Moderate Osteoarthritis Research Articles

Is it the time of a paradigm shift from intra-articular corticosteroid injections to regenerative medicine in osteoarthritis? review article

This article addresses the best practice in managing osteoarthritis (OA), weighing the benefits and risks of various intra-articular therapies. For many decades we had used intra-articular injections of corticosteroids (IACSs) as the only option after analgesics and physical therapy to help symptoms in patients who suffer from mild to moderate OA until they get ready for joint replacement. In advanced degenerative diseases, particularly in the elderly, we go directly to surgery except when there are multiple comorbidities, then surgery is not an option; thus, IACS injection is the only option left. Furthermore, in individuals suffering from renal disease, peptic ulcer, diabetes, or heart failure, we cannot use regular non-steroidal anti-inflammatory medicines, going the only option for frequent IACSs. Several kinds of literature suggest some harmful effects of IACSs. These include accelerated OA of the cartilage, subchondral insufficiency fracture, joint infection, and osteonecrosis. As the science progresses, regenerative therapies (RTs) emerge, including hyaluronic acid (HA), platelet-rich plasma (PRP), and mesenchymal stem cell (MSC) therapy. RTs carry an excellent safety profile compared to IACSs. That shift in paradigm by moving away from using IACSs in OA to those RTs has shown more prolonged symptomatic effects, slowing or stopping the progression of OA and sometimes regeneration of the cartilage and surrounding tissues.

Intra-articular Injection of Hyaluronic Acid (HA) and Plateletrich Plasma (PRP) in the Treatment of Mild and Moderate Osteoarthritis of Knee

Background: Osteoarthritis (OA) is the most prevalent chronic joint disorder worldwide and is associated with significant pain and disability. Introduction of platelet-rich plasma (PRP) injection has been viewed as an advance in the management of OA knee. Objective: To compare the effectiveness of PRP and Hyaluronic Acid (HA) in the treatment of mild and moderate OA knee Methods: The present randomized clinical trial had been conducted in the Department of Physical Medicine and Rehabilitation, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from 2018 to 2019. A total of 154 patients with mild and moderate OA knee were randomly allocated into two groups: group A (received PRP injection) and group B (received HA injection) where 133 patients completed the follow-up schedule. Outcomes were measured by OA specific translated and validated Bengali instrument- Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire and visual analogue scale (VAS 0-10). They were followed-up for 6 months. Results: There was no significant statistical difference at the baseline between the groups regarding age, sex, grading of OA knee, side involvement, mean duration of the disease, VAS scores and WOMAC scores. After one month, VAS score significantly decreased in PRP group compared to HA group (p<0.001). However, there was no statistical difference regarding total WOMAC scores between two groups (p=0.063). In third and sixth month, VAS score significantly decreased in PRP group compared to HA group (p<0.001). Though the stiffness and physical activity scores of WOMAC did not reduce significantly, the pain score reduced significantly in PRP group compared to HA group. In both groups, significant reduction of VAS and WOMAC total scores was observed after six months follow-up compared to baseline values (p<0.001). Conclusion: Intra-articular platelet-rich plasma improves pain and function of the knee in patients with osteoarthritis. Though intra-articular hyaluronic acid also improves pain and function in the foot, PRP is more effective than hyaluronic acid. Multi-centered clinical trial with long term follow-up should be conducted to see the effects of PRP and HA. Bangladesh Med Res Counc Bull 2021; 47(1): 62-69

Impact of osteoarthritis disease severity on treatment patterns and healthcare resource use: analysis of real-world data

Objective To understand treatment patterns and healthcare resource utilization (HCRU) related to osteoarthritis (OA) disease severity in patients in five European countries. Method Data were drawn from the Adelphi OA Disease Specific Programme™ (2017–18). Physicians classified their patients as having mild, moderate, or severe OA, and provided details on their current prescribed therapy and HCRU, including healthcare professional (HCP) consultations, diagnostics and testing, and hospitalizations. Comparisons between disease severity groups were made using analysis of variance and chi-squared tests. Results The study included 489 physicians (primary care physicians, rheumatologists, orthopaedic surgeons) reporting on 3596 OA patients: 24% mild, 53% moderate, and 23% severe disease. Both physicians and patients reported decreasing satisfaction with treatment with greater disease severity, despite the number of classes of prescribed drugs and increased use of opioids, which were used in almost half of patients with severe OA. For patients whose treatment was not effective, physicians prescribed the same therapeutic options, which were cycled in subsequent treatment lines, with multiple treatment regimens being commonly used. Patients with greater symptom severity also had more physician consultations, while the numbers of tests/imaging, predominantly X-rays, conducted to diagnose or monitor OA increased significantly with disease severity. The type of HCP involvement in patient management also varied by OA severity. Conclusions Across five European countries, the use of both non-pharmacological and pharmacological treatments increases with greater disease severity. Those with more severe disease place a greater demand on healthcare resources, with HCP consultations, tests, and hospital visits increasing with severity.

Vitamin D status is associated with inflammatory biomarkers and clinical symptoms in patients with knee osteoarthritis

Background and aimThe association between vitamin D status and osteoarthritis (OA) and bone remodeling has been shown previously. The present study was conducted to determine the association between vitamin D status and inflammatory biomarkers and clinical symptoms in patients with knee OA. MethodsThis case–control study was performed on 124 subjects with mild to moderate knee OA and 65 healthy controls. Demographic data was collected from all participants at baseline. We used Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC Index) for evaluating the severity of clinical symptoms in these patients. Serum levels of vitamin D as well as markers of inflammation including interleukin 1-β (IL-1β), interleukin 6 (IL-6), interleukin 10 (IL-10), tumor necrosis factor-alpha (TNF-α), high-sensitivity C-reactive protein (hs-CRP), and nuclear factor k-B (NF-κB) p65 were evaluated for each participant. ResultsThe results of the present study showed that patients with knee OA had lower levels of vitamin D and higher levels of IL-1β, TNF-α, hs-CRP, and NF-кB p65 compared with healthy controls (P < 0.0001). The levels of IL-1β, TNF-α, and NF-кB p65 in knee OA patients with vitamin D insufficiency were significantly higher compared with the knee OA patients with sufficient vitamin D (P < 0.05). Based on the linear regression analysis, serum vitamin D levels were inversely correlated with IL-1β, TNF-α, hs-CRP, and NF-кB p65 levels (P < 0.0001). Patients with sufficient vitamin D levels had lower total and physical function WOMAC scores compared with patients with vitamin D insufficiency (P = 0.011 and P = 0.010, respectively). ConclusionThe results suggest a strong link between vitamin D deficiency and increased inflammatory biomarkers as well as increased severity of clinical symptoms in knee OA patients.

Randomized double blind comparative study on efficacy and safety of oral oxaceprol 200 mg versus oral diclofenac 50 mg in patients with moderate osteoarthritis

Background: Osteoarthritis of knee is the most common form of arthritis globally, approximately 250 million people are suffering from osteoarthritis of the knee alone throughout the world. It is a chronic joint disease leading to cause cartilage degradation that involves synovial Inflammation, Subchondral bone remodelling, and Formation of osteophyte pathologically, which leads to cause pain, joint destruction and difficulty in walking. Aim of the current study was to compare the safety and efficacy of oxaceprol 200 mg versus diclofenac 50 mg in patients with moderate osteoarthritis and to determine cost-effectiveness between these two drugsMethods: this is a randomized controlled study, in our study total of 94 patients were screened, of which 85 patients met inclusion &amp; exclusion criteria. In this, 78 members gave written informed consent, they were randomly assigned by double-blind fashion into two treatment groups (oxaceprol and diclofenac). Results were analyzed by applying paired and unpaired student t-test by using SPSS softwareResults: In our study, both oxaceprol and diclofenac were extremely significant in reducing joint pain and joint stiffness and improving physical activity, but when comparing with one another oxaceprol group showed better results in improving physical activityConclusions: From our study, it is concluded that oxaceprol is equally efficacious as diclofenac in reducing knee pain, joint stiffness but more efficacious than diclofenac in improving physical activity of patients by enhancing bone remodelling.

The Association Between Physical Activity Level and Severity of Knee Osteoarthritis: A Single Centre Study in Saudi Arabia.

Background and aimKnee osteoarthritis (OA) is a disabling joint disease that results in degeneration of the joint cartilage. Many studies demonstrate the risk factors and complications of knee osteoarthritis, but how physical activity impacts the osteoarthritis severity needs to be studied. The study aimed to assess the impact and association of physical activity level with the severity of knee osteoarthritis among patients attending a single center in the Aseer region, southwest Saudi Arabia.MethodsAn analytical cross-sectional study was conducted targeting all patients clinically diagnosed with knee osteoarthritis in the Aseer region from June 2021 to September 2021. Data was collected using a pre-structured online questionnaire. The questionnaire included patients' socio-demographic data and clinical data on knee osteoarthritis. The level of physical activity was assessed using the International Physical Activity Questionnaire (IPAQ). The severity of knee osteoarthritis was assessed using the index of severity for osteoarthritis of the knee.ResultsOut of 473 patients clinically diagnosed with knee OA, only 145 patients met our inclusion criteria. Patients' ages ranged from 35 years to 71 years, with a mean age of 44.3 (±12.9) years. A total of 122 (84.1%) patients were females. Sixty-five (44.8%) patients complained of knee OA for less than two years, 46 (31.7%) for two to five years, and 34 (23.4%) were diagnosed for more than five years. A total of 96 (66.2%) had a low level of physical activity, 32 (22.1%) had a moderate level of physical activity, while 17 (11.7%) had a high level of physical activity. Thirty-eight (26.2%) cases complained of extremely severe knee OA, 37 (25.5%) had very severe knee OA, 28 (19.3%) complained of severe knee OA, 36 (24.9%) had mild to moderate knee OA, while six (4.1%) had minimal knee OA. There was a significant beneficial effect of physical activity on the severity of knee OA.ConclusionThe study revealed that physical activity, especially at high levels, was associated with lower knee OA severity which means a beneficial effect. Most of the patients included in the study had severe to extremely severe knee OA with low physical activity levels.

The Role of Wolves in Regulating a Chronic Non-communicable Disease, Osteoarthritis, in Prey Populations

It is widely accepted that predators disproportionately prey on individuals that are old, weak, diseased or injured. By selectively removing individuals with diseases, predators may play an important role in regulating the overall health of prey populations. However, that idea is seldom tested empirically. Here we assess the extent that wolves (Canis lupus) select adult moose (Alces alces) in Isle Royale National Park on the basis of age-class and osteoarthritis, a chronic, non-communicable disease. We also assess how temporal variation in kill rates (on moose by wolves) were associated with the subsequent incidence of osteoarthritis in the moose population over a 33-year period (1975–2007). Wolves showed strong selection for senescent moose and tended to avoid prime-aged adults. However, the presence of severe osteoarthritis, but not mild or moderate osteoarthritis, appeared to increase the vulnerability of prime-aged moose to predation. There was weak evidence to suggest that senescent moose with osteoarthritis maybe more vulnerable to wolves, compared to senescent moose without the disease. The incidence of osteoarthritis declined following years with higher kill rates–which is plausibly due to the selective removal of individuals with osteoarthritis. Together those results suggest that selective predation plays an important role in regulating the health of prey populations. Additionally, because osteoarthritis is influenced by genetic factors, these results highlight how wolf predation may act as a selective force against genes associated with developing severe osteoarthritis as a prime-aged adult. Our findings highlight one benefits of allowing predators to naturally regulate prey populations. The evidence we present for predation’s influence on the health of prey populations is also relevant for policy-related arguments about refraining from intensively hunting wolf populations.

Assessment of clinical outcome of platelet rich plasma (PRP) injection in progression of mild to moderate osteoarthritis patients, a retrospective study

Background and Objectives: Global reports (2020) state that an annual 86.7 million people (age >20 years) are diagnosed with incident knee Osteoarthritis. Various therapies and medications have been given to treat this condition and one such upcoming therapy is the use of Platelet-rich plasma. In spite of the promising outcomes, some experts in the field are yet skeptical about the use of Platelet-rich plasma therapy to treat osteoarthritis. In this study, the investigators attempt to measure the clinical outcome of platelet-rich plasma therapy in patients with progression of mild to moderate osteoarthritis. Methods: Analysis of 102 patient records was carried out from the years 2016-2020 to assess the clinical outcome of the intra-articular Platelet Rich Plasma (PRP) injection in the progression of mild to moderate osteoarthritis patients from the period of pre-injection to 12 months post-injection. Assessment tools such as the VAS and the WOMAC score were used. IBM SPSS software version 1.0 was used for the statistical data analysis. Results: Medical records analyzed of the patients showed a gradual decrease in pain, observed over a period of 12 months post-injection (as assessed by the VAS and WOMAC score). Significant reduction in swelling (Friedman test: Chi-square = 199.68, P< 0.0001) and tenderness (Friedman test: Chi-square = 199.14, P< 0.0001) was also observed. Conclusion: A significant reduction in pain, swelling, tenderness and improvement in function was observed post 12 months of the injection given. The results are encouraging when compared to pre-injection pain and symptoms, suggesting a positive clinical use of PRP injections for mild to moderate osteoarthritic patients.

Genicular Artery Embolization for Primary Knee Osteoarthritis.

Genicular artery embolization (GAE) is a novel treatment for knee osteoarthritis (OA) with increasing interest and utilization worldwide. The genicular arteries are selectively embolized using microspheres with subsequent cessation of abnormal synovial hyperemia, a process believed to arrest the inflammatory changes and pain associated with OA. Current data indicate that GAE offers sustained, 6-month improvement in Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) and visual analog scale scores in 80 to 85% of patients with mild to moderate OA. As GAE gains traction, future studies are needed to establish its safety and efficacy relative to placebo and other standard-of-care therapies while also characterizing populations for which it is most effective.

Does Less Pain Predict Better Quality of Life among Malaysian Patients with Mild-Moderate Knee Osteoarthritis?

This study aims to identify the relationship between knee functional status and Health-Related QoL (HRQoL) in mild to moderate knee osteoarthritis (OA) patients and to ascertain which subdomain of knee functional status best predicts good HRQoL. A cross-sectional study was conducted in an orthopaedic clinic of a tertiary hospital in Malaysia. Patients aged 40–75 years old with mild–moderate primary knee OA were recruited. The Knee Injury and Osteoarthritis Outcome Score (KOOS) and SF-36 questionnaires were used to measure knee functional status and HRQoL, respectively. Subdomains of KOOS include “function in daily living”, “function in recreational activities”, “pain”, “symptom”, and “knee-specific quality of life”. Subdomains for SF-36 are Physical Component Summary (PCS) and Mental Component Summary (MCS). Overall, 290 patients fulfilled the inclusion criteria of the study, with a mean age of 66.8 years old (±7.06). Majority were female (57.6%) and Malay (79.7%). The relationships between all KOOS and HRQoL subdomains were significant. “Pain” contributed most towards better physical HRQoL ((PCS) Adj. B (95% CI); 0.063 (0.044, 0.169)), while “function in daily living” contributed most towards better mental HRQoL ((MCS) Adj. B (95% CI); 0.624 (0.478, 0.769)). Thus, better HRQoL was related to better pain control and improved “function in daily living” in these patients.

Walking-related knee contact forces and associations with knee pain across people with mild, moderate and severe radiographic knee osteoarthritis: a cross-sectional study

To investigate knee contact forces (KCFs), and their relationships with knee pain, across grades of radiographic knee osteoarthritis (OA) severity. Cross-sectional exploratory analysis of 164 participants with medial knee OA. Radiographic severity was classified as mild (grade 2), moderate (grade 3) or severe (grade 4) using the Kellgren & Lawrence (KL) scale. Walking knee pain was assessed using an 11-point numerical rating scale. External knee adduction moment (external KAM) and internal muscle forces were used to calculate medial, lateral and total KCFs using a musculoskeletal computational model. Force-time series across stance phase of gait were compared across KL grades using Statistical Parametric Mapping. Associations between KCFs and pain across KL grades were assessed using linear models. Medial KCFs during early and middle stance were higher in participants with KL3 and KL4 compared to those with KL2. In contrast, lateral KCFs were higher in those with KL2 compared to KL3 and KL4 in middle to late stance. The external loading component (i.e., KAM) of the medial KCF during middle to late stance was also greater in participants with KL3 and KL4 compared to those with KL2, whereas the internal (i.e., muscle) component was greater in those with KL3 and KL4 compared to KL3 during early stance. There were no associations between medial KCF and knee pain in any KL grade. Medial and lateral KCFs differ between mild, moderate and severe radiographic knee OA but are not associated with knee pain severity for any radiographic OA grade.

Intra-Articular Injections of Autologous Adipose Tissue or Platelet-Rich Plasma Comparably Improve Clinical and Functional Outcomes in Patients with Knee Osteoarthritis.

The use of biologic therapies for the management of knee osteoarthritis (OA) has largely increased in recent years. The purpose of this study was to evaluate the efficiency and the therapeutic potential of platelet-rich plasma (PRP) and autologous adipose tissue (AAT) injections as a treatment for knee OA. Sixty participants were enrolled in the study: 20 healthy ones and 40 with minimal to moderate knee OA (KL I-III). The OA patients were randomly assigned either to the PRP or to the AAT group. The PRP samples showed a low expression level of NF-κB-responsive gene CCL5 and high expression levels of classic inflammatory and TNF-l INF responses. The AAT injection product was prepared using a Lipogems device, and its regenerative potential as well as the ability for expansion of mesenchymal stem cells were tested in the cell culture conditions. The patient assessments were carried out five times. Significant improvement was observed regardless of the treatment method in the VAS, KOOS, WOMAC and IKDC 2000 subjective evaluations as well as in the functional parameters. Intra-articular injections of AAT or PRP improved pain, symptoms, quality of life and functional capacity with a comparable effectiveness in the patients with mild to moderate knee osteoarthritis.

A New Generation of Osteochondral Autograft Transfer System for the Treatment of Osteochondritis Dissecans of the Femoral Condyle: Clinical Experience in 18 Dogs.

The aim of this study was to describe the clinical application and outcome of osteochondral autograft transfer using the COR system (COR; DePuy Synthes, Warsaw, Indiana, United States) for the treatment of osteochondritis dissecans (OCD) of the femoral condyle in dogs. Medical records of dogs that were treated for OCD of the femoral condyle using the COR system between February 2013 and March 2020 were retrospectively reviewed. The results of pre- and postoperative clinical and radiographic examinations were evaluated. Twenty stifles (18 dogs; 15 lateral and 5 medial femoral condyles) met the inclusion criteria. A single graft transfer was done in six stifle joints and mosaicplasty in 14 (2 grafts in 9/14 stifles; 3 grafts in 5/14 stifles). Proper anatomic reconstruction was confirmed intraoperatively and radiographically in all dogs. There were no major and three minor postoperative complications. At 3 months, 15 of 20 stifles (14 of 18 dogs) had no lameness or radiographic signs of inflammation. At 6 months, 12 of 13 dogs had no lameness or discomfort, and four of 13 stifles had radiographic evidence of moderate osteoarthritis. Treatment of OCD of the femoral condyle using the COR system is feasible in dogs, with low complications and provides a satisfactory short-term outcome.

The efficacy of a nutritional supplement containing green-lipped mussel, curcumin and blackcurrant leaf extract in dogs and cats with osteoarthritis.

BackgroundOsteoarthritis is a common disease in dogs and cats, and the search for novel treatment options is needed. The combination of green‐lipped mussel, curcumin and blackcurrant leaf extract has to date not been studied in dogs and cats.ObjectivesThe aim of this study was to test the effect of a supplement containing green‐lipped mussel (Perna canaliculus), curcumin (Curcuma longa) and blackcurrant (Ribes nigrum) leaf extract on locomotion and behaviour in client‐owned dogs and cats suffering from mild to moderate osteoarthritis.MethodsTo this end, 32 dogs and 16 cats were enrolled in a double‐blinded, randomised, crossover, placebo‐controlled trial for 10 weeks in cats and 16 weeks in dogs. Outcome parameters were the Helsinki Chronic Pain Index (HCPI) by pet owners in dogs and cats, Canine OsteoArthritis Staging Tool (COAST) by a veterinarian in dogs and Force Plate Analysis (FPA) in 18 dogs.ResultsIn dogs, the COAST improved significantly in the supplement group compared to baseline but was not different than the placebo group. In cats, the ability to groom, activity level, playfulness and walking up the stairs improved in the supplement group. No differences were found on HCPI scores and FPA in dogs. Several non‐responders were noted in both species, which were irrespective of the stage of osteoarthritis.ConclusionsOverall, the supplement had only partial positive effects in client‐owned dogs and cats with mild to moderate osteoarthritis. Further research with a larger sample size and longer duration is needed to expand these findings.

Pharmacological Effects of Hyaluronic Acid on Osteoarthritis of Knee Joint

This longitudinal type of prospective study was carried out the clinical outcome of intra-articular Hyaluronic Acid injection in the management of mild to moderate osteoarthritis of knee joint. The sample size was 78 which was selected purposively. Partially structured questionnaire was used to collect data from the respondents by face-to-face interview. All efforts were made to collect data accurately. For open questions, the respondents were asked in such a manner way so that they could speak freely and explain their opinion in a normal and neutral way. Regarding age in group distribution of the respondents it was found that majority (47.4%) were in the age group of more than 61 years. The man monthly family income was 215431.21 ± 16898.112 Taka. About 41.0% were overweight, 14.1% had hypertension, 80.8% had multiple symptoms of osteoarthritis in knee joint, 94.87% had restricted range of motion. It was identified that 92.31% relieved pain by injections, 60.25% had satisfactory feeling after injections. The relationship between age group of the respondents was statistically significant (p&lt;0.05; p&lt;0.01) with side effect of injection, pain relief after injection, feeling of patients after injection. The relationship between BMI of the respondents was statistically significant (p&lt;0.05; p&lt;0.01) with pain relief after injection, feeling of patients after injection. The relationship between complications of injection was statistically significant (p&lt;0.05; p&lt;0.01) with systemic diseases of the respondents. TAJ 2021; 34: No-2: 48-55

DETERMINING MINIMAL DETECTABLE CHANGE AND TEST-RETEST RELIABILITY OF TIMED UP AND GO TEST, 5 TIMES SIT TO STAND TEST, 10 METERS WALK TEST, AND MAXIMAL VOLUNTARY ISOMETRIC CONTRACTION OF KNEE EXTENSORS AND FLEXORS IN PATIENTS WITH KNEE OSTEOARTHRITIS

Introduction Timed Up and Go test (TUG), 5 Times Sit to Stand test (STS) and 10-meter Walk test (WT) are often used in clinical trials. Aim The purpose of this study is to determine the test-retest reliability of TUG, STS, 10WT and maximal voluntary isometric contraction (MVIC) of the knee extensors and flexors and to determine a minimal detectable change (MDC) for those tests in a population of patients with knee osteoarthritis (OA) who will undergo conservative treatment. Material and methods Sixty-one patients with symptomatic knee OA were included in this study. The testing protocol consisted of TUG, STS, 10WT and maximal voluntary isometric contraction (MVIC) of knee extensors and flexors. Participants were tested twice. Results TUG, STS, 10WT and MVIC and standardised MVIC of knee extensors and flexors showed an excellent test-retest reliability. Standard Error of Measurement and MDC95 for TUG was 0.37s and 1.01s, respectively; for STS was 0.69s and 1.91s, respectively; for 10WT was 0.23s and 0.65s, respectively; for MVIC of extensors was 19.66N and 54.5N, respectively; for MVIC of flexors was 9.73N and 26.96N, respectively; for standardised MVIC of extensors was 0.22 and 0.62, respectively; for standardised MVIC of flexors was 0.11 and 0.31, respectively. Conclusions TUG, STS, 10WT, and MVIC measurements have excellent test-retest reliability in mild to moderate knee OA patients. Changes greater than 1.01s for TUG, 1.91s for STS, 0.65s for 10WT, 0.62 for standardised MVIC of knee extensors and 0.31 for standardised MVIC of knee flexors may be used as clinically significant.

Predictors of Disparities in Patient-Reported Outcomes before and after Arthroscopic Meniscectomy.

The purpose of this study is to identify predictors of disparities in patient-reported outcome measures (PROMs) before and after arthroscopic meniscectomy. Knee injury and Osteoarthritis Outcome Score (KOOS) was used in this study. All patients who underwent single-knee arthroscopic meniscectomy from January 2012 to March 2018 performed by a single surgeon at an academic safety-net hospital were identified. We excluded patients who had undergone ipsilateral previous knee surgery, bilateral meniscectomy, or concomitant ligament, cartilage, or osteotomy procedures, and those with severe radiographic osteoarthritis in the operated knee, missing preoperative data, or military insurance. Data abstracted from medical records included demographics (age, sex, race, insurance type), clinical characteristics (body mass index, Charlson comorbidity index, and Kellgren-Lawrence [KL] grade), procedure codes, and KOOS assessed before and 90 days after surgery. Multivariable analyses investigated the associations between patient characteristics and the KOOS Pain, other Symptoms, and Function in activities of daily living (ADL) subscales. Among 251 eligible patients, most were female (65.5%), half were of nonwhite race (50.2%), and almost one third were insured by Medicaid (28.6%). Medicaid and black race were statistically significant (p < 0.05) predictors of worse preoperative values for all three KOOS subscales. Medicaid insurance also predicted a lower likelihood of successful surgery, defined as meeting the 10-point minimal clinically important difference, for the KOOS symptoms (p < 0.05) and KOOS ADL (p < 0.05) subscales. Compared with patients without definitive evidence of radiographic osteoarthrosis (KL grade 1), those with moderate radiographic osteoarthritis (KL grade 3) were less likely to have a successful surgical outcome (p < 0.05 for all subscales). Worse preoperative KOOS values predicted worse postoperative KOOS values (p < 0.001 for all subscales) and a lower likelihood of surgical success (p < 0.01 for all subscales). Insurance-based disparities in access to orthopaedic care for meniscus tears may explain worse preoperative PROMs and lower success rates of meniscectomy among Medicaid patients. Patients with meniscus tears and radiological and/or magnetic resonance imaging evidence of osteoarthritis should be carefully evaluated to determine the appropriateness of arthroscopic meniscectomy.

Rates and risk factors of intrapedicular accuracy and cranial facet joint violation among robot-assisted, fluoroscopy-guided percutaneous, and freehand techniques in pedicle screw fixation of thoracolumbar fractures: a comparative cohort study

BackgroundRobot-assisted (RA) technique has been increasingly applied in clinical practice, providing promising outcomes of inserting accuracy and cranial facet joint protection. However, studies comparing this novel method with other assisted methods are rare, and the controversy of the superiority between the insertion techniques remains. Thus, we compare the rates and risk factors of intrapedicular accuracy and cranial facet joint violation (FJV) of RA, fluoroscopy-guided percutaneous (FP), and freehand (FH) techniques in the treatment of thoracolumbar fractures.MethodsA total of 74 patients with thoracolumbar fractures requiring pedicle screw instruments were retrospectively included and divided into RA, FP, and FH groups from June 2016 to May 2020. The primary outcomes were the intrapedicular accuracy and cranial FJV. The factors that affected the intrapedicular accuracy and cranial FJV were assessed using multivariate analyses.ResultsThe optimal intrapedicular accuracy of pedicle screw placement (Grade A) in the RA, FP, and FH groups was 94.3%, 78.2%, and 88.7%, respectively. This finding indicates no significant differences of RA over FH technique (P = 0.062) and FP technique (P = 0.025), but significantly higher accuracies of RA over FP (P < 0.001). In addition, the rates of proximal FJV in RA, FP, and FH groups were 13.9%, 30.8%, and 22.7%, respectively. RA had a significantly greater proportion of intact facet joints than the FP (P = 0.002). However, FP and FH (P = 0.157), as well as RA and FH (P = 0.035) showed significantly similar outcomes with respect to the proximal FJV. The logistic regression analysis showed that FP technique (OR = 3.056) was independently associated with insertion accuracy. Meanwhile, the age (OR = 0.974), pedicle angle (OR = 0.921), moderate facet joint osteoarthritis (OR = 5.584), and severe facet joint osteoarthritis (OR = 11.956) were independently associated with cranial FJV.ConclusionRA technique showed a higher rate of intrapedicular accuracy and a lower rate of cranial FJV than FP technique, and similar outcomes to FH technique in terms of intrapedicular accuracy and cranial FJV. RA technique might be a safe method for pedicle screw placement in thoracolumbar surgery.Level of evidence3

Dickkopf‑3 and β‑catenin play opposite roles in the Wnt/β‑catenin pathway during the abnormal subchondral bone formation of human knee osteoarthritis.

Osteoarthritis (OA) is condition which poses a main concern to the aging population and its severity is expected to increase with the increasing life expectancy. In the future, several possible targets for OA treatment need to be defined. Dickkopf-related protein 3 (DKK3) is an atypical member of the Wnt-antagonistic dickkopf-related protein (DKK) family. The availability of research into the role of DKK3 in the abnormal remodeling of subchondral bone in human knee joints is currently limited. Thus, the aim of the present study was the evaluation of DKK3 expression in the abnormal bone remodeling of subchondral bone in human knee OA in order to clarify the role of DKK3 in subchondral bone remodeling and to acknowledge its potential relevance to β-catenin. In total, 38 specimens were collected from osteotomies of the medial tibial plateau of the human knee. The patient samples were then divided into the normal, mild, moderate and severe symptom groups, according to the Osteoarthritis Research Society International (OARSI) score. Following hematoxylin and eosin (H&E) and Safranin O-fast green staining for alkaline phosphatase (AZO method), changes in the distribution and number of osteocytes in the subchondral bone and the degree of sclerosis of the subchondral bone were observed. Immunohistochemical staining, immunofluorescence, western blot analysis and reverse-transcription quantitative PCR (RT-qPCR) were used for the detection of DKK3 and β-catenin expression level changes in osteoblasts in the subchondral bone of the medial tibial plateau. H&E and alkaline phosphatase staining revealed that the total number of osteocytes in the subchondral bone increased with the severity of the disease. The samples were also evaluated using Safranin O-Fast Green staining and were attributed a score according to the OARSI scoring system: The scoring number and cartilage damage increased along with OA severity. Immunohistochemistry and immunofluorescence assays demonstrated that β-catenin expression in osteocytes increased from mild to moderate, whereas DKK3 expression decreased with the development of arthritis from normal, mild to moderate. According to the results of western blot analysis, β-catenin expression was higher in moderate OA and then decreased in severe OA. On the other hand, the DKK3 levels decreased along with the progression from normal, mild to moderate OA. The results of RT-qPCR demonstrated that β-catenin and DKK3 gene expression differed with the degree of OA. On the whole, the present study demonstrates that DKK3 and β-catenin may play opposite roles in OA subchondral bone remodeling.

Science, Medicine, and the Anesthesiologist

Science, Medicine, and the Anesthesiologist