Prevalence of proximal tibia vara in Indonesian population with knee osteoarthritis

BackgroundProximal tibia vara has drawn interest since the concept of constitutional varus was introduced. Proximal tibia vara is a condition where the knee varus tilt the tibia condyle medially and shift the tibial articular surface medially. This condition affects medial proximal tibial angle measurements and the placement of the tibial implant in knee replacement surgery. Thus, it challenged the neutral knee arthroplasty alignment target because some people may present a proximal tibia vara. This study assesses the prevalence of the proximal tibia vara and the correlation to knee osteoarthritis grade.MethodsThis retrospective study was carried out from January 2021 to June 2021. Eighty-five limbs were included with the following inclusion criteria: knee osteoarthritis patients who received a long view lower extremity radiograph. The exclusions criteria were (1) patients who had undergone arthroplasty and lower extremity surgery before and (2) valgus knee deformity. The outcomes in this study were HKAA, MAD, TAD, MPTA, PTRP, LDFA, and PTS. Intraclass correlation (ICC) using two-way mixed was used to assess the reproducibility of the radiographic parameters. Multiple logistic regression was used to evaluate the correlation between knee osteoarthritis grade and radiographs parameters (MAD and TAD).ResultA total 85 limbs from 52 patients were assessed in this study. Proximal tibia vara was found in 18 knees (21%.). The logistic regression was performed to assess the correlation between the severity of the knee osteoarthritis and radiographic parameters (MAD, TAD, LDFA, and PTS) with an overall p-value < 0.001 and pseudo-R² = 0.29.ConclusionA significant portion of patients with knee osteoarthritis have proximal tibia vara, and it is a pre-existing condition. Since the pre-existing proximal tibia vara affects preoperative measurements, a long-standing lower extremity x-ray is recommended to be obtained as part of knee replacement preparation.     

关节镜清理术联合透明质酸钠治疗膝骨性关节炎的效果

目的探讨关节镜清理术联合透明质酸钠治疗膝骨性关节炎患者的效果。方法100例膝骨性关节炎患者随机分为两组各50例,对照组采用关节镜清理术治疗,实验组采用关节镜清理术联合透明质酸钠治疗,比较两组的关节液炎性因子水平、膝关节功能以及疼痛情况。结果治疗后,实验组的TNF-α、IL-6、IL-8水平均显著低于对照组(P<0.05)。治疗1个月、3个月、6个月后,实验组的Lysholm评分均显著高于对照组,VAS评分均显著低于对照组(P<0.05)。结论关节镜清理术联合透明质酸钠治疗膝骨性关节炎可降低患者关节液炎性因子水平,改善膝关节功能,减轻疼痛。     

Comparison of the treatment results of knee osteoarthritis using adipose tissue mesenchymal stromal cells derived through enzymatic digestion and mechanically fragmented adipose tissue

Introduction:Knee osteoarthritis is a common condition that affects daily functioning and decreases the quality of life. There are many ways of treatment depending on the stage of the disease. Advanced cases are qualified for arthroplasty, which is an extensive and demanding surgical procedure. Less advanced stages are treated in various ways: from rehabilitation, through oral and intra-articular pharmacotherapy, to surgical treatment (arthroscopy, osteotomy). Because surgical treatment is risky, scientists focus on less invasive therapeutic methods. The most valuable management is based on regeneration. Mesenchymal stromal cells (MSC) derived from the adipose tissue have a great regenerative and anti-inflammatory potential, therefore an attempt is being made to take advantage of them in knee osteoarthritis treatment.The study aims to compare the clinical effects of treatment of knee osteoarthritis using adipose tissue MSC obtained by an enzymatic method with the outcomes of the therapy with the mechanically fragmented adipose tissue.Methods:One hundred adults with primary knee osteoarthritis will undergo lipoaspiration under sterile conditions. The collected lipoaspirates will be further processed, depending on the randomly assigned group-enzymatically with the use of collagenase or mechanically using the Lipogems system. The preparations will be administered to the patients’ knee joints in the operating room under ultrasound control.The results of treatment will be assessed using Knee Injury and Osteoarthritis Outcome Score, measuring the flexibility of the knee joint, evaluating joint gap in X-ray and the quality of cartilage in magnetic resonance T2-mapping during 1 year after treatment.Discussion/conclusion:Identification and functional analysis of the regenerative capacity of adipose-derived MSC depending on three variables (body weight, sex, and age) will help to develop a targeted therapy for different groups of patients and will determine the effectiveness of both methods of treatment. An attempt will be made to identify groups of patients with the greatest regenerative potential of the adipose tissue, and thus indicate those with the most probable improvement of the joint condition.Trial registration:This study protocol has been approved by the Ethics Committee of Medical University of Warsaw and registered on www.clinicaltrials.gov: {"type":"clinical-trial","attrs":{"text":"NCT04675359","term_id":"NCT04675359"}}NCT04675359 (06 Jan 2021)     

Anatomic vs. reverse shoulder arthroplasty for glenohumeral osteoarthritis with intact rotator cuff: a retrospective comparison of patient-reported outcomes using the systems outcomes database with up to 5-year follow-up

BackgroundThe growing enthusiasm for the use of reverse shoulder arthroplasty (RSA) in the treatment of primary glenohumeral osteoarthritis (GHOA) with an intact rotator cuff is based on data derived from single-center studies with limited generalizability and follow-up. This study compared patient-reported outcomes (PROs) between RSA and total shoulder arthroplasty (TSA) for the treatment of primary GHOA with up to 5-year follow-up and examined temporal trends in the treatment of GHOA between 2012 and 2021.MethodsA retrospective review was performed on patients with primary GHOA undergoing primary arthroplasty surgery from the Surgical Outcomes System global registry between 2012 and 2021. PROs including the American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE) score, and visual analog scale (VAS) for pain were compared between RSA and TSA at 1, 2, and 5 years postoperatively.ResultsA total of 4451 patients were included, with 2693 (60.5%) undergoing TSA and 1758 (39.5%) undergoing RSA. Both RSA and TSA provided clinically excellent outcomes at 1 year postoperatively (ASES: 80.8 ± 17.9 vs. 85.9 ± 15.2, respectively; SANE: 74.8 ± 24.7 vs. 79.5 ± 22.9; VAS pain: 1.3 ± 2.0 vs. 1.1 ± 1.7; all P < .05) that were maintained at 2 years (ASES: 81.3 ± 19.3 vs. 87.3 ± 14.9; SANE: 74.8 ± 26.2 vs. 79.7 ± 24.7; VAS pain: 1.3 ± 2.1 vs. 1.0 ± 1.6; all P < .05) and 5 years (ASES: 81.7 ± 16.5 vs. 86.9 ± 15.3; SANE: 71.6 ± 28.5 vs. 78.2 ± 25.9; VAS pain: 1.0 ± 1.7 vs. 1.0 ± 1.7; all P < .05), with statistical significance favoring TSA. After controlling for age and sex, there was an adjusted difference of 4.5 units in the ASES score favoring TSA (P = .005) at 5 years postoperatively but no differences in adjusted SANE (P = .745) and VAS pain (P = .332) scores. The use of RSA for GHOA grew considerably over time, from representing only 17% of all replacements performed for GHOA in 2012 to nearly half (47%) in 2021 (P < .001).ConclusionRSA as a treatment for GHOA with an intact rotator cuff seems to yield PROs that are largely clinically equivalent to TSA extending to 5 years postoperatively. The observed statistical significance favoring TSA appears to be of marginal clinical benefit based on established minimal clinically important differences and may be a result of the large sample size. Further research using more granular clinical data and examining differences in range of motion and complications is warranted as it may change the value analysis.     

膝骨关节炎中医药系统生物学研究述评＊

膝骨关节炎（Knee Osteoarthritis， KOA）属于临床难治性疾病，其高发病率、高致残性给国民健康、社会发展造成了沉重的负担。在这种不利局面下，中医药在KOA的临床防治上发挥了巨大的作用，其根据“辨证施治”理念的指导对患者采用个体化治疗往往能够取得良好的临床疗效 。然而中医学在传统认知上作为经验医学的集成，现有的KOA中医药基础研究结果尚未完全阐明其客观化、现代化的属性，阻碍了中医药防治KOA科学内涵的揭示以及全面、系统的临床研究的开展和新药研发，如何开展完善、合理、可行的基础研究以进行KOA中医药客观化和现代化探索成为研究者不得不解决的重大难题。随着系统生物学知识结构和研究手段的完善与更新，其与中医药的结合已经成为阐释并创新中医药理论内核、突破中医药研究瓶颈的重要方法。本文通过总结、分析目前KOA中医药基础研究的现状与不足，突出系统生物学在目前KOA中医药研究中的关键作用及应用趋势，以期为今后KOA的中医药研究和发展提供新的思路与对策。     

Anatomic or reverse shoulder arthroplasty: indications and decision-making

Shoulder replacement surgery has become the gold standard treatment for end-stage glenohumeral arthropathies in patients who are fit for surgical treatment. The options include anatomic total shoulder replacement, reverse total shoulder replacement and humeral hemiarthroplasty procedures. Whilst for some patients and some indications there is little debate, decision-making for older patients with osteoarthritis remains one of the hot topics in shoulder surgery. In this article we will explore the treatment options, outcomes, and controversies.     

Disengagement of tibial insert locking pin in total knee arthroplasty - A rare failure case report

Total Knee Arthroplasty (TKA) has seen many advancements over the years. One such advancement is development of locking mechanism for polyethylene insert in modular implants. It aims to reduce micro motion and wear problems. Disengagement of locking pin from insert after primary TKA without trauma is rare complication. The author describes a rare case of disengagement of the polyethylene insert locking pin in primary total knee arthroplasty. Disengagement of the locking clip was observed 8 months after index operation without any trauma.     

Effect of altered sagittal-plane knee kinematics on loading during the early stance phase of gait

BackgroundIndividuals with knee osteoarthritis (OA) show various dynamic sagittal-plane changes during the early stance phase of gait. However, the effect of these kinematic alterations on knee load during the early stance remains poorly understood. Research question: The purpose of this study was to examine the effect of altered sagittal- plane knee kinematics on knee load during the early stance.MethodsA total of 13 healthy adult men underwent gait analysis trials using four conditions (baseline and three altered conditions). The three altered conditions were defined as follows:1) Less flexion (LF): a gait that decreased knee flexion excursion (KFE) owing to a reduced peak knee flexion angle compared to baseline.2) Initial flexion (IF): a gait with decreased KFE owing to an increased knee flexion angle at initial contact, during which the peak knee flexion angle did not differ from baseline.3) Flexion gait (FG): a gait that increased the knee flexion angle at initial contact but did not reduce KFE compared with the baseline.Data analyzed included peak external knee flexion moment (KFM), KFM impulse (impulse was an integral value from initial contact to peak value), peak vertical ground reaction force (VGRF), and maximum loading rate.ResultsBoth LF and IF conditions significantly decreased peak VGRF (p < 0.05) compared with the baseline. Peak KFM decreased in the LF condition and increased in the FG condition versus baseline (p < 0.05). A significantly increased KFM impulse was found in both IF and FG conditions when compared with baseline (p < 0.05).SignificanceAn increase in knee flexion angle during early stance increased knee loading. Interventions are likely required for improving excessive knee flexion during early stance phase of gait in individuals with knee OA.