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Pain catastrophizing is an exaggerated focus on pain sensations. It may be an independent factor influencing pain and functional outcomes of knee arthroplasty. We aimed to evaluate the association between pre-operative pain catastrophizing with pain and function outcomes up to one year after knee arthroplasty. We used data from a cohort study of patients undergoing primary knee arthroplasty (either total or unicompartmental arthroplasty) for knee osteoarthritis. Pain catastrophizing was assessed pre-operatively using the Pain Catastrophizing scale (PCS). Other baseline variables included demographics, body mass index, radiographic severity, anxiety, depression, and knee pain and function assessed using the Western Ontario and McMaster University Index (WOMAC). Patients completed the WOMAC at 6- and 12-months after arthroplasty. WOMAC pain and function scores were converted to interval scale and the association of PCS and changes of WOMAC pain and function were evaluated in generalized linear regression models with adjustment with confounding variables. Of the 1136 patients who underwent arthroplasty (70% female, 84% Chinese, 92% total knee arthroplasty), 1102 and 1089 provided data at 6- and 12-months post-operatively. Mean (± SD) age of patients was 65.9 (± 7.0) years. PCS was associated with a change in WOMAC pain at both 6-months and 12-months (β = − 0.04, 95% confidence interval: − 0.06, − 0.02; P < 0.001) post-operatively after adjustment in multivariable models; as well as change in WOMAC function at 6-months and 12-months. In this large cohort study, pre-operative pain catastrophizing was associated with lower improvements in pain and function at 6-months and 12-months after arthroplasty. [ABSTRACT FROM AUTHOR]

Proficiency in medical writing is crucial for disseminating reports of medical studies. The impact of workshops in this regard on participants' confidence is a subject of debate. We assessed the impact of a hands-on workshop on participants' confidence in medical writing. Participants of a 2-day "learning-by-doing" workshop held at McMaster University participated in this before-after study. We used a unique, reliable, and valid tool comprising two domains of confidence in medical writing and using English language before and after receiving the educational intervention. Of 25 participants, 21 completed the instrument before and after the workshop. Typical participants were female, and students in their 30s, who had not attended a prior workshop. The mean (95% CI) increase in the participants' confidence for domain 1 was 15.3 (10.5, 20.1), for domain 2 was 16.8 (9.8, 23.8), and for the total score was 32.1 (20.9, 43.2) (all P<0.001). Between-subgroup analyses showed the score increase was significantly higher in participants with less than 5 years of experience in medical research. The workshop had a positive impact on enhancing participants' confidence in writing skills, including using active verbs, crafting short sentences, summarizing main findings, and adhering to checklists like CONSORT. Hands-on medical writing workshops can boost participants' confidence in writing medical articles and using optimal English language. Targeting junior researchers and graduate students could result in a better outcome. Emphasizing the writing areas where participants achieved higher score changes might yield better outcomes for such workshops. [ABSTRACT FROM AUTHOR]

The size and axial alignment of prostheses, when planned during total knee replacement (TKA) are critical for recovery of knee function and improvement of knee pain symptoms. This research aims to study the effect of artificial intelligence (AI)-based preoperative three dimensional (3D) planning technology on prosthesis size and axial alignment planning in TKA, and to compare its advantages with two dimensional (2D) X-ray template measurement technology. A total of 60 patients with knee osteoarthritis (KOA) who underwent TKA for the first time were included in the AI (n = 30) and 2D (n = 30) groups. The preoperative and postoperative prosthesis size, femoral valgus correction angle (VCA) and hip-knee-ankle angle (HKA) were recorded and compared between the two groups. The results of the University of Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and the American Knee Association Score (AKS) were evaluated before surgery, 3 months, 6 months, and 12 months after surgery. The accuracy of prosthesis size, VCA and HKA prediction in AI group was significantly higher than that in 2D group (P < 0.05). The WOMAC and AKS scores in AI group at 3 months, 6 months and 12 months after surgery were better than those in 2D group (P < 0.05). Both groups showed significant improvement in WOMAC and AKS scores at 12 months follow-up. AI-based preoperative 3D planning technique has more reliable planning effect for prosthesis size and axial alignment in TKA. [ABSTRACT FROM AUTHOR]

Background: Knee osteoarthritis (OA) joint disease most commonly occurs in the elderly population, and it causes significant pain and functional limitations. Manual therapy, physical therapy modalities, taping techniques, patient education and therapeutic exercises, orthosis, and more recently, extracorporeal shock wave therapy (ESWT) are all used to treat knee OA. Kinesio taping (KT) is a therapeutic technique used to treat knee OA. Material and methods: This is a prospective study, non-probable sampling technique conducted in the Department of Orthopaedics, Sree Mookambika Institute of Medical Sciences, Kulasekharam from June 2023 to December 2023 for a period of 6 months, the study participants which include patient aged >40 and <70 years with Osteoarthritis knee population; Grade 0, I and II Osteoarthritis knee (Kellerman and Lawrence classification) with symptoms for more than 3 months according to the ACR clinical classification criteria and pain score of more than 4 cm on 10 cm visual analog scale (VAS) will be included in this study and exclude the patient with aged < 40 years Grade III and IV- Osteoarthritis knee (Kellerman and Lawrence classification), Active infection in the knee, Secondary Osteoarthritis, Previous knee surgery, Previous intra-articular knee injection. Results: Mean VAS score of 30 patients at pre-procedural, 6 weeks,3 months and 6 months follow up are 7.5±2, 7.0±1.5, 5.6±1.4 and 4.5±1.5 respectively and mean total WOMAC score of 30 patients at at pre-procedural, 6 weeks,3 months and 6 months follow up are 74±8.3, 65±8.1, 60± 7.5 55±12.2 respectively. Which shows a significant reduced in pain and improvement in the functional outcome. Conclusion: KT (kinesio tape) was found to improve pain and physical functioning of subjects with early knee osteoarthritis. The results of this study showed significant kinesio tape effects in the WOMAC subscales: pain, stiffness, and physical function and VAS score. This technique is recommended for early osteoarthritis not for the late stages. This technique is cost effective and easily available. WOMAC and VAS score are useful tool in assessing the Knee functional outcome. [ABSTRACT FROM AUTHOR]

Background As medical education programs transition to competency-based medical education (CBME), experiences transitioning in the context of small subspecialty programs remain unknown, yet they are needed for effective implementation and continual improvements. Objective To examine faculty and resident experiences transitioning to CBME in a small subspeciality program. Methods Using a qualitative descriptive approach and constructivist lens, faculty and residents in McMaster University's geriatric psychiatry subspecialty program were interviewed about their transition experiences between November 2021 and February 2022, after the program's soft launch of CBME in 2020. Interviews were transcribed and data were analyzed using thematic analysis. Reflexive memo writing and investigator and data triangulation strategies were employed to ensure rigor and trustworthiness of the data. Results Ten of the 17 faculty members (59%) and 3 residents (100%) participated. Six themes were developed: (1) Both faculty and residents see themselves as somewhat knowledgeable about CBME, but sources of knowledge vary; (2) More frequent feedback is beneficial; (3) Aspects of CBME that are challenging for residents are beneficial for faculty; (4) Competence committees are perceived positively despite most participants' limited firsthand experience with them; (5) Small program size is both a barrier and facilitator to providing and receiving feedback; and (6) Suggestions for improvement are centered on helping manage faculty and resident workload imposed by CBME. Conclusions Incongruent expectations surrounding entrustable professional activity management were highlighted as an area requiring support. Collegial relationships among faculty and residents made it difficult for faculty to provide constructive feedback but improved residents' perceptions of the feedback. [ABSTRACT FROM AUTHOR]

Background Multicompartmental osteoarthritis (MOA) in both tibiofemoral and patellofemoral joints is a more commonly occurring, but neglected, clinical condition, and we examined the short-term safety and efficacy of autologous stromal vascular fractions (SVFs) for MOA using a single-blind, prospective, randomized, placebo-controlled trial. Methods Seventy MOA patients were recruited and randomly assigned to the SVF group and hyaluronic acid (HA) group (control group). The scores of visual analog scale, the Western Ontario and McMaster University Osteoarthritis Index, and the Samsung Medical Center patellofemoral scoring system were assessed and compared between the two groups 3, 6 and 12 months after treatment. Results The SVF group had significantly better visual analog scale scores than the HA group at 6 and 12 months after treatment and had better Western Ontario and McMaster University Osteoarthritis Index scores than the HA group only at 6 months after treatment. For Samsung Medical Center patellofemoral scoring system of the patellofemoral joint, the SVF group had significantly better scores than the control group at all postoperative time points. The proportion of patients whose visual analog scale and Western Ontario and McMaster University Osteoarthritis Index scores were above the minimal clinically important improvement was higher in the SVF group than in the HA group in the majority of assessments. The improvement of bone marrow by SVF treatment was significantly better than that of the HA group as observed by pre- and postoperative Magnetic resonance imaging (MRI). Conclusions Multiple intra-articular injection of autologous SVF reduces pain and improves function in the short term in patients with early or midstage MOA. However, there was heterogeneity in the improvement of overall knee and isolated patellofemoral joint after treatment.   What is already known on this topic   Knee osteoarthritis (KOA) is the most common type of degenerative joint disease in humans. Autologous stromal vascular fraction (SVF) has been gradually applied to the treatment of KOA due to its multidifferentiation and ease of access. However, most current studies have focused on the tibiofemoral (TF) joint, and we know little about the performance of SVF in multiple compartments of the knee, including the patellofemoral (PF) joint. What this study adds   Multiple intra-articular injections of SVF are safe and effective for MOA in short-term (within 12 months) follow-up. Patients with MOA appear to have different feedback on treatment in different compartments of the knee, including the PF and TF joints, after SVF treatment. How this study might affect research, practice, or policy   More research is needed to clarify the appropriate dosage and injection schedule of SVF to standardize its clinical use. The rational selection of the indications for SVF in the treatment of KOA needs to be done more carefully when OA affects multiple compartments of the knee joint. [ABSTRACT FROM AUTHOR]

Background: Chondral defects in the knee present a significant challenge due to their limited self-healing capacity, often leading to joint degeneration and functional disability. Current treatments, including surgical approaches like mosaicplasty and regenerative therapies such as bone marrow aspirate concentrate (BMAC) augmentation, aim to address these defects and improve patient outcomes. Materials and Methods: This study conducted a single-center, randomized controlled trial to evaluate the efficacy of different treatment approaches and rehabilitation protocols for chondral defects. Thirty-seven subjects presenting with symptomatic chondral or osteochondral defects (>3 cm2) in the weight-bearing region of the femoral condyle were partitioned into three groups, and underwent mosaicplasty with or without BMAC augmentation, followed by either a 6-week or 12-week rehabilitation program. Group 1 (n = 10) received mosaicplasty combined with BMAC augmentation and engaged in a twelve-week two-phase rehabilitation protocol. Group 2 (n = 15) underwent mosaicplasty alone and participated in the same twelve-week two-phase rehabilitation regimen. Meanwhile, Group 3 (n = 12) underwent mosaicplasty and underwent a shorter six-week one-phase rehabilitation program. Clinical assessments were performed using the visual analog scale (VAS) for pain, goniometry for the knee's range of motion (ROM), manual muscle testing (MMT) for quadricep strength, and the Western Ontario and McMaster University Arthritis Index (WOMAC) for functional evaluation in three test phases. Results: Significant differences in WOMAC scale scores were observed between the three groups at the intermediate (F(2, 34) = 5.24, p < 0.010) and final (F(2, 34) = 111, p < 0.000) stages, with post hoc Tukey tests revealing variations shared among all three groups. The between-group analysis of the VAS scale demonstrated no statistically significant difference initially (F(2, 34) = 0.18, p < 0.982), but significant differences emerged following the intermediate (F(2, 34) = 11.40, p < 0.000) and final assessments (F(2, 34) = 59.87, p < 0.000), with post hoc Tukey tests revealing specific group variations, notably between Group 1 and both Group 2 and Group 3, and also between Group 3 and Group 2. The between-group analysis of quadricep muscle strength using MMT scores revealed no statistically significant differences initially (F(2, 34) = 0.376, p < 0.689) or following the intermediate assessment (F(2, 34) = 2.090, p < 0.139). The one-way ANOVA analysis showed no significant difference in the knee ROM initially (F(2, 34) = 1.037, p < 0.366), but significant differences emerged following intermediate (F(2, 34) = 9.38, p < 0.001) and final assessments (F(2, 34) = 11.60, p < 0.000). Post hoc Tukey tests revealed significant differences between Groups 1 and 2, Groups 1 and 3, and Groups 2 and 3 at intermediate and final assessments. Conclusions: The patients who received BMAC augmentation and completed a 12-week rehabilitation protocol had significantly better outcomes in pain relief, knee function, and ROM when compared to those who did not receive BMAC augmentation or those who completed a shorter rehabilitation period. Our findings suggest that combining mosaicplasty with BMAC augmentation and a comprehensive rehabilitation program can lead to superior clinical outcomes for patients with chondral defects in the knee. [ABSTRACT FROM AUTHOR]

Purpose: Condylar constrained knee prostheses (CCK) are increasingly used in revision total knee arthroplasty (rTKA), but the clinical effectiveness and long-term survival remain a debate. The purpose of this study is to report the long-term clinical and radiographic outcome, implant survival rate, and surgical safety of revision total knee arthroplasty with condylar constrained knee prosthesis. Methods: A retrospective cohort study was performed on patients undergoing rTKA with CCK. The cases who received rTKA with CCK from January 2005 to January 2022 were selected. The duration of operation, the estimated perioperative blood loss, and the intraoperative blood transfusion rate were recorded to evaluate surgical safety. The pain visual analog scale (VAS), range of motion (ROM), the Hospital for Special Surgery (HSS) score, the Knee Society Score (KSS), the Western Ontario and McMaster University Osteoarthritis Index (WOMAC), and the Oxford knee score (OKS) was recorded to assess clinical outcome. Standard anteroposterior, lateral, skyline and long-standing AP radiographs of the lower limbs were conducted to assess radiographic outcome. Implant survival was analyzed by Kaplan–Meier survival estimates. Results: Fifty-five cases were followed up for an average of 9.6 years (1–18 years), including 16 males and 38 females, with an average age of 66 and an average BMI of 26.9 kg/m2. The main reasons for revision were periprosthetic infection (32 knees, 58.2%) and aseptic loosening (13 knees, 23.6%). The duration of operation was 149 ± 56.2 min. The perioperative blood loss was 973.6 ± 421.6 ml. At the last follow-up, VAS (8.0 ± 1.1 to 1.3 ± 1.4), ROM (82.7° ± 26.1° to 108.4° ± 11.8°), HSS (45.0 ± 10.4 to 85.3 ± 8.6), KSKS (38.4 ± 12.1 to 88.5 ± 12.0), KSFS (19.6 ± 12.9 to 68.8 ± 15.1), WOMAC (67.9 ± 12.5 to 14.4 ± 9.5), and OKS (9.9 ± 4.2 to 41.6 ± 7.7) were significantly improved (P < 0.001). A total of five complications were observed, all of which were periprosthetic infection. Non-progressive radiolucent lines were observed in 26 knees (47.3%). The 10-year survival rate for no operation was 96.0%. The ten year survival rate for no revision was 98.0%. Conclusion: The use of CCK prosthesis for rTKA can achieve good long-term efficacy and prosthesis survival. [ABSTRACT FROM AUTHOR]

Background: The ultrasound-guided viscosupplementation of the hip joint with hyaluronic acid (HA) is considered a standard procedure among the conservative treatments for hip arthritis. The aim of this study was to evaluate the clinical benefit and the incidence of adverse events of the technique in an observational study at one year follow up. Methods: We evaluated a consecutive series of 85 patients with a diagnosis of symptomatic arthritis who underwent intra-articular ultrasound-guided hyaluronic acid injections. The scales used for evaluation were modified Harris Hip Score (mHHS), WOMAC (Western Ontario and McMaster University), and Hip Outcome Score (HOS) with subscale Sport (HOSs), for pain the Visual Analogic Scale (VAS). The patients were classified according to Tonnis' radiological classification of arthritis (range 0–3): 20 patients (grade 0), 32 (grade 1), 18 (grade 2), 15 (grade 3). Results: At last follow up, all the scales increased: mHHS from 59.35 to 82.1, HOS from 69.45 to 78.53, HOss from 47.4 to 58.11, VAS from 6.09 to 3.97, WOMAC from 33.2 to 31.5 (p < 0.05 for all the parameters); the results were elaborated with GraphPad Prism v5.0 (Prism Software La Jolla, CA, USA) using Wilcoxon's test. A total of 13 patients out of 85 needed arthroplasty, all classified as Tonnis grade 3. No serious adverse events were noted due to the procedure. Conclusions: Based on our findings, indication for the use of hyaluronic acid is limited to patients with mild to moderate arthritis. Patients in advanced arthritis refusing replacement surgery and asking for this treatment should be informed about the poor results of the technique even in the short term. [ABSTRACT FROM AUTHOR]

The maldistribution of family physicians challenges equitable primary care access in Canada. The Theory of Social Attachment suggests that preferential selection and distributed training interventions have potential in influencing physician disposition. However, evaluations of these approaches have focused predominantly on rural underservedness, with little research considering physician disposition in other underserved communities. Accordingly, this study investigated the association between the locations from which medical graduates apply to medical school, their undergraduate preclerkship, clerkship, residency experiences, and practice as indexed across an array of markers of underservedness. We built association models concerning the practice location of 347 family physicians who graduated from McMaster University's MD Program between 2010 and 2015. Postal code data of medical graduates' residence during secondary school, pre-clerkship, clerkship, residency and eventual practice locations were coded according to five Statistics Canada indices related to primary care underservedness: relative rurality, employment rate, proportion of visible minorities, proportion of Indigenous peoples, and neighbourhood socioeconomic status. Univariate and multivariable logistic regression models were then developed for each dependent variable (i.e., practice location expressed in terms of each index). Residency training locations were significantly associated with practice locations across all indices. The place of secondary school education also yielded significant relationships to practice location when indexed by employment rate and relative rurality. Education interventions that leverage residency training locations may be particularly influential in promoting family physician practice location. The findings are interpreted with respect to how investment in education policies can promote physician practice in underserved communities. [ABSTRACT FROM AUTHOR]

This article unveils the personal dedication of author Basil H. Johnston, together with the professional commitment of his publisher Anna Porter and agent Beverley Slopen, that led to the production and dissemination of Indian School Days. Published in 1988 by Toronto's Key Porter Books, Indian School Days was the first memoir to focus entirely on the Indian residential school experience in Canada and the first written by an Anishinaabemowin speaker. Drawing on primary material—archival documents held in the Basil H. Johnston fonds at McMaster University in Hamilton, Ontario, as well as my 2022 interview with his daughter, Tibby Johnston—the article argues for the distinctive allyship of Porter and Slopen with Johnston, three figures united in sensibility and purpose. Individually, each valued mutual understanding alongside career success and sought to challenge the prevailing bias against Indigenous writing within mainstream publishing. Collectively, they grasped the corrective significance of Indian School Days —as a work of remembrance, history, and art—and fostered awareness for a book that was central to the rise of Indigenous writing in Canada. [ABSTRACT FROM AUTHOR]

Cell therapy has been explored as a new regenerative treatment for osteoarthritis in the field of regenerative medicine. However, the efficacy of stem cell transplantation from different sources for the treatment of knee osteoarthritis (KOA) remains controversial. This study integrates and evaluates the previously published data of stem cell transplantation for KOA to explore the curative effect of different stem cells. We conducted a meta‐analysis of randomized controlled trials on stem cell therapy for KOA. Measures of efficacy included Visual Analog Scale (VAS), Lequesne index, Lysholm Knee Scoring Scale (LKSS), and Western Ontario and McMaster University Osteoarthritis Index (WOMAC). Joint injury was evaluated through the Whole‐Organ Magnetic Resonance Imaging Score (WORMS) system. We analyzed 16 studies involving 875 KOA patients. The stem cell treatment showed significant VAS reduction from the third month onwards. Subgroup analysis suggested the most significant pain relief at different postoperative months came from adipose‐derived and umbilical cord‐derived stem cells. Autologous adipose tissue resulted in better pain alleviation compared with allogenic. However, autologous bone marrow stem cells did not show increased pain relief over allogeneic ones. Combination therapy (HA and/or PRP) showed no effect. Autologous adipose‐derived stem cells demonstrate the most effective recovery of knee joint function. In WORMS assessment, there was no significant difference between the stem cell group and control. Stem cell transplantation proved safe and effective for KOA treatment. Different sources stem cells have a good effect on alleviating knee joint pain, restoring knee joint function, and minimizing patient trauma. [ABSTRACT FROM AUTHOR]

Gender-based violence (GBV) poses a significant concern in the construction and natural resources industries, where women, due to lower social status and integration, are at heightened risk. This systematic review aimed to identify the prevalence and experience of GBV in the construction and natural resources industries. A systematic search across databases including PubMed, OVID, Scopus, Web of Science, and CINAHL was conducted. The Risk of Bias Instrument for Cross-sectional Surveys of Attitudes and Practices by McMaster University and the Critical Appraisal of Qualitative Studies by the Center for Evidence Based Medicine at the University of Oxford were used to assess the studies included in the review. Six articles were included after full-text analysis. GBV was reported in the construction, mining, urban forestry, and arboriculture sectors. Workplace GBV was measured differently across the studies, and all studies examined more than one form of GBV. The main forms of GBV discussed in these studies were discrimination, sexual harassment, and sexism. The studies provided some insight for demographic factors that may or may not be associated with GBV, such as age, region of work, and number of years working in the industry. The review also suggests that workplace GBV has a negative impact on mental health and well-being outcomes, such as higher levels of stress and lower job satisfaction. The current research has not established the effectiveness of interventions, tools, or policies in these workplaces. Thus, additional research should include intervention studies that aim to minimize or prevent GBV in male-dominated workplaces. The current study can bring awareness and acknowledgement towards GBV in the workplace and highlight the importance of addressing it as this review outlines the negative consequences of GBV on mental health and well-being in these male-dominated industries. [ABSTRACT FROM AUTHOR]

Purpose: The tipping point (TP) of the knee joint is the centre of rotation of the joint in the coronal plane. This study aimed to define the TP in medial opening wedge high tibial osteotomy (MOWHTO). Methods: Data from 154 consecutive patients with varus knee malalignment, who underwent MOWHTO between 2017 and 2021, was retrospectively reviewed. The degree of preoperative osteoarthritis (OA), using the Kellgren–Lawrence (KL) grading system, was recorded. Long‐leg standing radiographs were used to record the alignment parameters, including the hip–knee–ankle angle (HKA), the mechanical lateral distal femoral angle (mLDFA), the medial proximal tibial angle (MPTA), the joint line convergence angle (JLCA) and the joint line obliquity (JLO) angle. Postoperative Tegner activity scores, Western Ontario and McMaster University Scores and patients' satisfaction were recorded. To define the TP, the relationship of all variables to Δ JLCA (absolute difference between preoperative to postoperative JLCA values) was analysed. Linear regression was employed for Δ JLCA to preoperative JLCA and postoperative and Δ MPTA (absolute difference between preoperative and postoperative values). K‐means clustering was used to partition observations into clusters, in which each observation belongs to the cluster with the nearest mean serving as a prototype of the cluster, and analysed if there was any specific threshold influencing Δ JLCA. After defining the TP, further subanalysis of the TP based on the preoperative KL OA grade and analysis of variance of this TP to the KL OA grade was performed. Results: A total of 154 patients (77.9% males and 22.1% females) were included. The mean age was 48.2 ± 11 years, and the mean body mass index was 27.1 ± 4 kg/m2. Preoperatively, 26 (16.9%) patients had KL grade IV OA. The mean preoperative and postoperative JLCA and the significance of their relation to Δ JLCA were 2.6° ± 1.8° (p < 0.0001) and 1.9° ± 1.8° (p = 0.6), respectively. The mean Δ JLCA was 1.4° ± 1.5°. The mean pre‐ and postoperative MPTA and the significance of their relation to Δ JLCA were 84.6 ± 2.2 (p = 0.005) and 91.8 ± 2.5 (p < 0.0007), respectively. The mean Δ MPTA was 7.2 ± 2.3 (p = 0.3). The mean preoperative and postoperative HKA and the significance of their relation to Δ JLCA were 174.6 ± 2.5 (p = 0.2) and 181.9 ± 2.4 (p = 0.7), respectively. The overall linear regression for Δ JLCA was statistically significant for preoperative JLCA (R2 = 0.3, p < 0.0001) and postoperative MPTA (R2 = 0.09, p = 0.0001) and statistically insignificant for Δ MPTA (R2 = 0.01, p = 0.2) and postoperative HKA (R2 = 0.04, p = 0.7). MPTA > 91.5° was the optimal threshold dividing this series data set between substantial and nonsignificant Δ JLCA. Conclusion: In this study, the main predictive factors for intra‐articular correction (Δ JLCA) after MOWHTO were the preoperative value of JLCA and the postoperative value of MPTA. A value of 92° for postoperative MPTA is potentially the optimal threshold to predict intra‐articular correction. Level of Evidence: Level IV, retrospective cohort study. [ABSTRACT FROM AUTHOR]

Background and Objectives: Knee osteoarthritis (KOA) is a degenerative disease that is continuously targeting people of different ages, but especially the elderly population, the number of which tends to increase continuously at the global level. Apart from age, excess weight can influence the evolution of the disease, with obesity being associated with a weak inflammation stage and an imbalance between pro-inflammatory and anti-inflammatory cytokines. The present work aimed to analyze specific biomarkers, namely ACRP-30, IL-10, TNF-α, and IL-6, in knee synovial fluid, and correlate them with KOA patients' clinical data, radiographic changes, and functional and pain scores. Materials and Methods: 24 subjects with KOA and over 50 years of age participate in the present study. Synovial fluid was harvested using ultrasound guidance from the target knees of the enrolled KOA patients, and the levels of ACRP-30, IL-10, TNF-α, and IL-6 were measured using enzyme-linked immunosorbent assays (ELISA). All patients underwent a supine X-ray at the target knee and were classified using Kellgren–Lawrence (K–L) grading. The Western Ontario and McMaster University Osteoarthritis Index (WOMAC) was used to assess self-reported physical function, pain, and stiffness. Results: The obtained results highlighted a significant correlation between age and adiponectin level (p = 0.0451, r = −0.412). Also, the IL-10 values are lower in cases where the intensity of the pain is more pronounced (p = 0.0405, r = −0.421). In addition, analyzing the data by gender, it was observed that in the case of males, stiffness is more related to age (p = 0.0079, r = 0.7993), compared to women (p = 0.0203, r = 0.6223). In the case of women, the progression of the disease tends to increase more intensively the WOMAC score's total values (p = 0.00031, r = 0.8342), compared with men (p = 0.0289, r = 7013). Regarding interleukins and BMI, significant correlations were observed only in the case of men. Conclusions: A significant correlation between age and adiponectin, and adiponectin and IL-6, suggests that advanced age may contribute to adiponectin reduction. Comparing men with women, it was observed that men's age is more related to rigidity, and IL-6 and IL-10 are directly correlated to BMI; in addition, women seem to be more sensitive to pain and stiffness. [ABSTRACT FROM AUTHOR]

BACKGROUND: Total knee arthroplasty is one of the effective methods to treat end-stage knee osteoarthritis. However, some patients still experience chronic post-surgical pain. It is significant to find out the influencing factors of chronic post-surgical pain. Demographic factors, social psychological factors and perioperative pain were the focus of previous studies, but muscle factors closely related to the occurrence and development of knee osteoarthritis were rarely reported. OBJECTIVE: To evaluate the value of preoperative quantitative ultrasound analysis of quadriceps femoris in predicting chronic post-surgical pain after total knee arthroplasty. METHODS: A total of 250 patients with knee osteoarthritis who underwent the first unilateral total knee arthroplasty under elective general anesthesia from January to August 2022 in the Affiliated Hospital of Xuzhou Medical University were selected. All patients were treated with the same anesthesia and operative methods. Before the surgery, clinical data were recorded, and the thickness and echo intensity of quadriceps femoris on the operated side were measured by ultrasound imaging, which could quantify the degree of quadriceps femoris atrophy. Multivariate logistic regression was used to analyze the independent factors affecting the occurrence of chronic post-surgical pain, and receiver operating characteristic curves were used to evaluate its predictive value. RESULTS AND CONCLUSION: (1) 250 subjects were involved in the result analysis, and 91 of them had chronic post-surgical pain, with an incidence of 36.4%. (2) There were significant differences between the chronic pain and non-chronic pain groups in preoperative pain score during movement, preoperative Western Ontario and McMaster University Osteoarthritis Index, preoperative anxiety and depression scale score, preoperative muscle thickness and echo intensity of quadriceps femoris, and postoperative acute pain score (P < 0.05). (3) Multivariate logistic regression analysis showed that preoperative thickness of quadriceps femoris was an independent protective factor for chronic post-surgical pain and preoperative pain score during movement was an independent risk factor for chronic post-surgical pain. (4) Receiver operating characteristic curves showed that the area under the curve of the preoperative thickness of quadriceps femoris was 0.625 (95%CI: 0.555-0.695), and the critical value was 2.78 cm, sensitivity was 0.802, specificity was 0.415. (5) It is concluded that the preoperative thickness of quadriceps femoris is an independent protective factor for chronic post-surgical pain, but its predictive efficacy is low, and its clinical application needs to be further verified or modified. [ABSTRACT FROM AUTHOR]

Background: The purpose was to compare the clinical and radiographic outcomes between preoperative mild and severe varus deformity after total knee arthroplasty (TKA) with medial stabilizing technique (MST). Methods: We retrospectively analyzed 158 knees of 125 female patients with a 2-year follow-up who underwent mechanically aligned TKA with MST between April 2018 and February 2021. Patients were divided into two groups; the severe varus group was defined as one with preoperative hip-knee ankle (HKA) angle ≥ 15° and the mild varus group with HKA angle < 15°. Pre- and post-operative clinical outcomes (Western Ontario and McMaster University Osteoarthritis Index, Knee Society Knee Score) and radiographic outcomes (medial proximal tibial angle (MPTA), HKA angle, lateral distal femoral angle (LDFA), joint line distance, and femoral component rotation angle) were compared between the groups. Results: Among the 158 knees analyzed, 131 and 27 were allocated to the mild and severe varus groups, respectively. Preoperative data showed that the MPTA (84.7° ± 2.8° vs. 80.7° ± 3.2°, p < 0.001) was significantly less in the severe varus group. In postoperative data, clinical outcomes were not different between the groups. Joint line distance (18.4 mm ± 2.8 mm vs. 18.6 mm ± 2.7 mm, p = 0.676) was also not significantly different. Femoral component rotation angle (−1.7° ± 1.0° vs. −1.0° ± 1.3°, p = 0.018) was more externally rotated in the severe varus group. Conclusions: Severe varus group showed comparable clinical and radiographic outcomes to that of mild varus group after mechanically aligned TKA with MST. [ABSTRACT FROM AUTHOR]

Caused by age or trauma, collapsed connective tissue can cause nerve entrapment and damage within the tarsal tunnel. Tarsal tunnel syndrome is relatively underdiagnosed. This study presents an intervention targeting damaged tissues surrounding the nerves and replacing the structural cushioning with a Wharton's jelly tissue allograft. The eight patients in our study, selected from four clinical sites, had tarsal tunnel-related defects. Patient outcomes were tracked on a 90-day calendar utilizing the Numeric Pain Rating Scale (NPRS) and the Western Ontario and McMaster University Arthritis Index (WOMAC). All patients had failed standard care practices for at least six weeks. Each patient received a Wharton's jelly tissue allograft to sites around the affected tarsal tunnel. No patients experienced adverse reactions. The percent change results calculated from the initial application to the 90-day follow-up showed an improvement of 59.43% in NPRS and a 37.58% improvement in WOMAC. This study provides evidence that WJ allograft applications are safe, minimally invasive, and efficacious for patients who have failed standard care treatments for tissue defects associated with tarsal tunnel syndrome. The limitations of this study include its small cohort size and nonblinded nature. The results of this study warrant further research to confirm the efficacy, optimal dose, protocol, and durability of Wharton's jelly. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to report the early to midterm results of medial opening wedge high tibial osteotomy (MOWHTO) from the largest single‐centre osteotomy database. The primary outcomes were reporting the radiological corrections and the functional outcomes represented by multiple patient‐reported outcome measures (PROMs). The secondary outcomes were to report the complications, revisions and survivorship up to 10 years postoperatively. Methods: A prospectively maintained single‐centre database of 1138 knee osteotomies was retrospectively reviewed. Patients who underwent MOWHTO and met the inclusion criteria were included. Those inclusion criteria were moderate to severe knee pain that failed conservative management; varus knee malalignment; and isolated medial osteoarthritis of the knee. A total of 651 cases, with a mean age of 46.7 ± 9 years and a mean body mass index of 29.6 ± 5.2 kg/m2, were included. This comprised 71% males (n = 462) and 29% females (n = 189). The mean follow‐up was 158.1 ± 45.4 months. Multiple PROMs were recorded preoperatively and serially postoperatively. This included the Knee injury and Osteoarthritis Outcome Scores, the Oxford Knee Score, the Oxford Knee Score‐Activity and Participation Questionnaire, the Western Ontario and McMaster University Scores, the Visual Analogue Scale for health and pain, and the EQ‐5D, which is a standardised measure of health‐related quality of life. All lower limb alignment measurements were recorded pre‐ and postoperatively. The rates of osteotomy revision, conversion to arthroplasty, complications, and 5‐ and 10‐year survivorship were recorded. Results: A total of 651 cases were followed up to a mean of 158.1 ± 45.4 months. The mean planned correction angle was 7.6° ± 2.9°. The mean planned opening wedge distance was 8.1 ± 3.1 mm. The mean intraoperative anterior and posterior osteotomy gaps opening were 7.7 ± 3.4 and 8.9 ± 3.8 mm, respectively. Postoperatively, the mean mechanical tibiofemoral angle improved from −5.7° ± 2.9° varus to 1.3° ± 2.5° valgus, the mean medial proximal tibial angle improved from preoperative 85.5° ± 2.3° to postoperative 91.6° ± 2.7° and the mean Mikulicz point improved from 21.7 ± 12.6% to 54.8 ± 11% (all p values < 0.001). All PROMs significantly improved at 24 months follow‐up (all p values < 0.001). The rate of osteotomy revision was 1.1% at a mean of 2 ± 2.5 years postoperatively. The overall rate of arthroplasty conversion was 9.1%. This comprised 5.8% total knee arthroplasty conversion at a mean of 6.9 ± 3.5 years postoperatively and 3.2% unicompartmental knee arthroplasty conversion at a mean of 5.7 ± 2.5 years postoperatively. An overall 10.3% complication rate was recorded. The 5 and 10‐year survivorship was 97.2% and 91.9%, respectively. Conclusion: MOWHTO is a radiologically and clinically rewarding procedure with a high survival rate at 5 and 10 years and a low complication rate in experienced hands. MOWHTO should be considered in patients presenting with medial unicompartmental knee pain with an evidence of overload and a varus mechanical coronal plane axis. Level of Evidence: Level IV, retrospective cohort study. [ABSTRACT FROM AUTHOR]

Purpose Enhanced recovery after surgery (ERAS) was characterized as patient-centered, evidence-based, multidisciplinary team-developed routes for a surgical speciality and institution to improve postoperative recovery and attenuate the surgical stress response. However, evidence of their effectiveness in osteoarthroplasty remains sparse. This study aimed to develop an ERAS standard and evaluate the significance of ERAS interventions for postoperative outcomes after primary total hip arthroplasty (THA) or total knee arthroplasty (TKA). Methods We searched Medline, Embase, Cochrane databases, and Clinicaltrials.gov for randomized controlled trials, cohort studies, and case–control studies until 24 February 2023. All relevant data were collected from studies meeting the inclusion criteria. Two reviewers independently assessed the risk of bias and extracted data. The primary outcome was the length of stay (LOS), postoperative complications, and readmission rate. The secondary outcomes included transfusion rate, mortality rate, visual analog score (VAS), the Western Ontario and McMaster University Osteoarthritis Index (WOMAC), Short Form 36 (SF-36) bodily pain (SF-36 BP), SF-36 physical function (SF-36 PF), oxford knee score, and range of motion (ROM). Results A total of 47 studies involving 76 971 patients (ERAS group: 29 702, control group: 47 269) met the inclusion criteria and were included in the meta-analysis. The result showed that ERAS could significantly shorten the LOS (WMD = −2.65, P  < .001), reduce transfusion rate (OR = 0.40, P  < .001), and lower 30-day postoperative mortality (OR = 0.46, P  = .01) without increasing postoperative complications or readmission rate. Apart from that, ERAS may decrease patients' VAS (WMD = −0.88, P  = .01) while improving their ROM (WMD = 6.65, P  = .004), SF-36 BP (WMD = 4.49, P  < .001), and SF-36 PF (WMD = 3.64, P  < .001) scores. However, there was no significant difference in WOMAC, oxford knee score between the ERAS and control groups. Furthermore, we determined that the following seven components of the ERAS program are highly advised: avoid bowel preparation, PONV prophylaxis, standardized anesthesia, use of local anesthetics for infiltration analgesia and nerve blocks, tranexamic acid, prevent hypothermia, and early mobilization. Conclusion Our meta-analysis suggested that the ERAS could significantly shorten the LOS, reduce transfusion rate, and lower 30-day postoperative mortality without increasing postoperative complications or readmission rate after THA and TKA. Meanwhile, ERAS could decrease the VAS of patients while improving their ROM, SF-36 BP, and SF-36 PF scores. Finally, we expect future studies to utilize the seven ERAS elements proposed in our meta-analysis to prevent increased readmission rate for patients with THA or TKA. Key message What is already known on this topic   A growing number of studies have identified a positive role for ERAS in arthroplasty; however, the clinical effectiveness and elements of ERAS need to be further defined. What this study adds   This research not only assesses the influence of ERAS on length of stay, complications, and readmission rates, but further evaluates the impact of ERAS on joint function and proposes the recommended seven elements of ERAS. How this study might affect research, practice, or policy   Given the potential advantages of ERAS, we encourage its use in arthroplasty and anticipate that future research will incorporate our proposed seven ERAS elements to prevent higher readmission rates in THA or TKA patients. Registration number   CRD42023390678. [ABSTRACT FROM AUTHOR]

Purpose: To quantify the clinical relevance of intra‐articular corticosteroid effects compared to placebo for the injective treatment of knee osteoarthritis (OA). Methods: The PubMed, Cochrane Library and Web of Science databases were searched on May 3, 2023. This study was conducted in accordance with the PRISMA guidelines. The inclusion criteria were randomized controlled trials (RCTs), published in English, with no time limitation regarding publication date, comparing intra‐articular corticosteroids and placebo injections for knee OA. The effects were quantified at short‐ (≤6 weeks), mid‐ (>6 weeks and ≤3 months), and long‐term (≥6 months) follow‐ups. The minimal clinically important difference (MCID) for the outcomes (visual analogue scale for pain ‐ VAS: 1.4, Western Ontario and McMaster University Osteoarthritis Index ‐ WOMAC: 9) was used to interpret the clinical improvement provided by intra‐articular corticosteroid injections compared to placebo. The quality of each article was assessed using the Cochrane RoB 2 tool and the GRADE guidelines. Results: Among the 1030 articles retrieved, 11 RCTs (842 patients) were included. A comparison of the two groups revealed statistically significant differences in the improvement of VAS and WOMAC scores in terms of the mean difference (MD); this difference was in favour of corticosteroids at short‐term (p < 0.001, MD = −1.6 and p < 0.001, MD = −9.9, respectively) and mid‐term follow‐ups (p = 0.001, mean MD = −1.3 and p = 0.005, MD = −4.9, respectively). No difference was observed at the long‐term follow‐up. The MDs between the improvements in the two groups reached the MCID values for the VAS and WOMAC only at the short‐term follow‐up. The RoB 2 tool and the GRADE evaluations showed the presence of risk of bias and limited quality of evidence. Conclusion: This systematic review and meta‐analysis demonstrated that intra‐articular corticosteroid injections offer clinically perceivable pain relief and functional improvement higher than the placebo effect only at short‐term follow‐up in patients affected by knee OA, with benefits losing clinical relevance already after 6 weeks. These results, together with the low number and the limited quality of the RCTs comparing this treatment with placebo, question the indication for the use of corticosteroid injections in clinical practice for the treatment of knee OA. Level of Evidence: Level I. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to compare long‐term clinical and radiographic outcomes and survival rates between navigation‐assisted (NAV) total knee arthroplasty (TKA) and conventional (CON) TKA using a mobile‐bearing insert. Methods: From May 2008 to December 2009, 45 and 63 mobile‐bearing TKA patients were enroled in the CON‐ and NAV‐TKA groups with 146.8 months follow‐up, respectively. Clinical outcomes (Western Ontario and McMaster University Osteoarthritis Index and Knee Society Scores), radiographic outcomes (hip‐knee‐ankle [HKA], lateral distal femoral, medial proximal tibial, γ, and δ angles), and survivorship were compared between both groups. Results: The number of HKA angle outliers (more than 3 degrees or less than −3 degree) was significantly lower in the NAV‐TKA group (24.4% vs. 9.5%, p = 0.036) than in the CON‐TKA group. However, long‐term clinical outcomes were similar between both groups. The cumulative survival rate (best‐case scenario) was 98.3% in the CON‐TKA group and 97.5% in the NAV‐TKA group, with no significant difference between the groups (p = 0.883). Conclusion: Long‐term clinical outcomes and survival rates were similar between the two groups despite fewer outliers of postoperative lower‐limb alignment in the NAV‐TKA group. Excellent survival rates were observed in both groups using mobile‐bearing inserts. Level of Evidence: Level IV, case series. [ABSTRACT FROM AUTHOR]

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Copyright of Canadian Journal for the Scholarship of Teaching & Learning is the property of Society for Teaching & Learning in Higher Education and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)