BACKGROUND Total knee arthroplasty(TKA)aims to restore motion and alleviate pain,enabling patients to return to daily activities.Despite advances in implants,surgery,and perioperative care,patient dissatisfaction rate...BACKGROUND Total knee arthroplasty(TKA)aims to restore motion and alleviate pain,enabling patients to return to daily activities.Despite advances in implants,surgery,and perioperative care,patient dissatisfaction rates remain significant.AIM To determine whether ankle symptoms are associated with inferior results of functional recovery of the knee following TKA.METHODS This prospective study included all patients with advanced knee osteoarthritis who underwent a primary unilateral TKA between August 2019 and December 2019 with data documented by the treating surgeon and outpatient physical therapists.Patients were categorized based on ankle symptoms using the Ame-rican Orthopaedic Foot and Ankle Society(AOFAS)score:(1)Group 1(AOFAS≤85,n=30);and(2)Group 2(AOFAS>85,n=49).Active range of motion(ROM),the Knee Injury and Osteoarthritis Outcome Score(KOOS),and the visual ana-logue scale(VAS)were compared between two groups.RESULTS Postoperative KOOS,ROM,and VAS significantly improved in both groups(P<0.001).However,at three months,KOOS(P=0.02)and extension motion(P=0.01)improvements were significantly greater in group 2.CONCLUSION These findings suggest that preoperative ankle symptoms may negatively impact early knee functional recovery,particularly in KOOS scores and extension motion.展开更多
BACKGROUND The prevalence of depressive symptoms in patients undergoing total knee arthroplasty(TKA)ranges from 22%to 26%.The impact of depression on functional status post-TKA remains controversial.AIM To be the firs...BACKGROUND The prevalence of depressive symptoms in patients undergoing total knee arthroplasty(TKA)ranges from 22%to 26%.The impact of depression on functional status post-TKA remains controversial.AIM To be the first study in Latin American population to evaluate the association between depression and functional status one year after TKA,hypothesizing that elderly patients with depression will demonstrate lower rates of functional improvement.METHODS We conducted an observational,descriptive and analytic,retrospective cohort study involving patients over 65 years old who were indicated for TKA.Assessments were made via the Program for Determination and Management of Risks for Practices and Procedures of the Division of Geriatric Medicine at the Italian Hospital of Buenos Aires,between June 2015 and July 2019.Depression screening was conducted using Yesavage’s abbreviated score and Patient Health Questionnaire-9,while functional ability was evaluated using the Knee Society Score(KSS).RESULTS Of the 100 patients analyzed,22(22%)screened positive for depression.The mean age was 80 years±6.3 years,with an average of 77.6 years±6 years in the depressed group and 80.6 years±6.3 years in the non-depressed group(P=0.05).Depressed patients showed significantly greater cognitive impairment[clock-face drawing test median:5(3-6)vs 6(5-7),P=0.06]and more risk factors for confusional syndrome(mean:8±2 vs 6.5±2.2,P=0.006).Frailty was also more prevalent in depressed patients[Edmonton:15(68%)vs 33(42%),P=0.05;Fried:17(77%)vs 42(54%),P=0.05].Postoperative Functional KSS were similar between groups(depressed:65±22.1 vs non-depressed:66.3±20.3,P=0.8).Linear regression analysis revealed no association between depression and changes in KSS.Spearman’s rank correlation coefficients were-0.0304(P=0.8)for Functional KSS variation and-0.1(P=0.3)for KSS variation.CONCLUSION Depression in patients with osteoarthritis should not hinder surgical planning.Identifying and treating depression preoperatively may enhance outcomes such as pain relief and reduce risks of acute confusional syndrome,cognitive impairment,and frailty.展开更多
Retrieval analysis in total knee arthroplasty(TKA)has been little studied in the literature.A narrative review of the literature to understand the current importance of retrieval analysis in TKA has been conducted.On ...Retrieval analysis in total knee arthroplasty(TKA)has been little studied in the literature.A narrative review of the literature to understand the current importance of retrieval analysis in TKA has been conducted.On August 27,2024,a literature search was performed in PubMed using“TKA retrieval analysis”as keywords.A total of 160 articles were found,of which only 19 were analyzed because they were directly related to the subject of this article.Rotating-platform(mobile-bearing)TKA has no surface damage advantage over fixed-bearing TKA.TKAs with central locking mechanisms are more prone to debond from the cement mantle.No major wear of the polyethylene(PE)component in TKA using oxidized zirconium components occurs.Femoral components of cobalt-chromium roughen more than oxidized zirconium femoral components.The use of a polished tibial tray over an unpolished design is advised.At short-run assessment(15 months on average),antioxidant-stabilized highly crosslinked PE components are not clinically different in surface damage,density of crosslinking,or oxidation compared to standard remelted highly crosslinked PE components.A correlation between implant position and PE component surface damage has been reported.It shows the importance of optimizing component position to reduce PE component damage.Contemporary knee tumor megaendoprostheses show notable volumetric metal wear originated at the rotating hinge.Retrieval analysis in TKA renders relevant data on how different prosthetic designs described in the literature perform.Such information can help to improve future prosthetic designs to increase prosthetic survival.展开更多
[Objectives]To explore the effects of electroacupuncture combined with rehabilitation training on knee joint function,three-dimensional(3D)gait,and inflammatory markers in patients with knee osteoarthritis(KOA)of cold...[Objectives]To explore the effects of electroacupuncture combined with rehabilitation training on knee joint function,three-dimensional(3D)gait,and inflammatory markers in patients with knee osteoarthritis(KOA)of cold-dampness obstruction syndrome.[Methods]A total of 162 KOA patients admitted to Huadong Hospital Affiliated to Fudan University from January 2021 to May 2023 were enrolled and randomly divided into an electroacupuncture group and a control group,with 81 patients in each group.The control group received routine rehabilitation training,while the electroacupuncture group received electroacupuncture treatment in addition to the same rehabilitation training,both for 4 weeks.The efficacy,syndrome scores,Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC),Lysholm Knee Score(LKS),3D gait parameters,and levels of inflammatory markers were compared between the two groups.[Results]Following treatment,the total effective rate in the electroacupuncture group was 92.59%,which was significantly higher than 77.78%observed in the control group(P<0.05).Additionally,the electroacupuncture group exhibited lower TCM syndrome scores(P<0.05),reduced WOMAC scores,and elevated LKS scores compared to the control group(P<0.05).Gait parameters,including step frequency,step speed,stride length,initial ground contact flexion angle,maximum swing phase extension angle,and support phase extension angle,were all higher in the electroacupuncture group.Additionally,the sagittal plane maximum abduction moment was lower in the electroacupuncture group.Inflammatory markers showed that interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)were lower in the electroacupuncture group,while transforming growth factor-β1(TGF-β1)was higher(P<0.05).[Conclusions]Electroacupuncture combined with rehabilitation training effectively enhances clinical efficacy,alleviates symptoms,improves knee joint mobility and walking ability,enhances knee function scores,and reduces inflammatory levels,contributing to the rapid recovery of knee joints in KOA patients.展开更多
BACKGROUND Total knee arthroplasty(TKA)is a widely used treatment for advanced knee osteoarthritis;however,the incidence of failures requiring revision surgery is increasing.Identifying the causes of TKA failure and a...BACKGROUND Total knee arthroplasty(TKA)is a widely used treatment for advanced knee osteoarthritis;however,the incidence of failures requiring revision surgery is increasing.Identifying the causes of TKA failure and assessing the outcomes of revision procedures are essential for improving patient care.We hypothesized that infection and aseptic loosening are the primary causes of TKA failure and that revision TKA(rTKA)significantly enhances functional outcomes.AIM To examine the primary causes of TKA failure and evaluate the functional outcomes following rTKA.METHODS This descriptive study was conducted at the Department of Orthopedic Surgery,Civil Hospital,Bahawalpur,from April to September 2024.A total of 118 patients undergoing rTKA for failed primary TKA were included.Data on demographics,causes of failure,and surgical details were collected.Functional outcomes were evaluated using the Knee Society Score and Visual Analog Scale before and six months after surgery.Statistical analysis was performed using SPSS version 25.0,with statistical significance set at P<0.05.RESULTS The leading causes of TKA failure were infection(45.8%),aseptic loosening(44.1%),and periprosthetic fractures(10.2%).The rTKA significantly improved knee function,with the mean Knee Society Score increasing from 39.43±6.18 to 78.91±6.17(P<0.001).Pain levels decreased substantially,with the mean Visual Analog Scale scores reducing from 7.99±1.37 to 1.42±1.17(P<0.001).No significant differences in outcomes were observed between single-stage and two-stage revision procedures.CONCLUSION Infection and aseptic loosening are the predominant causes of TKA failure.The rTKA effectively enhances knee function and alleviates pain,offering significant benefits to patients.展开更多
BACKGROUND Patellar resurfacing in knee arthroplasty remains a contentious issue,with various strategies including routine,selective,and non-resurfacing approaches.This review and meta-analysis aim to assess the incid...BACKGROUND Patellar resurfacing in knee arthroplasty remains a contentious issue,with various strategies including routine,selective,and non-resurfacing approaches.This review and meta-analysis aim to assess the incidence of patellar resurfacing,revision rates,patient satisfaction,and relevant knee scores associated with each method.AIM To determine the comparative effectiveness of routine,selective,and nonresurfacing strategies in patellar resurfacing within knee arthroplasty by evaluating incidence rates,revision rates,patient satisfaction,and knee function scores.METHODS A systematic review spanning from 1990 to 2024 was conducted using PubMed,Embase,and Cochrane Library databases.Studies reporting on the incidence of patellar resurfacing,revision rates,patient satisfaction,and relevant knee scores were included.Data from esteemed world registries such as the Australian Orthopaedic Association National Joint Replacement Registry,the National Joint Registry for England,Wales,Northern Ireland,and the Isle of Man and Danish Knee Arthroplasty Registry among others,were meticulously examined.Metaanalysis was employed to derive pooled estimates and 95%confidence intervals.RESULTS Analysis of data sourced from diverse world registries and literature sources unveiled significant disparities in the incidence of patellar resurfacing across different geographic regions and healthcare institutions.For instance,the incidence of routine patellar resurfacing ranged from 60%to 90%in some regions,while in others,it was as low as 30%to 50%.The meta-analysis indicated that routine resurfacing was associated with a lower revision rate of 3.5%(95%CI:2.8%-4.2%)compared to non-resurfacing approaches,which exhibited a higher revision rate of 6.8%(95%CI:5.5%-8.1%).Patient satisfaction outcomes showed variability,with routine resurfacing demonstrating higher mean satisfaction scores in functionality,pain relief,and stability categories.CONCLUSION The findings underscore the complexity of patellar resurfacing in knee arthroplasty and highlight the need for continued research to refine clinical practice.Future studies should prioritize prospective randomized controlled trials comparing different patellar resurfacing techniques using standardized outcome measures.Longitudinal studies with extended follow-up periods are necessary to evaluate the long-term outcomes and durability of various patellar resurfacing strategies.Collaborative efforts among multidisciplinary teams will be essential to conduct high-quality research that can provide actionable insights and improve patient outcomes.展开更多
Knee arthrofibrosis,characterized by excessive matrix protein production and deposition,substantially impairs basic daily functions,causing considerable distress and financial burden.However,the underlying pathomechan...Knee arthrofibrosis,characterized by excessive matrix protein production and deposition,substantially impairs basic daily functions,causing considerable distress and financial burden.However,the underlying pathomechanisms remain unclear.Here,we characterized the heterogeneous cell populations and cellular pathways by combination of flow cytometry and single-cell RNA-seq analysis of synovial tissues from six patients with or without knee arthrofibrosis.Increased macrophages and fibroblasts were observed with decreased numbers of fibroblast-like synoviocytes,endothelial cells,vascular smooth muscle cells,and T cells in the arthrofibrosis group compared with negative controls.展开更多
Osteoarthritis(OA)is an extremely prevalent degenerative joint disease which commonly occurs in the knee.In severe cases of knee OA,total knee arthroplasty(TKA)is often indicated to relieve pain and restore limb align...Osteoarthritis(OA)is an extremely prevalent degenerative joint disease which commonly occurs in the knee.In severe cases of knee OA,total knee arthroplasty(TKA)is often indicated to relieve pain and restore limb alignment.While studies have shown how TKA improves knee symptoms,the relationship between the operated knee with the hip and ankle remains understudied.A prospective study by Buterin et al showed a significant relationship between reduced ankle symptoms and better TKA recovery.The objective of this paper is to explore ways to expand the completed study to make it more widely applicable.These include sampling patients from multiple surgical centers in different cultural backgrounds,including different etiologies of OA,extending the study time points,and evaluating the contralateral limb.Together,the study by Buterin et al combined with future work can elucidate new TKA rehabilitation techniques which focus on the entire lower extremity.展开更多
Knee osteoarthritis(OA)is a debilitating condition with limited long-term treatment options.The therapeutic potential of mesenchymal stem cells(MSCs),particularly those derived from bone marrow aspirate concentrate,ha...Knee osteoarthritis(OA)is a debilitating condition with limited long-term treatment options.The therapeutic potential of mesenchymal stem cells(MSCs),particularly those derived from bone marrow aspirate concentrate,has garnered attention for cartilage repair in OA.While the iliac crest is the traditional site for bone marrow harvesting(BMH),associated morbidity has prompted the exploration of alternative sites such as the proximal tibia,distal femur,and proximal humerus.This paper reviews the impact of different harvesting sites on mesenchymal stem cell(MSC)yield,viability,and regenerative potential,emphasizing their relevance in knee OA treatment.The iliac crest consistently offers the highest MSC yield,but alternative sites within the surgical field of knee procedures offer comparable MSC characteristics with reduced morbidity.The integration of harvesting techniques into existing knee surgeries,such as total knee arthroplasty,provides a less invasive approach while maintaining thera-peutic efficacy.However,variability in MSC yield from these alternative sites underscores the need for further research to standardize techniques and optimize clinical outcomes.Future directions include large-scale comparative studies,advanced characterization of MSCs,and the development of personalized harvesting strategies.Ultimately,the findings suggest that optimizing the site of BMH can significantly influence the quality of MSC-based therapies for knee OA,enhancing their clinical utility and patient outcomes.展开更多
BACKGROUND Osteoarthritis(OA)is a prevalent joint disorder requiring innovative treatment approaches.AIM To evaluate the use of nanofat,a specialized form of adipose tissue-derived cells,in the treatment of OA,by exam...BACKGROUND Osteoarthritis(OA)is a prevalent joint disorder requiring innovative treatment approaches.AIM To evaluate the use of nanofat,a specialized form of adipose tissue-derived cells,in the treatment of OA,by examining its efficacy,safety profile,mechanisms of action,comparative effectiveness,and long-term outcomes.METHODS A comprehensive review of preclinical studies,clinical trials,and in vitro investigations was conducted.The included studies provided insights into the potential role of nanofat in OA treatment,addressing its efficacy,safety profile,mechanisms of action,comparative effectiveness,and long-term outcomes.RESULTS Clinical studies consistently reported the efficacy of nanofat in providing pain relief and functional improvement in patients with OA.Local adverse events were limited to the injection site,such as localized pain and inflammation,and resolved within a few days to weeks.Systemic adverse events were rare,and no significant long-term complications were observed.Mechanistically,nanofat was found to enhance chondrocyte proliferation,reduce inflammation,and promote angiogenesis,thereby contributing to its therapeutic effects.CONCLUSION Nanofat therapy holds promise as a therapeutic option for managing OA,providing pain relief,functional improvement,and potential tissue regeneration.The safety profile of nanofat treatment appears favorable,but long-term data are still limited.Standardized protocols,larger randomized controlled trials,longer follow-up periods,and cost-effectiveness evaluations are warranted to establish optimal protocols,comparative effectiveness,and long-term outcomes.Despite current limitations,nanofat therapy demonstrates translational potential and should be considered in clinical practice for OA treatment,with careful patient selection and monitoring.展开更多
Objective:Varied acupoint selections represent a potential cause of the uncertainty surrounding the efficacy of acupuncture for knee osteoarthritis(OA).Skin temperature,a guiding factor for acupoint selection,may help...Objective:Varied acupoint selections represent a potential cause of the uncertainty surrounding the efficacy of acupuncture for knee osteoarthritis(OA).Skin temperature,a guiding factor for acupoint selection,may help to address this issue.This study explored thermal sensitization of acupoints used for the treatment of knee OA.Methods:This cross-sectional case-control study enrolled cases aged 45–75 years with symptomatic knee OA and age-and gender-matched non-knee OA controls in a 1:1 ratio.All participants underwent infrared thermographic imaging.The primary outcome was the relative skin temperature of acupoint(STA),and the secondary outcome was the absolute STA of 11 acupoints.The Z test was used to compare the relative and absolute STAs between the groups.Principal component analysis was used to extract the common factors(CFs,acupoint cluster)in the STAs.A general linear model was used to identify factors affecting the STA in the knee OA cases.For the group comparisons of relative STA,P<0.0045(adjusted for 11 acupoints through Bonferroni correction)was considered to indicate statistical significance.For other analyses,P<0.05 was used as the threshold for statistical significance.Results:The analysis included 308 participants,consisting of 151 cases(mean age:[64.58±6.67]years;male:25.83%;mean body mass index:[25.70±3.16]kg/m~2)and 157 controls(mean age:[63.37±5.96]years;male:26.11%;mean body mass index:[24.47±2.84]kg/m~2).The relative STAs of ST34(P=0.0001),EX-LE2(P<0.0001),EX-LE5(P=0.0006),SP10(P<0.0001),BL40(P=0.0012)and GB39(P=0.0037)were higher in the knee OA group.No difference was found in the STAs of ST35,ST36,SP9,GB33 and GB34.Four CFs were identified for relative STA in both groups.The acupoints within each CF were consistent between the groups.The mean values of the relative STAs across each CF were higher in the knee OA group.In the knee OA cases,no factors were observed to affect the relative STA,while age and gender were found to affect the absolute STA.Conclusion:Among patients with knee OA,thermal sensitization occurs in the acupoints of the lower extremity,exhibiting localized and regional thermal consistencies.The thermally sensitized acupoints that we identified in this study,ST34,SP10,EX-LE2,EX-LE5,GB39 and BL40,may be good choices for the acupuncture treatment of knee OA.展开更多
BACKGROUND Knee osteoarthritis(KOA)is a leading cause of arthritis-related morbidity.Mesenchymal stem cells(MSCs),as living biopharmaceuticals,have emerged as a potential treatment option due to their anti-inflammator...BACKGROUND Knee osteoarthritis(KOA)is a leading cause of arthritis-related morbidity.Mesenchymal stem cells(MSCs),as living biopharmaceuticals,have emerged as a potential treatment option due to their anti-inflammatory and immunomodulatory properties.AIM To compare the safety and efficacy of allogenic MSCs(^(Allo)MSCs)vs autologous MSCs(^(Auto)MSCs)in treating KOA in clinical settings.METHODS We conducted a systematic review and network meta-analysis to compare the safety and efficacy of^(Allo)MSCs vs^(Auto)MSCs in treating KOA.Our systematic search of four databases,including PubMed,Cochrane,Embase,and ClinicalTrials.gov,identified relevant randomized controlled trials(RCTs)reporting MSC-based treatment for KOA and reporting visual analog scale,Western Ontario and McMaster Universities Osteoarthritis scores,and adverse events.We assessed the methodological quality of the studies using the Cochrane Collaboration tool and calculated risk ratios(RRs)and weighted mean differences[with 95%confidence intervals(CIs)].Our statistical analyses used the R-Studio network meta-packages(version 2023.12.0).The study protocol was pre-registered on the International Prospective Register of Systematic Reviews(ID:CRD42024590866).RESULTS Nineteen RCTs involving 1216 patients with KOA met the inclusion criteria of the study.The network metaanalysis showed that^(Allo)MSCs gave a significant re-duction in visual analog scale scores by 14.91 points(95%CI:-24.52 to-5.30)vs 12.95 points with^(Auto)MSCs(95%CI:-24.42 to-1.48).For Western Ontario and McMaster Universities Osteoarthritis score,^(Allo)MSCs led to a significant reduction of 23.12 points(95%CI:-31.15 to-15.10)compared with 12.45 points using^(Auto)MSCs(95%CI:-19.31 to-5.59),thus revealing a significant improvement with^(Allo)MSCs(weighted mean difference:-10.62,95%CI:-21.23 to-0.11).Additionally,^(Auto)MSCs treatment showed a higher risk of joint-related adverse events(RR=1.39,95%CI:1.07-1.79)compared with^(Allo)MSCs(RR=1.13,95%CI:1.01-1.25).CONCLUSION^(Allo)MSCs may offer superior clinical outcomes with a lower risk of adverse events compared with^(Auto)MSCs in the treatment of KOA.However,the need for further RCTs directly comparing the two MSC types is crucial to validate this data,underscoring the importance of our findings in this field.展开更多
BACKGROUND Knee osteoarthritis(KOA)is a prevalent degenerative joint disorder characterized by complex neuroinflammatory mechanisms involving peripheral-central nervous system crosstalk.Current research gaps exist reg...BACKGROUND Knee osteoarthritis(KOA)is a prevalent degenerative joint disorder characterized by complex neuroinflammatory mechanisms involving peripheral-central nervous system crosstalk.Current research gaps exist regarding the modulatory effects of biomechanical interventions such as postural correction training(PCT)on these pathways,particularly its impact on neurogenic inflammation and associated nerve dysfunction.AIM To examine the effect of PCT on chronic pain related to KOA,nerve function,and inflammatory factors and further assess the influencing factors.METHODS This study included 100 patients with chronic pain related to KOA admitted to our hospital from March 2022 to March 2024 who were selected as research subjects,and divided into a control group(conventional treatment,n=50)and observation group(combined treatment with PCT,n=50).Efficacy,pain[visual analog scale(VAS)],nerve function[the National Institute of Health Stroke Scale(NIHSS)]and inflammatory factors[interleukin(IL)-1β,IL-6,tumor necrosis factor-alpha(TNF-α),C-reactive protein(CRP)]were assessed and compared.Moreover,the factors influencing efficacy were assessed according to clinical efficacy.RESULTS The clinical effectiveness rate of 90.00%in the observation group was higher than that of 72.00%in the control group(P<0.05).VAS scores at 14 and 30 days of the intervention were lower than those before the intervention(P<0.05).Moreover,VAS scores in the observation group at 14 and 30 days after the intervention were lower than those in the control group(P<0.05).The NIHSS scores were lower after the intervention than those before the intervention for both groups(P<0.05).The improvement in NIHSS score in the observation group was higher than that in the control group(P<0.05).Inflammatory factors such as IL-1β,IL-6,TNF-α,and CRP in both groups among patients with osteoarthritis-related chronic pain were lower after the intervention than before the intervention(P<0.05).After the intervention,all inflammatory factors in the observation group were lower than those in the control group(P<0.05).The proportion of ineffective treatment combined with joint effusion,Kellgren-Lawrence(K-L)staging grade III-IV,fixed flexion contracture with varus and valgus deformity>5°,was higher in the control group than in the observation group(P<0.05),while the joint compartment involvement in the observation group was higher than that in the control group(P<0.05).The logistic regression results demonstrated that relevant joint effusion,K-L staging grade III-IV,fixed flexion contracture with varus and valgus deformity>5°,and intervention mode of PCT were higher in the control group than in the observation group(P<0.05)and were influencing factors on clinically ineffective treatment(P<0.05).CONCLUSION PCT can improve the treatment effect on chronic pain related to KOA,nerve function and inflammatory response.Joint effusion,joint stiffness,and KOA are factors for y ineffective treatment.Joint effusion,higher K-L stage,and larger flexion contracture were risk factors,while PCT was a protective factor for ineffective treatment.展开更多
BACKGROUND Osteoarthritis(OA)is a common degenerative joint disease that considerably affects the quality of life(QoL)of individuals,especially the elderly.The Kellgren-Lawrence(KL)grading system assesses the severity...BACKGROUND Osteoarthritis(OA)is a common degenerative joint disease that considerably affects the quality of life(QoL)of individuals,especially the elderly.The Kellgren-Lawrence(KL)grading system assesses the severity of OA through radiographic evaluation,whereas the Knee Injury and Osteoarthritis Outcome Score(KOOS)measures clinical symptoms and functional status.AIM To analyze the relationship between KL grades and KOOS to elucidate the association between radiographic severity and clinical manifestations of knee OA.METHODS A cross-sectional study was performed at King Fahd Hospital of the University,involving 164 adult patients diagnosed with knee OA.Patients were evaluated using the KL system,based on standing knee X-rays performed within the last six months.The KOOS questionnaire was utilised for clinical assessment,evaluating five domains:(1)Pain;(2)Symptoms;(3)Activities of daily living;(4)Sport and recreation function;and(5)Knee-related QoL.Analysis of variance was utilised to examine variations in KOOS domain scores among different patient variables.The correlations between KOOS domains were determined using Pearson's correlation.RESULTS KOOS scores demonstrated a significant decline in patients with elevated KL grades,with Grade 4 exhibiting the lowest scores and grade 1 the highest(P<0.001).The correlation between pain and activities of daily living was strong(r=0.871,P<0.001),as was the correlation with knee-related QoL(r=0.754,P<0.001).Notable age-related disparities were observed,as older patients(≥60 years)indicated poorer pain and functional outcomes.Gender differences were noted exclusively in symptoms,with females exhibiting lower scores than males(P=0.022).CONCLUSION The association between radiographic severity and clinical impact is shown by the substantial correlation between KL grading and KOOS results,especially in later stages of OA.The results highlight the necessity for thorough assessments that integrate radiographic and clinical evaluations for individualized therapy choices for OA patients.展开更多
Background:This study evaluates the ability of mobile AI voice assistants(AI-VAs)to provide accurate medical advice for early knee osteoarthritis(KOA)and compares their performance with conventional web searches and h...Background:This study evaluates the ability of mobile AI voice assistants(AI-VAs)to provide accurate medical advice for early knee osteoarthritis(KOA)and compares their performance with conventional web searches and human clinicians.Methods:From September to October 2024,two AI-VAs(Apple’s Siri and Huawei’s Xiaoyi)were tested on 15 KOA-related questions in Chinese and English.The assessment focused on the accuracy of voice recognition,response capabilities,and medical advice.Siri was further tested in four international regions(USA,UK,Germany,Hong Kong)using localized languages.Results:In Chinese-language tests,Siri and Xiaoyi showed comparable voice recognition(recognition accuracy:95.6%vs.93.3%)and response ability(speech response:88.9%vs.85.7%).However,Siri provided significantly more accurate medical advice(medical advice:95.6%vs.53.3%;Z=2.762,P<0.001).External validation via Global Quality Score further confirmed Siri’s superiority(mean Global Quality Score=4.0 vs.Xiaoai=0.9).Siri outperformed Xiaoyi in English-language tests(53.3%vs.0%).While Siri’s medical advice accuracy(95.6%)surpassed non-specialist clinicians(Z=2.685,P=0.007),it primarily reflects filtered search results(Baidu/Google)rather than clinical synthesis.Claims of equivalence to junior surgeons(98.2%)must be interpreted cautiously,as AI-VAs lack diagnostic reasoning capabilities.This distinction is critical to avoid overstating their role in clinical decision-making.Conclusion:Current AI-VAs offer limited value in providing precise medical advice for KOA,primarily serving as intermediaries for web search results.Their performance varies across languages,regions,and search engines.展开更多
Objective:Knee osteoarthritis is one of the important causes of disability worldwide.This study aims to analyze the disease burden of knee osteoarthritis,attributable risk factors among Chinese residents from 1990 to ...Objective:Knee osteoarthritis is one of the important causes of disability worldwide.This study aims to analyze the disease burden of knee osteoarthritis,attributable risk factors among Chinese residents from 1990 to 2021,and predict the disease burden trend for 2035.Methods:Data related to knee osteoarthritis in China from 1990 to 2021,including the number of incident cases,incidence rate,number of prevalent cases,prevalence rate,and years lived with disability(YLDs),were collected from the Global Burden of Disease Study(GBD2021)database.Joinpoint regression analysis was used to assess time trends,and the Bayesian-Age-Period-Cohort(BAPC)regression model was employed for future predictions.Results:From 1990 to 2021,the number of incident cases of knee osteoarthritis among Chinese residents increased from 3.65 million to 8.51 million,a rise of 133.16%,with an average annual increase of 3.15%.The incidence rate increased from 310.33 per 100,000 to 598.31 per 100,000,a rise of 92.80%,with an average annual increase of 2.55%.The number of prevalent cases increased from 41.04 million to 110 million,a rise of 166.97%,with an average annual increase of 3.61%.The prevalence rate increased from 3488.78 per 100,000 to 7701.69 per 100,000,a rise of 120.76%,with an average annual increase of 3.00%.The number of YLDs increased from 1.34 million to 3.55 million,a rise of 165.32%,with an average annual increase of 3.59%.The YLD rate increased from 113.86 per 100,000 to 249.81 per 100,000,a rise of 119.39%,with an average annual increase of 2.99%.High BMI was the only significant attributable risk factor,with the proportion of YLDs it caused continuing to rise.Predictions for 2035:The number of incident cases is expected to decline slightly from 5.89 million in 2022 to 5.72 million in 2035.The number of prevalent cases is expected to peak at 72.42 million in 2029 and be around 72.69 million in 2035.The number of YLDs is expected to increase year by year,from 2.35 million in 2022 to 2.35 million in 2035.Conclusion:The study reveals the increasing prevalence and disease burden of knee osteoarthritis among Chinese residents,emphasizing the importance of interventions targeting controllable risk factors.Although the prediction shows a slight decline in the number of incident cases in 2035,the number of prevalent cases and years of disability are expected to remain high,indicating the need for continued monitoring and intervention.展开更多
In this editorial,we comment on the recent article by Xiao et al,focusing on their investigation into whether the therapeutic efficacy of serum-free human umbilical cord mesenchymal stem cells(MSCs)differs from that o...In this editorial,we comment on the recent article by Xiao et al,focusing on their investigation into whether the therapeutic efficacy of serum-free human umbilical cord mesenchymal stem cells(MSCs)differs from that of serum-containing human umbilical cord MSCs in a mouse model of knee osteoarthritis(OA).The incidence of OA has significantly increased in recent years,primarily owing to sports-related injuries or degenerative diseases.However,the regenerative capacity of articular cartilage remains limited,necessitating artificial joint replacement for patients with advanced OA to enhance the quality of life.MSCs have been widely used in the clinical treatment of OA owing to their multidirectional differentiation potential and immunomodulatory effects.The focus of this paper lies in elucidating the mechanism underlying MSC transplantation for the treatment of knee OA,while also addressing the challenges encountered in MSC therapy and outlining future directions.展开更多
BACKGROUND Knee osteoarthritis(KOA)is a chronic condition characterized by joint pain and dysfunction,driven by aging and obesity.Research indicates that the gut microbiota significantly influences KOA,potentially aff...BACKGROUND Knee osteoarthritis(KOA)is a chronic condition characterized by joint pain and dysfunction,driven by aging and obesity.Research indicates that the gut microbiota significantly influences KOA,potentially affecting inflammation and disease progression through the gut-joint axis.Traditional treatments like nonsteroidal anti-inflammatory drugs offer symptom relief but have adverse effects.Emerging therapies like electroacupuncture(EA)and Tuina(TN)have shown promise in alleviating pain and improving joint function by targeting the gut microbiota.AIM To clarify the efficacy of EA with TN in treating KOA and its effect on gut microbiota regulation.METHODS Sixty patients with KOA were allocated to EA or EA+TN(ET)group(n=30 each).Seven acupoints were punctured.The ET group received TN after each EA session.Both groups completed 12 sessions.The visual analog scale(VAS)for assessing pain and the Western Ontario and McMaster Universities osteoarthritis index(WOMAC)for measuring pain intensity,joint stiffness,and functional capacity were employed to assess clinical outcomes.Pre-and post-treatment fecal specimens underwent 16S ribosomal RNA sequencing to analyze the gut microbiota.RESULTS The ET group showed higher rates of“effective”and“markedly effective”outcomes.The VAS score of the ET group remained significantly lower than that of the EA group(P<0.001)immediately after treatment and 1 week post-treatment.The total WOMAC score(P<0.001),pain(P=0.191),stiffness(P=0.015),and function scores(P<0.001)decreased significantly in the ET group post-treatment.The gut microbiota analysis revealed no significant changes in alpha diversity in either group.Beta-diversity analysis indicated distinct patterns in the ET group before and after treatment.Significant changes in microbial abundance were detected in both groups,highlighting variations in Firmicutes,Actinobacteria,Proteobacteria,and Bacteroidetes.CONCLUSION ET outperforms EA alone in improving KOA pain,stiffness,and function,potentially via gut microbiota modulation,intestinal barrier protection,and inflammation reduction.展开更多
Augmented reality(AR)is a technology that superimposes digital information onto real-world objects via head-mounted display devices to improve surgical finesse through visually enhanced medical information.With the ra...Augmented reality(AR)is a technology that superimposes digital information onto real-world objects via head-mounted display devices to improve surgical finesse through visually enhanced medical information.With the rapid development of digital technology,AR has been increasingly adopted in orthopedic surgeries across the globe,especially in total knee arthroplasty procedures which demand high precision.By overlaying digital information onto the surgeon's field of view,AR systems enhance precision,improve alignment accuracy,and reduce the risk of complications associated with malalignment.Some concerns have been raised despite accuracy,including the learning curve,long-term outcomes,and technical limitations.Furthermore,it is essential for health practitioners to gain trust in the utilisation of AR.展开更多
BACKGROUND Relieving pain is central to the early management of knee osteoarthritis,with a plethora of pharmacological agents licensed for this purpose.Intra-articular corticosteroid injections are a widely used optio...BACKGROUND Relieving pain is central to the early management of knee osteoarthritis,with a plethora of pharmacological agents licensed for this purpose.Intra-articular corticosteroid injections are a widely used option,albeit with variable efficacy.AIM To develop a machine learning(ML)model that predicts which patients will benefit from corticosteroid injections.METHODS Data from two prospective cohort studies[Osteoarthritis(OA)Initiative and Multicentre OA Study]was combined.The primary outcome was patientreported pain score following corticosteroid injection,assessed using the Western Ontario and McMaster Universities OA pain scale,with significant change defined using minimally clinically important difference and meaningful within person change.A ML algorithm was developed,utilizing linear discriminant analysis,to predict symptomatic improvement,and examine the association between pain scores and patient factors by calculating the sensitivity,specificity,positive predictive value,negative predictive value,accuracy,and F2 score.RESULTS A total of 330 patients were included,with a mean age of 63.4(SD:8.3).The mean Western Ontario and McMaster Universities OA pain score was 5.2(SD:4.1),with only 25.5%of patients achieving significant improvement in pain following corticosteroid injection.The ML model generated an accuracy of 67.8%(95%confidence interval:64.6%-70.9%),F1 score of 30.8%,and an area under the curve score of 0.60.CONCLUSION The model demonstrated feasibility to assist clinicians with decision-making in patient selection for corticosteroid injections.Further studies are required to improve the model prior to testing in clinical settings.展开更多
文摘BACKGROUND Total knee arthroplasty(TKA)aims to restore motion and alleviate pain,enabling patients to return to daily activities.Despite advances in implants,surgery,and perioperative care,patient dissatisfaction rates remain significant.AIM To determine whether ankle symptoms are associated with inferior results of functional recovery of the knee following TKA.METHODS This prospective study included all patients with advanced knee osteoarthritis who underwent a primary unilateral TKA between August 2019 and December 2019 with data documented by the treating surgeon and outpatient physical therapists.Patients were categorized based on ankle symptoms using the Ame-rican Orthopaedic Foot and Ankle Society(AOFAS)score:(1)Group 1(AOFAS≤85,n=30);and(2)Group 2(AOFAS>85,n=49).Active range of motion(ROM),the Knee Injury and Osteoarthritis Outcome Score(KOOS),and the visual ana-logue scale(VAS)were compared between two groups.RESULTS Postoperative KOOS,ROM,and VAS significantly improved in both groups(P<0.001).However,at three months,KOOS(P=0.02)and extension motion(P=0.01)improvements were significantly greater in group 2.CONCLUSION These findings suggest that preoperative ankle symptoms may negatively impact early knee functional recovery,particularly in KOOS scores and extension motion.
文摘BACKGROUND The prevalence of depressive symptoms in patients undergoing total knee arthroplasty(TKA)ranges from 22%to 26%.The impact of depression on functional status post-TKA remains controversial.AIM To be the first study in Latin American population to evaluate the association between depression and functional status one year after TKA,hypothesizing that elderly patients with depression will demonstrate lower rates of functional improvement.METHODS We conducted an observational,descriptive and analytic,retrospective cohort study involving patients over 65 years old who were indicated for TKA.Assessments were made via the Program for Determination and Management of Risks for Practices and Procedures of the Division of Geriatric Medicine at the Italian Hospital of Buenos Aires,between June 2015 and July 2019.Depression screening was conducted using Yesavage’s abbreviated score and Patient Health Questionnaire-9,while functional ability was evaluated using the Knee Society Score(KSS).RESULTS Of the 100 patients analyzed,22(22%)screened positive for depression.The mean age was 80 years±6.3 years,with an average of 77.6 years±6 years in the depressed group and 80.6 years±6.3 years in the non-depressed group(P=0.05).Depressed patients showed significantly greater cognitive impairment[clock-face drawing test median:5(3-6)vs 6(5-7),P=0.06]and more risk factors for confusional syndrome(mean:8±2 vs 6.5±2.2,P=0.006).Frailty was also more prevalent in depressed patients[Edmonton:15(68%)vs 33(42%),P=0.05;Fried:17(77%)vs 42(54%),P=0.05].Postoperative Functional KSS were similar between groups(depressed:65±22.1 vs non-depressed:66.3±20.3,P=0.8).Linear regression analysis revealed no association between depression and changes in KSS.Spearman’s rank correlation coefficients were-0.0304(P=0.8)for Functional KSS variation and-0.1(P=0.3)for KSS variation.CONCLUSION Depression in patients with osteoarthritis should not hinder surgical planning.Identifying and treating depression preoperatively may enhance outcomes such as pain relief and reduce risks of acute confusional syndrome,cognitive impairment,and frailty.
文摘Retrieval analysis in total knee arthroplasty(TKA)has been little studied in the literature.A narrative review of the literature to understand the current importance of retrieval analysis in TKA has been conducted.On August 27,2024,a literature search was performed in PubMed using“TKA retrieval analysis”as keywords.A total of 160 articles were found,of which only 19 were analyzed because they were directly related to the subject of this article.Rotating-platform(mobile-bearing)TKA has no surface damage advantage over fixed-bearing TKA.TKAs with central locking mechanisms are more prone to debond from the cement mantle.No major wear of the polyethylene(PE)component in TKA using oxidized zirconium components occurs.Femoral components of cobalt-chromium roughen more than oxidized zirconium femoral components.The use of a polished tibial tray over an unpolished design is advised.At short-run assessment(15 months on average),antioxidant-stabilized highly crosslinked PE components are not clinically different in surface damage,density of crosslinking,or oxidation compared to standard remelted highly crosslinked PE components.A correlation between implant position and PE component surface damage has been reported.It shows the importance of optimizing component position to reduce PE component damage.Contemporary knee tumor megaendoprostheses show notable volumetric metal wear originated at the rotating hinge.Retrieval analysis in TKA renders relevant data on how different prosthetic designs described in the literature perform.Such information can help to improve future prosthetic designs to increase prosthetic survival.
基金Supported by General Program of the National Natural Science Foundation of China(81973883)Three-Year Action Plan Project for Enhancing Clinical Skills and Clinical Innovation Capabilities of Municipal Hospitals(SHDC2020CR1010A).
文摘[Objectives]To explore the effects of electroacupuncture combined with rehabilitation training on knee joint function,three-dimensional(3D)gait,and inflammatory markers in patients with knee osteoarthritis(KOA)of cold-dampness obstruction syndrome.[Methods]A total of 162 KOA patients admitted to Huadong Hospital Affiliated to Fudan University from January 2021 to May 2023 were enrolled and randomly divided into an electroacupuncture group and a control group,with 81 patients in each group.The control group received routine rehabilitation training,while the electroacupuncture group received electroacupuncture treatment in addition to the same rehabilitation training,both for 4 weeks.The efficacy,syndrome scores,Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC),Lysholm Knee Score(LKS),3D gait parameters,and levels of inflammatory markers were compared between the two groups.[Results]Following treatment,the total effective rate in the electroacupuncture group was 92.59%,which was significantly higher than 77.78%observed in the control group(P<0.05).Additionally,the electroacupuncture group exhibited lower TCM syndrome scores(P<0.05),reduced WOMAC scores,and elevated LKS scores compared to the control group(P<0.05).Gait parameters,including step frequency,step speed,stride length,initial ground contact flexion angle,maximum swing phase extension angle,and support phase extension angle,were all higher in the electroacupuncture group.Additionally,the sagittal plane maximum abduction moment was lower in the electroacupuncture group.Inflammatory markers showed that interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)were lower in the electroacupuncture group,while transforming growth factor-β1(TGF-β1)was higher(P<0.05).[Conclusions]Electroacupuncture combined with rehabilitation training effectively enhances clinical efficacy,alleviates symptoms,improves knee joint mobility and walking ability,enhances knee function scores,and reduces inflammatory levels,contributing to the rapid recovery of knee joints in KOA patients.
文摘BACKGROUND Total knee arthroplasty(TKA)is a widely used treatment for advanced knee osteoarthritis;however,the incidence of failures requiring revision surgery is increasing.Identifying the causes of TKA failure and assessing the outcomes of revision procedures are essential for improving patient care.We hypothesized that infection and aseptic loosening are the primary causes of TKA failure and that revision TKA(rTKA)significantly enhances functional outcomes.AIM To examine the primary causes of TKA failure and evaluate the functional outcomes following rTKA.METHODS This descriptive study was conducted at the Department of Orthopedic Surgery,Civil Hospital,Bahawalpur,from April to September 2024.A total of 118 patients undergoing rTKA for failed primary TKA were included.Data on demographics,causes of failure,and surgical details were collected.Functional outcomes were evaluated using the Knee Society Score and Visual Analog Scale before and six months after surgery.Statistical analysis was performed using SPSS version 25.0,with statistical significance set at P<0.05.RESULTS The leading causes of TKA failure were infection(45.8%),aseptic loosening(44.1%),and periprosthetic fractures(10.2%).The rTKA significantly improved knee function,with the mean Knee Society Score increasing from 39.43±6.18 to 78.91±6.17(P<0.001).Pain levels decreased substantially,with the mean Visual Analog Scale scores reducing from 7.99±1.37 to 1.42±1.17(P<0.001).No significant differences in outcomes were observed between single-stage and two-stage revision procedures.CONCLUSION Infection and aseptic loosening are the predominant causes of TKA failure.The rTKA effectively enhances knee function and alleviates pain,offering significant benefits to patients.
文摘BACKGROUND Patellar resurfacing in knee arthroplasty remains a contentious issue,with various strategies including routine,selective,and non-resurfacing approaches.This review and meta-analysis aim to assess the incidence of patellar resurfacing,revision rates,patient satisfaction,and relevant knee scores associated with each method.AIM To determine the comparative effectiveness of routine,selective,and nonresurfacing strategies in patellar resurfacing within knee arthroplasty by evaluating incidence rates,revision rates,patient satisfaction,and knee function scores.METHODS A systematic review spanning from 1990 to 2024 was conducted using PubMed,Embase,and Cochrane Library databases.Studies reporting on the incidence of patellar resurfacing,revision rates,patient satisfaction,and relevant knee scores were included.Data from esteemed world registries such as the Australian Orthopaedic Association National Joint Replacement Registry,the National Joint Registry for England,Wales,Northern Ireland,and the Isle of Man and Danish Knee Arthroplasty Registry among others,were meticulously examined.Metaanalysis was employed to derive pooled estimates and 95%confidence intervals.RESULTS Analysis of data sourced from diverse world registries and literature sources unveiled significant disparities in the incidence of patellar resurfacing across different geographic regions and healthcare institutions.For instance,the incidence of routine patellar resurfacing ranged from 60%to 90%in some regions,while in others,it was as low as 30%to 50%.The meta-analysis indicated that routine resurfacing was associated with a lower revision rate of 3.5%(95%CI:2.8%-4.2%)compared to non-resurfacing approaches,which exhibited a higher revision rate of 6.8%(95%CI:5.5%-8.1%).Patient satisfaction outcomes showed variability,with routine resurfacing demonstrating higher mean satisfaction scores in functionality,pain relief,and stability categories.CONCLUSION The findings underscore the complexity of patellar resurfacing in knee arthroplasty and highlight the need for continued research to refine clinical practice.Future studies should prioritize prospective randomized controlled trials comparing different patellar resurfacing techniques using standardized outcome measures.Longitudinal studies with extended follow-up periods are necessary to evaluate the long-term outcomes and durability of various patellar resurfacing strategies.Collaborative efforts among multidisciplinary teams will be essential to conduct high-quality research that can provide actionable insights and improve patient outcomes.
基金The Shanghai Science and Technology Committee(22dz1204700)the MOST Key R&D Program of China(2022YFC2304703,2020YFA0907200)+2 种基金Innovative research team of high-level local universities in Shanghai,the National Natural Science Foundation of China(32270202,82272579,82272570,62372286)the Shanghai Talent Development Fund(No.2021057)the Shanghai Jiao Tong University Science and Technology Innovation Special Fund(No.2021JCPT02).
文摘Knee arthrofibrosis,characterized by excessive matrix protein production and deposition,substantially impairs basic daily functions,causing considerable distress and financial burden.However,the underlying pathomechanisms remain unclear.Here,we characterized the heterogeneous cell populations and cellular pathways by combination of flow cytometry and single-cell RNA-seq analysis of synovial tissues from six patients with or without knee arthrofibrosis.Increased macrophages and fibroblasts were observed with decreased numbers of fibroblast-like synoviocytes,endothelial cells,vascular smooth muscle cells,and T cells in the arthrofibrosis group compared with negative controls.
文摘Osteoarthritis(OA)is an extremely prevalent degenerative joint disease which commonly occurs in the knee.In severe cases of knee OA,total knee arthroplasty(TKA)is often indicated to relieve pain and restore limb alignment.While studies have shown how TKA improves knee symptoms,the relationship between the operated knee with the hip and ankle remains understudied.A prospective study by Buterin et al showed a significant relationship between reduced ankle symptoms and better TKA recovery.The objective of this paper is to explore ways to expand the completed study to make it more widely applicable.These include sampling patients from multiple surgical centers in different cultural backgrounds,including different etiologies of OA,extending the study time points,and evaluating the contralateral limb.Together,the study by Buterin et al combined with future work can elucidate new TKA rehabilitation techniques which focus on the entire lower extremity.
文摘Knee osteoarthritis(OA)is a debilitating condition with limited long-term treatment options.The therapeutic potential of mesenchymal stem cells(MSCs),particularly those derived from bone marrow aspirate concentrate,has garnered attention for cartilage repair in OA.While the iliac crest is the traditional site for bone marrow harvesting(BMH),associated morbidity has prompted the exploration of alternative sites such as the proximal tibia,distal femur,and proximal humerus.This paper reviews the impact of different harvesting sites on mesenchymal stem cell(MSC)yield,viability,and regenerative potential,emphasizing their relevance in knee OA treatment.The iliac crest consistently offers the highest MSC yield,but alternative sites within the surgical field of knee procedures offer comparable MSC characteristics with reduced morbidity.The integration of harvesting techniques into existing knee surgeries,such as total knee arthroplasty,provides a less invasive approach while maintaining thera-peutic efficacy.However,variability in MSC yield from these alternative sites underscores the need for further research to standardize techniques and optimize clinical outcomes.Future directions include large-scale comparative studies,advanced characterization of MSCs,and the development of personalized harvesting strategies.Ultimately,the findings suggest that optimizing the site of BMH can significantly influence the quality of MSC-based therapies for knee OA,enhancing their clinical utility and patient outcomes.
文摘BACKGROUND Osteoarthritis(OA)is a prevalent joint disorder requiring innovative treatment approaches.AIM To evaluate the use of nanofat,a specialized form of adipose tissue-derived cells,in the treatment of OA,by examining its efficacy,safety profile,mechanisms of action,comparative effectiveness,and long-term outcomes.METHODS A comprehensive review of preclinical studies,clinical trials,and in vitro investigations was conducted.The included studies provided insights into the potential role of nanofat in OA treatment,addressing its efficacy,safety profile,mechanisms of action,comparative effectiveness,and long-term outcomes.RESULTS Clinical studies consistently reported the efficacy of nanofat in providing pain relief and functional improvement in patients with OA.Local adverse events were limited to the injection site,such as localized pain and inflammation,and resolved within a few days to weeks.Systemic adverse events were rare,and no significant long-term complications were observed.Mechanistically,nanofat was found to enhance chondrocyte proliferation,reduce inflammation,and promote angiogenesis,thereby contributing to its therapeutic effects.CONCLUSION Nanofat therapy holds promise as a therapeutic option for managing OA,providing pain relief,functional improvement,and potential tissue regeneration.The safety profile of nanofat treatment appears favorable,but long-term data are still limited.Standardized protocols,larger randomized controlled trials,longer follow-up periods,and cost-effectiveness evaluations are warranted to establish optimal protocols,comparative effectiveness,and long-term outcomes.Despite current limitations,nanofat therapy demonstrates translational potential and should be considered in clinical practice for OA treatment,with careful patient selection and monitoring.
基金funded by the National Natural Science Foundation of China(No.82104693 and 81825024)。
文摘Objective:Varied acupoint selections represent a potential cause of the uncertainty surrounding the efficacy of acupuncture for knee osteoarthritis(OA).Skin temperature,a guiding factor for acupoint selection,may help to address this issue.This study explored thermal sensitization of acupoints used for the treatment of knee OA.Methods:This cross-sectional case-control study enrolled cases aged 45–75 years with symptomatic knee OA and age-and gender-matched non-knee OA controls in a 1:1 ratio.All participants underwent infrared thermographic imaging.The primary outcome was the relative skin temperature of acupoint(STA),and the secondary outcome was the absolute STA of 11 acupoints.The Z test was used to compare the relative and absolute STAs between the groups.Principal component analysis was used to extract the common factors(CFs,acupoint cluster)in the STAs.A general linear model was used to identify factors affecting the STA in the knee OA cases.For the group comparisons of relative STA,P<0.0045(adjusted for 11 acupoints through Bonferroni correction)was considered to indicate statistical significance.For other analyses,P<0.05 was used as the threshold for statistical significance.Results:The analysis included 308 participants,consisting of 151 cases(mean age:[64.58±6.67]years;male:25.83%;mean body mass index:[25.70±3.16]kg/m~2)and 157 controls(mean age:[63.37±5.96]years;male:26.11%;mean body mass index:[24.47±2.84]kg/m~2).The relative STAs of ST34(P=0.0001),EX-LE2(P<0.0001),EX-LE5(P=0.0006),SP10(P<0.0001),BL40(P=0.0012)and GB39(P=0.0037)were higher in the knee OA group.No difference was found in the STAs of ST35,ST36,SP9,GB33 and GB34.Four CFs were identified for relative STA in both groups.The acupoints within each CF were consistent between the groups.The mean values of the relative STAs across each CF were higher in the knee OA group.In the knee OA cases,no factors were observed to affect the relative STA,while age and gender were found to affect the absolute STA.Conclusion:Among patients with knee OA,thermal sensitization occurs in the acupoints of the lower extremity,exhibiting localized and regional thermal consistencies.The thermally sensitized acupoints that we identified in this study,ST34,SP10,EX-LE2,EX-LE5,GB39 and BL40,may be good choices for the acupuncture treatment of knee OA.
文摘BACKGROUND Knee osteoarthritis(KOA)is a leading cause of arthritis-related morbidity.Mesenchymal stem cells(MSCs),as living biopharmaceuticals,have emerged as a potential treatment option due to their anti-inflammatory and immunomodulatory properties.AIM To compare the safety and efficacy of allogenic MSCs(^(Allo)MSCs)vs autologous MSCs(^(Auto)MSCs)in treating KOA in clinical settings.METHODS We conducted a systematic review and network meta-analysis to compare the safety and efficacy of^(Allo)MSCs vs^(Auto)MSCs in treating KOA.Our systematic search of four databases,including PubMed,Cochrane,Embase,and ClinicalTrials.gov,identified relevant randomized controlled trials(RCTs)reporting MSC-based treatment for KOA and reporting visual analog scale,Western Ontario and McMaster Universities Osteoarthritis scores,and adverse events.We assessed the methodological quality of the studies using the Cochrane Collaboration tool and calculated risk ratios(RRs)and weighted mean differences[with 95%confidence intervals(CIs)].Our statistical analyses used the R-Studio network meta-packages(version 2023.12.0).The study protocol was pre-registered on the International Prospective Register of Systematic Reviews(ID:CRD42024590866).RESULTS Nineteen RCTs involving 1216 patients with KOA met the inclusion criteria of the study.The network metaanalysis showed that^(Allo)MSCs gave a significant re-duction in visual analog scale scores by 14.91 points(95%CI:-24.52 to-5.30)vs 12.95 points with^(Auto)MSCs(95%CI:-24.42 to-1.48).For Western Ontario and McMaster Universities Osteoarthritis score,^(Allo)MSCs led to a significant reduction of 23.12 points(95%CI:-31.15 to-15.10)compared with 12.45 points using^(Auto)MSCs(95%CI:-19.31 to-5.59),thus revealing a significant improvement with^(Allo)MSCs(weighted mean difference:-10.62,95%CI:-21.23 to-0.11).Additionally,^(Auto)MSCs treatment showed a higher risk of joint-related adverse events(RR=1.39,95%CI:1.07-1.79)compared with^(Allo)MSCs(RR=1.13,95%CI:1.01-1.25).CONCLUSION^(Allo)MSCs may offer superior clinical outcomes with a lower risk of adverse events compared with^(Auto)MSCs in the treatment of KOA.However,the need for further RCTs directly comparing the two MSC types is crucial to validate this data,underscoring the importance of our findings in this field.
文摘BACKGROUND Knee osteoarthritis(KOA)is a prevalent degenerative joint disorder characterized by complex neuroinflammatory mechanisms involving peripheral-central nervous system crosstalk.Current research gaps exist regarding the modulatory effects of biomechanical interventions such as postural correction training(PCT)on these pathways,particularly its impact on neurogenic inflammation and associated nerve dysfunction.AIM To examine the effect of PCT on chronic pain related to KOA,nerve function,and inflammatory factors and further assess the influencing factors.METHODS This study included 100 patients with chronic pain related to KOA admitted to our hospital from March 2022 to March 2024 who were selected as research subjects,and divided into a control group(conventional treatment,n=50)and observation group(combined treatment with PCT,n=50).Efficacy,pain[visual analog scale(VAS)],nerve function[the National Institute of Health Stroke Scale(NIHSS)]and inflammatory factors[interleukin(IL)-1β,IL-6,tumor necrosis factor-alpha(TNF-α),C-reactive protein(CRP)]were assessed and compared.Moreover,the factors influencing efficacy were assessed according to clinical efficacy.RESULTS The clinical effectiveness rate of 90.00%in the observation group was higher than that of 72.00%in the control group(P<0.05).VAS scores at 14 and 30 days of the intervention were lower than those before the intervention(P<0.05).Moreover,VAS scores in the observation group at 14 and 30 days after the intervention were lower than those in the control group(P<0.05).The NIHSS scores were lower after the intervention than those before the intervention for both groups(P<0.05).The improvement in NIHSS score in the observation group was higher than that in the control group(P<0.05).Inflammatory factors such as IL-1β,IL-6,TNF-α,and CRP in both groups among patients with osteoarthritis-related chronic pain were lower after the intervention than before the intervention(P<0.05).After the intervention,all inflammatory factors in the observation group were lower than those in the control group(P<0.05).The proportion of ineffective treatment combined with joint effusion,Kellgren-Lawrence(K-L)staging grade III-IV,fixed flexion contracture with varus and valgus deformity>5°,was higher in the control group than in the observation group(P<0.05),while the joint compartment involvement in the observation group was higher than that in the control group(P<0.05).The logistic regression results demonstrated that relevant joint effusion,K-L staging grade III-IV,fixed flexion contracture with varus and valgus deformity>5°,and intervention mode of PCT were higher in the control group than in the observation group(P<0.05)and were influencing factors on clinically ineffective treatment(P<0.05).CONCLUSION PCT can improve the treatment effect on chronic pain related to KOA,nerve function and inflammatory response.Joint effusion,joint stiffness,and KOA are factors for y ineffective treatment.Joint effusion,higher K-L stage,and larger flexion contracture were risk factors,while PCT was a protective factor for ineffective treatment.
文摘BACKGROUND Osteoarthritis(OA)is a common degenerative joint disease that considerably affects the quality of life(QoL)of individuals,especially the elderly.The Kellgren-Lawrence(KL)grading system assesses the severity of OA through radiographic evaluation,whereas the Knee Injury and Osteoarthritis Outcome Score(KOOS)measures clinical symptoms and functional status.AIM To analyze the relationship between KL grades and KOOS to elucidate the association between radiographic severity and clinical manifestations of knee OA.METHODS A cross-sectional study was performed at King Fahd Hospital of the University,involving 164 adult patients diagnosed with knee OA.Patients were evaluated using the KL system,based on standing knee X-rays performed within the last six months.The KOOS questionnaire was utilised for clinical assessment,evaluating five domains:(1)Pain;(2)Symptoms;(3)Activities of daily living;(4)Sport and recreation function;and(5)Knee-related QoL.Analysis of variance was utilised to examine variations in KOOS domain scores among different patient variables.The correlations between KOOS domains were determined using Pearson's correlation.RESULTS KOOS scores demonstrated a significant decline in patients with elevated KL grades,with Grade 4 exhibiting the lowest scores and grade 1 the highest(P<0.001).The correlation between pain and activities of daily living was strong(r=0.871,P<0.001),as was the correlation with knee-related QoL(r=0.754,P<0.001).Notable age-related disparities were observed,as older patients(≥60 years)indicated poorer pain and functional outcomes.Gender differences were noted exclusively in symptoms,with females exhibiting lower scores than males(P=0.022).CONCLUSION The association between radiographic severity and clinical impact is shown by the substantial correlation between KL grading and KOOS results,especially in later stages of OA.The results highlight the necessity for thorough assessments that integrate radiographic and clinical evaluations for individualized therapy choices for OA patients.
文摘Background:This study evaluates the ability of mobile AI voice assistants(AI-VAs)to provide accurate medical advice for early knee osteoarthritis(KOA)and compares their performance with conventional web searches and human clinicians.Methods:From September to October 2024,two AI-VAs(Apple’s Siri and Huawei’s Xiaoyi)were tested on 15 KOA-related questions in Chinese and English.The assessment focused on the accuracy of voice recognition,response capabilities,and medical advice.Siri was further tested in four international regions(USA,UK,Germany,Hong Kong)using localized languages.Results:In Chinese-language tests,Siri and Xiaoyi showed comparable voice recognition(recognition accuracy:95.6%vs.93.3%)and response ability(speech response:88.9%vs.85.7%).However,Siri provided significantly more accurate medical advice(medical advice:95.6%vs.53.3%;Z=2.762,P<0.001).External validation via Global Quality Score further confirmed Siri’s superiority(mean Global Quality Score=4.0 vs.Xiaoai=0.9).Siri outperformed Xiaoyi in English-language tests(53.3%vs.0%).While Siri’s medical advice accuracy(95.6%)surpassed non-specialist clinicians(Z=2.685,P=0.007),it primarily reflects filtered search results(Baidu/Google)rather than clinical synthesis.Claims of equivalence to junior surgeons(98.2%)must be interpreted cautiously,as AI-VAs lack diagnostic reasoning capabilities.This distinction is critical to avoid overstating their role in clinical decision-making.Conclusion:Current AI-VAs offer limited value in providing precise medical advice for KOA,primarily serving as intermediaries for web search results.Their performance varies across languages,regions,and search engines.
文摘Objective:Knee osteoarthritis is one of the important causes of disability worldwide.This study aims to analyze the disease burden of knee osteoarthritis,attributable risk factors among Chinese residents from 1990 to 2021,and predict the disease burden trend for 2035.Methods:Data related to knee osteoarthritis in China from 1990 to 2021,including the number of incident cases,incidence rate,number of prevalent cases,prevalence rate,and years lived with disability(YLDs),were collected from the Global Burden of Disease Study(GBD2021)database.Joinpoint regression analysis was used to assess time trends,and the Bayesian-Age-Period-Cohort(BAPC)regression model was employed for future predictions.Results:From 1990 to 2021,the number of incident cases of knee osteoarthritis among Chinese residents increased from 3.65 million to 8.51 million,a rise of 133.16%,with an average annual increase of 3.15%.The incidence rate increased from 310.33 per 100,000 to 598.31 per 100,000,a rise of 92.80%,with an average annual increase of 2.55%.The number of prevalent cases increased from 41.04 million to 110 million,a rise of 166.97%,with an average annual increase of 3.61%.The prevalence rate increased from 3488.78 per 100,000 to 7701.69 per 100,000,a rise of 120.76%,with an average annual increase of 3.00%.The number of YLDs increased from 1.34 million to 3.55 million,a rise of 165.32%,with an average annual increase of 3.59%.The YLD rate increased from 113.86 per 100,000 to 249.81 per 100,000,a rise of 119.39%,with an average annual increase of 2.99%.High BMI was the only significant attributable risk factor,with the proportion of YLDs it caused continuing to rise.Predictions for 2035:The number of incident cases is expected to decline slightly from 5.89 million in 2022 to 5.72 million in 2035.The number of prevalent cases is expected to peak at 72.42 million in 2029 and be around 72.69 million in 2035.The number of YLDs is expected to increase year by year,from 2.35 million in 2022 to 2.35 million in 2035.Conclusion:The study reveals the increasing prevalence and disease burden of knee osteoarthritis among Chinese residents,emphasizing the importance of interventions targeting controllable risk factors.Although the prediction shows a slight decline in the number of incident cases in 2035,the number of prevalent cases and years of disability are expected to remain high,indicating the need for continued monitoring and intervention.
文摘In this editorial,we comment on the recent article by Xiao et al,focusing on their investigation into whether the therapeutic efficacy of serum-free human umbilical cord mesenchymal stem cells(MSCs)differs from that of serum-containing human umbilical cord MSCs in a mouse model of knee osteoarthritis(OA).The incidence of OA has significantly increased in recent years,primarily owing to sports-related injuries or degenerative diseases.However,the regenerative capacity of articular cartilage remains limited,necessitating artificial joint replacement for patients with advanced OA to enhance the quality of life.MSCs have been widely used in the clinical treatment of OA owing to their multidirectional differentiation potential and immunomodulatory effects.The focus of this paper lies in elucidating the mechanism underlying MSC transplantation for the treatment of knee OA,while also addressing the challenges encountered in MSC therapy and outlining future directions.
基金Supported by Chongqing Municipal Health and Family Planning Commission and Chongqing Municipal Science and Technology Commission Jointly Funded Key Research Projects in Traditional Chinese Medicine,No.ZY201801007。
文摘BACKGROUND Knee osteoarthritis(KOA)is a chronic condition characterized by joint pain and dysfunction,driven by aging and obesity.Research indicates that the gut microbiota significantly influences KOA,potentially affecting inflammation and disease progression through the gut-joint axis.Traditional treatments like nonsteroidal anti-inflammatory drugs offer symptom relief but have adverse effects.Emerging therapies like electroacupuncture(EA)and Tuina(TN)have shown promise in alleviating pain and improving joint function by targeting the gut microbiota.AIM To clarify the efficacy of EA with TN in treating KOA and its effect on gut microbiota regulation.METHODS Sixty patients with KOA were allocated to EA or EA+TN(ET)group(n=30 each).Seven acupoints were punctured.The ET group received TN after each EA session.Both groups completed 12 sessions.The visual analog scale(VAS)for assessing pain and the Western Ontario and McMaster Universities osteoarthritis index(WOMAC)for measuring pain intensity,joint stiffness,and functional capacity were employed to assess clinical outcomes.Pre-and post-treatment fecal specimens underwent 16S ribosomal RNA sequencing to analyze the gut microbiota.RESULTS The ET group showed higher rates of“effective”and“markedly effective”outcomes.The VAS score of the ET group remained significantly lower than that of the EA group(P<0.001)immediately after treatment and 1 week post-treatment.The total WOMAC score(P<0.001),pain(P=0.191),stiffness(P=0.015),and function scores(P<0.001)decreased significantly in the ET group post-treatment.The gut microbiota analysis revealed no significant changes in alpha diversity in either group.Beta-diversity analysis indicated distinct patterns in the ET group before and after treatment.Significant changes in microbial abundance were detected in both groups,highlighting variations in Firmicutes,Actinobacteria,Proteobacteria,and Bacteroidetes.CONCLUSION ET outperforms EA alone in improving KOA pain,stiffness,and function,potentially via gut microbiota modulation,intestinal barrier protection,and inflammation reduction.
基金Supported by The Hunan Provincial Natural Science Foundation of China,No.2023JJ30773,No.2025JJ60480,and No.2025JJ60552The Scientific Research Program of The Hunan Provincial Health Commission,No.202204072544+4 种基金The Science and Technology Innovation Program of Hunan Province,No.2024RC3053The CBT ECR/MCR Scheme,No.324910-0028/07National Natural Science Foundation of China,No.32300652The Scientific Research Program of Hunan Provincial Health Commission,No.W20243023The Scientific Research Launch Project for New Employees of The Second Xiangya Hospital of Central South University.
文摘Augmented reality(AR)is a technology that superimposes digital information onto real-world objects via head-mounted display devices to improve surgical finesse through visually enhanced medical information.With the rapid development of digital technology,AR has been increasingly adopted in orthopedic surgeries across the globe,especially in total knee arthroplasty procedures which demand high precision.By overlaying digital information onto the surgeon's field of view,AR systems enhance precision,improve alignment accuracy,and reduce the risk of complications associated with malalignment.Some concerns have been raised despite accuracy,including the learning curve,long-term outcomes,and technical limitations.Furthermore,it is essential for health practitioners to gain trust in the utilisation of AR.
基金Supported by National Institute For Health and Care Research,No.NIHR302632.
文摘BACKGROUND Relieving pain is central to the early management of knee osteoarthritis,with a plethora of pharmacological agents licensed for this purpose.Intra-articular corticosteroid injections are a widely used option,albeit with variable efficacy.AIM To develop a machine learning(ML)model that predicts which patients will benefit from corticosteroid injections.METHODS Data from two prospective cohort studies[Osteoarthritis(OA)Initiative and Multicentre OA Study]was combined.The primary outcome was patientreported pain score following corticosteroid injection,assessed using the Western Ontario and McMaster Universities OA pain scale,with significant change defined using minimally clinically important difference and meaningful within person change.A ML algorithm was developed,utilizing linear discriminant analysis,to predict symptomatic improvement,and examine the association between pain scores and patient factors by calculating the sensitivity,specificity,positive predictive value,negative predictive value,accuracy,and F2 score.RESULTS A total of 330 patients were included,with a mean age of 63.4(SD:8.3).The mean Western Ontario and McMaster Universities OA pain score was 5.2(SD:4.1),with only 25.5%of patients achieving significant improvement in pain following corticosteroid injection.The ML model generated an accuracy of 67.8%(95%confidence interval:64.6%-70.9%),F1 score of 30.8%,and an area under the curve score of 0.60.CONCLUSION The model demonstrated feasibility to assist clinicians with decision-making in patient selection for corticosteroid injections.Further studies are required to improve the model prior to testing in clinical settings.
