Osteoarthritis Research Articles

Associations between urinary phytoestrogen mixed metabolites and osteoarthritis risk.

This study aims to explore the relationship between urinary phytoestrogen mixed metabolites and the risk of osteoarthritis (OA). Using data from the National Health and Nutrition Examination Survey (NHANES), a Weighted Quantile Sum (WQS) regression analysis was conducted to determine the dominant metabolites. Additionally, a Bayesian kernel machine regression (BKMR) model was utilized to explore the combined effects of phytoestrogen mixed metabolites on OA. Compared to the lowest quartile group, the highest quartile group of Enterodiol showed a 46% increased risk of OA (OR = 1.46, 95% CI: 1.09-1.96), while the highest quartile group of Enterlactone showed a 30% decreased risk of OA (OR = 0.70, 95% CI: 0.52-0.96). The WQS regression model analysis revealed a positive relationship between urinary phytoestrogen mixed metabolites and OA risk, with Enterodiol found to have the highest weight in this association. The BKMR model indicated that the association between urinary phytoestrogens and OA increased with concentration but did not reach statistical significance. The univariate exposure-response function demonstrated a positive association between Enterodiol and OA. There is a positive relationship between urinary phytoestrogen mixed metabolites and OA, with Enterodiol being an important factor influencing OA risk.

Is there a genetic relationship between blood glucose and osteoarthritis? A mendelian randomization study.

The relationship between blood glucose levels and osteoarthritis (OA) is unclear. This study aimed to investigate the genetic causal relationship between blood glucose-related traits and OA. We first performed univariate Mendelian randomization (UVMR) analyses using published genome-wide association study (GWAS) datasets with fasting glucose (FG), 2h-glucose post-challenge glucose (2hGlu), and glycosylated hemoglobin (HbA1c) as exposures, and hip osteoarthritis (HOA) and knee osteoarthritis (KOA) as outcomes; then, we performed inverse analyses of them. We used Inverse-variance weighted (IVW) analysis as the primary analysis, and sensitivity analyses were performed. Moreover, we performed multivariate Mendelian randomization (MVMR) to estimate the independent effect of exposure on outcome after adjusting for body mass index (BMI). Summarized data for blood glucose-related traits were obtained from the MAGIC Consortium study of the glucose trait genome and for OA from the UK Biobank and arcOGEN. Summarized data for BMI were obtained from the GIANT Consortium meta-analysis of individuals of European ancestry. A two-sided p value < 0.05 in UVMR was considered suggestive of significance when p < 0.0167 (Bonferroni correction p = 0.05/3 exposures) was considered statistically significant. We found significant negative genetic causality of FG for HOA and KOA, and these associations remained significant after we adjusted for the effect of BMI [odds ratios (ORs) of 0.829 (0.687-0.999, p = 0.049) and 0.741 (0.570-0.964, p = 0.025)]. HbA1c also had an independent negative genetic causal effect on HOA after adjustment for BMI [0.665 (0.463-0.954, p = 0.027)]. At the same time, there was no evidence of reverse genetic causality of OA on blood glucose-related traits. We further elucidated the relationship between blood glucose-related traits and OA by adjusting for the effect of BMI from a genetic causal perspective. This study provides new insights to further clarify the relationship between blood glucose levels and OA, as well as the pathogenesis, etiology and genetics of OA.

National Institute of Health and Care Excellence Clinical Criteria for the Diagnosis of Knee Osteoarthritis: A Prospective Diagnostic Accuracy Study in Individuals with Type 2 Diabetes.

The National Institute of Health and Care Excellence (NICE) criteria for osteoarthritis (OA) obviate the need for physical exam or imaging, and their use may improve timely diagnosis of OA. However, they have not been validated. Within a larger study of individuals with type 2 diabetes, participants with and without self-reported knee pain underwent assessment of the NICE criteria for knee OA by questionnaire (index test), and clinical evaluation for established or possible knee OA by a rheumatologist (reference standard). We calculated the sensitivity, specificity, likelihood ratio positive (LR+) and likelihood ratio negative (LR-) of the NICE criteria and modified NICE criteria without the stiffness criterion. Our study included 96 participants: mean age 65.4 (SD 8.3) years and 52% were women. Individuals who fulfilled NICE criteria for knee OA (55.2%) included a spectrum of pain severity on a 11-point pain numeric rating scale with a median score of 5 (range: 1-9). Rheumatologist assessment identified 56 (58.3%) participants with symptomatic knee OA. The sensitivity, specificity, LR+, and LR- of NICE criteria for symptomatic knee OA were 0.84 (95% CI 0.74, 0.94), 0.85 (95% CI 0.74, 0.96), 5.6 and 0.19, respectively. For modified NICE criteria, these were 0.89 (95% CI 0.82, 0.97), 0.85 (95% CI 0.74, 0.96), 5.93 and 0.13. The NICE criteria have high sensitivity and specificity for detecting symptomatic knee OA in a population with type 2 diabetes. We found that a modified version, omitting the stiffness criterion, performed similarly. These criteria should be validated in other settings and populations.

Exploring whether home-based neuromodulation can boost the analgesic effects of exercise in people with knee osteoarthritis: protocol for a double-blinded, pilot randomised controlled trial

IntroductionKnee osteoarthritis (OA) represents a leading cause of disability globally. Exercise has been demonstrated to improve pain and function in people with knee OA. However, when in pain, commencement of...

Comparative study of the effect of Thymus daenensis gel 5% and diclofenac in patients with knee osteoarthritis

Comparative study of the effect of Thymus daenensis gel 5% and diclofenac in patients with knee osteoarthritis

Biomechanical impact of progressive meniscal extrusion on the knee joint: a finite element analysis.

While measuring meniscal extrusion quantitatively is an early risk factor for knee osteoarthritis (KOA), the biomechanics involved in this process are not well understood. This study aimed to investigate the effects of varying degrees of medial and lateral meniscal extrusion and their material softening on knee osteoarthritis progression. Finite element analysis (FEA) was utilized to simulate varying degrees of meniscal extrusion (1-5mm) in 72 knee joint models, representing progressive meniscal degeneration and material softening due to injury. Changes in von Mises stress of the cartilage and menisci and the load distribution on the tibial plateau's meniscus and cartilage were studied under balanced standing posture in both healthy and injured knees, and statistical analysis was performed using Spearman correlation. Compared to healthy knees, peak stress in medial compartment tissues increased by over 40% with 4mm of medial meniscus extrusion, and in lateral compartment tissues with 2mm of lateral meniscus extrusion. Meniscus extrusion reduced the contact load between the meniscus and femoral cartilage but increased it between the tibial and femoral cartilages, with a maximum increase up to fivefold. Spearman correlation analysis indicated that meniscal extrusion significantly affected peak stress and contact loads in the respective knee compartment (p < 0.001), with a lesser impact on the opposite compartment. Notably, medial meniscal extrusion also significantly increased peak stress in the lateral tibial cartilage (p < 0.05). The quantitative analysis revealed that meniscal extrusion significantly affected the biomechanics of soft tissues within the same compartment, with limited impact on the opposite side. Specifically, Medial extrusion beyond 4mm significantly affected the biomechanics of the medial compartment, while lateral extrusion over 2mm had a similar impact on the lateral compartment. Meniscal softening, without altering joint contact characteristics, primarily affected the biomechanics of the meniscus itself, with minimal impact on other soft tissues.

Arthroscopic meniscal posterior root repair combined with centralization reduces medial menicus extrusion associated with posterior root tears: One-year clinical outcomes.

This study aimed to assess the short-term clinical efficacy of combining posterior meniscal root repair with meniscal centralization technology in the treatment of medial meniscus posterior root tears (MMPRTs) and notable meniscus extrusion. In this retrospective analysis, patients aged 43-76 years with only chronic posterior root tears of the medial meniscus and notable extrusion were followed up for 12-14 months. (1) persistent medial knee joint pain affecting daily life, presenting with joint space tenderness; (2) showing the ineffectiveness of conservative treatment for a minimum of 3 months; conservative treatment includes non-invasive methods such as nonsteroidal anti-inflammatory drugs, physical therapy and massage, but does not include intra-articular injections. (3) Kellgren-Lawrence Grades 0-II osteoarthritis (OA) of the knee joint; and (4) diagnosis of a posterior root tear of the medial meniscus with notable meniscus extrusion confirmed through knee-joint plain magnetic resonance imaging (MRI) scans, where coronal image revealed a meniscus body extrusion of ≥3 mm. (1) Kellgren-Lawrence Grades III-IV OA in the knee joint; (2) presence of knee joint infection or other structural damage to the knee joint; (3) history of previous knee joint surgery; (4) demonstrating joint instability or abnormal lower-limb alignment (varus deformity >5°); and (5) presence of severe mental illness, coagulation disorders, or other serious medical conditions. The Lysholms score, the Hospital for Special Surgery (HSS) knee score, the visual analogue scale (VAS) score and meniscal extrusion values were evaluated before and after surgery in 23 patients through a comparative analysis. The results of the follow-up conducted 12-14 months post-operatively indicated a significant improvement in the patients' conditions. In particular, the Lysholms scores (preoperative: 50.9 ± 10.2; 1-year post-surgery: 72.0 ± 8.4), HSS knee scores (preoperative: 45.9 ± 10.6; 1-year post-surgery: 79.1 ± 11.1) and VAS scores (preoperative: 4.0 ± 1.1; 1-year post-surgery: 0.9 ± 0.7) exhibited notable enhancements. Furthermore, compared to the preoperative values, the degree of meniscus extrusion measured by coronal MRI of the knee joint significantly improved post-operatively (preoperative: 3.7 ± 0.8 mm; 1-year post-surgery: 2.2 ± 0.6 mm). These findings all yielded a p < 0.05, signifying statistical significance. In patients with chronic MMPRTs and notable extrusion, a combination of posterior meniscal root repair and centralization technology can effectively restore meniscus function and rectify the medial meniscus displacement, resulting in favourable short-term clinical outcomes. Level IV.

Evaluating Criteria for Symptoms Suggestive of Early Osteoarthritis Over Two Years Post-Anterior Cruciate Ligament Reconstruction: Data From the New Zealand Anterior Cruciate Ligament Registry.

The objectives were to determine the prevalence of meeting criteria for symptoms suggestive of early osteoarthritis (OA) after anterior cruciate ligament reconstruction (ACLR) and to characterize the longitudinal changes in these symptoms during the first two years post-ACLR. We analyzed data from 10,231 patients aged 14 to 40 years in the New Zealand ACL Registry who completed the Knee Injury and Osteoarthritis Outcome Score (KOOS) at 6, 12, and 24 months post-ACLR. Symptoms suggestive of early OA were defined as scoring ≤85% on at least two of four KOOS subscales. Longitudinal patterns of change were categorized as persistent, resolution, new, inconsistent, or no symptoms across the three visits. Prevalence and odds ratios (ORs) of symptoms were compared across visits, sex, and age groups using generalized estimating equations, and longitudinal patterns of symptom change were analyzed using multinomial logistic regression. Prevalence of meeting criteria of symptoms suggestive of early OA was 68% at 6 months, 54% at 12 months, and 46% at 24 months post-ACLR. Longitudinally, 33% had persistent symptoms, 23% had no symptoms, 29% showed symptom resolution, 6% developed new symptoms, and 9% had inconsistent symptoms. Women consistently showed higher odds of symptoms (OR range 1.17-1.52). Older age groups demonstrated higher odds of symptoms, particularly at 6 months (OR range 1.64-2.45). Symptoms suggestive of early OA are highly prevalent within two years post-ACLR, with one third of patients experiencing persistent symptoms. These findings indicate that symptoms are more likely to persist rather than newly develop, emphasizing the importance of early identification and targeted interventions.

Building the OAChangeMap to Improve the Service Delivery of the New South Wales Osteoarthritis Chronic Care Program: A Worked Example of Using a Codesign Framework.

The Osteoarthritis Chronic Care Program (OACCP) has been implemented in Australian public hospitals to deliver best evidence osteoarthritis (OA) care. It is important to ensure that the OACCP continues to deliver evidence-based OA care as intended. We aimed to identify barriers and enablers to delivering the OACCP, prioritize the barriers, and generate strategies to address them. This study provides a worked example of a seven-step theory-informed codesign framework. We invited OACCP coordinators to participate in semistructured interviews (analyzed thematically) and complete a questionnaire to identify barriers and enablers to delivery of the OACCP. We then invited a broader group of stakeholders (OACCP coordinators, health managers, policy makers, consumers, and researchers) to prioritize the barriers via a short survey (survey 2). We held five codesign workshops in which we mapped the priority barriers to the Theoretical Domains Framework and developed strategies to address them. Sixteen coordinators were interviewed, and the main barriers identified were as follows: (1) patients often have beliefs that are inconsistent with best evidence care, (2) there are aspects of clinical care that are not delivered optimally, and (3) system-level factors are a barrier to optimal patient care and sustainability of the OACCP. We codesigned a plan for action with patient educational materials, shared decision-making tools, and health professional education and training. Our worked example of codesign used a theory-based, data-driven approach with key stakeholders, identified and prioritized barriers to the delivery of the OACCP, acknowledged enablers, and generated a plan for feasible strategies to improve the program.

Undergoing cartilage procedures before total knee arthroplasty is not associated with worse postoperative functional outcomes, readmission rates or complication rates.

Patients undergoing total knee arthroplasty (TKA) with prior knee cartilage surgery have unclear outcomes in the literature. This study compared outcomes after TKA in patients with or without prior knee cartilage surgery, and we hypothesized there would be equivocal outcomes between groups. A retrospective matched case-control study was conducted on patients from our institution who underwent ipsilateral cartilage procedure(s) and TKA (cases) or TKA alone (controls) from 2000 to 2022. Cartilage procedures included Autologous Chondrocyte Implantation (ACI), Osteochondral Allograft (OCA) and Microfracture (MFx). Matching was performed in 1:3 (case:control) ratio for age, sex, body mass index, Charlson Comorbidity Index, pre-TKA Kellgren-Lawrence osteoarthritis grade and follow-up for knee injury and osteoarthritis outcome score for joint replacement (KOOS-JR). Mann-Whitney U and χ2 analyses were conducted, with significance being a p < 0.05. A priori power analysis required 29 patients per cohort to reach a clinically detectable difference of 11 for KOOS-JR. Forty-three cases (one ACI, eight OCA and 34 MFx) and 129 controls were included after matching, with no significant demographic differences. Cases underwent TKA after cartilage surgery at a mean of 4.6 years. No significant differences existed between cases and controls for the preoperative KOOS-JR (45.2 vs. 47.8; p = 0.353), postoperative KOOS-JR (69.8 vs. 69.9; p = 0.974) or Delta KOOS-JR (30.4 vs. 26.0; p = 0.387). No significant differences existed for 90-day readmission rates (4.7% vs. 2.3%; p = 0.600) or revision TKA rates (11.6% vs. 5.4%; p = 0.177). Patients with and without prior cartilage surgery experience similar functional outcomes, readmission rates and revision rates after TKA on the same knee. Patients who are candidates for TKA with a history of cartilage surgery may be counselled that their surgical history on that knee does not convey the risk of worse functional outcomes. Level III case-control study.

Effect of Patient Resilience on Functional Outcomes After Anterior Cruciate Ligament Reconstruction.

Previous studies have examined the relationship between patient resilience and functional outcome scores after anterior cruciate ligament reconstruction (ACLR). However, past studies have failed to explore the longitudinal relationship between preoperative resilience and functional outcomes 2 years after ACLR. To evaluate the relationship between preoperative patient resilience and functional outcomes 2 years after ACLR. Cohort study; Level of evidence, 3. Patients were identified who underwent ACLR for anterior cruciate ligament tears between January and June 2020 at a single institution. Those who completed the Brief Resilience Scale preoperatively as part of routine patient questionnaires were considered for inclusion. Patients were contacted a minimum of 2 years after ACLR to complete the short form of the Knee injury and Osteoarthritis Outcome Score (KOOS-JR), Single Assessment Numeric Evaluation (SANE), International Knee Documentation Committee (IKDC) Subjective Knee Form, and visual analog scale (VAS). Outcomes were compared among patients with low resilience (LR), normal resilience (NR), and high resilience (HR), as defined in a previous study.23. A total of 81 patients were included in the final analysis, with 14 patients in the low preoperative resilience group, 54 in normal, and 13 in high. The mean age of the cohort was 32.0 years, and there were no significant differences in age, sex, race, graft type, or psychiatric comorbidities among the resilience groups. Significantly increased postoperative KOOS-JR scores were observed in patients in the HR group as compared with those in the NR and LR groups (94.8, 86.7, and 79.6, respectively; P = .031). There were also significantly increased postoperative SANE scores in patients in the HR group versus those in the NR and LR groups (92.3, 83.5, and 69.2; P = .012). Patients with high preoperative resilience achieved the IKDC Patient Acceptable Symptom State at significantly higher rates (P = .003). No significant differences were observed in postoperative VAS (P = .364), IKDC (P = .072), or change in IKDC (P = .448) over time among resilience groups. Postoperatively, 30 patients (37.0%) changed resilience groups, with 13 moving down and 17 moving up in category (low, n = 12; normal, n = 55; high, n = 14). Preoperative resilience correlated with KOOS-JR and SANE scores 2 years after ACLR but did not correlate with VAS, IKDC, or change in IKDC over the same period. Resilience was not static, with changes in resilience observed from initial to final evaluations. Resilience is not a strong predictor of postoperative patient-reported outcomes after ACLR.

Managing of Post-traumatic Knee Arthritis by Total Knee Arthroplasty: Case Report and Literature Review

Introduction: Post-traumatic knee osteoarthritis (PTOA) develops rapidly after injuries from sports, accidents, or falls. Unlike primary osteoarthritis, PTOA escalates quickly, causing severe joint damage and impairments. Early intervention is crucial to alleviate pain, restore function, and prevent further deterioration. Delayed treatment worsens symptoms and increases the need for invasive procedures like total knee arthroplasty (TKA). Case Presentation: A 29-year-old patient with a year of left knee pain, swelling, and difficulty straightening had no history of rheumatic or autoimmune diseases. Examination showed osteophytes, indicating osteoarthritis. He underwent TKA with no complications, achieving a satisfactory outcome: good range of motion, improved quality of life, and an Oxford Knee Score of 42. Discussion: PTOA typically follows trauma to the joint surface, with severity often correlating with the impact intensity. In this case, the patient’s rapid development of osteoarthritis, despite his young age and lack of pre-existing conditions, may suggest a genetic predisposition. Knee arthroplasty was chosen to restore function, aligning with research showing comparable outcomes for post-traumatic and primary osteoarthritis patients, though post-trauma cases can have higher complication rates due to comorbidities. Conclusion: Effective management of PTOA is crucial due to its rapid progression and significant impact on joint function and quality of life. Early intervention is key to preventing severe damage and reducing the need for invasive treatments. While TKA can be effective, its success depends on the severity of the condition. Timely management and preventive strategies are vital to improving outcomes and maintaining joint health. Keywords: post traumatic osteoarthritis, total knee arthroplasty, quality of life, early intervention, case report

What Is Knee Osteoarthritis?

This JAMA Patient Page describes knee osteoarthritis and its symptoms, diagnosis, and treatments.

Center of pressure in relation to foot morphology and knee symptoms in older women with medial knee joint deformity: A cross-sectional study.

To examine the correlations amongst center of pressure (COP) trajectories, foot morphology and knee symptoms in older women with medial knee deformity. This was a cross-sectional study. Participants were recruited from two local orthopedic clinics. Eighty-four female patients with medial knee deformity (Kellgren Lawrence grade ≥1) aged 60 years or older. Not applicable. COP trajectories during comfortable gait were obtained using a plantar pressure distribution platform. As foot morphology metrics, hallux valgus angle, navicular/foot ratio, and leg-heel alignment were measured. The knee society scoring system was used to evaluated knee symptom severity. We used statistical parametric mapping for COP trajectory analysis to reduce the bias caused by data extraction. Multiple linear regression in statistical parametric mapping was used to determine the correlations amongst foot morphology, knee symptom severity and COP trajectories. There was a correlation between higher navicular/foot ratio and medial shift on COP at initial contact (0〜3.0% stance phase, p<0.05) and at toe-off (95.3〜100% stance phase, p=0.04). Also, higher navicular/foot ratio was associated with lateral shift of COP during single leg stance phase (8.3〜80.1% stance phase, p<0.01). We also found a significant correlation between lateral shift of COP during loading response phase (6.8〜19.0% stance phase) and knee symptom severity (p=0.03). Our results indicated that patients with severe knee symptoms may benefit from intervention to modify the foot arch and to medially shift the COP, which may be capable of relieving knee symptoms. Although our results do not directly show pain reduction, a medial COP shift could indeed reduce pain in cases where knee adduction moment is responsible for pain. These findings may contribute to the further development of conservative intervention, which focus on knee OA patients' foot morphology.

Strength profiles in patients with knee osteoarthritis with and without unilateral transfemoral amputation

Background: Individuals with lower limb amputation have increased risk of developing knee osteoarthritis (KOA) in the intact limb, however there is little information regarding strength profiles in individuals with KOA with and without amputation. Objective: To compare lower extremity strength in individuals with KOA with and without unilateral transfemoral (TF) amputation. Study Design: Descriptive laboratory study. Methods: Seven participants with unilateral TF amputation (3F/4M, 58.0 ± 11.0 years, 172.7 ± 12.8 cm, 90.8 ± 19.1 kg, 38.8 ± 14.4 years after amputation) and symptomatic KOA in the intact limb and 9 participants with unilateral KOA (control (CON)) without leg amputation (4F/5M, 66.0 ± 9.9 years, 170.5 ± 10.7 cm, 86.8 ± 18.1 kg) participated in this study. Both groups completed strength testing on the involved limb with KOA and the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire to meaure subjective function. Strength variables were mass-normalized. Results: There were no significant differences between groups in age, mass, or height. The CON group reported significantly reduced subjective function on the KOOS total score (P = 0.049; d = 1.03) and KOOS symptoms scores (P = 0.047, d = 0.95) compared with the TF amputation group. A lower subjective function score indicates worse function. There were no other significant differences between groups on KOOS subcategories. The TF amputation group had significantly greater average isokinetic quadriceps torque (P = 0.05; d = 1.10), peak isokinetic quadriceps torque (P = 0.02; d = 1.36), and average isokinetic quadriceps power (P = 0.02; d = 1.38) compared with the CON group. There were no differences between groups in isometric knee extensor strength or any differences in knee flexor isokinetic or isometric strength. Conclusions: The TF amputation group demonstrated greater isokinetic knee extensor strength in their intact limb with KOA compared with the CON group osteoarthritic limb; however, there were no differences in isometric strength. Furthermore, the differences in isokinetic strength may suggest that those with a history of leg amputation may require more strength and power in the intact limb to maintain daily activity and, therefore, may require greater thresholds of strength to protect the knee joint from cartilage degradation.

Dyslipidemia induced inflammation mediated the association between obesity and Osteoarthritis: a population-based study.

This study aims to evaluate the mediation effect of dyslipidemia induced inflammation on the causal associations between obesity and Osteoarthritis (OA). This cross-sectional study used data from the National Health and Nutrition Examination Survey (1999-2010). The association between general and abdominal obesity (exposure), OA (outcome) and mediators (total cholesterol, high-density lipoprotein, and C-reactive protein) was assessed using multivariate linear and logistic regression models and mediation analysis. A total of 23,308 participants were enrolled in this study, and 2,180 were diagnosed with OA. Participants with obesity were more likely to have OA (general obesity: OR = 2.508, 95%CI: 1.602, 4.197, P < 0.001; abdominal obesity: OR = 3.814, 95%CI: 3.242, 4.509, P < 0.001) than those without the obesity. High quantile of total cholesterol (OR:1.399; 95%CI:1.235, 1.257; P < 0.001), high-density lipoprotein (OR:1.644; 95%CI:1.443, 1.874; P < 0.001) and C-reactive protein (OR:1.952; 95%CI:1.707, 2.237; P < 0.001) increased the risk of OA when compared to lowest quartile. In the linear regression, the betas varied from 0.668 (95%CI: 0.635, 0.741; P < 0.001) to 0.693 (95%CI: 0.674, 0.712; P < 0.001), suggesting that individual with obesity had higher C-reactive protein levels. Additionally, total cholesterol and high-density lipoprotein were associated with C-reactive protein. Mediation analyses showed that the causal association of obesity with OA risk was mediated by high-density lipoprotein and C-reactive protein, with the mediation proportion ranging from 17.216 to 45.058%. Moreover, high-density lipoprotein to C-reactive protein path acting as serial mediators in the associations between obesity and OA (general obesity: β = 0.012; 95%CI: 0.009-0.014; abdominal obesity: β = 0.011; 95%CI: 0.008-0.014). The association between obesity and OA is partially mediated by systemic inflammation caused by dyslipidemia. Our study suggested anti-lipid therapy may be positive for obese individuals with OA.

Inpatient cost comparison of total and unicompartmental knee arthroplasty in patients with medial compartmental osteoarthritis using time-driven activity-based costing.

Using time-driven activity-based costing (TDABC), we sought to compare the total facility costs, comprising supply and personnel costs during the episode of care for the index procedure, in patients with isolated medial compartmental knee osteoarthritis (OA) undergoing unicompartmental knee arthroplasty (UKA) versus total knee arthroplasty (TKA). We conducted a retrospective analysis of 100 UKAs and 100 TKAs from 2019 to 2022. From a larger sample of 4899 TKAs and 137 UKAs, patients with isolated medial OA (Kellgren-Lawrence Grade <2 in other compartments) were radiographically identified. Demographic data included age, sex and body mass index, with comorbidities controlled using the Charlson comorbidity index. Facility costs were calculated using TDABC and standardized in cost units (CUs), a metric for comparing costs across procedures. Multiple regression analysis was used to assess the independent effect of TKA versus UKA on facility costs. TKA patients had similar operative times (TKA vs. UKA: 1.01×, p = 0.783) and supply costs (1.00×, p = 0.866), where 'x' denotes the relative cost ratio. However, TKA was associated with higher personnel costs (260.0 vs. 222.5 CUs [1.17×], p < 0.001) and total facility costs, both including (706.3 vs. 667.5 CUs [1.06×], p = 0.007) and excluding implants (353.8 vs. 312.5 CUs [1.13×], p < 0.001). Adjusted for demographics and comorbidities, TKA had increased facility costs, including (32.2 CUs, 95% confidence interval [CI]: 2.9-61.5, p = 0.031) and excluding implants (37.8 CUs, 95% CI: 15.2-60.3, p = 0.001). TDABC analysis revealed higher total facility costs for the index procedure in TKA, suggesting UKA may be a cost-saving alternative for isolated medial compartment knee OA. Level III, retrospective comparative study.

Quality of Life Among Kurdish Patients With Knee Osteoarthritis in Duhok Governorate

Quality of Life Among Kurdish Patients With Knee Osteoarthritis in Duhok Governorate

Beyond the Hip: Clinical Phenotypes of Hip Osteoarthritis Across the Biopsychosocial Spectrum

Background/Objectives: To identify clinical phenotypes of hip osteoarthritis (OA) within a biopsychosocial framework. Methods: A cross-sectional analysis of 143 individuals with hip OA awaiting total hip arthroplasty (THA) was performed. Phenotyping features included sociodemographic and biomedical information, pain-related cognitions and emotions, mental disorders, traumatic experiences, self-efficacy, social support, perceived stress, and somatosensory function. Outcome measures included the hip disability and osteoarthritis outcome score and the numeric pain-rating scale. Decision tree learning was used to select the most important phenotyping features. K-means clustering analyses were performed to identify clinical phenotypes and a decision tree algorithm was trained to classify individuals in the identified clinical phenotypes. Results: Selected phenotyping features associated with pain and disability included a combination of biomedical, psychological, and social variables. Two distinct clinical phenotypes were identified. Individuals within the maladaptive phenotype (34%) reported more comorbidities, less self-efficacy and higher levels of anxiety, depression, pain-related fear-avoidance, and feelings of injustice. No differences were found regarding social support and somatosensory function. Regarding the outcome measures, individuals within the maladaptive phenotype reported higher levels of pain and disability. Finally, based on the Fear-Avoidance Components Scale (FACS) and the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A), individuals could be classified into the clinical phenotypes with 87.8% accuracy. Conclusions: Two clinical phenotypes, an adaptive and a maladaptive phenotype, can be identified in individuals with hip OA using the FACS and HADS-A. The identification of these clinical phenotypes represents a crucial step toward precision medicine, enabling the development of targeted treatment pathways tailored to the distinct biomedical and psychological features of each phenotype.

The Role of Platelet-Rich Plasma in the Management of Ankle Osteoarthritis: A Systematic Review

Ankle osteoarthritis (OA) is characterized by intraarticular, activity-related pain. mainly with weight-bearing activities. Several nonoperative therapies remain as the first choices, but there is still no consensus on which is the most effective. This study aimed to systematically synthesize the evidence regarding the effectiveness of PRP in the management of ankle OA. Searches were conducted on PubMed, Cochrane, CINAHL, and SPORTDiscus to find relevant articles from inception to December 2023. Details regarding study characteristics, PRP procedures, and outcomes were extracted. A quality assessment was developed according to Joanna Briggs Institute’s critical appraisal tool. A total of five studies met the inclusion criteria, with 184 patients receiving PRP therapy (mean age 55.7 years, and 51.1% were female). There were three case series, one prospective cohort, and one randomized controlled trial. Pain and function were the most frequently evaluated outcomes among the selected articles. They showed significant improvements in the short-term follow-ups, mostly in patients with II-III-stage ankle OA. There is currently insufficient evidence regarding the effectiveness and safety of PRPs in the treatment of ankle OA. A paucity of high-level research in the literature was also found.