Western Ontario McMaster Universities Osteoarthritis Research Articles

Association between extent of symptomatic joint involvement in osteoarthritis and comorbid lung disease: A cross-sectional study

Purpose: Comorbidity is highly prevalent in osteoarthritis, although the origin of this is not well understood. The presence of multiple symptomatic joint involvement in osteoarthritis, and noted associations between obesity and osteoarthritis in non-weight bearing joints, implicates osteoarthritis as a likely systemic disorder. Lung disease is prevalent in osteoarthritis populations and also has been associated with systemic factors. Our purpose is to investigate the association between the extent of symptomatic joint involvement in osteoarthritis and prevalent lung disease. Methods: Patients with end-stage hip and knee osteoarthritis were recruited from an orthopaedic clinic in 2010–2012. Patient questionnaires captured symptomatic joints, comorbidities (lung disease, heart disease, diabetes, and high blood pressure), height and weight, smoking status, functional limitations (Western Ontario McMaster University Osteoarthritis Index physical function subscale) and demographic characteristics. Bivariate analysis tested trends in lung disease prevalence by symptomatic joint count categories (1; 2–4; and 5+) stratified by body mass index (BMI: normal (18.5≤BMI<25); overweight (25≤BMI<30); obese (≥30)). Logistic regression analyses evaluated the association between symptomatic joint count (continuous) and lung disease, adjusting for assessed other study measures. Results: Study sample: 913 (469 knees and 444 hips). Mean age was 64 years, 44% male. Lung disease was reported by 9.5%. Mean symptomatic joint count was 4.4 (range: 1–20); almost 40% reported ≥5 symptomatic joints. Comparing individuals reporting lung disease with those who did not, those reporting lung disease had significantly higher mean BMI (mean ± SD: 33.2 ± 8.0 vs 29.4 ± 6.2); more previous/current smokers 41.4% vs 23.6%, greater comorbidity (significantly more with heart disease, diabetes, and high blood pressure), and greater symptomatic joint count (mean ± SD: 6.2 ± 4.4 vs 4.2 ± 3.2). A statistically significant increasing trend in lung disease prevalence was observed with joint count categories (1; 2–4; 5+) within BMI categories. Within the normal BMI group, lung disease prevalence increased from 2.1% to 9.5% (p=0.042), within the overweight group from 4.1% to 9.4% (p=0.016) and within the obese group from 9.3% to 20.5% (p=0.007). Logistic regression showed, adjusted for study covariates, each numerical increase in symptomatic joint count was associated with a 7% (OR: 1.07, 95% CI: 1.01, 1.14) increased likelihood of reporting lung disease. Other independent predictors of lung disease were previous/current smoker (OR: 2.64, 95% CI: 1.32, 4, 5.26), reporting diabetes (OR: 2.37, 95% CI: 1.28, 4.40) and having functional limitations (OR: 1.03, 95% CI: 1.01, 1.06). Males were significantly less likely to report lung disease than females (OR: 0.42, 95% CI: 0.23, 0.75). Conclusions: Findings suggest that ‘generalized’ osteoarthritis may reflect a more systemic osteoarthritis phenotype. This may have important implications for the medical treatment and management of osteoarthritis, suggesting that the extent of joint involvement, and the presence or risk of comorbidity, should be considered in patient education, in choice(s) of treatment and management strategies, and in osteoarthritis research.

Alumina Delta-on-Alumina Delta Bearing in Cementless Total Hip Arthroplasty in Patients Aged

BackgroundThere are limited studies to evaluate long-term clinical and radiographic outcomes of alumina delta ceramic-on-ceramic bearings in cementless total hip arthroplasty (THA). The purpose of this study was to evaluate the clinical and radiographic results, prevalence of osteolysis, squeaking, and fracture of ceramic material associated with the use of the alumina delta ceramic-on-alumina delta ceramic bearing in cementless THA in patients aged <50 years. MethodsWe reviewed the cases of 277 patients (334 hips) who underwent a cementless THA using alumina delta ceramic-on-alumina delta ceramic when they were 50 years or younger at the time of surgery. Demographic data; Harris Hip Score; Western Ontario McMaster Universities Osteoarthritis Index; and University of California, Los Angeles activity score were recorded. Radiographic and computerized tomographic evaluations were used to evaluate implant fixation and osteolysis. Squeaking sound and ceramic fracture were documented. The mean follow-up was 13.1 years (range, 10-14). ResultsThe mean postoperative Harris Hip Score, Western Ontario and McMaster Universities Osteoarthritis Index score, University of California, Los Angeles activity score were 93 points, 15 points, and 8.6 points, respectively. Two patients had thigh pain (grade 7 points). All acetabular components and all but 2 femoral components were well fixed. Thirty-three hips (10%) exhibited clicking sound, and 2 hips (0.6%) exhibited squeaking sound. No hip had osteolysis or ceramic head or liner fracture. ConclusionOur minimum 10-year follow-up results with the use of alumina delta ceramic-on-alumina delta ceramic bearings in patients aged <50 years suggest that cementless THA provides a high rate of survivorship without evidence of osteolysis or fracture of ceramic material.

Western medical acupuncture in a group setting for knee osteoarthritis: results of a pilot randomised controlled trial.

BackgroundEvidence suggests acupuncture may be effective for treating the symptoms of knee osteoarthritis. Offering this in a group setting may offer cost savings. The aim of this study was to establish the feasibility of a definitive trial to assess the clinical and cost-effectiveness of Western medical acupuncture given in groups, or given individually, for adults with severe knee pain attributable to osteoarthritis.MethodsA pilot randomised controlled trial (RCT) was conducted. Participants were recruited from seven general practices in Plymouth, Devon. Acupuncture was provided, at a dosage that increased up to and including electroacupuncture if no pain relief was reported, by one experienced acupuncturist in a community clinic. Potentially eligible adults aged at least 45 years with knee osteoarthritis were identified from practice registers, screened and randomised to either: (1) standardised advice and exercise booklet alone (‘standard’); (2) booklet plus group acupuncture (‘group’); and (3) booklet plus individual acupuncture (‘individual’). Both acupuncture arms received up to ten treatments over 12 weeks.Recruitment, retention and data completion rates were recorded, and participants completed questionnaires on acceptability. We collected pain, stiffness and function data (using the Western Ontario McMaster Universities Osteoarthritis Index; WOMAC) and general health (EQ-5D) and economic measures at baseline and 14 weeks post-randomisation.ResultsWe screened 149 people and randomised 60 (40 %), 20 per arm. The overall 14 week follow-up rate was 77 %, but only 70 % in the ‘standard’ group; 4.1 % of data points were missing. The study was acceptable to participants.Changes in WOMAC pain score (intention to treat complete case analysis) from baseline to 14 week follow-up were: ‘standard’, 0.4 (95 % confidence interval (CI) −1.4, 2.2, n = 14); ‘group’ −3.2 (95 % CI −5.1, −1.4, n = 17); ‘individual’ −2.4 (95 % CI −4.1, −0.7, n = 15).ConclusionsA definitive three-arm trial is feasible. Further follow-up reminders, minimum data collection and incentives should be considered to improve participant retention in the follow-up processes in the standardised advice and exercise booklet arm.Trial registration ISRCTN05305406 Electronic supplementary materialThe online version of this article (doi:10.1186/s40814-016-0051-5) contains supplementary material, which is available to authorized users.

Preoperative physical performance predictors of self-reported physical function and quality of life in patients scheduled for total knee arthroplasty.

[Purpose] To determine the preoperative self-reported and performance-based physical function of patients with end-stage knee osteoarthritis who awaited total knee arthroplasty. The preoperative physical performance factors that predicted self-reported physical function and quality of life were also identified. [Subjects and Methods] All adults with end-stage knee osteoarthritis awaiting surgery were enrolled. Before surgery, self-reported disease-specific physical function and self-reported pain were measured using the Western Ontario McMaster Universities Osteoarthritis Index, self-reported quality of life was measured using the EuroQOL five dimensions questionnaire, and physical performance tests were performed, the 6 minute walk test, the timed up-and-go test, instrumental gait analysis, and measurement of isometric knee flexor and extensor strength of the surgical and nonsurgical knees. [Results] In total, 55 adults (49 females; 73.3 ± 6.1 years) were included. This study showed that several preoperative self-reported and physical performance factors were predictive of self-reported physical function and quality of life. [Conclusion] In patients with end-stage knee osteoarthritis, preoperative pain and dynamic balance ability were the most powerful predictors of self-reported physical function. Preoperative pain and exercise tolerance were the most powerful predictors of quality of life. Preoperative rehabilitation strategies that focus on dynamic balance, aerobic, and resistance exercises may improve surgical outcomes.

Efficacy and tolerability of an undenatured type II collagen supplement in modulating knee osteoarthritis symptoms: a multicenter randomized, double-blind, placebo-controlled study

BackgroundUndenatured type II collagen (UC-II) is a nutritional supplement derived from chicken sternum cartilage. The purpose of this study was to evaluate the efficacy and tolerability of UC-II for knee osteoarthritis (OA) pain and associated symptoms compared to placebo and to glucosamine hydrochloride plus chondroitin sulfate (GC).MethodsOne hundred ninety one volunteers were randomized into three groups receiving a daily dose of UC-II (40 mg), GC (1500 mg G & 1200 mg C), or placebo for a 180-day period. The primary endpoint was the change in total Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) from baseline through day 180 for the UC-II group versus placebo and GC. Secondary endpoints included the Lequesne Functional Index (LFI), the Visual Analog Scale (VAS) for pain and the WOMAC subscales. Modified intent-to-treat analysis were performed for all endpoints using analysis of covariance and mixed model repeated measures, while incremental area under the curve was calculated by the intent-to-treat method.ResultsAt day 180, the UC-II group demonstrated a significant reduction in overall WOMAC score compared to placebo (p = 0.002) and GC (p = 0.04). Supplementation with UC-II also resulted in significant changes for all three WOMAC subscales: pain (p = 0.0003 vs. placebo; p = 0.016 vs. GC); stiffness (p = 0.004 vs. placebo; p = 0.044 vs. GC); physical function (p = 0.007 vs. placebo). Safety outcomes did not differ among the groups.ConclusionUC-II improved knee joint symptoms in knee OA subjects and was well-tolerated. Additional studies that elucidate the mechanism for this supplement’s actions are warranted.Trial registration CTRI/2013/05/003663; CTRI/2013/02/003348.

Possible Involvement of Serum and Synovial Fluid Resistin in Knee Osteoarthritis: Cartilage Damage, Clinical, and Radiological Links.

Resistin is an adipocytokine associated with inflammation and insulin resistance. Recent studies have shown that resistin plays an important role in the pathogenesis and progression in osteoarthritis (OA) patients. The current study was aimed at investigating the relationship between resistin in serum and synovial fluid (SF) and disease severity in patients with knee osteoarthritis. Seventy-four patients diagnosed with knee OA and 79 healthy controls receiving regular body check in our hospital were recruited in the study. The Noyes score method was used to assess articular cartilage damage arthroscopically. The symptomatic severity was evaluated according to the Western Ontario McMaster University Osteoarthritis (WOMAC) scores. The radiographic disease severity of OA was assessed by the Kellgren-Lawrence (K-L) grading system. The resistin levels in serum and SF were determined by enzyme-linked immunosorbent assay. Cartilage degradation marker CTX-II in SF was also examined. SF but not serum resistin levels are positively associated with Noyes scores, K-L grading scores WOMAC pain scores, physical functional scores and WOMAC total scores. In addition, SF resistin correlated positively with CTX-II. Resistin in SF might serve as a potential biomarker for reflecting the disease severity and cartilage degenerative extent of knee OA.

Abstract B29: Differences in physical fitness, disability, and health-related quality of life between physical active and sedentary Hispanic breast cancer survivors

Abstract Background: Breast cancer remains the leading cause of cancer mortality among Latina women in the US. Physical activity (PA) and exercise have been shown to reduce morbidity and mortality from cardiometabolic diseases and cancer while improving individual fitness; disability and health related quality of life (HRQoL). However, Latinas, particularly those who speak only Spanish, have not been included in studies in sufficient numbers to identify factors to promote their participation in cancer prevention interventions. Purpose: To compare physical fitness, disability, and HRQoL between physically active and sedentary Hispanic breast cancer survivors. Methods: A total of 94 women (Age: 55.4 ± 9.9; BMI: 29.87 ± 5.62; ) from the Puerto Rico Comprehensive Cancer Center and MD Anderson Cancer Center in Houston, TX participating in Project VIVA! were recruited for this study. The VIVA! Program is a 16-week exercise intervention emphasizing in the minimum guidelines from The American College of Sports Medicine targeting aerobic endurance, muscular strength, balance, and muscle endurance. Participants visited the clinic for fitness testing and assessment of physical activity (PA), disability, and HRQoL through a battery of self-administered questionnaires previous to starting the intervention. Physical activity was assessed using the International Physical Activity Questionnaire (IPAQ) in the preferred language of the participant; English or Spanish. The physical fitness assessment included: anthropometrics (BMI &amp; waist to hip ratio) measures, adiposity (% body fat) by skinfolds measurement, six-minute walk test (6MWT), lumbar and isquiotibial flexibility by sit-and-reach, grip strength by hand dynamometry, lower extremity endurance testing by sit-to-stand in 30 seconds, upper extremity, low back, and leg strength by Jackson strength testing protocol, shoulder range of motion (ROM) with inclinometer, and balance testing by a functional reach test. Upper and lower extremity function, joint motion and disability were assessed by The Disabilities of the Arm, Shoulder and Hand Score (QuickDASH) and The Western Ontario McMaster University Osteoarthritis Index (WOMAC), respectively. HRQoL was measured by the short version of the QOL (SF-36) questionnaire. For physical activity analyses, sample was divided into two groups based on results from the IPAQ; those with less than 150 min/wk (n = 58) and those exceeding 150 min/wk (n = 36). For analyses of sedentary time, sample was also divided into two groups based on the IPAQ; those spending less than 180 min/day in sitting (n = 46) and those spending greater than 180 mins/day sitting (n = 45). Groups were compared for all variables using analysis of variance (ANOVA). Results: ANOVA for physical activity revealed that those participants engaging in more than 150 min/wk of PA have better 6MWT (p = 0.04) and 30-second sit-to-stand ( p = 0.027) results demonstrating greater cardiorespiratory fitness and muscular endurance, respectively. Those participants spending less than 180 mins/day sitting exhibited better mental component scores in the SF-36 than those spending more time sitting (p = 0.012). Conclusion: It appears that meeting or exceeding the minimum recommended amount of PA and decreasing time spent in sedentary activities have positive physical fitness and HRQoL outcomes in Hispanic women breast cancer survivors. Even though the relationship between PA and sedentary behaviors with measures of physical fitness, disability, and HRQoL are difficult to establish, it is sound for clinicians to start considering PA as a preventive and rehabilitative strategy to improve breast cancer survivors HRQoL. Funding Sources: This project was partially supported by the Center for Energy Balance in Cancer Prevention and Survivorship, Duncan Family Institute, and by the following NIH awards: U54 CA 96297; P30 CA016672; R25T CA057730; and K01 CA 134550. Citation Format: Alexis Ortiz, Maribel Tirado-Gomez, Daniel C. Hughes, Velda Gonzalez, Karen Basen-Engquist. Differences in physical fitness, disability, and health-related quality of life between physical active and sedentary Hispanic breast cancer survivors. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B29.

The Patient's Perception Does Not Differ Following Subvastus and Medial Parapatellar Approaches in Total Knee Arthroplasty: A Simultaneous Bilateral Randomized Study

This simultaneous bilateral randomized study investigated whether patients would perceive the difference between the subvastus approach (SVA) and the medial parapatellar approach (MPA) after total knee arthroplasty (TKA). In 50 patients scheduled to undergo same-day bilateral TKA, one knee was randomly assigned to SVA and the other to MPA. Patient-reported measures (pain, Western Ontario McMaster University Osteoarthritis Index score, and side preference) and physician-assessed measures (isokinetic muscle strength, range of motion, and Knee Society score) were compared. No differences were observed in the patient-reported measures and physician-assessed measures, with the exception of greater quadriceps strength at postoperative 1week in knees that underwent SVA. Patients receiving contemporary perioperative management after same-day bilateral TKA do not perceive any difference between knees that underwent SVA or MPA.

Hypertonic dextrose injection (prolotherapy) for knee osteoarthritis: Long term outcomes

Knee osteoarthritis (OA) is a common, debilitating chronic disease. Prolotherapy is an injection therapy for chronic musculoskeletal pain. Recent 52-week randomized controlled and open label studies have reported improvement of knee OA-specific outcomes compared to baseline status, and blinded saline control injections and at-home exercise therapy (p<0.05). However, long term effects of prolotherapy for knee OA are unknown. We therefore assessed long-term effects of prolotherapy on knee pain, function and stiffness among adults with knee OA. Post clinical-trial, open-label follow-up study. Outpatient; adults with mild-to-severe knee OA completing a 52-week prolotherapy study were enrolled. Participants received 3-5 monthly interventions and were assessed using the validated Western Ontario McMaster University Osteoarthritis Index, (WOMAC, 0-100 points), at baseline, 12, 26, 52 weeks, and 2.5 years. 65 participants (58±7.4 years old, 38 female) received 4.6±0.69 injection sessions in the initial 17-week treatment period. They reported progressive improvement in WOMAC scores at all time points in excess of minimal clinical important improvement benchmarks during the initial 52-week study period, from 13.8±17.4 points (23.6%) at 12 weeks, to 20.9±2.8 points, (p<0.05; 35.8% improvement) at 2.5±0.6 years (range 1.6-3.5 years) in the current follow-up analysis. Among assessed covariates, none were predictive of improvement in the WOMAC score. Prolotherapy resulted in safe, significant, progressive improvement of knee pain, function and stiffness scores among most participants through a mean follow-up of 2.5 years and may be an appropriate therapy for patients with knee OA refractory to other conservative care.

Fractalkine (CX3CL1)

BackgroundElevated serum and synovial fluid (SF) fractalkine (CX3CL1) levels have been detected in patients with knee osteoarthritis (OA). The current study was carried out to investigate the association between serum...

Effectiveness of balance exercises in the acute post-operative phase following total hip and knee arthroplasty: A randomized clinical trial.

Objectives:To determine the effectiveness of balance exercises in the acute post-operative phase following total hip arthroplasty or total knee arthroplasty.Methods:Patients who had total hip arthroplasty (n = 30) or total knee arthroplasty (n = 33) were seen in their residence 1–2 times per week for 5 weeks. At the first post-operative home visit, patients were randomly assigned to either typical (TE, n = 33) or typical plus balance (TE + B, n = 30) exercise groups. The TE group completed seven typical surgery-specific joint range-of-motion and muscle strengthening exercises, while the TE + B group completed the typical exercises plus three balance exercises. Patients were assessed before and 5 weeks after administering the rehabilitation program using four outcome measures: (1) the Berg Balance Scale, (2) the Timed Up and Go test, (3) the Western Ontario McMaster Universities Osteoarthritis Index, and (4) the Activities-specific Balance Confidence Scale.Results:Post-intervention scores for all four outcome measures were significantly improved (p < 0.01) over baseline scores. Patients who participated in the TE + B group demonstrated significantly greater improvement on the Berg Balance Scale and the Timed Up and Go tests (p < 0.01).Conclusion:Balance exercises added to a typical rehabilitation program resulted in significantly greater improvements in balance and functional mobility compared to typical exercises alone.

Plasma and synovial fluid autotaxin correlate with severity in knee osteoarthritis

BackgroundThis study aimed to investigate the relationships between plasma and synovial autotaxin and the severity in knee osteoarthritis (OA) patients. MethodsA total of 90 participants (70 knee OA patients and 20 controls) were recruited. Autotaxin and high-sensitivity C-reactive protein (hs-CRP) levels were determined. The symptomatic and radiographic severity of OA was assessed using the Western Ontario McMaster University Osteoarthritis Index (WOMAC) scores and the Kellgren–Lawrence grades. ResultsOA patients had significantly higher circulating autotaxin and hs-CRP than controls. Plasma autotaxin was directly correlated with synovial fluid autotaxin (r=0.639, P<0.001). Additionally, plasma and synovial fluid autotaxin were associated with radiographic severity (P<0.001). Furthermore, plasma and synovial fluid autotaxin levels were positively correlated with WOMAC scores (r=0.558, P<0.001 and r=0.371, P=0.002, respectively). ConclusionPlasma and synovial fluid autotaxin levels were positively correlated with the severity of OA. Thus, autotaxin has potential as a biomarker reflecting the severity of knee OA.

Assessment of Knee Pain in Obese and Non-Obese Individuals Diagnosed with Osteoarthritis of the Knee Before and After Performance-Based Tests: A Pilot Study

Objective: 1) To examine whether self-reported pain, measured with the Western Ontario McMaster University Osteoarthritis Index pain subscale and Visual Analog Scale, of individuals diagnosed with knee Osteoarthritis would change after performance-based tests were completed; irrespective of their body weight and Body Mass Index. 2) To assess whether self-reported pain before and after performance-based tests differs between obese and non-obese individuals and whether both VAS and WOMAC scales of pain would demonstrate similar changes from before to after the completion of performance-based tests in obese and non-obese individuals with knee OA. 3) To observe whether depressive symptoms and BMI explain the variance of self-reported pain before and after performance based tests. Methods: This pilot study included 31 participants diagnosed with radiographic knee osteoarthritis by an orthopedic surgeon using the Kellgren-Lawrence Scale. The sample was divided in two groups of obese individuals with knee Osteoarthritis and non-obese individuals with knee osteoarthritis. Two self-reported measures, the Western Ontario McMaster University Osteoarthritis Index and Visual Analog Scale assessed knee pain before and after performance-based tests in these two groups of individuals. Depressive symptom was obtained with Back depression questionnaire II. Results: The Visual Analog Scale ratings showed a significant increase in pain in both groups, but the Western Ontario McMaster University Osteoarthritis Index pain subscale only captured a significant increase in the obese osteoarthritis group. A significant proportion of variance in pain before and after functional activities was explained by depressive symptoms and obesity, with higher levels of depression and obesity predicting worse reports of pain. Conclusion: The Visual Analog Scale pain rating may be a better tool for assessing knee pain of obese and non-obese individuals diagnosed with knee osteoarthritis. Furthermore, symptoms of depression might predict increase in knee pain and disability in obese individuals.

Correlation of IL-17 Level in Synovia and Severity of Knee Osteoarthritis.

BackgroundThe aim of this study was to evaluate the role of interleukin-17 (IL-17) level in synovia and its relationship with the severity of knee osteoarthritis (OA).Material/MethodsWe enrolled 226 OA patients and 106 controls in this study. The symptomatic/radiation severity of OA was assessed by the Western Ontario McMaster University Osteoarthritis Index (WOMAC) pain score/Kellgren-Lawrence (KL) grading system. Serum IL-17 levels were measured by enzyme-linked immunosorbent assay (ELISA).ResultsSynovia IL-17 levels were significantly higher in OA patients compared with controls (P<0.01), and were negatively correlated with OA severity. IL-17 level gradually decreased among different phases but lacked statistical significance.ConclusionsIL-17 might play a crucial role in the pathogenesis of OA and is closely related to pain. Blocking the IL-17 signaling pathway may delay pain related to OA.

VITAMIN D SUPPLEMENTATION AND FUNCTIONAL KNEE OSTEOARTHRITIS PROGRESSION IN OLDER ADULTS WITH OBESITY: DATA FROM THE OSTEOARTHRITIS INITIATIVE

Objective: Older adults with obesity are at increased risk of knee osteoarthritis (KOA) and vitamin D deficiency, but data on the effect of vitamin D supplementation in this population are equivocal. This study evaluated the effect of vitamin D supplementation on functional progression of KOA in older adults with obesity. Participants with Body Mass Index ≥30 kg/m2 and aged ≥ 60 years from the Osteoarthritis Initiative progression cohort were stratified by baseline vitamin D use. The relationship between vitamin D supplementation and progression of KOA at 72 months was characterized. The Western Ontario McMaster University Osteoarthritis Index (WOMAC) pain scale was the primary outcome measure. Secondary measures included: WOMAC disability, Physical Activity Scale for the Elderly, gait speed and Knee injury and Osteoarthritis Outcome Score (KOOS) scales. In older adults with KOA and obesity, baseline supplemental vitamin D use did not predict functional progression of osteoarthritis at 72 months.

Synovial Fluid HMGB-1 Levels are Associated with Osteoarthritis Severity.

Recent data have shown that enhanced cytokine production in knee osteoarthritis (OA) synovium are believed to promote pathological OA. High-mobility group box 1 (HMGB-1) as a well-known pro-inflammatory cytokine may influence the development of knee OA. The purpose of this study is to analyze the amount of and location of HMGB-1 in OA synovium and to compare it with controls who are afflicted with acute meniscal or cruciate ligament tears. We also evaluated the relationship between the level of HMGB-1 in synovial fluid with the severity of synovitis, clinical symptoms (pain, stiffness, daily activity), and radiological changes in patients with knee OA. Synovium and synovial fluid were harvested from seventy-four knee OA patients and thirty-four controls afflicted with acute meniscal or cruciate ligament tears. Kellgren-Lawrence (KL) grading system and Western Ontario McMaster University Osteoarthritis Index (WOMAC) assessment scale were applied to evaluate the radiological and clinic severity of OA patients. Additionally, for all patients, the microscopic synovitis was graded to evaluate the severity of synovium pathology. The location of HMGB-1 was determined in the synovium by immunohistochemistry. Synovium and synovial fluid HMGB-1 levels were measured by western blotting and enzyme-linked immunosorbent assay (ELISA), respectively. Synovium immunohistochemical analysis revealed that HMGB-1 displayed a strictly nuclear localization in controls; however, both nuclear and cytoplasmic distributions were present in OA patients. The percentage of HMGB-1 positive cells as well as cytoplasmic HMGB-1 cell population in OA patients were higher than those of controls (42.5% vs. 39.7% and 24.0% vs. 5.7%). Both synovium and synovial fluid HMGB-1 levels in OA patients were significantly higher than controls. In OA patients, HMGB-1 in the KL2/3 group was higher than in the KL4 group. Additionally, synovial fluid HMGB-1 levels in OA patients were positively associated with the severity of synovitis, pain, and daily activities. Our results demonstrated that HMGB-1 is overexpressed and relocated in synovial membranes of patients with knee OA. The increased synovial fluid HMGB-1 levels were associated with the severity of synovitis, pain, and daily activities in knee OA patients. These results suggested that HMGB-1, as a pro-inflammatory cytokine, may play a crucial role in the progression of knee OA.

Correlation of bone morphogenetic protein-2 levels in serum and synovial fluid with disease severity of knee osteoarthritis.

BackgroundThis study aimed to investigate the bone morphogenetic protein-2 (BMP-2) levels in serum and synovial fluid (SF) of patients with primary knee osteoarthritis (OA) and to exam its correlation with radiographic and symptomatic severity of the disease.Material/MethodsA total of 37 knee OA patients and 20 healthy controls were enrolled in this study. Knee OA radiographic grading was performed according to the Kellgren-Lawrence (KL) grading system by evaluating X-ray changes observed in anteroposterior knee radiography. Symptomatic severity of the disease was evaluated according to the Western Ontario McMaster University Osteoarthritis Index (WOMAC) scores. BMP-2 levels in serum and SF were determined using enzyme-linked immunosorbent assay.ResultsSerum BMP-2 level in patients with knee OA was higher than that in healthy controls. Knee OA patients with KL grade 4 showed significantly elevated BMP-2 levels in the serum and SF compared with those with KL grade 2 and 3. Knee OA patients with KL grade 3 had significant higher SF levels of BMP-2 than those with KL grade 2. BMP-2 levels in the serum and SF of knee OA patients were both positively correlated with KL grades and WOMAC scores.ConclusionsBMP2 levels in serum and SF were closely related to the radiographic and symptomatic severity of knee OA and may serve as an alternative biochemical parameter to determine disease severity of primary knee OA.

The relationship between synovial fluid VEGF and serum leptin with ultrasonographic findings in knee osteoarthritis.

This study aimed to determine synovial fluid and serum biomarkers which could accord with radiological and ultrasonographic findings in knee osteoarthritis. Thirty-four patients with knee osteoarthritis were detected with joint effusion by clinical examination. Both knee joints were examined using plain radiographs and ultrasonography. Questions were obtained for visual analog scale (VAS), Western Ontario McMaster Universities Osteoarthritis Index and Health Assessment Questionnaire (HAQ). Synovial fluid (SF) and serum levels of vascular endothelial growth factor (VEGF), matrix metalloproteinase (MMP)-13, leptin, resistin and cartilage oligomeric matrix protein (COMP) were measured using enzyme-linked immunosorbent assay. Synovial fluid VEGF level was positively correlated with Kellgren-Lawrence (KL) grades and it was higher in patients with KL grade 4 than those with KL grade 2. SF VEGF correlated with ultrasonographic findings, such as the length of medial osteophytes. The amount of effusion was positively correlated with SF resistin. Serum leptin level had positive correlation with HAQ and the length of medial osteophytes. MMP-13 or COMP levels were not correlated with radiographic or ultrasonographic findings. Synovial fluid VEGF level was correlated with radiographic grading, ultrasonographic findings and functional statues in knee osteoarthritis, and serum leptin level also correlated with the ultrasonographic findings and functional status of knee osteoarthritis.

Effects of two physiotherapy booster sessions on outcomes with home exercise in people with knee osteoarthritis: a randomized controlled trial.

Enhancing exercise adherence over the longer term is an important goal in self-management of knee osteoarthritis (OA). Following an initial period of more intensive exercise supervision, this study investigated whether 2 additional physiotherapy visits improved outcomes with continued home exercise over a subsequent 24-week period. A total of 78 people with medial knee OA (mean ± SD age 62.1 ± 6.9 years, mean ± SD body mass index 29.4 ± 4.0 kg/m(2) , and radiographic disease severity 19% mild, 49% moderate, and 32% severe) who completed a 12-week physiotherapist-supervised exercise trial were randomly allocated to 2 30-minute physiotherapy booster sessions (delivered by 8 physiotherapists in private clinics) or no booster sessions for the subsequent 24 weeks. All participants were asked to continue home exercises 4 times weekly. Primary outcomes were change in pain, using a 100-mm visual analog scale, and self-reported physical function, measured using the Western Ontario McMaster Universities Osteoarthritis Index. Participants and physiotherapists were unblinded to group allocation, although participants were blinded to the study hypothesis. A total of 74 participants (95%) completed the trial. There was no significant difference between groups for change in pain (mean difference [95% confidence interval (95% CI)] 0.7 mm [-9.4, 8.0]; P = 0.88) or physical function (-0.3 units [95% CI -4.0, 3.5]; P = 0.88). The mean ± SD percentage of home exercise sessions completed was 56% ± 34% in the booster group and 51% ± 37% in the control group (P > 0.05). Two booster sessions with a physiotherapist did not influence pain or physical function outcomes, or measures of home exercise adherence. These findings suggest other more effective strategies are needed to maximize longer-term adherence with the aim to achieve greater improvements in clinical outcomes from exercise in this patient population.

Patient-specific instrumentation improved mechanical alignment, while early clinical outcome was comparable to conventional instrumentation in TKA.

The aim of this prospective study was to compare early clinical outcome, radiological limb alignment, and three-dimensional (3D)-component positioning between conventional and computed tomography (CT)-based patient-specific instrumentation (PSI) in primary mobile-bearing total knee arthroplasty (TKA). Two hundred ninety consecutive patients (300 knees) with severe, debilitating osteoarthritis scheduled for TKA were included in this study using either conventional instrumentation (CVI, n = 150) or PSI (n = 150). Patients were clinically assessed before and 2 years after surgery according to the Knee-Society-Score (KSS) and the visual-analog-scale for pain (VAS). Additionally, the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) and the Oxford-Knee-Score (OKS) were collected at follow-up. To evaluate accuracy of CVI and PSI, hip-knee-ankle angle (HKA) and 3D-component positioning were assessed on postoperative radiographs and CT. Data of 222 knees (CVI: n = 108, PSI: n = 114) were available for analysis after a mean follow-up of 28.6 ± 5.2 months. At the early follow-up, clinical outcome (KSS, VAS, WOMAC, OKS) was comparable between the two groups. Mean HKA-deviation from the targeted neutral mechanical axis (CVI: 2.2° ± 1.7°; PSI: 1.5° ± 1.4°; p < 0.001), rates of outliers (CVI: 22.2%; PSI: 9.6%; p = 0.016), and 3D-component positioning outliers were significantly lower in the PSI group. Non-outliers (HKA: 180° ± 3°) showed better clinical results than outliers at the 2-year follow-up. CT-based PSI compared with CVI improves accuracy of mechanical alignment restoration and 3D-component positioning in primary TKA. While clinical outcome was comparable between the two instrumentation groups at early follow-up, significantly inferior outcome was detected in the subgroup of HKA-outliers. Prospective comparative study, Level II.