Symptomatic Knee Research Articles

Reliability of waveforms and gait metrics from multiple outdoor wearable inertial sensors collections in adults with knee osteoarthritis

Wearable sensors may allow research to move outside of controlled laboratory settings to be able to collect real-world data in clinical populations, such as older adults with osteoarthritis. However, the reliability of these sensors must be established across multiple out-of-lab data collections. Nine older adults with symptomatic knee arthritis wore wearable inertial sensors on their proximal tibias during an outdoor 6-minute walk test outside of a controlled laboratory setting as part of a pilot study. Reliability of the underlying waveforms, discrete peak outcomes, and spatiotemporal outcomes were assessed over four separate data collections, each approximately 1 week apart. Reliability at a different number of included strides was also assessed at 10, 20, 50, and 100 strides. The underlying waveforms and discrete peak outcome measures had good-to-excellent reliability for all axes, with lower reliability in frontal plane angular velocity axis. Spatiotemporal outcomes demonstrated excellent reliability. The inclusion of additional strides had little to no effect on reliability in most axes, but the confidence intervals generally became smaller across all axes. However, there was improvement in axes with lower (i.e., good) reliability. These data were collected in an out-of-lab setting, and the results are generally consistent with previous in-lab data collections, likely due to its semi-controlled nature. Additional out-of-laboratory research is required to investigate if these trends continue during truly free-living collections. This study provides support for increasing research conducted in out-of-lab data collections, as demonstrated by the good-to-excellent reliability of all axes.

Long-term effects of vitamin D supplementation and maintaining sufficient vitamin D on knee osteoarthritis over 5 years

ObjectivesThis study aimed to investigate the long-term effect of vitamin D supplementation compared to placebo over 5 years in participants with knee osteoarthritis (OA). We also aimed to describe the effect of maintaining sufficient serum vitamin D levels over five years in knee OA.MethodsParticipants (n = 173) from the Hobart centre of the Vitamin D Effects on Osteoarthritis (VIDEO) trial were extensively followed up 3 years after the cessation of 2-year investigational treatment. Participants were classified as maintaining sufficient vitamin D (n = 79) and not maintaining sufficient vitamin D (n = 61) groups.ResultsThere was no significant difference in change in the knee symptoms, depression, and serum levels of IL6 and hs-CRP between both comparisons after 3 years of cessation of the clinical trial. However, among participants who reported no knee surgery (KS), there was a significant improvement in WOMAC function (β: − 83.7, 95% CI: − 167.3, 0) and depression scores (β: − 1.3, 95% CI: − 2.3, − 0.2) in vitamin D group compared to the placebo group. Similarly, those who maintained adequate vitamin D levels over 5 years had significantly less WOMAC knee pain (β: − 33.9, 95% CI: − 65.7, − 2) and physical dysfunction (β: − 105.5, 95% CI: − 198.2, − 12.8) than participants with vitamin D deficiency over 5 years.ConclusionVitamin D supplementation over 2 years or maintaining vitamin D sufficiency for 5 years was not associated with statistically significant differences in change in knee symptom scores over 5 years. However, among participants who did not report KS, 2-year vitamin D supplementation and maintaining sufficient vitamin D was linked to modest improvements in knee symptoms and depression scores in knee OA.

Patients with bilateral patellar instability have multiple and symmetric risk factors in each knee.

Bilateral involvement is common in patients with patellar instability. The management of bilateral patellar instability is associated with increased complication rate. The higher complication rate in this cohort may be related to the presence of underlying anatomic risk factors. The purpose of the study was to evaluate the presence and side-to-side differences in risk factors between knees in bilateral patellar instability. In a retrospective study (2008-2017), demographic information, characteristics of patellar dislocation and anatomic risk factors on MRI (trochlear dysplasia, patellar height, tibial tubercle lateralization, patellar tilt, sulcus angle, bump height) were evaluated in both knees of all patients (n = 32, 15 males and 17 females) with bilateral patellar instability. The risk factors were analyzed based on established cut off values and were compared between gender, laterality and more symptomatic (index) knee. Knee symmetry and absolute differences between risk factors for both knees were analyzed. The mean age of 32 patients was 14.6 ± 2.3years. Of the 4 major anatomic risk factors, the most common were trochlear dysplasia in 59/64 (92.1%) knees and patella alta in 51/64 (79.7%) knees. Tibial tubercle lateralization was the least common risk factor being present in 8/64 (12.5%) knees. Of 64 knees, 55 (85.9%) had 2 or more risk factors and 30 (46.8%) had 3 or all 4 risk factors present. There were no significant differences in risk factors based on gender, laterality or index knee. There was symmetry between paired knees for 31/32 (96.8%) patients for trochlear depth, 29/32 (90.6%) for patellar tilt, 27/32 (84.3%) for TT-TG distance and 25/32 (78.1%) for patellar height. There were no significant differences in absolute measurements between knees for any of the risk factors. Patients with bilateral instability had multiple risk factors, with trochlear dysplasia being the most common and increased TT-TG distance being the least common. Majority of patients had 2 or more risk factors and about half had 3 or 4 risk factors in each knee. There was symmetry between paired knees for each risk factorwithout any significant differences between the index knee compared to the contralateral knee. Level III.

Osteoarthritis in patients with obesity: The bariatric surgery impacts on its evolution

Obesity is one of the main modifiable risk factors for osteoarthritis (OA). Moreover, obesity is associated with greater pain intensity and functional limitation, but also with a significantly lower responder rate to intra-articular treatments. Consequently, an arthroplasty is indicated earlier and more frequently in patients with obesity. However, pain and functional symptoms improve slightly less after arthroplasty in patients with obesity, who display higher incidence of early and late complications following prosthetic surgery. Bariatric surgery (BS) has increased worldwide and is efficient to induce major and sustainable weight-loss. Importantly, BS significantly reduces pain and functional limitation in patients with symptomatic knee OA. Biomarkers analysis also revealed a decrease in catabolic factors and an increase in anabolic one after BS suggesting a structural protective effect in knee OA. Nevertheless, the impact of BS prior to arthroplasty remains unclear. BS seems to decrease short- and mid-term complications such as infections or thrombosis. However, BS does not appear to modify long-term complications rate, and may even increase it, especially revisions and infections. Although few studies have compared the symptomatic and functional outcomes of joint replacement with or without BS, these are not significantly improved by prior BS. Despite these heterogeneous results, medico-economic studies found that BS prior to arthroplasty was cost-effective. To conclude, BS could significantly reduce the symptoms of OA and potentially slow its progression, but appears more disappointing in preventing long-term complications of arthroplasties and improving their functional results.

Autologous and Allogeneic Cytotherapies for Large Knee (Osteo)Chondral Defects: Manufacturing Process Benchmarking and Parallel Functional Qualification.

Cytotherapies are often necessary for the management of symptomatic large knee (osteo)-chondral defects. While autologous chondrocyte implantation (ACI) has been clinically used for 30 years, allogeneic cells (clinical-grade FE002 primary chondroprogenitors) have been investigated in translational settings (Swiss progenitor cell transplantation program). The aim of this study was to comparatively assess autologous and allogeneic approaches (quality, safety, functional attributes) to cell-based knee chondrotherapies developed for clinical use. Protocol benchmarking from a manufacturing process and control viewpoint enabled us to highlight the respective advantages and risks. Safety data (telomerase and soft agarose colony formation assays, high passage cell senescence) and risk analyses were reported for the allogeneic FE002 cellular active substance in preparation for an autologous to allogeneic clinical protocol transposition. Validation results on autologous bioengineered grafts (autologous chondrocyte-bearing Chondro-Gide scaffolds) confirmed significant chondrogenic induction (COL2 and ACAN upregulation, extracellular matrix synthesis) after 2 weeks of co-culture. Allogeneic grafts (bearing FE002 primary chondroprogenitors) displayed comparable endpoint quality and functionality attributes. Parameters of translational relevance (transport medium, finished product suturability) were validated for the allogeneic protocol. Notably, the process-based benchmarking of both approaches highlighted the key advantages of allogeneic FE002 cell-bearing grafts (reduced cellular variability, enhanced process standardization, rationalized logistical and clinical pathways). Overall, this study built on our robust knowledge and local experience with ACI (long-term safety and efficacy), setting an appropriate standard for further clinical investigations into allogeneic progenitor cell-based orthopedic protocols.

Awareness, Symptoms and Risk Factors Related to Symptomatic Knee Osteoarthritis in Middle Aged Adults of Rural Population

Awareness, Symptoms and Risk Factors Related to Symptomatic Knee Osteoarthritis in Middle Aged Adults of Rural Population

Effects of low-intensity exercise on spontaneously developed knee osteoarthritis in male senescence-accelerated mouse prone 8

BackgroundOsteoarthritis (OA) is a degenerative joint disease associated with aging, which often leads to joint stiffness and disability. Exercise is one of the most important non-pharmacological treatments and is prescribed as an indispensable treatment for OA. However, whether physical exercise is beneficial for preventing the progression of OA symptoms with age is poorly understood. We investigated the effects of exercise on spontaneously developed knee OA using male senescence-accelerated mouse prone 8 (SAMP8).MethodsTo examine age-related changes in the knee joints of SAMP8, knee articular cartilage changes, synovitis, knee joint flexion and extension angles, swelling, walking ability, and quadriceps muscle atrophy were analyzed at 3, 5, 7, and 9 months. SAMP8 were required to run at a speed of 10 m/min for 15 min/day from 7 to 9 months of age. The knee joint pathologies and symptoms of exercising and non-exercising mice were compared by histological, immunohistochemical, and morphometrical analyses.ResultsThe mice presented with various histological changes, including cartilage destruction, osteocyte formation, synovitis, declined joint angles, and swelling. Notably, medial and posterior cartilage destruction was more severe than that of the lateral and anterior cartilage. Knee joint angles were significantly correlated with the histological scores (modified Mankin and OARSI, osteophyte formation and synovial lining cell layer). Exercise did not attenuate cartilage degeneration in the medial and posterior tibial plateau, although the articular cartilage of the anterior and lateral tibial plateau and its histological scores was remained and significantly improved, respectively, by exercise. Exercise suppressed the age-related decline of collagen type II-positive areas in the remaining articular cartilage and improved the OA symptoms. Exercise reduced the expression of monocyte chemoattractant protein (MCP)-1 and tumor necrosis factor (TNF)-α positive macrophages in the synovium.ConclusionThis study revealed that SAMP8 developed spontaneous knee OA with age, which resembled the disease symptoms in humans. Low-intensity exercise temporarily alleviated degeneration of the remaining cartilage, synovitis, and age-related decreases in knee flexion angle, stride length, and muscle atrophy in SAMP8. However, exercise during OA progression with age may cause mechanical stress that could be both beneficial and detrimental to joint health.

The efficacy of strength or aerobic exercise on quality of life and knee function in patients with knee osteoarthritis. A multi-arm randomized controlled trial with 1-year follow-up

ObjectiveTo evaluate the efficacy of strength exercise or aerobic exercise compared to usual care on knee-related quality of life (QoL) and knee function at 4 months and 1 year in individuals with knee osteoarthritis.MethodsA three-arm randomized controlled trial (RCT) compared 12 weeks of strength exercise or aerobic exercise (stationary cycling) to usual care supervised by physiotherapists in primary care. We recruited 168 participants aged 35–70 years with symptomatic knee osteoarthritis. The primary outcome was The Knee Injury and Osteoarthritis Outcome Score (KOOS) QoL at 1 year. Secondary outcomes were self-reported function, pain, and self-efficacy, muscle strength and maximal oxygen uptake (VO2max) at 4 months and 1 year.ResultsThere were no differences between strength exercise and usual care on KOOS QoL (6.5, 95% CI -0.9 to 14), or for aerobic exercise and usual care (5.0, 95% CI -2.7 to 12.8), at 1 year. The two exercise groups showed better quadriceps muscle strength, and VO2max at 4 months, compared to usual care.ConclusionThis trial found no statistically significant effects of two exercise programs compared to usual care on KOOS QoL at 1 year in individuals with symptomatic and radiographic knee osteoarthritis, but an underpowered sample size may explain lack of efficacy between the intervention groups and the usual care group.ClinicalTrials.gov IdentifierNCT01682980.

Midterm results of intra-articular stromal vascular fraction injection for the treatment of knee osteoarthritis.

This study aimed to evaluate the safety and efficacy of intra-knee stromal vascular fraction (SVF) injection in patients with symptomatic knee osteoarthritis at the midterm (3-year) follow-up. SVF injection was applied to 25 knees of 20 patients. Eighteen patients (90%) were female, and the means ± standard deviations of age was 61.9 ± 7.8 (range, 50-76) years. Patients who received conservative treatment for at least 6months and had radiographic Kellgren-Lawrence (K-L) grades 2 and 3 varus gonarthrosis were included in the study. SVF was obtained from the umbilical region by liposuction using local anaesthesia. Patients were followed-up for 36months. Their visual analogue scale (VAS), Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and Lysholm scores were evaluated before and at 6, 12, 24 and 36months post-SVF injection. A statistically significant improvement (p < 0.05) was observed in VAS, WOMAC and Lysholm scores at the first 2-year follow-up compared to baseline. However, no statistically significant difference (n.s.) was observed in VAS, WOMAC and Lysholm scores at the 3-year follow-up compared with baseline. Intra-articular SVF injection decreased pain and significantly improved the functional outcomes in the first 2years in knees with grade 2-3 osteoarthritis; however, these positive effects of the injection disappeared in the 3rd year. Although short-term successful results of SVF have been reported in the literature, prospective studies are needed for medium- and long-term results.

Experiences and Perceptions of Using Smartphone Ecological Momentary Assessment for Reporting Knee Osteoarthritis Pain and Symptoms.

Knee osteoarthritis (OA) is a prevalent, painful, and disabling musculoskeletal condition. One method that could more accurately monitor the pain associated with knee OA is ecological momentary assessment (EMA) using a smartphone. The aim of this study was to explore participant experiences and perceptions of using smartphone EMA as a way of communicating knee OA pain and symptoms following participating in a 2-week smartphone EMA study. Using a maximum variation sampling method, participants were invited to share their thoughts and opinions in semistructured focus group interviews. Interviews were recorded and transcribed verbatim before thematic analysis using the general inductive approach. A total of 20 participants participated in 6 focus groups. Three themes and 7 subthemes were identified from the data. Identified themes included: user experience of smartphone EMA, data quality of smartphone EMA, and practical aspects of smartphone EMA. Overall, smartphone EMA was deemed as being an acceptable method for monitoring pain and symptoms associated with knee OA. These findings will assist researchers in designing future EMA studies alongside clinicians implementing smartphone EMA into practice. This study highlights that smartphone EMA is an acceptable method for capturing pain-related symptoms and experiences of those expereiencing knee OA. Future EMA studies should ensure design features are considered that reduce missing data and limit the responder burden to improve data quality.

The Prognostic Potential of End-Stage Knee Osteoarthritis and Its Components to Predict Knee Replacement: Data From the Osteoarthritis Initiative.

We aimed to determine how 2 definitions of end-stage knee osteoarthritis (esKOA) and each component (knee symptoms, persistent knee pain, radiographic severity, and presence of limited mobility or instability) related to future knee replacement (KR). We performed knee-based analyses of Osteoarthritis Initiative data from baseline to the first 4 annual follow-up visits, and data on KR from baseline until the fifth yearly contact. We calculated a base model using common risk factors for KR in logistic regression models with generalized estimating equations. We assessed model performance with area under the receiver-operating characteristic curve (AUC) and Hosmer-Lemeshow test. We then added esKOA or each component from the visit (< 12 months) before a KR and change in the year before a KR. We calculated the net reclassification improvement (NRI) index and the integrated discrimination improvement (IDI) index. Our sample was mostly female (58%), ≥ 65 years old, White (82%), and without radiographic knee osteoarthritis (50%). At the visit before a KR, Kellgren-Lawrence (KL) grades (ordinal scale; AUC 0.88, NRI 1.12, IDI 0.11), the alternate definition of esKOA (AUC 0.84, NRI 1.16, IDI 0.12), and a model with every component of esKOA (AUC 0.91, NRI 1.30, IDI 0.17) had the best performances. During the year before a KR, change in esKOA status (alternate definition) had the best performance (AUC 0.86, NRI 1.24, IDI 0.12). Radiographic severity may be a screening tool to find a knee that will likely receive a KR. However, esKOA may be an ideal outcome in clinical trials because a change in esKOA state predicts future KR.

Factors affecting the features of platelet-rich plasma in patients with knee osteoarthritis.

The aim of this study was to present an analysis of platelet-rich plasma obtained from patients with knee osteoarthritis and reveal the factors affecting its features. A total of 62 patients (mean age: 56.68 ± 7.13 years) with symptomatic knee osteoarthritis were included in this study. Age (years), gender, height (m), weight (kg), body mass index (kg/m2), duration of symptoms, smoking status, smoking index, general health status, and physical activity scores were recorded. Whole blood and platelet-rich plasma cell counts were performed with a hematology analyzer. White blood cell, red blood cell, and platelet counts were recorded. According to the dose of injected platelets, efficiency of the procedure, purity of platelet-rich plasma, and activation classification, dose of platelets, efficiency of the procedure (platelet recovery rate, %), and purity of the obtained platelet-rich plasma product (relative composition in platelets, %) were calculated. Correlation analysis between the features of platelet-rich plasma and the patient-related variables, including age, gender, body mass index, smoking status, smoking index, presence of other health conditions, physical activity scores, duration of symptoms, and pain levels, was performed. Dose of injected platelets, efficiency of the procedure, purity of platelet-rich plasma, and activation analysis showed that the dose of injected platelets was 3.25 billion, the efficiency of the process was 77%, and the purity rate of the platelet-rich plasma was 98.4%. Platelet-rich plasma platelet count was correlated with whole blood platelet count (r = 0.81, P < .001), whole blood white blood cell count (r = 0.39, P = .002), smoking status (r = 0.56, P = .03), smoking index (r = -0.63, P = .002), and the presence of hypertension (r = -0.31, P=.04). Platelet-rich plasma white blood cell and purity of platelet-rich plasma were correlated with the smoking status of the patients (r = 0.52, P = .01; r = 0.64, P = .003, respectively). This study has demonstrated that high dose and very pure platelet-rich plasma with medium efficiency was yielded with this platelet-rich plasma preparation procedure; whole blood platelet count, the presence of hypertension, and the smoking status of patients affect the features of the obtained platelet-rich plasma. Level IV, Diagnostic Study.

High-intensity laser therapy on pain relief in symptomatic knee osteoarthritis: A systematic review and meta-analysis.

Osteoarthritis is one of the leading causes of global disability and pain. To investigate whether High-Intensity Laser therapy has superior pain-relieving effects in individuals with symptomatic knee osteoarthritis. Searches were conducted using CENTRAL, MEDLINE, CINAHL, EMBASE, Web of Science, PEDro, and related reference lists with language limed to English. Clinical trials investigating the effectiveness of High-Intensity Laser therapy compared to other laser therapies, conventional therapies or exercises on knee osteoarthritis pain were included. The screening and selection of studies, data extraction, and methodological quality assessment were performed by two independent researchers. Studies were quantitatively integrated using the Review Manager Software and qualitative analysis using the criteria recommended by the Cochrane Collaboration. Nine studies meeting the eligibility criteria were identified, among which only one study was identified as excellent methodology quality, six was marked as good quality, and the remaining two studies were regarded as fair or poor quality. All studies reported positive effects of High-Intensity Laser therapy on knee osteoarthritis pain. Two studies (136 people) gave indication that there was moderate evidence that High-Intensity Laser therapy could be a promising new possibility in pain relief among patients with knee osteoarthritis compared with sham laser therapy in a short-term treatment (MD, -2.04, 95% CI, -2.12 to -1.96; Z= 51.01, P< 0.01). Four studies (160 people) showed that High-Intensity Laser therapy could be an effective modality on treating pain compared to conventional physiotherapies in decreasing visual analog scale score (MD, -0.98, 95% CI, -1.19 to -0.76; Z= 9.02, P< 0.01). Three studies (123 people) demonstrated that High-Intensity Laser therapy combined with exercises was more effective than placebo laser or lower-intensity laser combined with exercises in alleviating pain in patients with knee osteoarthritis (MD, -1.54, 95% CI, -1.84 to -1.24; Z= 10.06, P< 0.01). High-Intensity Laser therapy could be a promising and recommended modality in alleviating knee osteoarthritis pain, especially when it was implemented in combination with exercises.

Long-term Outcomes after Medial Open Wedge High Tibial Osteotomy - A Retrospective Study of 69 Patients.

High tibial osteotomy (HTO) is a widespread option to avoid or delay total knee arthroplasty (TKA). The present study aimed to assess the long-term survival rate and postoperative subjective knee function after isolated medial open wedge HTO in patients with symptomatic medial compartment knee osteoarthritis (OA) and varus malalignment.Sixty-nine patients (48.8±6.7, 35-66 years; preoperative mechanical tibiofemoral angle [mTFA] -5.3±3.4; -14.9-0.0° varus) treated with medial open wedge HTO using a TomoFix plate were included in this retrospective study, with a follow-up of at least 10 years (11.8±1.0 years). The survival rate after HTO was calculated after 5 and 10 years. Subjective knee function was assessed using Hospital for Special Surgery (HSS), Oxford knee, Lequesne, and Lysholm scores.Thirty-three patients underwent conversion to TKA, on average, 7.0±3.4 (1.3-13.7) years after HTO. Five- and ten-year survival rates were 84.1 and 60.9%, respectively. Patients without conversion to TKA showed a Lysholm score of 64.5 (35-92), Lequesne score of 7 (1-13), HSS score of 71 (56-86), and Oxford knee score of 38.5 (25-44) at the last follow-up (more than 10 years). Significantly higher scores were registered at the last follow-up compared to the preoperative state regarding the Lysholm score (preoperative: 43.5 [12-95]; follow-up: 64.5 [35-92]; p<0.001). The HSS score (preoperative: 69.5 [43-93]; follow-up: 71 [56-86]; p=0.6941) showed no statistically significant change during the 10-year follow-up period. The Lequesne score was significantly lower than the preoperative score (preoperative: 11.5 [0.5-22]; follow-up: 7 [1-13]; p<0.001), indicating a lower handicap.The majority of patients with a valgus medial compartmental knee OA treated with HTO with fixation using the TomoFix plate can expect no conversion to TKA for more than 10 years. Furthermore, patients without conversion to TKA after 10 years still had a significantly higher subjective knee function than preoperatively. Further research is needed to identify risk factors for conversion to TKA. This helps to guide surgeons in selecting patients who will benefit most from HTO.

Preoperative foot and ankle radiographic evaluation for total knee arthroplasty

PurposeTo radiographically evaluate the ankle and foot complications in preoperative patients for total knee arthroplasty (TKA) in Japan. MethodsThis study included 500 legs of 500 patients who planned to undergo primary TKA in affiliated hospitals of our university from August 2020 to November 2021. Hip to calcaneus view, anterior view of the ankle joint, and anterior and lateral views of the foot were taken within 1 month preoperatively. We measured hip-knee-ankle angle (HKA), mechanical ankle joint axis point (MAJAP), lateral distal tibial angle (LDTA), tibio-plafound inclination (TPI), talar inclination (TI), ankle joint line convergence angle (A-JLCA), talo-first metatarsal angle (TMA), calcaneal pitch angle (CPA), hallux valgus angle (HVA), first-second intermetatarsal angle (M1M2A), first fifth intermetatarsal angle (M1M5A), talonavicular coverage angle (TNCA), and percentage of Takakura Tanaka classification. ResultsMean measured values were as follows: HKA: 11.0°; MAJAP, 39.6%; LDTA: 92.2°; TPI: 6.9°; TI: 7.2°; A-JLCA: 0.3°; TMA:−4.3° (<−4° in 247 feet, 49.4%); CPA: 15.9°(<20° in 366 feet, 73.2%); HVA: 16.8° (mild in 70 feet, 14.0%; moderate in 42 feet, 8.4%; severe in 23 feet, 4.6%); M1M2A: 11.1°(>9° in 373 feet, 74.6%); M1M5A: 31.1°(≥30° in 321 feet, 64.2%); TNCA: 10.6° (≥7° in 375 feet, 75.0%); Takakura Tanaka classification Stage ​≥ ​IIIa in 108 feet, 21.6%. ConclusionsMild-to-severe hallux valgus was noted in 26.5% of patients and Stage IIIa or higher ankle osteoarthritis in 21.6%, and abnormal alignment—including flat feet—was indicated in some patients. Patient's knee, foot, and ankle symptoms should be considered before TKA.

Genicular Artery Embolization for Treatment of Knee Osteoarthritis: Interim Analysis of a Prospective Pilot Trial Including Effect on Serum Osteoarthritis-Associated Biomarkers

PurposeTo characterize the safety, efficacy, and potential role of genicular artery embolization (GAE) as a disease-modifying treatment for symptomatic knee osteoarthritis (OA). Materials and MethodsThis is an interim analysis of a prospective, single-arm clinical trial of patients with symptomatic knee OA who failed conservative therapy for greater than 3 months. Sixteen patients who underwent GAE using 250-μm microspheres and had at least 1 month of follow-up were included. Six patients completed the 12-month follow-up, and 10 patients remain enrolled. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was evaluated at baseline and at 1, 3, and 12 months. Serum and plasma samples were collected for biomarker analysis. The primary end point was the percentage of patients who achieved the minimal clinically important difference (MCID) for WOMAC pain score at 12 months. Baseline and follow-up outcomes were analyzed using the Wilcoxon matched-pairs signed-rank test. ResultsTechnical success of the procedure was 100%, with no major adverse events. The MCID was achieved in 5 of the 6 (83%) patients at 12 months. The mean WOMAC pain score decreased from 8.6 ± 2.7 at baseline to 4.9 ± 2.7 (P = .001), 4.4 ± 2.8 (P < .001), and 4.7 ± 2.7 (P = .094) at 1, 3, and 12 months, respectively. There was a statistically significant decrease in nerve growth factor (NGF) levels at 12 months. The remaining 8 biomarkers showed no significant change at 12 months. ConclusionsGAE is a safe and efficacious treatment for symptomatic knee OA. Decreased NGF levels after GAE may contribute to pain reduction and slowing of cartilage degeneration.

Ultrasound-Guided Injections of HYADD4 for Knee Osteoarthritis Improves Pain and Functional Outcomes at 3, 6, and 12 Months without Changes in Measured Synovial Fluid, Serum Collagen Biomarkers, or Most Synovial Fluid Biomarker Proteins at 3 Months.

Prior studies have demonstrated improved efficacy when intra-articular (IA) therapeutics are injected using ultrasound (US) guidance. The aim of this study was to determine if clinical improvement in pain and function after IA hyaluronic acid injections using US is associated with changes in SF volumes and biomarker proteins at 3 months. 49 subjects with symptomatic knee OA, BMI < 40, and KL radiographic grade II or III participated. Subjects with adequate aspirated synovial fluid (SF) volumes received two US-guided IA-HA injections of HYADD4 (24 mg/3 mL) 7 days apart. Clinical evaluations at 3, 6, and 12 months included WOMAC, VAS, PCS scores, 6 MWD, and US-measured SF depth. SF and blood were collected at 3 months and analyzed for four serum OA biomarkers and fifteen SF proteins. Statistical differences were observed at 3, 6, and 12 months compared to baseline values, with improvements at 12 months for WOMAC scores (50%), VAS (54%), and PCS scores (24%). MMP10 levels were lower at 3 months without changes in SF volumes, serum levels of C2C, COMP, HA, CPII, or SF levels of IL-1 ra, IL-4, 6, 7, 8, 15, 18, ILGFBP-1, 3, and MMP 1, 2, 3, 8, 9. Baseline clinical features or SF biomarker protein levels did not predict responsiveness at 3 months. Clinical improvements were observed at 12 months using US needle guidance for IA HA, whereas only one SF protein biomarker protein was different at 3 months. Larger studies are needed to identify which SF biomarkers will predict which individual OA patients will receive the greatest benefit from IA therapeutics.

Correlation between Primary Knee Osteoarthritis and Metabolic Syndrome among Egyptian Patients

Abstract Background Previous studies have suggested that metabolic syndrome is associated with osteoarthritis (OA). However, analyses have not addressed whether levels of individual metabolic syndrome components are related to OA. This study was undertaken to examine the relationship of metabolic syndrome and its components with radiographic and symptomatic knee OA Objective To assess the impact of metabolic syndrome and its components on the degree of structural damage and function impairment in a sample of Egyptian patients with symptomatic primary knee OA. Patients and Methods In this study, 116 Egyptian osteoarthritic patients were included, Patients were divided into 2 groups: Group A: includes 58 osteoarthritic patients with metabolic syndrome. Group B: includes 58 osteoarthritic patients without metabolic syndrome. Results There was a positive correlation detected between HAQ and hypertension with P-Value 0.002. There was a positive correlation detected between WOMAC and hypertension with P-Value 0.000.we found that OA was sever in hypertensive patients, old age, patients with high waist circumference and high levels of CRP, TG, FBG and 2HPP with P-value &amp;gt; 0.001. While there was no correlation between X-ray grading with and ESR, uric acid, cholesterol, LDL, HDL, HBA1C and insulin resistance with P-Value &amp;gt; 0.05 Conclusion We concluded that patients with knee OA and metabolic syndrome has more radiological damage and severe grades of functional disability in comparative to patients with OA without MS.

Concurrent Imaging and Clinical Study of the Efficacy of Hyaluronic Acid Injection for Knee Osteoarthritis: A Synovial Membrane Investigation with Ultrasound Imaging.

We investigated whether hyaluronic acid (HA) injections can ameliorate ultrasound-detected synovitis in knee osteoarthritis (OA). We recruited 103 patients with symptomatic knee OA and ultrasound-detected synovitis and performed two ultrasound-guided fluid drainage procedures, followed by the administration of a low-molecular-weight HA injection (2.5 mL) in the subpatellar bursa, at a 2-week interval. Knee ultrasound imaging evaluations were performed before injection (baseline) and at 1 and 6 months after the second injection and included the measurements of synovial vascularity by using color Doppler ultrasound, synovial fluid depth over the suprapatellar bursa (SF), and synovial hypertrophy (SH). Initial clinical assessments included a visual analog scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). VAS scores decreased significantly at both 1-month and 6-month evaluations (p < 0.001). WOMAC scores also significantly decreased at 1 month (p < 0.001), but not at 6 months (p = 0.23). The ultrasound parameters did not significantly change, except color Doppler grading, which tended to decrease at the 6-month evaluation (p = 0.059). Our findings revealed that two ultrasound-guided HA injections following fluid drainage improved pain and knee function but did not considerably influence imaging-detected synovitis in patients with knee OA.

Investigating the association between knee osteoarthritis symptoms with pain catastrophizing domains between Hispanics and non-Hispanic Whites.

Knee osteoarthritis (KOA) is a chronic disease accompanied by debilitating symptoms including pain, stiffness, and limited physical functionality, which have been shown to be associated with pain catastrophizing. Previous studies have revealed racial discrepancies in pain catastrophizing, notably between Hispanics and non-Hispanics while pointing to potential health disparities. Using a conceptual model, this study aimed to investigate racial differences in associations between KOA symptoms with specific pain catastrophizing domains (rumination, magnification, and helplessness). Patients with KOA (n = 253; 147 Hispanics, 106 non-Hispanic Whites) completed a survey that included measures of knee symptoms, pain catastrophizing, and demographic variables. Structural equation modeling revealed that among Hispanics, each pain catastrophizing domain (rumination, magnification, and helplessness) was associated with at least two symptomatic experiences, including pain severity and difficulty in physical function. Specifically, pain severity was associated with (a) rumination: β = 0.48, p < 0.001, (b) magnification: β = 0.31, p = 0.003; and (c) helplessness: β = 0.39, p < 0.001). Additionally, a lower score in physical function was associated with higher magnification (β = 0.26, p = 0.01), and helplessness (β = 0.25, p = 0.01). Among non-Hispanic White patients, pain severity was further associated with two domains of pain catastrophizing, including rumination (β = 0.39, p < 0.001) and helplessness (β = 0.35, p = 0.01). In addition, association pathways for demographic variables revealed that older Hispanics experienced greater challenges with higher pain severity (β = 0.26, p = 0.01) and greater difficulty with physical function (β = 0.31, p < 0.001) while Hispanics females experienced higher pain (β = 0.19, p = 0.03). These findings highlight the importance of designing tailored interventions that consider key demographic factors such as age, and gender, to improve physical function that might alleviate pain catastrophizing among Hispanics with KOA.