Burden of knee osteoarthritis in the Middle East and North Africa (MENA): an epidemiological analysis from 1990 to 2019.

BACKGROUND: Knee is the most affected joint in osteoarthritis (OA) and accounts for almost four-fifths of the burden of OA globally. We aimed to explore the prevalence, incidence, trends, and burden of knee OA during 1990-2019 in the Middle East and North Africa (MENA) region, using the Global Burden of Disease (GBD) study data. METHODS: This is an epidemiological study based on the GBD data from 1990 to 2019 on knee OA in MENA countries. The prevalence, incidence, and years lived with disability (YLD) numbers of knee OA were obtained for both genders. Similarly, age-standardized rates of these indexes per 100,000 people and the proportion of total YLD caused by knee OA in each country and for the MENA region were evaluated. RESULTS: The prevalence of knee osteoarthritis in the MENA region increased 2.88-fold, from 6.16 million cases to 17.75 million, between 1990 and 2019. Furthermore, in 2019, knee osteoarthritis accounted for approximately 1.69 million (95% UI 1.46-1.95) incident cases in MENA. The age-standardized prevalence was higher in women between 1990 (3.94% [95% UI 3.39-4.55] in women and 3.24% [95% UI 2.79-3.72] in men) and 2019 (4.44% [95% UI 3.83-5.10] in women and 3.66% [3.14-4.21] in men). Total YLDs due to knee osteoarthritis increased by more than 2.88-fold, rising from 196.29 thousand [95% UI 97.17-399.29] in 1990 to 564.66 thousand [95% UI 275.06-1,150.68] in 2019. In the year 2019, Kuwait, Turkey, and Oman had the highest age-standardized prevalence (4.42% [95% UI 3.79-5.08]), YLD (132.41 [95% UI 65.79-267.56] per 100 000), and increase (21.17%) in YLD compared with 1990 in MENA region, respectively. CONCLUSION: The prevalence of and YLDs due to knee OA in MENA has escalated over the last three decades. Considering the expanding burden of knee OA in MENA, policymakers should be more concerned to implement preventive strategies.

2018 International Consensus Meeting on Musculoskeletal Infection: Research Priorities from the General Assembly Questions.

Musculoskeletal infections (MSKI) remain the bane of orthopedic surgery, and result in grievous illness and inordinate costs that threaten healthcare systems. As prevention, diagnosis, and treatment has remained largely unchanged over the last 50 years, a 2nd International Consensus Meeting on Musculoskeletal Infection (ICM 2018, https://icmphilly.com) was completed. Questions pertaining to all areas of MSKI were extensively researched to prepare recommendations, which were discussed and voted on by the delegates using the Delphi methodology. The questions, including the General Assembly (GA) results, have been published (GA questions). However, as critical outcomes include: (i) incidence and cost data that substantiate the problems, and (ii) establishment of research priorities; an ICM 2018 research workgroup (RW) was assembled to accomplish these tasks. Here, we present the result of the RW consensus on the current and projected incidence of infection, and the costs per patient, for all orthopedic subspecialties, which range from 0.1% to 30%, and $17,000 to $150,000. The RW also identified the most important research questions. The Delphi methodology was utilized to initially derive four objective criteria to define a subset of the 164 GA questions that are high priority for future research. Thirty-eight questions (23% of all GA questions) achieved the requisite > 70% agreement vote, and are highlighted in this Consensus article within six thematic categories: acute versus chronic infection, host immunity, antibiotics, diagnosis, research caveats, and modifiable factors. Finally, the RW emphasizes that without appropriate funding to address these high priority research questions, a 3rd ICM on MSKI to address similar issues at greater cost is inevitable.

Open Versus Arthroscopic Mosaicplasty of the Knee: A Cadaveric Assessment of Accuracy of Graft Placement Using Navigation.

PURPOSE: The purpose of this study was to compare an open freehand mosaicplasty technique with an arthroscopic technique for the treatment of osteochondral lesions by measuring the instrument deviation, quantifying this deviation, and providing numerical information on the difference in the outcomes of these techniques. METHODS: Four cadaveric knees were used. Reference markers were attached to the femur, tibia, and donor/recipient site guides. A total of 10 osteochondral grafts were harvested and inserted into recipient sites arthroscopically and 10 similar grafts were inserted freehand. The angles of graft removal and placement were calculated for each of the surgical groups compared. Ostensibly, a navigation system was used as an aid, to measure the graft placement parameters. RESULTS: Statistical analysis revealed that there was no statistically significant difference between the arthroscopic method and the freehand method regarding the angle of graft removal at the donor site (P = .162), recipient site plug removal angle (P = .731), and recipient site graft placement angle (P = .630). In the freehand group, the mean angle of graft removal at the donor site was 12°, the mean angle of recipient site plug removal was 10.7°, and the mean angle of recipient site plug placement was 10.6°. Using the arthroscopic technique, the mean angle of graft removal at the donor site was 17.14°, the mean angle of recipient site plug removal was 12.0°, and the mean angle of recipient site graft placement was 10.14°. CONCLUSIONS: Our study revealed there was no statistically significant difference regarding precision and accuracy during harvesting, recipient site preparation, and plug placement between the 2 techniques. CLINICAL RELEVANCE: Controversy exists whether an open or arthroscopic osteoarticular transfer system (OATS) technique provides superior accuracy. According to our results, there is no statistically significant difference regarding better visualization, precision, and accuracy between the freehand and arthroscopic techniques. However, larger number of specimens are required for study.