Associations between biomarkers and skeletal muscle function in individuals with osteoarthritis: a systematic review and meta-analysis.

OBJECTIVES: Skeletal muscle dysfunction is the primary cause of functional limitations in osteoarthritis, associated biomarkers have the potential as targets for early disease identification, diagnosis, and prevention of osteoarthritis disability. This review aimed to identify associations between biomarkers and lower limb skeletal muscle function in individuals with osteoarthritis. METHODS: A systematic literature review and meta-analysis conducted in PubMed, MEDLINE, CINAHL, EMBASE, Scopus, SPORTDiscus and Web of Science databases from inception to 8th August 2023. Two independent reviewers performed the title, abstract, full-text screening, data extraction and methodological quality assessment. A meta-analysis was undertaken based on the available data. RESULTS: Twenty-four studies with 4101 participants with osteoarthritis were included (females: 78%; age range; 49 to 71 years). One study reported muscle-specific biomarkers (n = 3), whilst six studies reported osteoarthritis-specific markers (n = 5). Overall, 93 biomarkers were reported, predominately characterised as inflammatory (n = 35), metabolic (n = 15), and hormones (n = 10). Muscle strength and vitamin D reported a significant association (Hedge's g: 0.58 (Standard Error (SE): 0.27; P = 0.03), k = 3 studies). Walking speed and high-sensitivity C-reactive protein reported no significant associations (Hedge's g: -0.02 (SE: 0.05; P = 0.73), k = 3 studies). CONCLUSION: Associations between biomarkers and lower limb skeletal muscle function in individuals with osteoarthritis was limited, the few studies exploring lower limb muscle measures were mainly secondary outcomes. Furthermore, biomarkers were largely related to overall health, with a lack of muscle specific biomarkers. As such, the mechanistic pathways through which these associations occur are less evident, and difficult to draw clear conclusions on these relationships. TRIAL REGISTRATION: Registered on PROSPERO (CRD42022359405).

Electromyography Parameters to Discriminate Hand Osteoarthritis and Infer Their Functional Impact.

Surface-electromyography (sEMG) allows investigators to detect differences in muscle activation due to hand pathologies. However, its use as a functional indicator and the challenges related to the required normalization have not been fully addressed. This study aimed to use forearm muscle sEMG signals to distinguish between healthy individuals and patients with hand osteoarthritis (HOA). sEMG data were collected from seven sensors on the forearms of twenty-one healthy women and twenty women with HOA during the Sollerman test. Amplitude-based parameters (median and range) were normalized using three methods: maximum signals during Sollerman tasks (MAX), during maximum voluntary contraction tasks (MVC), and during maximum effort grasping (GRASP). Waveform parameters (new-zero-crossing and enhanced-wavelength) were also considered. MVC and GRASP resulted in higher values in patients. Discriminant analysis showed the worst success rates in predicting HOA for amplitude-based parameters, requiring extra tasks for normalization (MVC or GRASP), while when using both amplitude (MAX) and waveform parameters and only Sollerman tasks, the success rate reached 90.2% Results show the importance of normalization methods, highlight the potential of waveform parameters as reliable pathology indicators, and suggest sEMG as a diagnostic tool. Additionally, the comparison of sEMG parameters allows the functional impact of suffering from HOA to be inferred.

The interplay between osteoarthritis and osteoporosis: Mechanisms, implications, and treatment considerations - A narrative review.

This comprehensive review examines the relationship between osteoarthritis (OA) and osteoporosis (OP), two common disorders in the elderly. OA involves joint cartilage degeneration and pain, while OP leads to fractures due to reduced bone mass. Despite different pathologies, both conditions share risk factors such as age and genetics. Studies reveal mixed results: some show higher bone mineral density (BMD) in OA patients, suggesting an inverse relationship, while others find no significant link. Proposed mechanisms include mechanical loading, bone remodeling, and inflammation. Clinical strategies focus on maintaining bone health in OA and monitoring joint health in OP, with treatments like bisphosphonates and exercise. Understanding these interactions is crucial for developing integrated treatments to improve patient outcomes and quality of life. Further research is needed to clarify these complex mechanisms.

Social conditions impact functional outcome in patients with hand osteoarthritis: the low-income hand osteoarthritis (LIHOA) cohort.

BACKGROUND: Hand osteoarthritis (HOA) is a highly prevalent disease that may be impacted by social inequalities. Few studies in HOA are from underdeveloped regions. We intend to contribute to fill this gap presenting clinical characteristics of our low-income HOA cohort (LIHOA). METHODS: Data from 119 patients with a HOA diagnosis fulfilling ACR criteria seen between August 2019 and May 2023 in Fortaleza/Brazil. Evaluations included pain (VAS, visual analogue scale), X-ray (KL, Kellgren-Lawrence), grip and pinch strength (KgF), Cochin hand functional scale (CHFS), FIHOA, and SF-12 scores. Social data included monthly (<1, 1≥/<3, ≥3 MW) minimum wage earnings, occupation, and literacy [4 IF nodes. OA in other joints: 37 (36.2%) spine, 28 (29.4%) knee, 21 (20.5%) bunions. Functional impairment was mild [8 (5-14) median FIHOA]. Median serum CRP was 0.2 mg/dL (0.1-0.4) with 14 (20%) patients above reference value. Mean total KL score was 27.6 ± 13.6 with 21 (23%), 38 (41.7%), and 33 (36.2%) KL2, KL3, and KL4, respectively; 51 (54.8%) and 42 (45.2%) patients declared 9SY including 37.2% with a university degree. Individuals earning <3 MW had lower pinch (p < 0.004) and grip strength (p < 0.01), and higher FIHOA scores (p < 0.007), as compared to ≥3 MW earning group. Literacy or occupation did not impact outcome. SYSADOA were used by 13 (12.7%), 6 used oral and 3 topical anti-inflammatory drugs and 2 used 5 mg/d prednisone. CONCLUSION: Clinical characteristics in our LIHOA cohort mirror those reported in affluent regions. Socioeconomic disparities influenced functional outcome in LIHOA cohort.

Advancements in Subchondral Bone Biomechanics: Insights from Computed Tomography and Micro-Computed Tomography Imaging in Equine Models.

PURPOSE OF REVIEW: This review synthesizes recent advancements in understanding subchondral bone (SCB) biomechanics using computed tomography (CT) and micro-computed tomography (micro-CT) imaging in large animal models, particularly horses. RECENT FINDINGS: Recent studies highlight the complexity of SCB biomechanics, revealing variability in density, microstructure, and biomechanical properties across the depth of SCB from the joint surface, as well as at different joint locations. Early SCB abnormalities have been identified as predictive markers for both osteoarthritis (OA) and stress fractures. The development of standing CT systems has improved the practicality and accuracy of live animal imaging, aiding early diagnosis of SCB pathologies. While imaging advancements have enhanced our understanding of SCB, further research is required to elucidate the underlying mechanisms of joint disease and articular surface failure. Combining imaging with mechanical testing, computational modelling, and artificial intelligence (AI) promises earlier detection and better management of joint disease. Future research should refine these modalities and integrate them into clinical practice to enhance joint health outcomes in veterinary and human medicine.

Similar Pathophysiological Mechanisms Between Osteoarthritis and Vascular Disease.

Osteoarthritis (OA) is a prevalent, chronic joint disorder affecting millions of people worldwide, characterized by articular cartilage degradation, subchondral bone remodeling, synovial cytokine secretion, and osteophyte formation. OA primarily affects the hips, knees, hands, and spine. Patients with OA exhibit a higher prevalence of cardiovascular comorbidities and potentially important associations between OA and cardiovascular diseases have prompted investigations into potentially similar pathophysiological associations. This review explores the coexistence of atherosclerotic peripheral vascular disease (ASPVD) in OA patients, including evidence from a contemporary study suggesting associations between OA and arterial wall thickness and blood flow changes which are characteristic of early atherosclerosis, and which stimulate reactive pathology in endothelial cells. Observations from this study demonstrate elevated arterial flow volume and increased intima-media thickness in arteries ipsilateral to OA knees, suggesting a potential link between OA and arterial wall disease. We further explore the intricate relationship between the vascular system and skeletal health, highlighting bidirectional interactions among endothelial cells, inflammatory cells, and various bone cells. Mechanical endothelial cell dysfunction is discussed, emphasizing the impact of vessel wall material changes and endothelial cell responses to alterations in fluid shear stress. Inflammatory changes in OA and ASPVD are also explored, showcasing shared pathophysiological processes involving immune cell infiltration and pro-inflammatory cytokines. Additionally, the role of hypofibrinolysis in OA and ASPVD is discussed, highlighting similarities in elevations of the hypercoagulative and hypofibrinolytic factor, plasminogen activator inhibitor (PAI-1). The review suggests a provocative relationship among low-grade chronic inflammation, endothelial dysfunction, and hypofibrinolytic states in OA and ASPVD, warranting further investigation. In conclusion, this review provides an exploration of the possible associations between OA and ASPVD. While the ongoing study's findings and other reports are observational, they suggest shared pathophysiological processes and emphasize the need for further research to elucidate additional potentially correlative linkages between these conditions. Understanding common molecular pathways may pave a way for targeted interventions that address both OA and ASPVD.

Proprioceptive neuromuscular facilitation therapy versus manual therapy in patients with neck pain: a randomised controlled trial.

OBJECTIVE: To compare the effects of proprioceptive neuromuscular facilitation therapy with manual therapy in improving the range of motion, decreasing pain, and improving activity of daily living in patients with neck pain. DESIGN: Double-blinded, randomized, experimental study. PATIENTS: Women aged 45-65 with cervical pain due to osteoarthritis of the vertebral body and intervertebral disc. METHODS: A total of 93 randomly selected females were included in the study. They were randomly divided into 2 groups. One received proprioceptive neuromuscular facilitation treatment and the other received manual therapy. To evaluate functional capabilities, the Oswestry Disability Index and range of motion measure were used. To evaluate changes in subjective experience of pain the Visual Analogue Scale was used. RESULTS: In terms of the activities of daily living, pain, and range of motion of flexion, extension, lateral flexion to the right and left, and rotation to the right and left improvement in group I compared with group II was statistically significant (p < 0.05) at 2 weeks and 3 months' follow-up. CONCLUSION: Treatment according to proprioceptive neuromuscular facilitation is a better method in comparison with manual therapy regarding improvement of pain, range of motion, and daily functioning in patients with cervical pain.

Efficacy of denervation for osteoarthritis in the proximal interphalangeal joint (DOP): protocol of a randomized controlled trial.

BACKGROUND: Osteoarthritis (OA) contributes increasingly to disability worldwide. There is ample high-quality research on the treatment of knee and hip OA, whereas research on surgical and non-surgical treatment in hand OA is sparse. Limited evidence suggests that education and exercise may improve pain, function, stiffness, and grip strength in hand OA. The established surgical options in hand OA have disadvantages. Prostheses preserve motion but have a high complication rate, whereas fusions decrease function due to limited movement. There is an unmet need for high-quality research on treatment options for hand OA and a need for the development of effective and safe movement-sparing therapies. This study aims to compare the effects of a motion-preserving surgical treatment (denervation of the proximal interphalangeal (PIP) joint) with a patient education and exercise program on patient-reported outcomes and objective function in painful PIP OA. METHODS: In this parallel-group, two-armed, randomized, controlled superiority trial (RCT), 90 participants are assigned to surgical PIP joint denervation or education and exercise. Pain on load 1 year after intervention is the primary outcome measure. Secondary outcome measures include pain at rest, Patient-Rated Wrist and Hand Evaluation (PRWHE), HQ8 score, EQ5D-5L, objective physical function, complications, two-point discrimination, Mini Sollerman, consumption of analgesics, and the need for further surgery. Assessments are performed at baseline, 3 and 6 months, and 1 year after intervention. DISCUSSION: There are no previous RCTs comparing surgical and non-surgical treatment in PIP OA. If patient education plus exercise or PIP denervation improve function, these treatments could be implemented as first-line treatment options in PIP OA. However, if denervation does not achieve better results than non-surgical treatment, it is not justified to use in PIP OA. TRIAL REGISTRATION: Prospectively registered in ClinicalTrials.gov (NCT05980793) on 8 August 2023. URL https://classic. CLINICALTRIALS: gov/ct2/show/NCT05980793 .

Unraveling the joints: a narrative review of osteoarthritis.

Osteoarthritis (OA) is a chronic and progressive degenerative disease that affects joint structures, such as the hips, knees, and hands, involving the articular cartilage, subchondral bone, ligaments, capsule, and synovium. OA is characterized by a progressive degeneration of the joint structures, resulting in pain and decreased quality of life. Local and systemic risk factors pave the way for OA development. Different phenotypes may be identified, but three main molecular mechanisms define the endotypes: the bone-driven endotype, the synovitis-driven endotype, and the cartilage-driven endotype. The hallmark of OA pathophysiology involves more than just mechanical degradation; it includes the release of pro-inflammatory mediators, such as interleukins and TNF-α, which elucidates the significant roles of metabolic syndrome, diabetes, and cellular senescence in its development. OA is distinguished by a clinical presentation that varies significantly between people and is marked by pain, stiffness, and functional impairments. The clinical course can be split into Pre-OA, Early OA, Evident OA, and End-Stage. Depending on the stage of the disease, OA diagnosis frequently necessitates a complex strategy that combines clinical evaluation to detect joint tenderness, range of motion, and joint swelling or abnormalities, medical history assessment, imaging modalities, and laboratory investigations. There is no known treatment for OA, and different therapies are usually evaluated based on the stage of the disease to minimize pain and stiffness while maintaining joint function. Treatments are divided into the reduction of modifiable risk factors, pharmacologic therapies, rehabilitation, complementary therapies, interventional pain procedures, and surgery. OA clinical heterogeneity underlines the importance of prevention, early diagnosis, and identifying the phenotype and endotype to tailor the treatment.

Rheumatoid Arthritis and Osteoarthritis in Adult Women: A Functional Approach to the Stomatognathic System.

Rheumatoid arthritis and osteoarthritis both affect the articular cartilage, and are characterized by signs and symptoms that can affect the functions of the human body. This cross-sectional observational study evaluated electromyographic activity in the masseter and temporalis muscles, molar bite force, and mandibular mobility in adult women with rheumatoid arthritis or osteoarthritis. A total of 42 women were distributed into 3 groups: rheumatoid arthritis group (ARG, n=14); osteoarthritis group (OAG, n=14); and a healthy control group (CG, n=14). Electromyography was used to evaluate mandibular tasks at rest, right and left laterality, protrusion, and dental clenching during maximum voluntary contraction, with and without parafilm, and a dynamometer was used to analyse the right and left molar bite forces. A digital caliper was used to measure the range of mandibular movement for maximum mouth opening, right and left laterality, and protrusion. Statistical analyses were performed, including analysis of variance and Tukey's test (P<0.05). Electromyography showed no significant differences between the groups when evaluating the masticatory muscles during the mandibular tasks. Significant difference was observed between the ARG and CG, however, in the maximum right (P=0.007) and left (P=0.02) molar bite forces. Significant difference was observed in the maximum mouth opening of the ARG and OAG groups compared with that of the CG (P=0.009), suggesting that adult women with rheumatoid arthritis or osteoarthritis experience functional alterations in the stomatognathic system, particularly in molar bite force and maximum mouth opening.

The role of obesity and adipose tissue dysfunction in osteoarthritis pain.

Obesity has a pivotal and multifaceted role in pain associated with osteoarthritis (OA), extending beyond the mechanistic influence of BMI. It exerts its effects both directly and indirectly through various modifiable risk factors associated with OA-related pain. Adipose tissue dysfunction is highly involved in OA-related pain through local and systemic inflammation, immune dysfunction, and the production of pro-inflammatory cytokines and adipokines. Adipose tissue dysfunction is intricately connected with metabolic syndrome, which independently exerts specific effects on OA-related pain, distinct from its association with BMI. The interplay among obesity, adipose tissue dysfunction and metabolic syndrome influences OA-related pain through diverse pain mechanisms, including nociceptive pain, peripheral sensitization and central sensitization. These complex interactions contribute to the heightened pain experience observed in individuals with OA and obesity. In addition, pain management strategies are less efficient in individuals with obesity. Importantly, therapeutic interventions targeting obesity and metabolic syndrome hold promise in managing OA-related pain. A deeper understanding of the intricate relationship between obesity, metabolic syndrome and OA-related pain is crucial and could have important implications for improving pain management and developing innovative therapeutic options in OA.

Ion channels in osteoarthritis: emerging roles and potential targets.

Osteoarthritis (OA) is a highly prevalent joint disease that causes substantial disability, yet effective approaches to disease prevention or to the delay of OA progression are lacking. Emerging evidence has pinpointed ion channels as pivotal mediators in OA pathogenesis and as promising targets for disease-modifying treatments. Preclinical studies have assessed the potential of a variety of ion channel modulators to modify disease pathways involved in cartilage degeneration, synovial inflammation, bone hyperplasia and pain, and to provide symptomatic relief in models of OA. Some of these modulators are currently being evaluated in clinical trials. This review explores the structures and functions of ion channels, including transient receptor potential channels, Piezo channels, voltage-gated sodium channels, voltage-dependent calcium channels, potassium channels, acid-sensing ion channels, chloride channels and the ATP-dependent P2XR channels in the osteoarthritic joint. The discussion spans channel-targeting drug discovery and potential clinical applications, emphasizing opportunities for further research, and underscoring the growing clinical impact of ion channel biology in OA.

Non-invasive electroencephalography in awake cats: Feasibility and application to sensory processing in chronic pain.

BACKGROUND: Feline osteoarthritis (OA) leads to chronic pain and somatosensory sensitisation. In humans, sensory exposure can modulate chronic pain. Recently, electroencephalography (EEG) revealed a specific brain signature to human OA. However, EEG pain characterisation or its modulation does not exist in OA cats, and all EEG were conducted in sedated cats, using intradermal electrodes, which could alter sensory (pain) perception. NEW METHOD: Cats (n=11) affected by OA were assessed using ten gold-plated surface electrodes. Sensory stimuli were presented in random orders: response to mechanical temporal summation, grapefruit scent and mono-chromatic wavelengths (500 nm-blue, 525 nm-green and 627 nm-red light). The recorded EEG was processed to identify event-related potentials (ERP) and to perform spectral analysis (z-score). RESULTS: The procedure was well-tolerated. The ERPs were reported for both mechanical (F3, C3, Cz, P3, Pz) and olfactory stimuli (Cz, Pz). The main limitation was motion artifacts. Spectral analysis revealed a significant interaction between the power of EEG frequency bands and light wavelengths (p<0.001). All wavelengths considered, alpha band proportion was higher than that of delta and gamma bands (p<0.044), while the latter was lower than the beta band (p<0.016). Compared to green and red, exposure to blue light elicited distinct changes in EEG power over time (p<0.001). COMPARISON WITH EXISTING METHOD: This is the first demonstration of EEG feasibility in conscious cats with surface electrodes recording brain activity while exposing them to sensory stimulations. CONCLUSION: The identification of ERPs and spectral patterns opens new avenues for investigating feline chronic pain and its potential modulation through sensory interventions.

Comparison of nociceptor properties using electrophysiology in preclinical models of osteoarthritis.

Osteoarthritis (OA) pain originates in the joint by sensitization of articular nociceptors. While behavioural assessments provide valuable information regarding pain symptoms, the techniques are subjective and open to interpretation by the experimenter. This study used in vivo electrophysiological approaches to measure objectively joint nociceptor properties in three rodent models of OA. Single unit extracellular recordings of joint mechanosensitive afferents were carried out in male and female rats following either (1) transection of the medial meniscus (MMT: post-traumatic OA), (2) intra-articular injection of sodium monoiodoacetate (MIA: chemically-induced OA), or (3) intra-articular injection of lysophosphatidic acid (LPA: neuropathic OA). In naïve male control rats, the mechanical threshold of joint mechanonociceptors (23.5 ± 1.8 mNm) was significantly reduced with MMT (9.4 ± 1.1 mNm) and MIA (15.1 ± 1.6 mNm). In females, the mechanical threshold of naïve rats (23.2 ± 3.1 mNm) was reduced following induction of MMT (8.3 ± 1.0 mNm) and LPA (10.6 ± 2.2 mNm). Afferent firing frequency increased in male MMT (∼275 %), LPA (∼175 %), MIA (225 %), and female MMT (∼146 %), LPA (∼200 %), and MIA (∼192 %). Mechanical threshold and evoked firing were negatively correlated in all models for both sexes except LPA rats (male + female) and female MMT. These data indicate that MMT, MIA, and LPA induce peripheral sensitization of joint afferents thereby validating their use in OA pain studies.

Angiogenesis unveiled: Insights into its role and mechanisms in cartilage injury.

Osteoarthritis (OA) commonly results in compromised mobility and disability, thereby imposing a significant burden on healthcare systems. Cartilage injury is a prevalent pathological manifestation in OA and constitutes a central focus for the development of treatment strategies. Despite the considerable number of studies aimed at delaying this degenerative process, their outcomes remain unvalidated in preclinical settings. Recently, therapeutic strategies focused on angiogenesis have attracted the growing interest from researchers. Thus, we conducted a comprehensive literature review to elucidate the current progress in research and pinpoint research gaps in this domain. Additionally, it provides theoretical guidance for future research endeavors and the development of treatment strategies.

Immunomodulation and fibroblast dynamics driving nociceptive joint pain within inflammatory synovium: Unravelling mechanisms for therapeutic advancements in osteoarthritis.

OBJECTIVE: Synovitis is a widely accepted sign of osteoarthritis (OA), characterised by tissue hyperplasia, where increased infiltration of immune cells and proliferation of resident fibroblasts adopt a pro-inflammatory phenotype, and increased the production of pro-inflammatory mediators that are capable of sensitising and activating sensory nociceptors, which innervate the joint tissues. As such, it is important to understand the cellular composition of synovium and their involvement in pain sensitisation to better inform the development of effective analgesics. METHODS: Studies investigating pain sensitisation in OA with a focus on immune cells and fibroblasts were identified using PubMed, Web of Science and SCOPUS. RESULTS: In this review, we comprehensively assess the evidence that cellular crosstalk between resident immune cells or synovial fibroblasts with joint nociceptors in inflamed OA synovium contributes to peripheral pain sensitisation. Moreover, we explore whether the elucidation of common mechanisms identified in similar joint conditions may inform the development of more effective analgesics specifically targeting OA joint pain. CONCLUSION: The concept of local environment and cellular crosstalk within the inflammatory synovium as a driver of nociceptive joint pain presents a compelling opportunity for future research and therapeutic advancements.

Labor Force Participation in Adults With Osteoarthritis or Joint Symptoms Typical of Osteoarthritis: Findings From a Canadian Longitudinal Study on Aging.

OBJECTIVE: The purpose of the study is to examine the relationship between osteoarthritis (OA) and joint symptoms typical of OA and labor force participation. METHODS: Data are from the baseline questionnaire of the Canadian Longitudinal Study on Aging for respondents aged 45 to 74 years at baseline (n = 24,427). Individuals were categorized into one of five mutually exclusive arthritis status groups: diagnosed OA, diagnosed other type of arthritis, two to three symptomatic joint sites and no diagnosed arthritis, one symptomatic joint site and no diagnosed arthritis, and no arthritis and no joint symptoms. Age-stratified robust log-Poisson regression analysis was used to examine the association between arthritis status and labor force participation. RESULTS: Overall, 39% of the analytic sample reported being out of the labor force. Those with OA aged 45 to 54 and 55 to 64 years were significantly more likely to be out of the labor force than those with no arthritis or no joint symptoms, with prevalence ratios (PRs) of 1.34 (95% confidence interval [CI] 1.10-1.65) and 1.13 (95% CI 1.06-1.21), respectively, with similar results for those with two to three joint symptoms and no OA in the 45 to 54 years age group (PR 1.37 [95% CI 1.07-1.76]). There was no difference for those aged 65 to 74 years. Being an informal caregiver increased the likelihood of nonparticipation in the labor force for those aged 55 to 64 years (PR 1.09 [95% CI 1.04-1.15]). CONCLUSION: Our results suggest that an exclusive reliance on an OA diagnosis to understand impact on labor force participation may miss a large segment of the middle-aged population, which may have undiagnosed OA or be at greater risk of OA because of joint problems.

Patient-Experience of Trapeziectomy for Trapeziometacarpal Osteoarthritis in Wide-Awake Local Anesthesia no Tourniquet, 2-Year Follow-up.

PURPOSE OF THE STUDY: The purpose of this study was to assess the patient experience of trapeziectomy under WALANT for trapeziometacarpal joint (TMJ) osteoarthritis (OA) in a prospective study with 2-year follow-up. MATERIAL AND METHODS: The study included 23 patients with TMJ OA undergoing trapeziectomy with WALANT. All patients were seen by a hand therapist preoperatively and at 3, 12, and 24 months postoperatively. At each visit, VAS pain scores, thumb range of motion, grip strength, and Disabilities of the Arm, Shoulder and Hand (DASH) score were assessed. The Picker Patient Experience (PPE-15) questionnaire was administered within 2 weeks of surgery. RESULTS: All 23 patients completed the PPE-15 questionnaire. Their mean age was 64 years. The 21 patients who remained at the 24-month follow-up all said they would choose the same anaesthesia method again. At this follow-up, VAS pain scores, thumb range of motion, key pinch grip and DASH scores had improved significantly, while thumb opposition and hand grip strength remained largely unchanged. The majority of patients felt well informed before and during the procedure, and all patients rated pain relief as good or satisfactory. Nearly 40% of patients reported receiving inadequate information about the postoperative medications. DISCUSSION: Patients have a positive attitude to trapeziectomy with WALANT, and seem to prefer WALANT over other methods of anaesthesia. Trapeziectomy with WALANT for TMJ OA is a safe procedure and appears to give a functional outcome similar to trapeziectomy under general anaesthesia. CONCLUSIONS: Trapeziectomy with WALANT for TMJ OA is safe, preferred by patients and has similar clinical outcome as trapeziectomy in general anesthesia. KEY WORDS: trapeziectomy, osteoarthritis, WALANT.

Effective shape of ball-and-socket prosthesis in restoring range of thumb motion for total thumb carpometacarpal joint arthroplasty: three-dimensional motion analysis.

PURPOSE: Total joint arthroplasty (TJA) has often been used to treat thumb carpometacarpal (CMC) osteoarthritis (OA). However, guidelines for the CMC prosthesis shape remain unclear. This study aimed to identify the effective shape of a ball-and-socket prosthesis in restoring the range of thumb motion after TJA. METHODS: The participants were 10 healthy young adult men (22-32 years; 26.8 ± 3.57 [mean ± SD]). CT scans were performed in eight static limb positions during abduction and flexion. We defined three design variables (offset R, height H, and neck rotation angle Φ) as the variables that determine the basic shape of the ball-and-socket prosthesis. The ideal values of these design variables were examined based on the results of a 3D motion analysis, which evaluated the change in the posture of the first metacarpal (r, h, and φ corresponding to R, H, and Φ, respectively) relative to the center of rotation (COR) during abduction and flexion. We also simulated the effect of these design variables on the range of thumb motion after TJA using 3D CAD. RESULTS: We found that the values of r and h averaged over all limb positions were 6.92 ± 1.60 mm and 51.02 ± 1.67 mm, respectively, showing that these values remained constant regardless of limb position. In contrast, φ changed significantly. The simulation results indicated that Φ affected the range of thumb motion after TJA, and Φ = 0° relatively reproduced all limb positions compared to other values. CONCLUSION: Our results suggested that the desirable values of R and H were the average of r and h over several limb positions and that Φ = 0° was effective in restoring the range of thumb motion after TJA. Our results will provide surgeons with new guidelines for selecting a prosthesis.