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Objective: The objective was to examine potential pathways linking neighborhood disadvantage to pain severity in individuals with knee pain consistent with or at risk for knee osteoarthritis (KOA). Methods: The current investigation is a cross‐sectional analysis. Data were collected from 140 middle‐aged to older non‐Hispanic White and non‐Hispanic Black adults from the Understanding Pain and Limitations in Osteoarthritic Disease Study 2 (UPLOAD‐2). Relationships among neighborhood disadvantage, sleep efficiency, pain catastrophizing, and pain severity were assessed. Neighborhood disadvantage was quantified using the Area Deprivation Index, and actigraphy data were used to assess sleep efficiency. The Coping Strategies Questionnaire–Revised catastrophizing subscale and the Western Ontario and McMaster Universities Osteoarthritis Index pain severity scale were used to assess pain catastrophizing and pain severity, respectively. A serial mediation model assessed the neighborhood–sleep–catastrophizing–pain pathway, as well as the neighborhood–sleep–pain and the neighborhood–catastrophizing–pain pathways. Results: Greater neighborhood disadvantage was associated with worse sleep efficiency, ultimately contributing to greater pain severity. Although neither neighborhood disadvantage nor sleep efficiency were associated with pain catastrophizing, pain catastrophizing itself was associated with greater KOA pain. Conclusion: Neighborhood disadvantage impacts KOA pain outcomes through sleep efficiency but not pain catastrophizing, thereby highlighting environmental aspects that impact sleep as potential targets for intervention. [ABSTRACT FROM AUTHOR]

Changes in lower limb alignment after open‐wedge high tibial osteotomy (owHTO) influence joint kinematics. The aim of this study was to investigate the morphological and kinematic changes of the knee joint, in particular the patellofemoral joint, using a multibody simulation model. OwHTO with an open tibial wedge of 6–12 mm (1 mm intervals) was virtually performed on each of 13 three‐dimensional (3D) computer‐aided design models (CAD models) derived from computer tomography scans of full‐leg cadaver specimens. For each owHTO, an individual biomechanical simulation model was built and knee flexion from 5° to 100° was simulated using a multibody simulation model of the native knee. Morphologic and alignment parameters as well as tibiofemoral and patellofemoral kinematic parameters were evaluated. Almost linear changes in tibial tuberosity trochlea groove (TT‐TG) (0.42 mm/1 mm wedge height) were observed which led to pathological values (TT‐TG > 20 mm) in 3 out of 13 knees. Furthermore, a 6 mm increase in osteotomy wedge height increased lateral patellofemoral rotation by 0.8° (range: 0.39° to 1.11°) and led to a lateral patellar translation of 0.8 mm (range: 0.37–3.11 mm) on average. Additionally, valgisation led to a medial translation of the tibia and a decrease in the degree of tibial internal rotation during knee flexion of approximately 0.3°/1 mm increase in osteotomy wedge height. The increase in TT‐TG and the biomechanical effects observed influence patellofemoral tracking, which may increase retropatellar pressure and are potential risk factors for the development of anterior knee pain. [ABSTRACT FROM AUTHOR]

Aims: In many countries, pain is the most common indication for use of antidepressants in older adults. We reviewed the evidence from randomized controlled trials on the efficacy and safety of antidepressants, compared to all alternatives for pain in older adults (aged ≥65 years). Methods: Trials published from inception to 1 February 2024, were retrieved from 13 databases. Two independent reviewers extracted data on study and participant characteristics, primary efficacy (pain scores, converted to 0–100 scale) and harms. Estimates for efficacy were pooled using a random effects model and reported as difference in means and 95% CI. Quality of included trials was assessed using the Cochrane risk of bias tool. Results: Fifteen studies (n = 1369 participants) met the inclusion criteria. The most frequently studied antidepressants were duloxetine and amitriptyline (6/15 studies each). Pain related to knee osteoarthritis was the most studied (6/15 studies). For knee osteoarthritis, antidepressants did not provide a statistically significant effect for the immediate term (0–2 weeks), (−5.6, 95% confidence interval [CI]: −11.5 to 0.3), but duloxetine provided a statistically significant, albeit a very small effect in the intermediate term, (≥6 weeks and <12 months), (−9.1, 95% CI: −11.8 to −6.4). Almost half (7/15) of the studies reported increased withdrawal of participants in the antidepressant treatment group vs. the comparator group due to adverse events. Conclusions: For most chronic painful conditions, the benefits and harms of antidepressant medicines are unclear. This evidence is predominantly from trials with sample sizes of <100, have disclosed industry ties and classified as having unclear or high risk of bias. [ABSTRACT FROM AUTHOR]

Background: Obesity is a significant risk factor for osteoarthritis (OA). The most effective treatment for morbid obesity is bariatric surgery. Purpose: To study the effects of potential surgically induced weight loss on knee articular cartilage and OA symptoms of obese patients over a 12‐month follow‐up. Study Type: Prospective longitudinal cohort study. Subjects: 45 obese patients (38 female, BMI = 42.3 ± 6.5 kg/m2) who underwent gastric bypass (intervention group), and 46 age‐matched conservative‐care controls (37 female, BMI = 39.8 ± 4.6 kg/m2). Field Strength/Sequence: Multiecho spin echo sequence at 3 T. Assessment: Knee cartilage T2 measurements and WOMAC Indices were measured presurgery and after 12 months. The intervention group was split into successful (≥20% total weight loss (TWL)) and unsuccessful (<20% TWL) weight loss groups. T2 and WOMAC indices were also measured in controls at baseline and after 12 months. Changes among the three groups were analyzed. Statistical Tests: Analysis of variance (significance level 0.05). Results: Twenty‐six (58%) intervention patients achieved ≥20% TWL. The <20% TWL group demonstrated significantly more T2 reduction in the deep lateral femur over 12 months compared with the ≥20% TWL group (−3.83 ± 8.18 msec vs. 2.47 ± 6.54 msec, respectively), whereas no significant differences were observed on the medial femoral compartment (P = 0.385, P = 0.551, and P = 0.511 for bulk, superficial and deep regions, respectively). Changes in WOMAC indices over 12 months were significantly greater in the ≥20% TWL group compared with controls. In the <20% TWL group, pain significantly improved over 12 months compared with controls, while stiffness and function changes were not statistically significant (P = 0.063 and P = 0.051, respectively). Data Conclusion: Cartilage matrix, measured by T2, showed improvement on lateral femoral cartilage with <20% TWL compared with ≥20% TWL. Bariatric surgery provided significant improvements in knee symptoms with ≥20% TWL compared with conservative WL. This effect is also seen to some extent with <20% TWL compared with conservative WL. Level of Evidence: 2 Technical Efficacy: Stage 4 [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Methods Results Conclusion Pseudo‐patella baja (PPB) was one of the complications after total knee arthroplasty (TKA). This complication may be closely related to the occurrence of knee joint movement limitation and pain after TKA. This study aimed to investigate whether PPB affects clinical outcomes after TKA and to study the biomechanical effects of PPB after TKA.This study was a retrospective case series of 462 eligible patients (563 knees). Clinical evaluation was performed using the visual analogue scale (VAS), the Hospital for Special Surgery (HSS), the Western Ontario McMaster University Osteoarthritis Index (WOMAC) scoring systems, the 5‐Level EuroQol Generic Health Index (EQ‐5D‐5L), the Forgotten Joint Score‐12 (FJS‐12), and patient satisfaction. CT and MRI scans of two healthy left knees and TKA prostheses were taken; 3D models including PPB, True patella baja (TPB), normal patella, and patella alta (PA) were created in FEA and applied load along the direction of quadriceps femoris. T‐test, Mann–Whitney U‐test, chi‐squared (χ2) test, and analysis of variance (ANOVA) were performed using GraphPad Prism (Version 8, GraphPad Software, USA). A statistically significant difference was considered at p < 0.05 with bilateral α.The VAS, HSS, WOMAC, EQ‐5D‐5L, FJS‐12, and patient satisfaction scores in the PPB and TPB groups were significantly worse than those in the patella normal (PN) group (p < 0.05). The PPB group found a positive correlation between Blackburne–Peel index (BPI) and FJS‐12 score. PPB showed lower contact stress of patellofemoral joint compared to TPB when knee flexion was less than < 90° (p < 0.01), but no significant difference when flexion was more than > 90° (p > 0.05) in the finite element model with Patella baja (PB). The contact area of the patellofemoral joint tended to increase with the deepening of knee flexion, and decreased after reaching the peak value. The contact area of the patellofemoral joint tended to decrease with the increase in patellar height. There was no significant difference in the contact area of the patellofemoral joint among different patellar heights and different degrees of knee flexion (p > 0.05).PPB after TKA may increase patellofemoral joint stress and postoperative complications like anterior knee pain. [ABSTRACT FROM AUTHOR]

Diclofenac etalhyaluronate (DF‐HA) sustained diclofenac release with the effects of hyaluronic acid (HA), offering long‐term analgesia in osteoarthritis. In this study, the effects of DF‐HA on pain improvement and osteoarthritis were evaluated in a rat knee monoiodoacetate‐induced osteoarthritis model compared to HA. Eight rats per group had been injected with monoiodoacetate (2.0 mg) or saline in the right knee for 4 weeks and were injected with either DF‐HA (1.25 mg/kg; 0.5 mg), HA (0.5 mg), vehicle which was a substrate without DF‐HA (50 μL), or saline and followed for 4 weeks. Mechanical plantar skin sensitivity was assessed weekly using the von Frey assay. Osteoarthritis changes were monitored with Larsen scores via CT imaging at every 2 weeks. The articular cartilage was analyzed using OARSI scores through H&E, Safranin‐O staining at 8 weeks. The percentage of Iba‐1 positive microglia in the spinal dorsal horn and of FG + CGRP‐labeled cells among FG‐positive cells in the dorsal root ganglion were evaluated by immunohistochemical staining. TNF‐α and IL‐6 mRNA expression levels in the knee synovium were evaluated by PCR. The DF‐HA showed significantly improved pain hypersensitivity compared with the HA at 6–8 weeks. The percentage of Iba‐1‐positive microglia was significantly lower than that in the vehicle and the percentage of FG + CGRP/FG was significantly lower than that in the HA. OARSI scores did not differ among treatment groups, Larsen scores indicated lower in the DF‐HA than in the vehicle. DF‐HA was as effective as HA in joint protection and significantly improved inflammatory pain compared to HA. [ABSTRACT FROM AUTHOR]

Methyltransferase‐like 3 (METTL3) plays a role in the development of knee osteoarthritis (KOA). However, the mechanism underlying the role of METTL3 in KOA is unclear. This work investigated the effects of MELLT3 on ferroptosis and pain relief in in vitro and in vivo KOA models. Chondrocytes were treated with 10 ng/mL interleukin‐1β (IL‐1β) or 5 μM Erastin (ferroptosis inducer). IL‐1β or Erastin treatment inhibited cell viability and glutathione levels; increased Fe2+, lipid reactive oxygen species and malondialdehyde production; and decreased glutathione peroxidase 4, ferritin light chain and solute carrier family 7 member 11 levels. The overexpression of METTL3 facilitated the N6‐methyladenosine methylation of high mobility group box 1 (HMGB1). HMGB1 overexpression reversed the effect of sh‐METTL3 on IL‐1β‐treated chondrocytes. A KOA rat model was established by the injection of monosodium iodoacetate into the joints and successful model establishment was confirmed by haematoxylin and eosin staining and Safranin O/Fast Green staining. METTL3 depletion alleviated cartilage damage, the inflammatory response, ferroptosis and knee pain in KOA model rats, and these effects were reversed by the addition of HMGB1. In conclusion, METTL3 depletion inhibited ferroptosis and the inflammatory response, and ameliorated cartilage damage and knee pain during KOA progression by regulating HMGB1. Highlights: IL‐1β induced ferroptosis and increased METTL3 and HMGB1 levels in chondrocytes.METTL3 participated in IL‐1β‐induced ferroptosis by regulating HMGB1 m6A modification.Depletion of METTL3 attenuated KOA progression in a rat model by regulating HMGB1.METTL3 silencing mitigated pain by regulating HMGB1 in KOA model rats. [ABSTRACT FROM AUTHOR]

Placental‐derived allografts have been of interest as a potential nonsurgical treatment to reduce pain and improve function in knee osteoarthritis (OA). The purpose of this study was to evaluate the effect of single and repeat injection of amniotic suspension allograft (ASA) on pain, function, and cytokine levels using a destabilization of the medial meniscus (DMM) rat model of OA. Post‐DMM surgery, animals were treated with a single injection of either ASA, vehicle, or triamcinolone, or repeated injection of either ASA or vehicle. Behavioral testing including knee swelling, pain threshold, dynamic weight bearing (DWB), and gait analysis were evaluated during the in‐life phase. Postsacrifice, histopathology and serum and synovial fluid analyses were evaluated. Significant improvements in both DWB differentials and pain threshold were seen in response to repeated injection of ASA, while a single injection of ASA and triamcinolone resulted in significant improvements in pain threshold. Histopathology analysis found no significant differences regardless of treatment compared to vehicle, except for an increase in synovitis following repeated injection of ASA. A single injection of ASA and triamcinolone resulted in increased anti‐inflammatory cytokines; repeated ASA injection resulted in significant increases in several immune‐modulating factors relevant to OA. When comparing the impact of single and repeat ASA treatments on behavioral testing, repeated injection provided significant additional improvements in both pain and function. This study provides evidence demonstrating the impact of a second injection while also providing additional data for evaluating the use of ASA as a nonsurgical treatment for knee OA. [ABSTRACT FROM AUTHOR]

Background: Total knee arthroplasty is associated with an inflammatory response and high levels of pain in a subset of patients. Pain catastrophizing has been associated with acute postoperative pain. The association between these variables has not been investigated in an optimised fast‐track setup including preoperative glucocorticoids. The aim of this study was, first, to investigate the correlation between the increase in postoperative c‐reactive protein (CRP) and acute postoperative pain after total knee arthroplasty, and second, to investigate the correlation between the increase in CRP and preoperative pain catastrophizing. Methods: This study is a secondary analysis of data from 119 patients participating in two randomised controlled trials. Correlation analyses were performed for preoperative CRP and CRP increase at 24 and 48 h and pain during a well‐defined mobilisation at 24 and 48 h after total knee arthroplasty. Additionally, correlation analyses were performed between CRP increase and pain catastrophizing using the pain catastrophizing scale. Results: There was no correlation between preoperative CRP or postoperative CRP increase and pain at both 24 and 48 h. Analyses were similar when separated into high and low pain catastrophizers. There was no correlation between preoperative CRP or postoperative CRP increase and pain catastrophizing. Conclusion: There was no association between the postoperative CRP response and postoperative acute pain or pain catastrophizing in patients undergoing total knee arthroplasty in a well‐defined multimodal fast‐track regime including preoperative glucocorticoids. These results suggest that acute pain after knee arthroplasty is not reflected by CRP when applying preoperative glucocorticoids. [ABSTRACT FROM AUTHOR]

Introduction: To systematically compare the global prevalence of musculoskeletal pain and care‐seeking in rural and urban populations. Methods: A systematic review with meta‐analysis of observational studies reporting a direct comparison of rural and urban populations was conducted worldwide and included back, knee, hip, shoulder, neck pain and a broad diagnosis of 'musculoskeletal pain'. A search strategy combining terms related to 'prevalence', 'musculoskeletal pain' and 'rural' was used on the following databases: MEDLINE, Embase, CINAHL, Scopus, and rural and remote health from their inception to 1 June 2022. Random‐effects meta‐analysis was used to pool the data. Results were presented as odds ratios (OR) along with 95% confidence intervals (95% CI). Results: A total of 42 studies from 24 countries were included with a total population of 489 439 participants. The quality scores for the included studies, using the modified Newcastle Ottawa Scale tool, showed an average score of 0.78/1, which represents an overall good quality. The pooled analysis showed statistically greater odds of hip (OR = 1.62, 95% CI = 1.23–2.15), shoulder (OR = 1.42, 95% CI = 1.06–1.90) and overall musculoskeletal pain (OR = 1.26, 95% CI = 1.08–1.47) in rural populations compared to urban populations. Although the odds of seeking treatment were higher in rural populations this relationship was not statistically significant (OR = 0.76, 95% CI = 0.55–1.03). Conclusion: Very low‐certainty evidence suggests that musculoskeletal, hip and shoulder pain are more prevalent in rural than urban areas, although neck, back and knee pain, along with care‐seeking, showed no significant difference between these populations. Strategies aimed to reduce the burden of musculoskeletal pain should consider the specific needs and limited access to quality evidence‐based care for musculoskeletal pain of rural populations. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to study the recovery from, and incidence of, work‐restricting musculoskeletal pain after bariatric surgery compared with usual obesity care. Methods: Pain in different body regions was monitored using questionnaires in the nonrandomized, prospective, controlled Swedish Obese Subjects (SOS) study, which included 2007 participants treated with bariatric surgery and a matched control group of 2040 participants receiving usual obesity care at primary health care centers. Self‐reported pain in the neck and shoulders, back, hips, knees, and ankles was captured from questionnaires administered at baseline and after 1, 2, 3, 4, 6, 8, 10, 15, and 20 years. Results: Compared with matched controls, bariatric surgery was associated with better recovery from baseline work‐restricting knee and ankle pain in both the short (1–4 years) and long term (up to 20 years), as well as from back and hip pain in the short term. In participants without pain at baseline, bariatric surgery was associated with a lower incidence of developing new pain in the knee and ankle in the short and long term. Conclusions: Bariatric surgery was associated with better recovery from pain, primarily in weight‐bearing joints, as well as with prevention of pain development in the knee and ankle compared with matched controls receiving usual obesity care. [ABSTRACT FROM AUTHOR]

A 65-year-old man with a history of seronegative rheumatoid arthritis presented with pain and swelling in his knees and wrists. Despite previous treatments, his symptoms did not improve. Laboratory tests showed low potassium levels, high ESR, and high CRP. X-rays revealed osteoarthritic changes. The differential diagnosis includes various forms of arthritis, such as seronegative rheumatoid arthritis, peripheral spondyloarthritis, osteoarthritis, infectious arthritis, crystalline arthritis, and paraneoplastic arthritis. Further evaluation is needed to determine the correct diagnosis. In this case, the patient was diagnosed with chronic calcium pyrophosphate crystal inflammatory arthritis due to hypomagnesemia caused by proton pump inhibitor use. Checking for hypomagnesemia in patients with CPPD disease is important, and PPI use should be considered as a potential cause. [Extracted from the article]

Purpose: To compare the clinical efficacy of single‐bundle versus double‐bundle reconstruction of the medial patellofemoral ligament (MPFL) for recurrent patellar dislocation (RPD) regarding knee function scores, postoperative complications, and imaging assessments. Methods: A computerized search of PubMed, Cochrane Library, Embase, China Biomedical Literature Database (CBM), China National Knowledge Network (CNKI), and VIP Database was performed for single‐bundle versus double‐bundle reconstruction of the medial patellofemoral ligament for treatment of RPD. Randomized controlled trials (RCTs) were evaluated for quality using the risk‐of‐bias evaluation tool recommended by the Cochrane Collaboration Network, and Cohort studies (CSs) were assessed using the Newcastle‐Ottawa Scale (NOS) scale. Meta‐analysis was performed using RevMan 5.3 software and STATA 16.0. Results: Thirteen studies were included, four randomized controlled studies, and nine cohort studies. The level of evidence for the four randomized controlled studies was Ⅰ, and the nine cohort studies were Ⅲ. A total of 862 (891 knees) patients were included, of which 448 (465 knees) underwent double‐bundle MPFL reconstruction and 414 (426 knees) underwent single‐bundle MPFL reconstruction. Kujala score (MD = 2.06, 95% confidence interval [CI] [0.11, 4.01], p < 0.05), Tegner score (MD = 0.39, 95% CI [0.11, 0.68], p < 0.05), International Knee Documentation Committee (IKDC) score (MD = 4.88, 95% CI [1.46, 8.31], p < 0.05), and postoperative recurrence instability (odds ratio [OR] = 0.12, 95% CI [0.04, 0.44], p < 0.05) were better in the double‐bundle group than in the single‐bundle group. Lysholm score (MD = 0.86, 95% CI [−0.76, 2.48], p = n.s), patellar tilt angle (MD = −0.22, 95% CI [−0.54, 0.10], p = n.s), patellar lateral shift rate (MD = −0.16, 95% CI [−0.41, 0.09], p = n.s), congruence angle (MD = 0.06, 95% CI [−0.41, 0.52], p = n.s), postoperative knee pain (OR = 0.39, 95% CI [0.14, 1.11], p = n.s), and additional postoperative surgical treatment (OR = 0.20, 95% CI [0.01−6.25], p = n.s) had no statistically significant differences. Conclusions: Double‐bundle reconstruction of the medial patellofemoral ligament for RPD was superior to single‐bundle reconstruction in both knee function scores and postoperative recurrent patellar instability, and double‐bundle reconstruction of the medial patellofemoral ligament for RPD had better clinical outcomes. Level of Evidence: Level Ⅲ, Ⅰ and Ⅲ studies. [ABSTRACT FROM AUTHOR]

Background: Surgeons usually use the medial parapatellar or subvastus approaches for total knee arthroplasty (TKA). The subvastus approach is rapidly gaining recognition to reduce damage to the extensional mechanism and recover faster after surgery. This study compares the long‐term outcomes of the conventional medial parapatellar and subvastus approaches in primary TKA during a minimum 10‐year follow‐up. Methods: In a retrospective longitudinal follow‐up study from 2008 to 2013, 60 eligible patients for primary TKA were included. The patients were divided into two groups: one undergoing TKA with the subvastus approach (n = 30) and the other with the conventional medial parapatellar approach (n = 30). Postoperatively, the patients were followed up for 10–15 years. Patients were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Society Score (KSS), and Visual Analogue Scale index for pain. Results: The time required to perform an active straight leg raise (SLR) was significantly shorter in the subvastus group (p < 0.001) at early postoperation evaluation. Patients in the subvastus group had lower pain and better knee functional scores at the one‐year follow‐up (p < 0.05). There was no difference between the two groups regarding duration of hospitalisation, blood loss, operation time, length of the scar, and postoperative complications. Both approaches had similar long‐term results regarding pain and functional scores of WOMAC (6.2 ± 1.2 vs. 6.3 ± 1.3, p‐value = 0.69) and KSS scores (93.1 ± 6.8 vs. 95.0 ± 3.2, p‐value = 0.42). Conclusion: The subvastus approach was associated with a shorter time to achieve active SLR, higher functional scores, and better pain relief at early postoperative evaluations. However, both techniques had similar long‐term outcomes in terms of pain and functional scores, as measured by the WOMAC and KSS scales. Level of Evidence: II [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion The increasing number of semi‐invasive pain therapies in knee osteoarthritis poses challenges in decision‐making. This review aimed to simultaneously compare established intra‐articular therapies with newer peri‐articular therapies and explore effect modifiers.Randomized controlled trials were searched from five electronic databases without date or language restrictions. Study selection and data extraction of reports, retrieved up to May 2024, were performed independently by paired assessors. The primary outcome was 6‐month pain score. Nine treatments were included. The effect size (ES) for each treatment, relative to placebo, was estimated using standardized means difference and expressed with 95% confidence intervals (CI). The rigor of results was evaluated with subgroup/sensitivity analyses.A total of 111 studies (14,695 participants) were included, with intra‐articular hyaluronic acid having the greatest number of participants. Neuroablation demonstrated the greatest ES (1.08, 95% CI: 0.07, 2.10). While platelet‐rich plasma (PRP) ranked second (ES: 0.75, 95% CI: 0.28, 1.22), it was the only intervention demonstrating statistically significant effect at 3, 6, and 12 months. However, this statistical significance was lost in some sensitivity analyses. Larger estimates for biologics and PRP compared with prolotherapy, steroid, and hyaluronic acid injections were consistently observed across different timepoints and in multiple sensitivity analyses. Generally, no statistically significant difference was found between the nine types of therapies.Although there is robust evidence suggesting greater efficacy of PRP, potentially including biologics, over other interventions, future research is needed to identify the phenotype or patient subgroup that would benefit most from PRP. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion In individuals without radiographic knee osteoarthritis (OA), we investigated whether magnetic resonance imaging (MRI)–defined knee OA at baseline was associated with incident radiographic and symptomatic disease during up to 11 years of follow‐up.Osteoarthritis Initiative participants without tibiofemoral radiographic knee OA at baseline were assessed for MRI‐based tibiofemoral cartilage damage, osteophyte presence, bone marrow lesions, and meniscal damage/extrusion. We defined MRI knee OA using alternative, reported definitions (Def A and Def B). Kellgren–Lawrence (KL) grade, joint space narrowing (JSN), and frequent knee symptoms (Sx) were assessed at baseline, 1‐, 2‐, 3‐, 4‐, 6‐, 8‐, and 10/11‐year follow‐up visits. Incident tibiofemoral radiographic knee OA (outcome) was defined as (1) KL ≥2, (2) KL ≥2 and JSN, or (3) KL ≥2 and Sx. Adjusted Cox proportional hazards regression models examined associations of baseline MRI‐defined knee OA (Def A and Def B) with incident outcomes during up to 11 years of follow‐up.Among 1,621 participants (mean age ± SD 58.8 ± 9.0 years, mean body mass index ± SD 27.2 ± 4.5 kg/m2, 59.5% women), 17% had MRI‐defined knee OA by Def A and 24% by Def B. Baseline MRI‐defined knee OA was associated with incident KL ≥2 (odds ratio 2.94 [95% confidence interval (95% CI) 2.34–3.68] for Def A and 2.44 [95% CI 1.97–3.03] for Def B). However, a substantial proportion of individuals with baseline MRI‐defined knee OA did not develop incident KL ≥2 during follow‐up (59% for Def A and 64% for Def B). Findings were similar for the other two outcomes.Current MRI definitions of knee OA do not adequately identify knees that will develop radiographic and symptomatic disease. [ABSTRACT FROM AUTHOR]

Background: Folate has an important role in the functioning of the musculoskeletal system, including modulation of inflammation, immunity, cartilage regeneration, prevention of osteoporosis, and maintenance of muscle strength, but evidence on the association between folate intake and knee pain, functional scores, and radiographic progression in patients with knee osteoarthritis (OA) is still limited. Methodology: Our population‐based cohort was extracted from the osteoarthritis initiative (OAI), focusing on individuals with prevalent radiographic knee OA (with a Kellgren–Lawrence score ≥2). Folate consumption was determined using the food frequency questionnaire. Data regarding the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores and radiographic readings were collected over 48 months. We analyzed the compiled data using generalized additive mixed models. Results: Our cohort consisted of 1472 OA patients (626 men and 846 women, mean [SD] age 62.35 [8.92]). At the 48‐month follow‐up, we observed a significant correlation between higher folate intake and a slower progression of knee pain and functional scores, as evidenced by a statistically significant decrease in the WOMAC total score, WOMAC pain subscale score, and WOMAC function/disability subscale score (p <.05). The fully adjusted models estimated a reduction of −0.028 points per 50 μg/1000 kcal of daily folate intake on the WOMAC pain subscale, −0.117 points on the WOMAC function subscale, and −0.160 points on the total WOMAC scale. Furthermore, our nonparametric fit analysis suggested that a higher intake of folate might decelerate the radiographic progression of OA. Stratified analyses indicated that an increase in folate consumption might particularly benefit men, older adults, overweight and obese individuals, and those with a higher dietary fiber intake. Conclusion: Higher folate intake is correlated with improved knee function and reduced pain in patients with knee OA and might deter the radiographic progression of OA. The benefits appear to be more pronounced in men, older adults, overweight and obese individuals, and those with a higher dietary fiber intake. [ABSTRACT FROM AUTHOR]

Objective: To examine the relationship between C‐reactive protein (CRP) and knee pain, and further explore whether this association is mediated by obesity. Methods: The population was derived from 1999 to 2004 National Health and Nutrition Examination Survey. Logistic regression was used to analyze the relationship between CRP and knee pain in three different models, and the linear trend was analyzed. A restricted cubic spline model to assess the nonlinear dose−response relationship between CRP and knee pain. Mediation analyses were used to assess the potential mediating role of obesity. Subgroup analyses and sensitivity analyses were performed to ensure robustness. Results: Compared with adults with lower CRP (first quartile), those with higher CRP had higher risks of knee pain (odds ratio 1.39, 95% confidence interval 1.12−1.72 in third quartile; 1.56, 1.25−1.95 in fourth quartile) after adjusting for covariates (except body mass index [BMI]), and the proportion mediated by BMI was 76.10% (p <.001). BMI and CRP were linear dose−response correlated with knee pain. The odds ratio for those with obesity compared with normal to knee pain was 2.27 (1.42−3.65) in the first quartile of CRP, 1.99 (1.38−2.86) in the second, 2.15 (1.38−3.33) in the third, and 2.92 (1.72−4.97) in the fourth. Conclusion: Obesity mediated the systemic inflammation results in knee pain in US adults. Moreover, higher BMI was associated with higher knee pain risk in different degree CRP subgroups, supporting an important role of weight loss in reducing knee pain caused by systemic inflammation. [ABSTRACT FROM AUTHOR]

Background: Persistent high levels of knee pain after a total knee replacement have been estimated to affect 5%–10% of people and this is related to dissatisfaction with surgery, reduced function and reduced quality of life. This systematic review aims to evaluate the effectiveness of rehabilitation programs or strategies to reduce persistent pain and improve function and quality of life in people following a total knee replacement. Methods: The systematic review was conducted following PRISMA guidelines with a search of relevant online databases up to 17 July 2024. The search criteria included English language randomised controlled trials of rehabilitation programs or strategies in any setting to treat people with persistent knee pain more than 3 months after a total knee replacement. Rehabilitation could include exercise, education, cognitive strategies and self‐management programs and excluded medication trials, procedural techniques and complementary therapies. Results: After removal of duplicates, there were 468 abstracts screened for eligibility with 23 remaining for full‐text screening and finally, one study meeting the eligibility criteria. This study's interventions were pain neuroscience education alone and pain neuroscience education plus neuromuscular exercise. There were no statistically significant between‐group differences for pain reduction or functional improvement. Conclusion: The evidence examining the value of rehabilitation programs or strategies for pain reduction and functional improvement in people with persistent pain following total knee replacement is deficient. Given the high number of people affected annually, further research concerning both prevention and management of persistent pain after knee replacement is warranted. [ABSTRACT FROM AUTHOR]

Aim: To investigate the factors that influence readiness for hospital discharge in Chinese patients after total knee arthroplasty and to identify priorities for nursing interventions. Design: A cross‐sectional study. Methods: From January to August 2022, data were collected from 339 patients at two tertiary A‐level hospitals in Jinan, Shandong Province. SPSS 26.0 and Mplus 8.3 software were used for statistical analysis. Results: Results from multiple linear regression showed that patients' age, residence status, education level, knee pain during sleep, quality of discharge teaching, self‐efficacy for rehabilitation, pain control knowledge, and social support were factors influencing their readiness for hospital discharge. The results of the structural equation model had shown that there were also indirect effects of the education level, knee pain during sleep, quality of discharge teaching, and pain control knowledge. Conclusion: Patients' readiness for hospital discharge needs further improvement, hence physicians and nurses should judiciously allocate medical resources and concentrate their efforts on high‐risk groups characterized by low readiness for hospital discharge. Implications for the Profession and Patient Care: This study underscores the importance of physicians and nurses prioritizing key factors such as age, residency status, education level, and social support in total knee arthroplasty patients to enhance their readiness for hospital discharge. By implementing targeted discharge planning, effective pain management, and comprehensive rehabilitation education, healthcare providers can improve patient outcomes. Impact: This study identified key factors influencing readiness for hospital discharge in total knee arthroplasty patients, guiding targeted nursing interventions to improve post‐operative care. Reporting Method: STROBE. Patient or Public Contribution: The participants recruited for this study were actively engaged in the data collection process. [ABSTRACT FROM AUTHOR]

The updated Osteoarthritis of the Knee Clinical Care Standard aims to provide evidence-based care for individuals with knee osteoarthritis. The standard emphasizes non-surgical management and recommends against unnecessary procedures such as knee arthroscopy. It also focuses on comprehensive assessment and diagnosis, appropriate use of imaging, education and self-management, physical activity and exercise, weight management and nutrition, and the use of medicines to manage pain and mobility. The standard includes cultural safety and equity considerations and provides recommendations for effective communication between clinicians and patients. Resources are available to support consumers, clinicians, and health services in implementing the standard. [Extracted from the article]

To investigate the effects of patellar denervation (PD) and non‐patellar denervation (NPD) after primary total knee arthroplasty (TKA) without patellar resurfacing, this study conducted systematic electronic searches in November 2023 using PubMed, Embase, Web of Science, Cochrane, and Scopus, adhering to Cochrane Collaboration recommendations. Only randomized controlled trials (RCTs) were included. Additionally, a manual search was performed to identify potentially eligible studies from the reference lists of review articles. Two researchers independently conducted literature reviews, data extraction, and risk of bias assessments. The outcome analysis encompassed the incidence of anterior knee pain (AKP), visual analogue scale (VAS), range of motion (ROM), American Knee Society Score (KSS), Oxford Knee Score (OKS), patellar score (PS), complications, and reoperations. Meta‐analysis was executed using RevMan 5.3 software. To enhance the credibility of the study, TSA v0.9 software was utilized to perform power analysis on the overall efficacy of primary and secondary outcomes. Twelve studies involving 1745 patients (1587 knees) were included, with 852 undergoing PD and 893 undergoing NPD. Results indicated a superior reduction in AKP incidence in the PD group compared to the NPD group. Statistically significant differences were observed between PD and NPD in KSS, OKS, and PS. However, the upper limit of the 95% confidence interval for each outcome fell below the minimal clinically important difference (MCID). No significant differences were found in VAS and ROM between PD and NPD. Additionally, PD was not associated with an increased incidence of complications or reoperations. Within 12 months and beyond, PD was proven to be a beneficial intervention in reducing AKP following TKA without patellar resurfacing, achieved without an increase in complications or reoperations. Regarding KSS, OKS, and PS, the minimal advantage achievable through PD may not be clinically significant. [ABSTRACT FROM AUTHOR]

Objective: The management of the infrapatellar fat pad (IPFP) during total knee arthroplasty (TKA) remains controversial. This study aimed to evaluate a novel IPFP preservation technique—"the medially pedicled IPFP flap"—for reducing postoperative pain, wound complications, and improving functional recovery after TKA. Methods: A retrospective analysis was conducted on TKA cases at our institution from 2018 to 2021, including those with IPFP preservation (medially pedicled flap) versus IPFP complete resection. Patient demographics, perioperative parameters (blood loss, operative time, length of hospital stay, visual analogue scale [VAS] score, white cell count [WBC], C‐reactive protein [CRP], erythrocyte sedimentation rate [ESR], and wound oozing), and postoperative follow‐up data (VAS, Knee Society [KSS], or Knee Society functional assessment [KSFA] scores) were compared between groups. Independent sample t‐tests were used to compare continuous data and chi‐squared tests were used to compare categorical data between groups. Results: Six hundred thirty patients were included, with 278 in the medial pedicled IPFP flap group (preservation group) and 352 in the IPFP resection group (resection group). The operative time was significantly shorter in the preservation versus resection group (125.5 ± 23.2 vs 130.3 ± 28.7 mins, p = 0.03), as was the length of hospital stay (8.4 ± 2.7 vs 9.2 ± 2.3 days, p < 0.01). Regarding pain, the preservation group had significantly lower VAS scores on postoperative day 2 (2.0 ± 0.8 vs 2.4 ± 1.2, p < 0.001) and day 3 (1.5 ± 0.5 vs 1.8 ± 1.0, p < 0.001). CRP and ESR levels on postoperative day 5 were also significantly lower in the preservation group. Wound oozing rates were significantly lower in the preservation versus resection group (0.7% vs 2.8%, p = 0.04). No significant differences existed in VAS, KSS, or KSFA scores at the last follow‐up. Conclusion: The novel IPFP preservation technique significantly improved surgical exposure, shortened operative time and length of hospital stay. It also reduced wound pain and oozing compared to IPFP resection. [ABSTRACT FROM AUTHOR]

Multisite chronic pain (MCP) and site‐specific chronic pain (SSCP) may be influenced by circulating inflammatory proteins, but the causal relationship remains unknown. To overcome this limitation, two‐sample bidirectional Mendelian randomization (MR) analysis was used to analyse data for 91 circulating inflammatory proteins, MCP and SSCP encompassing headache, back pain, shoulder pain, hip pain, knee pain, stomach abdominal pain and facial pain. The primary MR method used was inverse variance weighting, sensitivity analyses included weighted median, MR pleiotropy residual sum and outlier and the Egger intercept method. Heterogeneity was also detected using Cochrane's Q test and leave‐one‐out analyses. Finally, a causal relationship between 29 circulating inflammatory proteins and chronic pain was identified. Among these proteins, 14 exhibited a protective effect, including MCP (T‐cell surface glycoprotein cluster of differentiation 5), headache (4E‐binding protein 1 [4EBP1], cluster of differentiation 40, cluster of differentiation 6 and C‐X‐C motif chemokine [CXCL] 11), back pain (leukaemia inhibitory factor), shoulder pain (fibroblast growth factor [FGF]‐5 and interleukin [IL]‐18R1), stomach abdominal pain (tumour necrosis factor [TNF]‐α), hip pain (CXCL1, IL‐20 and signalling lymphocytic activation molecule 1) and knee pain (IL‐7 and TNF‐β). Additionally, 15 proteins were identified as risk factors for MCP and SSCP: MCP (colony‐stimulating factor 1, human glial cell line‐derived neurotrophic factor and IL‐17C), headache (fms‐related tyrosine kinase 3 ligand, IL‐20 receptor subunit α [IL‐20RA], neurotrophin‐3 and tumour necrosis factor receptor superfamily member 9), facial pain (CXCL1), back pain (TNF), shoulder pain (IL‐17C and matrix metalloproteinase‐10), stomach abdominal pain (IL‐20RA), hip pain (C‐C motif chemokine 11/eotaxin‐1 and tumour necrosis factor ligand superfamily member 12) and knee pain (4EBP1). Importantly, in the opposite direction, MCP and SSCP did not exhibit a significant causal impact on circulating inflammatory proteins. Our study identified potential causal influences of various circulating inflammatory proteins on MCP and SSCP and provided promising treatments for the clinical management of MCP and SSCP. [ABSTRACT FROM AUTHOR]

Background: Knee osteoarthritis (OA) with extra‐articular deformity (EAD) is a rare condition for which achieving accurate alignment with total knee arthroplasty (TKA) is difficult. Extra‐articular corrective osteotomy may be necessary for severe deformities. Case Presentation: A 76‐year‐old man underwent TKA for knee OA with EAD due to malunion after fractures of the femur and tibia. The femoral varus and the tibial valgus/recurvatum deformities were mild and corrected by intra‐articular osteotomy using navigation (i.e., navigation‐assisted standard TKA). However, the femoral antecurvatum deformity was severe, and we performed extra‐articular corrective osteotomy simultaneously with TKA. Navigation was used not only for TKA but also for extra‐articular corrective osteotomies. The osteotomy site was fixed with a cemented stem and metaphyseal sleeve. The postoperative hip–knee–ankle angle was 1° varus, the femoral implant was implanted at 0.5° varus/0.5° flexion, and the tibial implant was implanted at 0.5° varus/0° posterior slope. Two years after surgery, improvements were obtained in the range of motion from 15°–95° to 0°–110°, the Knee Society Score from 39 to 92 points, and the functional score from 35 to 100 points. Conclusions: One‐stage TKA with extra‐articular corrective osteotomy achieved good clinical results due to accurate alignment using navigation and firm fixation of the osteotomy site using cemented‐stem and metaphyseal sleeve without any fixation devices. [ABSTRACT FROM AUTHOR]

Elderly patients often have more than one disease that affects walking behavior. An objective tool to identify which disease is the main cause of functional limitations may aid clinical decision making. Therefore, we investigated whether gait patterns could be used to identify degenerative diseases using machine learning. Data were extracted from a clinical database that included sagittal joint angles and spatiotemporal parameters measured using seven inertial sensors, and anthropometric data of patients with unilateral knee or hip osteoarthritis, lumbar or cervical spinal stenosis, and healthy controls. Various classification models were explored using the MATLAB Classification Learner app, and the optimizable Support Vector Machine was chosen as the best performing model. The accuracy of discrimination between healthy and pathologic gait was 82.3%, indicating that it is possible to distinguish pathological from healthy gait. The accuracy of discrimination between the different degenerative diseases was 51.4%, indicating the similarities in gait patterns between diseases need to be further explored. Overall, the differences between pathologic and healthy gait are distinct enough to classify using a classical machine learning model; however, routinely recorded gait characteristics and anthropometric data are not sufficient for successful discrimination of the degenerative diseases. [ABSTRACT FROM AUTHOR]

A study published in the journal Anaesthesia explores the association between the use of non-steroidal anti-inflammatory drugs (NSAIDs) and persistent opioid requirements after total knee arthroplasty (TKA). The study, based on national insurance claims data from the USA, found that patients who received peri-operative NSAID prescriptions had higher odds of continued opioid prescriptions at 90 days post-surgery compared to those without NSAID prescriptions. While the study does not prove causality, it suggests a potential association that warrants further research. The authors recommend additional observational analyses using different data sources and exploring other surgical cohorts to validate and refine these findings. [Extracted from the article]

Summary: Non‐steroidal anti‐inflammatory drugs (NSAIDs) are one of the mainstays of multimodal pain management. While effective for acute pain control, recent pre‐clinical evidence has raised concerns regarding an association between NSAIDs and chronic pain and potential opioid use. Our objective was to explore the association between peri‐operative use of prescription NSAIDs and the need for continued opioid prescriptions lasting 90–180 days in previously opioid‐naïve patients undergoing total knee arthroplasty. A database of health claims in the USA was used to identify all opioid‐naïve adult patients who underwent primary knee arthroplasty between January 2010 and October 2021. We evaluated the magnitude of association between peri‐operative prescription NSAID claims and claims for opioids at 90 days postoperatively using multivariable logistic regression models. Secondary outcomes included: the magnitude of association between peri‐operative NSAID prescription and claims for opioids at 180 days postoperatively; and identifying other potential factors associated with opioid claims at 90 days postoperatively. After risk adjustment using multivariable logistic regression models in the 789,736‐patient cohort, the adjusted odds ratio (95%CI) for a continuous claim of opioids at 90 and 180 days postoperatively among patients with a peri‐operative NSAID prescription within 30 days was 1.32 (1.30–1.35), p < 0.001; and 1.12 (1.10–1.15), p < 0.001, respectively. This estimate of effect remained robust at 90 days after accounting for known potential confounders, including pre‐existing knee pain and acute postoperative pain severity. Similar analysis of other pain medications (e.g. paracetamol) did not detect such an association. This population‐based cohort study suggests that peri‐operative prescription NSAID use may be associated with continued opioid prescription claims at 90 and 180 days after knee arthroplasty, even after adjusting for other observed covariates for continuous opioid claims. These novel findings can inform clinical decision‐making for post‐surgical pain management, risk–benefit discussions with patients and future research. [ABSTRACT FROM AUTHOR]

Background: Data suggests the infra‐patellar fat pad (IPFP) is resected in the majority of total knee arthroplasty cases. Current literature suggests there may be scope for increasing preservations rates. A systematic review and meta‐analysis of available literature was performed to assess if resection of IPFP resulted in superior patient outcomes. Methods: Scopus, PubMed, Cochrane, Embase and CINAHL were systematically searched in February 2024 for articles of relevance and meta‐analysis conducted. A standardized mean difference and confidence interval of 95% was calculated. An odds ratio was calculated for all included datasets. Heterogeneity was assessed for using the I2 statistic. Results: Thirteen studies were included within this review. IPFP resection shortened the patella tendon at 6 months post‐operatively (OR, 0.07; 95% CI, 0.02–0.12, P = 0.006). Results favoured preservation at 12 months post‐operatively (OR, 0.02; 95% CI, −0.02 to 0.06, P = 0.32). Oxford Knee Society (OKS) results statistically favoured preservation at 6 months (OR, 1.57; 95% CI, 0.74–2.39, P = 0.0002). Findings at 12 months favoured resection (OR, −0.49; 95% CI, −5.39, 4.41, P = 0.84). Resection increased anterior knee pain at 6–12 months post‐operatively (OR, 1.45; 95% CI, 1.12–1.89, P = 0.005). Combined subgroup analysis of flexion favoured resection (OR, −2.15; 95% CI, −6.52 to 2.22, P = 0.34). Conclusion: OKS and patella tendon length results favoured preservation at 6 months however did not reach minimal clinically important difference. Combined subgroup analysis of flexion did not yield a statistically significant result. Rates of anterior knee pain at 6–12 months favoured preservation. [ABSTRACT FROM AUTHOR]

Objective: Knee osteoarthritis (OA) is a leading cause of chronic pain in adults and shows wide interindividual variability, with peripheral and central factors contributing to the pain experience. Periarticular factors, such as muscle quality (eg, echo intensity [EI] and shear wave velocity [SWV]), may contribute to knee OA pain; however, the role of muscle quality in OA symptoms has yet to be fully established. Methods: Twenty‐six adults (age >50 years) meeting clinical criteria for knee OA were included in this cross‐sectional study. Quantitative ultrasound imaging was used to quantify EI and SWV in the rectus femoris of the index leg. Pearson correlations followed by multiple linear regression was used to determine associations between muscle quality and pain, controlling for strength, age, sex, and body mass index. Results: EI and SWV were significantly associated with movement‐evoked pain (b = 0.452–0.839, P = 0.024–0.029). Clinical pain intensity was significantly associated with SWV (b = 0.45, P = 0.034), as were pressure pain thresholds at the medial (b = −0.41, P = 0.025) and lateral (b = −0.54, P = 0.009) index knee joint line, adjusting for all covariates. Pain interference was significantly associated with knee extension strength (b = −0.51, P = 0.041). Conclusion: These preliminary findings suggest that EI and SWV may impact knee OA pain and could serve as malleable treatment targets. Findings also demonstrate that muscle quality is a unique construct, distinct from muscle strength, which may impact pain and treatment outcomes. More research is needed to fully understand the role of muscle quality in knee OA. [ABSTRACT FROM AUTHOR]

Objective: Both porous metal cones and metaphyseal sleeves are excellent implants for reconstructing severe bone defects in the knee joint, but they both exhibit design limitations. The porous metal cone, especially, has significant room for improvement in its shape design. The existing porous metal cones often feature a conical external surface with a relatively small taper, potentially compromising both rotational and axial stability. To improve both axial and rotational stability in porous metal cones, we developed a 3D‐printed stepped porous metal cone. This study aimed to assess the short‐term clinical outcome of the 3D‐printed stepped porous metal cone and to compare it with the clinical outcome of patients who underwent revision total knee arthroplasty (rTKA) with the metaphyseal sleeves during the same period. Method: Patients who underwent total knee arthroplasty revision with metaphyseal bone defect reconstruction from 2019 to 2021 were retrospectively analyzed. A total of 61 patients were enrolled in the study, including 15 patients using 3D‐printed stepped porous metal cones and 46 patients using metaphyseal metal sleeves. Thirty patients using metaphyseal sleeves were screened by propensity score matching method and compared with those using stepped cones. Analysis included the American Knee Society Score, the Hospital for Special Surgery knee score, the Western Ontario and McMaster Universities Arthritis index, the Short Form 12 (SF‐12) health survey, and radiographic assessment with a mean follow‐up of 28.5 ± 8.3 months. To conduct comparative analyses, unpaired Student's t‐tests were employed for continuous variables, while categorical variables were analyzed using the appropriate Fisher exact or chi‐squared test. Results: In this study, the survival rates of both the stepped cone and metaphyseal sleeve were 100%. There was no statistically significant difference in postoperative knee function scores between the two groups (p > 0.05). However, patients in the cone group had significantly higher mental component summary scores on the SF‐12 scale (p < 0.05) and higher increases in mean postoperative physical component summary scores than patients in the sleeve group (p < 0.05). In addition, patients in the cone group experienced fewer intraoperative and postoperative complications compared to the sleeve group. Conclusion: The 3D‐printed stepped porous metal cone can effectively reconstruct bone defects in complex rTKA and provide satisfactory early clinical and radiographic results. The 3D‐printed stepped cone provides a more stable structure similar to the sleeve while maintaining the original benefits of the cone making it a promising choice for rTKA. [ABSTRACT FROM AUTHOR]

Background: Musculoskeletal (MSK) pathologies significantly affect the rehabilitation course for patients admitted to an inpatient rehabilitation facility (IRF). The impact of a specialized inpatient MSK consult service has not been previously evaluated. Objective: To assess the demographics, pathologies, and impact on pain scores of patients who were evaluated by a specialized MSK consult service. Design: Retrospective descriptive analysis of patients at an IRF who were evaluated by the MSK consult service. Setting: Academic IRF. Participants: 230 patients evaluated by the MSK consult service over 4.5 years. Interventions: MSK consult service composed of sports medicine fellowship‐trained physiatrists who use history, physical examination, point‐of‐care ultrasound, and specialized MSK knowledge to assess and address MSK barriers to functional improvement. Main Outcome Measures: Primary rehabilitation diagnosis, length of stay, discharge destination, reason for consult, MSK diagnosis, need for injection, change in Numerical Pain Rating Scale (NPRS) pain scores, change in Functional Independence Measures (FIM). Results: A total of 230 consults met inclusion criteria for analysis. The most common symptoms were shoulder pain (47%), knee pain (30%), and hip/groin pain (10.4%). The MSK consult service made 82 different musculoskeletal and neuromuscular diagnoses. The most common primary rehabilitation diagnosis was stroke (28.3%). Injections were performed in 44.3% of consults, with an average reduction in NPRS pain score of 2.3 (SD 1.9) and a statistically significant reduction in average NPRS pain scores in patients who underwent injections compared to those who did not (p <.001). Conclusions: This study is the first to examine the use of an innovative inpatient MSK physiatry consult service in an IRF. This promising consult service can play a pivotal role in patient care by reducing functionally limiting MSK pain to allow for better toleration of therapies and to optimize functional gains. [ABSTRACT FROM AUTHOR]

Background: Knee osteoarthritis (OA) has been quite consistently associated with high physical workload and specific physical factors at work, while for hip OA, fewer studies are available, which still indicate possible associations with heavy lifting and physical workload. The objective of the study was to assess the association between exposure to workplace physical factors and incidence of knee and hip arthroplasty, as markers of severe OA in these joints. Methods: The study population was composed of employees 25–60 years who participated in the Turin 2011 census. For each job held since 1995, exposure to physical factors was assigned to individuals in the cohort through a Job‐Exposure Matrix constructed from the Italian O*NET database. Using Poisson regression models, the incidence of knee and hip arthroplasty for OA, identified through hospitalizations from 2012 to 2018, was examined in relation to cumulative exposure to 7 different physical hazards and a composite indicator of physical workload constructed from 17 physical factors (Ergo‐Index). Results: The risk of knee OA was significantly increased in the highest cumulative exposure quartile of physical workload (incidence rate ratio = 1.98, 95% confidence interval: 1.24–3.16) and of all single hazards examined, compared to the lowest quartile, with significant trends in risk with increasing exposure. In contrast, no association was found with hip OA, whose relative risks were close to or below one in all higher‐exposure quartiles of physical workload and of each single hazard. Conclusions: Our results indicate that exposure to physical hazards at work increases the likelihood of developing knee OA, but not hip OA. [ABSTRACT FROM AUTHOR]

This article examines the racial disparities in care and outcomes for individuals with rheumatic diseases. It highlights studies that have found African Americans with conditions like lupus and osteoarthritis receive lower quality care and have worse outcomes compared to other racial and ethnic groups. The article emphasizes the importance of clear definitions and frameworks when studying these inequities, and suggests using resources like the National Institute on Minority Health and Health Disparities and the WHO conceptual framework. It concludes by advocating for research that focuses on systemic factors rather than using race and ethnicity as proxies for experiences of racism. The text also discusses the measurement and analysis of structural racism and racialized inequities in healthcare, and the need for comprehensive data collection and analysis to understand the factors driving these inequities. The ultimate goal is to identify targets for interventions and eliminate racial disparities in healthcare. [Extracted from the article]

Objective: The objective of this study was to identify gait alterations related to worsening knee pain and worsening physical function, using machine learning approaches applied to wearable sensor–derived data from a large observational cohort. Methods: Participants in the Multicenter Osteoarthritis Study (MOST) completed a 20‐m walk test wearing inertial sensors on their lower back and ankles. Parameters describing spatiotemporal features of gait were extracted from these data. We used an ensemble machine learning technique ("super learning") to optimally discriminate between those with and without worsening physical function and, separately, those with and without worsening pain over two years. We then used log‐binomial regression to evaluate associations of the top 10 influential variables selected with super learning with each outcome. We also assessed whether the relation of altered gait with worsening function was mediated by changes in pain. Results: Of 2,324 participants, 29% and 24% had worsening knee pain and function over two years, respectively. From the super learner, several gait parameters were found to be influential for worsening pain and for worsening function. After adjusting for confounders, greater gait asymmetry, longer average step length, and lower dominant frequency were associated with worsening pain, and lower cadence was associated with worsening function. Worsening pain partially mediated the association of cadence with function. Conclusion: We identified gait alterations associated with worsening knee pain and those associated with worsening physical function. These alterations could be assessed with wearable sensors in clinical settings. Further research should determine whether they might be therapeutic targets to prevent worsening pain and worsening function. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to estimate the temporal trend of osteoarthritis (OA) burden in China by age, sex, and joint sites from 1990 to 2019 and predict the long‐term trend over the next 25 years. Methods: Using data from the Global Burden of Disease Study 2019, we estimated incident cases, prevalent cases, disability‐adjusted life years (DALYs) of OA, and DALYs of OA attributed to high body mass index (BMI), as well as corresponding age‐standardized rates (ASRs) for aforementioned indicies. Estimated annual percentage change (EAPC) and Nordpred age‐period‐cohort model were used to describe temporal trend changes and predict future disease burden. Results: From 1990 to 2019, the ASR of OA incidence increased from 472.53 per 100,000 to 509.84 per 100,000 people (EAPC: 0.36, 95% confidence interval [CI] 0.29–0.44); the ASR of OA prevalence increased from 5,880.58 per 100,000 to 6,330.06 per 100,000 people (EAPC 0.35, 95% CI 0.28–0.42); the ASR of OA DALYs increased from 206.38 per 100,000 to 224.78 per 100,000 people (EAPC 0.40, 95% CI 0.32–0.48). The ASR of OA DALYs attributed to high BMI increased rapidly, especially in men and patients with hip OA. Projections suggest an increasing trend in the incidence, prevalence, and DALYs of OA from 2019 to 2044, with the prevalent cases and DALYs of OA in China expected to increase by approximately 1.5 times over the next 25 years. Conclusion: The disease burden of OA has increased in China over the past 30 years and is expected to continue rising over the next 25 years. [ABSTRACT FROM AUTHOR]

Introduction: Fragility analysis is a method of further characterising the robustness of statistical outcomes. This study evaluates the statistical fragility of randomised controlled trials (RCTs) comparing patellar resurfacing versus non‐patellar surfacing in total knee arthroplasty (TKA). Methods: PubMed, MEDLINE and EMBASE were searched for RCTs comparing outcomes in TKA based on patellar resurfacing. Fragility index (FI) and reverse FI (collectively, "FI") were calculated for dichotomous outcomes as the number of outcome reversals needed to change statistical significance. Fragility quotient (FQ) was calculated by dividing the FI by the sample size for that outcome. Median FI and FQ were calculated for each individual outcome and for the overall study. Subanalyses were performed to assess FI and FQ based on outcome type, statistical significance and loss to follow‐up. Results: Twenty‐one RCTs were included in the analysis, capturing 3910 subjects. The overall median FI was 5.0 (interquartile range, [IQR] 4.0−6.0), and the overall median FQ was 0.048 (IQR 0.022−0.065). The outcome of anterior knee pain has a median FI of 6.0 (IQR 4.0−6.0) and a median FQ of 0.057 (IQR 0.025−0.065). Only five (7%) outcomes were significant. The loss to follow‐up was greater than the FI in 12 of 19 studies (63%) with available data. Conclusion: RCTs comparing patellar resurfacing in TKAs show significant statistical fragility; a few outcome reversals can alter findings. The majority of outcomes were nonsignificant, indicating that the choice to resurface the patella may not affect most clinical outcomes; however, clinical conclusions are limited by the statistical fragility of the analysed outcomes. Larger RCTs for this comparison are necessary, and we suggest adding FI and FQ to RCT reports with p values to improve the interpretability of results. Level of Evidence: Level II. [ABSTRACT FROM AUTHOR]

Purpose: To identify biomarkers in human blood or urine at an early stage of knee osteoarthritis (OA) and to elucidate if any can accurately differentiate between healthy controls and early knee OA patients and be considered as a candidate for widespread clinical use for early diagnosis of the disease. Methods: Medline, Embase and Web of Science were screened to identify comparative studies measuring differences in blood or urine biomarkers between healthy controls and knee OA patients at an early stage (grade 1 or 2 Kellgren–Laurence). Two independent reviewers screened the abstracts for eligibility, reviewed the full texts, assessed the methodological quality and extracted the data. The Joanna Briggs Institute critical appraisal tool for diagnostic test accuracy studies was used to assess the quality of the included studies. Due to relevant heterogeneity, meta‐analysis was not appropriate. Results: Five studies met the eligibility criteria. The examined biomarkers were adropin, collagen type II metabolite, C‐terminal cross‐linked telopeptide of type II collagen, C‐terminal cross‐linked telopeptide of type I collagen, cartilage oligomeric matrix protein, matrix metalloproteinase 3, N‐terminal propeptide of procollagen type IIA, type I procollagen N‐terminal propeptides, N‐terminal osteocalcin, angiopoietin‐2, follistatin, granulocyte colony‐stimulating factor, hepatocyte growth factor, interleukin‐8, leptin, platelet‐derived growth factor‐BB, platelet endothelial cell adhesion molecule‐1, vascular endothelial growth factor and calprotectin and totalling 19 biomarkers. All of the biomarkers were studied only once in the selected papers. Conclusions: There is no reliable biomarker available to differentiate between early knee OA in patients and healthy controls, but a potential role of a cluster of biomarkers to close this gap. There are several limitations, including inappropriate study designs, small sample sizes, nonconsecutive patient groups and inadequate statistical methods for evaluating biomarker performance in studies included. Level of Evidence: Level III. [ABSTRACT FROM AUTHOR]

Patellar tendinopathy is a relatively common cause of anterior knee pain in athletes. It is predominantly seen in sports involving jumping, running, abrupt change in direction like basketball, volleyball, soccer, sprinting and jumping. The main pathophysiology is considered to be repetitive microtrauma at the inferior pole of patella along with a poor healing response. Although eccentric exercises have shown to be beneficial, the improvement is often slow and may result in a less than satisfactory outcome. There is a growing interest of orthobiologics, mainly platelet‐rich plasma (PRP) in multiple chronic musculoskeletal pathologies. This narrative review aimed to analyse the current evidence on the role of orthobiologics in the management of recalcitrant patellar tendinopathy. Multiple studies have shown significant clinical improvement with negligible adverse effects on PRP injection for patellar tendinopathy. Most studies assessed report that the effects of PRP are sustained. However, among all studies evaluated, there is a considerable heterogeneity in terms of PRP composition, number of injections, dosage interval and postinjection rehabilitation protocol, pointing to the need for further research to enable standardisation of PRP therapy. Stem cells too have shown potential to be effective as a treatment modality for chronic patellar tendinopathy, but there is limited data to recommend its use outside of research setting or to enable a meaningful comparison to PRP. There is a promising role of orthobiologics in management of chronic patellar tendinopathy not responding to conventional treatment. Level of Evidence: Not applicable (narrative review). [ABSTRACT FROM AUTHOR]

Purpose: This original case series aims to describe an uncommon triad of clinical signs in patients presenting with persistent pain and inability to resume physical activities after knee hyperextension trauma. Methods: Patient history, clinical examination, arthroscopic findings and investigations of 12 patients who consulted with the senior author are presented. Results: Twelve patients (seven males/five females) presented with persistent pain after knee hyperextension trauma either in sport or a traffic accident. They had a median age of 18.5 and a median body mass index of 23 kg/m2. All had medical visits and at least one magnetic resonance imaging (MRI) before visiting the senior author's institution but the cause of their problems could not be explained. The clinical examination of the injured knee appeared normal except for an uncommon triad of clinical signs with the knee close to extension: (1) a grade 1+ anterior–posterior laxity around 10–20° of knee flexion with a firm end‐point (pseudo‐Lachman sign), (2) a grade 1+ tibiofemoral step‐off sign with a posterior drawer at 10–20° of knee flexion and (3) an increased knee hyperextension compared to the contralateral side. Arthroscopy of eight patients confirmed the pseudo‐Lachman sign with a grade I posterior drawer close to knee extension, normal posterior laxity at 90° of knee flexion and an intact anterior cruciate ligament. Conclusion: Patients displayed an increased hyperextension and posterior laxity close to knee extension which normalised at 90° of knee flexion. In patients with a history of knee hyperextension trauma associated with persistent pain, inability to resume physical activities, inconclusive MRIs and a standard clinical examination, clinicians should consider extending their investigations with the knee close to extension to identify this clinical triad consistent with a lesion to the posteromedial bundle of the posterior cruciate ligament. Level of evidence: Level IV. [ABSTRACT FROM AUTHOR]

Heterotopic ossification is ectopic lamellar bone formation within soft tissue and can result in significant functional limitations. There are multiple underlying etiologies of HO including musculoskeletal trauma and traumatic brain injury. Intra‐articular HO of the knee is rare and is typically located within the cruciate ligaments. We report a case of a 24‐year‐old female who presented with worsening right knee pain and limited knee extension two and a half years after a motor vehicle crash with multiple lower extremity fractures. Physical examination of the knee revealed anterior pain, limited extension, and a palpable infrapatellar prominence. Imaging showed a retropatellar tendon, intra‐articular excrescence of bone proximal to the anterior tibial plateau. Diagnostic arthroscopy with a 70° arthroscope identified HO at the proximal anterior tibial plateau, which was excised with a high‐speed burr under direct visualization. At the three‐month follow‐up, the patient remained asymptomatic and returned to sport. Retropatellar tendon, intra‐articular anterior knee HO is a rare but debilitating clinical entity that can be successfully and safely managed with excision under direct visualization using a 70° arthroscope. [ABSTRACT FROM AUTHOR]

This document is a collection of abstracts from the International Journal of Rheumatic Diseases, covering various topics related to rheumatic diseases. The abstracts discuss the management of gout, clinical manifestations associated with antisynthetase antibodies, the effectiveness of a fast-track clinic for giant cell arteritis, the management of patients on hydroxychloroquine, the performance of a fast-track pathway for giant cell arteritis, and the clinical outcomes of patients with giant cell arteritis treated with tocilizumab. Other articles explore topics such as the use of tocilizumab in inflammatory arthritis, a peer support group program for people with inflammatory arthritis, seasonal footwear choices of people with inflammatory arthritis, the experiences of mothers with rheumatoid arthritis, a sports intervention program for children with juvenile idiopathic arthritis, and the inadequate nursing and allied health workforce in Australian public rheumatology departments. Additionally, studies examine the correlation between gout and cardiovascular events, the diagnostic significance of intracellular versus extracellular calcium pyrophosphate crystals in CPP crystal arthritis, the effect of colchicine prophylaxis on gout remission, the future burden of arthritis in Australia, and the impact of juvenile arthritis and related conditions on the well-being of affected children and their families. The abstracts provide valuable insights into these topics and highlight the need for further research and appropriate healthcare services. [Extracted from the article]

Key Clinical Message: Isokinetic testing is a maximal muscle strength test which requires adequate patient's preparation and observer's care. While the available data suggests that isokinetic devices are safe, their use may rarely cause severe injuries. The screening of predisposing anatomical factors could help preventing injuries before testing. A 29‐year‐old athletic man presented an acute patellar dislocation on a healthy right knee during isokinetic muscle strength testing, which was conducted in the setting of an intensive physical rehabilitation program, for persistent left knee pain after arthroscopic surgery for meniscal tear. This is the first case to occur in an adult male without clear risk factors such as patellar dysplasia. Predisposing factors may include slightly elevated patellar tilt and lateral shift compared to the contralateral knee (researched from subsequent review of pre‐injury X‐rays), and an elevated quadricipital strength in the context of recreational bodybuilding. The dislocation occurred during eccentric extension phase of testing. Medial patellofemoral ligament reconstruction was conducted 6 months later. Isokinetic muscle strength testing is generally considered as a safe method, despite limited data on the devices' safety. Since severe injuries might rarely occur, adequate patient preparation is needed, as well as the screening of predisposing factors. [ABSTRACT FROM AUTHOR]

Introduction: We aimed to explore the molecular mechanisms through which platelet‐rich plasma (PRP) attenuates osteoarthritis (OA)‐induced pain, apoptosis, and inflammation. Methods: An in vivo model of OA was established by injuring rats using the anterior cruciate ligament transection method, whereas an in vitro model was generated by exposing chondrocytes to interleukin (IL)‐1β. Both models were then treated with PRP. Results: In both the in vivo and in vitro models, OA led to the suppression of the nuclear factor erythroid 2‐related factor 2 (Nrf2)/heme oxygenase‐1 (HO‐1) pathway, whereas treatment with PRP reactivated this molecular axis. Inhibition of the Nrf2/HO‐1 pathway using the Nrf2 inhibitor brusatol or through Nrf2 gene silencing counteracted the effects of PRP in reducing the tenderness and thermal pain thresholds of OA rats. Additionally, PRP reduced the mRNA expression of IL‐1β, IL‐6, tumor necrosis factor‐alpha (TNF‐α), and matrix metallopeptidase 13 (MMP‐13) and the protein expression of B‐cell lymphoma 2 (Bcl‐2), Bcl‐2 associated X‐protein (Bax), and caspase‐3. Furthermore, inflammation and apoptosis were induced by brusatol treatment or Nrf2 silencing. Additionally, in the in vitro model, PRP treatment increased the proliferation of chondrocytes and attenuated their inflammatory response and apoptosis, effects that were abrogated by Nrf2 depletion. Conclusions: The Nrf2/HO‐1 pathway participates in the PRP‐mediated attenuation of OA development by suppressing inflammation and apoptosis. [ABSTRACT FROM AUTHOR]

Objective: Early articular cartilage lesion (CL) is a vital sign in the onset of posttraumatic knee osteoarthritis (PTOA) in patients with anterior cruciate ligament deficiency (ACLD). Researchers have suggested that altered kinematics could accelerate CLs and, therefore, lead to the onset of PTOA. However, little is known about whether specific knee kinematics exist that lead to early CL in chronic ACLD knees. Level walking is the most frequent and relevant in vivo activity, which greatly impacts knee health. We hypothesized that the knee kinematics during level walking in chronic ACLD knees with early tibiofemoral CL would significantly differ from those of chronic ACLD knees without early tibiofemoral CL. Methods: Thirty patients with a chronic ACLD history, including 18 subjects with CLs and 12 subjects without CLs, and 35 healthy control subjects were recruited for the study from July 2020 to August 2022. The knee kinematic data during level walking were collected using a three‐dimensional motion analysis system. The kinematic differences between groups were compared using statistical parametric mapping with one dimension for One‐Way ANOVA. The cartilage statuses of the ACLD knees were assessed via MRI examination. The CLs distribution of subjects was evaluated using a modified Noyes scale and analyzed by chi‐square tests. Results: ACLD knees with CLs had significantly greater posterior tibial translation (7.7–8.0mm, 12%–18% gait cycle GC, p = 0.014) compared to ACLD knees without CLs during level walking. ACLD knees with CLs had greater posterior tibial translation (4.6–5.5mm, 0%–23% GC, p < 0.001; 5.8–8.0mm, 86%–100% GC, p < 0.001) than healthy controls during level walking. In the group of ACLD knees with CLs, CL is mainly located in the back of the tibia plateau and front of load bearing area of the medial femoral condyle (p < 0.05). Conclusion: Chronic anterior cruciate ligament deficient knees with cartilage lesions have increased posterior tibial translation compared to anterior cruciate ligament deficient knees without cartilage lesions and healthy subjects. The posterior tibial translation may play an important role in knee cartilage degeneration in ACLD knees. The increased posterior tibial translation and cartilage lesion characteristics may improve our understanding of the role of knee kinematics in cartilage degeneration and could be a helpful potential reference for anterior cruciate ligament deficient therapy, such as physical training to improve abnormal kinematic behavior. [ABSTRACT FROM AUTHOR]

Background: Patellofemoral pain (PFP) is characterized by chronic pain in the anterior aspect of the knee during loading activities. Many studies investigating muscle morphology changes for individuals with PFP focus on the proximal joints, however, few studies have investigated muscles of the foot and ankle complex. This study aimed to explore the differences in peroneal muscle size and activation between individuals with PFP and healthy controls using ultrasound imaging in weight‐bearing. Methods: A case‐control study in a university lab setting was conducted. Thirty individuals with PFP (age: 20.23 ± 3.30 years, mass: 74.70 ± 27.63 kgs, height: 161.32 ± 11.72 cm) and 30 healthy individuals (age: 20.33 ± 3.37 years, mass: 64.02 ± 11.00 kgs, height: 169.31 ± 9.30 cm) participated. Cross‐sectional area (CSA) images of the peroneal muscles were taken in non‐weight bearing and weight‐bearing positions. The functional activation ratio from lying to single‐leg standing (SLS) was calculated. Results: There was a statistically significant (p = 0.041) group (PFP, healthy) by position (non‐weight‐bearing, weight‐bearing) interaction for the peroneal muscle CSA with a Cohen's d effect size of 0.2 in non‐weight‐bearing position and 0.7 in weight‐bearing position. The functional activation ratio for the healthy group was significantly more (p = 0.01) than the PFP group. Conclusion: Peroneal muscles were found to be smaller in size in those with PFP compared to the healthy subjects in the weight‐bearing SLS position. This study found that those with PFP have lower activation of peroneal muscles in functional position. [ABSTRACT FROM AUTHOR]

Objective: To determine whether the dietary inflammatory index (DII) scores were associated with knee structural changes and pain over a 10.7‐year follow‐up. Methods: This study used data from a prospective population‐based cohort study (mean age 63 years, 51% female) in which 1,099, 875, 768, and 566 participants completed assessments at baseline, 2.6, 5.1, and 10.7 years, respectively. T1‐weighted and T2‐weighted magnetic resonance imaging was performed to measure cartilage volume (CV) and bone marrow lesions (BMLs) at baseline and 10.7 years. The Western Ontario and McMaster Universities Osteoarthritis Index pain questionnaire was used to measure knee pain at each visit. Pain trajectories ("minimal pain," "mild pain," and "moderate pain") were previously identified. Baseline energy‐adjusted DII (E‐DII) scores were calculated. Linear, log‐binomial regression, linear mixed‐effects modeling, and multi‐nominal logistic regression were used for analyses. Results: The mean ± SD E‐DII score at baseline was −0.48 ± 1.39. In multivariable analyses, higher E‐DII scores were not associated with tibial CV loss or BML size increase except for medial tibial BML size increase. Higher E‐DII scores were associated with a higher pain score (β = 0.21; 95% confidence interval [CI] 0.004–0.43) and an increased risk of belonging to the "moderate pain" compared to the "minimal pain" trajectory group (relative risk ratio 1.19; 95% CI 1.02–1.39). Conclusion: A proinflammatory diet, as indicated by a higher DII score, may be associated with a greater pain score and higher risk of more severe pain trajectory over 10 years. However, inconsistent findings related to structural changes suggest a discordance between the potential impact of diet on structural damage and pain in knee OA. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to determine dose parameters for resistance exercise associated with improvements in pain and physical function in knee and hip osteoarthritis (OA) and whether these improvements were related to adherence. Methods: We searched six databases, from inception to January 28, 2023, for randomized controlled trials comparing land‐based, resistance exercise–only interventions with no intervention, or any other intervention. There were four subgroups of intervention duration: 0 to <3 months, 3 to 6 months, >6 to <12 months, ≥12 months. The between‐group effect was calculated for immediate postintervention pain and physical function (activities of daily living [ADL] and sports/recreation [SPORT]). Results: For both knee and hip, data from 280 studies showed moderate benefit for pain, physical function ADL, and physical function SPORT in favor of interventions 3 to 6 months. For the knee, there was also a moderate benefit for physical function ADL in favor of interventions >6 to <12 months. From 151 knee and hip studies that provided total exercise volume data (frequency, time, duration), there was no association between volume with the effect size for pain and physical function. A total of 74 studies (69 knee, 5 hip) reported usable adherence data. There was no association between adherence with the effect size for pain and physical function. Conclusion: In knee and hip OA, resistance exercise interventions 3 to 6 months (and for the knee >6 to <12 months) duration improve pain and physical function. Improvements do not depend on exercise volume or adherence, suggesting exercise does not require rigid adherence to a specific dose. [ABSTRACT FROM AUTHOR]

Objective: Inflammation worsens joint destruction in osteoarthritis (OA) and aggravates pain. Although n‐3 fatty acids reduce inflammation, different n‐3 fatty acids have different effects on inflammation and clinical outcomes, with eicosapentaenoic acid (EPA) having the strongest effect. We examined whether specific essential fatty acid levels affected the development of OA. Methods: We studied participants from the Multicenter Osteoarthritis Study (MOST) at risk of developing knee OA. As part of MOST, participants were asked repeatedly about knee pain, and knee radiographs and magnetic resonance images (MRIs) were obtained. Using baseline fasting samples, we analyzed serum fatty acids with standard assays. After excluding participants with baseline OA, we defined two sets of cases based on their status through 60 months' follow‐up: those developing incident radiographic OA and those developing incident symptomatic OA (knee pain and radiographic OA). Controls did not develop these outcomes. Additionally, we examined worsening of MRI cartilage damage and synovitis and worsening knee pain and evaluated the number of hand joints affected by nodules. In regression models, we tested the association of each OA outcome with levels of specific n‐3 and n‐6 fatty acids, adjusting for age, sex, body mass index, education, physical activity, race, baseline pain, smoking, statin use, and depressive symptoms. Results: We studied 363 cases with incident symptomatic knee OA and 295 with incident radiographic knee OA. The mean age was 62 years (59% women). We found no associations of specific n‐3 fatty acid levels, including EPA, or of n‐6 fatty acid levels with incident OA (eg, for incident symptomatic knee OA, the odds ratio per SD increase in EPA was 1.0 [95% confidence interval 0.87–1.17]). Results for other OA outcomes also failed to suggest a protective effect of specific n‐3 fatty acids with OA outcomes. Conclusion: We found no association of serum levels of EPA or of other specific n‐3 fatty acids or n‐6 fatty acids with risk of incident knee OA or other OA outcomes. [ABSTRACT FROM AUTHOR]

The article discusses the use of steroids, particularly dexamethasone, in reducing postoperative complications by mitigating postoperative systemic inflammatory dysregulation. Studies have shown that high-dose dexamethasone can decrease complications and mortality after surgery, although lower doses may also be effective. The article emphasizes the importance of considering the dose of steroids and potential side effects, while also exploring the benefits of combining anti-inflammatory strategies for improved surgical outcomes. Future research is needed to determine optimal dosing regimens and identify patients who would benefit most from steroid therapy. [Extracted from the article]