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Increasing evidence is emerging to link age-associated complex musculoskeletal diseases, including osteoarthritis (OA), to developmental factors. Multiple studies have shown a functional role for DNA methylation in the genetic mechanisms of OA risk using articular cartilage samples taken from aged individuals, yet knowledge of temporal changes to the methylome during human cartilage development is limited. We quantified DNA methylation at ∼700,000 individual CpGs across the epigenome of developing human chondrocytes in 72 samples ranging from 7 to 21 post-conception weeks. We identified significant changes in 3% of all CpGs and >8,200 developmental differentially methylated regions. We further identified 24 loci at which OA genetic variants colocalize with methylation quantitative trait loci. Through integrating developmental and mature human chondrocyte datasets, we find evidence for functional effects exerted solely in development or throughout the life course. This will have profound impacts on future approaches to translating genetic pathways for therapeutic intervention., Competing Interests: Declaration of interests L.M. has received speaker and consultancy fees from Illumina., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Total joint arthroplasty (TJA) ranks among the most commonly performed orthopedic surgeries, with its annual incidence on the rise globally. Periprosthetic joint infection (PJI) remains a leading cause of arthroplasty failure. This review aims to summarize recent literature updates on the epidemiology, diagnosis, and management of PJI., Competing Interests: Disclosure The Authors have nothing to disclose. Declaration of AI and AI-assisted technologies in the writing process: During the preparation of this work, the authors used ChatGPT in order to check the grammar and improve readability. After using this tool, the authors reviewed and edited the content as needed and take full responsibility for the content of the publication., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: Total joint arthroplasty (TJA) is a common procedure that improves the quality of life for severe arthritis patients. The rising demand for TJA places enormous financial strain on the world's healthcare systems, which is exacerbated by postoperative readmissions for complications such as periprosthetic joint infections (PJIs). We conducted a systematic review and meta-analysis to determine if asymptomatic bacteriuria (ASB) increases infection risk., Methods: We conducted searches in three databases: PubMed, Scopus, and Web of Science. Screening steps have been carried out according to PRISMA guidelines. The study focused on patients who had undergone TJA and exhibited ASB. Two reviewers independently screened, assessed quality, and extracted data. Meta-analysis used Mantel-Haenszel method., Results: Following full-text screening, 12 studies were deemed eligible for inclusion in the systematic review, encompassing a total of 42,592 patients. A heightened occurrence of PJI was observed among TJA patients with ASB in comparison to controls (OR [95%CI] = 3.47 [1.42-8.44]). However, microorganisms responsible for the PJIs differed from those identified in the urine cultures of ASB. Additionally, analyses indicate that preoperative antibiotic treatment for ASB does not significantly affect the subsequent risk of PJI (OR [95% CI] = 1.00 [0.42-2.39]). Unlike surgical site infection (SSI), which did not show a difference in the rate of occurrence between the two groups, TJA patients with ASB were more likely to experience superficial wound infection (OR [95%CI] = 3.81 [2.02-7.21])., Conclusion: This review and meta-analysis confirm that ASB correlate with heightened risks of PJI and superficial infection in TJA patients. However, no relationship was found between ASB and PJI microorganisms which raise doubts about the role of ASB microorganisms as the direct cause of infection following TJA., Competing Interests: Declarations. Ethical approval: Not applicable. Competing interests: The authors have no competing interests to declare that are relevant to the content of this article., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Pain is the leading reason people seek orthopedic and rheumatological care. By definition, most pain can be classified as nociceptive, or pain resulting from non-neural tissue injury or potential injury, with between 15% and 50% of individuals suffering from concomitant neuropathic pain or the newest category of pain, nociplastic pain, defined as "pain arising from altered nociception despite no clear evidence of actual or threatened tissue damage, or of a disease or lesion affecting the somatosensory system." Pain classification is important because it affects treatment decisions at all levels of care. Although several instruments can assist with classifying treatment, physician designation is the reference standard. The appropriate treatment of pain should ideally involve multidisciplinary care including physical therapy, psychotherapy and integrative therapies when appropriate, and pharmacotherapy with non-steroidal anti-inflammatory drugs for acute, mechanical pain, membrane stabilizers for neuropathic and nociplastic pain, and serotonin-norepinephrine reuptake inhibitors and tricyclic antidepressants for all types of pain. For nonsurgical interventions, there is evidence to support a small effect for epidural steroid injections for an intermediate-term duration, and conflicting evidence for radiofrequency ablation to provide at least 6months of benefit for facet joint pain, knee osteoarthritis, and sacroiliac joint pain. Since pain and disability represent the top reason for elective surgery, it should be reserved for patients who fail conservative interventions. Risk factors for procedural failure are the same as risk factors for conservative treatment failure and include greater disease burden, psychopathology, opioid use, central sensitization and multiple comorbid pain conditions, poorly controlled preoperative and postoperative pain, and secondary gain., (Copyright © 2024. Published by Elsevier Masson SAS.)

Background: Patients with knee osteoarthritis (KOA) often present lower extremity motor dysfunction. However, traditional radiography is a static assessment and cannot achieve long-term dynamic functional monitoring. Plantar pressure signals have demonstrated potential applications in the diagnosis and rehabilitation monitoring of KOA., Objective: Through wearable gait analysis technology, we aim to obtain abundant gait information based on machine learning techniques to develop a simple, rapid, effective, and patient-friendly functional assessment model for the KOA rehabilitation process to provide long-term remote monitoring, which is conducive to reducing the burden of social health care system., Methods: This cross-sectional study enrolled patients diagnosed with KOA who were able to walk independently for 2 minutes. Participants were given clinically recommended functional tests, including the 40-m fast-paced walk test (40mFPWT) and timed up-and-go test (TUGT). We used a smart shoe system to gather gait pressure data from patients with KOA. The multidimensional gait features extracted from the data and physical characteristics were used to establish the KOA functional feature database for the plantar pressure measurement system. 40mFPWT and TUGT regression prediction models were trained using a series of mature machine learning algorithms. Furthermore, model stacking and average ensemble learning methods were adopted to further improve the generalization performance of the model. Mean absolute error (MAE), mean absolute percentage error (MAPE), and root mean squared error (RMSE) were used as regression performance metrics to evaluate the results of different models., Results: A total of 92 patients with KOA were included, exhibiting varying degrees of severity as evaluated by the Kellgren and Lawrence classification. A total of 380 gait features and 4 physical characteristics were extracted to form the feature database. Effective stepwise feature selection determined optimal feature subsets of 11 variables for the 40mFPWT and 10 variables for the TUGT. Among all models, the weighted average ensemble model using 4 tree-based models had the best generalization performance in the test set, with an MAE of 2.686 seconds, MAPE of 9.602%, and RMSE of 3.316 seconds for the prediction of the 40mFPWT and an MAE of 1.280 seconds, MAPE of 12.389%, and RMSE of 1.905 seconds for the prediction of the TUGT., Conclusions: This wearable plantar pressure feature technique can objectively quantify indicators that reflect functional status and is promising as a new tool for long-term remote functional monitoring of patients with KOA. Future work is needed to further explore and investigate the relationship between gait characteristics and functional status with more functional tests and in larger sample cohorts., (©Junan Xie, Shilin Li, Zhen Song, Lin Shu, Qing Zeng, Guozhi Huang, Yihuan Lin. Originally published in JMIR Aging (https://aging.jmir.org), 25.11.2024.)

Objective: This study aimed to compare the imaging features of bilateral knees, ankles, and the first metatarsophalangeal joint using high-frequency ultrasonography in male patients with familial and sporadic primary gout and sought to elucidate the relationship between the presence of tophi and various clinical indicators., Method: Male patients with primary gouty arthritis (GA) in the acute phase presenting to the Department of Rheumatology and Immunology at the First Affiliated Hospital of Chengdu Medical College from November 2020 to June 2022 were enrolled and classified into familial and sporadic gout groups. Comparative analyses of their clinical data and ultrasonographic imaging findings of the knees, ankles, and first metatarsophalangeal joints were performed between the groups. Univariate and multivariate logistic regression analyses, as well as receiver operating characteristic (ROC) analysis, were conducted to determine the effectiveness of significant factors in the prediction of tophi., Result: In comparison to male patients with sporadic gout, those with familial primary gout exhibited lower age, body mass index, disease duration, and serum uric acid (SUA) levels. However, they demonstrated higher incidences of tophi and bone erosion (54.6% in familial gout vs. 35.1% in sporadic gout, p  < 0.05; 71.2% in familial gout vs. 48.1% in sporadic gout, p  < 0.05, respectively), with a greater prevalence of tophi in the right first metatarsophalangeal joint (44.2% in familial gout vs. 32.3% in sporadic gout, p  < 0.05). Independent risk factors for tophi included family history (OR = 6.712), age (OR = 1.049), disease duration (OR = 1.134), and SUA levels (OR = 1.006). ROC analysis yielded an area under the curve of 0.883 ( p  < 0.05) for predicting joint tophi using these factors., Conclusion: Male patients with familial primary GA in the acute phase experienced earlier onset, shorter disease duration compared to those with sporadic gout. They also had more affected joints, more frequent and a wider distribution of tophi, especially in the right first metatarsophalangeal joint. Family history, age, disease duration, and SUA levels are predictive of tophi formation., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Wen, Ma, Dang, Lei, Hu and Liu.)

Objectives: To analyse temporomandibular disorders (TMD), bruxism and well-being in patients with fibromyalgia and compare these outcomes with a control group., Method: Diagnostic criteria for the assessment of TMD, bruxism and well-being were used in a clinic context including patients with fibromyalgia (n = 71) and a control group of healthy subjects (n = 151). Participants completed an online questionnaire measuring temporomandibular pain, headache attributed to TMD, jaw locking, joint sounds, headache to bruxism, potential sleep bruxism, potential awake bruxism, jaw functional limitation scale 8 (JFLS-8), generalised anxiety disorder scale 7, oral health impact profile scale 14, World Health Organization well-being index (WHO-5) and Pittsburgh sleep quality index (PSQI)., Results: TMD and bruxism were significantly associated with the type of population (χ 2  = 8.77-57.62; p < 0.05; ES = 0.20-0.51). Fibromyalgia patients showed higher prevalence (% values) than control group in temporomandibular pain, headache attributed to TMD, jaw locking, headache attributed to potential bruxism, sleep bruxism and awake bruxism. However, there was a greater prevalence of joint sounds in the control group compared to the fibromyalgia group. Also, fibromyalgia patients scored significantly higher (p < 0.001) on JFLS-8, GAD-7, OHIP-14 and PSQI with a large effect size (ES = 0.51-0.73), while WHO-5 scores were significantly lower (ES = 0.58)., Conclusion: Patients with fibromyalgia had greater prevalence than the control group in TMJ pain, headache attributed to TMD, jaw locking, headache attributed to bruxism, sleep bruxism and awake bruxism. Another main finding was that patients with fibromyalgia had greater jaw functional limitation, generalised anxiety and impact of oral health on an individual's life. In addition, fibromyalgia patients showed lower sleep quality and well-being index., (© 2024 John Wiley & Sons Ltd.)

The primary objective of this study is to precisely characterize the behavior of double bracket-to-circular Hollow Section (CHS) column joints due to combined internal forces resulting from double tensile loading in opposite directions. In order to accomplish this goal, an experimental program consisting of eight test specimens has been carried out and numerical finite element modeling has been employed for the same specimens to analyze the stresses and deformations that occur within the vicinity of bracket-to-CHS joints. A total of 15 finite element models were constructed to simulate the initial study, addressing boundary conditions and facilitating verification and results comparison. The study included an investigation of various parameters, including the spacing between brackets in the longitudinal direction, as well as the depth-to-thickness ratio of the CHS columns and adding a T-stiffener to the bracket configuration. The study determined that an increase in the diameter-to-thickness ratio of the CHS columns significantly reduced the overall strength of the joint. Furthermore, findings suggested that increasing the longitudinal spacing between brackets resulted in an increase in single-bracket joint strength and a minor reduction regarding joint strength considering the effect of line loading. Moreover, adding a T-stiffener shape for the brackets enhanced the joint strength and prevented bracket tip fracture. In addition, a distinct behavior arises when considering joints with positive eccentricity, where the forces' line of action extends beyond the circular cross-section of the CHS. In such cases, a reduction in joint strength is observed. Finally, a modification factor "A" is applied to the X-type branch plate-to-CHS strength equation presented by the AISC360-22 to account for the longitudinal spacing between brackets., (© 2024. The Author(s).)

Background and Objective: Ultrasound guidance plays a pivotal role in percutaneous procedures for diagnosing and managing musculoskeletal disorders. Such procedures encompass biopsies for tumor, diagnostic aspiration and therapeutic drainage of abscesses, hematomas, cysts and fluid collections, therapeutic injections into joints, nerves, and tendons, as well as aspirations of calcium deposits and extraction of foreign bodies. This review aims to compile the most frequent ultrasound-guided procedures in the musculoskeletal system and present the state-of-the-art in current advances and evidence., Methods: We performed a literature review on interventional ultrasound in the musculoskeletal system, and included reviews, systematic reviews, meta-analysis, and clinical trials published during the last 10 years. Articles related to imaging techniques different from ultrasound, or spinal, thoracoabdominal and facial procedures were excluded. A total of 120 articles were selected and included in this review. We qualitatively synthesized the main findings and complemented the review with illustrative images from our daily practice., Key Content and Findings: Most of the reviewed studies found superiority of ultrasound-guided versus landmark-guided procedures. Ultrasound was generally considered as a valuable tool for many specialists in diagnosing and treating many musculoskeletal pathologies, but some disparities in needle approaches, techniques, medication, and doses make it difficult to draw strong evidence in different clinical scenarios., Conclusions: Advances in ultrasound-guided procedures in the musculoskeletal system have enabled radiologists and other specialists to achieve high accuracy in diagnosing and treating various musculoskeletal conditions, including tumors, inflammatory and degenerative arthritis, tendinopathies, and bursal pathologies., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://qims.amegroups.com/article/view/10.21037/qims-24-176/coif). The special issue “Advances in Diagnostic Musculoskeletal Imaging and Image-guided Therapy” was commissioned by the editorial office without any funding or sponsorship. F.R.S. served as the unpaid Guest Editor of the issue and serves as an unpaid editorial board member of Quantitative Imaging in Medicine and Surgery. The authors have no other conflicts of interest to declare., (2024 AME Publishing Company. All rights reserved.)

Osteoarthritis (OA) is an incurable, painful, and debilitating joint disease affecting over 500 million people worldwide. The OA joint tissues are infiltrated by various immune cells, particularly macrophages, which are able to induce or perpetuate inflammation. Notably, synovitis and its macrophage component represent a target of interest for developing treatments. In this review, we describe the latest advances in understanding the heterogeneity of macrophage origins, phenotypes, and functions in the OA joint and the effect of current symptomatic therapies on these cells. We then highlight the therapeutic potential of anticytokines/chemokines, nano- and microdrug delivery, and future strategies to modulate macrophage functions in OA., (Copyright © 2024. Published by Elsevier Ltd.)

Background: Many patients suffer from osteoarthritis (OA) in multiple joints, possibly resulting in multiple joint arthroplasties (MJAs). Primarily, we determined the cumulative incidence (C in ) of MJA in hip and knee joints up to 10 years. Secondly, we calculated the mean time between the first and subsequent joint arthroplasty, and evaluated the different MJA trajectories. Lastly, we compared patient characteristics and outcomes (functionality and pain) after surgery between MJA patients and single hip arthroplasty or knee arthroplasty (HA and KA) patients., Methods: Primary index (first) HA or KA for OA were extracted from the Dutch Arthroplasty Register. The 1, 2, 5, and 10-year C in (including competing risk death) of MJA, mean time intervals, and MJA-trajectories were calculated and stratified for primary index HA or KA. Sex, preoperative age, and body mass index were compared using ordinal logistic regression. Outcomes, measured preoperatively, 3, 6, and 12 months postoperatively (function: Hip Disability or Knee Injury and OA Outcome Score; Pain: Numerical Rating Scale), were compared using linear regression., Results: A total of 140,406 HA-patients and 140,268 KA-patients were included. One, 2, 5, and 10-year C in for a second arthroplasty were respectively 8.9% [95% confidence interval (CI): 8.7 to 9.0], 14.3% [95% CI: 14.1 to 14.5], 24.0% [95% CI: 23.7 to 24.2], and 32.7% [95% CI: 32.2 to 33.1] after index HA, and 9.5% [95% CI: 9.4 to 9.7], 16.0% [95% CI: 15.9 to 16.2], 26.4% [95% CI: 26.1 to 26.6], and 35.8% [95% CI: 35.4 to 36.3] after index KA. The 10-year C in for > 2 arthroplasties were small in both the index HA and KA groups. Time-intervals from first to second, third, and fourth arthroplasty were 26 [95% CI: 26.1 to 26.7], 47 [95% CI: 46.4 to 48.4], and 58 [95% CI: 55.4 to 61.1] months after index HA, and 26 [95% CI: 25.9 to 26.3], 52 [95% CI: 50.8 to 52.7], and 61 [95% CI: 58.3 to 63.4] months after index KA. There were 83% of the second arthroplasties placed in the contralateral cognate joint (ie, knee or hip). Differences in postoperative functionality and pain between MJAs and single HAs and KAs were small., Conclusions: The 10-year C in showed that about one-third of patients received a second arthroplasty after approximately 2 years, with the majority in the contralateral cognate joint. Few patients received > 2 arthroplasties within 10 years. Being a women, having a higher body mass index, and being younger increased the odds of MJA. Postoperative outcomes were slightly negatively affected by MJA., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Purpose: Knee joint dislocations, though rare, present significant challenges due to potential complications like vascular and nerve damage, and are known to be often linked to sports injuries, accidents and obesity. This study aims to analyse the epidemiology, incidence and treatment approaches for knee dislocations in Germany from 2019 to 2022., Methods: This retrospective cohort study utilized data from the German Institute for the Hospital Remuneration System to examine knee dislocation cases across German medical institutions. Patient data coded under International Statistical Classification of Diseases and Related Health Problems 10 for 'knee dislocation' enabled detailed analysis by age, sex and surgical procedures categorized by operation and procedure codes. The Patient Clinical Complexity Level (PCCL) assessed complication severity., Results: Analysis of 1643 knee dislocation cases revealed an incidence rate of 0.44-0.54 per 100,000 inhabitants annually. During the years 2020 and 2021, there were fewer cases of knee dislocations. Male patients comprised 50%-56% of cases, with an average hospital stay of 11 days. Most cases were PCCL 0 (62%-72%) and predominantly affected patients aged 18-29 years. Anterior tibial dislocations were common among classified cases. Injuries included ligament ruptures, meniscus lesions and grade I soft-tissue injuries. Patients with pre-existing knee prostheses constituted 0%-16% annually. Treatment involved closed reduction, external fixation and surgeries like capsuloligamentous reconstructions and arthroscopic procedures. Revision knee arthroplasty was required in 2%-9% of cases, with obesity rates up to 7%., Conclusions: This study provides valuable insights into the epidemiology, incidence and treatment of knee dislocations in Germany, with a focus on demographic risk factors, treatment complexities and the impact of obesity and knee prostheses. The findings emphasize the importance of specialized care in larger hospitals, comprehensive management of concomitant injuries and the need for improved coding accuracy. Future research should aim to refine treatment protocols., Level of Evidence: Level III., (© 2024 The Author(s). Knee Surgery, Sports Traumatology, Arthroscopy published by John Wiley & Sons Ltd on behalf of European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)

Background Research has suggested that bone health may be impaired in patients with diabetic neuropathy, with a potential increased risk of fracture. Here, we sought to evaluate the frequency of joint replacements in individuals with and without DN. Our work may allow for prophylaxis to prevent further deterioration in bone health and reduce the necessity of surgical procedures. Methods We conducted a retrospective chart review, from 2019 through 2023, using the UTHealth Rio Grande Valley electronic medical records system. We evaluated odds ratios of fracture history in patients with DN, other diabetic complications, or diabetes (n=10,416). Multiple confounders were considered from patient characteristics, including age, sex, ethnicity, and county of residence. Statistical tests were performed with a significance level of 0.05 to further evaluate our data. Results We observed that there was no significant difference in the distribution of joint replacement across patients with DN, other diabetic complications, or diabetes. Ethnicity and sex were found to not significantly affect the odds of joint replacement. However, older individuals were significantly more likely to have joint replacement than younger individuals (p=0.0004). Conclusion Our results suggest that joint replacement frequency was not increased in diabetic populations in the Rio Grande Valley. Thus, we suggest that interventions to promote bone health should not be limited to specific diabetic patient groups. Further studies should be conducted to determine the exact mechanisms by which bone is affected by DN to allow for improved knowledge and care of bone health in DN patients., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Martin et al.)

Background Magnetic resonance imaging (MRI) arthrography has been a mainstay in the diagnosis of musculoskeletal (MSK) joint-related pathology for decades. With the advent of MRI and further advancements incorporating powerful magnetic fields, the radiological landscape is undergoing a shift. The objective of this study is to evaluate the relevance and preference for MRI arthrography versus MRI among MSK radiologists in our current clinical practice across a range of geographic locations. Methods A global survey of 52 MSK radiologists was conducted to understand current practices, preferences, and recommendations related to the adoption of MRI arthrography and advanced MRI technologies. Responses were analyzed using descriptive statistics, and significant trends were compiled to present the overall preferences of the participants from their clinical experience. Results The majority of the respondents were from the UK (65%), followed by India (13%), the United States (11.5%), and the United Arab Emirates (8%). Of the radiologists surveyed, 98% currently perform MRI arthrogram procedures within their practice, with 27% of clinicians conducting more than 100 MRI arthrogram procedures annually. Regarding the adoption of 3T MRI scanners, 79% of respondents affirmed they have access to the technology within their respective institutions. Concerning the choice of contrast agents used, 84% preferred dilute gadolinium, 8% used saline, 4% used both gadolinium and saline, and another 4% opted for alternative agents. Despite the growing accessibility and utility of 3T MRI, MRI arthrograms remain a favored procedure, especially for shoulder pathology and postoperative cases. For the hip and wrist, the preference leans toward 3T MRI, except for more complex diagnostic purposes or postoperative cases. Conclusions The study's findings suggest that while the advent of the 3T MRI has impacted the frequency with which MRI arthrograms are conducted, it cannot entirely replace the precision and specificity MRI arthrography offers for particular joint pathologies. As institutions expand upon their MRI and imaging infrastructure, further research in this area may help guide MSK radiologists in selecting the most appropriate imaging modality for patients on a case-by-case basis., Competing Interests: Human subjects: All authors have confirmed that this study did not involve human participants or tissue. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Baskar et al.)

Purpose: Growing interest surrounds the role of human gut microbiome in the development of degenerative pathologies such as osteoarthritis (OA), but microbes have recently been detected also in other sites previously considered to be sterile. Evidence emerged suggesting that even native and osteoarthritic knee joints may host several microbial species possibly involved in the osteoarthritic degeneration. This is the first systematic review critically collecting all the available evidence on the existence and composition of knee intra-articular microbiome., Methods: A systematic research on the PubMed, Cochrane and Google Scholar databases was performed. Human clinical studies investigating the presence of intra-articular microbiome in native osteoarthritic knee joints with next-generation sequencing techniques were collected., Results: A total of eight studies were included reporting data on 255 knees. All the included studies reported evidence supporting the existence of an intra-articular microbiome in native knee joints, with detection rates varying from 5.8% to 100%. Bacteria from the Proteobacteria phylum were found to be among the most identified followed by the Actinobacteria, Firmicutes, Fusobacteria, and Bacteroideta phyla. Proteobacteria phylum were also found to be more common in osteoarthritic knees when compared to healthy joints. Furthermore, several pathways correlating those microbes to knee OA progression have been suggested and summarized in this review., Conclusions: Evidence collected in this systematic review suggests that the native knee joint, previously presumed to be a sterile environment, hosts a peculiar intra-articular microbiome with a unique composition. Furthermore, its alteration may have a link with the progression of knee osteoarthritis.

Weight-bearing computed tomography has multiple advantages in evaluating the hindfoot and ankle. It can assess hindfoot and ankle alignment, pathology in ankle arthritis, and complications related to total ankle replacements. It is an essential tool in ankle osteoarthritis diagnostic, preoperative planning, and total ankle replacement outcomes. It allows for better accuracy and reproducibility of alignment and implant size. In addition, it has the potential to more assertively detect complications related to weight bearing., (Copyright © 2024 Elsevier Inc. All rights reserved.)

The hip joint is home to a diverse range of neoplasms, as well as many pseudo lesions, including post-traumatic, infectious, and degenerative processes. Through careful evaluation of the clinical context, location, and imaging features, these entities can be distinguished, enabling accurate and efficient diagnosis. While not exhaustive, this article reviews a selection of benign, malignant, and non-neoplastic lesions affecting the hip bones, cartilage, and soft tissues, focusing on their notable imaging and pathologic features., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

An increasing number of indications are emerging for point-of-care ultrasound to diagnose and treat musculoskeletal complaints. Low cost, dynamic imaging, immediate results, and added advantage of portability have made ultrasound an important imaging modality in urgent care, emergency department (ED), and other musculoskeletal care clinics. This article reviews the use of musculoskeletal ultrasound to help evaluate articular and periarticular structures to evaluate for mechanical injuries and inflammatory arthritis., Competing Interests: Disclosure A.L. Day: Royalties from Springer International for Manual of Musculoskeletal Ultrasound Textbook. M.J. Kohler, Royalties from Springer International for Musculoskeletal Ultrasound in Rheumatology Review Textbook; Janssen/Johnson and Johnson-Medical Advisory Board; Setpoint Medical-Research PI; Novartis-Medical Advisory Board. E. Chew and L. Nazarian: No disclosures., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Condylar fractures are a major cause of morbidity and mortality in Thoroughbred racehorses. Condylar fractures have a variety of fracture configurations that suggest there may be differences in aetiopathogenesis., Objective: To determine if exercise history differs with condylar fracture location in a population of Thoroughbred racehorses., Study Design: Retrospective analysis of clinical and exercise data., Methods: Exercise history of Thoroughbred racehorses that had condylar fracture repair between 1 January 2018 and 28 February 2021 was compared between racehorses that had fractures located radiographically either within the parasagittal groove (PSG) or abaxial to the PSG (non-PSG). Age, sex, and last event (race, timed work) matched control groups were compared between the PSG and non-PSG groups. Additionally, exercise history variables of both groups were each compared with a group-specific control population, each consisting of three control racehorses of equivalent age and sex matched to each affected racehorse by last event (race or official timed work) before fracture., Results: Eighty-two horses with 84 fractures (45 PSG, 39 non-PSG) met inclusion criteria. Age was not different between groups (PSG: 3.4 ± 1.3 years [mean ± SD], non-PSG: 3.7 ± 1.3, p = 0.3). Number of races (PSG: 5.3 ± 7.1, non-PSG: 11.4 ± 8.9, p < 0.001), total race furlongs (PSG: 38.2 ± 54.7, non-PSG: 79.2 ± 64, p = 0.003), and number of active days (PSG: 304 ± 224, non-PSG: 488 ± 314, p = 0.003) before fracture were greater; while mean number of layups was fewer (PSG: 1.0 ± 1.2, non-PSG: 0.5 ± 0.7, p = 0.02) in horses with non-PSG fracture. Horses with non-PSG fracture had more differences compared with their respective control group than horses with PSG fractures. Outcomes following fracture repair were not different between groups., Main Limitations: Retrospective study, one regional racehorse population, two-dimensional imaging and potential inherent bias for fracture localisation, low statistical power for return to performance analysis., Conclusions: Thoroughbred racehorses with non-PSG condylar fractures have a more extensive exercise history than horses with PSG condylar fractures, suggesting differences in fracture aetiopathogenesis., (© 2024 The Authors. Equine Veterinary Journal published by John Wiley & Sons Ltd on behalf of EVJ Ltd.)

Background: Knee osteoarthritis prevalently causes significant pain, activity limitations, psychological distress, and reduced quality of life. Despite lower limb strength training being a core treatment for knee osteoarthritis, adherence remains a challenge, prompting the exploration of virtual reality (VR) to improve exercise compliance. Recent research suggests the potential of VR in providing enhanced pain management and functional outcomes for knee osteoarthritis, necessitating further exploration of immersive VR technology., Objective: We aimed to study the feasibility, acceptability, and preliminary efficacy of an immersive VR-assisted lower limb strength training for knee osteoarthritis (VRiKnee)., Methods: A convergent, parallel, mixed methods study was conducted in 30 participants with knee osteoarthritis. After 1:1 randomization, the VRiKnee group (n=15) was assigned to perform repetitive concentric quadriceps and isometric vastus medialis oblique exercise in an immersive environment using a head-mounted display for 12 weeks. The control group (n=15) completed the same exercises without VRiKnee. VRiKnee participants were interviewed at week 12 to study VRiKnee acceptability and user experience. Quantitative data included feasibility outcomes such as recruitment, dropout, and exercise adherence rates, and effectiveness outcomes such as the numeric rating scale, the Western Ontario and McMaster Universities Osteoarthritis Index (100 points) pain and function subscales, and objective physical activity measured by metabolic equivalents of task using an ActivPAL accelerometer. Qualitative data were analyzed by thematic analysis, followed by integration with quantitative data using joint displays., Results: The recruitment rate was 100% (N=30), with enrollment of 30 participants in 7.57 weeks. The median age was 63.5 (IQR 61.8-66.3) years, with 76% (n=23) being female. The response rates were 80% and 93% for the VRiKnee and control groups. Dropout rates were 13% for VRiKnee and 7% for the control group. Median exercise adherence was 77% (IQR 37-104%) for VRiKnee and 62% (IQR 40-166%) for the control group, respectively, with adherence reduction over this study's period and no significant intergroup differences (P=.82). No statistically significant differences were observed in primary and secondary outcomes, though positive trends were observed in pain and stiffness. Cybersickness was reported by 5 (33%) participants in the VRiKnee group. In the qualitative analysis, 4 themes, 11 subthemes, and 16 quotes were generated, identifying facilitators and barriers with practical suggestions to enhance the usability of VRiKnee., Conclusions: VRiKnee demonstrated feasibility, acceptability, and potential efficacy in managing knee osteoarthritis. Future trials of larger sample sizes and better VR designs will confirm its role in clinical practice., (© Hermione Hin Man Lo, Marques Ng, Pak Yiu Hugo Fong, Harmony Hoi Ki Lai, Bo Wang, Samuel Yeung-shan Wong, Regina Wing Shan Sit. Originally published in JMIR Serious Games (https://games.jmir.org).)

Prosthesis loosening due to lack of osteointegration between an implant and surrounding bone tissue is one of the most common causes of implant failure. Further, bacterial contamination and biofilm formation onto implants represent a serious complication after surgery. The enhancement of osteointegration can be achieved by using bioconductive materials that promote biological responses in the body, stimulating bone growth and thus bonding to tissue. Through the incorporation of antibacterial substances in bioconductive, biodegradable calcium phosphate (CaP) coatings, faster osteointegration and bactericidal properties can be achieved. In this study, Cu-doped CaP supraparticles are spray-dried and suspension-sprayed CaP ceramic coatings with antibacterial properties are prepared using high-velocity suspension flame spraying (HVSFS). The objective was to increase the coatings' porosity and investigate which Cu-doped supraparticles have the strongest antibacterial properties when introduced into the coating layers. Biocompatibility was tested on human Osteosarcoma cells MG63. A porosity of at least 13% was achieved and the supraparticles could be implemented, enhancing it up to 16%. The results showed that the addition of Cu-doped supraparticles did not significantly reduce the number of viable cells compared to the Cu-free sample, demonstrating good biocompatibility. The antimicrobial activity was assessed against the bacterial strains Escherichia coli and Staphylococcus aureus , with Safe Airborne Antibacterial testing showing a significant reduction in both Gram-positive and Gram-negative strains on the Cu-doped coatings.

Background: Axial spondyloarthritis (AS) is a chronic inflammatory rheumatic disease characterized by potentially disabling inflammation of the spine and adjacent joints. Regular exercise is a cornerstone of treatment. However, patients with AS currently have little support. YogiTherapy (MaD Lab) is an app developed to support patients with AS by providing instructions for yoga-based home exercise therapy., Objective: This study aimed to evaluate the usability and acceptance of the newly designed YogiTherapy app for patients with AS., Methods: Patients completed the User Version of the Mobile Application Rating Scale (uMARS) and net promoter score (NPS) questionnaires after the app introduction. Wilcoxon Mann-Whitney rank sum test, chi-square test for count data, and correlation analysis were conducted to examine the usability of the app, acceptance, and patient characteristics., Results: A total of 65 patients with AS (33, 51% female; age: mean 43.3, SD 13.6 years) were included in the study from May 2022 to June 2023. Subsequently, the data were analyzed. Usability was rated moderate, with a mean uMARS of 3.35 (SD 0.47) points on a scale from 0 to 5. The highest-rated uMARS dimension was information (mean 3.88, SD 0.63), followed by functionality (mean 3.84, SD 0.87). Females reported a significantly higher uMARS total score than males (mean 3.47, SD 0.48 vs mean 3.23, SD 0.45; P=.03, Vargha and Delaney A [VDA] 0.66, 95% CI 0.53-0.77). The mean average of the NPS was 6.23 (SD 2.64) points (on a scale from 0 to 10), based on 43% (26/65 nonpromoters, 42% (25/65) indifferent, and 15% (9/65) promoters. A total of 7% (5/65) of those surveyed did not answer the question. When applying the NPS formula, the result is -26%. The NPS showed a positive correlation with the usage of mobile apps (r=0.39; P=.02). uMARS functionality was significantly higher rated by patients younger than 41 years (mean 4.17, SD 0.55 vs mean 3.54, SD 1; P<.001; VDA 0.69, 95% CI 0.56-0.80). Patients considering mobile apps as useful reported higher uMARS (r=0.38, P=.02). The uMARS app quality mean score was correlated with the frequency of using apps (r=-0.21, P<.001)., Conclusions: The results revealed moderate acceptance and usability ratings, prompting further app improvement. Significant differences were observed between age and gender. Our results emphasize the need for further improvements in YogiTherapy., (©Lara Grube, Pascal Petit, Nicolas Vuillerme, Marlies Nitschke, Obioma Bertrand Nwosu, Johannes Knitza, Martin Krusche, Ann-Kristin Seifer, Bjoern M Eskofier, Georg Schett, Harriet Morf. Originally published in JMIR Formative Research (https://formative.jmir.org), 19.09.2024.)

The vascular and lymphatic systems are integral to maintaining skeletal homeostasis and responding to pathological conditions in bone and joint tissues. This review explores the interplay between blood vessels and lymphatic vessels in bones and joints, focusing on their roles in homeostasis, regeneration, and disease progression. Type H blood vessels, characterized by high expression of CD31 and endomucin, are crucial for coupling angiogenesis with osteogenesis, thus supporting bone homeostasis and repair. These vessels facilitate nutrient delivery and waste removal, and their dysfunction can lead to conditions such as ischemia and arthritis. Recent discoveries have highlighted the presence and significance of lymphatic vessels within bone tissue, challenging the traditional view that bones are devoid of lymphatics. Lymphatic vessels contribute to interstitial fluid regulation, immune cell trafficking, and tissue repair through lymphangiocrine signaling. The pathological alterations in these networks are closely linked to inflammatory joint diseases, emphasizing the need for further research into their co-regulatory mechanisms. This comprehensive review summarizes the current understanding of the structural and functional aspects of vascular and lymphatic networks in bone and joint tissues, their roles in homeostasis, and the implications of their dysfunction in disease. By elucidating the dynamic interactions between these systems, we aim to enhance the understanding of their contributions to skeletal health and disease, potentially informing the development of targeted therapeutic strategies., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Huang, Liao, Yang and Zhang.)

Background: Clinical evaluation in the determination of the etiology of axial spine pain is limited., Objective: To determine if a set of three features of the clinical history are indicative of C1-2 joint edema on MRI., Methods: All patients from one physician's practice who had axial cervical spine pain from 2021 to 2023 were evaluated. Cases were defined as those with all 3 of the ASL criteria, defined as Age >65, Superior cervical/suboccipital pain, and exacerbation of pain primarily by Lateral cervical spine rotation. Age-matched controls had axial cervical spine pain without meeting the ASL criteria. Edema around the atlantoaxial joint and/or odontoid was evaluated by STIR MR sequences., Results: The ASL criteria had a sensitivity of 82 % [95 % CI: 64-100 %], specificity of 79 %, [95 % CI: 63-95 %], positive predictive value of 74 % [95 % CI: 54-94 %], and negative predictive value of 86 % [95 % CI: 72-100 %] in diagnosing C1-2 joint edema., Conclusion: A positive ASL criteria is sensitive and specific in the diagnosis of C1-2 joint edema, which may have clinical implications., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Joshua Levin reports a relationship with State Farm Insurance Companies that includes: consulting or advisory. Joshua Levin reports a relationship with Liberty Mutual Group Inc that includes: consulting or advisory. Joshua Levin reports a relationship with Allstate Insurance that includes: consulting or advisory. Joshua Levin reports a relationship with Hanover Insurance Group that includes: consulting or advisory. Joshua Levin reports a relationship with GEICO that includes: consulting or advisory. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Objective: To provide a review on acromegaly and its orofacial manifestations, with a focus on associated arthropathies and temporomandibular joint disorders (TMD)., Methods: A review of current literature was performed through an electronic search of three databases: PubMed, ScienceDirect, and Google Scholar. The literature review was focused on the following topics of interest: etiology, diagnosis, and management of acromegaly, orofacial manifestations of acromegaly, acromegalic arthropathies, and acromegaly-associated TMD., Results: Acromegaly is a chronic multisystem condition in which excessive production of growth hormone in adults, most commonly caused by benign pituitary adenomas, leads to somatic overgrowth. Orofacial changes are considered hallmarks of the disease. It is important for dentists to recognize signs and symptoms of acromegaly, as this may help to achieve early diagnosis and improve overall disease prognosis. Acromegalic arthropathies typically involve large joints, however, the temporomandibular joints (TMJ) can be affected. TMD associated with acromegaly is under-recognized and poorly characterized in current literature., Conclusion: In the appropriate clinical context, acromegaly should be considered as part of the differential diagnosis for patients presenting with TMD. Further studies are needed to better characterize the nature of TMD associated with acromegaly and to define the role of TMJ involvement in early diagnosis., (© 2024 Wiley Periodicals LLC.)

Objectives: To introduce and evaluate a simple method for assessing joint inflammation and structural damage on whole-body MRI (WBMRI) in juvenile idiopathic arthritis (JIA), which is usable in clinical practice., Methods: The proposed system utilizes post-contrast Dixon WBMRI scans. Joints are assessed for synovitis (grade 0-2) and structural damage (present/absent) at 81 sites. The synovitis grading is based on features including above-normal intensity synovial enhancement, synovial hypertrophy, joint effusion, subarticular bone marrow oedema and peri-articular soft tissue oedema.This system was evaluated in a prospective study of 60 young people (47 patients with JIA and 13 controls with non-inflammatory musculoskeletal pain) who underwent a WBMRI. Three readers (blinded to diagnosis) independently reviewed all images and re-reviewed 20 individual scans. The intra- and inter-reader overall agreement (OA) and the intra- and inter-reader Gwet's agreement coefficients 2 (GAC2) were measured for the detection of a) participants with ≥1 joint with inflammation or structural damage and b) joint inflammation or structural damage for each joint., Results: The inter-reader OA for detecting patients with ≥1 joint with inflammation, defined as grade 2 synovitis (G2), and ≥1 joint with structural damage were 80% and 73%, respectively. The intra-reader OA for readers 1-3 was 80-90% and 75-90%, respectively. The inter-reader OA and GAC2 for joint inflammation (G2) at each joint were both ≥85% for all joints but were lower if grade 1 synovitis was included as positive., Conclusion: The intra- and inter-reader agreements of this WBMRI assessment system are adequate for assessing objective joint inflammation and damage in JIA., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Society for Rheumatology.)

This review focuses on the most frequent whole-body MRI applications in patients with rheumatological pathologies, for which this tool can be helpful to both radiologists and clinicians. It reports technical aspects of the acquisition of both 1.5 and 3.0 T scanners. The article lists the main findings that help radiologists during the evaluation of a specific pathology, both in the diagnostic phase and during follow-up., Competing Interests: Disclosure The authors have no relevant financial or nonfinancial interests to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: Osteoarthritis (OA) prevalence and incidence varies between women and men, but it is unknown whether this follows sex-specific differences in systemic factors (e.g. hormones) and/or differences in pre-morbid joint anatomy. We recognize that classifications of sex within humans cannot be reduced to female/male, but given the lack of literature on non-binary individuals, this review is limited to the sexual dimorphism of articular morphotypes., Methods: Based on a Pubmed search using relevant terms, and input from experts, we selected articles based on the authors' judgment of their relevance, interest, originality, and scientific quality; no "hard" bibliometric measures were used to evaluate their quality or importance. Focus was on clinical rather than pre-clinical studies, with most (imaging) data being available for the knee joint., Results: After introducing "sexual dimorphism", the specific literature on articular morphotypes is reviewed, structured by: radiographic joint space width (JSW), meniscus, ligaments, articular cartilage morphology, articular cartilage composition and deformation, and articular tissue response to treatment., Conclusions: Sex-specific differences were clearly observed for JSW, meniscus damage, ligament size, and cartilage morphometry (volume, thickness, and surface areas) but not for cartilage composition. Ligament and cartilage measures were smaller in women even after matching for confounders. Taken together, the findings indicate that female (knee) joints may be structurally more vulnerable and at greater risk of OA. The "one size/sex fits all" approach must be abandoned in OA research, and all observational and interventional studies should report their results for sex-specific strata, at least in pre-specified secondary or post-hoc analyses., Competing Interests: Declaration of Competing Interest Felix Eckstein and Wolfgang Wirth are employees of Chondrometrics GmbH, a company providing professional image analysis service to researchers in academia and to the pharmaceutical industry. Felix Eckstein, Wolfgang Wirth and Reinhard Putz are owners of Chondrometrics GmbH. Felix Eckstein has provided consulting services to Merck KGA, Kolon Tissuegene (KTG), Galapagos, Novartis, 4 P Pharma, and Formation Bio. Felix Eckstein and Wolfgang Wirth have received funding from multiple sources, including public bodies and the pharmaceutical industry (detailed list upon request)., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: To estimate the prevalence of temporomandibular dysfunction in scleroderma patients according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and to correlate it with disease variables., Methods: Temporomandibular dysfunction was evaluated in 75 scleroderma patients and 74 healthy controls using DC/TMD. Gastrointestinal symptoms were evaluated through the University of California Los Angeles (UCLA) score in scleroderma patients., Results: There was no difference of prevalence in temporomandibular dysfunction [30 (40%) vs 30 (40.5%); p > 00.05] between scleroderma patients and healthy controls. Scleroderma patients had a significant reduction in all oral movements compared to healthy controls. Scleroderma patients with temporomandibular dysfunction had a statistically higher score in the UCLA distention/bloating item [1.75 (0.5-2.38) vs 0.75 (0.25-1.75); p < 0.05] than scleroderma patients without temporomandibular dysfunction., Discussion: Temporomandibular dysfunction prevalence between scleroderma patients and healthy controls is similar. In scleroderma patients, temporomandibular dysfunction reduces oral mobility and opening, which worsens distension/bloating.

Background: Mycoplasma hyopharyngis is a commensal bacterium in the upper respiratory tract of swine. As it is recognized to be apathogenic, examinations regarding this species are scarce, compared to other swine mycoplasmas. However, in a few cases, M. hyopharyngis was detected in lesions of different organs. This report presents a case study in which M. hyopharyngis (along with other bacteria) was isolated from the joint of a pig showing lameness., Case Presentation: A Hungarian farm was repopulated with 250 gilts and 1,700 finishers after undergoing a complete depopulation and disinfection. Two days later, cases of diarrhoea and septicaemia caused by Salmonella enterica serovar typhimurium were seen in the finishers. At the same time, following the first farrowing, swollen joints were observed in 21-25 days old piglets. Joint samples were collected, and isolation of Mycoplasma sp. and other bacteria was attempted. Analysis of the joint samples revealed the presence of Staphylococcus haemolyticus, Staphylococcus hyicus, Aerococcus viridans, Trueperella pyogenes, Streptococcus agalactiae and M. hyopharyngis., Conclusions: This is the second isolation of M. hyopharyngis from joints, which highlights the necessity of a better understanding the biology of this often-overlooked species, and its role in the progress of arthritis or other lesions.

Scintigraphy and Positron Emission Tomography (PET) are both nuclear medicine imaging techniques, providing functional information of the imaged areas. Scintigraphy is a two-dimensional projected imaging technique that was introduced in equine imaging in the late 1970s. Scintigraphy allows imaging of large body parts and can cover multiple areas, remaining the only technique commonly used in horses for whole body imaging. PET is a cross-sectional imaging technique, first used in horses in 2015, allowing higher resolution three-dimensional functional imaging of the equine distal limb. This manuscript will cover current use and values of these two modalities in equine lameness diagnosis.

Background: The objective of this study was to compare and analyze the representative opening and closing movement of Tai Chi elastic band exercise with the reverse fly movement of elastic band resistance training. The aim was to explore the biomechanical differences between the two exercises and provide theoretical support for the application of Tai Chi elastic band exercise in health intervention., Methods: A total of 26 male participants were recruited and randomly divided into two groups in a 1:1 ratio. There were 13 participants in each Tai Chi elastic band exercise group and elastic band resistance training group. Both groups of participants used an elastic band to perform movement in the experiment. Experimental data were collected using the Vicon infrared motion capture system and Delsys surface EMG system. The AnyBody software was utilized to simulate the creation of a musculoskeletal model for both exercises., Result: The study found that the Tai Chi elastic band exercise group exhibited smaller horizontal abduction angle and flexion angle of the shoulder joint, as well as normalized RMS of the anterior deltoid and triceps brachii, compared to the elastic band resistance training group ( P < 0.01); the Tai Chi elastic band exercise group exhibited greater elbow flexion angle, elbow flexion torque, and muscle strength of the infraspinatus, coracobrachialis, biceps brachii, brachialis and brachioradialis, compared to the elastic band resistance training group ( P < 0.01); the Tai Chi elastic band exercise group exhibited smaller horizontal abduction angular velocity of the shoulder joint and a lower normalized RMS of the posterior deltoid, compared to the elastic band resistance training group ( P < 0.05)., Conclusion: (1) The opening and closing movement of Tai Chi elastic band exercise is characterized by a large elbow flexion angle, a small shoulder joint horizontal angle and flexion angle, and a slow and uniform speed of movement. The reverse fly movement of elastic band resistance training is characterized by a large horizontal abduction angle of the shoulder joint, a large flexion angle of the shoulder joint, a small flexion angle of the elbow joint, and a fast and uneven speed. (2) The opening and closing movement exerts a greater torque on the elbow flexion, while the reverse fly movement exerts a greater torque on the shoulder joint horizontal abduction and external rotation. (3) The opening and closing movement provide greater stimulation to the infraspinatus, coracobrachialis, and elbow flexor, while the reverse fly movement provides greater stimulation to the posterior deltoid, anterior deltoid, subscapularis, and elbow extensor. In summary, the variation in joint angle, joint angular velocity, and hand position could be the factor contributing to the differences in joint torque and muscle activity between the opening and closing movement of Tai Chi elastic band exercise and the reverse fly movement of elastic band resistance training., Competing Interests: The authors declare that they have no competing interests., (© 2024 Liu et al.)

Intra-articular blood, iron and hemosiderin, hydroxyl radical cytokines, and neo-angiogenesis cause synovial inflammation, which leads to cartilage and joint damage. Platelet-rich plasma (PRP) inhibits most of the mediators that produce and maintain synovitis. We compile here our work showing the clinical effectiveness of intra-articular PRP injections and their potential role in stopping articular cartilage damage due to bleeding and its possible repair. A total of 116 joints, including knees (63%), elbows (19.8%), and ankles (17.2%), were treated with intra-articular injections of PRP. Moreover, we also show here the number of extracellular DNA traps (ETs) and the PRP effect in the synovial fluid of patients at the time of treatment and six months after. Clinically, it is demonstrated that PRP is effective in reducing bleeding episodes ( p < 0.001) and pain ( p < 0.0001) and improving the hemophilia joint health score (HJHS) ( p < 0.001) at one year of follow-up. Furthermore, our results demonstrate that PRP inhibits ET formation in vitro and reconstitutes the immune system's cellular components in the synovial fluid of patients after treatment. We conclude that PRP can be considered an effective, safe, and easy treatment for hemophilic synovitis.

Background: Fungal periprosthetic joint infection (FPJI) is an infrequent but devastating complication that imposes a heavy burden on patients. At present, a consensus regarding the most optimal surgical option for patients with FPJI, the ideal duration of systemic antifungal treatment, and many other issues has not been reached., Methods: A comprehensive literature search was performed on the PubMed and Embase databases. The search criteria employed were as follows: (fungal OR candida OR mycotic) AND periprosthetic joint infection. Initially, the titles and abstracts were screened, and subsequently, studies deemed irrelevant or duplicative were eliminated. Following this, the complete texts of remaining articles were thoroughly examined. According to the inclusion and exclusion criteria, 489 joints in 24 articles were screened out. We further extracted the demographic characteristics (age, gender, body mass index, etc.), clinical presentation, fungal species, presence of bacterial coinfection, surgical methods, systemic and local antifungal therapy, and treatment outcomes. Subgroup data were analyzed according to fungal species and bacterial coinfection. Univariate logistic regression analysis was conducted to ascertain the risk factors associated with the infection recurrence., Results: A total of 506 fungi were identified within 489 joints. The most prevalent fungal species were Candida albicans (41.5%). Out of 247 joints (50.5%) presenting with concurrent fungal and bacterial infections. Among the initial surgical interventions, two-stage exchange was the most common (59.1%). The infection recurrence rates of DAIR, resection arthroplasty, two-stage, one-stage, and three-stage exchange were 81.4%, 53.1%, 47.7%, 35.0%, and 30%, respectively. The mean duration of systemic antifungal therapy was 12.8 weeks. The most common drugs used both in intravenous (55.9%) and oral therapy (84.0%) were fluconazole. The proportion of patients who used antifungal drugs after replantation (two-stage and three-stage) was 87.6%. 33.2% of cement spacer or fixed cement contained antifungal drugs, of which amphotericin B was the main choice (82.7%). FPJI caused by candida albicans (OR = 1.717, p = 0.041) and DAIR (OR = 8.433, p = 0.003) were risk factors for infection recurrence., Conclusions: Two-stage exchange remains the most commonly used surgical approach. The reliability of one- and three-exchange needs further evaluation due to the small sample size. Antifungal-loaded cement spacers, and direct intra-articular injections of antimycotics after reimplatation should be strongly considered. Medication is not standardized but rather individualized according to microbiology and the status of patients., (© 2024. The Author(s).)

Mammalian cells produce and metabolize almost exclusively L-lactate, bacterial species have the capacity to produce both D-lactate and L-lactate. The aim of this study was to evaluate the intrinsic production of D- and L-lactate in the most common pathogenic microorganisms causing septic arthritis (SA) and periprosthetic joint infection (PJI) as a potential biomarker for the diagnosis of infection. Following microorganisms were grown according to ATCC culture guides and tested for production of D- and L-lactate: Staphylococcus aureus (ATCC 43300), Staphylococcus epidermidis (ATCC 35984), Enterococcus faecalis (ATCC 19433), Streptococcus pyogenes (ATCC 19615), Escherichia coli (ATCC 25922), Pseudomonas aeruginosa (ATCC 27853), Cutibacterium acnes (ATCC 11827), and Candida albicans (ATCC 90028). Pathogens were inoculated in 8 ml of appropriate liquid media and incubated as planktonic or biofilm form in either aerobic, anaerobic or CO 2 atmosphere up to 312 h. D- and L-lactate measurements were performed at different time points: 0, 6, 9, 12 and 24 h, then once per day for slow-growing pathogens. Samples were serially diluted and plated for colony counting. Liquid culture media without microorganisms served as a negative control. Production of D-lactate was observed in all tested microorganisms, whereas no L-lactate was detected in E. coli , P. aeruginosa, and C. albicans . Maximal concentration of D-lactate was produced by S. aureus (10.99 mmol/L), followed by E. coli (1.22 mmol/L), and S. epidermidis (0.48 mmol/L). Maximal L-lactate concentration was observed in S. pyogenes (10.12 mmol/L), followed by S. aureus (9.71 mmol/L), E. faecalis (2.64 mmol/L), and S. epidermidis (2.50 mmol/L). S. epidermidis bacterial biofilm produced significantly higher amount of D- and L-lactate compared to planktonic form ( p  = 0.015 and p  = 0.002, respectively). Our study has demonstrated that the most common pathogenic microorganisms causing SA and PJI have the capability to generate measurable amounts of D-lactate in both planktonic and biofilm form, highlighting the practical value of this biomarker as an indicator for bacterial and fungal infections. In contrast to D-lactate, the absence of L-lactate production in certain tested bacteria, as well as in fungi, suggests that L-lactate is not eligible as a biomarker for diagnosing microbial infections., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Morovic, Gonzalez Moreno, Trampuz and Karbysheva.)

Purpose: Septic arthritis is a dangerous medical condition requiring prompt diagnosis, often via arthrocentesis. A "dry tap" occurs when no fluid is aspirated. We hypothesized that the absence of a joint effusion on pre-procedure advanced imaging would reliably predict a dry tap and exclude septic arthritis., Methods: A cohort of 217 arthrocentesis cases of large joints (hips, shoulders, knees) from our institution, with pre-procedure advanced imaging (CT, MR, US) of the same joint performed within the previous 48 h, was analyzed. Exclusion criteria included non-native joints or inadequate imaging of the affected joint. These cases underwent blinded review by 4 radiologists who measured the deepest pocket of joint fluid on the pre-procedure imaging. Wilcoxon rank-sum test was performed comparing joint fluid pocket size to outcomes of successful aspiration and final diagnosis., Results: A smaller average joint pocket fluid size was present on advanced imaging in both dry taps compared with successful arthrocenteses (p < .0001), and in uninfected joints compared with septic joints (p = .0001). However, the overlap of values was too great to allow for a perfectly predictive cutoff. 29% (5/17) of patients with no visible joint fluid on pre-aspiration imaging underwent successful arthrocentesis, one case representing septic arthritis., Conclusion: Volume of joint fluid on advanced pre-arthrocentesis imaging cannot reliably predict subsequent dry tap nor exclude septic arthritis., (© 2024. The Author(s), under exclusive licence to American Society of Emergency Radiology (ASER).)

Introduction and Importance: Arterial injury is extremely rare after total knee arthroplasty., Case Presentation: We describe a 68-year-old woman with dislocation of total knee arthroplasty after falling from a height. She had a popliteal artery injury and a vascular bypass was performed in delay. The patient died of a second myocardial infarction 3.5 months after her first introduction to our center., Clinical Discussion: Due to the prominent risk of vascular injuries after dislocation in TKA patients, we recommend performing vascular evaluations using CT angiography for all patients., Conclusion: Any untreated vascular compromise in the setting of TKA dislocation may lead to devastating outcomes such as amputation and death., Competing Interests: Conflict of interest statement All authors do not have conflicts of interest., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Aim: To develop a new tool for identifying joint hypermobility of the paediatric foot and ankle, based on a dichotomous scoring system utilising the Lower Limb Assessment Score (LLAS), to separate the foot and ankle items., Material and Methods: A total of 205 children, aged between 5 and 10 years, participated in a cross-sectional study. The new tool Foot and Ankle Flexibility Index (FAFI) was predicated upon the last 7 items of LLAS, which are specific to the foot and ankle. The internal consistency was measured with Cronbach's test. Kappa statistics with 95% CI were calculated to verify the level of inter-rater and intra-rater agreement for the FAFI., Results: Cronbach's alpha returned 0.82. The correlations between items returned a mean of 0.59 (range: 0.43-0.74). The discrimination score on the ROC curve (4 points) showed that the model can be used to identify children with joint hypermobility of the foot and ankle. Inter-rater reliability was largely good (ICC = 0.89). Excellent intra-rater reliability was found (ICC = 0.96) CONCLUSIONS: This study identified high reliability between evaluators, and high sensitivity and specificity, for a new reliable and valid tool for the identification of foot and ankle joint hypermobility., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Rheumatoid arthritis (RA) is a type of joint injury, which can induce the activation of inflammatory factors and polarization of tissue macrophages. Total phenolics from Laggera alata (TPLA) has been reported to exhibit anti-inflammatory effect in various diseases. However, its specific function in RA is still unknown. Here, the protective properties of TPLA were studied in collagen-induced arthritis (CIA)-induced RA mice. RA mouse model was established through the CIA induction. Arthritis score, hind paw thickness, and the body weight of the RA mice were evaluated in each group. H&E staining was conducted in hind paw and joint tissues for histopathological staining. The distal femur was analyzed by microCT, and bone loss-related indicators were assessed. The expression of macrophage polarization markers was detected by immunofluorescence staining in RA mice. The serum levels of inflammatory markers were determined by enzyme-linked immunosorbent assay (ELISA). TPLA reduced the CIA-induced arthritis score and hind paw thickness in mice. The body weight of the CIA mouse was significantly increased by TPLA treatment. TPLA improved the CIA-induced histopathological changes in the hind paw and joint tissues from the mice. TPLA inhibited the bone loss and alleviated bone destruction in CIA mouse model. TPLA altered the macrophage phenotype from M1 macrophages into M2 in CIA mice. TPLA suppressed the levels of inflammatory markers both in the serum and joint tissues of the CIA mice. TPLA mitigated RA development by suppressing inflammatory reaction through the inhibition of M1 microphage polarization., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objectives: Previous research shows that sacroiliac (SI) joint fusion is age and sex dependent. Older individuals-specifically starting in the fifth or sixth decade of life-are more likely to develop SI fusion. Females have a lower frequency of SI joint fusion than males, perhaps due to pregnancy or parturition. This study examines the relationship between SI joint fusion with both sex and parity status in females. The issue is whether the prevalence of SI fusion in nulliparous females is more similar to that of males or parous females., Materials and Methods: The sample consists of 46 nulliparous females, 119 parous females, and 158 males from the William M. Bass Donated Skeletal Collection. Ages of the individuals ranged from 50 to 89 years. Sex, age, and parity status were self-reported., Results: The frequency of SI joint fusion is significantly different among males (13.29%), nulliparous females (6.52%), and parous females (0.84%). Pairwise comparison of the three groups for SI joint fusion shows that parous females and males are significantly different, but nulliparous females are nonsignificantly different from parous females and males., Discussion: Parity status does not appear to be a factor in the sexually dimorphic nature of SI joint fusion in this sample. Rather, biomechanical and hormonal factors may have a greater contribution to higher rates of SI joint fusion in males than females., (© 2024 The Author(s). American Journal of Biological Anthropology published by Wiley Periodicals LLC.)

Objective: To determine the accuracy of ultrasound for diagnosing hip luxation in dogs presenting for hind limb lameness., Methods: 24 client-owned dogs presenting with pelvic limb lameness and concern for hip luxation were enrolled in this prospective diagnostic accuracy study from April 1, 2021, to July 1, 2022. An experienced ultrasonographer and a novice ultrasonographer, both masked to the diagnoses, performed hip ultrasonography using a point-of-care ultrasound machine. The experienced evaluator also performed a more comprehensive ultrasonography with a high-end ultrasound machine to characterize concurrent pelvis and hip disease. Pelvic radiographs served as the criterion standard for the diagnosis of hip luxation., Results: Ultrasonographic diagnosis of hip luxation demonstrated high accuracy, ranging from 84.2% to 100% for detecting the presence of luxation and 80.6% to 98.1% for diagnosing the direction of luxation for the novice and experienced evaluators, respectively, with substantial interevaluator agreement (κ = 0.722). Compared to radiographs, ultrasound accurately diagnosed the presence of osteoarthrosis with almost perfect agreement (κ = 0.913) and the presence of fractures of the femoral head/neck and the nonaxial portions of the pelvis with substantial intermodality agreement (κ = 0.775). In 36% of patients, ultrasound identified injury to soft tissue structures that contribute to hip stability, including the gluteal muscles, gemelli, and joint capsule., Conclusions: Ultrasound can be utilized to accurately diagnose the presence of hip luxation and document concurrent hip and pelvic disease., Clinical Relevance: Applications include the use of ultrasonography as part of a routine point-of-care protocol to catalogue injuries in patients with acute trauma and in mobile practice or remote settings where radiography is not readily available.

Background and Objective: Osteoarthritis (OA) is the most common age-related disease of joints with increasing global prevalence. Persistent inflammation within the joint space is speculated to be the cause of OA. Resveratrol is an anti-inflammatory and antioxidant compound which can influence cartilage metabolism through multiple signalling pathways. This systematic review and meta-analysis aimed to summarize the therapeutic effects of resveratrol in animal models of OA., Methods: A comprehensive literature search was performed using PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, China Wanfang and VIP databases in May 2023. Studies on the effects of resveratrol in animal models of OA written in English or Mandarin, published from the inception of databases until the date of the search were considered., Results: Fifteen eligibility studies were included and analysed. Resveratrol was shown to inhibit the secretion of interleukin-1β, tumour necrosis factor-α, interleukin-6, nitric oxide, and apoptosis of articular chondrocytes. Joint structure as indicated by Mankin scores was restored with resveratrol in animal OA models., Conclusion: Resveratrol is a potential therapeutic agent for OA based on animal studies. Further evidence from well-planned human studies would be required to validate its clinical efficacies., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors. Published by Elsevier Ltd.)

Introduction: Hemophilia can detrimentally affect patients' quality of life and likelihood of survival. In the evolving landscape of therapies, the therapeutic gain of each treatment must be understood to accurately position it in the therapeutic armamentarium. Accordingly, appropriate outcomes must be measured with appropriate tools., Areas Covered: Our narrative review (PubMed search for 'hemophilia AND outcome' until June 2023), provides a compendium of outcome measures used in hemophilia clinical research. To define each outcome measure's relative value and applicability, several characteristics are critically discussed., Expert Opinion: Bleeding assessment, first annual/annualized bleeding rate, remains central in evaluating the efficacy and safety of hemophilia treatments. As modern therapies improve clinical outcomes toward zero bleeding events, this endpoint may become less sensitive to detect differences between therapeutic approaches. Technological advancements necessitate the adaptation of outcome measures to address infrequent bleeding events, age-related comorbidities, and laboratory parameters with limited comparability after different treatments. Considerable effort has been dedicated to the development of tools that comprehensively assess coagulation, such as thrombin generation assays. Patient-reported outcome measures are gaining importance although limited by their subjectivity. A definitive set of research outcome measures remains elusive. Outcomes may need to be tailored to different therapeutic interventions.

Background: Chronic spontaneous urticaria (CSU) can present with non-skin related symptoms (NSRS), including recurrent unexplained fever, joint, bone, or muscle pain (JBMP), and malaise, which also occur in other conditions that manifest with wheals (eg, urticarial vasculitis or autoinflammatory disorders) or without wheals (eg, infection)., Objective: We sought to determine the rate of patients with CSU affected by fever, JBMP, and malaise, their trigger factors, links with clinical and laboratory characteristics, and their impact on everyday life and treatment responses., Methods: We analyzed baseline data from the Chronic Urticaria Registry of 2,521 patients with CSU who were aged 16 years or older., Results: One third of CSU patients (31.2%; 786 of 2,521) had one or more NSRS, including recurrent fever (5.3%), JBMP (19.1%), and/or malaise (18.6%). In a multivariable analysis, having one or more of these NSRS correlated with food and infection as trigger factors of urticaria (adjusted odds ratio [aOR] = 1.7 and 1.5), wheals of 24 hours or greater duration (aOR = 2.5), sleep disturbance (aOR = 2.4), anxiety (aOR = 2.8), comorbid atopic dermatitis (aOR = 2.1), gastrointestinal disease (aOR = 1.8), elevated leukocytes (aOR = 1.7) and erythrocyte sedimentation rate (aOR = 1.5). In a bivariate analysis, these NSRS were additionally associated with higher disease activity (weekly Urticaria Activity Score, median: 21 vs 14; P = .009), longer disease duration (years, median: 2 vs 1; P = .001), the presence of angioedema (74.6% vs 58.7%; P < .001), worse quality of life (Chronic Urticaria Quality of Life Questionnaire, median: 42 vs 29; P < .001) and more frequent poor control of CSU (78% vs 69%; P < .001)., Conclusions: The presence of NSRS in a subpopulation of patients with CSU points to the need for better control of the disease, exclusion of comorbid conditions, and/or exclusion of urticarial vasculitis and urticarial autoinflammatory diseases., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose: The aim of this study was to investigate the efficacy of calcitonin (CT) in animal models of experimental osteoarthritis (OA) and rheumatoid arthritis (RA), as new stabilized CT formulations are currently being introduced., Methods: A comprehensive and systemic literature search was conducted in PubMed/MEDLINE and Embase databases to identify articles with original data on CT treatment of preclinical OA and RA. Methodological quality was assessed using the Systematic Review Centre for Laboratory Animal Experimentation's risk of bias tool for animal intervention studies. To provide summary estimates of efficacy, a meta-analysis was conducted for outcomes reported in four or more studies, using a random-effects model. Subgroup analyses were employed to correct for study specifics., Results: Twenty-six studies were ultimately evaluated and data from 16 studies could be analyzed in the meta-analysis, which included the following outcomes: bone mineral density, bone volume, levels of cross-linked C-telopeptide of type I collagen, histopathological arthritis score, and mechanical allodynia. For all considered outcome parameters, CT-treated groups were significantly superior to control groups (P = 0.002; P = 0.01; P < 0.00001; P < 0.00001; P = 0.04). For most outcomes, effect sizes were significantly greater in OA than in RA (P ≤ 0.025). High in-between study heterogeneity was detected., Conclusion: There is preclinical evidence for an antioxidant, anti-inflammatory, antinociceptive, cartilage- and bone-protective effect of CT in RA and OA. Given these effects, CT presents a promising agent for the treatment of both diseases, although the potential seems to be greater in OA.

Fibrotic changes in musculoskeletal diseases arise from the abnormal buildup of fibrotic tissue around the joints, leading to limited mobility, compromised joint function, and diminished quality of life. Relaxin (RLX) attenuates fibrosis by accelerating collagen degradation and inhibiting excessive extracellular matrix (ECM) production. Further, RLX disrupts myofibroblast activation by modulating the TGF-β/Smads signaling pathways, which reduces connective tissue fibrosis. However, the mechanisms and effects of RLX in musculoskeletal pathologies are emerging as increasing research focuses on relaxin's impact on skin, ligaments, tendons, cartilage, joint capsules, connective tissues, and muscles. This review delineates the actions of relaxin within the musculoskeletal system and the challenges to its clinical application. Relaxin shows significant potential in both in vivo and in vitro studies for broadly managing musculoskeletal fibrosis; however, challenges such as short biological half-life and sex-specific responses may pose hurdles for clinical use., Competing Interests: Declaration of competing interest M.W.G, A.N., and E.K.R, are co-founders of Ortholevo, Inc. ]M.W.G.’s interests are managed by Boston University in accordance with their COI management policies. A.N.’s and E.K.R.’s interests are managed by Beth Israel Deaconess Medical Center in accordance with their COI management policies., (Copyright © 2024. Published by Elsevier Inc.)

Bats have many unique qualities amongst mammals; one of particular importance is their reported tolerance to viruses without developing disease. Here, the authors present evidence to the contrary by describing and demonstrating viral nucleic acids within lesions from eptesipox virus (EfPV) infection in big brown bats. One hundred and thirty bats submitted for necropsy from Saskatchewan, Canada, between 2017 and 2021 were screened for EfPV by polymerase chain reaction (PCR); 2 had amplifiable poxvirus DNA. The lesions associated with infection were oral and pharyngeal ulcerations and joint swelling in 2/2 and 1/2 cases, respectively. These changes were nonspecific for poxvirus infection, although intracytoplasmic viral inclusion bodies within the epithelium, as observed in 2/2 bats, are diagnostic when present. Viral nucleic acids, detected by in situ hybridization (ISH), were observed in the epithelium adjacent to ulcerative lesions from both cases and within the joint proliferation of 1 case. A new isolate of EfPV was obtained from 1 case and its identity was confirmed with electron microscopy and whole genome sequencing. Juxtanuclear replication factories were observed in most cells; however, rare intranuclear virus particles were also observed. The significance of the presence of virus particles within the nucleus is uncertain. Whole genome assembly indicated that the nucleotide sequence of the genome of this EfPV isolate was 99.7% identical to a previous isolate from big brown bats in Washington, USA between 2009 and 2011. This work demonstrates that bats are not resistant to the development of disease with viral infections and raises questions about the dogma of poxvirus intracytoplasmic replication., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: Variations in total knee arthroplasty (TKA) joint line height may lead to complications such as pain and altered joint mechanics, while posterior condylar offset (PCO) can influence knee stability., Methods: Single-centre, single-surgeon retrospective analysis from December 2019 to May 2023 investigated primary unilateral TKA (Nexgen Legacy, Zimmer Biomet) in patients with knee osteoarthritis, using ROSA robotic system (raTKA) or conventional manual technique (mTKA). Joint line height and PCO were measured and compared in 182 raTKA and 144 mTKA patients., Results: The groups were matched in age (p = 0.847) and sex distribution (p = 0.2). Excellent interobserver agreement (ICC ≥ 0.9). RaTKA mean joint line height difference was - 0.0001 mm (± 3.48, 95% CI - 0.509, 0.509) (p = 0.523), - 0.951 mm for mTKA (± 4.33, 95% CI - 1.664, - 0.237) (p = 0.009). RaTKA mean PCO difference was 0.52 mm (± 2.45, 95% CI 0.160, 0.880) (p = 0.005), 1.15 mm for mTKA (± 4.01, 95% CI - 1.496, 1.818) (p < 0.001). Mean difference in joint line height of 0.95 mm between groups was significant (p = 0.027), and for PCO, it was 0.63 mm, demonstrating tendency towards significance (p = 0.08). Mean absolute value in joint line height difference between groups was not significant (p = 0.235) but highly significant for PCO (p < 0.001)., Conclusion: The ROSA knee robotic system can more accurately restore joint line height and PCO compared to conventional manual TKA. The improved degree of precision raTKA offers may be a vehicle for better Patient-Reported Outcome Measures, but further correlational studies are required., (© 2024. The Author(s).)

This paper attempts to analyze the random fatigue life and failure modes of joints using two calculation methods. Three kinds of tests were carried out, which were the static test, constant amplitude fatigue test and the random fatigue test, and four kinds of joints were designed. After the static test, the joint was subjected to a constant amplitude fatigue test by selecting different percentages of load according to the static strength. In order to predict the random fatigue life more precisely, two calculation methods were carried out, which were the linear cumulative damage method and the equivalent loading finite element method. Based on the linear cumulative damage hypothesis, the fatigue life of the joint was established as a function of the load amplitude, and then, the random life prediction was calculated by the amplitude distribution of the random loading. Another method was the equivalent loading method, which was to obtain the equivalent constant amplitude fatigue loading of the random loading spectrum. The finite element model was established based on the stiffness and strength degradation rule. The equivalent random life and fatigue failure modes of the joint were modeled. The two life prediction methods show good agreement with the fatigue experimental result, and all prediction results were included in a scatter band of the factor of 2.

Purpose: The aim of the present study was to investigate the clinical efficiency of hybrid alloplastic temporomandibular joint (TMJ) prosthesis in patients undergoing TMJ total alloplastic joint replacement (TMJR). The prosthesis utilized for this study for TMJR is a hybrid variant with combination of stock prototype design and a partial customization of components., Materials and Methods: A prospective clinical study was conducted involving five patients with unilateral TMJ ankylosis or end-stage joint disease (ESJD) indicated for and requiring TMJR. The patients underwent resection of the joint or gap arthroplasty followed by TMJR using the hybrid alloplastic TMJ prosthesis. The subjective and objective variables that included the jaw function (JF), inter-incisal opening (IO), diet intake (DI) and quality of life (QoL) were assessed using the psychometric modified Likert scale. The nutritional status of the patients was evaluated using the mid-upper arm circumference (MUAC) as reference., Results: The assessed study variables demonstrated functional and observational improvement in the post-operative follow-up when compared to the pre-operative period. The patients showed an improvement in overall QoL and nutritional status post-operatively. The follow-up period showed subjective and objective improvement in the parameters assessed among the study population., Conclusion: There is a technical and clinical feasibility to utilize the hybrid alloplastic TMJ prosthesis as a reliable alloplastic option for treating patients requiring TMJR, with prudent indications., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)