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Purpose: The purpose of this study was to evaluate the relationship between the joint line convergence angle (JLCA) and the severity of medial knee osteoarthritis (OA). We hypothesise that JLCA is the most associated factor with the severity of medial knee OA. Methods: This retrospective study included a total of 202 knees that underwent either high tibial osteotomy or medial meniscus repair/partial resection. Kellgren–Lawrence grade and hip–knee–ankle angle (HKAA), mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA) and JLCA were assessed from preoperative radiographs. Medial meniscus extrusion (MME) was measured using preoperative magnetic resonance imaging. The International Cartilage Research Society (ICRS) grade on the medial femoral condyle and medial tibial plateau were also assessed. The relationships between JLCA and Kellgren–Lawrence grades and MME and ICRS grades were analysed using Spearman's correlation test and regression analysis. Results: The JLCA was correlated with the Kellgren–Lawrence grade (R = 0.765, p < 0.001), MME (R = 0.638, p < 0.001), ICRS grade on the MFC (R = 0.586, p < 0.001) and the MTP (R = 0.586, p < 0.001). Regression analysis showed that age (p = 0.002) and JLCA (p < 0.001) were associated with Kellgren–Lawrence grade. Furthermore, JLCA was related to ICRS grade on the MFC (p < 0.001) and MTP (p < 0.001). Conclusion: The JLCA, reflecting radiological severity, meniscus status, and cartilage lesion, was the most associated alignment parameter in the severity of medial knee OA. The JLCA may be beneficial for quantitative assessment of medial knee OA. Level of Evidence: Level III, retrospective cohort study. [ABSTRACT FROM AUTHOR]

Knee osteoarthritis (OA), also known as degenerative arthritis, is a disease characterized by irreversible changes in the cartilage and bones comprising the joints, resulting in pain, impaired function, and deformity. Furthermore, independent of natural aging, the rate of change in joint cartilage has increased in recent years, which is mainly attributed to environmental factors. The rising incidence of knee-related disorders emphasizes the importance of analyzing the morphology and kinematics of knee structure. This study introduces a knee measurement system designed to replicate the motions of knee using 3D-printing technology, providing insights into knee mechanics with OA level. The research explores the stages of OA using the Kellgren–Lawrence (KL) grade scale, highlighting the variations in the force applied to the knee bone according to movement. The developed knee-simulation system, utilizing the four-bar-link theory, presents a novel approach to studying OA levels 0 to 4. As OA progresses, the cartilage deteriorates, affecting the movement of OA. The OA-based knee measurement system that incorporates soft tissues and skeletons can assist in developing a personalized diagnostic approach for knee disease. This will also help to enhance surgical effectiveness by facilitating the creation of personalized prosthetic joints for individual patients and offering a customized surgical simulation. [ABSTRACT FROM AUTHOR]

Abstract Purpose The purpose of this study was to evaluate the relationship between the joint line convergence angle (JLCA) and the severity of medial knee osteoarthritis (OA). We hypothesise that JLCA is the most associated factor with the severity of medial knee OA. Methods This retrospective study included a total of 202 knees that underwent either high tibial osteotomy or medial meniscus repair/partial resection. Kellgren–Lawrence grade and hip–knee–ankle angle (HKAA), mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA) and JLCA were assessed from preoperative radiographs. Medial meniscus extrusion (MME) was measured using preoperative magnetic resonance imaging. The International Cartilage Research Society (ICRS) grade on the medial femoral condyle and medial tibial plateau were also assessed. The relationships between JLCA and Kellgren–Lawrence grades and MME and ICRS grades were analysed using Spearman's correlation test and regression analysis. Results The JLCA was correlated with the Kellgren–Lawrence grade (R = 0.765, p

Purpose: This study aimed to investigate postoperative patient satisfaction at mid- to long-term follow-up after proximal fibular osteotomy and to identify risk factors for patient dissatisfaction. Methods: This was a retrospective cross-sectional study that included 252 knees from 160 osteoarthritis (OA) patients who underwent proximal fibular osteotomy with a follow-up of four to eight years. Patients were categorized into a satisfied group (satisfaction score ≥ 20) or a dissatisfied group (satisfaction score < 20) based on the New Knee Society Score (New KSS). Patient demographics, preoperative pain visual analogue scale (VAS) score, preoperative Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, Kellgren–Lawrence (K-L) grade, preoperative hip-knee-ankle (HKA) angle, and preoperative medial proximal tibial angle (MPTA) were compared between the two groups. Multiple logistic regression analysis was used to identify risk factors for patient dissatisfaction. Results: Of the 203 knees, 130 (64.0%) were satisfied with their results. Multiple logistic regression analysis demonstrated that severe medial OA (K-L grade = IV) was an independent risk factor for patient dissatisfaction after proximal fibular osteotomy (OR 8.334, 95% CI 3.815–18.206, P < 0.001). Conclusion: Our study confirmed that proximal fibular osteotomy was a simple and effective treatment for medial OA patients, and majority of our patients obtained a higher satisfaction rate within mid- to long-term follow-up after surgery. Severe medial OA, however, was an independent risk factor for dissatisfaction. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the correlation between fibular head height and the incidence and severity of osteoarthritis associated with varus knee deformity. The fibular head height, joint line convergence angle (JLCA) and medial proximal tibial angle (MPTA) were measured in a three-dimensional model. Ordinal multivariate logistic regression was used to analyze the correlation between fibular head height and Kellgren–Lawrence (K–L) grade. Pearson correlation was used to analyze the correlation between fibular head height and K–L grade. A total of 232 patients (232 knees) were finally included in the study. There were significant differences in JLCA and hip–knee–ankle angle (P < 0.05), and both JLCA and hip–knee–ankle angle increased with severe aggravation of K–L grade. Both fibular head height and MPTA decreased as the K–L grade was severely aggravated. There was a significant negative correlation between K–L grade and fibular head height (r = −0.812, P < 0.001). Furthermore, there was a significant negative correlation between fibular head height and hip–knee–ankle angle (r = −0.7905, P < 0.001). In addition to body mass index, fibular head height is a risk factor for the pathogenesis of osteoarthritis associated with varus knee deformity; the smaller the fibular head height, the more severe the degree of varus deformity.

Purpose: To evaluate the mid-term results of medial open-wedge high tibial osteotomy (OWHTO) based on Kellgren–Lawrence (KL) grades. Materials and methods: We retrospectively evaluated clinical and radiographic outcomes of 93 patients (mean age 61.4 years, mean follow-up 64.2 months, 109 consecutive knees) who underwent OWHTO for medial compartment osteoarthritis (OA). KL grade was used to evaluate knee OA (KL-1 22 cases; KL-2, 51 cases; KL-3, 36 cases). The clinical outcomes were assessed using Japanese Orthopaedic Association (JOA) and Lysholm scores. Radiographic outcomes were assessed using pre- and post-operative mechanical axis percentage, femorotibial angle, medial proximal tibial angle, and joint line convergence angle. Hinge fracture frequency and OA progression were also evaluated based on KL grades. Results: The JOA score improved significantly from 70.3 ± 14.9 to 96.2 ± 4.4, 64.1 ± 12.5 to 95.1 ± 5.1, and 68.6 ± 11.4 to 92.1 ± 6.1 in the KL-1, KL-2, and KL-3 groups, respectively. The JOA score in the KL-3 group was significantly lower than in the other groups. The Lysholm score improved significantly from 62.6 ± 8.8 to 97.7 ± 4.7, 62.1 ± 8.1 to 96.7 ± 4.2, and 59.2 ± 9.2 to 95.8 ± 4.6 in the KL-1, KL-2, and KL-3 groups, respectively. The post-operative Lysholm scores were not significantly different among the groups. There were significant differences in radiographic parameters pre-operatively, but not post-operatively, among the groups. Although there were no significant differences in hinge fracture frequency and OA progression, the KL-3 grade predicted OA progression on multivariate analysis. Conclusions: Mid-term results of OWHTO significantly improved. However, clinical score in the KL-3 group was lower than that in the KL-1 and KL-2 groups; radiological OA progression was a risk factor in KL-3. [ABSTRACT FROM AUTHOR]

Osteoarthritis (OA) is a common form of knee arthritis which causes significant disability and is threatening to plague patient's quality of life. Although this chronic condition does not lead to fatality, still there exists no known cure for OA. Diagnosis of OA can be confirmed primarily based on radiographic findings. Being a progressive disease, early identification of OA is crucial for clinical interventions to curtail the OA degeneration. Kellgren-Lawrence (KL) grading system has been traditionally employed to assess the knee OA severity. Due to the recent advancements of deep learning in computer vision, more studies have employed deep neural network in automatically predicting KL grade from plain knee joint radiograph. However, these studies treat KL grading as a multi-class classification task and ignore the inherent ordinal nature within the KL grades. In this study, we propose an ordinal regression module for neural networks to treat KL grading as an ordinal regression task. Our module takes an input from neural network and produces 4 cut-points to partition the prediction space into 5 respective KL grades. The proposed model is optimized by a cumulative-link loss function. Performance of the model is evaluated against various notable neural networks and significant improvements on the knee OA KL grade prediction were demonstrated. [ABSTRACT FROM AUTHOR]

Abstract Background To identify medial open-wedge high tibial osteotomy (MOWHTO) prognostic factors with wedge-shaped spacer implantation (spacer-type MOWHTO) for varus medial compartment knee osteoarthritis. Methods Patients who underwent spacer-type MOWHTO between August 2018 and September 2019 were prospectively enrolled in this study. Patients were divided into effective group and invalid group based on the Western Ontario and McMasters University Osteoarthritis Index (WOMAC) score one year postoperatively. The variables assessed at baseline and one year postoperatively including age, sex, body mass index (BMI), Kellgren–Lawrence (K–L) grade, hip–knee–ankle angle (HKAA), medial proximal tibial angle (MPTA), posterior tibial slope angle (PTSA), Blackburn–Peel index (BPI), duration of symptoms, and WOMAC score were compared. Prognostic factors were analyzed using logistic regression, and the corresponding odds ratios were also calculated. Results A total of 104 patients were enrolled in the study protocol at one year postoperatively. The WOMAC score decreased from 72.39 ± 12.95 at baseline to 20.06 ± 12.96 at one year postoperatively. Univariate analysis revealed that the significant predictors of the WOMAC score were age > 70 years, BMI > 30 kg/m2, K–L grade IV, and pre-HKAA > 10° (P 70 (OR = 4.861) and K–L grade IV (OR = 6.590) were significantly associated with the higher WOMAC score at one year postoperatively. Conclusions Spacer-type MOWHTO is an effective treatment for osteoarthritis with varus deformity. The prognostic factors for spacer-type MOWHTO are age and K–L grade.

To clarify the relevance of physical activity (PA) with respect to a decrease in minimal joint space (MJS) of the nonoperative hip in female patients at 24 months post-contralateral total hip arthroplasty (THA). This prospective cohort study was conducted from six to 24 months post-THA. The subjects were 85 female patients with hip osteoarthritis (OA) who had undergone unilateral THA. The primary outcome was a change in MJS (ΔMJS). Daily step counts and moderate to vigorous physical activity were measured. To identify factors related to ΔMJS, a generalized linear model approach was used, with adjustment factors, Kellgren-Lawrence (KL) grade, PA, and interaction terms between PA and KL grade as explanatory variables. The interaction term between daily step count and KL grade was significant. The regression coefficient of the daily step count for ΔMJS was significant in the KL ≥ 1 group, but not in the KL = 0 group. A model with adjustment factors, an interaction term, and PA showed that the daily step count increased ΔMJS. PA was related to ΔMJS of the nonoperative hip in female patients with KL grade ≥1, but was not related to ΔMJS in patients without OA post-THA. Excessive daily step count may be a risk factor for a decrease in MJS of the nonoperative hip., (© 2024 Orthopaedic Research Society.)

Background: Although medial open-wedge high tibial osteotomy (MOWHTO) is the treatment of choice for patients with mild to moderate osteoarthritis with varus malalignment, concerns about inferior outcomes in patients with preoperative radiological kissing lesion (RKL) remain. Purpose: To compare the mid- to long-term clinical and radiological results and survivorship after MOWHTO in patients with versus without preoperative RKL. Study Design: Cohort study; Level of evidence, 3. Methods: Included were 122 knees in patients who underwent MOWHTO with a medial locked plate and had minimum 5-year follow-up data. The mean age at surgery was 55.9 years (range, 38-65 years), and the mean follow-up was 7.5 years (range, 5-12.8 years). All patients had undergone second-look arthroscopy around 2 years after MOWHTO. The knees were divided into an RKL group (n = 17) and no-RKL group (n = 105) based on preoperative standing radiographs. The authors compared postoperative American Knee Society (AKS) knee and function scores, range of motion, and improvements in AKS scores between groups, as well as hip-knee-ankle angle, medial proximal tibial angle, and joint-line convergence angle from preoperatively to postoperatively. Also compared were the degree of cartilage regeneration between first- and second-look arthroscopy and the survival rate after index surgery. Results: Preoperative AKS scores were significantly lower in the RKL group versus the no-RKL group (AKS knee, 79.6 ± 7.5 vs 83.8 ± 3.9, P =.037; AKS function, 68.8 ± 9.3 vs 76.0 ± 5.1, P =.006). Likewise, postoperative AKS scores were significantly lower in the RKL group versus the no-RKL group (AKS knee: 91.3 ± 4.2 vs 94.4 ± 1.6, respectively, P =.008; AKS function: 90.0 ± 10.0 vs 97.6 ± 4.5, respectively, P =.007). However, all patients had excellent postoperative AKS knee and function scores (>80). Moreover, there were no between-group differences in pre- to postoperative improvement in AKS scores, postoperative radiological changes, or grade of cartilage regeneration. The survival rates in the RKL and no-RKL groups were 100% and 97.1%, respectively (P ≥.999). Conclusion: Although the latest clinical scores were lower in the RKL group than in the no-RKL group, comparable results in postoperative clinical improvement, cartilage regeneration, and survivorship were observed in patients with RKL at mid- to long-term follow-up. [ABSTRACT FROM AUTHOR]

Abstract Background This study identified whether Functional Index for Hand Osteoarthritis (FIHOA) is associated with pain, hand muscle strength, health-related quality of life, and radiographic severity in hand osteoarthritis (OA). Methods We consecutively recruited 95 patients with hand OA. The FIHOA was used to assess questionnaire-based physical function in hand OA. Health-related quality of life was evaluated using EuroQol-5 dimension (EQ-5D). Radiographic changes of hand joints were measured by Kellgren-Lawrence (K-L) grade, which was determined based on total radiographic severity score and number of affected joints. Other measures included patient’s visual analogue scale (VAS) score for pain and performance-based function indexes such as grip and pinch strength. Statistical analysis was performed using Mann-Whitney U test, Spearman’s correlation analysis, and multivariate logistic regression analysis. Results FIHOA score was negatively associated with grip and pinch hand strength and EQ-5D and positively correlated to VAS pain (p 4) (p 4) was related with increased VAS pain and with lower EQ-5D index (p = 0.008 and p = 0.013, respectively). There was no association between FIHOA score and measures of total radiographic severity score and number of affected joints. Conclusion This study observes that FIHOA score is associated with patient-reported VAS pain, hand muscle strength indexes, and EQ-5D but not radiographic severity in hand OA.

Background: To identify medial open-wedge high tibial osteotomy (MOWHTO) prognostic factors with wedge-shaped spacer implantation (spacer-type MOWHTO) for varus medial compartment knee osteoarthritis. Methods: Patients who underwent spacer-type MOWHTO between August 2018 and September 2019 were prospectively enrolled in this study. Patients were divided into effective group and invalid group based on the Western Ontario and McMasters University Osteoarthritis Index (WOMAC) score one year postoperatively. The variables assessed at baseline and one year postoperatively including age, sex, body mass index (BMI), Kellgren–Lawrence (K–L) grade, hip–knee–ankle angle (HKAA), medial proximal tibial angle (MPTA), posterior tibial slope angle (PTSA), Blackburn–Peel index (BPI), duration of symptoms, and WOMAC score were compared. Prognostic factors were analyzed using logistic regression, and the corresponding odds ratios were also calculated. Results: A total of 104 patients were enrolled in the study protocol at one year postoperatively. The WOMAC score decreased from 72.39 ± 12.95 at baseline to 20.06 ± 12.96 at one year postoperatively. Univariate analysis revealed that the significant predictors of the WOMAC score were age > 70 years, BMI > 30 kg/m2, K–L grade IV, and pre-HKAA > 10° (P < 0.1 for all). Multivariable logistic regression analysis revealed that age > 70 (OR = 4.861) and K–L grade IV (OR = 6.590) were significantly associated with the higher WOMAC score at one year postoperatively. Conclusions: Spacer-type MOWHTO is an effective treatment for osteoarthritis with varus deformity. The prognostic factors for spacer-type MOWHTO are age and K–L grade. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the correlation between fibular head height and the incidence and severity of osteoarthritis associated with varus knee deformity. The fibular head height, joint line convergence angle (JLCA) and medial proximal tibial angle (MPTA) were measured in a three-dimensional model. Ordinal multivariate logistic regression was used to analyze the correlation between fibular head height and Kellgren-Lawrence (K-L) grade. Pearson correlation was used to analyze the correlation between fibular head height and K-L grade. A total of 232 patients (232 knees) were finally included in the study. There were significant differences in JLCA and hip-knee-ankle angle (P < 0.05), and both JLCA and hip-knee-ankle angle increased with severe aggravation of K-L grade. Both fibular head height and MPTA decreased as the K-L grade was severely aggravated. There was a significant negative correlation between K-L grade and fibular head height (r =-0.812, P < 0.001). Furthermore, there was a significant negative correlation between fibular head height and hip-knee-ankle angle (r = -0.7905, P < 0.001). In addition to body mass index, fibular head height is a risk factor for the pathogenesis of osteoarthritis associated with varus knee deformity; the smaller the fibular head height, the more severe the degree of varus deformity. [ABSTRACT FROM AUTHOR]

There have been few studies in English literature identifying the potential association and clinical significance of MATN-3 rs8176070 (SNP6) polymorphism in patients with primary knee Osteoarthritis Knee. Objective of this paper was to evaluate the association of matrilin gene-3 and primary osteoarthritis of knee through systematic review of these studies. We did an extensive literature using relevant keywords .3 eligible studies were included for systematic review. Two studies showed significant association, in which Patients with the B\b genotype had worse clinical and radiological findings than those with B\B and b\b genotype. The third study in Indian population did not find any correlation. On the basis of this systematic review we can safely suggest that there is dearth of such studies in literature therefore more of such studies with wider and larger study population shall be undertaken to find Correlation of genetic in this multifactorial disorder and possible cure.

Abstract Background The disease modifying potential of osteoarthritis therapies are of increasing interest, including their effects on delaying total knee replacement (TKR). To date, there have been no studies to determine the effect of LMWF-5A, a novel anti-inflammatory compound derived from human serum albumin, on delaying TKR. Methods We evaluated time to TKR three years after patients participated in a randomized trial of three intra-articular injections of LMWF-5A or saline. Patients were contacted via last known phone number and were asked to participate in a short nine item telephone questionnaire; verbal consent was obtained. The primary endpoint was incidence of TKR (%). Results In total, 39 of 45 patients responded (87% response rate). The overall incidence of TKR was 38.5% (15/39). TKR rates were higher in patients with more severe osteoarthritis defined by Kellgren-Lawrence grade 4, compared to patients with moderate osteoarthritis defined by Kellgren-Lawrence grade 3 (56% vs. 26%, p = 0.06). Overall, there were no differences in TKR rates by treatment arm (39% LMWF-5A vs. 38% saline, p = 0.92). In the severe osteoarthritis subset (n = 16), treatment with LMWF-5A resulted in a lower incidence of TKR compared to saline vehicle arm (40% vs. 83%, p = 0.15). TKR rates were significantly lower with LMWF-5A in patients who responded to treatment (14% with LMWF-5A, vs. 100% with saline, p = 0.03). Conclusion This study demonstrates significant delays in TKR for patients with severe osteoarthritis treated with LMWF-5A, suggesting that LMWF-5A has the potential to provide structure modifying/preserving therapy in this population.

One-leg standing (OLS) balance is an important predictor of falls in people of advanced age. In this population, muscle weakness and knee osteoarthritis also contribute to falls and resultant fractures and thereby affect mortality rates. The Kellgren–Lawrence (KL) classification is widely used in the radiographic evaluation of knee osteoarthritis. This study was performed to evaluate OLS balance and the quadriceps strength (QS) for each KL grade and to clarify the impact of the knee osteoarthritis grade on OLS balance and QS. OLS balance shows results compatible with those of previous reports when independent walking is possible because of maintenance of QS regardless of the OA grade. This single-center prospective cross-sectional study included data on 106 male orthopedic patients (106 knees) aged ≥80 years who could walk independently. OLS balance with eyes open was assessed using the patient's preferred leg. A handheld dynamometer was used to measure QS. The ratio of muscle strength to body weight (QS/BW ratio) was used to evaluate outcomes. Weight-bearing standing knee radiographs were evaluated using the KL classification. OLS balance and the QS/BW ratio were evaluated for each KL grade, and the correlations of the KL grade with OLS balance and the QS/BW ratio were assessed simultaneously. For each KL grade, the number of participants (n), median OLS balance (seconds), and QS/BW ratio (N/kg) were as follows: grade I: 24, 12, and 4.9; grade II: 51, 14, and 5.2; grade III: 22, 14, and 4.9; and grade IV: 9, 26, and 5.7, respectively. There were no significant differences in either OLS balance or the QS/BW ratio among the four grades. Participants exhibited good OLS balance and QS/BW ratio regardless of their KL grade. This study demonstrated an absence of correlations of the KL grade with OLS balance and the QS/BW ratio, as was previously reported for the KL grade and pain. Level II prospective study. [ABSTRACT FROM AUTHOR]

There have been few studies in English literature identifying the potential association and clinical significance of MATN-3 rs8176070 (SNP6) polymorphism in patients with primary knee Osteoarthritis Knee. The objective of this review was to evaluate the association of matrilin gene-3 and primary osteoarthritis of knee through systematic review of these studies. We did an extensive literature using relevant keywords and eligible studies were included for systematic review. Two studies showed significant association, in which patients with the B\b genotype had worse clinical and radiological findings than those with B\B and b\b genotype. The third study in Indian population did not find any correlation. On the basis of this systematic review we can safely suggest that there is dearth of such studies in literature therefore more of such studies with wider and larger study population shall be undertaken to find Correlation of genetic in this multifactorial disorder and possible cure. [ABSTRACT FROM AUTHOR]

Background: Although current advances in surgical techniques have improved outcomes of the medial opening-wedge high tibial osteotomy (MOWHTO), the factors associated with patient dissatisfaction remain unclear. Thus, the purpose of this study is to identify risk factors for patient dissatisfaction following contemporary MOWHTO.Methods: We retrospectively reviewed prospectively collected data on 140 consecutive MOWHTO patients using an anatomical locking plate with a minimum follow-up of 2 years. Patient demographics, pain Visual Analogue Scale, Western Ontario and McMaster Universities Osteoarthritis Index, Kellgren-Lawrence (K-L) grade, activity level, articular cartilage and meniscal status, hip-knee-ankle angle, change in alignment, and postoperative weight-bearing line ratio were recorded. Patients were categorized using the New Knee Society Score into satisfied (satisfaction score ≥20) or dissatisfied (satisfaction score <20) groups. Patient and surgical factors were compared between the groups by the identified predictors. Multiple logistic regression analysis was used to analyze risk factors, including K-L grade IV medial osteoarthritis (OA), preoperative pain Visual Analogue Scale, total Western Ontario and McMaster Universities Osteoarthritis Index score, postoperative hip-knee-ankle angle, change in alignment, and partial meniscectomy.Results: Of the 140 patients, 24 (17.1%) were dissatisfied with their results. Multiple logistic regression analysis showed that only K-L grade IV medial OA was statistically associated with patient dissatisfaction following MOWHTO (odds ratio 4.911, 95% confidence interval 1.820-13.256, P < .01).Conclusion: Severe medial OA was an independent risk factor for dissatisfaction following contemporary MOWHTO using a rigid locking plate. Surgeons should take this into consideration when counseling and choosing surgical options in MOWHTO candidates with severe medial OA.Level Of Evidence: Level III. [ABSTRACT FROM AUTHOR]

We compared the prediction efficiency of the multiple-joint space width (JSW) and the minimum-JSW on knee osteoarthritis (KOA) severity and progression by using a deep learning approach. A convolutional neural network (CNN) with ResU-Net architecture was developed for knee X-ray imaging segmentation and has attained a segmentation efficiency of 98.9% intersection over union (IoU) on the distal femur and proximal tibia. Later, by leveraging the image segmentation, the minimum and multiple-JSWs in the tibiofemoral joint were estimated and then validated by radiologist measurements in the Osteoarthritis Initiative (OAI) dataset using Pearson correlation and Bland–Altman plots. The agreement between the CNN-based estimation and radiologist’s measurement of minimum-JSWs reached 0.7801 (p < 0.0001). The estimated JSWs were deployed to predict the radiographic severity and progression of KOA defined by Kellgren-Lawrence (KL) grades using the XGBoost model. The 64-point multiple-JSWs achieved the best performance in predicting KOA progression within 48 months, with the area-under-receiver operating characteristic curve (AUC) of 0.621, outperforming the commonly used minimum-JSW with 0.554 AUC. We provided a fully automated radiographic assessment tool for KOA with comparable performance to the radiologists and showed that the fine-grained measurement of multiple-JSWs yields superior prediction performance for KOA over the minimum-JSW.

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Introduction: The role of genetic factors influencing osteoarthritis (OA) susceptibility is well documented and several candidate genes have been identified to be associated with it. Among these genes are Bone Morphogenetic Protein 5 (BMP5) and Smad family member 3 (SMAD3), all involved in Transforming Growth Factor (TGF) signaling pathway. The knee is the commonly affected joint, and knee OA has an especially high prevalence in Asian population. Aim: To investigate associations between Single Nucleotide Polymorphisms (SNPs) rs12901499 in SMAD3 and rs921126 in the BMP5 gene with knee OA susceptibility in and around Lucknow, Uttar Pradesh, India. Materials and Methods: SNPs rs12901499 in SMAD3 and rs921126 in BMP5 were genotyped in patients with knee OA and age- sex matched OA-free controls from our population. A total of 450 patients with knee OA and 458 controls were enrolled in the study. Venous blood samples were obtained from all cases as well as controls for PCR-RFLP (Polymerase Chain Reaction- Restriction Fragment Length Polymorphism). Data was collected and entered in excel sheets. Statistical analyses of the data were performed using statistical software package SPSS version 16.0. Chi-square, Student’s t-test and logistic regression tests were used to analyse the data. Results: GA and GG genotypes of both SNPs (rs12901499 and rs921126), and variant G, were associated with a significantly increased risk of knee OA. A significantly increased risk of knee OA was associated with the genotype GG and GA of rs12901499 (p < 0.03 and p 55 years (adjusted OR= 3.4), similarly in rs12901499, GG mutant compared with AA homozygote was strong in female (adjusted OR= 1.5) and in those aged >55 years (adjusted OR= 1.5). Conclusion: The results showed that both in SMAD3 rs12901499 and BMP5 921126, G allele is significantly associated with knee OA. A to G change and variant G genotype may contribute to knee OA risk in our study population of Lucknow.

Objective: Osteoarthritis (OA) is a multifactorial, degenerative, and inflammatory disorder of joints causing damage of the articular cartilage, formation of osteophytes, and eburination of the subchondral bone. Matrilin-3 (MATN-3) is a non-collagenous oligomeric extracellular matrix protein (ECM), which is the smallest member of the matrilin family. This study was conducted to identify the potential association and clinical significance of MATN-3 rs8176070 (SNP6) polymorphism in a series of Egyptian patients with primary knee OA. Material and Methods: Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used to determine genotypes of MATN-3 SNP6 for 50 primary knee OA patients in addition to 50 healthy subjects of the same sex and age range. Full history was obtained from OA patients, followed by clinical examination, together with clinical assessment of the severity of knee OA using Lequesne Algofunctional Index score and radiological grading using the Kellgren-Lawrence grade scale (KL). Results: With regard to genotypes of MATN-3 gene SNP6 (rs8176070), a statistically significant difference between OA patients and healthy control subjects was found for the B\b genotype and b allele (p=0.046 and 0.042 respectively), with the prevalence being higher in OA patients with a high risk to develop OA (Odds Ratio [OR]=2.250, 95% CI=1.011-5.008). Patients with the B\b genotype had worse clinical and radiological findings than those with B\B and b\b genotypes. Conclusion: The investigated polymorphism in the MATN-3 gene may reflect the risk and severity of knee OA in Egyptian patients, particularly with the B\b genotype. [ABSTRACT FROM AUTHOR]

Purpose: We assessed erythrocyte sedimentation rate and high-sensitivity C-reactive protein concentration in knee osteoarthritis and non-knee osteoarthritis. In addition, we investigated potential relationship between the levels of erythrocyte sedimentation rate and high-sensitivity C-reactive protein with clinical findings and radiographic severity.Methods: We compared erythrocyte sedimentation rate and high-sensitivity C-reactive protein concentration between 104 patients with knee osteoarthritis (knee osteoarthritis group; 25 males, 79 females; mean age, 73 y) and 50 patients without knee osteoarthritis (non-knee osteoarthritis group; 16 males, 34 females; mean age, 64 y) excluding any patients with comorbid joint osteoarthritis, rheumatoid arthritis, malignant tumours or inflammatory diseases. In the knee osteoarthritis group, we assessed whether erythrocyte sedimentation rate and high-sensitivity C-reactive protein concentration differed in clinical features and Kellgren-Lawrence (KL) grades.Results: Erythrocyte sedimentation rate and high-sensitivity C-reactive protein were significantly higher in the knee osteoarthritis group than in the non-knee osteoarthritis group (P = 0.0013 and 0.00010, respectively). In the knee osteoarthritis group, erythrocyte sedimentation rate was significantly elevated in patients with tenderness and patellar ballottement (P = 0.032 and 0.038, respectively), and high-sensitivity C-reactive protein concentration was significantly elevated in patients with tenderness, swelling and patellar ballottement (P = 0.0042, 0.00030 and 0.019, respectively). Erythrocyte sedimentation rate in KL-I was lower than erythrocyte sedimentation rate in KL-III and -IV (P = 0.012 and 0.037, respectively). Erythrocyte sedimentation rate in KL-II did not significantly differ from erythrocyte sedimentation rate in the other groups. High-sensitivity C-reactive protein concentration was lower in grade I than in KL-II, -III and -IV (P = 0.044, 0.0085 and 0.049, respectively).Conclusions: Erythrocyte sedimentation rate and high-sensitivity C-reactive protein concentration were higher in patients with knee osteoarthritis and were related to clinical features. In knee osteoarthritis, high-sensitivity C-reactive protein concentration may increase in early-stage KL-II. [ABSTRACT FROM AUTHOR]

Osteoarthritis (OA) is a chronic joint disease characterized by articular cartilage degeneration and secondary bone hyperplasia. C-reactive protein (CRP) is an acute-phase protein that is widely used as a marker of inflammation. Elevated plasma levels of CRP are commonly observed in patients with OA during the acute phase. Current evidence indicates that CRP dissociating into a monomeric form (mCRP) is the main functional conformation at inflammatory loci. However, it remains unclear whether mCRP is associated with OA and whether mCRP can be used as a biomarker for its pathogenesis. In the present study, the concentration of CRP, mCRP and anti-mCRP autoantibody were detected by performing ELISA. The levels of plasma CRP, mCRP and anti-mCRP autoantibody between healthy subjects and patients with OA were compared. The results revealed that plasma mCRP was strongly associated with OA, while mCRP autoantibodies exhibited little correlation with this condition. Additionally, it was identified that the plasma mCRP levels in Kellgren-Lawrence (KL) grade 4 patients were significantly higher than in those with KL grade 3. Thus, it was revealed in the present study that plasma level of mCRP is associated with OA, which may directly reflect the disease degree of patients. Therefore, mCRP may be a potential indicator that can be used to monitor the disease activity and evaluate the efficiency of OA therapy. [ABSTRACT FROM AUTHOR]

Abstract: We evaluated the efficacy of intra-articular viscosupplementation with sodium hyaluronate in the management of osteoarthritis of the subtalar joint. A total of 22 patients, aged 22 to 72 years (mean 53), with symptomatic subtalar joint osteoarthritis of 1 to 20 years'' duration (mean 4.2) and a severity of Kellgren–Lawrence grade II to IV and Paley and Hall grade 1 to 3, were entered into the present study. Intra-articular injections of 10 mg sodium hyaluronate (Euflexxa) were administered weekly to the subtalar joint for 3 weeks. Clinical evaluations and objective scoring using the American Orthopaedic Foot and Ankle Society Ankle Hindfoot score, visual analog scale, maximum walking distance, pain frequency, and subjective global function were performed at baseline and 4, 12, and 28 weeks after treatment. Significant improvement occurred in the American Orthopaedic Foot and Ankle Society Ankle Hindfoot scores (baseline score 54.5, week 28 score 73.7; p < .01) and visual analog scale assessment (baseline pain, stiffness, and function score 5.4, 5.8, and 6.9; week 28 pain, stiffness, and function score 2.8, 3.1, and 3.8, respectively; p < .01). Global assessment showed improvement in 18 of 20 patients completing the study (p < .01). The tolerated walking distance significantly improved from 770 ± 886 m to 2,075 ± 1,500 m (p < .001). Improvement lasted for more than 6 months. Intra-articular injection of sodium hyaluronate should be considered in the conservative management of subtalar osteoarthritis. [Copyright &y& Elsevier]

The association between clinical parameters and forearm bone mineral density (BMD) in postmenopausal females with radiographic hand OA has not been determined. We investigated the difference in forearm BMD between radiographic hand OA and non-radiographic hand OA, and also the association between clinical parameters of patients and the level of forearm BMD. A total of 180 postmenopausal patients with hand OA were enrolled in this study. We classified them into two groups according to the Kellgren–Lawrence (K–L) radiological grade, one with radiographic hand OA (K–L grade ≥ 2) and the other with non-radiographic OA (K–L grade < 2) as controls. The number of nodal joints, swollen joints and tender joints were determined in the physical examination, and measures of BMD (g/cm2), Australian Canadian (AUSCAN) OA hand index, grip strength, pinch strength, and visual analogue scale (VAS) were also estimated. Patients with radiographic hand OA had lower distal radius BMD when compared with controls (0.35 ± 0.06 vs. 0.40 ± 0.05, P < 0.001). After adjusting for variables such as age, menopausal duration, number of nodal joints, and AUSCAN function index, the difference in BMD between the two groups was also significantly different (0.35 ± 0.04 vs. 0.38 ± 0.04, P < 0.001). For analysis of risk factors for forearm BMD in hand OA, age and K–L OA grade in total hand OA are considered risk factors, whereas age and menopause duration contribute to the forearm BMD in radiographic hand OA patients ( P < 0.001, P = 0.002, respectively). The development of osteoporosis at the distal radius in radiographic hand OA is associated with older age (OR = 1.216, P = 0.002), lower BMI (OR = 0.777, P = 0.004) and lower stiffness in the AUSCAN OA index (OR = 0.505, P = 0.003). This study shows that the BMD levels of the distal radius in patients with radiographic hand OA are significantly lower when compared to those of controls. Forearm BMD levels are positively associated with age and K–L radiological grade in total hand OA, whereas age and menopausal duration are closely related with radiographic hand OA. The presence of osteoporosis in the distal radius in radiographic hand OA may be influenced by age, BMI, and stiffness on the AUSCAN index. [ABSTRACT FROM AUTHOR]

Simple Summary: Minimum-joint space width (JSW) is a prevalent clinical parameter in quantifying the joint space narrowing condition in knee osteoarthritis (KOA). In this study, we propose a novel multiple-JSW measurement, which is estimated by a deep learning-based model in an automated manner. The performance of the proposed automated measurement is found to be superior to the conventionally used minimum-JSW in the severity classification and progression prediction of KOA owing to the additional information of the joint space morphology encoded in the new approach. It is further demonstrated that the deep learning-based approach yields comparable performance as the measurement by radiologists. The approach presented in this work may lead to the development of a computer-aided tool for clinical practitioners that could facilitate the KOA diagnosis and prognosis with the fully automated, accurate, and efficient computation of the joint-space parameters. We compared the prediction efficiency of the multiple-joint space width (JSW) and the minimum-JSW on knee osteoarthritis (KOA) severity and progression by using a deep learning approach. A convolutional neural network (CNN) with ResU-Net architecture was developed for knee X-ray imaging segmentation and has attained a segmentation efficiency of 98.9% intersection over union (IoU) on the distal femur and proximal tibia. Later, by leveraging the image segmentation, the minimum and multiple-JSWs in the tibiofemoral joint were estimated and then validated by radiologist measurements in the Osteoarthritis Initiative (OAI) dataset using Pearson correlation and Bland–Altman plots. The agreement between the CNN-based estimation and radiologist's measurement of minimum-JSWs reached 0.7801 (p < 0.0001). The estimated JSWs were deployed to predict the radiographic severity and progression of KOA defined by Kellgren-Lawrence (KL) grades using the XGBoost model. The 64-point multiple-JSWs achieved the best performance in predicting KOA progression within 48 months, with the area-under-receiver operating characteristic curve (AUC) of 0.621, outperforming the commonly used minimum-JSW with 0.554 AUC. We provided a fully automated radiographic assessment tool for KOA with comparable performance to the radiologists and showed that the fine-grained measurement of multiple-JSWs yields superior prediction performance for KOA over the minimum-JSW. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: This study was aimed to measure soluble lectin-like oxidized low-density lipoprotein receptor-1 (sLOX-1) levels in serum and synovial fluid (SF) of knee osteoarthritis (OA) patients and to investigate the correlation between sLOX-1 levels and the disease severity. Design and methods: Two hundred and sixteen OA patients and 83 healthy controls were enrolled in this study. All OA patients were scored for Kellgren–Lawrence (KL) grade (0–4). The sLOX-1 levels were measured by enzyme-linked immunosorbent assay (ELISA). Results: In OA patients, the mean sLOX-1 levels in SF were markedly lower than those in paired serum samples (P<0.01). The SF sLOX-1 levels increased with higher KL grade (P<0.01) and were significantly correlated with disease severity (r =0.324, P<0.01). SF sLOX-1 level was the independent factor for predicting the disease severity of OA (β: 0.281, 95%CI: 0.145–0.396). Conclusions: SF sLOX-1 levels were independently and positively associated with disease severity in knee OA. [Copyright &y& Elsevier]

Background: Osteoarthritis (OA) and osteoporosis (OP) are the 2 most common bone disorders associated with aging. We can simply assume that older patients have a higher incidence of OA and OP with more severity. Although several papers have conducted studies on the relationship between OA and OP, none of them has demonstrated a conclusive link. In this study, we used radiological knee OA and bone mineral density (BMD; T-score of the total hip and lumbar spine) to analyze the incidence of OA and OP in a large population. We aimed to determine the relationship between OA and OP and investigate the associated risk factors., Methods: This cross-sectional study used data extracted from the 2010-2012 Korea National Health and Nutrition Examination Survey. We evaluated a total of 4,250 participants aged ≥ 50 years who underwent knee radiography and dual-energy X-ray absorptiometry and their laboratory results. The relationship between radiological knee OA and BMD was assessed. The generalized linear model was used to evaluate the relationship between BMD and Kellgren-Lawrence (KL) grade., Results: The higher KL grade was associated with older age, higher body mass index (BMI), female sex, and lower hemoglobin level ( p < 0.001). No significant association was found between OA and the following variables: white blood cell, platelet, total cholesterol, vitamin D, alkaline phosphatase, parathyroid hormone, hypertension, diabetes, asthma, dyslipidemia, smoking status, alcohol consumption, and regular exercise ( p > 0.05). After adjusting for confounding factors (age, BMI, diabetes, hypertension, smoking, and alcohol consumption), the average T-scores of total hip and lumbar spine were the highest in the mild OA group with KL grade 2 (-0.22 ± 1.08 and -0.89 ± 1.46, respectively, p < 0.001). The average T-scores of the total hip and lumbar spine significantly decreased as OA progressed from moderate (KL grade 3; -0.49 ± 1.05 and -1.33 ± 1.38, respectively, p < 0.001) to severe (KL grade 4; -0.73 ± 1.13 and -1.74 ± 1.75, respectively, p < 0.001). T-scores of the moderate-to-severe OA group were significantly lower than those of the non-OA group (KL grades 0 and 1, p < 0.001)., Conclusions: Compared with the non-OA group, BMD (T-scores of the total hip and lumbar spine) was higher in the mild OA group and lower in the moderate-to-severe OA group., Competing Interests: CONFLICT OF INTEREST: No potential conflict of interest relevant to this article was reported., (Copyright © 2021 by The Korean Orthopaedic Association.)

The minimal clinically important improvement (MCII) is the smallest change that signifies an important improvement. Disease severity may complicate MCII. We developed an eight-question survey examining MCII in patients with severe knee osteoarthritis (Kellgren-Lawrence grade 4). Twenty-seven of 101 clinicians completed the survey. An MCII of 20% was selected most frequently for pain, function, and patient global assessment. Clinicians were divided on responder rate, selecting 20%, 30%, and 50% equally. These findings suggest a 20% MCII may be useful in patients with severe osteoarthritis, but that there is not enough evidence to support a responder rate in this population. [ABSTRACT FROM AUTHOR]

Objective: There is a debate over the relevance of ultrasound abnormalities to the pain, functional impairment, and radiologic severity in hand osteoarthritis (OA) This study aims to determine the association between ultrasound abnormalities and clinical, functional, and radiographic measures in hand OA., Methods: A total of 66 patients was consecutively enrolled All patients with gray-scale synovitis, joint effusion, and osteophytes were examined by ultrasound for 20 hand joints Radiographic changes in both hands were evaluated by the Kellgren-Lawrence (K-L) grading system and were described as total radiographic severity score and number of affected joints Other measures were also assessed, including each patient's visual analogue scale for pain, the Functional Index for Hand Osteoarthritis for functional disability, and grip and pinch strength for hand muscle strength., Results: In total, 10 patients with gray-scale synovitis, 35 with joint effusion, and 66 with osteophytes were detected in hand OA scans on ultrasound Osteophytes on ultrasound were significantly associated with total radiographic severity score and number of affected joint (r=0293, p=0003 and r=0336, p<0001, respectively) In addition, there were weak associations of synovitis and joint effusion with radiographic changes Patients with higher total radiographic severity score showed larger number of ultrasound-detected abnormalities, such as synovitis, joint effusion, and osteophytes (p=0011, p=0002, and p<0001, respectively)., Conclusion: This study shows that ultrasound findings, especially osteophytes, were associated with radiographic changes based on K-L grade, but not clinical and functional status in hand OA., Competing Interests: CONFLICT OF INTEREST No potential conflict of interest relevant to this article was reported., (Copyright © 2021 by The Korean College of Rheumatology. All rights reserved.)

Introduction: The role of genetic factors influencing osteoarthritis (OA) susceptibility is well documented and several candidate genes have been identified to be associated with it. Among these genes are Bone Morphogenetic Protein 5 ( BMP5 ) and Smad family member 3 ( SMAD3) , all involved in Transforming Growth Factor (TGF) signaling pathway. The knee is the commonly affected joint, and knee OA has an especially high prevalence in Asian population., Aim: To investigate associations between Single Nucleotide Polymorphisms (SNPs) rs12901499 in SMAD3 and rs921126 in the BMP5 gene with knee OA susceptibility in and around Lucknow, Uttar Pradesh, India., Materials and Methods: SNPs rs12901499 in SMAD3 and rs921126 in BMP5 were genotyped in patients with knee OA and age- sex matched OA-free controls from our population. A total of 450 patients with knee OA and 458 controls were enrolled in the study. Venous blood samples were obtained from all cases as well as controls for PCR-RFLP (Polymerase Chain Reaction- Restriction Fragment Length Polymorphism). Data was collected and entered in excel sheets. Statistical analyses of the data were performed using statistical software package SPSS version 16.0. Chi-square, Student's t-test and logistic regression tests were used to analyse the data., Results: GA and GG genotypes of both SNPs (rs12901499 and rs921126), and variant G, were associated with a significantly increased risk of knee OA. A significantly increased risk of knee OA was associated with the genotype GG and GA of rs12901499 (p < 0.03 and p <0.004 respectively) and rs921126 (p< 0.0001 and p<0.001 respectively) compared with the AA genotype. In addition, those bearing at least one G allele (GG + GA) had a significantly increased risk of knee OA compared with those without the G allele (AA) in rs921126 (p< 0.0001). However, in rs12901499, significant association with the risk of knee OA was not found (p<0.4). On age and gender based stratification, the association between the risk of OA and rs921126 GG mutant compared with AA homozygotes was strong in both gender (adjusted OR= 2.93 for male and 2.25 for female) and in those aged >55 years (adjusted OR= 3.4), similarly in rs12901499, GG mutant compared with AA homozygote was strong in female (adjusted OR= 1.5) and in those aged >55 years (adjusted OR= 1.5)., Conclusion: The results showed that both in SMAD3 rs12901499 and BMP5 921126, G allele is significantly associated with knee OA. A to G change and variant G genotype may contribute to knee OA risk in our study population of Lucknow.

Background: Knee injection therapy is less effective for severe osteoarthritis (OA), specifically Kellgren-Lawrence (KL) grade 4. Patient selection for knee injection trials has historically been based on extension anteroposterior (AP) radiographic evaluation; however, emerging evidence suggests that KL grading using a flexion posteroanterior (PA) radiograph more accurately and reproducibly predicts disease severity. The impact of radiographic view on patient selection and outcome after knee injection therapy remains unknown., Hypothesis: A 45° flexion PA radiograph will reveal more advanced knee OA in certain patients. These patients will report worse pre- and postinjection outcomes., Study Design: Cohort study; Level of evidence, 3., Methods: Four raters independently graded extension AP and flexion PA radiographs from 91 patients previously enrolled in a knee injection trial. Patients determined to have KL grade 4 OA by any rater on extension AP radiographs were excluded. Among included patients, those upgraded to KL grade 4 on flexion PA radiographs by at least 2 raters constituted group 2, while all remaining patients constituted group 1. Demographic data and patient-reported outcome scores before injection and at 6 weeks, 3 months, 6 months, and 12 months postinjection were compared between groups., Results: Overall, 64 patients met the inclusion criteria, of which 19 patients (30%) constituted group 2. Compared with group 1, patients in group 2 were older (58.7 vs 52.3 years, P = .02), had worse visual analog scale pain scores before (6.6 vs 5.3, P = .03) and 6 months after injection (5.3 vs 3.5, P = .01), had less improvement in both Lysholm (8.5 vs 20.5, P = .02) and Short Form-12 physical component (-2.2 vs 1.7, P = .03) scores from preinjection to 6 months postinjection, and had less improvement in both Lysholm (1.6 vs 13.1, P = .03) and Knee injury and Osteoarthritis Outcome Score sport subscale (-2.1 vs 16, P = .01) scores from preinjection to 12 months postinjection., Conclusion: One in 3 patients considered to have mild to moderate knee OA on extension AP radiography is upgraded to severe knee OA (KL grade 4) on flexion PA radiography. These patients report worse preinjection outcomes, worse pain scores at short-term follow-up, and decreased improvement in knee function scores between 6 months and 1 year postinjection., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: A.B.Y. receives research support from Arthrex and NuTech. B.J.C. receives research support from Aesculap/B.Braun, Arthrex, Cytori, Medipost, Ossur, Smith & Nephew, Tornier, and Zimmer; is a paid consultant for Arthrex, Regentis, and Zimmer; receives royalties from Arthrex, DJ Orthopaedics, Elsevier, Saunders/Mosby-Elsevier, and SLACK Inc; and has stock/stock options in Carticept and Regentis.