Prevalence of similar or worse symptom and osteoarthritis severity of index and contralateral knees prior to knee arthroplasty: A cross-sectional multicenter cohort study

BackgroundPatients considering knee arthroplasty (KA) and consulting orthopedic surgeons use different criteria to judge surgical appropriateness with surgeons placing high priority on osteoarthritis (OA) severity and age while patients place greatest emphasis on pain severity. In the face of fluctuating symptoms and high rates of bilateral knee OA, selection of the optimal knee for KA surgery can be challenging. This study examined osteoarthritis and symptom severity profiles of index versus contralateral knees of persons preparing for KA.MethodsThe nine-year Osteoarthritis Initiative data from 427 participants and five-year Multicenter Osteoarthritis Study data from 377 participants undergoing KA were included. The Western Ontario and McMaster Universities Osteoarthritis Index Pain, Function, and Stiffness Scales for both knees and radiographic readings were obtained at the visit prior to knee arthroplasty. Radar plots illustrated symptom and OA severity. Prevalence estimates of the proportion of contralateral knees with comparable or worse symptoms and OA severity relative to the index knee were reported.ResultsThe prevalence of comparable or worse knee OA on the contralateral knees as compared with index knees is 26% (95% CI = 22%, 30%). Prevalence of the same or worse WOMAC Pain for the contralateral knees relative to the index knees is 17% (95% CI = 14%, 21%).ConclusionsThe prevalence of comparable/worse knee OA or symptoms on the contralateral knees relative to index knees of persons undergoing unilateral KA is substantial. Methods for selecting the surgical knee should be reconsidered for this substantial subgroup of patients.     

Mid-term functional,clinical, and radiological outcomes with factors affecting revision of mobile-bearing medial unicompartmental knee arthroplasty

BackgroundTo evaluate and compare the clinical and radiological outcomes of patients subjected to medial unicompartmental knee arthroplasty (UKA).MethodsThe study included 146 knees of 115 consecutive medial UKAs patients with a minimum five-year follow-up. Pre- and postoperative functional and clinical outcomes were measured using the Visual Analog Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Oxford Knee Score (OKS), American Knee Society Score (AKSS-O), knee range of motion (ROM), and Short-Form Health Survey (SF-36). The Kellgren–Lawrence osteoarthritis (OA) grading system was used for the evaluation of the OA status. The joint line convergence angle (JLCA) of the operated and contralateral knee, the tibiofemoral coronal angle (TFCA), and the tibial slope angle were used in the radiological evaluation.ResultsThe mean age of patients was 58.8 ± 7.0 years. The mean follow-up period was 7.41 ± 1.54 years. Good to excellent functional outcomes were obtained according to VAS, WOMAC, OKS, AKSS-O, and SF-36 scores. Insert dislocation was the main reason for revision surgery (nine patients, 90%). Preoperative body mass index (BMI), postoperative BMI, American Society of Anesthesiologists (ASA) Score, postoperative knee flexion contracture, mean increase in postoperative medial joint space (PMJS) height, and OA progression were found to affect the revision status.ConclusionsGood to excellent functional, clinical, and radiological outcomes were obtained with medial UKA at a minimum follow-up of five years. Differences in preoperative and postoperative radiological parameters except an increase in PMJS height had no impact on revision status.     

Existence of a neuropathic pain component in patients with osteoarthritis of the knee

Purpose

Pain from osteoarthritis (OA) is generally classified as nociceptive (inflammatory). Animal models of knee OA have shown that sensory nerve fibers innervating the knee are significantly damaged with destruction of subchondral bone junction, and induce neuropathic pain (NP). Our objective was to examine NP in the knees of OA patients using painDETECT (an NP questionnaire) and to evaluate the relationship between NP, pain intensity, and stage of OA.

Materials and Methods

Ninety-two knee OA patients were evaluated in this study. Pain scores using Visual Analogue Scales (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), painDETECT, duration of symptoms, severity of OA using the Kellgren-Lawrence (KL) system, and amount of joint fluid were evaluated and compared using a Spearman''s correlation coefficient by rank test.

Results

Our study identified at least 5.4% of our knee OA patients as likely to have NP and 15.2% as possibly having NP. The painDETECT score was significantly correlated with the VAS and WOMAC pain severity. Compared with the painDETECT score, there was a tendency for positive correlation with the KL grade, and tendency for negative correlation with the existence and amount of joint fluid, but these correlations were not significant.

Conclusion

PainDETECT scores classified 5.4% of pain from knee OA as NP. NP tended to be seen in patients with less joint fluid and increased KL grade, both of which corresponded to late stages of OA. It is important to consider the existence of NP in the treatment of knee OA pain.     

Correlation between static limb alignment and peak knee adduction angle during gait is affected by subject pain in medial knee osteoarthritis

BackgroundAlthough increases in knee adduction moment (KAM) and angle (KAA) during gait are considered key pathologies that produce mechanical overload in the medial compartment of knee osteoarthritis (OA), it is unclear how these pathologies are related to subjective pain. The purpose of this study was to examine how subjective pain is related to such pathologies.MethodsGait analysis was performed in 31 participants with medial knee OA. The knees were classified into three groups based on Kellgren–Lawrence (KL) grade: early (0 and 1), moderate (2), and severe (3 and 4). Subjective pain was evaluated by the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index pain score. The knees were classified into low- and high-pain groups based on the pain score.ResultsThe WOMAC pain score did not correlate with either peak KAM or peak KAA. Although a positive correlation between static limb alignment and peak KAA was observed in the low-pain group, it was not observed in the high-pain group. Knee flexion angle at heel strike correlated negatively with the gap between static femorotibial angle and peak KAA in the high-pain group.ConclusionsAlthough a direct correlation between subjective pain and peak KAM or KAA was not observed, our results suggest a compensatory movement in the high-pain group of participants to reduce KAA increases in the early stance phase. Such movements would be one of the reasons why it is difficult to obtain a consistent relationship between subjective pain and load-related parameters.     

Factors associated with poor self-reported function and quality of life in patients with end-stage knee or hip osteoarthritis immediately prior to total joint arthroplasty

IntroductionThe aim was to evaluate patients’ perception of function and physical and mental dimensions of health-related quality of life (HRQoL) in patients with end-stage knee or hip osteoarthritis (OA) immediately prior to surgery and to identify the factors associated with the outcomes.Material and methodsThe study included 200 patients with end-stage OA (100 knee OA and 100 hip OA patients). Self-reported physical function was assessed using the Oxford Knee Score or Oxford Hip Score. Physical and mental dimensions of HRQoL were assessed using the physical and mental component summary scores of the 36-Item Short-Form Health Survey. Multivariate linear regression analysis was used to identify the sociodemographic, clinical and psychological factors associated with self-reported function and physical and mental dimensions of HRQoL.ResultsEnd-stage knee or hip OA patients had poor function and physical dimension of HRQoL, while the mental dimension of HRQoL was not impaired. In knee OA, pain, flexion range of motion (ROM), catastrophizing, and anxiety were significantly associated with self-reported function (explained 56% of the variance), whereas catastrophizing explained 10% of the variance of the physical dimension of HRQoL. In hip OA, flexion ROM, catastrophizing and being employed were significantly associated with self-reported function (explained 44% of the variance), whereas catastrophizing and flexion ROM explained 34% of the variance of the physical dimension of HRQoL.ConclusionsMany investigated factors were associated with poor self-reported function and HRQoL in knee and hip OA. However, the most important factors for both knee and hip OA were catastrophizing and flexion ROM.     

Females with knee osteoarthritis use a detrimental knee loading strategy when squatting

BackgroundThe purpose of this study was to identify sex differences in lower limb kinematics, kinetics, and muscle activation patterns between individuals with osteoarthritis and healthy controls during a two-legged squat.MethodThirty OA (15 females) and 30 healthy (15 females) participants performed three 2-legged squats. Sagittal and frontal plane hip, knee, and ankle kinematics and kinetics were calculated. Two-way ANOVAs (Sex X OA Status) were used to characterize differences in squatting strategies between sexes and between those with and without knee OA.ResultsA greater decrease in sagittal hip, knee, and ankle range of motion and knee joint power was observed in the OA participants compared to the healthy controls. Females with OA had significantly reduced hip and knee adduction angles compared to the healthy females and males with OA. Females also had decreased hip power, hip flexion, and hip adduction moments and knee adduction moments compared to their male counterparts, with the greatest deficits observed in the females with OA. Females with OA also had the highest magnitude of muscle activation for the quadriceps, hamstrings, and gastrocnemius throughout the squat, while males with OA showed increased activation of the vastus lateralis and medial gastrocnemius compared to the healthy males.ConclusionsOA significantly altered biomechanics and neuromuscular control during the squat, with males employing a hip-dominant strategy, allowing them to achieve a greater lower limb range of motion.     

A pilot study on using acupuncture and transcutaneous electrical nerve stimulation (TENS) to treat knee osteoarthritis (OA)

Background

The present study tests whether a combined treatment of acupuncture and transcutaneous electrical nerve stimulation (TENS) is more effective than acupuncture or TENS alone for treating knee osteoarthritis (OA).

Methods

Thirty-two patients with knee OA were randomly allocated to four groups. The acupuncture group (ACP) received only acupuncture treatment at selected acupoints for knee pain; the TENS group (TENS) received only TENS treatment at pain areas; the acupuncture and TENS group (A&T) received both acupuncture and TENS treatments; the control group (CT) received topical poultice (only when necessary). Each group received specific weekly treatment five times during the study. Outcome measures were pain intensity in a visual analogue scale (VAS) and knee function in terms of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).

Results

The ACP, TENS and A&T groups reported lower VAS and WOMAC scores than the control group. Significant reduction in pain intensity (P = 0.039) and significant improvement in knee function (P = 0.008) were shown in the A&T group.

Conclusion

Combined acupuncture and TENS treatment was effective in pain relief and knee function improvement for the sampled patients suffering from knee OA.     

Vitamin D status is associated with inflammatory biomarkers and clinical symptoms in patients with knee osteoarthritis

Background and aimThe association between vitamin D status and osteoarthritis (OA) and bone remodeling has been shown previously. The present study was conducted to determine the association between vitamin D status and inflammatory biomarkers and clinical symptoms in patients with knee OA.MethodsThis case–control study was performed on 124 subjects with mild to moderate knee OA and 65 healthy controls. Demographic data was collected from all participants at baseline. We used Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC Index) for evaluating the severity of clinical symptoms in these patients. Serum levels of vitamin D as well as markers of inflammation including interleukin 1-β (IL-1β), interleukin 6 (IL-6), interleukin 10 (IL-10), tumor necrosis factor-alpha (TNF-α), high-sensitivity C-reactive protein (hs-CRP), and nuclear factor k-B (NF-κB) p65 were evaluated for each participant.ResultsThe results of the present study showed that patients with knee OA had lower levels of vitamin D and higher levels of IL-1β, TNF-α, hs-CRP, and NF-кB p65 compared with healthy controls (P < 0.0001). The levels of IL-1β, TNF-α, and NF-кB p65 in knee OA patients with vitamin D insufficiency were significantly higher compared with the knee OA patients with sufficient vitamin D (P < 0.05). Based on the linear regression analysis, serum vitamin D levels were inversely correlated with IL-1β, TNF-α, hs-CRP, and NF-кB p65 levels (P < 0.0001). Patients with sufficient vitamin D levels had lower total and physical function WOMAC scores compared with patients with vitamin D insufficiency (P = 0.011 and P = 0.010, respectively).ConclusionThe results suggest a strong link between vitamin D deficiency and increased inflammatory biomarkers as well as increased severity of clinical symptoms in knee OA patients.     

Efficacy of Direct Injection of Etanercept into Knee Joints for Pain in Moderate and Severe Knee Osteoarthritis

Purpose

Osteoarthritic (OA) pain is largely considered to be inflammatory pain. However, during the last stage of knee OA, sensory nerve fibers in the knee are shown to be significantly damaged when the subchondral bone junction is destroyed, and this can induce neuropathic pain. Several authors have reported that tumor necrosis factor-α (TNFα) in a knee joint plays a crucial role in pain modulation. The purpose of the current study was to evaluate the efficacy of etanercept, a TNFα inhibitor, for pain in knee OA.

Materials and Methods

Thirty-nine patients with knee OA and a 2-4 Kellgren-Lawrence grading were evaluated in this prospective study. Patients were divided into two groups; hyaluronic acid (HA) and etanercept injection. All patients received a single injection into the knee. Pain scores were evaluated before and 4 weeks after injection using a visual analogue scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and they were compared between the groups.

Results

Before injection, VAS and WOMAC scores were not significantly different between the groups (p>0.05). Significant pain relief was found in the etanercept group at 1 and 2 weeks by VAS, and at 4 weeks by WOMAC score, compared with the HA group (p<0.05). No adverse events were observed in either group.

Conclusion

Direct injection of etanercept into OA knee joints was an effective treatment for pain in moderate and severe OA patients. Furthermore, this finding suggests that TNFα is one factor that induces OA pain.     

High expression of TNF alpha is associated with −308 and −238 TNF alpha polymorphisms in knee osteoarthritis

Knee osteoarthritis (OA) is a common chronic degenerative disease characterized by the loss of articular cartilage components due to an imbalance between extracellular matrix destruction and repair. The proinflammatory cytokines involved in OA, TNFα and IL1β, are considered the major implicated. The aim of this study was to investigate the relationship between TNFα ?308 and ?238 polymorphisms with messenger RNA (mRNA) and soluble TNFα expression in knee OA patients and healthy subjects (HS). Case–control study involved 50 knee OA patients classified according to 1986 ACR Classification Criteria, as well as 100 HS. The Western Ontario and McMaster Universities Osteoarthritis Index and Lequesne disability index were applied to OA patients. The ?308 and ?238 polymorphisms were determined by polymerase chain reaction–restriction fragment length polymorphism technique. The TNFα mRNA expression was quantified by real-time PCR using TaqMan method. The sTNFα levels were measured by enzyme-linked immunosorbent assay. The TNFα mRNA expression in knee OA patients was higher than in HS (1.56-fold). In addition, the TNFα mRNA expression was higher in carriers of G allele in the knee OA group for both polymorphisms. The sTNFα levels were increased in G/G versus G/A genotypes in both studied polymorphisms (p < 0.05). However, the TNFα ?308 and ?238 genotypes did not show statistical differences between groups. The G allele of TNFα ?308 and ?238 polymorphisms is associated with high mRNA and soluble expression in knee OA patients. However, it is not a marker of susceptibility in Western Mexico. Further studies are necessary to confirm these findings.     

Cartilage regeneration in osteoarthritic knees treated with distal femoral osteotomy and intra-lesional implantation of allogenic human umbilical cord blood-derived mesenchymal stem cells: A report of two cases

BackgroundTo treat lateral compartment osteoarthritis caused by a valgus deformity, partial or total knee joint arthroplasty is recommended. However, for young patients, joint preservation surgery such as distal femoral osteotomy (DFO) can be an alternative treatment option. Combined cartilage defects of lateral compartment osteoarthritis can be restored by human umbilical cord blood-derived mesenchymal stem cells (hUCB-MSCs). This case report presents the results of DFO and hUCB-MSC implantation for treating two patients with valgus deformity who had lateral compartment osteoarthritis.Case presentationTwo middle-aged patients with lateral compartment osteoarthritis and valgus deformity were treated using DFO and hUCB-MSC implantation. They recovered sufficiently to perform moderate exercise one year after surgery. The International Knee Documentation Committee, visual analog scale, and Western Ontario and McMaster Universities Osteoarthritis Index scores showed continuous improvement after surgery. Cartilage regeneration of International Cartilage Repair Society Grade 1, which was similar to normal, was observed in both patients through second-look arthroscopy. With time, the modified two-dimensional magnetic resonance observation of cartilage repair tissue scores also increased in both cases.ConclusionThis is the first case report detailing the results of treating lateral compartment osteoarthritis using hUCB-MSCs and DFO. In conclusion, this can be considered a new treatment option for such cases.     

Effects of preoperative physiotherapy in hip osteoarthritis patients awaiting total hip replacement

Introduction

The World Health Organization (WHO) claimed osteoarthritis as a civilization-related disease. The effectiveness of preoperative physiotherapy among patients suffering hip osteoarthritis (OA) at the end of their conservative treatment is rarely described in the literature. The aim of this study was to assess the quality of life and musculoskeletal health status of patients who received preoperative physiotherapy before total hip replacement (THR) surgery within a year prior to admission for a scheduled THR and those who did not.

Material and methods

Forty-five patients, admitted to the Department of Orthopaedics and Traumatology of Locomotor System for elective total hip replacement surgery, were recruited for this study. The assessment consisted of a detailed interview using various questionnaires: the Harris Hip Score (HHS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the 36-Item Short Form Health Survey (SF-36), and the Hip disability and Osteoarthritis Outcome Score (HOOS), as well as physical examination. Patients were assigned to groups based on their attendance of preoperative physiotherapy within a year prior to surgery.

Results

Among patients who received preoperative physiotherapy a significant improvement was found for pain, daily functioning, vitality, psychological health, social life, and (active and passive) internal rotation (p < 0.05).

Conclusions

Patients are not routinely referred to physiotherapy within a year before total hip replacement surgery. This study confirmed that pre-operative physiotherapy may have a positive influence on selected musculoskeletal system status indicators and quality of life in hip osteoarthritis patients awaiting surgery.     

Association between in vivo knee kinematics during gait and the severity of knee osteoarthritis

BackgroundOsteoarthritis patients may exhibit different kinematics according to the disease stage. However, changes in the frontal and horizontal planes in each stage remain unclear. The purpose of this study was to investigate changes in the knee kinematic gait variables of osteoarthritis patients, including the frontal and horizontal planes, with respect to the severity of the disease.MethodsForty-five patients with knee osteoarthritis and 13 healthy young subjects were recruited for the experiment. All subjects were examined while walking on a 10-m walkway at a self-selected speed. In each trial, we calculated the angular displacements of flexion/extension, abduction/adduction, and external/internal tibial rotation. We also measured muscle strength, range of motion (ROM), and alignment. We compared the differences in osteoarthritis severity and knee kinematic variables between osteoarthritis patients and normal subjects.ResultsThe flexion angle at the time of foot contact was significantly less in patients with severe and moderate osteoarthritis than in normal subjects (both p < 0.01). The abduction angle at the 50% stance phase was significantly less in patients with severe osteoarthritis than in normal subjects (p < 0.05). The excursion of axial tibial rotation was significantly less in patients with early osteoarthritis than in normal subjects (p < 0.05).ConclusionOsteoarthritis patients had different knee kinematics during gait, depending on the progress of osteoarthritis. Early-stage patients exhibit decreased axial tibial rotation excursion, while severe-stage patient exhibit increased knee adduction.     

The efficacy of intra-articular injections in the treatment of knee osteoarthritis: A network meta-analysis of randomized controlled trials

PurposeOsteoarthritis (OA) is a debilitating joint disease characterized by progressive loss of articular cartilage. Intra-articular injections are a mainstay of nonoperative treatment, however, there is controversy as to the optimal injectable for these patients. The purpose of the current study is to perform a network meta-analysis of the randomized control trials in the literature to ascertain whether there is a superior injectable nonoperative treatment for knee OA.MethodsThe literature search was conducted based on the PRISMA guidelines. Randomized control trials (RCTs) evaluating intra-articular injectables in osteoarthritic knees were included. Data was extracted and Visual Analogue Scale (VAS) scores and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, where available were analyzed at 1, 3, 6 and 12 months. Clinical outcomes were compared using a frequentist approach to network meta-analysis, with statistical analysis performed using R. The treatment options were ranked using the P-Score.ResultsSeventy-nine RCTs with 8761 patients were included in this review. Intra-articular injectables evaluated included autologous conditioned serum (ACS), bone marrow aspirate concentrate (BMAC), botulinum toxin, corticosteroids (CS), hyaluronic acid (HA), mesenchymal stem cells (MSC), ozone, saline placebo, platelet-rich plasma (PRP), plasma rich in growth factor (PRGF), and stromal vascular fraction (SVF). At 4–6 weeks and 3 months of follow-up, the treatment with the highest P-Score for WOMAC score was high molecular weight (HMW) HA + CS [P-Score = 0.9500 and 8503, respectively]. At 6-months follow-up, the treatment with the highest P-Score for WOMAC score was PRP [P-Score = 0.7676]. At all post-injection time points, the treatment with the highest P-Score for VAS score [P-Score Range = 0.8631–9927] and Womac score at 12 Months [P-Score = 0.9044] was SVF.ConclusionsThe current evidence shows that SVF injections result in the greatest improvement in pain and functional outcomes in patients with knee OA at up to 1 year of follow-up.     

Which patientswith osteoarthritis of hip and/or knee benefit most from behavioral graded activity?

Our objective was to investigate whether behavioral graded activity (BGA) has particular benefit in specific subgroups of osteoarthritis (OA) patients. Two hundred participants with OA of hip or knee, or both (clinical American College of Rheumatology, ACR, criteria) participated in a randomized clinical trial on the efficacy of BGA compared to treatment according to the Dutch physiotherapy guideline (usual care; UC). Changes in pain (Visual Analog Scale, VAS), physical functioning (Western Ontario and McMaster Universities Osteoarthritis Index, WOMAC, and McMaster Toronto Arthritis Questionnaire, MACTAR), and patient global assessment were compared for specific subgroups. Subgroups were assigned by the median split method and were analyzed using analysis of covariance. Beneficial effects of BGA were found for patients with a relatively low level of physical functioning (p?0.03). Furthermore, beneficial effects of BGA in patients with a low level of internal locus of control were marginally significant (p =.05). Patients with a relatively low level of physical functioning benefit more from BGA compared to UC. Compared to UC, BGA is the preferred treatment option in patients with a low level of physical functioning.     

超声疗法治疗膝骨关节炎疼痛的荟萃分析

背景：超声疗法被推荐为治疗骨关节炎引起的疼痛和运动能力丧失的理疗方法之一。但其对于治疗骨关节疼痛的有效性在以往的各项研究中尚存在争议。 目的：分析研究超声疗法治疗膝骨关节炎疼痛的有效性。 方法：计算机检索PubMed、Ovid/Medline、Ovid/EMBASE、Cochrane数据库以及手工检索相关文献的参考文献。所有检索截止至2014年3月31日。收集国内外公开发表的有关超声疗法治疗膝骨关节炎有效性的随机对照试验。 结果与结论：纳入Meta分析的研究共8个。8篇文献中6篇文献同时用了目测类比疼痛评分和麦克马斯特大学骨关节炎指数(WOMAC)疼痛评分评价超声疗法治疗膝骨关节炎疼痛的效果,1篇文献仅用了目测类比疼痛评分,1篇文献仅用了麦克马斯特大学骨关节炎指数(WOMAC)疼痛评分,将此文献中的麦克马斯特大学骨关节炎指数(WOMAC)疼痛评分数值转换成目测类比疼痛评分数值进行数据分析。累计研究对象570例。治疗组和对照组的目测类比疼痛评分(标准化均值差：-0.51;95%置信区间：-0.68,-0.33;P=0.05)组间差异有显著性意义。可见超声波疗法是治疗膝骨关节炎疼痛的有效方法。 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程全文链接：     

Isokinetic assessment of the hip muscles in patients with osteoarthritis of the knee

OBJECTIVES:

To evaluate the difference in isokinetic strength of hip muscles between patients with knee osteoarthritis (OA) and matched healthy controls, and to establish the correlation between this isokinetic strength and pain and function in patients with knee OA.

METHODS:

25 patients with a diagnosis of unilateral knee OA, 25 patients with bilateral knee OA, and 50 matched controls were evaluated using the visual analog scale for pain, knee Lequesne index, Western Ontario and McMaster Universities questionnaire and an isokinetic test.

RESULTS:

The groups were matched for age, gender and body mass index. The results of the isokinetic test revealed lower peak torque of the hip in patients with OA of the knee than in the control group for all movements studied. Strong correlations were found between the peak torque, visual analog scale and function.

CONCLUSIONS:

Patients with OA of the knee exhibit lower isokinetic strength in the hip muscles than healthy control subjects. Strengthening the muscles surrounding the hip joint may help to decrease pain in people with knee OA. Some correlations between pain/function and peak torque were found.     

Residual varus alignment after total knee arthroplasty increases knee adduction moment without improving patient function: A propensity score-matched cohort study

BackgroundTargeting residual varus alignment in total knee arthroplasty may be functionally beneficial to preoperative varus patients.MethodsBilateral TKA patients were enrolled. According to the postoperative hip-knee-ankle axis, patients were allocated into residual varus (3° ± 1°) alignment group or neutral (0° ± 1°) alignment group. Then, 1:2 propensity score matching was used to match preoperative variables. Finally, matched neutral (n = 45) and varus groups (n = 32) were followed-up for two years and compared. The primary outcome was the Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcomes were range of motion (ROM), Knee Society knee score and function score, spatiotemporal gait parameters, dynamic alignment, knee flexion angle, knee adduction moment (KAM) and internal knee extension moment.ResultsAt two years after surgery, the mean difference of WOMAC score was 0.3 (95% CI, [? 3.1, 3.7]) between the two groups. All secondary outcomes, except KAM and dynamic alignment, showed no significant difference between the two groups. Residual varus alignment group showed increased KAM and maximum KAM was 19% higher (P = 0.006).ConclusionsResidual varus alignment showed no clinical benefits, and both groups of patients had a functionally identical knee gait biomechanics, except for increased KAM and varus alignment. The authors consider that even in patients with varus alignment, the first principle is still achieving neutral alignment, which is helpful for reducing the KAM.Level of evidenceIII, retrospective cohort study.     

Serum and synovial fluid concentrations of interleukin-18 and interleukin-20 in patients with osteoarthritis of the knee and their correlation with other markers of inflammation and turnover of joint cartilage

IntroductionOsteoarthritis (OA) is the most common degenerative joint disease, and its aetiology is not entirely known. The aim of the study was to evaluate the involvement of interleukin-18 (IL-18) and interleukin-20 (IL-20) in the pathogenesis of knee OA and their correlations with other markers of inflammation and destruction of joint cartilage, as well as clinical and radiological changes.Material and methodsThe study included 25 patients with knee OA and a control group. The concentration of IL-18, IL-20, IL-6, MMP-1, MMP-3, COMP, PG-AG, and YKL-40 in serum and synovial fluid (SF) were determined. We also evaluated radiological lesions of the knee joint according to the Kellgren-Lawrence (K-L) scale, and clinical severity of the disease according to Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Lequesne Index.ResultsThe concentrations of IL-18 and IL-20 were statistically significantly higher in serum of patients with OA than in the control group (106.00 ±189.76 pg/ml vs. 16.73 ±16.99 pg/ml, p < 0.001, 17.69 ±13.45 pg/ml vs. 9.76 ±9.00 pg/ml, p < 0.014). Serum concentration of IL-18 positively correlated with MMP-3 (R = 0.58; p = 0.006) and YKL-40 (R = 0.48; p = 0.002). The degree of radiological advancement of OA (K-L scale) correlated positively with clinical evaluation (WOMAC, R = 0.74, p ≤ 0.001; Lequesne Index, R = 0.57, p = 0.003).ConclusionsThe analysis of ROC curves showed that IL-20 as well as COMP, MMP-3, and YKL-40 may be diagnostic markers of knee OA. The observations indicate that IL-18 potentially mediates mainly in intra-articular processes and IL-20 could be primarily responsible for the systemic inflammatory reaction.     

Serum Interleukin-15 Levels Are Associated with Severity of Pain in Patients with Knee Osteoarthritis

Background. Inflammation plays a crucial role in the development and progression of osteoarthritis (OA). Interleukin-15 (IL-15) is a well-known proinflammatory cytokine. Objective. We aimed at evaluating the relationship between serum IL-15 levels and the severity of pain as well as radiographic progression in patients with knee OA. Methods. Two hundred and twenty-six OA patients and 106 controls were enrolled in this study. The symptomatic/radiological severity of OA was assessed by the Western Ontario McMaster University Osteoarthritis Index- (WOMAC-)pain scores/Kellgren-Lawrence (KL) grading system. Serum IL-15 levels were measured by enzyme-linked immunosorbent assay (ELISA). Results. Serum IL-15 levels were significantly higher in OA patients compared with controls. Serum IL-15 levels were independently and positively correlated with WOMAC-pain scores but not KL grades in OA patients. Conclusions. We demonstrated that increased serum IL-15 levels were independently correlated with self-reported greater pain in knee OA patients. These results suggest that IL-15 might play a crucial role in the pathogenesis of OA related pain and therapeutic interventions by blocking IL-15 signaling pathways to delay the degenerative process of OA related pain which warrants further investigations.