Maintenance of the paraspinal muscles may protect against radiographic knee osteoarthritis.

BACKGROUND: Knee osteoarthritis (OA) is an increasing health problem worldwide. So far, only obesity and quadriceps weakness are identified as modifiable risk factors for knee OA. Core muscle strengthening is becoming increasingly popular among older adults because of its ability to enhance the activities of daily living during old age. This study investigated the associations of the size and quality of the abdominal trunk muscles with radiographic knee osteoarthritis (RKOA). METHODS: From 2012 to 2016, data were collected from 146 males and 135 females (age 63.9±13.4 years, BMI 23.2±3.8 kg/m2) at annual musculoskeletal examinations, including knee radiographs and body composition analyses, by dual-energy X-ray absorptiometry. Cross-sectional areas of abdominal trunk muscles were measured using a single-slice computed tomography scan image obtained at the level of the umbilicus. RESULTS: The prevalence of RKOA was 21.2% in males and 28.1% in females. Compared to subjects without RKOA, subjects with RKOA were ~6 years older and had smaller paraspinal muscle (38.4±8.7 vs 33.1±10.1 cm2, p<0.01 in males; 24.1±7.1 vs 20.7±7.5 cm2, p<0.05 in females). In contrast, there was no decrease in appendicular or total lean mass, and only in females, BMI and total fat mass (FM) were higher in subjects with RKOA (21.5±3.5 vs 24.5±4.4 kg/m2, 16.7±7.0 vs 20.5±7.7 kg, respectively, both p<0.01). After adjusting for age and sex, smaller cross-sectional area/lower attenuation value of the paraspinal muscles was associated with RKOA (both p<0.05), while greater appendicular or total lean mass as well as greater FM was associated with RKOA. The size and quality of the paraspinal muscles were not associated with knee pain or habitual exercise. CONCLUSION: Small, poor-quality paraspinal muscles may be linked to a higher risk of RKOA, but appendicular or total lean mass was not a good predictor of RKOA.

Midterm Clinical Outcomes and MR Imaging Changes after Transcatheter Arterial Embolization as a Treatment for Mild to Moderate Radiographic Knee Osteoarthritis Resistant to Conservative Treatment.

PURPOSE: To describe the safety and efficacy of transcatheter arterial embolization for mild to moderate radiographic knee osteoarthritis (OA) that is resistant to conservative treatment. MATERIALS AND METHODS: This prospective study included 72 patients (95 knees) with OA of Kellgren-Lawrence (KL) grade 1-3 and persisting moderate to severe pain that was resistant to conservative management who were treated with transcatheter arterial embolization between July 2012 and March 2016. Clinical outcomes were evaluated at 1, 4, and 6 months and then every 6 months for a maximum of 4 years. The Whole-Organ Magnetic Resonance Imaging Score (WORMS) was evaluated at baseline and at 2 years after embolization in 35 knees. RESULTS: Abnormal neovessels were identified in all cases. There were no major adverse events related to the procedures. Mean Western Ontario and McMaster Universities Osteoarthritis Index pain scores significantly decreased from baseline to 1, 4, 6, 12, and 24 months after treatment (12.1 vs 6.2, 4.4, 3.7, 3.0, and 2.6; all P < .001). The cumulative clinical success rates at 6 months and 3 years after embolization were 86.3% (95% confidence interval [CI], 78%-92%) and 79.8% (95% CI, 69%-87%), respectively. WORMS scores at 2 years after embolization in 35 knees showed significant improvement of synovitis vs baseline (P = .0016) and no osteonecrosis or other evidence indicating aggressive progression of degenerative changes. CONCLUSIONS: Transcatheter arterial embolization significantly improved pain symptoms and clinical function in patients with mild to moderate knee OA that was resistant to conservative treatment.

What is the most effective posture to conduct vibration from the lower to the upper extremities during whole-body vibration exercise?

BACKGROUND: Whole-body vibration (WBV) exercise is widely used for training and rehabilitation. However, the optimal posture for training both the upper and lower extremities simultaneously remains to be established. OBJECTIVES: The objective of this study was to search for an effective posture to conduct vibration from the lower to the upper extremities while performing WBV exercises without any adverse effects. METHODS: Twelve healthy volunteers (age: 22-34 years) were enrolled in the study. To measure the magnitude of vibration, four accelerometers were attached to the upper arm, back, thigh, and calf of each subject. Vibrations were produced using a WBV platform (Galileo 900) with an amplitude of 4 mm at two frequencies, 15 and 30 Hz. The following three postures were examined: posture A, standing posture with the knees flexed at 30°; posture B, crouching position with no direct contact between the knees and elbows; and posture C, crouching position with direct contact between the knees and elbows. The ratio of the magnitude of vibration at the thigh, back, and upper arm relative to that at the calf was used as an index of vibration conduction. RESULTS: Posture B was associated with a greater magnitude of vibration to the calf than posture A at 15 Hz, and postures B and C were associated with greater magnitudes of vibration than posture A at 30 Hz. Posture C was associated with a vibration conduction to the upper arm that was 4.62 times and 8.26 times greater than that for posture A at 15 and 30 Hz, respectively. CONCLUSION: This study revealed that a crouching position on a WBV platform with direct contact between the knees and elbows was effective for conducting vibration from the lower to the upper extremities.

Transcatheter arterial embolization as a treatment for medial knee pain in patients with mild to moderate osteoarthritis.

PURPOSE: Osteoarthritis is a common cause of pain and disability. Mild to moderate knee osteoarthritis that is resistant to nonsurgical options and not severe enough to warrant joint replacement represents a challenge in its management. On the basis of the hypothesis that neovessels and accompanying nerves are possible sources of pain, previous work demonstrated that transcatheter arterial embolization for chronic painful conditions resulted in excellent pain relief. We hypothesized that transcatheter arterial embolization can relieve pain associated with knee osteoarthritis. METHODS: Transcatheter arterial embolization for mild to moderate knee osteoarthritis using imipenem/cilastatin sodium or 75 µm calibrated Embozene microspheres as an embolic agent has been performed in 11 and three patients, respectively. We assessed adverse events and changes in Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scores. RESULTS: Abnormal neovessels were identified within soft tissue surrounding knee joint in all cases by arteriography. No major adverse events were related to the procedures. Transcatheter arterial embolization rapidly improved WOMAC pain scores from 12.2 ± 1.9 to 3.3 ± 2.1 at 1 month after the procedure, with further improvement at 4 months (1.7 ± 2.2) and WOMAC total scores from 47.3 ± 5.8 to 11.6 ± 5.4 at 1 month, and to 6.3 ± 6.0 at 4 months. These improvements were maintained in most cases at the final follow-up examination at a mean of 12 ± 5 months (range 4-19 months). CONCLUSION: Transcatheter arterial embolization for mild to moderate knee osteoarthritis was feasible, rapidly relieved resistant pain, and restored knee function.