Rate Of Osteoarthritis Progression Research Articles

Progression of Osteoarthritis at Long-term Follow-up in Patients Treated for Symptomatic Femoroacetabular Impingement With Hip Arthroscopy Compared With Nonsurgically Treated Patients

Background: Femoroacetabular impingement (FAI) is a common cause of hip pain, especially in young patients. When left untreated, it has been demonstrated to be a risk factor for the onset or progression of osteoarthritis (OA) and has been identified as one of the main contributors leading to the need for total hip arthroplasty (THA) at a young age. While the short-term therapeutic potential of hip arthroscopy is widely recognized, little is known regarding its potential mid- to long-term preventive effect on the progression of hip OA. Purpose: To (1) report clinical outcomes of arthroscopically treated FAI syndrome with a minimum 5-year follow-up and compare the results to a cohort with FAI treated nonsurgically and (2) determine the influence of hip arthroscopy on the onset and progression of hip OA in patients diagnosed with FAI. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who had hip pain and were diagnosed with FAI were included. Exclusion criteria were (1) previous or concomitant hip surgery, (2) <5 years of follow-up, and (3) insufficient radiographs. Patients treated with hip arthroscopy were compared with a cohort of patients with FAI who were treated nonsurgically. Kaplan-Meier estimates of failure (defined as conversion to THA) were performed. Bivariate analysis and Cox regression were used to identify factors associated with inferior clinical and radiographic outcomes. Results: A total of 957 patients (650 female, 307 male; 1114 hips) (mean age, 28.03 ± 8.9 years [range, 6.5-41.0 years]) with FAI were included. A total of 132 hips underwent hip arthroscopy and 982 hips were nonoperatively treated. The mean follow-up was 12.5 ± 4.7 years (range, 5.0-23.4 years). At the final follow-up, the rate of OA progression was 26.5% in the operative group and 35.2% in the nonoperative cohort (P < .01). Conversion to THA was performed in 6.8% of the surgical patients and 10.5% of the initially nonsurgical patients (P = .19). Additionally, there was no significant difference in the risk of failure between the operatively and nonoperatively treated patients. Male sex, increased age at initial diagnosis, presence of cam morphology, and increased initial Tönnis grade were risk factors for failure (male sex: hazard ratio [HR], 2.3; P < .01; per year of increased age: HR, 1.1; P < .01; presence of cam: HR, 3.5; P < .01; per Tönnis grade: HR, 4.0; P < .01). Conclusion: At a mean follow-up of nearly 13 years, 7% of patients of the surgical group experienced progression to THA, compared with 11% of the nonoperative control group. While most of the operative group showed little to no OA at final follow-up, moderate OA (Tönnis grade 2) was present in 12% of the cohort compared with 22% of nonsurgical patients. Increased age at diagnosis, male sex, presence of a cam morphology, and presence of initial arthritic joint changes were found to be risk factors for failure. The results of this study demonstrated evidence for a preventive effect of hip arthroscopy on the development and progression of OA in young patients with FAI at mid- to long-term follow-up.

Subchondral insufficiency fracture is a predictive factor of osteoarthritis progression and conversion to arthroplasty in non-surgically treated medial meniscus root tear.

To investigate the radiographic and clinical outcomes of non-surgical treatment for medial meniscus posterior root tear (MMPRT), and prognostic factors for osteoarthritis (OA) progression and clinical failure. A prospectively collected database was retrospectively reviewed for patients who were diagnosed with acute medial meniscus posterior root tear (MMPRT) between 2013 and 2021 and treated non-surgically for more than 2years. Patient demographic characteristics and clinical outcomes including pain numeric rating scale (NRS), International Knee Documentation Committee (IKDC) subjective score, Lysholm score, and Tegner activity scale were evaluated. For radiographic evaluation, knee radiographs were obtained to assess the angle of knee alignment and Kellgren-Lawrence (K-L) grade during the first and annually follow-up visits. Baseline magnetic resonance (MR) images were reviewed for the presence of medial meniscus extrusion, bone marrow edema, subchondral insufficiency fracture of medial femoral condyle, and cartilage lesion. The OA progression group was defined as patients who experienced a worsening of one or more grades in the K-L classification system. Prognostic factors were evaluated for OA progression and conversion to total knee arthroplasty (TKA). Ninety-four patients (90 female and 4 male) with a mean age of 67.0 ± 7.3years (range, 53-83years) were followed for a mean of 46.1 ± 22.1months (range, 24.1-170.5). During the follow-up period, no significant differences in clinical scores were observed, and there were also no significant differences between the groups with and without OA progression. Overall, 12 patients (13%) underwent TKA at a mean of 20.7 ± 16.5months (range, 8-69months) and 34 patients (36%) demonstrated OA progression at a mean time of 24 ± 15months (range, 12-62). The subchondral insufficiency fracture was a prognostic factor for OA progression (p = 0.045 for knee radiograph and p = 0.019 for MR) and conversion to TKA (RR, 4.08 [95% CI 1.23-13.57]; p = 0.022). Non-surgical treatment for acute medial meniscus posterior root tear did not result in any significant change in clinical outcomes from the initial to the final follow-up. The rate of conversion to arthroplasty was 13%, and the rate of osteoarthritis progression was 36%. Furthermore, subchondral insufficiency fracture was found to be a concomitant prognostic factor correlated with OA progression and conversion to arthroplasty. This information can provide insights for physicians when discussing treatment options with patients, particularly regarding the use of non-surgical treatment and may contribute as a source for future studies of medial meniscus posterior root tear. IV.

Facet Joint Violation by Thoracolumbar Percutaneous Pedicle Screw and Its Effect on Progression of Facet Joint Osteoarthritis.

Study DesignA retrospective study.PurposeThis study aimed to investigate the rate and associated factors of facet violation (FV) in percutaneous pedicle screws (PPS) from the thoracic to the lumbar spine and the effect of FV on facet osteoarthritis (OA) progression.Overview of LiteratureSome reports claim PPS has a higher FV rate than conventional open surgery. However, previous reports of FV in PPS were limited to the lumbar spine; only a few reports included the thoracic spine.MethodsThe present study includes 1,028 PPS inserted from T4 to S1 in 218 patients. The rate of FV and facet OA progression after FV were assessed using computed tomography (CT) scans conducted postoperatively at 1 week and 6 months or more. To identify factors associated with FV or facet OA progression after FV, a multivariate logistic regression analysis was conducted. To investigate whether FV caused facet OA progression, we compared OA progression between patients with FV and matched controls.ResultsFV was observed in 68 (6.6%) of the 1,028 facets, and the thoracic spine was identified as an independent factor associated with FV. OA progression was detected in 48.2% of the cases with FV via CT scans conducted postoperatively at a mean duration of 22.6 months. The time between CT scans was identified as an independent factor for facet OA progression after FV. The rate of OA progression in patients with FV was significantly greater than that of the controls.ConclusionsFV was observed in 6.6% of the patients, and the thoracic spine was identified as an independent factor associated with FV. OA progression of a violated facet occurs over time. FV is considered a complication leading to facet OA progression.

Mild to Moderate Varus Alignment in Relation to Surgical Repair of a Medial Meniscus Root Tear: A Matched-Cohort Controlled Study With 2 Years of Follow-up

Background: Increased varus alignment of the lower extremity is known to be a poor prognostic factor for the surgical repair for a medial meniscus root tear (MMRT). However, given the concept of constitutional varus, which is present in a substantial portion of the normal population, the generally accepted surgical indication for MMRT concerning a varus alignment of 5° may be unnecessarily narrow. Purpose: To compare the surgical outcomes of arthroscopic transtibial pullout repair of MMRT according to the degree of varus alignment of the lower extremity. Study Design: Cohort study; Level of evidence, 3 Methods: Patients who underwent isolated arthroscopic transtibial pullout repair of MMRT between January 2010 and July 2017 at one institution and had a minimum follow-up of 2 years were included in this study. Patients were classified into 1 of 2 groups: the experimental group (n = 22) included patients with a preoperative hip-knee-ankle angle between 5° and 10° varus (mild to moderate varus alignment) and the control group (n = 51) included those with a preoperative hip-knee-ankle angle <5° varus (neutral alignment). Clinical scores and radiographic parameters were compared between the groups to assess surgical outcomes, which were statistically matched for potential confounders (age, body mass index, the severity of cartilage lesion) by use of the inverse probability of treatment weighting. A noninferiority trial was performed comparing the experimental and control groups in terms of subjective outcomes (International Knee Documentation Committee subjective and Lysholm scores) and objective outcomes (postoperative medial meniscal extrusion and the rate of osteoarthritis progression). Results: There were no statistically significant differences in surgical outcomes between the groups in subjective and objective aspects, which were consistent before and after inverse probability of treatment weighting. Apart from the clinical improvement observed in both groups, overall degenerative changes in the knee were found, although progression rates did not differ between the groups. In terms of the noninferiority trial, the overall surgical outcomes in the experimental group were not inferior to those in the control group. Conclusion: The short-term surgical outcomes of arthroscopic transtibial pullout repair for MMRT of patients with mild to moderate varus alignment were not inferior to but rather comparable with those with neutral alignment in terms of subjective and objective aspects. Therefore, it would be inappropriate to exclude patients with a diagnosis of MMRT from being indicated for the surgery simply because of mild to moderate varus alignment.

Rotator cuff integrity is correlated to superior functional results and slower osteoarthritis progression ten years after arthroscopic repair

Aim The aim of this study was to evaluate survivorship and functional results of arthroscopic rotator cuff (RC) repairs at a minimum follow-up of ten years. Secondary goals were to compare outcomes in patients with and without re-tears and to relate lesions’ characteristics with clinical, functional and radiological results. Background Arthroscopic repair is considered the gold standard treatment for RC tears, but studies describing long-term results after arthroscopic RC repair are still scarce. Methods Patients were prospectively re-evaluated at least ten years after arthroscopic RC repair. American Shoulder and Elbow Surgeons Shoulder Score (ASES), range of motion (ROM), Constant Murley Score (CMS), isometric strength in forward flexion (fl) and abduction (ab) were measured. Shoulder radiographs were used to measure the acromion-humeral distance (AHD) and classify shoulder osteoarthritis (OA) according to Samilson-Prieto. Ultrasound examination was performed to assess supraspinatus (SSp) re-rupture as a dichotomous variable. Results One hundred and two patients were available for functional and radiological evaluation. In 47 of them (46.5%), a discontinuity of the SSp was diagnosed echographically. Two groups of patients were created and compared depending on echographic tendon integrity: significant differences in favour of patients with intact SSp were detected in ASES (P = 0.0086), ROM (ab: P = 0.0143, fl : P = 0.0069), CMS (P > 0.0001), strength (ab and fl: P > 0.0001), and AHD (P > 0.0001). Patients with smaller (C1-C2) lesions (62.4%) developed significantly greater ROM (ab : P = 0.0174, fl: P = 0.0164), CMS (P = 0.0007), strength in ab (P > 0.0006), strength in fl (P > 0.0001), and showed higher AHD (P > 0.0001). Larger (C3-C4) lesions (37.6 %) were significantly more prone to re-tear (P = 0.0002) and progression of OA (P = 0.0003) than smaller ones. Conclusions These long-term results of arthroscopic RC repair indicate that RC integrity is important to maintain functional results and prevent OA progression. Independently from RC integrity, patients with smaller lesions maintain a superior functional level and a slower rate of OA progression.

Role of full-thickness cartilage defects in knee osteoarthritis (OA) incidence and progression: Data from the OA Initiative.

The purpose of this study is to determine whether full-thickness tibiofemoral cartilage defects are predictive of incident radiographic OA, progression of radiographic OA, and progression to severe radiographic OA. Participants in the OA Initiative (n = 1317, 38.1% male, mean age 60.9 years SD 9.2) with baseline MRIs and Kellgren-Lawrence (KL) OA grade 0-3 (none to moderate OA) were included. All participants had follow-up radiographs at mean 4.9 years (max 8.0). The effect of full-thickness defect presence, size, and location on risk of incident OA (KL grade 2+), overall progression of OA (increase in KL grade 1+ points), or compartment-specific OA progression was assessed with Cox proportional hazards modeling with adjustment for demographic factors, weight, and knee alignment. The yearly incidence of tibiofemoral OA was 0.3% (CI 0.2-0.4%); defect presence, size, and location were not associated with incident OA risk. The yearly rate of OA progression was 3.8% in participants without tibiofemoral full-thickness defects, 6.7% with medial defects, and 6.3% with lateral defects. Medial bipolar (kissing) lesions were an independent risk factor for OA progression as well as medial compartment progression. Lateral tibial-sided full-thickness defects increased risk of lateral progression (increase in lateral OARSI grade). In older adults, isolated full-thickness cartilage defects do not increase short-term risk of incident OA. However, in the setting of preexisting mild or moderate OA, medial bipolar (kissing) defects increase risk of overall OA progression (KL grade) as well as progression of medial compartment OA. Lateral tibial defects increase risk of lateral compartment OA progression. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.

The prognostic and diagnostic value of 18F-FDG PET/CT for assessment of symptomatic osteoarthritis.

The objective of this study was to assess the clinical significance of increased fluorine-18-fluorodeoxyglucose (F-FDG) uptake on PET/CT in joints for evaluation of symptomatic osteoarthritis (OA) and prediction of progression. In this prospective study, shoulder, hip, and knee joints were imaged in 65 patients undergoing routine F-FDG PET/CT imaging. Patients completed the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire to assess joint pain, stiffness, and physical function. Standardized uptake values (SUVs) were measured in hip, knee, acromioclavicular (AC), and glenohumeral (GH) joints. Scout PET/CT images were evaluated for OA using the Kellgren and Lawrence (K/L) system. Patients were followed-up for 5 years to determine the progression of OA on the basis of follow-up imaging or surgical intervention. SUV of knee (r=0.309, P=0.0003), hip (r=0.260, P=0.0027), AC (r=0.186, P=0.0313), and GH (r=0.191, P=0.0271) joints correlated with WOMAC overall scores. Furthermore, SUV of knee (r=0.410, P<0.0001), hip (r=0.203, P=0.0199), and AC (r=0.364, P<0.0001) joints correlated with K/L scores. The area under the receiver operating characteristic curves for SUV were 0.734 (knee), 0.678 (hip), 0.661 (AC), and 0.544 (GH) for symptomatic OA detection based on WOMAC overall z-score greater or equal to 2. Compared with K/L score [hazard ratio (HR)=0.798, P=0.5324], age (HR=0.992, P=0.8978), and WOMAC overall score (HR=1.089, P=0.1265), only SUV (HR=5.653, P=0.0229) was an independent predictor of OA progression in the knees. F-FDG PET/CT may be helpful with localization of painful abnormalities in the inflamed regions of the joints, which could potentially be used to direct individualized treatment in moderate and severe OA. Furthermore, SUV measurement on F-FDG PET/CT could serve as an inflammation activity index in the knees that may be predictive of outcomes and progression rate of OA.

Arthroscopic Fragment Resection for Capitellar Osteochondritis Dissecans in Adolescent Athletes: 5- to 12-Year Follow-up.

Background:Capitellar osteochondritis dissecans (OCD) in skeletally immature athletes has often been seen in baseball players and gymnasts. The choice of surgical procedure for unstable lesions in skeletally immature athletes remains controversial.Purpose:To investigate functional outcomes and radiographic changes in the midterm to long-term postoperative period after arthroscopic (AS) resection for small to large capitellar OCD lesions in skeletally immature athletes.Study Design:Case series; Level of evidence, 4.Methods:A total of 38 elbows in 38 patients (33 boys, 5 girls; mean age, 14 years [range, 13-15 years]) with skeletally immature elbows underwent AS resection for capitellar OCD. Patients were observed for at least 5 years (mean, 8 years [range, 5-12 years]). Elbows with a lesion width that did not exceed one-half of the radial head diameter were assigned to group 1 (n = 17 elbows), and larger lesions were assigned to group 2 (n = 21 elbows). Functional scores, patient satisfaction, range of motion (ROM), and osteoarthritis (OA) grades were evaluated between the groups.Results:All patients returned to sports activity. Functional scores at the final follow-up were not significantly different between the groups. Patient satisfaction scores were significantly higher in group 1 than in group 2. There was significant improvement in flexion ROM at the final follow-up compared with preoperative values in group 1 (P = .017), and there was a significant between-group difference (group 1: 141°; group 2: 133°; P = .002). Extension ROM showed significant improvement in both groups (group 1: from –8° to 3°; group 2: from –17° to –1°; P < .001 for both). Group 1 tended to have better extension than group 2, but the difference was not significant. There were no elbows with severe OA in either group, but the OA grade progressed in 5 elbows (29%) in group 1 and 9 elbows (43%) in group 2, and this rate of OA progression was statistically significant between groups (P = .005).Conclusion:Both functional outcomes and radiological findings after AS fragment resection were excellent in elbows with small lesions. Although overall outcomes were acceptable in elbows with larger lesions, flexion ROM and patient satisfaction scores were significantly inferior to those in elbows with smaller lesions.

The Development of a Model for Measurement of a Clinical Information System for the Prevention of Osteoarthritis

This paper is focused on the development of a model for measurement of a clinical information system for the prevention of osteoarthritis. The subjects of this paper were 106 patients who had been visited a general hospital which located in Chungnam area. As a result of this study, significantly positive changes of behaviors such as taking vegetables, limiting consumption of alcoholic beverage, and practicing the healthy lifestyles of exercising diminished the progression rate of osteoarthritis. There was a significant difference in body weight control after information intervention(t=2.56, p=.037). This paper found that the health promoting behaviors in osteoarthritis patients were increased by 52.9-64.1% compared with previous status and the patients positively perceived on a clinical management system. Therefore, the clinical management system for the prevention of osteoarthritis can be applied to any hospital which has health promotion center.

Imaging of activated macrophages in experimental osteoarthritis using folate-targeted animal single-photon-emission computed tomography/computed tomography

Evaluation of macrophage activation may provide essential information about the etiology and progression rate of osteoarthritis (OA). Activated macrophages abundantly express folate receptor β (FRβ), which can be targeted using radioactive-labeled folic acid. This study was undertaken to investigate whether macrophage activation can be monitored in small animal models of OA using a folate radiotracer and to determine whether macrophage activation differs in different models of OA with different OA progression. Two rat models of OA were used: the mono-iodoacetate (MIA) model, which is a fast-progressing biochemically induced model, and the anterior cruciate ligament transection (ACLT) model, which induces OA at a slower pace. Images were obtained using high-resolution small animal single-photon-emission computed tomography/computed tomography. The specificity of the technique was tested by eradicating macrophages using clodronate-laden liposomes and blockade of FRβ by cold folic acid. The MIA model had high initial macrophage activation, with a peak after 2 weeks which disappeared after 8 weeks. The ACLT model showed less activation but was still active 12 weeks after induction. The technique allowed monitoring of the disease process over time, in which late stages of the disease showed less macrophage activation than early stages, especially in the fast-progressing MIA model of OA. Our findings indicate that macrophage activation in experimental OA can clearly be demonstrated and monitored by the folate radiotracer. The high resolution, high sensitivity, and high specificity of the technique allow clear localization of macrophage activity in a disease model that is not known for abundant macrophage involvement.

Repeated measurement study of hand osteoarthritis in an apparently healthy Caucasian population

The rate of hand osteoarthritis (OA) progression remains controversial due to a shortage of longitudinal studies. We performed a longitudinal, 8-year follow-up study to evaluate the rate of hand OA progression in men and women. This analysis included the influence of age, sex, anthropometric traits, baseline level of hand OA, smoking, alcohol consumption, and familial effects on the progression rate of hand OA. The collected data included information on 263 (127 males and 136 females) Chuvashians (Russian Federation) who had been assessed in 1994 and 2002 by the same investigators. The Kellgren-Lawrence (K-L) grading system was applied to assess the extent of OA development from hand radiographs for various joints and for the hand as a whole. We found high and statistically significant correlations between initial and repeated OA scores but no association between the rate of hand OA progression and anthropometric features, life-style factors, or familial effects. A positive correlation was observed between baseline levels of OA in distal interphalangeal (DIP) joints and the rate of its progression in postmenopausal women. Our results showed a significant difference between the sexes in sum K-L score of metacarpophalangeal (MP) joints in a young (<47) population and in a score of affected DIP joints (K-L > or = 2) in the population over the age of 47 (i.e., most of females were postmenopausal). Our data also suggest a weak but significant correlation in the rate of OA progression in DIP and proximal interphalangeal (PIP) joints and weak negative associations between DIP and MP joints, especially in females.