Severity Of Knee Osteoarthritis Research Articles

Machine learning-based bioimpedance assessment of knee osteoarthritis severity

This study proposes a multiclass model to classify the severity of knee osteoarthritis (KOA) using bioimpedance measurements. The experimental setup considered three types of measurements using eight electrodes: global impedance with adjacent pattern, global impedance with opposite pattern, and direct impedance measurement, which were taken using an electronic device proposed by authors and based on the Analog Devices AD5933 impedance converter. The study comprised 37 participants, 25 with healthy knees and 13 with three different degrees of KOA. All participants performed 20 repetitions of each of the following five tasks: (i) sitting with the knee bent, (ii) sitting with the knee extended, (iii) sitting and performing successive extensions and flexions of the knee, (iv) standing, and (v) walking. Data from the 15 experimental setups (3 types of measurements×5 exercises) were used to train a multiclass random forest. The training and validation cycle was repeated 100 times using random undersampling. At each of the 100 cycles, 80% of the data were used for training and the rest for testing. The results showed that the proposed approach achieved average sensitivities and specificities of 100% for the four KOA severity grades in the extension, cyclic, and gait tasks. This suggests that the proposed method can serve as a screening tool to determine which individuals should undergo x-rays or magnetic resonance imaging for further evaluation of KOA.

The predictive value of body mass index, waist circumference, and triglycerides/ high-density lipoprotein cholesterol ratio in assessing severity in patients with knee osteoarthritis and metabolic syndrome

BackgroundStudies have shown the importance of metabolic factors like BMI, waist circumference, and lipid profile in predicting knee osteoarthritis severity. However, their predictive ability in knee osteoarthritis patients with metabolic syndrome still needs to be explored. ObjectivesEvaluate the predictive ability of Body mass index (BMI), waist circumference, and triglyceride/ High-density lipoprotein cholesterol (HDL-c) ratio in determining the severity of knee osteoarthritis in patients with metabolic syndrome. Materials and methodsA cross-sectional study at Ho Chi Minh City Hospital for Rehabilitation and Professional Diseases from January 2023 to January 2024 included 697 patients meeting ACR 1991 and NCEP-ATP III criteria for knee osteoarthritis and metabolic syndrome, respectively. Logistic regression analyzed the predictive ability of BMI, waist circumference, and triglyceride/HDL-C ratios. Six hundred ninety-seven patients were divided into two groups: severe and non-severe knee osteoarthritis. The criteria for severity were defined as the presence of both: (1) Kellgren-Lawrence grade 3 or higher on knee radiographs and (2) moderate or higher knee pain. Two models were constructed to analyze the predictive ability of severe knee osteoarthritis. Model 1 included univariate factors, while Model 2 incorporated multivariate models. ResultsAmong the 697 patients who participated in the study, the average age was 58.7 ± 12.1 years, and females accounted for 71.3 %. The mean BMI and waist circumference were 24.8 ± 2.0 kg/m2 and 86.2 ± 6.0 cm, respectively. In model 1 (univariate), the discriminative ability of BMI, waist circumference, and triglycerides/HDL-c in predicting severity was excellent, with respective AUCs of 0.90 (95 % CI: 0.87–0.92, p < 0.001), 0.81 (95 % CI: 0.78–0.85, p < 0.001), and 0.85 (95 % CI: 0.82–0.88, p < 0.001). In model 2 (combined model), the combination of all three factors resulted in an AUC of 0.93 (95 % CI: 0.91–0.95, p < 0.001) with a specificity of up to 90.2 %. ConclusionBMI, waist circumference, and triglyceride/HDL-C ratio are individual and combined predictors of knee osteoarthritis severity in patients with metabolic syndrome.

Comprehensive Study on Scoring and Grading Systems for Predicting the Severity of Knee Osteoarthritis.

Knee Osteoarthritis (KOA) is a degenerative joint ailment characterized by cartilage loss, which can be seen using imaging modalities and converted into imaging features. The older population is the most affected by knee OA, which affects 16% of people worldwide who are 15 years of age and older. Due to cartilage tissue degradation, primary knee OA develops in older people. In contrast, joint overuse or trauma in younger people can cause secondary knee OA. Early identification of knee OA, according to research, may be a successful management tactic for the condition. Scoring scales and grading systems are important tools for the management of knee osteoarthritis as they allow clinicians to measure the progression of the disease's severity and provide suggestions on suitable treatment at identified stages. The comprehensive study reviews various subjective and objective knee evaluation scoring systems that effectively score and grade the KOA based on where defects or changes in articular cartilage occur. Recent studies reveal that AI-based approaches, such as that of DenseNet, integrating the concept of deep learning for scoring and grading the KOA, outperform various state-of-the-art methods in order to predict the KOA at an early stage.

Effect of kinesio taping and exercise on functional impairment in patients with different degrees of knee osteoarthritis

BACKGROUND: Kinesio Taping (KT) is used for musculoskeletal problems. KT optimizes and reduces mechanical stresses on soft tissues. However, the benefits of KT and traditional exercises for different severities of knee osteoarthritis (OA) remains controversial. OBJECTIVES: This study aimed to investigate the effects of tension KT and traditional physical therapy on different severities of knee OA. METHODS: Fifty-six male patients with knee OA, aged 60–75-y years, were allocated to groups A and B based on grades 1 and 2 and grades 3 and 4 on the Kellgren-Lawrence scale, respectively. Tension KT and traditional physical therapy were administrated to both groups for 6-wks. The extensor peak moment of quadriceps and knee flexion range of motion (ROM) were recorded using an isokinetic dynamometer and universal goniometer, respectively. Visual analog scale (VAS) was used to score pain level. Statistical analysis was performed using the ANCOVA test. RESULTS: ANCOVA revealed an increase in peak extensor moment of quadriceps (Pre: 51.6 ± 2.8 Nm; Post: 63.3 ± 4.3 Nm), knee flexion ROM (Pre: 112.8∘7.2; Post: 122.9∘4.8), and pain improvement (Pre: 5.1 ± 1.07; Post: 2.8 ± 1.6) in group A (p&lt; 0.001). Group B showed insignificant improvements in all outcome measures (p&gt; 0.05). CONCLUSION: KT with traditional physical therapy improved knee pain, quadriceps strength, and knee ROM in older males with knee OA grades 1 and 2. KT and traditional physical therapy were insufficient to produce considerable effects on grades 3 and 4 of knee OA.

Performance analysis of Alexnet for Classification of Knee Osteoarthritis.

In recent years, automated grading of knee osteoarthritis (KOA) has focused on determining disease progression. Clinical examinations and radiographic image review are necessary for diagnosis. Timely and accurate diagnosis, along with medical care, can slow down KOA progression. X-rays and MRI are crucial diagnostic tools. KOA diagnosis traditionally relies on radiologists' and clinicians' experience. However, the rapid development of deep learning technology (AI) offers promising solutions for medical applications. The objective of this study was to review and summarize various methods proposed by researchers for the automated grading of KOA. Additionally, this study aimed to evaluate the performance of the AlexNet model in classifying the severity of KOA. The performance of the AlexNet model has been compared to that of other models, and the results have been assessed. A comprehensive review of existing research on automated grading of KOA has been conducted. Various methods proposed by different researchers have been examined and summarized. The AlexNet model has been employed for classifying the severity of KOA, and its performance has been evaluated. A comparative analysis has been carried out to compare the performance of the AlexNet model with that of other models. The results obtained from the evaluation have been assessed to determine the effectiveness of the AlexNet model in the automated grading of KOA. The results of the study indicate that the AlexNet model demonstrates promising performance in classifying the severity of KOA. Comparative analysis reveals that the AlexNet model outperforms other models in terms of accuracy and efficiency. The evaluation of the model's performance provides valuable insights into the effectiveness of deep learning techniques for automated grading of KOA. This study highlights the significance of automated grading in the diagnosis and management of knee osteoarthritis. The utilization of deep learning technology, particularly the AlexNet model, shows promise in accurately classifying the severity of KOA. The findings suggest that automated grading methods can serve as valuable tools for healthcare professionals in assessing the progression of KOA and providing appropriate medical care. Further research and development in this area can contribute to enhancing the efficiency and accuracy of automated grading systems for KOA.

Radiographic knee osteoarthritis severity has no impact on fall risk: the locomotive syndrome and health outcomes in the aizu cohort study (LOHAS): a cross-sectional study

BackgroundTo investigate factors that have an impact on the risk of falls and determine whether radiographic knee osteoarthritis (KOA) is a factor involved in falls independent of knee pain, psychological factors, and physical function.MethodsA cross-sectional analysis was conducted on 1083 subjects for the 2009 Locomotive Syndrome and Health Outcomes in the Aizu Cohort Study (LOHAS). A logistic regression analysis was performed to examine the relationship between radiographic KOA and fall history.ResultsFall history was significantly associated with the severity of knee pain. Compared to subjects with no knee pain, the odds ratio (OR) was 1.53 times higher in the subjects with mild knee pain (95% confidence interval [CI]: 1.04–2.25), 1.69 times higher in those with moderate knee pain (95%CI: 1.03–2.79), and 2.98 times higher in those with severe knee pain (95%CI: 1.67–5.30). In subjects with depression, the OR was 1.91 (95%CI: 1.25–2.92), and in those with decreased mobility, the OR was 1.70 (95%CI: 1.08–2.69). Age, gender, knee crepitus, BMI, OLST, and sleeping pill use were not significantly associated with fall risk. In a multivariate analysis, radiographic KOA severity was not significantly associated with fall risk (OR 0.81, 95%CI 0.44–1.50 in mild OA; OR 1.10, 95%CI 0.57–2.14 in severe OA).ConclusionKnee pain, decreased mobility, and depression, but not the radiographic KOA severity, were significantly associated with a fall risk. Regardless of the individual's radiographic KOA severity, the risk of falls may be reduced by treating his/her knee pain, mobility problems, and/or psychological factors.

Cross-sectional study on the relationship between Body Mass Index and severity of knee osteoarthritis

Background. Musculoskeletal diseases like osteoarthritis (OA) are widespread. OA affects the knees, makes the joints wear out and hurt, and makes it hard to move around. Body mass index (BMI) is a way to measure obesity, which is linked to a higher chance of getting OA and making it worse. The main aim of this cross-sectional study was to find out how body mass index (BMI) is related to how lousy knee osteoarthritis is. Methods. One hundred people at the Shri Guru Ram Rai Institute of Medical and Health Sciences in Dehradun met the study’s requirements and were enrolled. The Kellgren-Lawrence grading method was used to find the severity of knee osteoarthritis (OA), and standard measurements were used to calculate body mass index (BMI). A correlation study was done to examine the link between BMI and the severity of OA. Results. The sample included 100 participants on average of 60 years old. The typical knee OA symptoms lasted five years. A body mass index distribution analysis showed 35% obese, 40% overweight, and 25% underweight or average weight. Twenty percent of knee OA patients were mild, 35 percent intermediate, 30 percent severe, and 15 percent progressed. The association investigation revealed a significant positive correlation between BMI and knee osteoarthritis severity (r = 0.65, p &lt; 0.001). Conclusion. Our results show that being overweight can worsen knee OA, proving that people with this problem need to watch their weight. If we treat obesity as a risk factor that can be changed, we might be able to improve the results of OA.

β-crosslaps in knee osteoarthritis – assessment and rehabilitation

Abstract: The bone turnover is important for the progression of osteoarthritis. The C-terminal telopeptide of type I collagen, β-CrossLaps (β-CTx) is considered as the first-choice bone resorption markers. Today, the biochemical markers have been associated with pain and disease severity in knee osteoarthritis (KOA) patients. We studied the association between β-CTx and functional status in KOA patients, pre- and postrehabilitation program. The primary goals of our study are both to establish the correlation between the serum level of β-CTx and other parameters of clinical and functional status in KOA patients and to compare the CTX-I values before and after rehabilitation program. We respected the actual international management recommendations for KOA. A total of 130 patients were randomly allocated into two distinct groups: Study Group (SG = 90 patients) performed 10 sessions of complete rehabilitation program (magnetodiaflux, transcutaneous nerve stimulation, ultrasound and low intensity laser treatment, kinetic measures), and Control Group (CG = 40 patients) performed 10 sessions of kinetic program. Both programs were performed daily, 5 days/week, 2 weeks. Evaluation of patients was carried out in two stages - initial (T1) and after 3 months (T2). Comparing the initial values with the final ones for β-CTx, we noticed a high significant difference between initial and final values only in SG patients. For the both T1 and T2 moments, there was no a statistically significant difference between β-CTx values from the two groups. Analyzing the differences between the values of clinical parameters (Six Minutes Walking Test, Timed Up-and-Go test, walk cadence and Symmetry index in walk) obtained between the patients from the two groups, we noticed that, for the T2 moment, there was a statistically significant difference between studied parameters, except walk cadence. In the assessment of global KOA patient status (clinical and functional status in accordance with bone-cartilage interface dynamics), β-CTx has significant value and could be used for monitoring the individualized rehabilitation program.

Deep Learning Based Knee Osteoarthritis Detection and Classification

Knee osteoarthritis (OA) is a musculoskeletal disease that significantly affects patients' quality of life. Early and accurate diagnosis of knee osteoarthritis is important for timely intervention and development of appropriate treatment plans. In this study, we present a novel approach using artificial intelligence (AI)-based deep learning to solve the problem of knee joint localization, joint width (JSW) area, and grading of knee OA from digital radiographs. The main aim of this study is to investigate the effectiveness of the deep learning method in predicting knee OA severity based on the Kellgren Lawrence (KL) rating. To achieve this, we developed a custom tool that uses neural networks (CNN) to analyze digital radiographs of the knee joint. Our approach focuses on identifying the presence of knee OA and measuring its severity according to the KL score.

Plasma microRNA-320c as a Potential Biomarker for the Severity of Knee Osteoarthritis and Regulates cAMP Responsive Element Binding Protein 5 (CREB5) in Chondrocytes.

Osteoarthritis (OA) is a commonly known prevalent joint disease, with limited therapeutic methods. This study aimed to investigate the expression of plasma microRNA-320c (miR-320c) in patients with knee OA and to explore the clinical value and potential mechanism of miR-320c in knee OA. Forty knee OA patients and 20 healthy controls were enrolled. The levels of plasma miR-320c and plasma inflammatory cytokines were measured by real-time PCR or ELISA. Correlations of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores and cytokine levels with the miR-320c expression level were evaluated by Pearson correlation analysis. Then, a receiver operating characteristic (ROC) curve was drawn to analyse the diagnostic value of miR-320c in OA. Finally, the interaction of miR-320c and cAMP responsive element binding protein 5 (CREB5) was determined using a luciferase reporter assay, and the effect of CREB5 on the cAMP pathway was assessed. The expression level of plasma miR-320c was significantly higher in OA patients than in healthy controls (p < 0.05). The increased plasma miR-320c level was positively correlated with the WOMAC score (r = 0.796, p < 0.001) and the plasma interleukin (IL)-1β (r = 0.814, p < 0.001) and IL-6 (r = 0.695, p < 0.001) levels in patients with OA. ROC curve analysis demonstrated the relatively high diagnostic accuracy of plasma miR-320c for OA. Furthermore, the luciferase reporter assay results showed that miR-320c regulates CREB5 expression by binding to the CREB5 3'-untranslated region. Moreover, suppression of CREB5 significantly reduced the expression levels of c-fos and c-jun. Our results indicate that plasma miR-320c may serve as a potential novel predictor of the severity of knee OA and that miR-320c may play an important role in the pathogenesis of OA through inhibiting the cAMP pathway by targeting CREB5.

Subchondral bone expansion in advanced knee osteoarthritis: Relation with radiographic severity and role in surgical decision-making

BackgroundJoint space width (JSW) is a traditional imaging marker for knee osteoarthritis (OA) severity, but it lacks sensitivity in advanced cases. We propose tibial subchondral bone area (TSBA), a new CT imaging marker to explore its relationship with OA radiographic severity, and to test its performance for classifying surgical decisions between unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) compared to JSW. MethodsWe collected clinical, radiograph, and CT data from 182 patients who underwent primary knee arthroplasty (73 UKA, 109 TKA). The radiographic severity was scored using Kellgren-Lawrence (KL) grading system. TSBA and JSW were extracted from 3D CT-reconstruction model. We used independent t-test to investigate the relationship between TSBA and KL grade, and binary logistic regression to identify factors associated with TKA risk. The accuracy of TSBA, JSW and established classification model in differentiating between UKA and TKA was assessed using AUC. ResultsAll parameters exhibited inter- and intra-class coefficients greater than 0.966. Patients with KL grade 4 had significantly larger TSBA than those with KL grade 3. TSBA (0.708 of AUC) was superior to minimal/average JSW (0.547/0.554 of AUC) associated with the risk of receiving TKA. Medial TSBA, together with gender and Knee Society Knee Score, emerged as independent classification factors in multivariate analysis. The overall AUC of composite model for surgical decision-making was 0.822. ConclusionTibial subchondral bone area is an independent imaging marker for radiographic severity, and is superior to JSW for surgical decision-making between UKA and TKA in advanced OA patients.

Analysis of human ABO Blood Group as a risk factor with knee osteoarthritis at tertiary care hospital in Pakistan

Objective: To investigate the association and risk estimation of ABO blood group distribution and clinical attributes in patients with Knee Osteoarthritis.&#x0D; Method: This was a hospital-based study conducted at, Liaquat University Hospital Hyderabad from December, 2019 to December, 2022 to investigate this least researched area of highly prevalent musculoskeletal disease in Pakistan. Non-Probability Convenience Sampling was used for selecting 190 cases of confirm Knee Osteoarthritis patients diagnosed by Orthopedic surgeon based on standard clinical and radiographic criteria. Data were analyzed using IBM-SPSS version 23.0. Percentages and frequencies were counted for categorical data. Pearson Chi Square test and fisher’s exact test were used to check the association and Multinomial Logistic Regression was used to estimate the risk for moderate and severe kellgren grading Knee Osteoarthritis (KOA) cases with ABO blood grouping in comparison of mild Kellgren grading.&#x0D; Results: A total of 190 cases of Knee Osteoarthritis (KOA) were included in the study. Females (61.6%) and patients with age 50 and above were 40.5 % were found in greater proportion. Majority (41.6%) were classified radiologically as mild cases with O group (39.5%) and positive Rh antigen (95.8%). Strong association (p = &lt;0.01) was found between gender, age group and ABO blood group with KOA radiological Kellgren and Lawrence score.&#x0D; Conclusion: There is strong relation in between radiological grading of knee osteoarthritis severity and A blood group, gender and age.&#x0D; doi: https://doi.org/10.12669/pjms.40.5.8865&#x0D; How to cite this: Shaikh SR, Atta Ur Rahman A, Makhdoom A. Analysis of human ABO Blood Group as a risk factor with knee osteoarthritis at tertiary care hospital in Pakistan. Pak J Med Sci. 2024;40(5):---------. doi: https://doi.org/10.12669/pjms.40.5.8865&#x0D; This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Impact of Hip and Knee Osteoarthritis on Full Body Sagittal Alignment and Compensation for Sagittal Spinal Deformity.

Retrospective review of prospectively collected data. To investigate the effect of lower extremity osteoarthritis on sagittal alignment and compensatory mechanisms in adult spinal deformity (ASD). Spine, hip, and knee pathologies often overlap in ASD patients. Limited data exists on how lower extremity osteoarthritis impacts sagittal alignment and compensatory mechanisms in ASD. In total, 527 preoperative ASD patients with full body radiographs were included. Patients were grouped by Kellgren-Lawrence grade of bilateral hips and knees and stratified by quartile of T1-Pelvic Angle (T1PA) severity into low-, mid-, high-, and severe-T1PA. Full-body alignment and compensation were compared across quartiles. Regression analysis examined the incremental impact of hip and knee osteoarthritis severity on compensation. The mean T1PA for low-, mid-, high-, and severe-T1PA groups was 7.3°, 19.5°, 27.8°, and 41.6°, respectively. Mid-T1PA patients with severe hip osteoarthritis had an increased sagittal vertical axis and global sagittal alignment ( P <0.001). Increasing hip osteoarthritis severity resulted in decreased pelvic tilt ( P =0.001) and sacrofemoral angle ( P <0.001), but increased knee flexion ( P =0.012). Regression analysis revealed that with increasing T1PA, pelvic tilt correlated inversely with hip osteoarthritis and positively with knee osteoarthritis ( r2 =0.812). Hip osteoarthritis decreased compensation through sacrofemoral angle (β-coefficient=-0.206). Knee and hip osteoarthritis contributed to greater knee flexion (β-coefficients=0.215, 0.101; respectively). For pelvic shift, only hip osteoarthritis significantly contributed to the model (β-coefficient=0.100). For the same magnitude of spinal deformity, increased hip osteoarthritis severity was associated with worse truncal and full body alignment with posterior translation of the pelvis. Patients with severe hip and knee osteoarthritis exhibited decreased hip extension and pelvic tilt but increased knee flexion. This examines sagittal alignment and compensation in ASD patients with hip and knee arthritis and may help delineate whether hip and knee flexion is due to spinal deformity compensation or lower extremity osteoarthritis.

Association Between Occurrence of Knee Osteoarthritis and Physical Activity in Older Adults

Background: Knee osteoarthritis (OA) is a leading cause of disability among older adults, significantly affecting their quality of life and mobility. The relationship between physical activity and the severity of knee OA symptoms has been a subject of extensive research, with mixed results on whether physical activity exacerbates or alleviates OA symptoms. Objective: This study aimed to investigate the association between physical activity levels and the severity of knee osteoarthritis, as well as to assess the impact of physical activity on the health-related quality of life among individuals with knee OA. Methods: A cross-sectional study was conducted among 171 patients diagnosed with knee osteoarthritis at four medical institutions. Data on demographics, physical activity levels, and OA severity were collected through standardized questionnaires, including the SF-36 Health Survey and the Knee injury and Osteoarthritis Outcome Score (KOOS). Physical activity levels were categorized as poor, moderate, and good. The severity of knee OA was classified as no OA, moderate OA, and extreme OA. Statistical analysis was performed using SPSS version 25, employing descriptive statistics, chi-square tests for categorical variables, and Pearson's correlation to assess the association between physical activity levels and OA severity. Results: The study population comprised 35.1% males and 64.9% females, with a mean age of 71.1±3.9 years. Regarding physical activity, 30.4% engaged in poor, 46.8% in moderate, and 22.8% in good physical activity. The severity of knee OA was reported as extreme in 25.1% of patients, moderate in 49.1%, and absent in 25.7%. Statistical analysis revealed a significant association between physical activity levels and knee OA severity (Pearson Chi-Square = .000), indicating that higher levels of physical activity were associated with lower severity of OA symptoms. Conclusion: This study supports the notion that engaging in physical activity is associated with a reduced severity of knee osteoarthritis symptoms and suggests that physical activity could be beneficial for managing OA symptoms and improving the quality of life among individuals with knee OA. These findings highlight the importance of promoting physical activity as a key component of knee OA management strategies.

Association Between Pain and Radiological Changes in Patients with Knee Osteoarthritis

Background: Knee osteoarthritis (OA) is a leading cause of disability worldwide, characterized by joint degeneration, pain, and functional limitations. Despite the prevalence of knee OA, the relationship between radiographic changes and the severity of pain remains complex. Previous studies have offered conflicting views on the association between structural joint alterations and clinical symptoms. Objective: The aim of this study was to investigate the association between radiographic degenerative changes in the knee, as classified by the Kellgren and Lawrence grading system, and the severity of resting pain measured using the Numeric Pain Rating Scale (NPRS). Methods: This cross-sectional study was conducted on 70 patients diagnosed with knee OA at multiple healthcare facilities in Lahore, Pakistan, from July 2022 to January 2023. Participants aged between 40 and 80 years, both males and females, were included. The severity of knee OA was determined using the Kellgren-Lawrence grading system through X-ray evaluations. Pain severity was assessed using the NPRS. Data were analyzed using SPSS version 25.0, with chi-square tests applied to explore the association between radiographic grades of knee OA and pain severity. Results: The distribution of knee OA severity among participants was as follows: Grade I (22.9%), Grade II (25.7%), Grade III (32.9%), and Grade IV (18.6%). Pain severity reported by participants was predominantly mild (55.7%), followed by moderate (37.1%) and severe (7.1%). Statistical analysis revealed a significant association between the grade of knee OA and the severity of resting pain (Chi-square = 30.06, p &lt; 0.0001), indicating that higher grades of knee OA were correlated with increased pain severity. Conclusion: The study confirmed a significant association between radiographic degenerative changes in knee OA and the severity of resting pain. These findings suggest the need for comprehensive clinical assessments in patients with knee OA, incorporating both radiographic evaluations and pain severity measures to guide management and treatment strategies.

The association of folate deficiency with clinical and radiological severity of knee osteoarthritis.

Folate deficiency is often observed in patients with inflammatory diseases, raising questions about its role in knee osteoarthritis (OA) progression. This study aimed to assess the association of folate deficiency with the clinical and radiological severity of knee OA. A prospective cross-sectional study was conducted from January 1, 2019 to January 1, 2020. Primary knee OA patients referred to orthopedic clinics in Zabol, Iran were included. Radiographic severity was gauged utilizing the Kellgren-Lawrence (KL) classification. For clinical severity, patients completed the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire. IBM SPSS v.27 facilitated the statistical analysis. Forty-nine knee OA patients, averaging 67.45±13.44 years in age, were analyzed. Spearman correlation analysis revealed a negative correlation between folate levels and both WOMAC and KL scores. The correlation was stronger between folate and KL score (Spearman correlation coefficient:-0.75) than between folate and WOMAC total score (Spearman correlation coefficient:-0.46). Additionally, a significantly higher KL score was observed in patients with folate deficiency (p=0.004). Our study highlights a significant correlation between folate deficiency and increased severity of OA, which is evident in radiological and clinical assessments. These findings suggest that folate plays a key role in OA pathogenesis and could be a modifiable factor in its management.

Comparison of short-term clinical outcomes between open-wedge high tibial osteotomy and tibial condylar valgus osteotomy

BackgroundThis study aimed to compare radiological features and short-term clinical outcomes between open-wedge high tibial osteotomy (OWHTO) and tibial condylar valgus osteotomy (TCVO), to provide information facilitating decision-making regarding those two procedures.MethodsTwenty-seven cases involving 30 knees that had undergone OWHTO (HTO group) and eighteen cases involving 19 knees that had undergone TCVO (TCVO group) for medial compartment knee osteoarthritis (OA) were retrospectively evaluated. Patient characteristics, severity of knee OA, lower limb alignment, joint congruity and instability were measured from standing full-length leg and knee radiographs obtained before and 1 year after surgery. Range of motion in the knee joint was measured and Knee Injury and Osteoarthritis Outcome Score (KOOS) was obtained to evaluate clinical results preoperatively and 1 year postoperatively.ResultsMean age was significantly higher in the TCVO group than in the HTO group. Radiological features in the TCVO group included greater frequencies of advanced knee OA, varus lower limb malalignment, higher joint line convergence angle, and varus-valgus joint instability compared to the HTO group before surgery. However, alignment of the lower limb and joint instability improved to comparable levels after surgery in both groups. Maximum flexion angles were significantly lower in the TCVO group than in the HTO group both pre- and postoperatively. Mean values in all KOOS subscales recovered similarly after surgery in both groups, although postoperative scores on three subscales (Symptom, Pain, and ADL) were lower in the TCVO group (Symptom: HTO, 79.0; TCVO, 67.5; Pain: HTO, 80.5; TCVO, 71.1; ADL: HTO, 86.9; TCVO, 78.0).ConclusionsBoth osteotomy procedures improved short-term clinical outcomes postoperatively. TCVO appears preferable in cases of advanced knee OA with incongruity and high varus-valgus joint instability. An appropriate choice of osteotomy procedure is important to obtain favorable clinical outcomes.

Efficacy, safety and prospects of using a combination of native type II collagen, methylsulfonylmethane, boswellic acids, vitamin C and vitamin D&lt;sub&gt;3&lt;/sub&gt; in knee osteoarthritis: a resolution of the Expert panel

A meeting of the Expert Council on September 9, 2023 considered the last challenges in the treatment of osteoarthritis (OA) including OA in comorbid patients. Leading experts in rheumatology, traumatology and other relevant disciplines participated in the meeting. The key goal of Expert Council was the discussion of potential application of a combination of undenatured (native) type II collagen, methylsulfonylmethane, boswellic acids, vitamins C and D (Artneo complex) as a part of complex OA therapy. The experts concluded that Artneo for stage I–III knee OA patients is not just non-inferior in comparison with a combination of chondroitin sulfate and glucosamine hydrochloride but excels it in the decrease of magnetic resonance imaging synovitis markers and dynamics of Lequesne index for knee osteoarthritis severity. The proven efficacy and the favorable safety profile of 6-months Artneo course deserve the attention of medical community and the active implementation of Artneo complex into ambulatory practice, first of all, for the treatment of patients with mild or moderate synovitis and/or burdened with comorbidities.

Are patients with knee osteoarthritis aware that platelet-rich plasma is a treatment option?

Osteoarthritis (OA) is a prevalent joint disease, particularly affecting the knees. This condition is often managed through various treatments, including intra-articular injections such as corticosteroids (CS), hyaluronic acid (HA), and platelet-rich plasma (PRP). PRP has shown promising outcomes in recent studies although it does lack strong endorsement in some clinical guidelines due to inconsistent results and lack of standardized results. This study was conducted to assess patient awareness and the frequency of PRP offered for the treatment of knee OA, compared to CS and HA. In a cross-sectional study, 46 knee OA patients were surveyed regarding their knowledge and experiences of CS, HA, and PRP injections. The questionnaires were administered between September 2022 and February 2023. Additionally, the study evaluated the severity of patients knee OA, using the Western Ontario and McMaster Universities Arthritis Index, and gathered demographic information from the participants. CS injections were offered to 93.5%, and 100% of participants had previously heard of this type of injection. HA injections were offered to 37%, and 65.9% of participants had heard of them. PRP was offered to 2%, and 6.5% had ever heard of it. This study underscores the limited awareness and utilization of PRP among knee OA patients. Patients and physicians need to be more informed of all of the treatment options available for knee OA, especially orthobiologics such as PRP. Future research in larger, diverse populations is needed.

Endoplasmic reticulum stress-related protein GRP78 and CHOP levels in synovial fluid correlate with disease progression of primary knee osteoarthritis: A cross-sectional study.

Endoplasmic reticulum (ER) stress has been shown to play an important role in osteoarthritis (OA). This study was aimed at assessing the relationship of endoplasmic reticulum (ER) stress-related glucose-regulated protein 78 (GRP78) and CCAAT/enhancer-binding protein homologous protein (CHOP) concentrations in the serum/synovial fluid (SF) with disease severity of primary knee osteoarthritis (pkOA). Patients with pkOA together with healthy individuals were consecutively recruited from our hospital. The levels of GRP78 and CHOP in serum / SF were detected using enzyme-linked immunosorbent assay. The levels of IL-6 and MMP-3 were also examined. Radiographic progression of pkOA was evaluated based on Kellgren-Lawrence (K-L) grades. Receiver Operating Characteristic (ROC) curves were used to assess the diagnostic value of GRP78/CHOP levels with regard to K-L grades. The assessment of clinical severity was conducted using the visual analogue scale (VAS), Oxford knee score (OKS), and Lequesne algofunctional index (LAI). A total of 140 pkOA patients and 140 healthy individuals were included. Serum GRP78 and CHOP levels in pkOA patients were not significantly different from those in healthy individuals. The SF GRP78 and CHOP levels in healthy controls were not detected due to ethical reasons. Compared to those with K-L grade 2 and 3, the pkOA patients with K-L grade 4 had higher GRP78 and CHOP levels in the SF with statistical significance. In addition, the pkOA patients with K-L grade 3 exhibited drastically upregulated GRP78 and CHOP concentrations in the SF compared to those with K-L grade 2. Positive correlations of GRP78 and CHOP levels with K-L grades, IL-6, and MMP-3 levels in the SF were observed. ROC curve analysis indicated that both GRP78 and CHOP levels may act as decent indicators with regard to OA. GRP78 and CHOP concentrations in the SF were positively correlated with VAS/LAI score and negatively associated with OKS score. The study indicated that GRP78 and CHOP levels in the SF but not the serum were positively correlated with disease severity of pkOA.