Influence of Body Mass Index on Sagittal Knee Range of Motion and Gait Speed Recovery 1-Year After Total Knee Arthroplasty

Background

The purpose of this prospective study was to investigate the influence of body mass index (BMI) on gait parameters preoperatively and 1 year after total knee arthroplasty (TKA).

Assessment of postural stability in women with hip osteoarthritis: A case–control study

Objective

The aim of the study was to assessment the impact of hip osteoarthritis on postural stability.

Dexamethasone inhibits inflammation and cartilage damage in a new model of post‐traumatic osteoarthritis

Corticosteroids are used in musculoskeletal diseases, and offer patient relief. Injections of corticosteroids are recommended for management of osteoarthritis (OA). Current data have shown the role of corticosteroids in ameliorating pain. We hypothesized that repeated intra‐articular injections of high dose dexamethasone would protect the cartilage from damage in a post‐traumatic model of OA. Eighteen female New Zealand White rabbits were used. Twelve underwent surgery to induce OA; six of them received intra‐articular injections of dexamethasone every 3 days for 3 weeks. The other six rabbits served as operated controls. Six additional rabbits served as non‐operated controls. All animals were euthanized 3 weeks post‐surgery. Knees were assessed grossly. Cartilage, synovium, and fat pad were assessed histologically. Synovium and fat pad were analyzed with qPCR and Western blots. Surgical controls had cartilage damage which was supressed with dexamethasone. Dexamethasone significantly decreased synovial expression of interleukin‐1β and collagen I, and a trend to decrease synovial matrix metalloproteinase3 expression. There were also significantly lower levels of interleukin‐1β protein with dexamethasone treatment. Dexamethasone significantly decreased fat pad expression of matrix metalloproteinase13, basic fibroblast growth factor, and interleukin8, and a trend to decrease matrix metalloproteinase3 and transforming growth factorβ expression. Dexamethasone decreased joint inflammation and joint tissue degradation and was chondroprotective in this unique model of PTOA. © 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 32:566–572, 2014.     

The Cone-and-Plate(let) analyzer is not suitable to monitor clopidogrel therapy: A comparison with the flowcytometric VASP assay and optical aggregometry

Introduction

High on-clopidogrel platelet reactivity has been associated with an increased risk for atherothrombotic events. A new player on the horizon is the IMPACT-R ADP-test using ADP pre-stimulation. We here report the results of a thorough evaluation of this new device.

Materials and methods

The IMPACT-R ADP-test was evaluated in different categories of subjects. First, normal range values were determined in healthy subjects (n = 46). Second, the effect of 600 mg of clopidogrel was evaluated with the IMPACT-R ADP-test and two other well-validated methods (flowcytometric VASP-analysis and optical aggregometry) in 21 patients. Third, a head-to-head comparison between the IMPACT-R ADP-test and optical aggregometry was performed in a large cohort of patients on dual antiplatelet therapy.

Results

The results of the IMPACT-R ADP-test were highly variable throughout healthy subjects. The administration of a high clopidogrel loading dose resulted in a small but significant increase in surface coverage but 61.9% of the patients were still identified as clopidogrel nonresponder. In contrast, optical aggregometry and VASP-analysis identified 24% and 33% of these patients as a clopidogrel nonresponder, respectively. Head-to-head comparison with optical aggregometry in 451 patients showed only a modest correlation between both methods (r ∼ 0.20, p < 0.0001).

Conclusions

The IMPACT-R ADP-test is relatively insensitive to the effects of clopidogrel and cannot substitute for methods such as flowcytometric VASP-analysis and optical aggregometry. Further studies are required to establish the clinical usefulness of IMPACT-R ADP-test to accurately predict the occurrence of major adverse cardiovascular events in patients with high on-clopidogrel platelet reactivity before it can be implemented in clinical practice.     

Flavocoxid is as effective as naproxen for managing the signs and symptoms of osteoarthritis of the knee in humans: a short-term randomized,double-blind pilot study

Flavocoxid (Limbrel), a proprietary mixture of flavonoid molecules (baicalin and catechin), was tested against a traditional nonsteroidal anti-inflammatory drug, naproxen, for the management of the signs and symptoms of moderate osteoarthritis (OA) in humans. Discomfort and global disease activity were used as the primary end points, and safety assessments were also taken for both treatments as a secondary endpoint. In this double-blind study, 103 subjects were randomly assigned to receive either flavocoxid [500 mg twice daily (BID)] or naproxen (500 mg BID) in a 1-month onset of action trial. Outcome measures included the short Western Ontario and McMaster University Osteoarthritis Index, subject Visual Analogue Scale for discomfort and global response, and investigator Visual Analogue Scale for global response and fecal occult blood. Both flavocoxid and naproxen showed significant reduction in the signs and symptoms of knee OA (P ≤ .001). There were no statistically detectable differences between the flavocoxid and naproxen groups with respect to any of the outcome variables. Similarly, there were no statistically detectable differences between the groups with respect to any adverse event, although there was a trend toward a higher incidence of edema and nonspecific musculoskeletal discomfort in the naproxen group. In this short-term pilot study, flavocoxid was as effective as naproxen in controlling the signs and symptoms of OA of the knee and would present a safe and effective option for those individuals on traditional nonsteroidal anti-inflammatory drugs or cyclooxygenase-2 inhibitors. A low incidence of adverse events was reported for both groups.     

阿仑磷酸盐治疗老年性OA患者临床研究

目的：探讨阿仑磷酸盐在治疗老年性OA患者中的作用及可能机制。方法：用双能X线骨密度仪测定使用阿仑磷酸盐治疗的OA患者前后的骨密度，应用ELISA法检测患者前后血清中护骨素、破骨细胞分化因子（ODF）的水平。结果：应用双磷酸盐治疗的患者骨密度显著高于未使用者和使用前（P〈0.05）;血清中OPG/ODF水平，双磷酸盐治疗的患者高于未治疗的患者和治疗前（P〈0.05）。绪论双磷酸盐可以提高OA患者的骨密度，并可能通过改变OPG/ODF水平对骨代谢进行调节的。     

Factors Influencing the Improvement of Gait Ability After Total Hip Arthroplasty

We aimed to investigate the factors influencing gait improvement in the patients who had undergone total hip arthroplasty. We performed gait analysis on 43 female patients with unilateral hip osteoarthritis. All the patients were analyzed before and at 2, 6, and 12 months after the surgery. There were significant reductions in spatiotemporal parameters in the patients with hip osteoarthritis compared with the control group. The mean values of the spatiotemporal parameters of the patients showed considerable improvement by 12 months after surgery; however, they did not reach the same values as those observed in the healthy subjects. The stage of osteoarthritis and the changes in the leg-length discrepancies were the factors that most influenced gait improvement after total hip arthroplasty throughout the follow-up period.     

Strontium ranelate,a promising disease modifying osteoarthritis drug

Introduction: The articular cartilage and subchondral bone may have potential crosstalk in the development and progression of osteoarthritis (OA). Strontium ranelate (SrR) has the ability to dissociate the bone remodeling process and to change the balance between bone resorption and bone formation. Its effect on subchondral bone makes it a potential disease- modifying osteoarthritis drug (DMOAD) in the treatment of OA. The aim of the current review is to summarize up-to-date pharmacological and clinical data of SrR for OA treatment.

Areas covered: A literature search was performed on PubMed and European Medicines Agency (EMA) website for all publications and documents related to SrR and OA. References of related studies were searched by hand. Treatment with SrR, especially at the dosage of 2 g/day, was associated with reduced radiographic knee OA progression, and with meaningful clinical improvement. It was also significantly associated with decreased MRI-assessed cartilage volume loss (CVL) and bone marrow lesions (BMLs).

Expert opinion: SrR could be a promising DMOAD particularly for OA patients with bone phenotypes. The clinical efficacy and side effects of SrR for OA treatment need to be further investigated in future clinical trials before clinical application.