Prevalence Of Knee Osteoarthritis Research Articles

Validation of screening questionnaires for evaluation of knee osteoarthritis prevalence in the general population of Singapore.

BackgroundThe prevalence of symptomatic knee osteoarthritis (KOA) in Singapore is unknown. We aimed to: (i) validate questionnaires to screen for symptomatic KOA; and (ii) estimate the prevalence of symptomatic KOA in Singapore using the validated algorithms.MethodsSubjects aged ≥50 years were evaluated for symptomatic KOA based on American College of Rheumatology clinical and radiographic criteria in a rheumatology clinic, and completed three sets of adapted screening questionnaires. The better performing screening questionnaire with adequate sensitivity and specificity was adminitered to a nationally representative sample of survey subjects (n = 3364) to estimate the weighted prevalence of symptomatic KOA in Singapore.ResultsOut of 146 subjects evaluated in the clinic, 45 had symptomatic KOA. A screening algorithm which consisted of three KOA symptoms or one symptom plus physician‐diagnosed KOA produced high specificity (0.95, 95% confidence intervals [CI]: 0.88–0.98) but low sensivity (0.44, 95% CI: 0.30–0.60). Replacing the term ‘KOA’ with ‘physician‐diagnosed ageing‐related knee problem’ improved the sensivity (0.62, 95% CI: 0.47–0.76) without significantly compromising the specificity (0.87, 95% CI: 0.79–0.93). The prevalence of symptomatic KOA weighted to the Singapore population distribution were 4.7% and 11%, using the most conservative and more liberal algorithms, respectively. There was a sharp rise in prevalence after age of 40. The weighted prevalence of KOA was higher in women and among Indian and Malay than Chinese.ConclusionOur study adapted and validated questionnaires to the local context to screen for symptomatic KOA. We estimated the prevalence of symptomatic KOA in Singapore utilizing the better‐performing algorithms.

Prevalence of knee osteoarthritis in a suburban, Srilankan, adult female population: a population-based study.

Prevalence of knee osteoarthritis (KOA) has not been assessed in Sri Lanka, since 2006. This study aimed to determine the prevalence of clinical KOA and radiographic KOA and to assess the severity of it, among adult females of a suburban setting in Sri Lanka. A cross-sectional survey was conducted among a representative sample of 666 females aged 50 years or more resident in Pita Kotte Medical Officer of Health area. Four physiotherapy graduates applied American College of Rheumatology (ACR) criteria by performing the clinical assessment in the households. Participants with clinical knee osteoarthritis were referred for radiography to identify radiographic osteoarthritis and to assess severity. Age standardized prevalence of clinical KOA for Sri Lanka was estimated based on population statistics of 2001 Census. Study included 666 adult females with a response rate of 99.4%. The mean age was 63.3 years (±9.29 years). A total of 134 were found to satisfy ACR criteria resulting in a crude prevalence of clinical KOA of 20.1% (95% CI 17.0%-23.2%). Estimated age standardized prevalence of clinical KOA for Sri Lanka was 21.8% (95% CI 21.7-21.9). Among those with clinical KOA 58.9% showed radiographic KOA and the prevalence of moderate/severe KOA among those with clinical KOA was 29.9%. Prevalence of clinical KOA among the adult females over 50 years was high with considerable proportion of them being moderate /severe KOA. These findings should be used to advice the health authorities regarding improving preventive and curative services for KOA.

Association between metabolic syndrome and knee osteoarthritis: a cross-sectional study

BackgroundOsteoarthritis (OA) is the most prevalent chronic joint disease in China. The aim of this study was to examine the association between metabolic syndrome (MetS) and knee OA in a population-based Chinese study.MethodsData included in this analysis is from a cross-sectional study, i.e., the Xiangya Hospital Health Management Center Study. MetS was diagnosed according to the criteria defined by the Chinese Diabetes Society. Radiographic knee OA was defined as changes equivalent to Kellgren-Lawrence (K-L) grade 2 or above at least one side. Associations between MetS and its components with OA were evaluated by conducting multivariable adjusted logistic regression.ResultsA total of 5764 participants were included in the present study. The unadjusted OR (1.27, 95%CI: 1.10–1.47, P = 0.001), age-sex adjusted OR (1.17, 95%CI: 1.01–1.36, P = 0.041) and multivariable adjusted OR (1.17, 95%CI: 1.01–1.36, P = 0.043) all suggested a positive association between MetS and knee OA. Besides, its components (e.g., overweight, hypertension and dyslipidemia) were also associated with the prevalence of radiographic knee OA respectively, after adjusting for some confounding factors. In addition, with the accumulation of MetS components, the prevalence of knee OA increased. Furthermore, MetS as a whole was associated with the prevalence of knee osteophyte (OSP) (OR = 1.72, 95%CI: 1.42–2.09, P < 0.001), but not joint space narrowing (JSN) (OR = 1.06, 95%CI: 0.91–1.23, P = 0.449).ConclusionsThe findings of the present study indicated that there was a positive association between the prevalence of MetS and knee OA. However, MetS as a whole was associated with the higher prevalence of knee OSP, but not JSN, which should shed light on our understanding the association between MetS and OA.

The quality-of-life burden of knee osteoarthritis in New Zealand adults: A model-based evaluation.

BackgroundKnee osteoarthritis is a leading global cause of health-related quality of life loss. The aim of this project was to quantify health losses arising from knee osteoarthritis in New Zealand (NZ) in terms of quality-adjusted life years (QALYs) lost.MethodsThe Osteoarthritis Policy Model (OAPol), a validated Monte Carlo computer simulation model, was used to estimate QALYs lost due to knee osteoarthritis in the NZ adult population aged 40–84 over their lifetimes from the base year of 2006 until death. Data were from the NZ Health Survey, NZ Burden of Diseases, NZ Census, and relevant literature. QALYs were derived from NZ EQ-5D value set 2. Sensitivity to health state valuation, disease and pain prevalence were assessed in secondary analyses.ResultsBased on NZ EQ-5D health state valuations, mean health losses due to knee osteoarthritis over people’s lifetimes in NZ are 3.44 QALYs per person, corresponding to 467,240 QALYs across the adult population. Average estimated per person QALY losses are higher for non-Māori females (3.55) than Māori females (3.38), and higher for non-Māori males (3.34) than Māori males (2.60). The proportion of QALYs lost out of the total quality-adjusted life expectancy for those without knee osteoarthritis is similar across all subgroups, ranging from 20 to 23 percent.ConclusionsAt both the individual and population levels, knee osteoarthritis is responsible for large lifetime QALY losses. QALY losses are higher for females than males due to greater prevalence of knee osteoarthritis and higher life expectancy, and lower for Māori than non-Māori due to lower life expectancy. Large health gains are potentially realisable from public health and policy measures aimed at decreasing incidence, progression, pain, and disability of osteoarthritis.

Association of C-reactive protein positivity among groups of patients with knee osteoarthritis in Erbil

Background and objective: Osteoarthritis is the most common joint disease and a leading cause of disability. Increased circulating levels of C-reactive protein have been associated with prevalent knee osteoarthritis. This study aimed to assess the association between C- reactive protein positivity in patients with knee osteoarthritis in Erbil Methods: Data from100 participants in this case-control study were enrolled from May 1st to December 1st, 2015 in Rizgary Teaching Hospital in Erbil city. Data were divided into two groups. The cases included 50 patients (17 male and 33 female) with a mean age of 58.9 ±3.8 years and diagnosed with primary knee osteoarthritis of one or both knee joints. Controls included 50 persons (17 male and 33 female) with a mean age of 58.1 ±3.9 years without knee osteoarthritis and matched for age, sex, and body mass index. C-reactive protein qualitatively measured. Patients were radiologically assessed by Kellgren and Lawrence grading scale (grade 0-4). Results: C-reactive protein was positive in 41 out of 50 (82%) of knee osteoarthritis patients compared to 3 out of 50 (6%) of healthy controls (P = 0.001). C- reactive protein positivity among knee osteoarthritis patients were significantly associated with body mass index, positive family history of knee osteoarthritis, duration of diseases, and Kellgren and Lawrence grade (P 0.05). Conclusion: C-reactive protein positivity was significantly associated with knee osteoarthritis compared to healthy controls. Furthermore, body mass index, positive family history of knee osteoarthritis, early osteoarthritis, and Kellgren and Lawrence grade II, were significantly associated with positive C-reactive protein in knee osteoarthritis.

Prevalence of Knee Osteoarthritis among Elderly Patients Attending Orthopaedics Department: A Hospital Based Study

Background: OA (Osteoarthritis) knee incidence is rising by increasing average age of general population. Osteoarthritis (OA) is a common disease found in old aged population. Therefore, this study was conducted to examine the prevalence and risk factors for knee osteoarthritis in elderly men and women. Methods: The study was conducted in the Department of Orthopaedics, Varun Arjun Medical College, Banthra, Shahjahanpur, U.P, India from February 2016 to July 2016. On the basis of inclusion and exclusion criteria, 125 patients were randomly selected from OPD and IPD of Hospital. The interview was structured as follows. Data was recorded on a standardized predesigned and a pre-tested questionnaire. Questionnaire focused on Socio-demographic profile and assessment of possible risk factors (age, family history, obesity, physical activity, and occupational knee bending and knee injury). Measurements like height, weight and body mass index (BMI) were recorded. Results: A complete interview was possible in 102 subjects (58.62% response rate). Participation was poorer among men and there was a slightly higher prevalence of radiographic changes of OA in women than in men. However, there was a significantly higher proportion of women with symptomatic disease (14% of all women versus 9% of all men; P = 0.003). Conclusions: : In our study, we observed that there is association between age, sex and BMI with OA. The incidence of OA increased as the age advances; hence it is likely that if preventive measures can be taken in the earlier age groups OA can be prevented.

The Association of Recreational and Competitive Running With Hip and Knee Osteoarthritis: A Systematic Review and Meta-analysis.

Study Design Systematic review and meta-analysis. Background Running is a healthy and popular activity worldwide, but data regarding its association with osteoarthritis (OA) are conflicting. Objectives To evaluate the association of hip and knee OA with running and to explore the influence of running intensity on this association. Methods PubMed, Embase, and Cochrane Library databases were used to identify studies investigating the occurrence of OA of the hip and/or knee among runners. A meta-analysis of studies comparing this occurrence between runners and controls (sedentary, nonrunning individuals) was conducted. Runners were regarded as "competitive" if they were reported as professional/elite athletes or participated in international competitions. Recreational runners were individuals running in a nonprofessional (amateur) context. The prevalence rate and odds ratio (with 95% confidence interval [CI]) for OA between runners (at competitive and recreational levels) and controls were calculated. Subgroup analyses were conducted for OA location (hip or knee), sex, and years of exposure to running (less or more than 15 years). Results Twenty-five studies (n = 125810 individuals) were included and 17 (n = 114829 individuals) were meta-analyzed. The overall prevalence of hip and knee OA was 13.3% (95% CI: 11.6%, 15.2%) in competitive runners, 3.5% (95% CI: 3.4%, 3.6%) in recreational runners, and 10.2% (95% CI: 9.9%, 10.6%) in controls. The odds ratio for hip and/or knee OA in competitive runners was higher than that in recreational runners (1.34; 95% CI: 0.97, 1.86 and 0.86; 95% CI: 0.69, 1.07, respectively; controls as reference group; for difference, P<.001). Exposure to running of less than 15 years was associated with a lower association with hip and/or knee OA compared with controls (OR = 0.6; 95% CI: 0.49, 0.73). Conclusion Recreational runners had a lower occurrence of OA compared with competitive runners and controls. These results indicated that a more sedentary lifestyle or long exposure to high-volume and/or high-intensity running are both associated with hip and/or knee OA. However, it was not possible to determine whether these associations were causative or confounded by other risk factors, such as previous injury. Level of Evidence Etiology/harm, level 2a. J Orthop Sports Phys Ther 2017;47(6):373-390. doi:10.2519/jospt.2017.7137.

Clinical outcome of intra-articular hyaluronic acid injection for knee joint osteoarthritis: a prospective interventional study from a tertiary care hospital

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; The prevalence of knee osteoarthritis (OA) is estimated to be 14%&lt;strong&gt; &lt;/strong&gt;and 6% in rural and&lt;strong&gt; &lt;/strong&gt;urban areas of India, respectively. In severe cases, the American Academy of Orthopedics Surgeons recommends non-steroidal anti-inflammatory drugs (NSAIDs). A prospective interventional study was conducted to evaluate the effectiveness of intra-articlular hyaluronic acid injection (IAHA) in knee OA patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Medical records of 29 patients with knee OA, who were treated with IAHA injection, were analyzed using a 24 item WOMAC scale for the pain, stiffness, and physical function scores. Furthermore, the patients’ quality of life was evaluated based on the SF-12 scale and a global status assessment of knee OA was performed using the Likert scale and visual analogue scale (VAS). The data were analysed statistically.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; The overall WOMAC pain, stiffness, and physical function scores decreased following the IAHA administration in patients with knee OA. The mean pain scores decreased from 10.82 to 3.62 and stiffness scores dropped from 4.34 to 2.03. The mean physical function scores decreased from 36.75 to 17.1 (p&amp;lt;0.0001). The Likert scale and VAS demonstrated statistically significant (P &amp;lt; 0.0001) improvement in the patient’s health status. Overall, nearly 80% of the patients expressed little-to-none physical or emotional problems four weeks after IAHA treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;A single IAHA injection provided statistically significant improvement in pain, disability, and quality of life in knee OA patients. &lt;/p&gt;

Study of association of age and BMI with knee osteoarthritis among females in age group of 40 to 60 years in urban population of Kadapa town

Background: Knee osteoarthritis is a significant problem in ageing population as females are more prone for the disease compare to males. Increase in life expectancy has made ageing worldwide phenomenon including developing countries. Risk factors related to the knee osteoarthritis may be multiple but female sex, age and obesity are more common in any region of country and world. The aim and objective of the study was to estimate the prevalence of knee osteoarthritis among females in age group of 40 to 60 years and see the effect of age and weight of patient on knee osteoarthritis.Methods: Cross sectional study was conducted at field practice area of Community Medicine Department in Kadapa town among females in age group of 40 to 60 years. Total 150 females participated in the study from the urban health training centre area in one month (November-December 2011) and study was conducted with personal interviews of participants in preformed questionnaire after obtaining the consent. Results: 150 participants were enrolled in the study, in age group of 40 to 50 years 76 (50.67%) and 50 to 60 years 74 (49.33%). Total 63 (42%) participants were affected with knee osteoarthritis. Among them 25 (32.89%) participants were in the age group of 40-50 years and 38 (51.35%) in the age group of 50 to 60 years which is significantly more. As per BMI participant with BMI &gt;25 were significantly more affected 29 (63.04%) compared with participants with normal BMI, 17 (33.33%). Conclusions: Knee osteoarthritis is significantly associated with advanced age and obesity.

Injectable Biological Treatments for Osteoarthritis of the Knee.

➢ The increasing prevalence of knee osteoarthritis in an aging and active population necessitates the development of therapies designed to relieve symptoms, to delay the need for total joint replacement, and to potentially stimulate chondrocyte growth.➢ Growth factor therapies such as platelet-rich plasma have been studied extensively for knee osteoarthritis, with the recent publication of clinical studies. Although the majority of studies conclude that platelet-rich plasma has the potential to provide symptomatic relief on a short-term basis, to our knowledge, long-term data are lacking.➢ Growing interest in stem cell therapy for knee osteoarthritis has led to various studies utilizing mesenchymal stem cells from adipose, bone marrow, or peripheral blood sources. Although studies have shown excellent early clinical results, the ability to improve collection rates of mesenchymal stem cells and methods to direct mesenchymal stem cell differentiation to chondrocytes and to promote chondrogenesis remains a focus for future research.➢ There are still many questions about platelet-rich plasma and its effectiveness for knee osteoarthritis. Differences in preparation technique make effective evaluation and comparison difficult.➢ Bone marrow mesenchymal stem cells currently remain the only stem cell product that appears to be approved by the U.S. Food and Drug Administration (FDA) without any potential questions about use. Further clinical studies are still necessary to fully understand their role.

Joint Loading in Runners Does Not Initiate Knee Osteoarthritis.

Runners do not have a greater prevalence of knee osteoarthritis (OA) than nonrunners. The hypothesis that joint loads in running do not cause OA is forwarded. Two mechanisms are proposed: 1) cumulative load, which is surprisingly low in running, is more important for OA risk than peak load, and 2) running conditions cartilage to withstand the mechanical stresses of running.

Osteoarthritis and joint replacements of the lower limb and spine in ex-professional soccer players: A systematic review.

After a professional career as a soccer player, the risk of developing osteoarthritis (OA) in different joints of the spine and lower limb might be increased. The extent of this problem to date is not clear. Therefore, the aim of this systematic review is to summarize the prevalence of OA and joint replacement of the lower limb and spine in former professional soccer players. Relevant databases were searched with different combinations of key words: for example, OA, hip, knee, ankle, foot, joint replacement, soccer. Studies were included if they were original research, included a sample of former professional male soccer players, and had OA in the lower limb and/or spine; OA was diagnosed either through questionnaires or X-rays; and the article is in English, Dutch, or German. Sixteen studies with 1576 former players and 2153 control subjects were included in the review. Studies agreed that the prevalence of hip OA and hip replacements is significantly higher in former players compared to the control group. For the ankle and spine, there is only limited information, and for the prevalence of knee OA and knee replacement, the results are contradictory. The quality of the included studies was moderate. Future studies should have a prospective design to control for confounding factors, to identify possible risk factors and consequences for the individuals, and to be able to develop a prevention program.

High prevalence of knee osteoarthritis at a minimum 10-year follow-up after knee dislocation surgery

Long-term outcomes and the prevalence of osteoarthritis after surgical treatment of knee dislocations are lacking in the literature. The purpose of this study was to investigate the prevalence of knee osteoarthritis and knee function at a minimum of 10 years after knee dislocation surgery. Sixty-five patients surgically treated for knee dislocations at a single level I trauma center between May 1996 and December 2004 were evaluated at a minimum of 10 years. Patients were evaluated with radiographs for knee osteoarthritis using the Kellgren-Lawrence (KL) grading system, Tegner activity score, Lysholm score, IKDC-2000, KOOS, subjective stability on physical examination, KT-1000 arthrometer, and single-leg hop tests. Osteoarthritis was defined as KL grades 2 or greater. The median follow-up time was 12.7 years (range 10.0-18.8years), and the median age was 46.9 years (range 26.8-76.1years). Radiographic osteoarthritis was present in 42% (23, 14, and 5% in KL grades II, III, and IV, respectively) of the patients in the operated knee compared to 6% in the uninjured knee. Knee function was generally improved with a median Tegner activity score of 4 (range 1-8), an average Lysholm score of 84 ± 17, and an average IKDC-2000 score of 73 ± 19. Twenty-seven patients (42%) developed OA 10 years after surgical treatment of knee dislocations. Patients reported improved knee function and minimal-to-moderate pain. Age at surgery was a predictor of development of OA, with more patients >30 years at the time of surgery developing OA. Meniscal and cartilage injuries at time of surgery were not associated with development of OA. Patients being treated for knee dislocation should be counselled about the increased long-term risk of post-traumatic OA. III.

Lectin-like, oxidized low-density lipoprotein receptor-1-deficient mice show resistance to age-related knee osteoarthritis.

The lectin-like, oxidized low-density lipoprotein (ox-LDL) receptor-1 (LOX-1)/ox-LDL system contributes to atherosclerosis and may be involved in cartilage degeneration. The purpose of this study was to determine whether the LOX-1/ox-LDL system contributes to age-related osteoarthritis (OA) in vivo, using LOX-1 knockout (LOX-1 KO) mice. Knee cartilage from 6, 12, and 18-month old (n = 10/group) C57Bl/6 wild-type (WT) and LOX-1 KO mice was evaluated by determining the Osteoarthritis Research Society International (OARSI) score of Safranin-O stained samples. The prevalence of knee OA in both mouse strains was also investigated. Expression levels of LOX-1, ox-LDL, runt-related transcription factor-2 (Runx2), type-X collagen (COL X), and matrix metalloproteinase-13 (MMP-13) in the articular chondrocytes were analyzed immunohistologically. No significant difference was observed in the mean scores of WT (2.00±0.61) and LOX-1 KO mice (2.00±0.49) at 6 months of age (P=1.00, n=10). At 12 and 18 months of age, the mean scores of LOX-1 KO mice (3.75±0.93 and 5.50±0.78) were significantly lower than those of WT mice (5.25±1.14 and 9.00±1.01; P<0.001 in both cases; n=10). The prevalence of OA in LOX-1 KO mice was lower than that in WT mice at 12 and 18 months of age (40 vs 70%, 70 vs 90%, respectively; n=10). The expression levels of Runx2, COL X, and MMP-13 in articular chondrocytes significantly decreased in LOX-1 KO, mice compared with those in WT mice. The study indicated that the LOX-1/ox-LDL system in chondrocytes plays a role in the pathogenesis of age-related knee OA, which is potentially a target for preventing OA progression.

Degeneration in ACL Injured Knees with and without Reconstruction in Relation to Muscle Size and Fat Content-Data from the Osteoarthritis Initiative.

BackgroundAnterior cruciate ligaments (ACL) injuries represent a major risk factor for early osteoarthritis (OA).PurposeTo evaluate the prevalence and 4-year progression of knee OA measured with 3T MR-imaging in individuals with ruptured, reconstructed or normal ACL and to assess the impact of thigh muscle characteristics.MethodsA total of 54 knees (23/54 male, 31/54 female) were recruited from the Osteoarthritis Initiative (OAI). At baseline, 15/54 subjects had prevalent ACL ruptures and 15/54 subjects had prevalent ACL reconstruction (24/54 normal ACL). Western Ontario and McMasters Universities Arthritis Index (WOMAC) scores, Physical Activity Scores of the Elderly (PASE) and thigh muscle characteristics including strength, fat infiltration (Goutallier score) and thigh muscle cross-sectional area (CSA) MR measurements were obtained at baseline. Whole-organ MR-imaging Scores (WORMS) were obtained at baseline and at a 4-year follow-up time-point. Multivariate regression models, adjusting for covariates (age, gender, body mass index), were used for statistical analysis.ResultsAt baseline, subjects with prevalent ACL ruptures had worse WORMS total scores (mean±SEM, 44.1±3.5) than subjects with ACL reconstruction (30.8±4.0; P = 0.015) and worse than subjects with normal ACL (21.3±3.0; P<0.001). Cartilage scores were worse in both femorotibial compartments in ACL injured knees than in knees with normal ACL (P<0.05). Knees with ACL reconstruction showed an increased degeneration of the medial meniscus (P = 0.036), cartilage degeneration at the medial femoral condyle (P = 0.011). In a multivariate regression model, including both ACL groups and total muscle characteristics as influence parameters, high thigh muscle CSA, high muscle/ fat ratio and low Goutallier scores were associated with less degenerative changes at the knee, independent of ACL status. Knees with ACL reconstruction showed an increased progression of cartilage degeneration at the medial tibia compared to the normal ACL group (P = 0.027).ConclusionsHigh thigh muscle CSA is associated with less degenerative changes at the knee, independent of the ACL status and may potentially be advantageous in the prevention of early OA.

Knee Osteoarthritis Is Associated With Previous Meniscus and Anterior Cruciate Ligament Surgery Among Elite College American Football Athletes.

Background:Football puts athletes at risk for knee injuries such meniscus and anterior cruciate ligament (ACL) tears, which are associated with the development of osteoarthritis (OA). Previous knee surgery, player position, and body mass index (BMI) may be associated with knee OA.Hypothesis:In elite football players undergoing knee magnetic resonance imaging at the National Football League’s Invitational Combine, the prevalence of knee OA is associated with previous knee surgery and BMI.Study Design:Retrospective cohort.Level of Evidence:Level 4.Methods:A retrospective review was performed of all participants of the National Football League Combine from 2005 to 2009 who underwent magnetic resonance imaging of the knee because of prior knee injury, surgery, or knee-related symptoms or concerning examination findings. Imaging studies were reviewed for evidence of OA. History of previous knee surgery—including ACL reconstruction, meniscal procedures, and articular cartilage surgery—and position were recorded for each athlete. BMI was calculated based on height and weight.Results:There was a higher prevalence of OA in knees with a history of previous knee surgery (23% vs 4.0%, P < 0.001). The prevalence of knee OA was 4.0% in those without previous knee surgery, 11% in those with a history of meniscus repair, 24% of those with a history of ACL reconstruction, and 27% of those with a history of partial meniscectomy. Among knees with a previous ACL reconstruction, the rate of OA doubled in tibiofemoral compartments in which meniscal surgery was performed. BMI >30 kg/m2 was also associated with a higher risk of OA (P = 0.007) but player position was not associated with knee OA.Conclusions:Previous knee surgery, particularly ACL reconstruction and partial meniscectomy, and elevated BMI are associated with knee OA in elite football players. Future research should investigate ways to minimize the risk of OA after knee surgery in these athletes.Clinical Relevance:Treatment of knee injuries in football athletes should consider chondroprotection, including meniscal preservation and cartilage repair, when possible.

Poor expectations of knee replacement benefit are associated with modifiable psychological factors and influence the decision to have surgery: A cross-sectional and longitudinal study of a community-based sample

BackgroundTotal knee arthroplasty (TKA) is a highly effective surgery, but is underutilized by some patient groups. This study determined factors associated with a person's expectations with respect to pain and walking function following a TKA procedure, should they elect to undergo a TKA. MethodsA total of 3542 people were studied with or at risk of knee osteoarthritis and enrolled in the community-based Osteoarthritis Initiative (OAI). Multivariable logistic regression analyses identified demographic, socioeconomic, osteoarthritis-related, joint replacement awareness, and psychological correlates as poor outcome expectations. Logistic regression determined if outcome expectation was associated with future knee arthroplasty utilization. ResultsApproximately 25% of the sample expected a poor outcome. Several factors were associated with poor pain outcome expectation, with the most powerful being African American race (Odds Ratio (OR)=2.11, 95% CI=1.69, 2.64) and an interaction between clinical depression symptoms and pain catastrophizing (OR=3.17, 95% CI=2.26, 4.44 when both were coded ‘yes’). Whether a person had knee OA did not affect expectations. Pain outcome expectations were strongly associated with future TKA utilization (OR=4.9, 95% CI=2.2, 11.1). ConclusionA variety of modifiable psychological factors impact people's expectations of the extent of pain and walking difficulty following a potential future TKA. Expectations strongly predict future TKA utilization. Given the high prevalence of knee osteoarthritis, mass media educational interventions for the population may assist in better aligning expectations with evidence-based knee arthroplasty outcomes and lead to more appropriate utilization of an effective procedure.

Hyaluronic acid injection therapy for osteoarthritis of the knee: concordant efficacy and conflicting serious adverse events in two systematic reviews.

BackgroundThe prevalence of knee osteoarthritis (OA)/degenerative joint disease (DJD) is increasing in the USA. Systematic reviews of treatment efficacy and adverse events (AEs) of hyaluronic acid (HA) injections report conflicting evidence about the balance of benefits and harms. We review evidence on efficacy and AEs of intraarticular viscosupplementation with HA in older individuals with knee osteoarthritis and account for differences in these conclusions from another systematic review.MethodsWe searched PubMed and eight other databases and gray literature sources from 1990 to December 12, 2014. Double-blind placebo-controlled randomized controlled trials (RCTs) reporting functional outcomes or quality-of-life; RCTs and observational studies on delay/avoidance of arthroplasty; RCTs, case reports, and large cohort studies and case series assessing safety; and systematic reviews reporting on knee pain were considered for inclusion.A standardized, pre-defined protocol was applied by two independent reviewers to screen titles and abstracts, review full text, and extract details on study design, interventions, outcomes, and quality. We compared our results with those of a prior systematic review and found them to be discrepant; our analysis of why this discrepancy occurred is the focus of this manuscript.ResultsEighteen RCTs reported functional outcomes: pooled analysis of ten placebo-controlled, blinded trials showed a standardized mean difference of −0.23 (95 % confidence interval (CI) −0.45 to −0.01) favoring HA at 6 months. Studies reported few serious adverse events (SAEs) and no significant differences in non-serious adverse events (NSAEs) (relative risk (RR) [95 % CI] 1.03 [0.93–1.15] or SAEs (RR [95 % CI] 1.39 [0.78–2.47]). A recent prior systematic review reported similar functional outcomes, but significant SAE risk. Differences in SAE inclusion and synthesis accounted for the disparate conclusions.ConclusionsTrials show a small but significant effect of HA on function on which recent systematic reviews agree, but lack of AE synthesis standardization leads to opposite conclusions about the balance of benefits and harms. A limitation of the re-analysis of the prior systematic review is that it required imputation of missing data.Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-016-0363-9) contains supplementary material, which is available to authorized users.

Association between Knee Osteoarthritis, Cardiovascular Risk Factors, and the Framingham Risk Score in South Koreans: A Cross-Sectional Study.

BackgroundOsteoarthritis is a significant burden on personal health and for social cost, and its prevalence is rising. Recent research has revealed an association between osteoarthritis and cardiovascular disease, and this study uses the Framingham risk score (FRS), which is widely used as a composite index of cardiovascular risk factors, to investigate the association between osteoarthritis and various cardiovascular risk factors.MethodsA total 9,514 participants aged 50 years or older who received knee X-ray diagnosis of the 5th Korean National Health and Nutrition Examination Survey (total surveyees = 24,173) released by the Korean Centers for Disease Control and Prevention was included for analysis. Knee osteoarthritis patients were defined as participants with K-L grade ≥2 on knee X-ray regardless of knee pain. The association between major cardiovascular risk factors (blood pressure, diabetes, cholesterol, and smoking habits), FRS, and knee osteoarthritis was analyzed, adjusting for various covariates.ResultsPrevalence of knee osteoarthritis in Koreans aged ≥50 years was 36.6%, and higher in women (men: 24.9%, women: 45.4%). Prevalence of knee osteoarthritis in participants with hypertension was significantly higher than those without hypertension (fully adjusted odds ratio (OR) 1.26; 95% confidence interval (CI) 1.08–1.48). Knee osteoarthritis prevalence was also higher in participants with impaired fasting glucose or diabetes than those without (age, sex adjusted OR 1.19; 95% CI 1.00–1.41). Also, OR values increased statistically significantly with FRS as a continuous variable (fully adjusted OR 1.007; 95% CI 1.00–1.01).ConclusionsPrevalence of knee osteoarthritis was associated with hypertension and diabetes, which are major cardiovascular risk factors, and the FRS. Further studies on FRS pertaining to its relationship with osteoarthritis are warranted.

Adherence to a Mediterranean diet is associated with lower prevalence of osteoarthritis: Data from the osteoarthritis initiative.

The Mediterranean diet appears to be beneficial for several medical conditions, but data regarding osteoarthritis (OA) are not available. The aim of this study was to investigate if adherence to the Mediterranean diet is associated with a lower prevalence of OA of the knee in a large cohort from North America. 4358 community-dwelling participants (2527 females; mean age: 61.2 years) from the Osteoarthritis Initiative were included. Adherence to the Mediterranean diet was evaluated through a validated Mediterranean diet score (aMED) categorized into quartiles (Q). Knee OA was diagnosed both clinically and radiologically. The strength of the association between aMED (divided in quartiles) and knee OA was investigated through a logistic regression analysis and reported as odds ratios (ORs) with 95% confidence intervals (CIs), adjusted for potential confounders. Participants with a higher adherence to Mediterranean diet had a significantly lower prevalence of knee OA compared to those with lower adherence (Q4: 25.2% vs. Q1: 33.8%; p<0.0001). Using a logistic regression analysis, adjusting for 10 potential confounders with those in the lowest quartile of aMED as reference, participants with the highest aMED had a significant reduction in presence of knee OA (OR, 0.83; 95% CIs: 0.69-0.99, p=0.04). Among the individual components of Mediterranean diet, only higher use of cereals was associated with lower odds of having knee OA (OR: 0.76; 95%CI: 0.60-0.98; p=0.03). Higher adherence to a Mediterranean diet is associated with lower prevalence of knee OA. This remained when adjusting for potential confounders.