Artificial intelligence can be used in the identification and classification of shoulder osteoarthritis and avascular necrosis on plain radiographs: a training study of 7,139 radiograph sets.

BACKGROUND AND PURPOSE: Knowledge concerning the use AI models for the classification of glenohumeral osteoarthritis (GHOA) and avascular necrosis (AVN) of the humeral head is lacking. We aimed to analyze how a deep learning (DL) model trained to identify and grade GHOA on plain radiographs performs. Our secondary aim was to train a DL model to identify and grade AVN on plain radiographs. PATIENTS AND METHODS: A modified ResNet-type network was trained on a dataset of radiographic shoulder examinations from a large tertiary hospital. A total of 7,139 radiographs were included. The dataset included various projections of the shoulder, and the network was trained using stochastic gradient descent. Performance evaluation metrics, area under the receiver operating characteristic curve (AUC), sensitivity, and specificity were used to assess the network's performance for each outcome. RESULTS: The network demonstrated AUC values ranging from 0.73 to 0.93 for GHOA classification and > 0.90 for all AVN classification classes. The network exhibited lower AUC for mild cases compared with definitive cases of GHOA. When none and mild grades were combined, the AUC increased, suggesting difficulties in distinguishing between these 2 grades. CONCLUSION: We found that a DL model can be trained to identify and grade GHOA on plain radiographs. Furthermore, we show that a DL model can identify and grade AVN on plain radiographs. The network performed well, particularly for definitive cases of GHOA and any level of AVN. However, challenges remain in distinguishing between none and mild GHOA grades.

No differences between conservative and surgical management of acromioclavicular joint osteoarthritis: a scoping review.

PURPOSE: To conduct a scoping review to clarify the management of acromioclavicular joint osteoarthritis, as well as to identify any existing gaps in the current knowledge. METHODS: Studies were identified by electronic databases (Ovid, Pubmed) from their inception up to April 2nd, 2020. All studies reporting functional outcomes after conservative or surgical treatment of acromioclavicular joint osteoarthritis, either primary or secondary to trauma or distal clavicle osteolysis, were included. Following data were extracted: authors, year of publication, study design (prospective or retrospective), LOE, number of shoulders treated conservatively or surgically, patients' age, OA classification, type of conservative treatment, surgical approach, surgical technique, functional outcomes, complications, revisions, and length of follow-up. Descriptive statistics was used. Quality appraisal was assessed through the Cochrane risk of bias tool for LOE I/II studies, while the MINORS checklist was used for LOE III/IV studies. RESULTS: Nineteen studies were included for a total of 861 shoulders. Mean age of participants was 48.5 ± 7.4 years. Mean follow-up was 43.8 ± 29.9 months. Four studies reported functional results after conservative treatment, whereas 15 studies were focused on surgical management. No studies directly compared conservative and surgical treatment. Seven studies reported a surgical approach after failure of previous conservative treatment. All studies reported functional improvement and pain relief. Complication rate was low. Overall methodological quality of included studies was very low. CONCLUSION: Conservative and surgical treatments are both effective in acromioclavicular joint osteoarthritis management. However, available data did not allow to establish the superiority of one technique over another. LEVEL OF EVIDENCE: Level IV.

Arthroscopic osteocapsular arthroplasty for advanced-stage primary osteoarthritis of the elbow using a computed tomography-based classification.

HYPOTHESIS: Arthroscopic osteocapsular arthroplasty for stage III osteoarthritis (advanced stage) shows worse clinical and radiologic outcomes compared with stage I or II according to computed tomography (CT)-based classification. METHODS: Clinical and radiologic outcomes in 65 patients treated with arthroscopic osteocapsular arthroplasty were retrospectively analyzed for range of motion (ROM) arc, functional score (Mayo Elbow Performance Score [MEPS]), and pain score (visual analog scale [VAS]). Patients were classified into stage I or II (n = 44) and stage III (n = 21) groups according to CT-based classification, and postoperative clinical outcomes and complications were analyzed. RESULTS: Mean follow-up duration was 32.9 ± 13.7 months (range, 24-69). The average patient age was 52 ± 10 years (range, 40-63). Improvements from preoperative to final follow-up were seen in the overall ROM-flexion from 94° ± 19° to 129° ± 14° (P < .01), ROM-extension from 25° ± 12° to 14° ± 7° (P < .01), MEPS from 45 ± 13 to 78 ± 14 (P < .01), and VAS score from 6.3 ± 1.6 to 3.1 ± 1.4 (P < .01). Subgroup analysis using the CT-based classification revealed that stage III led to worsened VAS score and MEPS than stage I or II. CONCLUSIONS: Arthroscopic osteocapsular arthroplasty can be recommended for its favorable overall treatment outcomes for elbow osteoarthritis. However, stage III shows worse clinical and radiologic outcomes compared with stage I or II according to CT-based classification.

Intraobserver and interobserver reliability of the computed tomography-based radiographic classification of primary elbow osteoarthritis: comparison with plain radiograph-based classification and clinical assessment.

OBJECTIVES: To develop a staging system that could better reflect symptoms by the spurs quantification in the fossa and joint space narrowing using computed tomography (CT) for elbow arthritis and to evaluate its reproducibility with multiple readers. METHODS: This retrospective study evaluated 81 cases of primary elbow osteoarthritis using both plain radiography and CT. Qualitative and quantitative analyses were independently performed by four orthopedic surgeons using previous and newly proposed staging systems. The reproducibility of the new system was analyzed with intraclass correlation coefficients (ICC). Correlations between symptoms and radiologic classification were assessed using Pearson's correlation coefficient (PCC). RESULTS: The interobserver agreement (1) and intraobserver agreement (2) among the four evaluators was present by ICC. (1) The system of Hastings and Rettig [first observation, 0.544 (95% confidence interval (CI), 0.436-0.649); second observation, 0.582 (95% CI, 0.478-0.682)] and Broberg and Morrey's staging system [first observation, 0.620 (95% CI, 0.521-0.714); second observation, 0.656 (95% CI, 0.562-0.743)] showed substantial and moderate retrospective agreement, whereas the CT-based staging system showed almost perfect agreement [first observation, 0.867 (95% CI, 0.820-0.906); second observation, 0.909 (95% CI, 0.875-0.936)]. (2) The intraobserver agreement was almost perfect in the Brogerg and Morrey's and CT-based staging systems. CT-based staging showed high correlation with visual analogue scale (PCC 0.754, P < 0.001) and Mayo elbow performance score (PCC -0.614, P < 0.001) and moderate correlation with range of motion (PCC -0.458, P < 0.001). CONCLUSIONS: CT-based staging system was highly reproducible and clinically feasible than previous plain radiograph-based staging systems.

Phenotypes of osteoarthritis: current state and future implications.

In the most recent years, an extraordinary research effort has emerged to disentangle osteoarthritis heterogeneity, opening new avenues for progressing with therapeutic development and unravelling the pathogenesis of this complex condition. Several phenotypes and endotypes have been proposed albeit none has been sufficiently validated for clinical or research use as yet. This review discusses the latest advances in OA phenotyping including how new modern statistical strategies based on machine learning and big data can help advance this field of research.

Clinical Outcome of Osteocapsular Arthroplasty for Primary Osteoarthritis of the Elbow: Comparison of Arthroscopic and Open Procedure.

PURPOSE: To compare clinical and radiologic outcomes following open (OPEN) and arthroscopic (ARTHRO) osteocapsular arthroplasty for primary elbow osteoarthritis. METHODS: Patients treated with osteocapsular arthroplasty between January 2010 and December 2015 were divided into OPEN and ARTHRO groups. OPEN was performed from January 2010 to October 2012, and ARTHRO from November 2012 to December 2015. OPEN and ARTHRO were performed in 35 and 52 elbows, respectively. Clinical outcome was measured using range of motion (ROM) arc, functional score (Mayo Elbow Performance Score [MEPS]), and pain score (visual analog scale [VAS]). Conventional radiography was used for outcome analysis. Outcomes were analyzed according to ulnohumeral joint (UHJ) narrowing using the computed tomography-based modified Broberg and Morrey classification. RESULTS: Mean follow-up time was 36.6 ± 14.4 (24-89) and 35.4 ± 14.2 (24-83) months following OPEN and ARTHRO, respectively. Average ages were 50.0 ± 7.0 (40-63) and 52.4+10.4 (41-75) years in OPEN and ARTHRO groups, respectively. Overall scores for ROM (preoperative to final follow-up: 65.5° ± 22.8 to 112.0° ± 50.9, P < .01), MEPS (42.9 ± 13.7 to 73.7 ± 16.6, P < .01), and VAS (6.6 ± 1.3 to 4.0 ± 2.3, P < .01) were improved. Preoperative ROM improved from 64.0° ± 23.3 to 118.0° ± 17.8 following OPEN and 66.5° ± 22.6 to 108.0° ± 24.0 following ARTHRO. Preoperative MEPS improved from 40.7 ± 15.6 to 73.6 ± 16.7 following OPEN and 44.3 ± 12.2 to 73.8 ± 16.7 following ARTHRO. Preoperative VAS improved from 6.9 ± 1.2 to 3.9 ± 2.6 following OPEN and 6.4 ± 1.3 to 4.1 ± 2.0 following arthro. In both groups, the last follow-up VAS score and MEPS were worse in the narrowing group (UHJ <2 mm, grades 2 and 3) than in the intact group (UHJ >2 mm, grade 1) (P < .01). CONCLUSIONS: Arthroscopic osteocapsular arthroplasty is comparable to the OPEN procedure in managing primary osteoarthritis of the elbow; however, the OPEN procedure shows the better outcome in improvement of flexion limitation. Neither procedures can guarantee an excellent outcome in the patients with severe UHJ narrowing. LEVEL OF EVIDENCE: Level III, retrospective comparative trial.

Intraobserver and interobserver reliability of the modified Walch classification using radiographs and computed tomography.

BACKGROUND: The Walch classification was introduced to classify glenoid morphology in primary glenohumeral osteoarthritis. A modified Walch classification was recently proposed, with 2 additional categories, B3 (monoconcave glenoid with posterior bone loss leading to retroversion > 15° or subluxation > 70%) and D (excessive anterior subluxation), as well as a more precise definition of subtypes A2 and C. The purpose of this study was to evaluate the intraobserver and interobserver agreement of the modified Walch classification system using both plain radiographs and computed tomography (CT). METHODS: Three fellowship-trained shoulder surgeons blindly and independently evaluated radiographs and CT scans of 100 consecutive shoulders (98 patients) with primary glenohumeral osteoarthritis and classified all shoulders according to the modified Walch classification in 4 separate sessions, each 4 weeks apart. Statistical analysis with the κ coefficient was used to evaluate reliability. RESULTS: The first reading by the most senior observer on the basis of CT scans was used as the gold standard (distribution: A1, 18; A2, 12; B1, 20; B2, 25; B3, 22; C, 1; and D, 2). The average intraobserver agreement for radiographs and CT scans was 0.73 (substantial; 0.72, 0.74, and 0.72) and 0.73 (substantial; 0.77, 0.69, and 0.72), respectively. The average interobserver agreement was 0.55 (moderate; 0.61, 0.51, and 0.53) for radiographs and 0.52 (moderate; 0.63, 0.50, and 0.43) for CT scans. CONCLUSION: Intraobserver agreement of the modified Walch classification was substantial both for axillary radiographs and for CT scans. Interobserver agreement was fair. Although the modified Walch classification represents an improvement over the original classification, automated computer-based analysis of CT scans may be needed to further improve the value of this classification.

[Osteoarthritis classifications : Modification proposal for the criteria of Kellgren and Vallotton]. / Arthrose-Klassifikationen : Modifizierungsvorschlag für die Kriterien nach Kellgren und Vallotton.

BACKGROUND: In imaging diagnostics, classification schemes are very common. As far as osteoarthritis is concerned, the Kellgren classification is the most popular. However, the Kellgren classification, which has been used for more than 50 years, is based on nonspecific criteria; thus, high interobserver variability has been reported. In addition, the Kellgren classifications have not been coordinated with magnetic resonance imaging (MRI)-based classification schemes, e.g., Vallotton. AIM: In this paper, we present some modifications concerning the criteria for both the Kellgren classification and its comparison with the MRI-based Vallotton classification. METHODS: The current surgical and imaging classifications and the precision of the nomenclature are analyzed. X­ray and MRI findings are compared. RESULTS: Suggestions for both a modification of the Kellgren classification as far as the criteria are concerned and a hierarchy (ranking) of X­ray and MRI findings to make clinical decisions more valuable are proposed. CONCLUSION: These proposed modifications (Kellgren and ranking) would be helpful for routine reporting and allow for better interobserver reliability, in particular for special reports (e.g. consultations, expert opinions, advanced diagnostics).

Clinical utility and potential of ultrasound in osteoarthritis.

Osteoarthritis (OA) is the most common disorder of human joints. Imaging is necessary in daily practice for OA patients, and conventional radiography remains the gold standard. However, conventional radiography is not sensitive in the early stage of OA and cannot clearly detect inflammatory condition. Recently, ultrasonography (US) is widely used in musculoskeletal field and US performs better or at least equally well for identification of osteophytes and morphologic degeneration of cartilage in OA patients. US provides relevant additional diagnostic information on pathologic changes in soft tissue (e.g., synovitis, meniscal injuries and Baker's cysts) not depicted by conventional radiography. The advantage of US is its ability to visualize even in small and hidden morphologic change even in small joints. Thus, US may be a useful imaging technique for not only knee OA but also hand OA. This review article explains relevant pathologic findings in OA and clinical usefulness in daily practice with US images.

The diagnostic clinical value of thumb metacarpal grind, pressure-shear, flexion, and extension tests for carpometacarpal osteoarthritis.

STUDY DESIGN: Clinical measurement. INTRODUCTION: Common provocative maneuvers to differentiate thumb carpometacarpal (CMC) osteoarthritis from other sources of pain are the grind, metacarpal (MC) flexion, and MC extension tests. A maneuver known as the pressure-shear test is described here. PURPOSE OF THE STUDY: To compare the diagnostic value of the grind, metacarpal flexion, metacarpal extension, and pressure-shear tests for CMC osteoarthritis of the thumb. METHODS: The diagnostic accuracy of each test was compared in 127 thumbs from 104 patients. Sensitivity, specificity, and predictive values of each test were calculated. In a secondary analysis, polychoric correlation coefficients were used to assess the correlation of each test with severity defined by Eaton-Littler stage. RESULTS: The overall diagnostic accuracy of the thumb MC grind, pressure-shear, flexion, and extension tests were 70%, 98%, 47%, and 55%, respectively. The sensitivities were 64%, 99%, 36%, and 46%, respectively, and specificities were 100%, 95%, 100%, and 100%, respectively. For the diagnosis of Thumb CMC arthritis, the MC pressure-shear test was superior overall in terms of overall diagnostic accuracy and sensitivity, while having comparable specificity to the other maneuvers. CONCLUSION: The pressure-shear test was found to be superior to the commonly used grind maneuver and the provocative maneuvers of MC flexion and extension tests to confirm diagnosis of CMC osteoarthritis.

Is osteoarthritis one disease or a collection of many?

OA is a multifaceted and heterogeneous syndrome that may be amenable to tailored treatment. There has been an increasing focus within the OA research community on the identification of meaningful OA phenotypes with potential implications for prognosis and treatment. Experimental and clinical data combined with sophisticated statistical approaches have been used to characterize and define phenotypes from the symptomatic and structural perspectives. An improved understanding of the existing phenotypes based on underlying disease mechanisms may shed light on the distinct entities that make up the disease. This narrative review provides an updated summary of the most recent advances in this field as well as limitations from previous approaches that can be addressed in future studies.

Radiological glenohumeral osteoarthritis in long-term type 1 diabetes. Prevalence and reliability of three classification systems. The Dialong shoulder study.

OBJECTIVE: In the present study, we evaluate the intra- and interrater agreement of radiological glenohumeral OA using three different classification systems and estimate the prevalence of radiological and clinical glenohumeral OA in patients with type 1 diabetes mellitus (DM1), for over 45 years and controls (The Dialong study). MATERIALS AND METHODS: We included 102 patients with DM1 (49% women, mean age, 61.9 years) and 73 controls (57% women, mean age, 62.6 years). Anterior-posterior shoulder radiographs were interpreted by two observers applying the Kellgren-Lawrence (K-L), Samilson-Prieto (S-P) and Samilson-Prieto Allain (S-PA) classifications. RESULTS: The interrater agreement was moderate (weighted kappa, 0.46 to 0.48) for all classifications and the intrarater agreement mainly substantial (0.48-0.86) for both observers. The agreed prevalence of radiological OA was 26 and 18% (OR 1.6 (0.8 to 3.3), p = 0.22, 44 and 26% (OR 2.2 (1.2 to 4.2), p = 0.02) and 30 and 17% (OR 2.1 (1.0 to 4.5), p = 0.05) for the K-L, S-P and S-PA classifications respectively in the diabetes and control groups. The prevalence of moderate or severe radiological OA was 1 to 6% and clinical OA 1 to 2% with no difference between the groups. CONCLUSION: The prevalence of radiological glenohumeral OA was higher in the diabetes group with the Samilson-Prieto classification systems, but not associated with clinical OA. The interrater agreement was moderate. We recommend the Samilson-Prieto Allain classification for glenohumeral OA to avoid interpretation of osteophytes < 1 mm as OA in patient groups with a low pre-test likelihood of glenohumeral OA.

Does the Age of a Patient Affect the Outcome of Temporomandibular Joint Arthroscopic Surgery?

PURPOSE: Although temporomandibular joint (TMJ) disorders encompass all age groups, it is generally considered to affect young to middle-age adults. The aim of this investigation was to study patients who met the criteria for TMJ arthroscopy and to determine whether there was a difference in outcomes between younger and older patients. MATERIALS AND METHODS: This was a retrospective chart review of patients who underwent TMJ operative arthroscopy. The primary variable studied was patient age. Major outcome variables included changes in subjective pain measured by a visual analog scale (VAS) and changes in maximum interincisal opening (MIO) after arthroscopic surgery. Other variables of interest included the presence of systemic disease, synovitis, and osteoarthritis diagnosed arthroscopically. Data analysis included the Student t test, regression analysis (R Studio, Boston, MA), and χ2 test with a P value less than .05 indicating statistical significance. RESULTS: The study population consisted of 103 patients diagnosed with internal derangement and severe inflammatory or degenerative TMJ disease (Wilkes stages II to V) who underwent operative arthroscopy. Patients were divided into 2 groups based on age (group Y, <40 yr old, n = 51, mean age, 26 yr; group O, >40 yr old, n = 52, mean age, 56 yr). The presence of osteoarthritis diagnosed arthroscopically was significantly greater in group O than in group Y (P < .01). There was significant postoperative improvement in pain (VAS) and MIO in group Y (P < .01) and group O (P < .01). Although the 2 groups showed substantial improvement after arthroscopy, when comparing differences in outcomes between the groups, the absolute postoperative pain level for group O was significantly lower than for group Y (P < .05). Comparison of postoperative MIO did not show a significant difference between group Y and group O (P = .286). CONCLUSIONS: Groups Y and O showed substantial improvement in pain (VAS) and mandibular mobility (MIO) after surgical TMJ arthroscopy. Group O had a higher prevalence of arthroscopically diagnosed osteoarthritis and lower postoperative pain levels compared with group Y. Older patients with advanced TMJ disease responded well to TMJ arthroscopy.

Radiographs and computed tomography scans show similar observer agreement when classifying glenoid morphology in glenohumeral arthritis.

BACKGROUND: Glenohumeral subluxation and glenoid morphology are commonly evaluated in primary osteoarthritis by use of the Walch classification. The reliability of this classification system has been analyzed only by computed tomography (CT). The purpose of this study was to determine the reliability of plain axillary radiographs compared with CT scans. METHODS: Three shoulder surgeons blindly and independently evaluated the radiographs and CT scans of 75 consecutive shoulders with primary glenohumeral osteoarthritis. Each observer classified all shoulders according to Walch in 4 separate sessions, each 6 weeks apart. There were 2 sessions using only radiographs and 2 using only CT scans. The order of shoulders evaluated was randomized. RESULTS: The first reading by the most senior observer based on CT was arbitrarily used as the "gold standard" (A1, 21; A2, 13; B1, 12; B2, 28; C, 1). The average intraobserver agreement for radiographs was 0.66 (substantial; 0.66, 0.59, and 0.74 for each observer). The average intraobserver agreement for CT scans was 0.60 (moderate; 0.53, 0.61, and 0.65). Pairwise comparisons between observers showed higher agreement for radiographs than for CT scans (0.48 vs. 0.39). The average agreement for observations on radiographs and CT scans was 0.42 (moderate; 0.40, 0.37, and 0.50). CONCLUSION: In this study, intraobserver agreement using the Walch classification based on axillary radiographs was substantial and compared favorably with agreement based on CT scans. The Walch classification provides a useful frame of reference when assessing subluxation and glenoid morphology in primary glenohumeral osteoarthritis, but not unlike other classification systems, it does not allow perfect agreement among observers.

Can glenoid wear be accurately assessed using x-ray imaging? Evaluating agreement of x-ray and magnetic resonance imaging (MRI) Walch classification.

BACKGROUND: The Walch classification is the most recognized means of assessing glenoid wear in preoperative planning for shoulder arthroplasty. This classification relies on advanced imaging, which is more expensive and less practical than plain radiographs. The purpose of this study was to determine whether the Walch classification could be accurately applied to x-ray images compared with magnetic resonance imaging (MRI) as the gold standard. We hypothesized that x-ray images cannot adequately replace advanced imaging in the evaluation of glenoid wear. METHODS: Preoperative axillary x-ray images and MRI scans of 50 patients assessed for shoulder arthroplasty were independently reviewed by 5 raters. Glenoid wear was individually classified according to the Walch classification using each imaging modality. The raters then collectively reviewed the MRI scans and assigned a consensus classification to serve as the gold standard. The κ coefficient was used to determine interobserver agreement for x-ray images and independent MRI reads, as well as the agreement between x-ray images and consensus MRI. RESULTS: The inter-rater agreement for x-ray images and MRIs was "moderate" (κ = 0.42 and κ = 0.47, respectively) for the 5-category Walch classification (A1, A2, B1, B2, C) and "moderate" (κ = 0.54 and κ = 0.59, respectively) for the 3-category Walch classification (A, B, C). The agreement between x-ray images and consensus MRI was much lower: "fair-to-moderate" (κ = 0.21-0.51) for the 5-category and "moderate" (κ = 0.36-0.60) for the 3-category Walch classification. DISCUSSION: The inter-rater agreement between x-ray images and consensus MRI is "fair-to-moderate." This is lower than the previously reported reliability of the Walch classification using computed tomography scans. Accordingly, x-ray images are inferior to advanced imaging when assessing glenoid wear.

Classification of humeral head pathomorphology in primary osteoarthritis: a radiographic and in vivo photographic analysis.

BACKGROUND: The purpose of this study was to characterize the pathologic changes of the osteoarthritic humeral head. METHODS: The study included 55 patients with primary osteoarthritis who underwent anatomic shoulder arthroplasty. Several radiologic parameters (radiography, magnetic resonance imaging) were assessed. Humeral head deformity in the transverse plane and humeral cartilage erosion in the coronal plane were chosen for photographic measurements from the resected humeral heads. RESULTS: In the coronal plane, 82% of patients presented with an aspherical humeral head shape with a significantly longer caudal osteophyte. In the transverse plane, 50% of all patients showed a decentered apex. Patients with an aspherical humeral head shape in the transverse plane showed an aspherical humeral head shape in the coronal plane in 94% and a significantly longer osteophyte than patients with spherical humeral head shape, showing a 3-dimensional deformity of the humeral head during progression of primary osteoarthritis. Patients with an osteophyte length between 7 and 12 mm were associated with a glenoid type B2 in 30% and a decentered apex in the transverse plane in 38%. Patients with a humeral osteophyte longer than 13 mm were significantly more frequently associated with a type B2 glenoid (71%; P < .0001) and a decentered apex in the transverse plane in 52%. CONCLUSION: It seems that the progression of primary osteoarthritis of the glenohumeral joint is characterized by an increasing 3-dimensional deformity of the humeral head related to the glenoid morphology. We therefore propose an extended Samilson-Prieto classification with type A (spherical) and type B (aspherical) and grade I-IV osteophytes.

The Association of Tibia Femur Ratio and Degenerative Disease of the Spine, Hips, and Knees.

BACKGROUND: When individuals with asymmetric lower extremities present for evaluation of limb-length inequality, correction can occur at the tibia, femur, or in both bones; however, there are limited data available to justify either technique. The aim of this study is to examine the normal ratio of tibia length/femur length (T/F), and to explore the relationship between T/F ratio and osteoarthritis of the spine, hips, and knees. METHODS: Bone lengths of 1152 cadaveric femora and tibiae from the Hamann-Todd osteological collection were measured. Degenerative joint disease was graded in the hip, knee, and spine. Correlations between the ratio of T/F and osteoarthritis were evaluated with multiple regression analysis. RESULTS: The average ratio of T/F was 0.80±0.03. There was a strong correlation between age and arthritis at all sites, with standardized ß ranging from 0.44 to 0.57 (P<0.0005 for all). There was a significant correlation between increasing T/F and hip arthritis (standardized ß=0.08, P=0.006), and knee arthritis (standardized ß=0.08, P=0.008). DISCUSSION: Increasing tibia length relative to femur length was found to be a significant predictor of ipsilateral hip and knee arthritis. Therefore, we recommend that when performing limb lengthening, surgical planning should lean toward recreating the normal ratio of 0.80. In circumstances where one bone is to be overlengthened relative to the other, bias should be toward overlengthening the femur. This same principle can be applied to limb-reduction surgery, where in certain circumstances, one may choose to preferentially shorten the tibia. CLINICAL RELEVANCE: This is the first study to report long-term consequences of lower extremity segment disproportion.

The cytokinome in osteoarthritis, a new paradigm in diagnosis and prognosis of cartilage disease.

At present, diagnosis and progression monitoring of osteoarthritis (OA) is made through radiological and clinical assessment. Several studies investigated the role of synovial fluid analysis, to find out whether joint disease could be characterized by the pattern of cytokines, which acts during the pathogenic process or in specific stages of it. Online PubMed-Medline search was performed in order to retrieve evidence concerning synovial fluid analysis of cytokines involved in OA degenerative process. Concerning pro-inflammatory cytokines, it has been shown that interleukin (IL)-6, TNF-α and IL-17 are mainly over-expressed in the synovial fluid of OA joints, as well as anti-inflammatory cytokine IL-10. Variations of cytokines levels occur with radiological and clinical progression. It was also reported that metalloproteinases are involved. Synovial fluid analysis may be helpful in defining stage and type of OA, but more research is needed, especially focusing on the variation of sets of cytokines during OA stages and correlating these patterns with clinical features.

Reliability of classification for post-traumatic ankle osteoarthritis.

PURPOSE: The purpose of this study was to identify the most reliable classification system for clinical outcome studies to categorize post-traumatic-fracture-osteoarthritis. METHODS: A total of 118 orthopaedic surgeons and residents-gathered in the Ankle Platform Study Collaborative Science of Variation Group-evaluated 128 anteroposterior and lateral radiographs of patients after a bi- or trimalleolar ankle fracture on a Web-based platform in order to rate post-traumatic osteoarthritis according to the classification systems coined by (1) van Dijk, (2) Kellgren, and (3) Takakura. Reliability was evaluated with the use of the Siegel and Castellan's multirater kappa measure. Differences between classification systems were compared using the two-sample Z-test. RESULTS: Interobserver agreement of surgeons who participated in the survey was fair for the van Dijk osteoarthritis scale (k = 0.24), and poor for the Takakura (k = 0.19) and the Kellgren systems (k = 0.18) according to the categorical rating of Landis and Koch. This difference in one categorical rating was found to be significant (p < 0.001, CI 0.046-0.053) with the high numbers of observers and cases available. CONCLUSIONS: This study documents fair interobserver agreement for the van Dijk osteoarthritis scale, and poor interobserver agreement for the Takakura and Kellgren osteoarthritis classification systems. Because of the low interobserver agreement for the van Dijk, Kellgren, and Takakura classification systems, those systems cannot be used for clinical decision-making. LEVEL OF EVIDENCE: Development of diagnostic criteria on basis of consecutive patients, Level II.

Radiographic progression of arthritic changes in shoulders with degenerative rotator cuff tears.

BACKGROUND: Very little longitudinal information has been available regarding the relationship of cuff tears and arthritis. The purpose of this study was to determine the midterm risk of and risk factors for rotator cuff tear arthropathy progression in a cohort of subjects with an asymptomatic rotator cuff tear. METHODS: Baseline (visit 1), 5-year (visit 2), and most recent follow-up (visit 3) radiographs were reviewed in a cohort of 105 subjects enrolled for longitudinal surveillance of asymptomatic degenerative rotator cuff tears and 33 controls. The radiographs were assessed in a blinded, randomized fashion by 3 observers who graded glenohumeral arthritic changes using the Hamada scores, Samilson-Prieto (SPO) scores, and acromiohumeral interval (AHI). RESULTS: Osteoarthritis (SPO classification), cuff tear arthropathy (Hamada classification), and AHI progressed between visits 1 and 3 (median, 8 years; P < .001 in all cases). SPO progression was not significantly different for partial- vs. full-thickness vs. control baseline tear types (P = .19). Both full-thickness and partial-thickness tears had greater progression in Hamada scores than controls did in the first 5 years of follow-up (P = .02 and P = .03, respectively), but scores did not differ between partial- and full-thickness tears. Tears with and without enlargement did not differ in progression in SPO grade, Hamada grade, or AHI. CONCLUSIONS: Glenohumeral arthritic changes progress significantly but remain minimal within an 8-year period in early to moderate degenerative cuff disease. Whereas the presence of a rotator cuff tear influences progression in Hamada grade, the magnitude of radiographic progression is not influenced by tear severity or enlargement at midterm time points.