Prognostic value of B-score for predicting joint replacement in the context of osteoarthritis phenotypes: Data from the osteoarthritis initiative.

Objective: Developing new therapies for knee osteoarthritis (KOA) requires improved prediction of disease progression. This study evaluated the prognostic value of clinical clusters and machine-learning derived quantitative 3D bone shape B-score for predicting total and partial knee replacement (KR). Design: This retrospective study used longitudinal data from the Osteoarthritis Initiative. A previous study used patients' clinical profiles to delineate phenotypic clusters. For these clusters, the distribution of B-scores was assessed (employing Tukey's method). The value of both cluster allocation and B-score for KR-prediction was then evaluated using multivariable Cox regression models and Kaplan-Meier curves for time-to-event analyses. The impact of using B-score vs. cluster was evaluated using a likelihood ratio test for the multivariable Cox model; global performances were assessed by concordance statistics (Harrell's C-index) and time dependent receiver operating characteristic (ROC) curves. Results: B-score differed significantly for the individual clinical clusters (p â€‹< â€‹0.001). Overall, 9.4% of participants had a KR over 9 years, with a shorter time to event in clusters with high B-score at baseline. Those clusters were characterized clinically by a high rate of comorbidities and potential signs of inflammation. Both phenotype and B-score independently predicted KR, with better prediction if combined (P â€‹< â€‹0.001). B-score added predictive value in groups with less pain and radiographic severity but limited physical activity. Conclusions: B-scores correlated with phenotypes based on clinical patient profiles. B-score and phenotype independently predicted KR surgery, with higher predictive value if combined. This can be used for patient stratification in drug development and potentially risk prediction in clinical practice.

Pain-phenotyping in osteoarthritis: Current concepts, evidence, and considerations towards a comprehensive framework for assessment and treatment.

Objectives: Pain as central symptom of osteoarthritis (OA) needs to be addressed as part of successful treatment. The assessment of pain as feature of disease or outcome in clinical practice and drug development remains a challenge due to its multidimensionality and the plethora of confounders. This article aims at providing insights into our understanding of OA pain-phenotypes and suggests a framework for systematic and comprehensive assessments. Methods: This narrative review is based on a search of current literature for various combinations of the search terms "pain-phenotype" and "knee OA" and summarizes current knowledge on OA pain-phenotypes, putting OA pain and its assessment into perspective of current research efforts. Results: Pain is a complex phenomenon, not necessarily associated with tissue damage. Various pain-phenotypes have been described in knee OA. Among those, a phenotype with high pain levels not necessarily matching structural changes and a phenotype with low pain levels and impact are relatively consistent. Further subgroups can be differentiated based on patient reported outcome measures, assessments of comorbidities, anxiety and depression, sleep, activity and objective measures such as quantitative sensory testing. Conclusions: The complexity of both OA as disease and pain in OA prompt the definition of a set of variables that facilitate assessments comparable across studies to maximize our understanding of pain, as central concern for the patient.

Eating disorder risks and awareness among female elite cyclists: an anonymous survey.

BACKGROUND: Eating disorders (EDs) are an increasingly recognized concern in professional sports. Previous studies suggests that both female gender and endurance sports put athletes at risk. Female elite cyclists are hence of specific interest. The present study aimed at evaluating the distribution of the individual risk of ED in this group. Further the association between individual risk and both the awareness for the topic ED and the deviation from "normal" weight was depicted. METHODS: Female cyclists registered with the Union Cycliste Internationale were contacted via email or facebook and asked to complete a survey comprising age, weight, the Eating-Attitude-Test (EAT-26), and questions regarding ED awareness. The observed distribution of the EAT-26 score was compared to results from previous studies in normal subjects and athletes. The distribution of the ED awareness was described and ED awareness was correlated with the EAT-26 score. Both the deviation from ideal weight and the body mass index (BMI) were correlated with the EAT-26 score. RESULTS: Of the 409 registered athletes 386 could be contacted, 122 completed the questionnaire. Age ranged from 20-44yrs, BMI from 17.0 to 24.6 kg/m2. In the EAT-26, 39 cyclists (32.0%) scored above 20 points indicating a potential benefit from clinical evaluation, 34 cyclists (27.9%) scored 10-19 points suggesting disordered eating. Sixteen athletes (13.2%) had been treated for an ED. About 70% of athletes had been pressured to lose weight. The mean EAT-26 score was above the average observed in normal female populations. It was also above the average observed in many female athlete populations, but lower than in other leanness focussed sports. More than 80%of athletes perceived elite cyclists at risk for developing ED. Increased ED awareness and deviation from the ideal weight were associated with higher EAT-26 scores, but not the body mass index. CONCLUSION: Female cyclists are at risk of developing ED and they are aware of this risk. To improve their health and well-being, increased efforts to support elite cyclists and their teams in preventive activities and early detection are crucial.

[Reconstruction of osseous defects using the Masquelet technique]. / Rekonstruktion ossärer Defekte mit der Masquelet-Technik.

The Masquelet procedure or induced membrane technique presents a treatment option for relatively large osseous defects, e.g. after trauma, tumour resection or osteomyelitis even in the presence of unfavourable soft tissues. Initially developed at the end of the last century by the French surgeon Masquelet, the technique relies on a bioactive membrane that forms a foreign body reaction around a cement spacer. This spacer is implanted in the residual defect after rigorous debridement of bone and soft tissue during a first-stage procedure. A second-stage intervention is performed 1-2 months later with removal of the spacer under preservation of the membrane that has since formed around the cement. The membrane acts as an internal bioreactor exerting its effect via a rich vascularization and secretion of growth and differentiation factors. The void within the membrane is filled with an autologous cancellous graft. After adequate stabilisation using standard techniques, a gradual corticalisation of the graft can be observed over the duration of several months, with remodelling in the long-term course.The following article describes the original technique, our preferred approach including indication, surgical technique and postoperative follow-up. Additionally, the biological background and clinical tips and tricks are presented.

Perspective on the evolution of cell-based bone tissue engineering strategies.

Despite the compelling clinical needs in enhancing bone regeneration and the potential offered by the field of tissue engineering, the adoption of cell-based bone graft substitutes in clinical practice is limited to date. In fact, no study has yet convincingly demonstrated reproducible clinical performance of tissue-engineered implants and at least equivalent cost-effectiveness compared to the current treatment standards. Here, we propose and discuss how tissue engineering strategies could be evolved towards more efficient solutions, depicting three different experimental paradigms: (i) bioreactor-based production; (ii) intraoperative manufacturing, and (iii) developmental engineering. The described approaches reflect the need to streamline graft manufacturing processes while maintaining the potency of osteoprogenitors and recapitulating the sequence of biological steps occurring during bone development, including vascularization. The need to combine the assessment of efficacy of the different strategies with the understanding of their mechanisms of action in the target regenerative processes is highlighted. This will be crucial to identify the necessary and sufficient set of signals that need to be delivered at the injury or defect site and should thus form the basis to define release criteria for reproducibly effective engineered bone graft substitutes.

[Open stabilization and primary hip arthroplasty in geriatric patients with acetabular fractures: combination of minimally invasive techniques]. / Offene Stabilisierung und Endoprothetik bei geriatrischen Patienten mit acetabulären Frakturen: Kombination minimal-invasiver Operationstechniken.

Fractures of the acetabulum after low-energy trauma in geriatric patients suffering from osteoporosis are increasing in number and significance due to demographic changes. The results of current therapeutic principles though tend to be poor in this population, while risk and treatment-related morbidity of surgical or conservative approaches are substantial.The treatment of geriatric patients can be challenging, not only because of their often complex medical history. They essentially need rapid functional restoration and return to their familiar environment to avoid general decline unlike younger patients for whom rather the long-term perspective is crucial. This article critically discusses the current literature and reports on first experiences with a new surgical concept in six geriatric patients aged 82-91 years: the combination of an anterior minimally invasive approach for open reduction and internal fixation of the acetabulum combined with an anterior minimally invasive (AMIS®) approach to the hip for total hip arthroplasty with promising short-term results.

[Prophylaxis of venous thromboembolism in orthopaedic surgery--trivial option, huge potential]. / Thromboseprophylaxe in der orthopädischen Chirurgie--vernachlässigte Option mit grossem Potenzial.

Venous thromboembolism (VTE) is a common, sometimes even fatal though preventable complication after surgical interventions, especially in orthopaedic surgery. The risk can be reduced by more than 50 % by mechanical means and different anticoagulant drugs. However, only few patients receive adequate treatment. Medicamentous options are limited and somewhat difficult. Most anticoagulant substances act indirectly, therefore their efficacy can easily be impaired. For some, the pharmacokinetics are quite unfavourable. Furthermore, these drugs can cause severe adverse reactions; and since drug therapy either needs daily injections or routine blood checks, its acceptance is limited even further. Fortunately, new substances have reached phase III and will shortly be released. They have a broad therapeutic index, favourable pharmacodynamics and -kinetics and seem to cause only few adverse events. Rivaroxaban, for example, is approved for orthopaedic interventions like total hip or knee replacement. Orally administered, it interacts directly with factor Xa. It proved to be superior compared to the standard therapy with Enoxaparin, has a similar risk profile and needs no routine blood checks. The following article gives a critical survey of the problem, therapeutic options, current guidelines and new possibilities. Hopefully, these new simplified therapy options will increase the acceptance of VTE prophylaxis so that the rate of fatal complications after orthopaedic interventions can further be reduced.