveEpidemiological and experimental studies have suggested that lipid disorders might be involved in the pathophysiology of knee osteoarthritis (OA). Studies assessing the effect of statins on knee OA progression have shown conflicting results. We investigated the impact of statin use on radiological progression in patients with radiological and symptomatic knee OA. MethodsIn total, 336 patients from the placebo arm of SEKOIA trial completed the 3-year follow-up and were included in this post-hoc analysis. Statin use was recorded at baseline interview. Minimal medial tibiofemoral joint space was measured on plain radiographs by an automated method at baseline and then annually. Radiologic progression was defined as joint space narrowing≥0.5mm over 3 years. ResultsOverall, 71 patients were statin users (21.1%). They had a higher BMI (31.1±5.3 vs. 29.3±5.2kg/m2, P=0.008), a higher sum of metabolic factors (≥3 factors: 43.7% vs 7.2%; P for trend<0.001) and a higher rate of radiological progression (49.3% vs. 32.1%, P=0.007) as compared to statin non-users. The significant association between radiological progression and statin use was independent of age, gender, WOMAC global score, disease duration, baseline joint space width, hypertension, type 2 diabetes, obesity (BMI>30kg/m2) and cardiovascular diseases [relative risk 1.49 (95% CI: 1.10–2.02), P=0.010]. ConclusionAmong patients with knee OA, statin use was associated with radiological worsening over 3 years, regardless of other potential confounding factors (obesity, type 2 diabetes, hypertension, disease duration, symptom intensity and radiological severity).

Changes in Knee Joint Space Width in Treatment with a New Hyaluronic-Based Hydrogel

AbstractObjective: Our purpose was to assess the effect of a new hyaluronic acid-based (Hymovis®) injections on joint space width narrowing in patients diagnosed with knee osteoarthritis.Methods: A prospective clinical trial was conducted in the Department of Orthopedics and Traumatology II from the Clinical County Hospital, Tîrgu Mureș, Romania. Thirty-five patients diagnosed with idiopathic knee osteoarthritis received two intraarticular injections with hyaluronic acid-based hydrogel (24 mg of hyaluronic acid/3 ml) at one-week interval. Anteroposterior radiographs were obtained before the injections, at six and twelve months after. Minimum joint space width was measured by two senior orthopaedics surgeons at each follow up. Each radiograph was measured again by the same evaluators two weeks apart.Results: Thirty-one patients were present at the final follow-up. A minor reduction in mean weight was noticed (from 82.2 kg ± 16.2 kg to 80.9 kg ± 16.0, p &gt; 0.398) without any correlation with joint space width narrowing. There were no major changes at the first follow up (6 months) regarding joint space narrowing. A reduction in joint space width was observed however at 12 months varying from 4.4 mm (SD ± 1.64, range 1.8-7.1) at the first assessment to 4.3 mm (SD ± 1.26, range 0.0-6.8) at the final follow-up but with no statistical difference (p=0.237).Conclusion: No significant modification in joint space width at the final follow-up secondarily proved that two injections of Hymovis® may slow down narrowing in the knee joint space over a one-year period.

Radiographic measurements of the hip joint and their associations with hip pain in Japanese men and women: the Research on Osteoarthritis/osteoporosis Against Disability (ROAD) study.

To investigate radiographic measurements of the hip joint and their associations with hip pain, and the prevalence of acetabular dysplasia defined by radiographic measurements of the hip joint in Japanese men and women using the large-scale population-based cohort of the Research on Osteoarthritis/osteoporosis Against Disability (ROAD) study. From the baseline survey of the ROAD study (cross-sectional study), 2963 participants (1040 men, 1923 women; mean age, 70.2 years) were analyzed. All participants underwent radiographic examinations of both hips using an anteroposterior view under weight-bearing. Minimum joint space width (mJSW), central-edge (CE) angle, acetabular depth-to-width ratio (ADR), and acetabular head index (AHI) were measured. Associations between these radiographic measurements and hip pain were assessed by calculating odds ratios (ORs) using multivariable logistic-regression analysis. Acetabular dysplasia was defined as a CE angle <20°. Mean radiographic measurements of the hip joint for men were: mJSW, 3.8mm; CE angle, 30.6°; ADR, 262.1 per 1000; and AHI, 81.4%. For women, these values were: mJSW, 3.4mm; CE angle, 29.9°; ADR, 262.7 per 1000; and AHI, 81.2%. Associations were seen between hip pain and each of mJSW, CE angle, ADR, and AHI (OR 4.52, 95% confidence interval 3.45-5.97; 1.14, 1.11-1.18; 1.31, 1.24-1.40; and 1.15, 1.12-1.18, respectively). Acetabular dysplasia showed an overall prevalence of 13.9%, and was significantly more prevalent in women than in men (P=0.012). The present study of radiographic measurements of the hip joint showed that mJSW, CE angle, ADR, and AHI were associated with hip pain.

Longitudinal change in thigh muscle strength prior to and concurrent with symptomatic and radiographic knee osteoarthritis progression: data from the Osteoarthritis Initiative.

To investigate whether symptomatic and/or radiographic knee osteoarthritis (KOA) progression is associated with prior and/or concurrent change in thigh muscle strength in men or women. Osteoarthritis Initiative (OAI) participants with isometric muscle strength measurements at baseline, 2- and 4-year follow-up (n=1785: 1016 women) were grouped into 1) those with vs without symptomatic progression (i.e., increase ≥9 in WOMAC-pain [scale: 0-100]); and 2) those with vs without radiographic progression (i.e., decrease in minimum joint space width (JSW) ≥0.7mm) between year-two and year-four follow-up. Sex-specific changes in thigh muscle strength concurrent (between year-two and year-four follow-up) and prior to (between baseline and year-two follow-up) symptomatic and radiographic progression were compared between groups (progression vs no progression) using analysis of covariance, with adjustment for age and body mass index. In women, but not in men, loss in knee extensor and flexor strength was greater concurrent with symptomatic progression (extensors:-3.7%, 95% confidence interval [CI]-6.4,-0.9; flexors:-7.2% 95% CI-10.7,-3.7) than in women without symptomatic progression (extensors:-0.3%, 95% CI-1.9, 1.3, P=0.030; flexors:-2.6%, 95% CI-4.7,-0.6, P=0.018). No association was found between extensor or flexor strength loss concurrent to radiographic progression, in either men or women, nor any statistically significant association between prior change in muscle strength with symptomatic or radiographic progression. These findings suggest that there is concurrent but not prior longitudinal association between loss in muscle strength and symptomatic KOA progression that is specific to women.

Copy number loss in the region of the ASPN gene in patients with acetabular dysplasia: ASPN CNV in acetabular dysplasia.

ObjectivesWe have previously investigated an association between the genome copy number variation (CNV) and acetabular dysplasia (AD). Hip osteoarthritis is associated with a genetic polymorphism in the aspartic acid repeat in the N-terminal region of the asporin (ASPN) gene; therefore, the present study aimed to investigate whether the CNV of ASPN is involved in the pathogenesis of AD.MethodsAcetabular coverage of all subjects was evaluated using radiological findings (Sharp angle, centre-edge (CE) angle, acetabular roof obliquity (ARO) angle, and minimum joint space width). Genomic DNA was extracted from peripheral blood leukocytes. Agilent’s region-targeted high-density oligonucleotide tiling microarray was used to analyse 64 female AD patients and 32 female control subjects. All statistical analyses were performed using EZR software (Fisher’s exact probability test, Pearson’s correlation test, and Student’s t-test).ResultsCNV analysis of the ASPN gene revealed a copy number loss in significantly more AD patients (9/64) than control subjects (0/32; p = 0.0212). This loss occurred within a 60 kb region on 9q22.31, which harbours the gene for ASPN. The mean radiological parameters of these AD patients were significantly worse than those of the other subjects (Sharp angle, p = 0.0056; CE angle, p = 0.0076; ARO angle, p = 0.0065), and all nine patients required operative therapy such as total hip arthroplasty or pelvic osteotomy. Moreover, six of these nine patients had a history of operative or conservative therapy for developmental dysplasia of the hip.ConclusionsCopy number loss within the region harbouring the ASPN gene on 9q22.31 is associated with severe AD. A copy number loss in the ASPN gene region may play a role in the aetiology of severe AD.Cite this article: T. Sekimoto, M. Ishii, M. Emi, S. Kurogi, T. Funamoto, Y. Yonezawa, T. Tajima, T. Sakamoto, H. Hamada, E. Chosa. Copy number loss in the region of the ASPN gene in patients with acetabular dysplasia: ASPN CNV in acetabular dysplasia. Bone Joint Res 2017;6:439–445. DOI: 10.1302/2046-3758.67.BJR-2016-0094.R1.