Symptomatic Knee Osteoarthritis Research Articles

Poster 290: Effect of Platelet-rich Plasma Injections on Cartilage T1rho in Knee Osteoarthritis

Poster 290: Effect of Platelet-rich Plasma Injections on Cartilage T1rho in Knee Osteoarthritis

The effect of a barley-based food product in alleviating knee osteoarthritis discomfort symptoms in Egyptian female patients

Background/aim Osteoarthritis is a common joint condition that causes cartilage to erode. There are numerous conventional treatments available, including nonsteroidal anti-inflammatory medicines and pharmaceuticals containing glucosamine; however, taking them can result in serious side effects. The aim of this study was to prepare barley-based food product enriched with ginger, curcumin, garlic powder, and onion powder and to evaluate the effect of consumption of the prepared macaroni for 2 months, in alleviating knee osteoarthritis discomfort symptoms in female patients complaining of grade 2–3 knee osteoarthritis. Patients and methods The present study enrolled 51 Egyptian middle age females patients with a mean age of 51±8.37 years, diagnosed with bilateral grade two to three knee osteoarthritis were recruited from the National Research Centre rheumatology and rehabilitation clinic. Anthropometric measurements and blood samples were collected after 8 weeks of daily barley based macaroni supplementation (75 grams raw). Serum levels of IL1β, IL4 and IL6 were measured using Elisa techniques, while Total Antioxidant Capacity, Malondialdehyde, and Glutathione S-transferase were measured by the colorimetric methods. Results Chemical composition analysis of the prepared barley-based macaroni demonstrated a decrease in total carbohydrate content and an increase in crude fiber, protein, and fat content compared with the control (semolina wheat-based macaroni); 100 grams of the prepared uncooked barley macaroni provided 342.46 Kcal. The reevaluation of the anthropometric parameters after 8 weeks of daily macaroni supplementation denoting improvement without statistical significance (P>0.05), and the clinical characteristics of knee joint osteoarthritis (Lequesne Index, WOMAC score, and Timed Up and Go test) significantly improved which meant less pain and stiffness. The serum pro-inflammatory cytokines IL1β and IL6 declined significantly and the serum anti-inflammatory cytokine IL4 raised significantly (P≤0.05), besides, barley based macaroni supplementation significantly improved the antioxidant status, which was achieved through the rise of serum Total Antioxidant Capacity and the decline of Malondialdehyde and Glutathione S-transferase activity (P≤0.05). Conclusion Barley-based prepared macaroni enriched with curcumin and ginger must be considered in alleviating the severity of knee OA symptoms to aid patients in getting their life back to near normal.

Randomized, double-blind, placebo-controlled study to evaluate the effect of treatment with an SPMs-enriched oil on chronic pain and inflammation, functionality, and quality of life in patients with symptomatic knee osteoarthritis: GAUDI study

BackgroundSpecialized pro-resolving mediators (SPMs), including 18-HEPE, 17-HDHA, and 14-HDHA are recognized as potentially therapeutic in inflammatory diseases because SPMs regulate the inflammation process, which leads to, for example; swelling and the sensation of pain. In osteoarthritis (OA), chronic pain is described as the symptom that reduces patients´ quality of life (QoL). The GAUDI study evaluated the efficacy of SPMs supplementation in reducing pain in the symptomatic knee of OA patients.MethodsThis randomized, multicenter, double-blind, and placebo-controlled parallel-group pilot study was performed in Spain and conducted on adults 18–68 years old diagnosed with symptomatic knee OA. Patients were enrolled in the study for up to 24 weeks, which included a 12-week intervention period and a follow-up visit on week 24. The primary endpoint was pain change measured through a Visual Analog Scale (VAS). Secondary endpoints included: Pain change evaluation, stiffness, and function according to the WOMAC index; assessment of constant, intermittent, and total pain according to the OMERACT-OARSI score; evaluation of changes in health-related QoL parameters; the use or not of concomitant, rescue, and anti-inflammatory medication; and safety and tolerability assessments.ResultsPatients were enrolled in the study from May 2018 to September 2021. VAS pain score was evaluated in the per protocol population (n = 51 patients), in which we observed a statistically significant reduction after 8 weeks (p = 0.039) and 12 weeks (p = 0.031) of treatment in patients consuming SPMs (n = 23 subjects) vs. placebo (n = 28 subjects). In line with the OMERACT-OARSI score, intermittent pain was reduced after 12 weeks with statistical significance (p = 0.019) in patients treated with SPMs (n = 23 subjects) vs. placebo (n = 28 subjects). Functional status as WOMAC score did not significantly change after SPMs or placebo consumption. Notably, patients consuming SPMs showed improvements in all five aspects of the EUROQoL-5, including a significant improvement in the usual-activities dimension. None of the patients required rescue medication, nor were any adverse events reported.ConclusionsThese findings suggest that sustained SPMs consumption reduces pain in OA patients while also improving their Quality of Life. These results also support the safety profile of SPMs supplementation.Trial registration NCT05633849. Registered 1 December 1 2022. Retrospectively registered, https://clinicaltrials.gov/ct2/show/study/NCT05633849

An Indonesian Version of Validity and Reliability Test of Knee Outcome Survey - Activities of Daily Living Scale in Knee Osteoarthritis ABSTRACT Introduction: Knee osteoarthritis (OA) symptoms greatly limit daily activities and cause functional disability


 
 
 
 
 
 
 
 
 
 Introduction. Knee osteoarthritis (OA) symptoms greatly limit daily activities and cause functional disability, limiting participation and reducing quality of life. It is necessary to evaluate patients’ perspectives to clinical outcomes regarding the quality and success of knee OA management. The Knee Outcome Survey Activity Daily Living Scale (KOS-ADLS) is an instrument to assess these perspectives. This study tests the validity and reliability of a translation of KOS-ADLS.
 Methods. This study is a cross-sectional study involving 65 subjects and was conducted in the Medical Rehabilitation Department, Musculoskeletal division of Cipto Mangunkusumo Hospital from 01/10/2020 to 31/08/2021. Results from the Indonesia translation of KOS-ADLS (KOS-
 
 
 
 
 
 
 
 
 ADLS-Ina) were tested for validity with Pearson correlation with p<0.05 and r>0.3 and reliability was tested with internal consistency of α-cronbach and Intraclass Correlation Coefficient ≥ 0.7.Results. The correlation value for total items was 0.461–0.792. As for the internal consistency the α-cronbach set at 0.911 and ICC was 0.969 (0.950–0.981). KOS-ADLS-Ina is proved that both Pearson’s correlation and internal consistency values have value above the minimal intended value with significancy p<0.05.
 Conclusions. KOS-ADLS-Ina is demonstrated to be a valid and reliable functional capacity instrument to be used in the Indonesian population.
 
 
 
 
 
 

Clinical Efficacy and Safety of the Intra-articular Injection of Autologous Adipose-Derived Mesenchymal Stem Cells for Knee Osteoarthritis: A Phase III, Randomized, Double-Blind, Placebo-Controlled Trial

Background: Intra-articular injection of autologous culture-expanded adipose-derived mesenchymal stem cells (ADMSCs) has introduced a promising treatment option for knee osteoarthritis. Although the clinical efficacy and safety of ADMSCs have been reported, the treatment remains controversial owing to the small sample sizes and heterogeneous osteoarthritis grades in previous studies. Purpose: To assess the efficacy and safety of intra-articular injection of ADMSCs as compared with placebo in alleviating pain and improving functional capacity in a large sample of patients with knee osteoarthritis of Kellgren-Lawrence (K-L) grade 3. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: This phase III multicenter clinical trial was a double-blind randomized controlled study that included 261 patients with K-L grade 3 symptomatic knee osteoarthritis who were administered a single injection of autologous culture-expanded ADMSCs or placebo. Clinical data were assessed at baseline and at 3 and 6 months after the injection. The primary endpoints were improvements in 100-mm visual analog scale (VAS) for pain and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for function at 6 months after the injection. The secondary endpoints included clinical and radiologic examinations and safety after injection. The changes in cartilage defects after injection were assessed by magnetic resonance imaging at 6 months. Results: The ADMSC and control groups included 125 and 127 patients available for follow-up, respectively. At 6 months, the ADMSC group showed significantly better improvements in 100-mm VAS (ADMSC vs control, 25.2 vs 15.5; P = .004) and total WOMAC score (21.7 vs 14.3; P = .002) as compared with the control group. The linear mixed model analysis indicated significantly better improvements in all clinical outcomes in the ADMSC group after 6 months. At 6 months, the ADMSC group achieved significantly higher proportions of patients above the minimal clinically important difference in 100-mm VAS and WOMAC score. Radiologic outcomes and adverse events did not demonstrate significant differences between the groups. No serious treatment-related adverse events were observed. Magnetic resonance imaging revealed no significant difference in change of cartilage defects between the groups at 6 months. Conclusion: Intra-articular injection of autologous culture-expanded ADMSCs provided significant pain relief and functional improvements in patients with K-L grade 3 osteoarthritis. Long-term results are needed to determine the disease-modifying effects of ADMSCs, such as structural changes, and the duration of effect of intra-articular injection of ADMSCs in knee osteoarthritis. Registration: NCT03990805 (ClinicalTrials.gov identifier).

The clinical profile of individuals with symptoms of knee osteoarthritis referred to secondary care in Denmark: Across-sectional study of 282 people.

The clinical profile of individuals with symptoms of knee osteoarthritis referred to secondary care in Denmark: Across-sectional study of 282 people.

Assessment of return to sport and functional outcomes following distal femoral, double level and high tibial osteotomies for active patients with symptomatic varus malalignment.

This study indicated the outcomes of three surgical techniques for the treatment of symptomatic unicompartmental knee osteoarthritis (UKOA) with varus malalignment in younger, active patients: distal femoral osteotomy (DFO), double-level osteotomy (DLO) and high tibial osteotomy (HTO). The outcomes measured included the return to sport, sport activity and functional scores. A total of 103 patients (19 DFO, 43 DLO, 41 HTO) were enrolled in the study and were divided into three groups based on their oriented deformity, each undergoing one of the three surgical techniques. All patients underwent pre- and post-operative evaluations including X-rays, physical exams and functional assessments. All three surgical techniques were effective in treating UKOA with constitutional malalignment. The average time to return to sport was similar among the three groups (DFO: 6.4 ± 0.3 [5.8-7] months, DLO: 4.9 ± 0.2 [4.5-5.3] months, HTO: 5.6 ± 0.2 [5.2-6] months). The sport activity and functional scores improved significantly for all three groups, with no significant differences observed among the groups. Various knee osteotomy procedures, DFO, DLO, and HTO, result in high RTS rates and quick RTS times with satisfactory functional scores. Despite pre- to post-operative improvements in sport activities following DFO and DLO, pre-symptom levels were not reached following all evaluated procedures. Retrospective case-control study, Level III.

Doing our bit to save the planet: Identifying and abandoning low value surgery.

Doing our bit to save the planet: Identifying and abandoning low value surgery.

Arabic version of the intermittent and constant osteoarthritis pain questionnaire (ICOAP-Ar): translation, cross-cultural adaptation, and measurement properties

BackgroundPain is the most incapacitating symptom of knee osteoarthritis (OA), with intermittent and/or continuous nature as described by the patients. Accuracy of pain assessment tools across different cultures is important. This study aimed to translate and culturally adapt the Intermittent and Constant OsteoArthritis Pain (ICOAP) measure into Arabic (ICOAP-Ar) and evaluate its psychometric properties in patients with knee OA.MethodsThe ICOAP was cross-culturally adapted following the recommended guidelines from English. Knee OA patients from outpatient clinics were recruited to assess the structural (confirmatory factor analysis) and construct validity (Spearman’s correlation coefficient - rho) to assess the relationship between the ICOAP-Ar and the pain and symptoms subscales of the Knee Injury and Osteoarthritis Outcome Score (KOOS), in addition to internal consistency (Cronbach’s alpha and the corrected item-total correlation). A week later, test-retest reliability (intraclass correlation coefficient (ICC)) was evaluated. Following four weeks of physical therapy treatment, the ICOAP-Ar responsiveness was evaluated using the receiver operating characteristic curve.ResultsNinety-seven participants were recruited (age = 52.97 ± 9.9). A model with single pain construct showed acceptable fit (Comparative fit index = 0.92). The ICOAP-Ar total and subscales had a strong to moderate negative correlation with the KOOS pain and symptoms domains, respectively. The ICOAP-Ar total and subscales demonstrated satisfactory internal consistency (α = 0.86–0.93). The ICCs were excellent (ICCs = 0.89–0.92) with acceptable corrected item total correlations (rho = 0.53–0.87) for the ICOAP-Ar items. The ICOAP-Ar responsiveness was good with moderate effect size (ES = 0.51–0.65) and large standardized response mean (SRM = 0.86–0.99). A cut-off point of 51.1/100 was determined with moderate accuracy (Area under the curve = 0.81, sensitivity = 85%, specificity = 71%). No floor or ceiling effects were found.ConclusionsThe ICOAP-Ar exhibited good validity, reliability, and responsiveness after physical therapy treatment for knee OA, which renders it reliable for evaluating knee OA pain in clinical and research settings.

Meloxicam emulgel potently suppressed cartilage degradation in knee osteoarthritis: Optimization, formulation, industrial scalability and pharmacodynamic analysis

Background and objectiveMeloxicam (MLX) is prescribed for the management of pain and inflammation allied with osteoarthritis (OA). However, MLX causes intestinal damage in long term administration. Hence, meloxicam loaded emulgel (MLX-emulgel) was optimized, formulated and examined under stringent parameters in monosodium-iodoacetate (MIA) induced knee OA in Wistar rats. Methods and resultsNanoemulsion of MLX was fabricated by ultrasonication and microfluidization method with a droplet size of 66.81 ± 5.31-nm and zeta potential of −24.6 ± 0.72-mV. Further, MLX nanoemulsion was optimized with centrifugation, heating-cooling cycles and transmittance parameters in addition to scale-up feasibility with microfluidizer. Post optimization, MLX-nanoemulsion was tailored as emulgel with Carbopol Ultrez 10 NF and assessed for pH, rheology, textural properties, assay and stability features. The in-vitro release study revealed the Korsmeyer-Peppas release kinetics and ex-vivo skin permeation was improved by 6.71-folds. The skin distribution of MLX-emulgel evinced the transfollicular mode of permeation. In-vivo study indicated the protective action of MLX-emulegl expressed in terms of inflammatory cyctokines level, X-ray analysis of knee joints of rats, histopathology and OARSI (Osteoarthritis Research Society International) scoring. MLX-emulgel treated group displayed lower (P < 0.001) level of COX-2 intensity as compared to positive control group. However, it was comparable (P > 0.05) to the normal control group, MLX oral dispersion, i.v. solution and etoricoxib gel groups. MLX-emulgel showcased an alternative to the long term usage of analgesics for relieving the symptoms of knee OA. ConclusionMLX-emulgel may be a potential candidate for translating in to a clinically viable dosage form in the management of knee OA.

The Association between Oxytocin and Lower Limb Osteoarthritis: A Prospective Cohort Study

Oxytocin (OT), a neuropeptide best known for its role in emotional and social behaviors, has been linked to osteoarthritis (OA). This study aimed to investigate the serum OT level in hip and/or knee OA patients and to study its association with disease progression. Patients from the KHOALA cohort with symptomatic hip and/or knee OA (Kellgren and Lawrence (KL) scores of 2 and 3) and follow-up at 5 years were included in this analysis. The primary endpoint was structural radiological progression, which was defined as an increase of at least one KL point at 5 years. Logistic regression models were used to estimate the associations between OT levels and KL progression while controlling for gender, age, BMI, diabetes and leptin levels. Data from 174 hip OA patients and 332 knee OA patients were analyzed independently. No differences in OT levels were found between the ‘progressors’ and ‘non-progressors’ groups among the hip OA patients and knee OA patients, respectively. No statistically significant associations were found between the OT levels at baseline and KL progression at 5 years, the KL score at baseline or the clinical outcomes. Higher structural damage at baseline and severe structural progression of hip and knee osteoarthritis did not appear to be associated with a low serum OT level at baseline.

A Robust Framework for Severity Detection of Knee Osteoarthritis Using an Efficient Deep Learning Model

With the changing lifestyle, a large population suffers from a bone disease known as an osteoarthritis affecting the knee, spine, and hip. Therefore, timely detection and classification of the disease are necessary to minimize the loss, however, it is a time-consuming task and requires various tests and physicians’ in-depth analysis. Thus, an accurate automated technique, timely detection and classification are needed to cope with the aforementioned challenges. This study proposes a technique based on an efficient DenseNet that uses the knee image’ features to identify the Knee Osteoarthritis (KOA) and determine its severity level according to the KL grading system such as Grade-I, Grade-II, Grade-III, and Grade-IV. We introduced the reweighted cross-entropy loss function which makes our proposed algorithm more robust as the training data is imbalanced. The dense connections of efficient DenseNet with regularization power help to reduce the overfitting during the training of small knee sample training sets. The proposed algorithm is an efficient approach that can identify the early symptoms of KOA and classify the severity level of the disease for better decision making by orthopedics. The algorithm is a pre-trained network that does not require a huge training set, therefore, the existing dataset i.e. Mendeley VI has been utilized for the training and testing. Additionally, cross-validation has been employed using the OAI dataset to assess the performance of the proposed model. The algorithm achieved 98.22% accuracy over the testing set and 98.08% accuracy over cross-validation. Various experiments have been performed to confirm that our proposed algorithm is more consistent and capable of detecting and classifying the KOA disease than existing state of the art.

Integrated Care for Comprehensive Management of Patients with Osteoarthritis: Program Development and Implementation.

Treatment of symptomatic osteoarthritis (OA) is often complicated by comorbidities, which put patients at potentially higher risks following operative interventions. Management of these comorbidities is usually separate from orthopaedic care, with patients invited to return to their orthopaedic surgeon once surgical risk factors are better controlled. However, this practice can lead to disjointed care, resulting in uncertainty, mistrust, unmanaged pain, and dissatisfaction for patients. Integrated care teams provide an effective option for coordinated comprehensive nonoperative and preoperative management of patients with knee OA and medical comorbidities. The objective of this article is to summarize the process for implementation of an integrated program to manage patients with symptomatic knee OA and the initial outcomes at our institution as an example of the effects of integrated patient management in orthopaedics. At the author's institution, an integrated program was implemented, successfully addressing the unmet need for coordinated care for patients with bone and joint health problems and medical comorbidities. Patients who completed the full program experienced significant improvements in both pain and function. Potential applications for knee surgeons considering implementing integrated care models could include pre- and postoperative management programs, nonoperative management program, and programs seeking to meet key metrics such as improved readmission rates, patient satisfaction, or value-based care. For effective program implementation, careful planning with convenient referral mechanisms, leadership buy-in, and patient-centered communication protocols are required.

SP26. Efficacy of Microfragmented Adipose Tissue for Treatment of Symptomatic Knee Osteoarthritis: A Randomized, Placebo-controlled Study

SP26. Efficacy of Microfragmented Adipose Tissue for Treatment of Symptomatic Knee Osteoarthritis: A Randomized, Placebo-controlled Study

Asymmetric Flexion Contracture is Associated With Leg Length Inequality in Patients With Knee Osteoarthritis: Data From the Osteoarthritis Initiative

ObjectiveTo evaluate whether knee flexion contracture (FC) was associated with leg length inequality (LLI) and/or morbidity in knee osteoarthritis (OA). DesignWe accessed 2 databases: (1) the Osteoarthritis Initiative (OAI) cohort, including participants with, or at-risk of OA, and (2) the Ottawa Knee Osteoarthritis cross-sectional database (OKOA), including participants with primary advanced knee OA. Both included demographics, radiographic data, knee range of motion, leg length, pain, and function scales. SettingTertiary care academic rheumatology and orthopedic clinics. ParticipantsPatients with or at-risk of primary OA. We included 881 OAI and 72 OKOA participants (N=953). InterventionNot applicable. Main Outcome MeasuresThe primary outcome tested the association between the difference in knee extensions of the OA and contralateral knees (the knee extension difference, or KExD) and LLI. This was evaluated using bivariate regression, followed by a multivariable linear regression model. ResultsOAI participants had less severe knee OA [Kellgren and Lawrence (KL) score 1.9±1.3] vs OKOA (KL score 3.4±0.6). The KExD correlated with LLI for both databases (OAI: R=0.167; P≤.001; OKOA: R=0.339; P=.004). Multivariable regression showed an effect of KExD on LLI in both databases (OAI: β=0.37[0.18,0.57]; P<.001, OKOA: β=0.73[0.20,1.26]; P=.007). When broken down by subgroup, the OAI moderate-severe OA group showed a significant effect of KExD on LLI (β=0.60 [0.34,0.85]; P<.001). ConclusionsOA-related loss of knee extension was associated with LLI for those with moderate-severe OA. Because LLI correlates with worse knee OA symptoms, discovering an FC should cue clinicians to evaluate for LLI, an easily-treatable finding that may help reduce OA-associated morbidity for those approaching the need for arthroplasty.

Leukocyte-Rich Platelet-Rich Plasma Is Predominantly Anti-inflammatory Compared With Leukocyte-Poor Platelet-Rich Plasma in Patients With Mild-Moderate Knee Osteoarthritis: A Prospective, Descriptive Laboratory Study

Background: Platelet-rich plasma (PRP) has been used extensively in clinical practice to treat patients with symptomatic knee osteoarthritis (OA). Leukocyte-poor PRP (LP-PRP) has been clinically preferred over leukocyte-rich PRP (LR-PRP); however, it is unclear which cytokine mediators of pain and inflammation are present in LR-PRP and LP-PRP from patients with mild to moderate knee OA in order to rationalize a specific formulation. Hypothesis: LP-PRP would be predominantly anti-inflammatory and have reduced nociceptive pain mediators compared with LR-PRP from the same individual with mild to moderate knee OA. Study Design: Controlled laboratory study. Methods: A total of 24 unique samples of PRP were prepared in order to assess 48 samples of LR-PRP and LP-PRP taken from 12 patients (6 male and 6 female) with symptomatic knee OA of Kellgren-Lawrence grade 2 to 3. Patients underwent blood collection for LR-PRP and LP-PRP preparation through a double-spin protocol to obtain baseline whole blood, platelet concentration, and white blood cell subtypes. LR-PRP and LP-PRP from the same patient were produced at the same time and underwent a comprehensive panel through Luminex (multicytokine profiling) to assess key mediators of inflammation: interleukin 1 receptor antagonist (IL-1Ra), interleukin 4, 6, 8, and 10 (IL-4, IL-6, IL-8, and IL-10), IL-1β, tissue necrosis factor α (TNF-α), and matrix metalloproteinase 9 (MMP-9). To assess mediators of nociceptive pain, nerve growth factor (NGF) and tartrate resistant acid phosphatase 5 (TRAP5) were also assessed. Results: LR-PRP from patients with mild to moderate knee OA expressed significantly more IL-1Ra, IL-4, IL-8, and MMP-9 compared with LP-PRP formulations from the same patients. No significant differences were found between LR-PRP and LP-PRP in mediators of nociceptive pain—namely, NGF and TRAP5. Other mediators including TNF-α, IL-1β, IL-6, and IL-10 were also found to have no significant expression differences between LR-PRP and LP-PRP. Conclusion: LR-PRP expressed significantly more IL-1Ra, IL-4, and IL-8, suggesting that LR-PRP may be more anti-inflammatory than LP-PRP. MMP-9 was expressed in higher concentrations in LR-PRP, suggesting that LR-PRP may be more chondrotoxic than LP-PRP. Clinical Relevance: LR-PRP was found to have a robust expression of anti-inflammatory mediators compared with LP-PRP and may be beneficial to patients with long-term knee OA where chronic low-grade inflammation is present. Mechanistic clinical trials are needed to elucidate the key mediators in both LR-PRP and LP-PRP to assess their effect on long-term progression of knee OA.

Geriatric syndromes and nutrition status of elderly osteoarthritis patients

This study describes numerous characteristics of comorbidities and geriatric syndromes in elderly osteoarthritis patients at the National Geriatrics Hospital. A cross-sectional study on 184 knee osteoarthritis (OA) patients aged ≥ 60 years old treated at the National Geriatrics Hospital. The mean age of the patients was 73.12 ± 8.62 years, male patients accounted for 83.7%. Most participants (85.9%) had experienced 2 sides of knee OA, more than half of these participants (63.6%) were experiencing moderate pain. There were 73 patients with reduced mobility accounting for 39.7%. The dependency ratio of functional activities on the ADL scale was 32.6%, and on the IADL scale it was 35.9%. The number of participants using less than 5 drugs was 45.7%. More than half of the survey participants used polypharmacy accounting for 54.3%. There was a significant association between nutritional status and reduced physical function (ADLs and IADLs), impaired cognitive function, depression status and sleep disorder. Geriatric syndromes and risk of malnutrition are common in older OA patients, and assessment for them should be done routinely in these patients to early detect impaired physical activities, impaired cognitions, depression problems, sleep disturbances and progressive symptoms of knee osteoarthritis.

Joint Response to Exercise Is Affected by Knee Osteoarthritis: An Infrared Thermography Analysis.

Infrared thermography can be used to evaluate the inflammation characterizing the joint environment of OA knees, but there is limited evidence on the response to physical exercise. Identifying the response to exercise of OA knees and the influencing variables could provide important information to better profile patients with different knee OA patterns. Sixty consecutive patients (38 men/22 women, 61.4 ± 9.2 years) with symptomatic knee OA were enrolled. Patients were evaluated with a standardized protocol using a thermographic camera (FLIR-T1020) positioned at 1 m with image acquisition of an anterior view at baseline, immediately after, and at 5 min after a 2-min knee flexion-extension exercise with a 2 kg anklet. Patients' demographic and clinical characteristics were documented and correlated with the thermographic changes. This study demonstrated that the temperature response to exercise in symptomatic knee OA was affected by some demographic and clinical characteristics of the assessed patients. Patients with a poor clinical knee status presented with a lower response to exercise, and women showed a greater temperature decrease than men. Not all evaluated ROIs showed the same trend, which underlines the need to specifically study the different joint subareas to identify the inflammatory component and joint response while investigating knee OA patterns.

Effectiveness of continuous passive motion protocol as an adjunct to standard physiotherapy protocol for post-operative rehabilitation in Total Knee Arthroplasty (TKA) cases

Osteoarthritis (OA) of the knee is a relatively prevalent disorder, and prevalence rises with age. Total knee replacement surgery (TKA) is a frequent operation that has significantly improved the quality of life for millions of people with symptomatic knee OA. TKA postoperative care has been discussed regarding the utility of CPM; it has been shown to speed up the recovery of full range of motion, shorten hospital stays, lessen discomfort, speed up wound healing, and lower the risk of DVT. The current study was conducted to compare Effectiveness of CPM protocol as an adjunct to Standard Physiotherapy protocol in Post-operative Rehabilitation of TKA cases. From July to December 2021, three affiliated hospitals hosted the randomised controlled study, which included patients who had complete knee arthroplasty surgery. After surgery, patients were randomly allocated to one of two groups: From the first surgical day till discharge, Group A got twice daily PT and continuous passive motion (CPM), while Group B only received the usual physiotherapy programme from the first postoperative day. Evaluation of the results took place the day after discharge. The participants in the 2 groups' baseline outcome measurement characteristics were comparable.

Integrin Subunit Alpha M, ITGAM Nonsynonymous SNP Is Associated with Knee Osteoarthritis among Thais: A Case-Control Study

Knee osteoarthritis (OA), which is one of the most common degenerative joint diseases, presents a multifactorial etiology, involving multiple causative factors including genetic and environmental determinants. Four human neutrophil antigen (HNA) systems can be determined using each HNA allele by single-nucleotide polymorphisms (SNPs). However, there are no data on HNA polymorphisms and knee OA in Thailand, so we investigated the association of HNA SNPs and knee OA in the Thai population. In a case-control study, detection of HNA-1, -3, -4, and -5 alleles by polymerase chain reaction with sequence-specific priming (PCR-SSP) was performed in participants with and without symptomatic knee OA. Logistic regression models were used to estimate the odds ratio (OR) and 95% confidence interval (CI) between cases and controls. Among 200 participants, 117 (58.5%) had knee OA; 83 (41.5%) did not and were included as controls in this study. An integrin subunit alpha M (ITGAM) nonsynonymous SNP, rs1143679, was markedly associated with symptomatic knee OA. The ITGAM*01*01 genotype was identified as an important increased risk factor for knee OA (adjusted OR = 5.645, 95% CI = 1.799-17.711, p = 0.003). These findings may contribute to our understanding of the application prospects for therapeutic approaches to knee OA.