Radiographic Severity Of Knee Osteoarthritis Research Articles

Prevalence of knee pain, radiographic osteoarthritis and arthroplasty in retired professional footballers compared with men in the general population: a cross-sectional study

ObjectivesTo determine the prevalence of knee pain, radiographic knee osteoarthritis (RKOA), total knee replacement (TKR) and associated risk factors in male ex-professional footballers compared with men in the general population...

Association between the severity of symptomatic knee osteoarthritis and cumulative metabolic factors.

The association between cumulative metabolic syndrome (MS) factors and knee osteoarthritis (KOA) has been highlighted over the past two decades. To clarify the relationship between cumulative MS factors and symptomatic KOA. A cross-sectional survey involving 119 women aged 45-88years who were scheduled to undergo knee surgery was conducted. They were stratified into tertiles of symptoms as assessed by the Japanese Orthopedic Association score for KOA. Multinomial logistic regressions were performed using the severity of symptomatic KOA as the dependent variable and each MS factor or the cumulative MS factors as the independent variables. Logistic regression analyses were performed with the upper tertile of stratified symptoms of subjects used as the reference group. After adjustment for confounders, KOA patients who had two (p = 0.004) or three or more (p < 0.0001) MS factors were significantly more likely to have severe symptoms compared to those who had no MS factors. MS factors excluding obesity were similarly analyzed. Even after additional adjustment for body mass index (BMI), KOA patients who had two or more (p = 0.005) MS factors were significantly more likely to have severe symptoms. Among KOA female patients diagnosed using radiographic definition, the severity of symptomatic KOA was significantly associated with hypertension, dyslipidemia, and the number of MS factors after adjustment for age, BMI, strength of the knee extensor, and Kellgren-Lawrence grade. The severity of radiographic KOA was not associated with any MS factor or cumulative MS factors.

Metabolite profiles of synovial fluid change with the radiographic severity of knee osteoarthritis

ObjectivesTo investigate potential pathogenic pathways in the synovial fluid of osteoarthritis (OA) patients at different disease stages [early vs. late, determined based on the Kellgren–Lawrence (KL) grading scale], through metabolite profiles that were performed by using gas-chromatography/time-of-flight mass spectrometry (GC/TOF MS). MethodsSynovial fluid samples were obtained from 15 patients with knee OA, divided into early- (KL grade: 1 and 2) and late-stage OA (KL grade: 3 and 4). Metabolite profiles of OA based on KL grading scale were performed using GC/TOF MS, with multivariate statistical analyses conducted by orthogonal partial least squares discriminant analysis (OPLS-DA) and hierarchical clustering analysis (HCA). ResultsA total of 114 metabolites were identified and classified into various classes, such as amino acids, sugars and sugar alcohols, fatty acids, and organic acids. Significant discrimination of metabolite profiles between the early- and late-stage OA groups was shown by OPLS-DA and HCA. Twenty-eight metabolites, including malate, ethanolamine, squalene, glycerol, myristic acid, oleic acid, lanosterol, heptadecanoic acid, and capric acid, were identified as critical metabolites for discriminating between the early- and late-OA groups by using Student's t-test, as they showed significant differences in abundance between the two OA groups. These metabolites were related to fatty acid metabolism, glycerolipid metabolism, and the tricarboxylic acid cycle. ConclusionsThese results revealed that metabolite profiles are robustly altered along the radiographic stage of knee OA. Metabolomic approaches based on GC/TOF MS could provide valuable information on the underlying pathogenic mechanisms of OA progression.

Direct in vivo evidence of activated macrophages in human osteoarthritis

Through binding to folate receptor-β (FR-β), the new (99m)Tc-EC20 (Etarfolatide) imaging technique detects activated but not resting macrophages invivo. The goal of this study was to investigate macrophage-related inflammation in osteoarthritis (OA). Twenty-five individuals (50 knees) with symptomatic OA of at least one knee underwent SPECT-CT imaging of both knees and planar imaging of the whole body after injection of Etarfolatide. Scans and knee radiographs were scored blinded to clinical information including knee and other joint site pain severity. Measures of association controlled for age, gender, body mass index (BMI) and employed repeated measures to adjust for correlation between knees. Activated macrophages were present in the majority (76%) of knees. The quantity of knee-related macrophages was significantly associated with knee pain severity (R=0.60, P<0.0001) and radiographic knee OA severity including joint space narrowing (R=0.68, P=0.007), and osteophyte (R=0.66, P=0.001). Macrophages were also localized to joints commonly affected by OA including hand finger joints (12%), thumb bases (28%), shoulders (26%), great toes (18%) and ankles (12%). The presence of joint pain at fingers, wrists, ankles and great toes was significantly positively associated with presence of activated macrophages at these sites (P<0.0001-0.04). This study provides the first direct invivo evidence for macrophage involvement in OA in a substantial proportion of human knees. The association of quantity of activated macrophages with radiographic knee OA severity and joint symptoms suggests that drugs targeting macrophages and macrophage-associated inflammatory pathways may have the potential to be both symptom and structure modifying.

The Relationship between HIF-2α and VEGF with Radiographic Severity in the Primary Osteoarthritic Knee.

PurposeThe aim of this study was to determine the relationship of hypoxia-inducible factor-2 (HIF-2α) and vascular endothelial growth factor (VEGF) with radiographic severity in primary osteoarthritis (OA) of the knee. Expression of these two factors in cartilage samples from OA knee joints was examined at mRNA and protein levels.Materials and MethodsKnee joints were examined using plain radiographs, and OA severity was assessed using the Kellgren and Lawrence (KL) grading system. Specimens were collected from 29 patients (31 knees) who underwent total knee replacement because of severe medial OA of the knee (KL grades 3 and 4), 16 patients who underwent knee arthroscopy (KL grade 2), and 5 patients with traumatic knees (KL grade 0). HIF-2α and VEGF expression was quantified by real-time polymerase chain reaction and western blotting.ResultsCartilage degeneration correlated with the radiographic severity grade. OA severity, determined using the Mankin scale, correlated positively with the KL grade (r=0.8790, p<0.01), and HIF-2α and VEGF levels with the radiographic severity of knee OA (r=0.7001, p<0.05; r=0.6647, p<0.05).ConclusionIn OA cartilage, HIF-2α and VEGF mRNA and protein levels were significantly and positively correlated. The expression of both factors correlated positively with the KL grade. HIF-2α and VEGF, therefore, may serve as biochemical markers as well as potential therapeutic targets in knee OA.

One-year results of voluntary-based supervised exercise or treatment at orthopedic clinic for radiographic severe knee osteoarthritis.

[Purpose] In this study, we investigated the efficacy of supervised physical exercise or conventional treatment on symptomatic knee osteoarthritis with severe morphological degeneration. [Subjects] Sixty-six patients with severe radiographic knee osteoarthritis were enrolled. [Methods] Participants were separated into two groups: in one group patients conducted physical exercise under supervision; while in the other group they were treated by conventional clinical methods for one year. Participants filled out two types of questionnaires; the Japanese Knee Osteoarthritis Measure and the Pain Disability Assessment Scale at baseline and one year following enrollment in the study. Two-way repeated measures analysis of variance was used to examine the effects over time and by group for a total of 43 participants; consisting of an exercise group (n=20) and a clinical group (n=23) excluding 23 dropouts. [Results] Analysis did not show a significant time-course effect or interaction between time-course and the groups in both questionnaires. On the other hand, there were significant group effects in both questionnaires with an advantage in the exercise group. [Conclusion] These results indicate that patients with knee osteoarthritis under supervised exercise conditions are more likely to maintain a better clinical outcome at one-year follow-up, despite the severe morphological degeneration in their knees.

Nonoperative treatment improves pain irrespective of radiographic severity

Background and purpose — The discrepancy between symptoms and radiographic severity of knee osteoarthritis (OA) is well described. However, little is known about whether radiographic severity is predictive of the clinical result of nonoperative treatment. We investigated whether radiographic severity and treatment type were associated with improvements in pain after nonoperative treatment of patients with knee OA.Patients and methods — A 5-year consecutive series of patients deemed not eligible for total knee arthroplasty (TKA) by an experienced orthopedic surgeon was contacted 1–5 years later. Radiographic severity, age, sex, and BMI were registered at the consultation. At follow-up, patients were asked to answer a questionnaire on type of treatment and improvements in pain after treatment.Results — Of 1,848 patients who were not eligible for TKA, 1,414 (77%) completed the follow-up questionnaire (mean age 66 (24–96) years; 55% women). Radiographic severity was not associated with improvements in pain even after adjusting for treatment type, age, sex, and BMI (p > 0.1). The odds ratio of improvement was higher by a factor of 2 in patients who received physiotherapy or multimodal treatment than in patients who did not.Interpretation — Radiographic severity was not associated with improvements in pain after nonoperative treatment. Patients who are not eligible for TKA can confidently be referred to nonoperative treatment even if they have severe radiographic OA. The treatment should preferably be multimodal, including physiotherapy, as recommended in Danish and international clinical guidelines.

Do Knee Moments Normalized to Measures of Knee Cartilage Area Better Classify the Severity of Knee Osteoarthritis?

Investigations of joint loading in knee osteoarthritis (OA) typically normalize the knee adduction moment to global measures of body size (eg, body mass, height) to allow comparison between individuals. However, such measurements may not reflect knee size. This study used a morphometric measurement of the cartilage surface area on the medial tibial plateau, which better represents medial knee size. This study aimed to determine whether normalizing the peak knee adduction moment and knee adduction moment impulse during gait to the medial tibial bone-cartilage interface could classify radiographic knee OA severity more accurately than traditional normalization techniques. Individuals with mild (N = 22) and severe (N = 17) radiographic knee OA participated. The medial tibial bone-cartilage interface was quantified from magnetic resonance imaging scans. Gait analysis was performed, and the peak knee adduction moment and knee adduction moment impulse were calculated in nonnormalized units and normalized to body mass, body weight × height, and the medial tibial bone-cartilage interface. Receiver operating characteristic curves compared the ability of each knee adduction moment normalization technique to classify participants according to radiographic disease severity. No normalization technique was superior at distinguishing between OA severities. Knee adduction moments normalized to medial knee size were not more sensitive to OA severity.

Does Metabolic Syndrome or its Individual Components Affect Pain and Function in Knee Osteoarthritis Women?

Current studies and research support the role of metabolic syndrome (MetS) in knee osteoarthritis (OA). However, few studies have focused on its impact on knee OA parameters. The aim of this study was to investigate if metabolic syndrome or its individual components affect the intensity of pain, functional disability, and radiographic severity in knee osteoarthritis women. We conducted a cross sectional study including confirmed radiographic knee osteoarthritis according to Kellgren and Lawrence scale, with and without metabolic syndrome according to the National Cholesterol Education Program Adult Treatment Panel III criteria. The two groups were compared for pain Visual Analogue Scale (VAS), Lequesne index, Womac function, and radiological grade after adjusting for significant covariates. Multiple regression analysis was used to identify the independent effects of each specific component for metabolic syndrome on knee osteoarthritis parameters. One hundred thirty women were included. The mean age was 56.68 ±8.07 [34-75] years, and the mean BMI was 32.54±2.92 [23-37] kg/m2. The prevalence of metabolic syndrome was 48.5%. Women with and without metabolic syndrome had similar knee osteoarthritis parameters. However, accumulation of MetS components was associated with higher level of pain (OR = 3.7, CI = [1.5-5.9], p=0.001), independently of age and BMI. Multiple regression analyses showed, after adjusting for all covariates, that hyperglycemia had a positive impact on pain (p=0.009), waist circumference was positively associated with Lequesne index (p=0.04), high triglycerides level was significantly associated with increased pain (p=0.04) and higher Lequesne score (p=0.05), and Systolic blood pressure was positively correlated with Lequesne index (p=0.01). In addition to weight reduction, appropriate treatment of metabolic syndrome needs to become an important management strategy for knee pain and functional impairment.

The relationship between the presence of depressive symptoms and the severity of self-reported knee pain in the middle aged and elderly.

Knee pain is a very common symptom of knee osteoarthritis (OA), and identification of the major contributors to knee pain is important to establish management plans for patients with knee OA. Among the potential contributors, we hypothesized that coexisting depressive symptoms might increase the severity of knee pain because the increased cytokine levels and neurotransmitter changes related to depression are known to influence the threshold of physical pain perception. Therefore, a possible relationship between self-reported depressive symptoms and self-reported knee pain has been explored. Additionally, we sought to determine factors influencing the severity of knee pain in a middle-aged and elderly Korean population using data from the fifth Korean National Health and Nutrition Examination Survey. In total, 6599 persons aged ≥50years were evaluated in terms of the radiographic severity of OA and pain severity using 10-point numerical rating scales. Depressive mood was assessed using a polar question: "Had the subject felt despair or depression every day for more than 2weeks during the past year?" The Kellgren-Lawrence knee OA grade, depression, gender, educational level, household income, smoking status, marital status, living place, comorbidity status, BMI, and age were identified by multiple linear regression as variables affecting knee pain severity. The presence of depressive symptoms was associated with an increased risk of severe knee pain (odds ratio 2.55 [95% confidence interval 1.77-3.66]). After stratifying the group in terms of the radiographic severity of knee OA, the relationship with depression persisted in the minimal (2.89 [1.90-4.32]) and moderate OA subgroups (2.29 [1.33-3.94]), but not in the severe OA subgroup. Severe knee pain was independently associated with the presence of depressive symptoms in middle-aged and elderly Korean subjects. This suggests that screening for and treatment of depression may help improve knee pain in elderly individuals. II.

Severe radiographic knee osteoarthritis – does Kellgren and Lawrence grade 4 represent end stage disease? – the MOST study

To determine what MRI-detectable osteoarthritis features that are not visualized on radiography demonstrate progression longitudinally in Kellgren and Lawrence (KL) grade 4 knees. We studied subjects from the Multicenter Osteoarthritis Study who had KL grade 4 knees at baseline and had baseline and 30-month MRI. Cartilage damage, bone marrow lesions (BMLs), meniscal damage, synovitis (signal changes in Hoffa fat pad), and effusion (fluid equivalent signal in the joint cavity) were semiquantitatively scored using the Whole Organ MRI Score (WORMS) system in five subregions of the medial and lateral tibiofemoral (TF) compartments. Analysis was performed for the compartment showing bone-on-bone appearance ("index") on radiograph and also for the other TF compartment of the same knee. Synovitis and effusion were assessed for the whole knee. Changes in scores at follow-up were noted for each feature. For cartilage and BML, within-grade changes were also recorded. 140 subjects (164 knees) were included (50% women, mean age 66.0 ± 8.6 years, mean BMI 30.4 ± 5.1 kg/m(2)). Longitudinally, 51 index compartments (34%) showed an increase in the sum of cartilage scores from all subregions. In the other compartment, 25% showed an increase in the sum score for cartilage damage. For BMLs in the index compartment, 50 knees (33%) showed an increase in maximum score and 32 (21%) showed a decrease. Meniscal status mostly remained stable. Effusion worsened in 36 knees (25%) and improved in 13 knees (9%). Synovitis worsened in 14 knees (10%) and improved in six knees (4%). In KL grade 4 knees, MRI-detected cartilage loss and fluctuation of BMLs, effusion, and synovitis occurred frequently over a 30-month period.

Association of plasma and synovial fluid periostin with radiographic knee osteoarthritis: Cross-sectional study

ObjectiveTo investigate plasma and synovial fluid (SF) periostin of knee osteoarthritis (OA) patients and to determine the relationship between periostin levels and the radiographic severity. MethodsA total of 110 subjects (90 knee OA patients and 20 healthy controls) were enrolled in this study. Plasma and SF periostin were examined using an enzyme-linked immunosorbent assay. OA grading was performed using the Kellgren-Lawrence classification. ResultsAlthough plasma periostin was greater in OA patients than in controls, the difference was not significant. Additionally, SF periostin was significantly higher with respect to paired plasma (P<0.001). Moreover, plasma and SF periostin demonstrated significantly positive correlation with the radiographic severity of knee OA (r=0.537, P<0.001 and r=0.427, P<0.001, respectively). Subsequent analysis revealed that there was a positive correlation between plasma and SF periostin (r=0.368, P<0.001). ConclusionsPlasma and SF periostin levels were positively correlated with the radiographic severity of knee OA.

Association of CCL13 Levels in Serum and Synovial Fluid With the Radiographic Severity of Knee Osteoarthritis

ObjectiveCCL13, a recently identified CC chemokine, plays an important role in the process of joint destruction, which is considered a common cause for osteoarthritis (OA). This study aims to examine...

Serum and Synovial Fluid Nesfatin-1 Concentration is Associated with Radiographic Severity of Knee Osteoarthritis

BackgroundNesfatin-1, a member of the adipokine family, has been detected in synovial fluid (SF) from OA patients. This study aimed to determine whether there is a marked correlation of nesfatin-1 levels in serum and SF of knee OA patients with the disease severity of OA.Material/MethodsThis cross-sectional research enrolled 202 knee OA subjects. The Kellgren-Lawrence grading system was utilized to evaluate the severity of knee OA.ResultsElevated nesfatin-1 concentrations in serum were found in knee OA patients compared with the controls. Nesfatin-1 concentrations were markedly elevated with increased KL grades. Serum and SF nesfatin-1 concentrations were both significantly associated with the disease severity evaluated by KL grading criteria.ConclusionsOur investigation indicates a marked association of serum and SF nesfatin-1 concentrations with OA disease severity.

Physical Activity and Spatial Differences in Medial Knee T1rho and T2 Relaxation Times in Knee Osteoarthritis

Cross-sectional. To investigate the association between knee loading- related osteoarthritis (OA) risk factors (obesity, malalignment, and physical activity) and medial knee laminar (superficial and deep) T1rho and T2 relaxation times. The interaction of various modifiable loading-related knee risk factors and cartilage health in knee OA is currently not well known. Participants with and without knee OA (n = 151) underwent magnetic resonance imaging at 3 T for superficial and deep cartilage T1rho and T2 magnetic resonance relaxation times in the medial femur (MF) and medial tibia (MT). Other variables included radiographic Kellgren-Lawrence (KL) grade, alignment, pain and symptoms using the Knee injury and Osteoarthritis Outcome Score, and physical activity using the International Physical Activity Questionnaire (IPAQ). Individuals with a KL grade of 4 were excluded. Group differences were calculated using 1-way analysis of variance, adjusting for age and body mass index. Linear regression models were created with age, sex, body mass index, alignment, KL grade, and the IPAQ scores to predict the laminar T1rho and T2 times. Total IPAQ scores were the only significant predictors among the loading-related variables for superficial MF T1rho (P = .005), deep MT T1rho (P = .026), and superficial MF T2 (P = .049). Additionally, the KL grade predicted the superficial MF T1rho (P = .023) and deep MT T1rho (P = .022). Higher physical activity levels and worse radiographic severity of knee OA, but not obesity or alignment, were associated with worse cartilage composition.

Saline-Assisted Aspirations for Collecting Synovial Fluid From Noneffused Knees: Technique and Validation

To better understand why a knee develops osteoarthritis after joint trauma we need to assess the local biochemical changes. Unfortunately, it is challenging to obtain synovial fluid from a knee with no effusion. To describe the authors' protocol for aspirating synovial fluid from noneffused knees. Second, they demonstrate the validity of this method by evaluating the relationships between normalized and raw biomarker concentrations among knees with effusion (undergoing a traditional aspiration) and without effusion (requiring a saline-assisted aspiration). Validation study based on secondary analyses from 2 cohort studies. Outpatient orthopedic clinic and basic-science laboratory. Participants had moderate to severe radiographic knee osteoarthritis (n = 15 with and 11 without effusion) and no osteoarthritis or effusion (n = 4). The same orthopedic surgeon performed all synovial-fluid joint aspirations, including saline-assisted aspirations. The authors used multiplex enzyme-linked immunosorbent assays to determine 7 synovial-fluid biomarker concentrations. They then calculated correlations between raw and normalized (to total synovial-fluid protein content) biomarker concentrations. The authors excluded 1 sample collected with a saline-assisted aspiration because it contained blood. Normalized biomarker concentrations had positive associations with raw biomarker concentrations (r = .77-.99), with the exception of interleukin-13 and interleukin-1β among knees that underwent a saline-assisted aspiration. Excluding interleukin-1β, associations between normalized and raw biomarker concentrations were consistent between knees that had a saline-assisted or traditional aspiration. Saline-assisted aspiration is a valid technique for assessing the local biochemical changes in knees without effusion.

OP0059 The Coexistance of Osteoarthritis and Neuropathic Pain

BackgroundThe discordance between the structural damage and the severity of the pain in knee osteoarthritis (OA) suggests the effect of central and peripheral sensitization mechanisms on pain perception. This comes...

Correlation between sialic acid levels in the synovial fluid and the radiographic severity of knee osteoarthritis.

Osteoarthritis (OA) is associated with the presence of inflammation. Sialic acid (SA), an acetylated derivative of neuraminic acid, is reported to be a useful biomarker of inflammation. The aim of the present study was to investigate the correlation between SA levels in the serum and synovial fluid (SF) and radiographic severity in patients with knee OA. A total of 234 patients with knee OA were recruited for the study, as well as 20 patients that had suffered a knee injury or fracture (without knee OA) and 160 healthy controls. Radiological grading of OA in the knee was conducted according to the Kellgren-Lawrence (KL) grading system. SA levels in the serum and SF were measured using Warren’s thiobarbituric acid assay. The results demonstrated that knee OA patients exhibited significantly elevated levels of serum SA when compared with the healthy controls, and also significantly elevated levels of SF SA when compared with the knee fracture patients. Higher SA levels in the SF were identified in knee OA patients with KL grade 4 as compared with patients with KL grade 2 or 3. In addition, OA patients of KL grade 3 had significantly higher SA levels in the SF as compared with patients with KL grade 2 (P<0.01). The SA levels in the SF of the knee OA patients positively correlated with the KL grades (r=0.353; P<0.01). However, there was no significant correlation identified between serum SA levels and KL grade. Therefore, SA levels in the SF positively correlated with the radiographic severity of OA, thus, SA levels in the SF may serve as a biomarker for the progression of OA.

Plasma and synovial fluid sclerostin are inversely associated with radiographic severity of knee osteoarthritis

ObjectiveThe purpose of this study was to analyze sclerostin in plasma and synovial fluid of knee osteoarthritis (OA) patients and to investigate the association between sclerostin levels and radiographic severity. Design and methodsA total of 190 subjects (95 knee OA patients and 95 healthy controls) were recruited in the present study. Sclerostin levels in plasma and synovial fluid were assessed using an enzyme-linked immunosorbent assay. OA grading was performed using the Kellgren–Lawrence classification. ResultsPlasma sclerostin levels were significantly lower in OA patients than in healthy controls (P=0.004). Additionally, sclerostin levels in plasma were significantly higher with respect to paired synovial fluid (P<0.001). Moreover, sclerostin levels in plasma and synovial fluid demonstrated a significant inverse correlation with the radiographic severity of knee OA (r=−0.464, P<0.001 and r=−0.592, P<0.001, respectively). Subsequent analysis revealed that there was a positive correlation between plasma and synovial sclerostin levels (r=0.657, P<0.001). ConclusionsSclerostin was significantly lower in OA plasma samples when compared with healthy controls. Plasma and synovial fluid sclerostin levels were inversely associated with the radiographic severity of knee OA. Therefore, sclerostin may be utilized as a biochemical marker for reflecting disease severity in primary knee OA.

A comparison of knee extensor and hip abductor torque, pain, stifness and physical function between healthy and men with early knee osteoarthritis

A comparison of knee extensor and hip abductor torque, pain, stifness and physical function between healthy and men with early knee osteoarthritis