Severe Osteoarthritis Research Articles

Knee Osteoarthritis SCAENet: Adaptive Knee Osteoarthritis Severity Assessment Using Spatial Separable Convolution with Attention-Based Ensemble Networks with Hybrid Optimization Strategy.

Osteoarthritis (OA) of the knee is a chronic state that significantly lowers the quality of life for its patients. Early detection and lifetime monitoring of the progression of OA are necessary for preventive therapy. In the course of therapy, the Kellgren and Lawrence (KL) assessment model categorizes the rigidity of OA. Deep techniques have recently been used to increase the precision and effectiveness of OA severity assessments. The training process is compromised by low-confidence samples, which are less accurate than normal ones. In this work, a deep learning-based knee osteoarthritis severity assessment model is recommended to accurately identify the condition in patients. The phases of the designed model are data collection, feature extraction, and prediction. At first, the images are generally gathered from online resources. The gathered images are given into the feature extraction phase. A new model is implemented to predict knee osteoarthritis named Spatial Separable Convolution with Attention-based Ensemble Networks (SCAENet), which includes feature extraction, stacked target-based feature pool generation, and knee osteoarthritis prediction. The feature extraction is done using ResNet, Visual Geometry Group (VGG16), and DenseNet. The stacked target-based feature pool is obtained from the SCAENet. Hence, the stacked target-based feature pool is obtained by the Hybridization of Equilibrium Slime Mould with Bald Eagle Search Optimization (HESM-BESO). Here, the knee osteoarthritis's severity prediction is performed using the dimensional convolutional neural network (1DCNN) technique. The designed SCAENet model is validated with other conventional methods to show high performance.

Effect of lower-limb isokinetic muscle strengthening on knee function and joint contact force in knee osteoarthritis patients awaiting total knee arthroplasty: study protocol for a randomized controlled trial.

Knee osteoarthritis (OA) is a common and serious joint disease and patients mainly suffer from knee pain and dysfunction, significantly impacting their quality of life and daily activities. Non-pharmacological treatments and total knee arthroplasty (TKA) are the two major treatments for knee OA. TKA is the primary treatment for severe knee OA patients, however, the postoperative rehabilitation results are not entirely satisfactory. To enhance postoperative rehabilitation outcomes, preoperative lower-limb muscle strengthening has aroused attention and demonstrated significant results on functional recovery after TKA. Specifically, isokinetic muscle strengthening (IMS) has been highly anticipated as an efficient training method. Nevertheless, its effects in perioperative and long-term periods of TKA require further investigation. This study aims to evaluate the impact of preoperative lower-limb IMS during the 4weeks before TKA on the perioperative and postoperative outcomes, with particular attention on knee function, pain, and inflammatory response. In this study, 104 patients awaiting TKA will be randomized to 2 groups: the IMS and health education groups. All patients will be evaluated at baseline, post-intervention, discharge day, and postoperative day 14, with follow-up assessments at 6weeks, 3, 6, and 12months after discharge. The primary outcome will be the Knee Injury and Osteoarthritis Outcome Score 3months after TKA and the medial-to-lateral knee contact force ratio. The secondary outcomes will be changes in lower-limb muscle strength, knee pain, inflammation response, active range of motion, performance-based function (5-times Sit-to-Stand Test, Time Up-and-Go Test, 3m walking speed), Berg Balance Scale, and surgical need. Lower-limb IMS can improve muscle strength, pain, and function for early knee OA patients. However, the effects of different doses of IMS on perioperative and postoperative knee pain, inflammation response, and function after TKA are inconclusive. This study will provide high-quality evidence to assess the efficacy of IMS in end-stage patients who will undergo TKA. Understanding IMS in end-stage knee OA patients will help guide future surgical management for this population. Trial Registration Chinese Clinical Trial Registry ChiCTR2400088136.

A novel deep learning approach for automated grading of knee osteoarthritis severity

A novel deep learning approach for automated grading of knee osteoarthritis severity

Jianpi qingre tongluo prescription alleviates the senescence-associated secretory phenotype with osteoarthritis by regulating STAG1/TP53/P21 signaling pathway

Ethnopharmacological relevanceJianpi Qingre Chubi prescription primarily consists of a compound formula, also known as Huangqin Qingre Chubi Capsules (HQC), which strengthens the spleen and resolves dampness, clear heat, and collaterals. Long-term clinical use has shown that HQC improves joint swelling and pain in patients with osteoarthritis. Mechanistically, we demonstrated that HQC inhibits inflammatory responses, extracellular matrix degradation, and delays chondrocyte senescence. AimTo determine the bioactivity and mechanism of action of Jianpi Qingre Tongluo prescription (HQC) on osteoarthritis (OA). Materials and methodsFirst, the chondroprotective effects of HQC were assessed using histopathology, immunohistochemical staining and protein blotting in an OA rat model. Additionally, we identified key targets for crucial targets of HQC in OA using the Network Pharmacology and Gene Expression Omnibus (GEO) dataset (GSE98918 and GSE152805). In vitro conditions, IL-1β-treated chondrocytes served to study the impact of HQC on OA development and the senescence-associated secretory phenotype (SASP). This was evaluated using a series of approaches, such as flow cytometry assays, and immunofluorescence staining, and then verified by rescue experiments. ResultsTherapy with HQC attenuated the severity of osteoarthritis (demonstrated by histopathology, OARSI grading scores, and Mankin scores) and SASP factors (as indicated by IL-1β, IL-6, IL-4, IL-37, MMP13, ADAMTS5, COL2A1, and ACAN levels, and apoptotic cell death). HQC might treat osteoarthritis via four important targets (STAG1, TP53, P21, and P16), with the p53 signalling pathway representing one of the main pathways. The HQC acts primarily on chondrocyte clusters. In vitro experiments indicated that STAG1 overexpression accelerates chondrocyte apoptosis, promotes SASP factor expression and extracellular matrix (ECM) degradation, and facilitates OA progression. HQC-containing serum suppressed the expression of the STAG1/TP53/P21 pathway, regulated SASP factors, and restored ECM balance. ConclusionJianpi Qingre Tongluo prescription modulated SASP factors by regulating the STAG1/TP53/P21 signal transduction axis and decelerating cartilage senescence and degradation in patients with OA. Jianpi Qingre Tongluo may be an effective drug candidate.

Evaluating the Efficacy of Platelet-Rich Plasma in Treating Primary Knee Osteoarthritis: A Prospective Interventional Study.

Knee osteoarthritis (OA) is a prevalent degenerative joint disorder causing pain, stiffness, and reduced function, significantly impacting the quality of life. Current treatments mainly provide symptomatic relief, with limited efficacy in halting disease progression. Platelet-rich plasma (PRP), a biological therapy rich in growth factors, has gained attention as a potential treatment for knee OA due to its regenerative properties. This study evaluates the efficacy of PRP in managing primary knee OA. This prospective interventional study included 100 patients diagnosed with primary knee OA, categorized using the Kellgren-Lawrence grading scale. Leukocyte-reduced PRP was prepared using the double-spin method and injected into the knee joint. The efficacy of PRP was assessed using the Western Ontario and McMaster Universities Arthritis (WOMAC) Index and Visual Analogue Scale (VAS) pain scores at six weeks, three months, and six months post-injection. Statistical analysis was performed using SPSS version 25.0, with significance set at p<0.05. Significant improvements in the WOMAC and VAS scores were observed at all-time points post-PRP injection. The WOMAC score decreased from a baseline of 81.06 to 63.52 at six months (p < 0.001), and the VAS score reduced from 7.53 to 3.09 (p < 0.001). PRP was more effective in patients with lower body mass index (BMI) and less severe OA (Grades 1 and 2). Adverse events were mild, with 18% reporting mild pain or swelling. PRP therapy significantly improves pain and function in patients with primary knee OA, particularly in early-stage disease. The treatment is generally safe, with minor adverse effects. PRP presents a promising non-surgical option, especially for those seeking to delay or avoid knee arthroplasty.

Influence of Platelet Concentration on the Clinical Outcome of Platelet-Rich Plasma Injections in Knee Osteoarthritis

Background: Platelet-rich plasma (PRP) is one of the most frequently used orthobiologic products for the injection treatment of patients affected by knee osteoarthritis (OA). Some preliminary evidence supports the influence of platelet concentration on patients’ clinical outcomes. Purpose: To analyze if platelet concentration can influence the safety and clinical efficacy of PRP injections for the treatment of patients with knee OA. Study Design: Cohort study; Level of evidence, 3. Methods: This study consisted of 253 patients with knee OA (142 men, 111 women; mean ± SD age, 54.8 ± 11.4 years; Kellgren-Lawrence grades 1-3) who were treated with 3 intra-articular injections of 5 mL of autologous leukocyte-rich or leukocyte-poor PRP. All patients were prospectively evaluated at baseline and at 2, 6, and 12 months. Patients were clinically assessed thorough the Knee injury and Osteoarthritis Outcome Score (KOOS) subscales and the International Knee Documentation Committee (IKDC) Subjective score. Platelet concentration was correlated with clinical outcome. Further analysis was performed by stratifying patients into 3 groups (homogeneous for OA severity) based on platelet concentration (high, medium, and low). All complications and adverse events were reported, as well as failures. Results: An overall statistically significant improvement in all clinical scores was documented from baseline to each follow-up evaluation. Platelet concentration positively correlated with clinical outcome. KOOS Pain improved more with higher platelet concentration at 2 months (P = .036; rho = 0.132), 6 months (P = .009; rho = 0.165), and 12 months (P = .014; rho = 0.155). The same trend was shown by the other KOOS subscales and by the IKDC Subjective score, as well as by the comparison of the groups of high-, medium-, and low-platelet PRP. The highest failure rate (15.0%) was found in the low-platelet group as compared with the medium-platelet group (3.3%) and the high-platelet group (3.3%). No differences were observed among the 3 groups in terms of adverse events. Conclusion: This study demonstrated that platelet concentration influences the clinical outcome of PRP injections in knee OA treatment. PRP with a higher platelet concentration provides a lower failure rate and higher clinical improvement as compared with PRP with a lower platelet concentration, with overall better results up to 12 months of follow-up in patients with knee OA.

Gene therapy for fat-1 prevents obesity-induced metabolic dysfunction, cellular senescence, and osteoarthritis

Obesity is one of the primary risk factors for osteoarthritis (OA), acting through cross talk among altered biomechanics, metabolism, adipokines, and dietary free fatty acid (FA) composition. Obesity and aging have been linked to cellular senescence in various tissues, resulting in increased local and systemic inflammation and immune dysfunction. We hypothesized that obesity and joint injury lead to cellular senescence that is typically associated with increased OA severity or with aging and that the ratio of omega-6 (ω-6) to omega-3 (ω-3) FAs regulates these pathologic effects. Mice were placed on an ω-6-rich high-fat diet or a lean control diet and underwent destabilization of the medial meniscus to induce OA. Obesity and joint injury significantly increased cellular senescence in subcutaneous and visceral fat as well as joint tissues such as synovium and cartilage. Using adeno-associated virus (AAV) gene therapy for fat-1, a fatty acid desaturase that converts ω-6 to ω-3 FAs, decreasing the serum ω-6:ω-3 FA ratio had a strong senomorphic and therapeutic effect, mitigating metabolic dysfunction, cellular senescence, and joint degeneration. In vitro coculture of bone marrow-derived macrophages and chondrocytes from control and AAV8-fat1-treated mice were used to examine the roles of various FA mediators in regulating chondrocyte senescence. Our results suggest that obesity and joint injury result in a premature "aging" of the joint as measured by senescence markers, and these changes can be ameliorated by altering FA composition using fat-1 gene therapy. These findings support the potential for fat-1 gene therapy to treat obesity- and/or injury-induced OA clinically.

An Evaluation of Intra-articular Pathologies Accompanying Tibial Plateau Fractures Postoperatively.

Tibial plateau fractures are one of the most complex and common intra-articular fractures encountered in trauma surgery. This study aimsto evaluate the MRI intra-articular findings of patients with tibial plateau fractures treated surgically and the functional and radiological changes after surgical treatment. A total of 91 patients admitted to our clinic between 2010 and 2019 and operated for tibial plateau fracture were identified from the hospital information system. Patients were excluded fromthe study if aged <18 years, if the radiographs and MRIs were not suitable for the measurements, or if they could not be contacted by telephone. The study was completed with 49 operated knees and 49 healthy knees of 49 patients. The patients were evaluated with respect to demographic characteristics, KneeSocietyKneeScore (KSKS), KneeSocietyFunction Score (KSFS), KneeInjuryandOsteoarthritisOutcomeScore (KOOS) functional and clinical scores, Rasmussen, Kellgren-Lawrence, and Whole-OrganMagneticResonanceImagingScore (WORMS) radiological scoring, and meniscus and ligament pathologies examined on the follow-up MR images. The patients comprised 39 males and 10 females with a mean age of 45.9±11.89 years, and a mean follow-up of 58.2±30.7 months. The fractures were seen to be 49% (n=24)in the lateral plateau, 6.1% (n=4) in the medial plateau, and 42.9% (n=21) were bicondylar fractures involving both plateaux. The KSKS knee score was satisfactory in 85.7% of the patients, the KSFS functional score in 89.7%, and the Rassmussen radiological score in 93.8%. In the KOOS subjective questionnaire, the mean points obtained were 430.7, and the mean total WORMS points were 34.2. According to the Kellgren-Lawrence grades, severe osteoarthritis (grade 3-4) developed in 18.3% (n=9) of the patients. Meniscus injuries that are overlooked at the time of the first injury or which may develop in the subsequent process were not found to seriously affect the functional outcomes of tibial plateau fractures. It can be considered that even if a ligament injury is seen to be accompanying the fracture at the time of the first trauma, the effect is not great in terms of prognosis, and the treatment can remain conservative, especially for collateral ligament injuries.

Optimizing the Preoperative Preparation of Sarcopenic Older People: The Role of Prehabilitation and Nutritional Supplementation before Knee Arthroplasty.

Age-related loss of skeletal muscle strength and mass is linked to adverse postoperative outcomes in older individuals with sarcopenia. Half of patients suffer from severe associated osteoarthritis requiring orthopedic interventions. Mitigating the onset and progression of sarcopenia before surgery is essential to improve the prognosis and reduce surgical complications. The aim of this research was to innovatively explore whether the preoperative period could be the appropriate timeframe to empower surgical resilience, through prehabilitation and dietary supplementation, in older sarcopenic patients undergoing knee arthroplasty. The current literature concerning the effectiveness of prehabilitation and dietary supplementation before knee arthroplasty in sarcopenic older individuals was reviewed, following the SANRA criteria, between December 2023 and February 2024. The study inclusion criteria were as follows: (1) prehabilitation and/or dietary supplementation interventions; (2) human participants aged 65 years and older; (3) relevant outcome reporting (functional status, postoperative complications, and patient-reported outcomes); and (4) articles written in English The extracted information included study characteristics, demographics, intervention details, outcomes, and the main findings. Merged prehabilitation and dietary supplementation strategies extrapolated from the current literature and involving strength, resistance, balance, and flexibility training, as well as essential amino acids, iron, vitamin D, adenosine triphosphate, and glucosamine sulphate supplementation, could improve the functional capacity, ability to withstand the upcoming surgical stressors, and postoperative outcomes in older people undergoing knee arthroplasty. Addressing complex links between knee osteoarthritis and sarcopenia in older individuals undergoing knee arthroplasty requires a multidimensional approach. Prehabilitation emerges as a crucial preliminary step, allowing the optimization of surgical outcomes. Nutraceutical integration, included in a comprehensive care plan, could have a synergic effect in achieving prehabilitation goals. Those interventions are essential for surgical resilience, in terms of muscle function preservation, recovery acceleration, and overall quality of life enhancement. Intensive collaboration among specialists could advance knowledge and the sharable consensus concerning the critical and evolutive field of perioperative care.

The Role of Disease Severity, Affected Joints, and Physical Activity Levels on Functional Impairment in Osteoarthritis after the COVID-19 Pandemic

Hip and knee osteoarthritis (OA) is common among Chilean adults over 60, impacting their functionality. This study aimed to determine how health factors such as disease severity, type of OA, medication use, and physical activity levels relate to functionality in individuals with OA. The sample size included 67 women and 13 men aged 38 to 92 (66.6 ± 11.2) with diagnosed knee or hip OA. The International Physical Activity Questionnaire-Short Form (IPAQ-SF) was used to estimate physical activity, the Lequesne Index for functional impairment, and the VAS (Visual Analog Scale) for pain. Data were collected from December 2022 to March 2023. We performed bivariate analyses, which indicated that greater OA severity and bilateral OA are associated with increased functional impairment and pain. Medication use was correlated with higher pain levels, and physical activity was correlated with functionality; there was no correlation with age. Here, 65.4% of the variance in functionality problems was explained by OA severity, bilateral involvement, and pain level, highlighting their impact on functionality. Functionality problems were higher in individuals who suffered higher levels of severity when they performed lower levels of physical activity. These findings underscore the importance of promoting physical activity to improve the quality of life for individuals with OA.

Total knee replacement in severe genu recurvatum. High prosthetic survival rate without deformity recurrence, using rotating hinge prosthesis

IntroductionGenu recurvatum can originate from neurological and non-neurological causes. Its presence associated with knee osteoarthritis represents 1 % of the causes of total knee replacement (TKR). The aim of this retrospective study was to show the functional outcomes, recurrence rate and prosthetic survival in patients with genu recurvatum treated with articulated rotating hinge prostheses. Methodsbetween January of 2008 and December of 2021, we performed 3224 primary TKR, of which 34 (1 %) had recurvatum. This was defined as hyperextension ≥10°. Inclusion crirteria were patients with primary TKR and recurvatum that were treated with a rotating hinge prosthesis (Endo Model, Walderman Link, Ham, Germany), and completed a minimum follow-up of 24 months. Final series consisted in 23 patients with 25 TKR with 15 (65.22 %) females and a mean age of 66.8 ± 14.2 years old. The median follow-up was 5.0 (range 2.11–11.5). Clinical analysis was performed with the use of Knee Society Score (KSS) and Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC). Prosthetic survival rate was calculated with a Kaplan-Meier curve considering as the endpoint of the analysis revision due to any reason. Recurrence was defined as the presence of hyperextension ≥ 5° after surgery. Resultsof the 23 patients, 9 (39.13 %) had history of neurological disorders. Median recurvatum observed was 20.12° (range 13.0° - 30.2°). A median of 19.6° (range 10.1° - 55.4°) valgus misalignment was observed in 19 patients and 10.7° (range 2.0–23.5°) of varus was observed in 6 (24 %) patients. Clinical and functional KSS improved significantly after 12 months (from 34.2 ± 9.8 and 40.1 ± 12.6 to 82.1 ± 7.5 and 89.2 ± 6.8 respectively; p < 0.01) and at the end of the study (84.3 ± 7.5 and 90.0 ± 11.3; p < 0.01). Final mean WOMAC value was 24.1 ± 9.6. One (4.0 %) complication was registered after surgery (superficial infection). Four (16.0 %) patients had demarcation. Prosthetic survival rate was 100 % at the end of the study. ConclusionThe rotating hinge prosthesis restores joint function in patients with severe knee osteoarthritis with and without neurological disorders, without recurrence of misalignment and with excellent survival rates.

Standardized maps – an emerging approach to leverage quantitative information in knee imaging

ObjectiveProperty maps, which capture spatial variations across the entire joint, are emerging as a powerful means for extracting and analyzing quantitative information from knee 3D imaging datasets, particularly from CT and MRI data. This perspective paper aims to discuss the processing pipelines used so far, as well as the results they have enabled with respect to osteoarthritis. DesignThe key methodological steps for obtaining property maps, including segmentation, property calculation, and standardization are presented and analysis methods are discussed. Representative studies are also examined to illustrate the state-of-the-art in this field. ResultsThree main processing pipelines have been used, with the segmentation, property calculation, and standardization steps occurring in different orders. Many methods have been successfully considered for ordering these steps, without any looking generally preferable to the others. Thanks to recent advances in segmentation and standardization techniques, routine processing of property maps appears conceivable in the near future. Maps have been analyzed for multiple purposes, including group comparisons, pattern recognition, and cross-property modelling. Mostly maps of cartilage thickness and composition, as well as maps of bone shape and mineral density have been reported. They revealed distinct patterns associated with osteoarthritis severity, achieved high diagnostic accuracy, and identified relationships among tissue properties. ConclusionsProperty maps represent a promising approach for leveraging the extensive information in imaging data. They are particularly interesting for standardizing complex spatial variations in tissue properties, enabling global analysis and modelling. Once challenging to obtain and interpret, current mapping methods are being improved to the point that property maps may well be in routine use in the near future.

Spermidine attenuates chondrocyte inflammation and cellular pyroptosis through the AhR/NF-κB axis and the NLRP3/caspase-1/GSDMD pathway.

Osteoarthritis (OA) is a prevalent chronic degenerative disease, marked by a complex interplay of mechanical stress, inflammation, and metabolic imbalances. Recent studies have highlighted the potential of spermidine (SPD), a naturally occurring polyamine known for its anti-inflammatory and antioxidant properties, as a promising therapeutic agent for OA. This study delves into the therapeutic efficacy and mechanistic pathways of SPD in mitigating OA symptoms. Forty Sprague-Dawley rats were randomly assigned to four groups, including the CG (sham operation), model (anterior cruciate ligament transection [ACLT], and treatment (ACLT + two different doses of SPD) groups. In vivo, correlations between OA severity and different interventions were assessed by ELISA, X-rays, CT imaging, histological staining, and immunohistochemistry. In vitro, IL-1β was used to trigger chondrocyte inflammation, and SPD's cytotoxicity was assessed in primary rat chondrocytes. Next, inflammatory markers, extracellular matrix (ECM) proteins, and pathway marker proteins were detected in chondrocytes administered IL-1β alone, SPD, or aryl hydrocarbon receptor (AhR) silencing, by qRT-PCR, Griess reaction, ELISA, Western blot, and immunofluorescence. Morphological alterations and pyroptosis in chondrocytes were examined by transmission electron microscopy (TEM) and flow cytometry. Our research reveals that SPD exerts significant anti-inflammatory and antipyroptotic effects on IL-1β-treated chondrocytes and in anterior cruciate ligament transection (ACLT) rat models of OA, primarily through interaction with the Aryl hydrocarbon receptor (AhR). Specifically, SPD's binding to AhR plays a crucial role in modulating the inflammatory response and cellular pyroptosis by inhibiting both the AhR/NF-κB and NLRP3/caspase-1/GSDMD signaling pathways. Furthermore, the knockdown of AhR was found to negate the beneficial effects of SPD, underscoring the centrality of the AhR pathway in SPD's action mechanism. Additionally, SPD was observed to promote the preservation of cartilage integrity and suppress ECM degradation, further supporting its potential as an effective intervention for OA. Collectively, our findings propose SPD as a novel therapeutic approach for OA treatment, targeting the AhR pathway to counteract the disease's progression and highlighting the need for further clinical evaluation to fully establish its therapeutic utility.

The effect of corticosteroid injections in the treatment of greater trochanteric pain syndrome: lessons for advanced practitioners

Greater trochanteric pain syndrome (GTPS) is a broad term employed to characterise lateral hip pain originating from the structures attached to the greater trochanter of the femur. It can lead to a decrease in work participation, elevated levels of pain and dysfunction impeding physical activity and a diminished quality of life; these features align with those observed in individuals with severe hip osteoarthritis. Effectively managing GTPS can present considerable challenges. Generally, patients with GTPS tend to respond favourably to conservative management techniques, such as corticosteroid injections. However, there is still some debate regarding the specific estimation of effect that corticosteroid injections have. This was recently explored in a systematic review by Wang et al (2022) . This commentary critically assesses the methodologies used in the review and provides a broader understanding of its findings in the context of the four pillars of advanced practice: clinical practice, leadership, education and research.

Deep Learning for Automatic Knee Osteoarthritis Severity Grading and Classification.

Knee osteoarthritis (OA) is a prevalent condition that significantly impacts the quality of life, often leading to the need for knee replacement surgery. Accurate and timely identification of knee degeneration is crucial for effective treatment and management. Traditional methods of diagnosing OA rely heavily on radiological assessments, which can be time-consuming and subjective. This study aims to address these challenges by developing a deep learning-based method to predict the likelihood of knee replacement and the Kellgren-Lawrence (KL) grade of knee OA from X-ray images. We employed the Osteoarthritis Initiative (OAI) dataset and utilized a transfer learning approach with the Inception V3 architecture to enhance the accuracy of OA detection. Our approach involved training 14 different models-Xception, VGG16, VGG19, ResNet50, ResNet101, ResNet152, ResNet50V2, ResNet101V2, ResNet152V2, Inception V3, Inception, ResNetV2, DenseNet121, DenseNet169, DenseNet201-and comparing their performance. The study incorporated pixel ratio computation and picture pre-processing, alongside a decision tree model for prediction. Our experiments revealed that the Inception V3 model achieved the highest training accuracy of 91% and testing accuracy of 67%, with notable performance in both training and validation phases. This model effectively identified the presence and severity of OA, correlating with the Kellgren-Lawrence scale and facilitating the assessment of knee replacement needs. By integrating advanced deep learning techniques with radiological diagnostics, our methodology supports radiologists in making more accurate and prompt decisions regarding knee degeneration. The Inception V3 model stands out as the optimal choice for knee X-ray analysis, contributing to more efficient and timely healthcare delivery for patients with knee osteoarthritis.

People with osteoarthritis have a higher component of neuropathic pain as compared to those with rheumatoid arthritis: A cross-sectional study.

Neuropathic pain may be present in a proportion of patients with osteoarthritis (OA) and rheumatoid arthritis (RA). Its presence may lead to the requirement of altered management approaches in these conditions. This study investigated the prevalence of neuropathic pain in OA as compared to that in RA. Patients with OA and RA were included cross-sectionally if they had no other known neuropathic disorder. The PainDETECT questionnaire was used to assess neuropathic pain. WOMAC and CDAI scores were used to assess disease severity in OA and RA respectively. 69 patients with OA with a mean WOMAC score of 53.30 ± 16.39 and 98 patients with RA with a mean CDAI of 25.48 ± 16.99 were compared. The median PainDETECT score for OA was 13 (0-30) and RA was 5 (0-37) [p<0.001]. 15 patients with OA and six patients with RA were highly likely to have neuropathic pain, while 15 patients with OA and 30 patients with RA were classified as possibly having neuropathic pain. Thus, the proportion of patients free from neuropathic pain was higher in the RA group (63.3%) than in the OA group (39.1%) [p = 0.003]. Both the prevalence and the severity of neuropathic pain were significantly higher in OA than in RA. These findings suggest that neuropathic pain is an important factor in OA, as in RA, and must be considered in management as well as in future research in both these conditions.

Differences in Time to Return to Work Between Patients Undergoing Staged Versus Simultaneous Bilateral Total Hip Arthroplasty

BackgroundPatients who undergo total hip arthroplasty (THA) oftentimes have severe osteoarthritis in both hips and may consider staged or simultaneous bilateral THA (bTHA). The goal of this study was to compare the total workdays missed following staged and simultaneous bTHA performed via either postero-lateral (PA) or direct anterior approach (DAA). MethodsPatients who were (1) employed, (2) underwent a staged (within 12 months) or simultaneous bTHA at our institution between February 1, 2016, and December 31, 2021, (3) completed a return-to-work questionnaire, and (4) had the same surgical approach for both THAs were included. The primary outcome of interest was the total days of work missed. ResultsWe identified 78 employed patients who had undergone staged bTHA (62 PA, 16 DAA) and 76 patients (44 PA, 32 DAA) who underwent simultaneous bTHA, and had completed the return-to-work questionnaire. Simultaneous bTHA patients missed an average of 25.6 days of work (SD: 14.3 days) compared to staged bTHA patients, who missed an average of 36.9 days of work (SD: 23.4) when combining days missed from both operations (P < 0.001). In multivariate mixed regression analysis adjusted for sex, age, body mass index, American Society of Anesthesiologists status, type of work, and surgical approach, the staged bTHA group missed a mean of 8.2 more days of work (SD: 3.3) compared to the simultaneous bTHA group (95% confidence interval: 1.8 to 14.7, P = 0.013). ConclusionsEmployed patients who underwent simultaneous bTHA missed an average of 8.2 fewer days of work compared to those who were treated with staged bTHA. These findings may help surgeons counsel their employed patients who have bilateral hip osteoarthritis and are considering surgical treatment. Level of EvidenceIV, retrospective cohort study.

Characterization of articular lesions associated with glenohumeral instability using arthroscopy.

The prevalence of osteoarthritis (OA) associated with instability of the shoulder ranges between 4% and 60%. Articular cartilage is, however, routinely assessed in these patients using radiographs or scans (2D or 3D), with little opportunity to record early signs of cartilage damage. The aim of this study was to assess the prevalence and localization of chondral lesions and synovial damage in patients undergoing arthroscopic surgery for instablility of the shoulder, in order to classify them and to identify risk factors for the development of glenohumeral OA. A total of 140 shoulders in 140 patients with a mean age of 28.5 years (15 to 55), who underwent arthroscopic treatment for recurrent glenohumeral instability, were included. The prevalence and distribution of chondral lesions and synovial damage were analyzed and graded into stages according to the division of the humeral head and glenoid into quadrants. The following factors that might affect the prevalence and severity of chondral damage were recorded: sex, dominance, age, age at the time of the first dislocation, number of dislocations, time between the first dislocation and surgery, preoperative sporting activity, Beighton score, type of instability, and joint laxity. A total of 133 patients (95%) had synovial or chondral lesions. At the time of surgery, shoulders were graded as having mild, moderate, and severe OA in 55 (39.2%), 72 (51.4%), and six (4.2%) patients, respectively. A Hill-Sachs lesion and fibrillation affecting the anteroinferior glenoid cartilage were the most common findings. There was a significant positive correlation between the the severity of the development of glenohumeral OA and the patient's age, their age at the time of the first dislocation, and the number of dislocations (p = 0.004, p = 0.011, and p = 0.031, respectively). Synovial inflammation and chondral damage associated with instability of the shoulder are more prevalent than previously reported. The classification using quadrants gives surgeons more information about the chondral damage, and could explain the pattern of development of glenohumeral OA after stabilization of the shoulder. As the number of dislocations showed a positive correlation with the development of OA, this might be an argument for early stabilization.

Influence of Knee Osteoarthritis Severity, Knee Pain, and Depression on Physical Function: A Cross-Sectional Study.

Decreased physical function with increasing life expectancy is a public health concern worldwide. Knee osteoarthritis (KOA) is considered one of the primary illnesses causing decreased physical function. Depression affects decreased physical function and is closely related to knee pain in KOA. However, the effect of these interacting factors on physical function is not clear. We conducted a cross-sectional analysis of the baseline data of 1106 subjects of the 2009 Locomotive Syndrome and Health Outcome in Aizu Cohort Study (LOHAS). We determined the association between their Timed Up and Go test (TUG) scores and radiographic KOA, knee pain, and depression in a multivariate analysis. Severe knee pain was significantly associated with decreased physical function (the odds ratio [OR] was 2.13, 95% confidence interval [CI]: 1.32-4.89), as was depression (OR 2.64, 95% CI 1.61-4.33). Only Kellgren-Lawrence (KL) grade 4 was significantly associated with decreased physical function in the radiographic KOA severity (OR 6.58, 95% CI 1.75-24.68). Severe knee pain and depression were significantly associated with decreased physical function, but not radiographic KOA severity except for KL grade 4. The limitations of using radiographic KOA severity alone as the indicator of assessment for physical function were suggested. When assessing decreased physical function, the clinical focus tends to be on radiographic KOA severity, but it is important to consider the patient's knee pain and psychological factors.

Investigating the potential impact of ELF3-associated SNPs on chondrocyte inflammation

Objective: Chondrocyte inflammation is a critical factor in degenerative joint diseases, such as osteoarthritis (OA), significantly impairing quality of life through chronic pain and limited mobility. Genetic predisposition is recognized as a critical factor in the progression of chondrocyte inflammation and OA, with particular focus on the role of genetic variants in the expression and regulation of inflammatory mediators. This study aimed to obtain information about the potential roles of a few genes containing ELF3-associated SNPs in the pathogenesis of chondrocyte inflammation. Materials and Methods: GVAT Database was used to select top candidate SNPs associated with ELF3, a cardinal transcription factor in chondrocyte inflammation. Inflammation was induced by IL-1β treatment in differentiated chondrocytes to analyze gene expression patterns. Transcriptome analysis was done by RNA sequencing. Results: The most important SNPs that could potentially affect the binding affinity of ELF3 transcription factor were analyzed. As a result of the analysis, 52% of ELF3-associated SNPs were found in protein-coding regions, 40% in gene-free intergenic regions, and 8% in non-coding RNA sequences. Some of these SNPs are located in regulatory regions (enhancers). A significant increase in expression levels in the ELF3 gene was detected after IL-1β administration, indicating that IL-1β promotes the activity of this transcription factor. mRNA expressions of TLN2, BABAM2, PEPD, and NUDT5 were also increased after IL-1β stimulation. Conclusion: The presence of ELF3-associated SNPs in the enhancer sequences of TLN2 and BABAM2 genes, in addition to the increased expression of these two genes upon IL-1β stimulation, suggested that TLN2 and BABAM2 genes may be associated with the severity of chondrocyte inflammation and OA.