Total Knee Pain Research Articles

The Diagnostic Characteristic and Reproducibility of Bone Scintigraphy Single-Photon Emission Computed Tomography/Computed Tomography for Diagnosing Aseptic Loosening of Uncemented Total Knee Arthroplasty

BackgroundThe primary objective of this study was to investigate the diagnostic characteristics of bone scintigraphy single-photon emission computed tomography/computed tomography (BS-SPECT/CT) for diagnosing aseptic loosening after uncemented total knee arthroplasty (TKA), and to evaluate the following aspects: how to manage inconclusive results, the interobserver reliability, and the location of tracer uptake between symptomatic cases with and without aseptic loosening. MethodsIn this study, 180 patients who had uncemented TKA and persistent knee pain suspected of aseptic loosening were included. As part of routine medical care, BS-SPECT/CT was used, and its results were compared with the reference standard, which involved revision surgery for aseptic loosening or a 12-month follow-up without revision or imaging. Inconclusive BS-SPECT/CT results were considered either negative (best-case scenario) or positive (worst-case scenario). Sensitivity, specificity, positive/negative likelihood ratios (LRs), and positive/negative predictive values (PPV and NPV) were calculated. Sensitivity analyses were conducted by comparing the diagnostic characteristics between cases with a follow-up of less and more than 2 years of follow-up. The anatomical distribution of tracer uptake and interobserver reliability were also evaluated. ResultsOf the 180 BS-SPECT/CT scans conducted, 22 were determined positive, 113 negative, and 45 inconclusive. The best-case scenario showed a sensitivity of 66.7%, specificity of 93.8%, +LR 10.8, −LR 0.4, PPV 54.6%, and NPV 96.2%. In contrast, the worst-case scenario had a sensitivity of 94.4%, specificity of 69.1%, +LR 3.1, −LR 0.1, PPV 25.4%, and NPV 99.1%. Sensitivity analyses revealed no relevant differences in characteristics between the 2 TKA-interval groups. The interobserver reliability was fair-to-moderate (κ = 0.39; 95% confidence interval 0.18 to 0.60), with an estimated agreement of 79% (95% confidence interval 70 to 87). Four prosthetic zones had a notably higher proportion of cases with tracer uptake in those with aseptic loosening compared to those without. ConclusionsThe test characteristics of BS-SPECT/CT were deemed appropriate in patients who have complaints of uncemented TKA suspected of aseptic loosening. Inconclusive cases were best categorized as negative, especially in patients who have a short interval between TKA and the first BS-SPECT/CT. Increased tracer uptake in 4 prosthetic zones was observed in cases of aseptic loosening, although interobserver reliability was fair to moderate. Level of EvidenceLevel III, Diagnostic Retrospective Cohort Study.

Brain predicted age difference mediates pain impact on physical performance in community dwelling middle to older aged adults.

The purpose of the study was to examine associations between physical performance and brain aging in individuals with knee pain and whether the association between pain and physical performance is mediated by brain aging. Participants (n=202) with low impact knee pain (n=111), high impact knee pain (n=60) and pain-free controls (n=31) completed self-reported pain, magnetic resonance imaging (MRI), and a Short Physical Performance Battery (SPPB) that included balance, walking, and sit to stand tasks. Brain predicted age difference, calculated using machine learning from MRI images, significantly mediated the relationships between walking and knee pain impact (CI: -0.124; -0.013), walking and pain-severity (CI: -0.008; -0.001), total SPPB score and knee pain impact (CI: -0.232; -0.025), and total SPPB scores and pain-severity (CI: -0.019; -0.001). Brain-aging begins to explain the association between pain and physical performance, especially walking. This study supports the idea that a brain aging prediction can be calculated from shorter duration MRI sequences and possibly implemented in a clinical setting to be used to identify individuals with pain who are at risk for accelerated brain atrophy and increased likelihood of disability.

Osteophytes mediate the associations between cartilage morphology and changes in knee symptoms in patients with knee osteoarthritis

AimsTo investigate whether the associations between cartilage defects and cartilage volumes with changes in knee symptoms were mediated by osteophytes.MethodsData from the Vitamin D Effects on Osteoarthritis (VIDEO) study were analyzed as a cohort. The Western Ontario and McMaster Universities Osteoarthritis Index was used to assess knee symptoms at baseline and follow-up. Osteophytes, cartilage defects, and cartilage volumes were measured using magnetic resonance imaging at baseline. Associations between cartilage morphology and changes in knee symptoms were assessed using linear regression models, and mediation analysis was used to test whether these associations were mediated by osteophytes.ResultsA total of 334 participants (aged 50 to 79 years) with symptomatic knee osteoarthritis were included in the analysis. Cartilage defects were significantly associated with change in total knee pain, change in weight-bearing pain, and change in non-weight-bearing pain after adjustment for age, sex, body mass index, and intervention. Cartilage volume was significantly associated with change in weight-bearing pain and change in physical dysfunction after adjustment. Lateral tibiofemoral and patellar osteophyte mediated the associations of cartilage defects with change in total knee pain (49–55%) and change in weight-bearing pain (61–62%) and the association of cartilage volume with change in weight-bearing pain (27–30%) and dysfunction (24–25%). Both cartilage defects and cartilage volume had no direct effects on change in knee symptoms.ConclusionsThe significant associations between cartilage morphology and changes in knee symptoms were indirect and were partly mediated by osteophytes.

The interactions between MRI-detected osteophytes and bone marrow lesions or effusion-synovitis on knee symptom progression: an exploratory study

To investigate the longitudinal association between MRI-detected osteophyte scores and progression of knee symptoms, and whether the association was modified in the presence of bone marrow lesions (BMLs) or effusion-synovitis. Data from Vitamin D Effects on Osteoarthritis (VIDEO) study, a randomized, double-blinded and placebo-controlled clinical trial in symptomatic knee osteoarthritis (OA) patients, were analyzed as an exploratory study. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was used to assess knee symptoms. Osteophytes, BMLs and effusion-synovitis were measured using MRI. 334 participants with MRI information and WOMAC score (baseline and follow-up) were included in the analyses, with 24.3% of them having knee pain increased 2 years later. Statistically significant interactions were found between MRI-detected osteophytes and BMLs or effusion-synovitis on increased knee symptoms. In participants with BMLs, higher baseline scores of MRI-detected osteophytes in most compartments were significantly associated with increased total knee pain, weight-bearing pain, stiffness, and physical dysfunction, after adjustment for age, sex, body mass index, intervention and effusion-synovitis. In participants with effusion-synovitis, higher baseline scores of MRI-detected osteophytes in almost all the compartments were significantly associated with increased total knee pain, weight-bearing pain, stiffness, and physical dysfunction, after adjustment for age, sex, body mass index, intervention and BMLs. In contrast, MRI-detected osteophyte scores were generally not associated with knee symptom progression in participants without baseline BMLs or effusion-synovitis. MRI-detected OPs are associated with increased total knee pain, weight-bearing knee pain, stiffness and physical dysfunction in participants presenting BMLs or effusion-synovitis, but not in participants lacking BMLs or effusion-synovitis. This suggests they could interact with bone or synovial abnormalities to induce symptoms in knee OA.

Cross-Cultural Adaptation and Validation of the Arabic Version of the Intermittent and Constant Osteoarthritis Pain Questionnaire.

This study aimed to translate and adapt the Intermittent and Constant Osteoarthritis Pain questionnaire into the Arabic language and evaluate the validity and reliability of this scale for participants with knee or hip osteoarthritis. This questionnaire was translated based on the Manufacturers Alliance for Productivity and Innovation protocol. The test-retest reliability was calculated using the Intraclass Correlation Coefficient. Then, Cronbach’s alpha was used to assess the internal consistency of Intermittent and Constant Osteoarthritis Pain questionnaire. After that, the criterion validity was evaluated against the Knee injury and Osteoarthritis Outcome Score. A total of 90 participants were included in this study, of which 29 participants were re-evaluated for reliability testing. The Intraclass Correlation Coefficient of the Knee Intermittent and Constant Osteoarthritis Pain questionnaire were 0.841, 0.923 and 0.911 for the total, constant, and intermittent knee pain, respectively. Cronbach’s alpha was 0.88, 0.93 and 0.94 for the total score, the intermittent knee pain and the constant knee pain, respectively. Eventually, criterion validity was r=0.24(P<0.05). Intermittent and Constant Osteoarthritis Pain in Arabic is a valid and reliable instrument to be used in Arabic-speaking patients with knee/hip osteoarthritis.

The Use of a High-Tech Knee Pad for Reduction of the Postoperative Effusion after Total Knee Arthroplasty.

Purpose After total knee arthroplasty (TKA), pain and swelling, especially in older and less cooperative patients, can limit the retrieval of a good range of motion and muscle tone and consequently the achievement of an optimal function outcome. A high-tech knee pad made of metal fibers emitting infrared energy was used in a group of patients undergoing TKA to assess its efficacy in the postoperative period with respect to a group with a placebo. Methods Twelve patients used knee pads after surgery for 3 weeks and were evaluated using visual analog scale (VAS), Knee Society Rating Score, Cincinnati Knee Rating Score, and painkillers at specific timings. Results At 3 weeks, all scores improved in a significant manner in the treated group compared with the placebo group. At 2 months after surgery, VAS was better in the study group than the control group, whereas other parameters were similar. However, the use of rescue drugs was less in the study group than in the placebo group. Conclusion A high-tech knee pad may contribute to a faster recovery within the first week after a knee replacement, limiting the use of painkillers and allowing a quick functional recovery by the control of pain and postoperative effusion. Level of Evidence Level II, randomized prospective study with small sample size.

Association between MRI-detected osteophytes and changes in knee structures and pain in older adults: a cohort study.

To describe cross-sectional and longitudinal associations between magnetic resonance imaging (MRI)-detected osteophytes (OPs) and knee structural abnormalities and knee pain in older adults. A prospective population-based cohort study of 895 participants aged 50-80 years (mean age 62 years, 50% female) was performed. T1-or T2-weighted fat suppressed MRI was used to assess knee OPs, cartilage volume, cartilage defects and bone marrow lesions (BMLs) at baseline and after 2.6 years. Radiographically-detected OPs were scored according to the Osteoarthritis Research Society International (OARSI) atlas. Knee pain was assessed using a self-administered questionnaire at baseline, 2.6 and 5 years later. 85% of participants had MRI-detected OPs at baseline, while 10% of participants had radiographically-detected OPs. Cross-sectionally, higher gardes of MRI-detected OPs in all compartments were significantly, independently and site-specifically associated with higher prevalences of cartilage defects and BMLs, lower cartilage volume and higher prevalence of knee pain. Longitudinally, higher gardes of baseline MRI-detected OPs site-specifically predicted greater risks of any increase in cartilage defects or BMLs, and loss of cartilage volume in medial and lateral tibiofemoral (LTF) and total compartments over 2.6 years in multivariable analyses. These significant associations were similar in those without radiographically-detected OPs. MTF and total OP scores were significantly associated with change in total knee pain over 2.6 and 5 years but these became non-significant after adjustment for cartilage defects and BMLs. MRI-detected knee OPs are common and appear to be clinically relevant to knee structural changes in older adults.

Patellofemoral Bone Marrow Lesions: Natural History and Associations With Pain and Structure.

To describe the natural history of patellofemoral (PF) joint bone marrow lesions (BMLs) over 2.6 years and associations between changes in PF joint BMLs, knee pain, and knee cartilage morphology in older adults over 5 years. A prospective population-based cohort study of men and women ages 50-80 years (mean age 63 years, n = 406) was performed. PF joint BMLs, knee cartilage volume, and cartilage defect scores (range 0-4) were measured using the Whole-Organ Magnetic Resonance Imaging Score system at baseline and at 2.6 years. Knee pain was assessed by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores at baseline and at 5 years. At baseline, 27% (n = 109) had PF joint BMLs; 24% of these increased (WOMAC score change of ≥1) at followup, 44% persisted, 32% decreased, and 21% resolved completely. Of those without PF joint BMLs at baseline, 20% of participants developed PF joint BMLs over 2.6 years. In multivariable analyses, a change in PF joint BMLs was deleteriously associated with a change in total knee pain (β = 0.67, 95% confidence interval [95% CI] 0.03, 1.31) and knee pain when going up/down stairs (β = 0.24, 95% CI 0.04, 0.44) over 5 years. Baseline PF joint and tibiofemoral joint cartilage volume were protective for PF joint BMLs (relative risk [RR] 0.69, 95% CI 0.52, 0.90 for PF joint), while baseline PF joint cartilage defects were associated with an increase in PF joint BMLs (RR 1.73, 95% CI 1.38, 2.17) over 2.6 years. TF joint cartilage defects were not associated with increases in PF joint BMLs. PF joint BMLs are not static, and change is clinically relevant. PF joint cartilage morphology predicts increases in PF joint BMLs.

Cross-Sectional and Longitudinal Associations Between Serum Levels of High-Sensitivity C-Reactive Protein, Knee Bone Marrow Lesions, and Knee Pain in Patients With Knee Osteoarthritis.

To describe associations between serum high-sensitivity C-reactive protein (hsCRP), knee bone marrow lesions (BMLs), and knee pain, cross-sectionally and longitudinally, in patients with knee osteoarthritis (OA). Patients (n = 192) with symptomatic knee OA (mean age 63 years, range 50-79, women 53%) were assessed at baseline and after 24 months. Serum hsCRP was measured using enzyme-linked immunosorbent assay. Knee BMLs were scored using the modified Whole-Organ Magnetic Resonance Imaging (MRI) Score from T2-weighted fat-supressed fast spin-echo MRI. Knee pain was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index. Quartiles of baseline serum hsCRP were associated with the presence of knee BMLs (prevalence ratio 1.07 per quartile [95% confidence interval (95% CI) 1.00, 1.15]) and total knee pain scores (β 13.66 per quartile [95% CI 2.26, 25.07]) in multivariable analyses. Longitudinally, higher baseline hsCRP was associated with an increase in BML score (risk ratio 1.37 per quartile [95% CI 1.10, 1.70]), and change in hsCRP was positively associated with change in BML score (β 0.19 [95% CI 0.05, 0.34]) in adjusted analyses. Baseline hsCRP was not associated with change in total knee pain, but change in hsCRP was positively and significantly associated with change in total knee pain (β 4.71 [95% CI 0.48, 8.94]). This became nonsignificant after adjustment for changes in BML score. In patients with knee OA, serum hsCRP is associated with knee BML scores and, to a lesser extent, pain both cross-sectionally and longitudinally, suggesting that inflammation is linked with BMLs and their associated pain.

Correlates of knee bone marrow lesions in younger adults.

BackgroundSubchondral bone marrow lesions (BMLs) play a key role in the pathogenesis of osteoarthritis (OA) and are associated with pain and structural progression in knee OA. However, little is known about clinical significance and determinants of BMLs of the knee joint in younger adults. We aimed to describe the prevalence and environmental (physical activity), structural (cartilage defects, meniscal lesions) and clinical (pain, stiffness, physical dysfunction) correlates of BMLs in younger adults and to determine whether cholesterol levels measured 5 years prior were associated with current BMLs in young adults.MethodsSubjects broadly representative of the Australian young adult population (n = 328, aged 31–41 years, female 48.7 %) underwent T1- and proton density-weighted fat-suppressed magnetic resonance imaging (MRI) in their dominant knee. BMLs, cartilage defects, meniscal lesions and cartilage volume were measured. Knee pain was assessed by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and physical activity was measured by the International Physical Activity Questionnaire (IPAQ). Cholesterol levels including high-density lipoprotein (HDL) were assessed 5 years prior to MRI.ResultsThe overall prevalence of BML was 17 % (grade 1: 10.7 %, grade 2: 4.3 %, grade 3: 1.8 %). BML was positively associated with increasing age and previous knee injury but not body mass index. Moderate physical activity (prevalence ratio (PR):0.93, 95 % CI: 0.87, 0.99) and HDL cholesterol (PR:0.36, 95 % CI: 0.15, 0.87) were negatively associated with BML, while vigorous activity (PR:1.02, 95 % CI: 1.01, 1.03) was positively associated with medial tibiofemoral BMLs. BMLs were associated with more severe total WOMAC knee pain (>5 vs ≤5, PR:1.05, 95 % CI: 1.02, 1.09) and WOMAC dysfunction (PR:1.75, 95 % CI: 1.07, 2.89), total knee cartilage defects (PR:2.65, 95 % CI: 1.47, 4.80) and total meniscal lesion score (PR:1.92, 95 % CI: 1.13, 3.28).ConclusionsBMLs in young adults are associated with knee symptoms and knee structural lesions. Moderate physical activity and HDL cholesterol are beneficially associated with BMLs; in contrast, vigorous physical activity is weakly but positively associated with medial tibiofemoral BMLs.Electronic supplementary materialThe online version of this article (doi:10.1186/s13075-016-0938-9) contains supplementary material, which is available to authorized users.

Signal intensity alteration in the infrapatellar fat pad at baseline for the prediction of knee symptoms and structure in older adults: a cohort study

ObjectiveTo describe the associations between infrapatellar fat pad (IPFP) signal intensity alteration at baseline and knee symptoms and structural changes in older adults.MethodsA total of 874 subjects (mean 62.1 years,...

Cross-sectional and Longitudinal Associations between Knee Joint Effusion Synovitis and Knee Pain in Older Adults.

To describe the cross-sectional and longitudinal associations between knee regional effusion synovitis and knee pain in older adults. Data from a population-based random sample (n = 880, mean age 62 yrs, 50% women) were used. Baseline knee joint effusion synovitis was graded (0-3) using T2-weighted magnetic resonance imaging (MRI) in the suprapatellar pouch, central portion, posterior femoral recess, and subpopliteal recess. Effusion synovitis of the whole joint was defined as a score of ≥ 2 in any subregion. Other knee structural (including cartilage, bone marrow, and menisci) lesions were assessed by MRI at baseline. Knee pain was assessed by the Western Ontario and McMaster Universities Osteoarthritis Index questionnaire at baseline and 2.6 years later. Multivariable analyses were performed after adjustment for age, sex, body mass index, and other structural lesions. The prevalence of effusion synovitis was 67%. Suprapatellar pouch effusion synovitis was significantly and independently associated with increased total and nonweight-bearing knee pain in both cross-sectional and longitudinal analyses (for an increase in total knee pain of ≥ 5, RR 1.26 per grade, 95% CI 1.04-1.52), and increased weight-bearing knee pain in longitudinal analysis only. Effusion synovitis in posterior femoral recess and central portion were independently associated with increases in nonweight-bearing pain (RR 1.63 per grade, 95% CI 1.32-2.01 and RR 1.29 per grade, 95% CI 1.01-1.65, respectively) in longitudinal analyses only. Knee joint effusion synovitis has independent associations with knee pain in older adults. Suprapatellar pouch effusion synovitis is associated with nonweight-bearing and weight-bearing knee pain, while posterior femoral recess and central portion effusion synovitis are only associated with nonweight-bearing pain.

Changes in patellofemoral bone marrow lesions and knee pain: Natural history and the associations with structure

s / Osteoarthritis and Cartilage 23 (2015) A82eA416 A298 2. IGF-II is capable of promoting cartilage matrix maintenance in injuryinduced OA in mice and in human OA cartilage ex vivo cultures. 469 CHANGES IN PATELLOFEMORAL BONE MARROW LESIONS AND KNEE PAIN: NATURAL HISTORY AND THE ASSOCIATIONS WITH STRUCTURE Z. Zhu y, C. Ding y, X. Jin y, B. Antony y, W. Han y, L. Laslett y, F. Cicuttini z, G. Jones y. yMenzies Inst. for Med. Res., Hobart, Australia; zDept. of Epidemiology and Preventive Med., Monash Univ., Melbourne, Melbourne, Australia Purpose: Bone marrow lesions (BMls) are recognized as an important subchondral feature in knee OA and play a vital role in the diease progression. The patellofemoral joint (PFJ) is a common site of pain and contributes to functional limitations among OA patients. However, there are very few clinical or epidemiological studies that reveal the association between PFJ BMLs and clinical symptoms as well as cartilage structural morphologies. Meanwhile, the natural history of PFJ BMLs has not yet been described. The aims of this study were, therefore, to describe the natural history of MRI-detected BMLs in PFJ over 2.6 years and evaluate the association between increases in PFJ BMLs, knee pain and knee cartilage morphology in older adults. Methods: 406 males and females were randomly selected from local community (mean age 63 years, range 51 to 79) and followed up for 2.6 years. PFJ BMLs were determined on T2-weighted fat saturated magnetic resonance imaging (MRI) using Whole-Organ MRI Score system (WORMS). Knee cartilage volume and cartilage defects scores (0-4) were determined on T1-weighted fat suppression MRI using WORMS. Knee pain was accessed byWestern Ontario and McMaster Universities Osteoarthritis (WOMAC) scores. Student's t-tests and Pearson's c2 tests were used to compare the differences between subjects with and without an increase in PFJ BMLs. Crude and adjusted linear regression was used to determine whether PFJ BML changes over 2.5 years were associated with changes in knee pain in the different sub-scales over 5 years, before and after adjustment for potential confounders. Binary logistic regression was used to examine the associations between increases in PFJ BMLs as an outcome, and baseline cartilage volumes as well as baseline cartilage defect scores as predictors, both before and after adjustment for potential confounders. Results: At baseline, 27% (n1⁄4109) had PFJ BMLs, 24% of these showed progression (change in score of 1) at follow-up, 44% persisted and 21% completely resolved. Of those 73% (n1⁄4297) who did not have PFJ BMLs at baseline, 19.7% of them developed new PFJ BMLs over 2.6 years. In multivariable analysis, change in PFJ BMLs was positively associated with increases in total knee pain (b: 0.81, 95% CI: 0.15, 1.48) and knee pain when going up/down stairs (b: 0.29, 95% CI: 0.08, 0.50) over 5 years. While baseline patellar cartilage volume predicted a decrease in PFJ BMLs (OR: 0.62, 95% CI: 0.43, 0.90), baseline patellar cartilage defects were associated with an increase in PFJ BMLs (OR: 1.75, 95% CI: 1.28, 2.40) over 2.6 years. Tibiofemoral cartilage volume and defects were not associated with changes in PFJ BMLs. Conclusions: PFJ BMLs are not static and change is clinically relevant. An increase in PFJ BMLs can be predicted by reduced patellar cartilage volume and increased patellar cartilage defects site-specifically.

IGF-II inhibits promotes cartilage integrity in experimental osteoarthritis and IL-1β-induced catabolic activity in chondrocytes

IGF-II inhibits promotes cartilage integrity in experimental osteoarthritis and IL-1β-induced catabolic activity in chondrocytes

The offspring of people with a total knee replacement for severe primary knee osteoarthritis have a higher risk of worsening knee pain over 8 years

ObjectiveTo investigate whether offspring having at least one parent with a total knee replacement for severe primary knee osteoarthritis (OA) have an increased risk of worsening knee pain over 8...

OP0061 Cross-Sectional and Longitudinal Associations between Knee Joint Effusion and Knee Pain in Older Adults

BackgroundKnee pain is a prominent symptom of osteoarthritis (OA). Joint synovial effusion could contribute to pain, but the relationship between them remains controversial. In addition, the effects of joint effusions...

SAT0105 Adiposity and Loss of Lean Mass Are Associated with Increased Knee Pain in Older Adults

BackgroundObesity is one of the most important risk factors for knee pain in the elderly [1]. Cross sectional studies suggest that body fat mass is associated with knee pain and...

A longitudinal study of the association between infrapatellar fat pad maximal area and changes in knee symptoms and structure in older adults

BackgroundThe infrapatellar fat pad (IPFP) is of uncertain significance for knee osteoarthritis. The aim of this study was to describe the longitudinal associations between baseline IPFP maximal area and changes...

Pain relief, functional recovery and associated medical treatments reduction in large-scale population with osteoarthritis receiving injections of viscosupplement incorporating high concentration of sorbitol

Pain relief, functional recovery and associated medical treatments reduction in large-scale population with osteoarthritis receiving injections of viscosupplement incorporating high concentration of sorbitol

Reliability of common clinical standing balance tests for people with hip osteoarthritis

Reliability of common clinical standing balance tests for people with hip osteoarthritis