Design and evaluation of a wedge-shaped adaptive knee orthosis for the human lower limbs.

Introduction: The incidence of knee osteoarthritis (KOA) is moderately correlated with age and body weight and increases with life span and weight gain, associated with tearing and wearing the knee joints. KOA can adjust the force through the human lower limbs, redistribute the load of the knee joint, reduce the pain, and restore mobility when the arthritis changes are mild. However, most of the existing knee orthosis cannot be adjusted adaptively according to the needs of patients. Methodology: This study establishes a biomechanical model of the knee joint to analyze the medial and lateral forces acting on the joint. The new adjustable knee orthosis is designed. It applies the principle of four-point bending to apply pressure to both sides of the knee joint, thereby adjusting the varus angle and modifying the medial and lateral forces on the knee joint. Through structural optimization, the prototype of the knee orthosis weighs only 324 g. Utilizing three-dimensional scanning technology, discrete point cloud data of the leg surface is obtained, reconstructed, and processed to create a 3D model of the human leg surface. The design ensures a close fit to the human leg surface, offering comfortable wear. A pressure sensing film system is employed to build a pressure sensing test system, where the knee orthosis is worn on a prosthesis for pressure testing to evaluate its ability to adjust knee joint forces. Results: The pressure test results demonstrate that the knee orthosis can stably provide an adjustment angle of 0-7° and sustain a maximum force of 10N on both sides of the knee joint over extended periods. A self-developed 8-channel plantar pressure sensing insole is calibrated against commercial plantar pressure sensors. Human wear tests on 15 subjects show that during the operation of the knee orthosis, it significantly adjusts plantar pressures, reducing lateral foot pressures by 22% overall, with more pronounced corrective effects observed in lighter participants. Discussion: In this study, a wedge-shaped adaptive knee orthosis was provided for KOA patients. The four-point force principle was used to balance the force between femurs and tibia and adjust the meniscus contact gap. The orthotic appliance has the advantages of simple mechanical structure, adjustable correction Angle and good wearing comfort.

A Preliminary Study of Quantitative MRI Cartilage Loss Fraction and Its Association With Future Arthroplasty Using the Osteoarthritis Initiative Database.

Background and objective  Osteoarthritis (OA) is the most common arthritis in the world. Despite the high disease burden, there is no therapy to prevent, halt, or reverse OA, and many clinical trials relied on radiographic biomarkers for therapy response. It is important to identify patients with early OA who will eventually need arthroplasty, the end-stage treatment for osteoarthritis. This pilot study evaluates a novel MRI biomarker, cartilage loss fraction, for association with future arthroplasty and evaluates its feasibility of use and effect size estimates. Materials and methods Publicly available knee MRIs from the Osteoarthritis Initiative were used. A total of 38 participants with Kellgren-Lawrence (K-L) grade >1 and 38 participants with K-L grade ≤ 1 at enrollment were matched in age, sex, race, and BMI, and assessed for the degree of full-thickness cartilage loss, or cartilage loss fraction. Univariate conditional logistic regression analysis was performed for differences in cartilage loss fractions between groups. Receiver operating characteristic (ROC) curve analysis was performed to assess the association of MRI biomarkers and knee arthroplasty during the eight-year follow-up. Results The medial femoral condyle, medial tibial plateau, total, and two-year progression cartilage loss fractions were significantly higher in participants with K-L grade >1 (p < 0.01 for all) and showed high area under the curve (AUC) values on ROC analysis (812, 0.827, 0.917, and 0.933, respectively). These results were comparable or more strongly associated with other OA grading schemes. Conclusion MRI biomarker cartilage loss fractions are significantly higher in subjects with K-L grade >1 and show a strong association with arthroplasty. After further validation, cartilage loss fracture may be used to predict future arthroplasty.

METTL3 mediated ferroptosis in chondrocytes and promoted pain in KOA via HMGB1 m6A modification.

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

Machine learning analysis of serum cholesterol's impact on knee osteoarthritis progression.

The controversy surrounding whether serum total cholesterol is a risk factor for the graded progression of knee osteoarthritis (KOA) has prompted this study to develop an authentic prediction model using a machine learning (ML) algorithm. The objective was to investigate whether serum total cholesterol plays a significant role in the progression of KOA. This cross-sectional study utilized data from the public database DRYAD. LASSO regression was employed to identify risk factors associated with the graded progression of KOA. Additionally, six ML algorithms were utilized in conjunction with clinical features and relevant variables to construct a prediction model. The significance and ranking of variables were carefully analyzed. The variables incorporated in the model include JBS3, Diabetes, Hypertension, HDL, TC, BMI, SES, and AGE. Serum total cholesterol emerged as a significant risk factor for the graded progression of KOA in all six ML algorithms used for importance ranking. XGBoost algorithm was based on the combined best performance of the training and validation sets. The ML algorithm enables predictive modeling of risk factors for the progression of the KOA K-L classification and confirms that serum total cholesterol is an important risk factor for the progression of KOA.

The Intra-Articular Combination of Fentanyl, Dexamethasone, Clonidine, Ropivacaine, and Dextrose to Treat Pain Due to Knee Osteoarthritis: A Case Report.

We report a case involving the pain management of a patient with knee osteoarthritis (KOA), where conventional treatment failed to provide pain relief. Instead, a multimodal approach including an intra-articular (IA) injection of a combination of various agents was applied successfully. The pharmacological treatment resulted in minimal improvement. After experiencing failure with IA hyaluronic acid and platelet-rich plasma injections, an IA combination of fentanyl 50 mcg, dexamethasone 8 mg, clonidine 150 mcg, ropivacaine 7.5% 5 ml, dextrose 30% 5 ml, and normal saline 5 ml was applied. The treatment led to a two-year pain relief. The multimodal approach seems to offer satisfactory and encouraging results as the improvement in the quality of life led to favorable physical and psychological outcomes in the patient.

Early Outcome of Simultaneous Bilateral Total Knee Arthroplasty Through the Oxford Knee Score in a Developing Country: A Prospective Cohort.

Introduction The most common degenerative joint disease in adults is osteoarthritis. The gold standard treatment option for this aging society with greater functional demands is total knee arthroplasty. The Oxford Knee Score (OKS) assesses factors such as stiffness, pain, function, satisfaction, and quality of life, allowing you to quantify treatment success after surgery. According to published research, there isn't a perfect postoperative timepoint to use the OKS to obtain TKA outcomes. Therefore, at the time of evaluation, the OKS should reflect the best possible outcome for the patient group. This study was conducted to see the OKS in patients who underwent simultaneous bilateral knee replacement at six weeks and six months postoperatively and to see if there was a clinically significant difference in the mean OKS. Methods This prospective cross-sectional study was conducted at the Section of Orthopedic Surgery at Aga Khan University Hospital, a tertiary care center in Karachi, Pakistan. Patients who underwent simultaneous bilateral total knee replacement from October 2023 till December 2023 were included; exclusion criteria included patients who had a recent knee infection and extensor mechanism disruption. OKS was calculated at six weeks and six months postoperatively. Results The total number of patients included in the study was 49 with a mean age of 61.9 +/- 6.1. There were 42 (85.7%) females and 7 (14.3%) males. The mean BMI of our patients was 33.3 +/- 3.8. The radiographic Kellgren Lawrence Grading (KLG) was used and 38 (77.6%) patients were placed in Grade IV KLG, and 11 (22.4%) were placed in Grade III KLG. The mean OKS preoperatively was 12.6 +/- 3.5. At six weeks, the OKS showed improvement, with the mean being 20.6 +/- 3.0. At six months postoperatively, there was a significant improvement in the OKS, with the mean now being 42.7 +/- 2.4. At six weeks post-surgery, the mean improvement in the OKS score was 7.9 +/- 2.71, whereas at six months post-surgery, the mean improvement in the OKS score was 30.1 +/- 3.6. This difference was significant (p-value=0.03). Conclusion Our study showed a clinically significant difference between the mean OKS at the six-week and six-month timeline, with a significant increase in the mean improvement OKS score at six months. OKS should be utilized six months postoperatively to assess the outcome of simultaneous bilateral knee arthroplasty patients.

Mapping the Research Landscape of Intra-Articular Knee Injections: A Bibliometric Analysis Using the Scopus Database.

Intraarticular injection of osteoarthritis knee is one of the treatment options for pain management and delays the need for knee surgery. Various materials have been promoted for the procedure, ranging from corticosteroid to viscosupplement to the more recent autologous biological materials. Despite the increasing attention and interest in regard to the material selection, efficacy, safety, and effect of this intervention, a comprehensive bibliometric analysis using the Scopus database has yet to be conducted. In this bibliometric analysis, we reviewed the Scopus database from 2003 to 2023 to investigate the literature on intraarticular injection for the treatment of knee osteoarthritis. A total of 1,318 articles that satisfied the selection criteria were included in this review. The trend of intervention shows changes since 2006, with corticosteroid injection and hyaluronic acid as the main topics of publication before 2006. However, starting in 2010, there has been a noticeable shift towards biological agents, such as plasma-rich proteins, and autologous materials, including marrow aspiration and stromal vascular fraction. This shift reflects the increasing interest in regenerative medicine and the potential of these newer therapies to provide improved outcomes. The overwhelming majority of the articles were authored by researchers and clinicians from across European countries, the United States of America (USA), and Australia. Similarly, most of the articles with the highest number of citations were authored by researchers and clinicians from these regions. This comprehensive bibliometric analysis using Scopus in the domain of intraarticular injection has the potential to act as a roadmap for researchers, clinicians, and policymakers, facilitating informed decision-making, promoting collaborative initiatives, and guiding the development of future studies to further advance the options of knee intraarticular injection, specifically in the management of knee osteoarthritis.

Staged Bi-compartmental Knee Arthroplasty for Contralateral Compartment Failure After Medial Unicompartmental Knee Arthroplasty in Dialysis Patients: Two Case Reports.

Unicompartmental knee arthroplasty (UKA) is a minimally invasive surgical technique with good clinical outcomes; however, its outcomes in patients undergoing hemodialysis are unknown. Herein, we report two cases of patients undergoing hemodialysis who underwent staged bi-compartmental UKA (Bi-UKA) for early contralateral compartment failure after medial UKA. We describe the case of early contralateral compartment failure after medial UKA in two women patients aged 71 and 72 years with a dialysis history of seven and 22 years, respectively. Three months after right medial UKA, she had persistent joint edema and arthralgia after minor trauma, with recurrent gait disturbance in the first case. An MRI showed a bone marrow lesion in the contralateral compartment, and a lateral UKA was added. In the second case, the knee pain worsened without any trigger three years after leaving the medial UKA. A subchondral insufficiency fracture (SIF) was diagnosed by a plain radiograph showing a radiolucent area on the lateral femoral condyle. Gait disturbance did not improve, and a lateral UKA was performed. In our hospital, medial UKA was performed on seven knees of dialysis patients in 10 years since 2011, and contralateral compartment failure was observed in two knees at an early stage. In both cases, lumbar bone density was normal and there was no postoperative overcorrection in leg alignment, but a SIF of the contralateral side occurred, suggesting that bone fragility of the contralateral compartment due to long-term dialysis was the underlying cause. Staged Bi-UKA was minimally invasive and useful as a revision surgery.

Correlation Between Coronal Position Sequence of Lumbar and WOMAC Score in Knee Osteoarthritis (KOA) in Standard Standing Position.

INTRODUCTION: Sagittal sequences of the spine have been shown to correlate with knee osteoarthritis (KOA), but coronal sequences and KOA have never been studied before. The study required patients to use a standard standing posture and aimed to explore the relationship between coronal position of lumbar spine and WOMAC score in KOA. METHODS: This is a cross-sectional observational study. Data on a total of 268 patients with KOA were collected. Patients were photographed in a standard standing position and lumbar-sacrum offset distance (L-SOD) and lumbar-knee offset distance (ΔL-KOD) were calculated. Patients were then divided into different groups according to different critical values and differences were compared. RESULTS: In the L-SOD of L1-3, WOMAC function (P = 0.021, P = 0.032, P = 0.001) and total score (P = 0.039, P = 0.034, P < 0.001) were different. In the L-SOD of L3-4, WOMAC pain score were different (P = 0.001, P = 0.032). At a cutoff of 13 mm, ΔL-KOD of L1-2 showed significant differences in pain part (P = 0.025, P = 0.039) and total score (P = 0.036, P = 0.050). There were significant differences in pain (P = 0.023, P = 0.027, P = 0.022), function (P = 0.048, P = 0.038, P = 0.047), and total score (P = 0.030, P = 0.027, P = 0.029) of L3-5. In the 18-mm cutoff group, only L1 and L2 have differences in the pain part (P = 0.050, P = 0.038). CONCLUSION: Coronal balance of the lumbar spine is associated with knee pain and function. The pelvis plays an important role in maintaining the coronal balance. Both the lumbar spine and the knee joint should be considered when developing the surgical strategy.

As a result of population aging, the number of patients suffering from both knee osteoarthritis (KOA) and degenerative diseases of the lumbar spine is increasing. It has been reported that patients with KOA have less symptomatic recovery after lumbar surgery, and that patients with lumbar degenerative disease have less symptomatic improvement after knee surgery than those without lumbar disease. So the knee and lumbar must be interacting in some way. Previous studies have confirmed the correlation between lumbar sagittal position sequence and KOA. However, no studies have been conducted on coronal sequences and KOA of the lumbar spine. We believe that it is because patients are required to stand naturally when taking coronal x-rays, and natural standing will lead to individual differences in the distance between the feet of patients, thereby preventing analysis. In our study, for the first time, we used a uniform stance to avoid this effect. The advantage of uniform stance is that individual differences can be excluded, and the same patient can be compared before and after treatment (because the natural stance of the patient's feet will be different before and after treatment), which is greatly conducive to the study. Our research found that the offset of the lumbar spine in the coronal position and the distance between the central vertical line of the lumbar spine and the bilateral knee joint are significantly correlated with knee pain and function. This may have some guiding significance for lumbar and knee surgery. For lumbar surgery (such as degenerative scoliosis), previous studies have suggested that short segment fixation is sufficient for patients with small Cobb angle. However, according to our conclusion, this may cause accelerated knee joint degeneration in the patient's later stages, which requires the surgeon to comprehensively evaluate the condition of the patient's knee and lumbar spine, and then formulate surgical strategies. The same is true for knee surgery: previous studies have shown no significant correlation between knee deformity and pain. Therefore, for patients with knee deformity and accompanying pain, knee surgery may not be the best choice, and it is more important to correct the deviation of the spine.

Hybrid Closed Wedge High Tibial Osteotomy Maintains the Leg Length After Surgery Compared With Open Wedge High Tibial Osteotomy.

BACKGROUND: This study aimed to assess the changes in leg length following open wedge high tibial osteotomy (OWHTO) and hybrid closed wedge high tibial osteotomy (h-CWHTO) and whether the change in leg length was associated with preoperative radiographic factors and the change in planned opening or closing width. METHODS: We retrospectively evaluated the data of patients who underwent OWHTO (n=57) and h-CWHTO (n=31) between 2016 and 2019. Standing full-length anteroposterior radiographs were obtained preoperatively and one year postoperatively. Changes in the lower leg and tibial length were measured using radiography, and the planned opening or closing width was decided via operative planning. Flexion contracture was examined preoperatively and one year postoperatively using a goniometer, and the correlation factors and changes in leg length were analyzed using Spearman's rank correlation. RESULTS: In the OWHTO group, the lower leg was significantly longer by a mean of 6.0±8.7 mm compared to that preoperatively (p<0.01); however, no significant difference was observed in the h-CWHTO group (mean, -0.56±11.6 mm) (p=0.788). In the OWHTO group, flexion contracture did not improve after surgery, however, in the h-CWHTO group, flexion contracture significantly improved from -7.1±7.0 degrees to -4.7±6.2 degrees postoperatively (p<0.01). No radiographic factors or bone opening or closing width were associated with changes in leg length in both groups. CONCLUSION: OWHTO led to a significant elongation of the lower leg while leg length was maintained post-h-CWHTO. However, the changes in leg length following both OWHTO and h-CWHTO were not predictable from preoperative radiographic factors or changes in bone width.

Obesity Is Associated with Asymptomatic Vertebral Fractures: A Yakumo Study.

(1) Background: Patients with primary vertebral fracture (VF) are at high risk of re-fracture and mortality. However, approximately two-thirds of patients with VFs receive minimal clinical attention. (2) Methods: The current study aimed to investigate the factors associated with asymptomatic VFs in middle-aged and elderly individuals who underwent resident health examinations. (3) Results: The current study included 217 participants aged > 50 years. VFs were diagnosed based on lateral radiographic images using Genant's semiquantitative (SQ) method. The participants were divided into non-VF (N; SQ grade 0) and asymptomatic VF (F; SQ grades 1-3) groups. Data on body composition, blood tests, quality of life measures, and radiographic parameters were assessed. A total of 195 participants were included in the N group (mean age, 64.8 ± 7.8 years), and 22 were in the F group (mean age, 66.1 ± 7.9 years). The F group had a significantly higher body mass index (BMI), body fat percentage (BF%), and proportion of patients with knee osteoarthritis (KOA) than the N group. The F group had a significantly higher knee joint pain visual analog scale (VAS) score and painDETECT score than the N group. Logistic regression analysis showed that BF% was associated with asymptomatic VFs. (4) Conclusions: Middle-aged and elderly individuals with asymptomatic VF presented with high BMIs, BF%, and incidence of KOA.

A Gender-Bias-Mitigated, Data-Driven Precision Medicine System to Assist in the Selection of Biological Treatments of Grade 3 and 4 Knee Osteoarthritis: Development and Preliminary Validation of precisionKNEE.

Objective To identify key variables predictive of patient responses to microfragmented adipose tissue (MFAT) treatment in knee osteoarthritis (KOA) and evaluate its potential to delay or mitigate the need for total knee replacement (TKR). Methods We utilised a dataset comprising 329 patients treated with MFAT for KOA, incorporating variables such as gender, age, BMI, arthritic aetiology, radiological grade, and Oxford Knee Scores (OKS) pre- and post-treatment. We employed random forest regressors for model training and testing, with gender bias mitigation and outlier detection to enhance prediction accuracy. Model performance was assessed through root mean squared error (RMSE) and mean absolute error (MAE), with further validation in a TKR-suitable patient subset. Results The model achieved a test RMSE of 6.72 and an MAE of 5.38, reflecting moderate predictive accuracy across the patient cohort. Stratification by gender revealed no statistically significant differences between actual and predicted OKS improvements (p-values: males = 0.93, females = 0.92). For the subset of patients suitable for TKR, the model presented an increased RMSE of 9.77 and MAE of 7.81, indicating reduced accuracy in this group. The decision tree analysis identified pre-operative OKS, radiological grade, and gender as significant predictors of post-treatment outcomes, with pre-operative OKS being the most critical determinant. Patients with lower pre-operative OKS showed varying responses based on radiological severity and gender, suggesting a nuanced interaction between these factors in determining treatment efficacy. Conclusion This study highlights the potential of MFAT as a non-surgical alternative for KOA treatment, emphasising the importance of personalised patient assessments. While promising, the predictive model warrants further refinement and validation with a larger, more diverse dataset to improve its utility in clinical decision-making for KOA management.

Biomechanics of the lower limb in patients with mild knee osteoarthritis during the sit-to-stand task.

BACKGROUND: Knee osteoarthritis (KOA) is a prevalent and debilitating condition that markedly affects the sit-to-stand (STS) activity of patients, a prerequisite for daily activities. Biomechanical recognition of movements in patients with mild KOA is currently attracting attention. However, limited studies have been conducted solely on the observed differences in sagittal plane movement and muscle activation. AIM: This study aimed to identify three-dimensional biomechanical and muscle activation characteristics of the STS activity in patients with mild KOA. METHODS: A cross-sectional study was conducted to observe the differences between patients with mild KOA and a control group (CG). It was conducted to observe the differences in muscle activation, including root mean square (RMS%) and integrated electromyography (items), kinematic parameters like range of motion (ROM) and maximum angular velocity, as well as dynamic parameters such as joint moment and vertical ground reaction force (vGRF). RESULTS: Patients with mild KOA had a higher body mass index and longer task duration. In the sagittal plane, patients with KOA showed an increased ROM of the pelvic region, reduced ROM of the hip-knee-ankle joint, and diminished maximum angular velocity of the knee-ankle joint. Furthermore, patients with KOA displayed increased knee-ankle joint ROM in the coronal plane and decreased ankle joint ROM in the horizontal plane. Integrated vGRF was higher in both lower limbs, whereas the vGRF of the affected side was lower. Furthermore, patients showed a decreased peak adduction moment (PADM) and increased peak external rotation moment in the knee joint and smaller PADM and peak internal rotation moment in the ankle joint. The affected side exhibited decreased RMS% and iEMG values of the gluteus medius, vastus medialis, and vastus lateralis muscles, as well as a decreased RMS% of the rectus femoris muscle. Conversely, RMS% and iEMG values of the biceps femoris, lateral gastrocnemius, and medial gastrocnemius muscles were higher. CONCLUSION: The unbalanced activation characteristics of the anterior and posterior muscle groups, combined with changes in joint moment in the three-dimensional plane of the affected joint, may pose a potential risk of injury to the irritated articular cartilage.

Knee osteoarthritis pendulum therapy: In vivo evaluation and a randomised, single-blind feasibility clinical trial.

Background: Exercise is recommended as the first-line management for knee osteoarthritis (KOA); however, it is difficult to determine which specific exercises are more effective. This study aimed to explore the potential mechanism and effectiveness of a leg-swinging exercise practiced in China, called 'KOA pendulum therapy' (KOAPT). Intraarticular hydrostatic and dynamic pressure (IHDP) are suggested to partially explain the signs and symptoms of KOA. As such this paper set out to explore this mechanism in vivo in minipigs and in human volunteers alongside a feasibility clinical trial. The objective of this study is 1) to analyze the effect of KOAPT on local mechanical and circulation environment of the knee in experimental animals and healthy volunteers; and 2) to test if it is feasible to run a large sample, randomized/single blind clinical trial. Methods: IHDP of the knee was measured in ten minipigs and ten volunteers (five healthy and five KOA patients). The effect of leg swinging on synovial blood flow and synovial fluid content depletion in minipigs were also measured. Fifty KOA patients were randomly divided into two groups for a feasibility clinical trial. One group performed KOAPT (targeting 1000 swings/leg/day), and the other performed walking exercise (targeting 4000 steps/day) for 12 weeks with 12 weeks of follow-up. Results: The results showed dynamic intra-articular pressure changes in the knee joint, increases in local blood flow, and depletion of synovial fluid contents during pendulum leg swinging in minipigs. The intra-articular pressure in healthy human knee joints was -11.32 ± 0.21 (cmH2O), whereas in KOA patients, it was -3.52 ± 0.34 (cmH2O). Measures were completed by 100% of participants in all groups with 95-98% adherence to training in both groups in the feasibility clinical trial. There were significant decreases in the Oxford knee score in both KOAPT and walking groups after intervention (p < 0.01), but no significant differences between the two groups. Conclusion: We conclude that KOAPT exhibited potential as an intervention to improve symptoms of KOA possibly through a mechanism of normalising mechanical pressure in the knee; however, optimisation of the method, longer-term intervention and a large sample randomized-single blind clinical trial with a minimal 524 cases are needed to demonstrate whether there is any superior benefit over other exercises. The translational potential of this article: The research aimed to investigate the effect of an ancient leg-swinging exercise on knee osteoarthritis. A minipig animal model was used to establish the potential mechanism underlying the exercise of knee osteoarthritis pendulum therapy, followed by a randomised, single-blind feasibility clinical trial in comparison with a commonly-practised walking exercise regimen. Based on the results of the feasibility trial, a large sample clinical trial is proposed for future research, in order to develop an effective exercise therapy for KOA.

Dense Multi-Scale Graph Convolutional Network for Knee Joint Cartilage Segmentation.

In this paper, we propose a dense multi-scale adaptive graph convolutional network (DMA-GCN) method for automatic segmentation of the knee joint cartilage from MR images. Under the multi-atlas setting, the suggested approach exhibits several novelties, as described in the following. First, our models integrate both local-level and global-level learning simultaneously. The local learning task aggregates spatial contextual information from aligned spatial neighborhoods of nodes, at multiple scales, while global learning explores pairwise affinities between nodes, located globally at different positions in the image. We propose two different structures of building models, whereby the local and global convolutional units are combined by following an alternating or a sequential manner. Secondly, based on the previous models, we develop the DMA-GCN network, by utilizing a densely connected architecture with residual skip connections. This is a deeper GCN structure, expanded over different block layers, thus being capable of providing more expressive node feature representations. Third, all units pertaining to the overall network are equipped with their individual adaptive graph learning mechanism, which allows the graph structures to be automatically learned during training. The proposed cartilage segmentation method is evaluated on the entire publicly available Osteoarthritis Initiative (OAI) cohort. To this end, we have devised a thorough experimental setup, with the goal of investigating the effect of several factors of our approach on the classification rates. Furthermore, we present exhaustive comparative results, considering traditional existing methods, six deep learning segmentation methods, and seven graph-based convolution methods, including the currently most representative models from this field. The obtained results demonstrate that the DMA-GCN outperforms all competing methods across all evaluation measures, providing DSC=95.71% and DSC=94.02% for the segmentation of femoral and tibial cartilage, respectively.

Effect of l-Carnitine Supplementation on Osteoarthritis: A Systematic Review.

SCOPE: Comprehensive assessment of l-carnitine's safety and effectiveness in reducing inflammatory markers in osteoarthritis (OA) patients. METHODS AND RESULTS: Journal articles on l-carnitine for OA are gathered using computer searches of PubMed, Embase, the Cochrane Library, and Web of Science. The kind of literature that is found is restricted to clinical randomized controlled trials (RCTs). The Cochrane Handbook risk of bias assessment tool RevMan 5.4 software is used to conduct a meta-analysis. The systematic assessment comprises eight trials totaling 619 patients; the included studies' quality is mediocre. The study's findings demonstrate that OA patients' Western Ontario and McMaster University (WOMAC) function improves and that treatment efficacy outperforms that of the control group (mean difference [MD] = -7.75, 95% CI [-14.63, -0.86]; Z = 2.21; p = 0.03), WOMAC total (MD = -10.24, 95% CI [-18.97, -1.51]; Z = 2.30; p = 0.02), and visual analogue scale (VAS) pain (MD = -14.01, 95% CI [-16.16, -11.85]; Z = 12.74; p < 0.00001). The studies that are methodically reviewed also discover heterogeneity, which may have resulted from the created pooled data and requires more analysis. CONCLUSION: In patients with OA, l-carnitine effectively decreases clinical signs and symptoms, inflammatory markers, pain, and stiffness indicators, and significantly improves WOMAC and VAS scores.

Advanced Erosive Gouty Arthropathy of the Knee.

A 57-year-old male, with chronic bilateral knee pain and a history of poorly controlled hyperuricemia leading to gouty attacks, underwent orthopedic assessment. Radiographic and MRI findings confirmed chronic gouty arthropathy with erosive bony defects, the most significant on the right proximal tibia. Total knee arthroplasty (TKA) was performed without any complications, addressing the bony defect with cement and a semi-constrained prosthesis. However, a gouty attack led to prolonged wound discharge and periprosthetic infection postoperatively, prompting revision surgery with debridement, antibiotics, and implant retention (DAIR). Intraoperative cultures revealed methicillin-sensitive Staphylococcus aureus (MSSA). The treatment included vancomycin and rifampicin. Two years post-surgery, the patient walked pain-free with a knee range of motion of 0-90º. This report highlights the complexity of treating gout-related knee osteoarthritis, emphasizing early intervention to mitigate risks of extensive surgical procedures and infections.

Assessment of Public Knowledge and Awareness of Knee Osteoarthritis Among Individuals Aged 18-65 in the United Arab Emirates (UAE).

Background Osteoarthritis (OA) is a disease characterized by chronic degeneration of articular cartilage and subchondral bone and inflammation of the synovium, leading to pain and joint disability. The best-known risk factors for OA are increasing age and obesity. Public knowledge of this disease should be assessed as OA, given its high prevalence, which places a significant burden on patients' daily activities and their overall quality of life. Methodology This cross-sectional study was conducted between September and November 2023 among the United Arab Emirates (UAE) population using an online survey form. The survey responses were then analyzed using the SPSS Statistics system (IBM Corp. IBM SPSS Statistics for Windows. Armonk, NY: IBM Corp). Results A total of 363 people participated in this study. The sample showed a high level of knowledge of the underlying mechanism of OA, with 233 (64.2%) correctly identifying the cause. In addition, most of the participants, 244 (67.2%), were aware that OA is a chronic disease, and 243 (66.9%) knew that it is not a rare disease. Moreover, 288 (79.6%) could identify that a high BMI is a major risk factor for OA. Total and partial joint replacement for advanced disease remain the mainstay of treatment. In this study, 241 (66.4%) participants knew that joint replacement surgery was the final option to relieve the symptoms of OA. The total knowledge level of the participants showed that only 74 (20.4%) had good knowledge, 91 (25.1%) had average knowledge, and a majority of 198 (54.5%) had poor knowledge. Our study showed that a higher level of education leads to a better understanding and awareness of OA, which is generally expected (p=0.019). In addition, trust in healthcare and study material as a source of information on the topic significantly impacts knowledge, in contrast to trust in relying on family, media, and personal history (p<0.001). Conclusion OA severely limits daily activities, and the prevalence of OA is anticipated to double in the next decade. In this study, we aimed to determine the level of public knowledge about knee OA. The results indicate that the level of knowledge among individuals aged 18 to 65 in the UAE is low. Accordingly, raising awareness among the public will result in early detection of the disease, clearing misconceptions, and controlling dangerous and unproven procedures for the treatment of OA.

Exploring the Potential of Lateral Wedge Insoles in Alleviating Bone Marrow Lesions in End-Stage Knee Osteoarthritis: A Preliminary Case Report.

The efficacy of lateral wedge insoles (LWIs) in patients with end-stage knee osteoarthritis (OA) is unclear. A 43-year-old male underwent two anterior cruciate ligament reconstructions in his right knee and was later diagnosed with end-stage knee OA. An LWI combining arch support with a lateral heel wedge was fabricated for this patient and used over 12 months. As a result, after 12 months, the bone marrow lesion (BML), as measured by the magnetic resonance imaging Osteoarthritis Knee Score (MOAKS), was downgraded from grade 2 to grade 1. The use of LWI in a patient with end-stage knee OA showed lower co-contraction ratios in knee muscles even after 12 months. The results provide preliminary evidence suggesting the use of LWI in patients with end-stage knee OA has potential benefits for reducing BML.