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1.
Medicine (Baltimore) ; 99(40): e22538, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019462

RESUMO

The current studies revealed inconsistent relationship between reproductive factors and osteoarthritis. Community-based research has not been conducted in China. The study was to examine the association of reproductive factors with the prevalence of knee osteoarthritis (OA).Through a multistage stratified random sampling method, 10 streets or villages from 5 cities in Hunan province were randomly selected, a total 2746 eligible women aged 50 to 83 were recruited in this cross-sectional study. A structured questionnaire including demographic factors, socio-economic status, reproductive factors, and knee OA was used. According to the criteria of American College of Rheumatology, clinical knee OA was assessed by doctors in community or village health clinics for knee pain, age, morning stiffness, crepitus on active motion or for knee pain, morning stiffness, crepitus on active motion, and tenderness of the bony navigation of the joint. Self-reported age of menarche, parity, abortion history, and menopausal status were collected.The prevalence of knee OA was 13.44%. Abortion is associated with knee OA (odds ratio [OR] = 1.271, 95% confidence interval [CI] = 1.007, 1.606), but age at menarche, parity, and menopausal status were not the factors. Furthermore, age (OR = 1.040, 95% CI = 1.020, 1.060), weight (OR = 1.019, 95% CI = 1.004, 1.035), higher education level (OR = 1.530, 95% CI = 1.121, 2.088), higher monthly household income (OR = .583, 95% CI = 0.441, 0.770 for 3000-4999 ¥ and OR = 0.599, 95% CI = 0.431, 0.833 for 5000 ¥ or more), and chronic gastritis (OR = 3.364, 95% CI = 2.548, 4.442) were associated with knee OA.Abortion may increase the risk of knee OA. Special attention should be paid to women with a history of abortion, and women who are planning to abort should be informed of the risk of knee OA later in life. The relationship between abortion and knee OA should be interpreted with caution and further confirmed.


Assuntos
Aborto Espontâneo/epidemiologia , Osteoartrite do Joelho/epidemiologia , Osteoartrite do Joelho/etiologia , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/patologia , Dor/diagnóstico , Dor/epidemiologia , Prevalência , Radiografia/métodos , Medição de Risco , Autorrelato , Classe Social , Inquéritos e Questionários
2.
Zhonghua Yi Xue Za Zhi ; 100(31): 2429-2434, 2020 Aug 18.
Artigo em Chinês | MEDLINE | ID: mdl-32819058

RESUMO

Objective: To investigate the application and efficacy of the one-stage total knee arthroplasty (TKA) of intra-articular compensation osteotomy in knee osteoarthritis(KOA) patients with extra-articular deformity (EAD). Methods: A retrospective study of 9 patients with end-stage KOA and EAD undergoing one-stage TKA from January 2014 to December 2017 in the First Affiliated Hospital of Zhejiang Chinese Medical University was performed. There were 3 males and 6 females with an average age of 56 years(range, 19-77 years);5 cases of simple coronal deformity (varus 10°-27°, mean 18.2°), 3 cases of sagittal deformity (recurvatum15°-35°, mean 22.6°), 1 case combined with coronal and sagittal deformity (varus 16°, recurvatum 31°); hemophilia dysplasia in 1 case, fracture malformation in 8 cases. Main outcome measures included the mechanical axis, range of motion (ROM) and Hospital for Special Surgery Knee Score (HSS). Results: The mean follow-up period was 33.2 months (range, 25-47 months). The mechanical axis angle was restored from 12.4°±4.1°to 1.4°±0.9°(t=7.954, P<0.01). The HSS was improved from 28±14 preoperatively to 87±7 postoperatively (t=-11.174, P=0.013). The ROM increased from 56°±22°to 99°±8° (t=-5.480, P=0.010). There was no complications such as joint instability, infection, fracture, common peroneal nerve injury and early prosthesis loosening. Conclusions: For KOA patients with femoral EAD, one-stage TKA with intra-articular compensatory osteotomy can effectively restore the mechanical axis and obtain satisfying joint function. Through a series of measures such as preoperative measurement, soft tissue evaluation and 3D printing, the accuracy of surgery can be improved and the difficulty of surgery can be reduced.


Assuntos
Artroplastia do Joelho , Prótese do Joelho , Osteoartrite do Joelho/diagnóstico por imagem , Adulto , Idoso , Feminino , Fêmur/cirurgia , Humanos , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Radiografia , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
3.
Bone Joint J ; 102-B(8): 1016-1024, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32731825

RESUMO

AIMS: Although bone cement is the primary mode of fixation in total knee arthroplasty (TKA), cementless fixation is gaining interest as it has the potential of achieving lasting biological fixation. By 3D printing an implant, highly porous structures can be manufactured, promoting osseointegration into the implant to prevent aseptic loosening. This study compares the migration of cementless, 3D-printed TKA to cemented TKA of a similar design up to two years of follow-up using radiostereometric analysis (RSA) known for its ability to predict aseptic loosening. METHODS: A total of 72 patients were randomized to either cementless 3D-printed or a cemented cruciate retaining TKA. RSA and clinical scores were evaluated at baseline and postoperatively at three, 12, and 24 months. A mixed model was used to analyze the repeated measurements. RESULTS: The mean maximum total point motion (MTPM) at three, 12, and 24 months was 0.33 mm (95% confidence interval (CI) 0.25 to 0.42), 0.42 mm (95% CI 0.33 to 0.51), and 0.47 mm (95% CI 0.38 to 0.57) respectively in the cemented group, versus 0.52 mm (95% CI 0.43 to 0.63), 0.62 mm (95% CI 0.52 to 0.73), and 0.64 mm (95% CI 0.53 to 0.75) in the cementless group (p = 0.003). However, using three months as baseline, no difference in mean migration between groups was found (p = 0.497). Three implants in the cemented group showed a > 0.2 mm increase in MTPM between one and two years of follow-up. In the cementless group, one implant was revised due to pain and progressive migration, and one patient had a liner-exchange due to a deep infection. CONCLUSION: The cementless TKA migrated more than the cemented TKA in the first two-year period. This difference was mainly due to a higher initial migration of the cementless TKA in the first three postoperative months after which stabilization was observed in all but one malaligned and early revised TKA. Whether the biological fixation of the cementless implants will result in an increased long-term survivorship requires a longer follow-up. Cite this article: Bone Joint J 2020;102-B(8):1016-1024.


Assuntos
Artroplastia do Joelho/efeitos adversos , Cimentos para Ossos/farmacologia , Osteoartrite do Joelho/cirurgia , Impressão Tridimensional , Falha de Prótese , Análise Radioestereométrica/métodos , Idoso , Artroplastia do Joelho/métodos , Feminino , Seguimentos , Migração de Corpo Estranho/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Osteoartrite do Joelho/diagnóstico por imagem , Desenho de Prótese , Reoperação/métodos , Medição de Risco , Índice de Gravidade de Doença , Fatores de Tempo
4.
Bone Joint J ; 102-B(8): 1033-1040, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32731833

RESUMO

AIMS: To report mid- to long-term results of Oxford mobile bearing domed lateral unicompartmental knee arthroplasty (UKA), and determine the effect of potential contraindications on outcome. METHODS: A total of 325 consecutive domed lateral UKAs undertaken for the recommended indications were included, and their functional and survival outcomes were assessed. The effects of age, weight, activity, and the presence of full-thickness erosions of cartilage in the patellofemoral joint on outcome were evaluated. RESULTS: Median follow-up was seven years (3 to 14), and mean age at surgery was 65 years (39 to 90). Median Oxford Knee Score (OKS) was 43 (interquartile range (IQR) 37 to 47), with 260 (80%) achieving a good or excellent score (OKS > 34). Revisions occurred in 34 (10%); 14 (4%) were for dislocation, of which 12 had no recurrence following insertion of a new bearing, and 12 (4%) were revised for medial osteoarthritis (OA). Ten-year survival was 85% (95% confidence interval (CI) 79 to 90, at risk 72). Age, weight, activity, and patellofemoral erosions did not have a significant effect on the clinical outcome or survival. CONCLUSION: Domed lateral UKA provides a good alternative to total knee arthroplasty (TKA) in the management of lateral compartment OA. Although dislocation is relatively easy to treat successfully, the dislocation rate of 4% is high. It is recommended that the stability of the bearing is assessed intraoperatively. If the bearing can easily be displaced, the fixed rather than the mobile bearing version of the Oxford lateral tibial component should be inserted instead. Younger age, heavier weight, high activity, and patellofemoral erosions did not detrimentally affect outcome, so should not be considered contraindications. Cite this article: Bone Joint J 2020;102-B(8):1033-1040.


Assuntos
Artroplastia do Joelho/métodos , Hemiartroplastia/métodos , Osteoartrite do Joelho/cirurgia , Desenho de Prótese/métodos , Reoperação/métodos , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Joelho/efeitos adversos , Bases de Dados Factuais , Feminino , Seguimentos , Hemiartroplastia/efeitos adversos , Humanos , Luxações Articulares/cirurgia , Prótese do Joelho , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico por imagem , Falha de Prótese , Recuperação de Função Fisiológica , Estudos Retrospectivos , Medição de Risco , Fatores de Tempo , Resultado do Tratamento
5.
Bone Joint J ; 102-B(8): 1025-1032, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32731836

RESUMO

AIMS: Total knee arthroplasty is an established treatment for knee osteoarthritis with excellent long-term results, but there remains controversy about the role of uncemented prostheses. We present the long-term results of a randomized trial comparing an uncemented tantalum metal tibial component with a conventional cemented component of the same implant design. METHODS: Patients under the age of 70 years with symptomatic osteoarthritis of the knee were randomized to receive either an uncemented tantalum metal tibial monoblock component or a standard cemented modular component. The mean age at time of recruitment to the study was 63 years (50 to 70), 46 (51.1%) knees were in male patients, and the mean body mass index was 30.4 kg/m2 (21 to 36). The same cruciate retaining total knee system was used in both groups. All patients received an uncemented femoral component and no patients had their patella resurfaced. Patient outcomes were assessed preoperatively and postoperatively using the modified Oxford Knee Score, Knee Society Score, and 12-Item Short-Form Health Survey questionnaire (SF-12) score. Radiographs were analyzed using the American Knee Society Radiograph Evaluation score. Operative complications, reoperations, or revision surgery were recorded. A total of 90 knees were randomized and at last review 77 knees were assessed. In all, 11 patients had died and two were lost to follow-up. RESULTS: At final review all patients were between 11 and 15 years following surgery. In total, 41 of the knees were cemented and 36 uncemented. There were no revisions in the cemented group and one revision in the uncemented group for fracture. The uncemented group reported better outcomes with both statistically and clinically significant (p = 0.001) improvements in knee-specific Oxford and Knee Society scores compared with the cemented group. The global SF-12 scores demonstrated no statistical difference (p = 0.812). Uncemented knees had better radiological analysis compared with the cemented group (p < 0.001). CONCLUSION: Use of an uncemented trabecular metal tibial implant can afford better long-term clinical outcomes when compared to cemented tibial components of a matched design. However, both have excellent survivorship up to 15 years after implantation. Cite this article: Bone Joint J 2020;102-B(8):1025-1032.


Assuntos
Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/métodos , Cimentos para Ossos/farmacologia , Osteoartrite do Joelho/cirurgia , Desenho de Prótese/métodos , Falha de Prótese , Idoso , Feminino , Seguimentos , Humanos , Masculino , Metais/uso terapêutico , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico por imagem , Reoperação/estatística & dados numéricos , Medição de Risco , Método Simples-Cego , Tantálio/uso terapêutico , Tíbia/cirurgia , Fatores de Tempo , Resultado do Tratamento
6.
Bone Joint J ; 102-B(6): 716-726, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32475247

RESUMO

AIMS: This study aims to determine the proportion of patients with end-stage knee osteoarthritis (OA) possibly suitable for partial (PKA) or combined partial knee arthroplasty (CPKA) according to patterns of full-thickness cartilage loss and anterior cruciate ligament (ACL) status. METHODS: A cross-sectional analysis of 300 consecutive patients (mean age 69 years (SD 9.5, 44 to 91), mean body mass index (BMI) 30.6 (SD 5.5, 20 to 53), 178 female (59.3%)) undergoing total knee arthroplasty (TKA) for Kellgren-Lawrence grade ≥ 3 knee OA was conducted. The point of maximal tibial bone loss on preoperative lateral radiographs was determined as a percentage of the tibial diameter. At surgery, Lachman's test and ACL status were recorded. The presence of full-thickness cartilage loss within 16 articular surface regions (two patella, eight femoral, six tibial) was recorded. RESULTS: According to articular cartilage loss and ACL status, 195/293 (67%) were suitable for PKA or CPKA: medial unicompartmental knee arthroplasty (UKA) 97/293 (33%); lateral UKA 25 (9%); medial bicompartmental arthroplasty 31 (11%); lateral bicompartmental arthroplasty 12 (4%); bicondylar-UKA 23 (8%); and patellofemoral arthroplasty (PFA) seven (2%). The ACL was intact in 166 (55%), frayed in 82 (27%), disrupted in 12 (4%), and absent in 33 (11%). Lachman testing was specific (97%) but poorly sensitive (38%) for disrupted/absent ACLs. The point of maximal tibial bone loss showed good interclass correlation (ICC 0.797, 0.73 to 0.85 95% confidence interval (CI); p < 0.001) and was more posterior when the ACL was absent. Maximum tibial bone loss occurring at > 55% of the anterior to posterior distance predicted ACL absence with 93% sensitivity and 91% specificity (area under the curve 0.97 (0.94 to 0.99 95% CI; p < 0.001). CONCLUSION: ACL status can be reliably determined from a lateral radiograph using the location of maximal tibial bone loss. According to regions of cartilage loss and ACL status, two-thirds of patients with end-stage knee OA could potentially be treated with PKA or CPKA. Cite this article: Bone Joint J 2020;102-B(6):716-726.


Assuntos
Ligamento Cruzado Anterior/patologia , Artroplastia do Joelho , Cartilagem Articular/patologia , Osteoartrite do Joelho/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Ligamento Cruzado Anterior/diagnóstico por imagem , Cartilagem Articular/diagnóstico por imagem , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/diagnóstico por imagem , Radiografia , Índice de Gravidade de Doença
7.
AJR Am J Roentgenol ; 215(2): 441-447, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32374669

RESUMO

OBJECTIVE. Cartilage loss on preoperative knee MRI is a predictor of poor outcomes after arthroscopic partial meniscectomy. The purpose of this study was to compare the ability to predict outcomes after arthroscopic partial meniscectomy with a clinically used modified Outerbridge system versus a semiquantitative MRI Osteoarthritis Knee Score system for grading cartilage loss. MATERIALS AND METHODS. Patients who underwent preoperative knee MRI within 6 months of arthroscopic partial meniscectomy and who had outcomes available from the time of surgery and 1 year later were eligible for inclusion. Cases were evaluated by two radiologists and one radiology fellow with the use of both grading systems. The accuracy of each system in discriminating between surgical success and failure was estimated using the ROC curve (AUC) with 95% CIs. A Wald test was used to assess noninferiority of the clinical grading system. Interreader agreement regarding the accuracy of the grading systems in predicting outcomes was also compared. RESULTS. A total of 78 patients (38 women and 40 men; mean age, 56.6 years) were included in the study. A prediction model using clinical grading (AUC = 0.695; 95% CI, 0.566-0.824) was noninferior (p = 0.047) to a model using MRI Osteoarthritis Knee Score grading (AUC = 0.683; 95% CI, 0.539-0.827). Both MRI prediction models performed better than a model using demographic characteristics only (AUC = 0.667; 95% CI, 0.522-0.812). Inter-reader agreement with clinical grading (80.8%) was higher than that with MRI Osteoarthritis Knee Score grading (65.0%; p = 0.012). CONCLUSION. A clinically used system to grade cartilage loss on MRI is as effective as a semiquantitative system for predicting outcomes after arthroscopic partial meniscectomy, while also offering improved interreader agreement.


Assuntos
Artroscopia , Cartilagem Articular/diagnóstico por imagem , Cartilagem Articular/patologia , Imagem por Ressonância Magnética , Meniscectomia/métodos , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/patologia , Valor Preditivo dos Testes , Estudos Retrospectivos , Resultado do Tratamento
8.
JAMA Netw Open ; 3(5): e204049, 2020 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-32364594

RESUMO

Importance: Persons with knee symptoms recognize the health benefits of engaging in physical activity, but uncertainty persists about whether regular strenuous physical activity or exercise can accelerate tissue damage. A sedentary lifestyle of inactivity or underloading may also be associated with deleterious joint health. Objective: To establish whether long-term strenuous physical activity participation and extensive sitting behavior are each associated with increased risk of developing radiographic knee osteoarthritis (KOA) in individuals at high risk for the disease. Design, Setting, and Participants: This cohort study analyzed data from the Osteoarthritis Initiative, a prospective longitudinal cohort study of men and women with or at an increased risk of developing symptomatic, radiographic KOA. Community-dwelling adults were recruited from 4 US sites (Baltimore, Maryland; Columbus, Ohio; Pittsburgh, Pennsylvania; and Pawtucket, Rhode Island) and were followed up for up to 10 years. Individuals were included if they had a baseline Kellgren and Lawrence grade of 0 in both knees and completed a PASE (Physical Activity Scale for the Elderly) questionnaire at baseline and at least 2 follow-up visits over an 8-year interval. Data analyses were conducted from May 2018 to November 2018. Exposures: Baseline to 8-year trajectories of strenuous physical activity participation and extensive sitting behavior were identified using group-based trajectory models. Main Outcomes and Measures: Incident radiographic KOA, defined as Kellgren and Lawrence grade 2 or higher in either knee by the 10-year follow-up visit. Results: A total of 1194 participants were included in the sample (697 women [58.4%]), with a baseline mean (SD) age of 58.4 (8.9) years and mean body mass index (BMI) of 26.8 (4.5). Four distinct trajectories of weekly hours spent in strenuous physical activities and 3 distinct trajectories of extensive sitting were identified. Long-term engagement in low-to-moderate physical activities (adjusted odds ratio [OR], 0.69; 95% CI, 0.48-1.01) or any strenuous physical activities (adjusted OR, 0.75; 95% CI, 0.53-1.07) was not associated with 10-year incident radiographic KOA. Persistent extensive sitting was not associated with incident KOA. Despite relatively mild symptoms and high function in this early-stage sample, 594 participants (49.7%) did not engage in any strenuous physical activities (ie, 0 h/wk) across 8 years, and 507 (42.5%) engaged in persistent moderate-to-high frequency of extensive sitting. Older age, higher BMI, more severe knee pain, non-college graduate educational level, weaker quadriceps, and depression were each associated with a persistent lack of engagement in strenuous physical activities. Conclusions and Relevance: Results from this study appeared to show no association between long-term strenuous physical activity participation and incident radiographic KOA. The findings raise the possibility of a protective association between incident KOA and a low-to-moderate level of strenuous physical activities.


Assuntos
Exercício Físico , Osteoartrite do Joelho/epidemiologia , Postura Sentada , Feminino , Humanos , Incidência , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/fisiopatologia , Estudos Prospectivos , Fatores de Risco , Inquéritos e Questionários , Estados Unidos/epidemiologia
9.
Br J Sports Med ; 54(9): 546-553, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32276925

RESUMO

BACKGROUND: Not meeting functional performance criteria increases reinjury risk after ACL reconstruction (ACLR), but the implications for osteoarthritis are not well known. OBJECTIVE: To determine if poor functional performance post-ACLR is associated with risk of worsening early osteoarthritis features, knee symptoms, function and quality of life (QoL). METHODS: Seventy-eight participants (48 men) aged 28±15 years completed a functional performance test battery (three hop tests, one-leg-rise) 1 year post-ACLR. Poor functional performance was defined as <90% limb symmetry index (LSI) on each test. At 1 and 5 years, MRI, Knee injury Osteoarthritis Outcome Score (KOOS) and International Knee Documentation Committee (IKDC) subjective form were completed. Primary outcomes were: (i) worsening patellofemoral and tibiofemoral MRI-osteoarthritis features (cartilage, bone marrow lesions (BMLs) and meniscus) and (ii) change in KOOS and IKDC scores, between 1 and 5 years. RESULTS: Only 14 (18%) passed (≥90% LSI on all tests) the functional test battery. Poor functional performance on the battery (all four tests <90% LSI) 1 year post-ACLR was associated with 3.66 times (95% CI 1.12 to 12.01) greater risk of worsening patellofemoral BMLs. A triple-crossover hop <90% LSI was associated with 2.09 (95% CI 1.15 to 3.81) times greater risk of worsening patellofemoral cartilage. There was generally no association between functional performance and tibiofemoral MRI-osteoarthritis features, or KOOS/IKDC scores. CONCLUSION: Only one in five participants met common functional performance criteria (≥90% LSI all four tests) 1 year post-ACLR. Poor function on all four tests was associated with a 3.66 times increased risk of worsening patellofemoral BMLs, and generally not associated with decline in self-reported outcomes.


Assuntos
Lesões do Ligamento Cruzado Anterior/fisiopatologia , Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/efeitos adversos , Osteoartrite do Joelho/diagnóstico por imagem , Adolescente , Adulto , Progressão da Doença , Feminino , Seguimentos , Humanos , Joelho/diagnóstico por imagem , Estudos Longitudinais , Imagem por Ressonância Magnética , Masculino , Osteoartrite do Joelho/etiologia , Medidas de Resultados Relatados pelo Paciente , Complicações Pós-Operatórias , Estudos Prospectivos , Qualidade de Vida , Recuperação de Função Fisiológica , Fatores de Risco , Adulto Jovem
10.
Bone Joint J ; 102-B(4): 426-433, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32228087

RESUMO

AIMS: To compare patients undergoing total knee arthroplasty (TKA) with ≤ 80° range of movement (ROM) operated with a 2 mm increase in the flexion gap with matched non-stiff patients with at least 100° of preoperative ROM and balanced flexion and extension gaps. METHODS: In a retrospective cohort study, 98 TKAs (91 patients) with a preoperative ROM of ≤ 80° were examined. Mean follow-up time was 53 months (24 to 112). All TKAs in stiff knees were performed with a 2 mm increased flexion gap. Data were compared to a matched control group of 98 TKAs (86 patients) with a mean follow-up of 43 months (24 to 89). Knees in the control group had a preoperative ROM of at least 100° and balanced flexion and extension gaps. In all stiff and non-stiff knees posterior stabilized (PS) TKAs with patellar resurfacing in combination with adequate soft tissue balancing were used. RESULTS: Overall mean ROM in stiff knees increased preoperatively from 67° (0° to 80°) to 114° postoperatively (65° to 135°) (p < 0.001). Mean knee flexion improved from 82° (0° to 110°) to 115° (65° to 135°) and mean flexion contracture decreased from 14° (0° to 50°) to 1° (0° to 10°) (p < 0.001). The mean Knee Society Score (KSS) improved from 34 (0 to 71) to 88 (38 to 100) (p < 0.001) and the KSS Functional Score from 43 (0 to 70) to 86 (0 to 100). Seven knees (7%) required manipulations under anaesthesia (MUA) and none of the knees had flexion instability. The mean overall ROM in the control group improved from 117° (100° to 140°) to 123° (100° to 130°) (p < 0.001). Mean knee flexion improved from 119° (100° to 140°) to 123° (100° to 130°) (p < 0.001) and mean flexion contracture decreased from 2° (0° to 15°) to 0° (0° to 5°) (p < 0.001). None of the knees in the control group had flexion instability or required MUA. The mean KSS Knee Score improved from 48 (0 to 80) to 94 (79 to 100) (p < 0.001) and the KSS Functional Score from 52 (5 to 100) to 95 (60 to 100) (p < 0.001). Mean improvement in ROM (p < 0.001) and KSS Knee Score (p = 0.017) were greater in knees with preoperative stiffness compared with the control group, but the KSS Functional Score improvement was comparable (p = 0.885). CONCLUSION: TKA with a 2 mm increased flexion gap provided a significant improvement of ROM in knees with preoperative stiffness. While the improvement in ROM was greater, the absolute postoperative ROM was less than in matched non-stiff knees. PS TKA with patellar resurfacing and a 2 mm increased flexion gap, in combination with adequate soft tissue balancing, provides excellent ROM and knee function when stiffness of the knee had been present preoperatively. Cite this article: Bone Joint J 2020;102-B(4):426-433.


Assuntos
Artroplastia do Joelho/métodos , Articulação do Joelho/fisiopatologia , Osteoartrite do Joelho/cirurgia , Amplitude de Movimento Articular , Adulto , Idoso , Idoso de 80 Anos ou mais , Artrite Reumatoide/diagnóstico por imagem , Artrite Reumatoide/fisiopatologia , Artrite Reumatoide/cirurgia , Estudos de Casos e Controles , Feminino , Seguimentos , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/fisiopatologia , Patela/cirurgia , Período Pré-Operatório , Radiografia , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento
11.
Radiology ; 295(2): 373-380, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32154774

RESUMO

Background Diffusion-weighted imaging (DWI) can depict the inflamed synovial membrane in arthritis. Purpose To study the diagnostic accuracy of DWI for the detection of arthritis compared with the clinical reference standard and to compare DWI to contrast material-enhanced MRI for the detection of synovial inflammation. Materials and Methods In this institutional review board-approved prospective study, 45 participants with juvenile idiopathic arthritis (JIA) or suspected of having JIA (seven boys, 38 girls; median age, 14 years [interquartile range, 12-16 years]) were included between December 2015 and December 2018. Study participants underwent pre- and postcontrast 3.0-T MRI of the knee with an additional DWI sequence. For the clinical reference standard, a multidisciplinary team determined the presence or absence of arthritis on the basis of clinical, laboratory, and imaging findings (excluding DWI). Two data sets were scored by two radiologists blinded to all clinical data; data set 1 contained pre- and postcontrast sequences (contrast-enhanced MRI), and data set 2 contained precontrast and DWI sequences (DWI). Diagnostic accuracy was determined by comparing the scores of the DWI data set to those of the clinical reference standard. Second, DWI was compared with contrast-enhanced MRI regarding detection of synovial inflammation. Results Sensitivity for detection of arthritis for DWI was 93% (13 of the 14 participants with arthritis were correctly classified with DWI; 95% confidence interval [CI]: 64%, 100%) and specificity was 81% (25 of 31 participants without arthritis were correctly classified with DWI; 95% CI: 62%, 92%). Scores for synovial inflammation at DWI and contrast-enhanced MRI agreed in 37 of 45 participants (82%), resulting in a sensitivity of 92% (12 of 13 participants; 95% CI: 62%, 100%) and specificity of 78% (25 of 32 participants; 95% CI: 60%, 90%) with DWI when contrast-enhanced MRI was considered the reference standard. Conclusion Diffusion-weighted imaging (DWI) was accurate in detecting arthritis in pediatric participants with juvenile idiopathic arthritis (JIA) or suspected of having JIA and showed agreement with contrast-enhanced MRI. The results indicate that DWI could replace contrast-enhanced MRI for imaging of synovial inflammation in this patient group. © RSNA, 2020 Online supplemental material is available for this article.


Assuntos
Artrite Juvenil/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética/métodos , Osteoartrite do Joelho/diagnóstico por imagem , Adolescente , Criança , Meios de Contraste , Feminino , Humanos , Masculino , Estudos Prospectivos , Sensibilidade e Especificidade
12.
Drugs R D ; 20(1): 39-45, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32078147

RESUMO

BACKGROUND AND OBJECTIVE: Clodronate is a nitrogen-free bisphosphonate that is widely and effectively used in the treatment of many osteo-metabolic disorders. The objective of our study was to evaluate the effectiveness of clodronate in reducing pain and bone marrow edema in knee osteoarthritis. METHODS: In total, 74 patients were included in the study. Group 1 received intramuscular clodronate 200 mg daily for 15 days and then once weekly for the next 11.5 months; group 2 received intramuscular clodronate 200 mg daily for 15 days and then once weekly for the next 2.5 months. Visual analog scale (VAS) scores were recorded at baseline (T0) and after 30 days (T1), 3 months (T2), 6 months (T3), 9 months (T4), and 12 months (end of study; T5). We also evaluated functional status and use of paracetamol (T0, T1, T2, T3, T4, and T5) and changes in Whole Organ Magnetic Resonance Imaging Score (WORMS; T0, T2, and T5). RESULTS: Both groups had a statistically significant reduction in VAS score until 3 months. Group 1 then experienced further VAS reductions, whereas VAS scores for group 2 progressively increased. Pain, stiffness, and physical function also showed the same trend, as did bone marrow edema extension, which was evaluated with WORMS. CONCLUSION: Our study indicates that intramuscular administration of a therapeutic dose of clodronate followed by a maintenance dose is effective in the management of symptomatic knee osteoarthritis, improving functional outcomes and reducing pain and bone marrow edema. Prolonged treatment increases the long-term efficacy of clodronate compared with the shorter schedule.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Ácido Clodrônico/uso terapêutico , Osteoartrite do Joelho/tratamento farmacológico , Dor/tratamento farmacológico , Idoso , Conservadores da Densidade Óssea/administração & dosagem , Ácido Clodrônico/administração & dosagem , Relação Dose-Resposta a Droga , Feminino , Humanos , Masculino , Osteoartrite do Joelho/diagnóstico por imagem , Dor/diagnóstico por imagem , Medição da Dor , Fatores de Tempo , Resultado do Tratamento
13.
Scand J Med Sci Sports ; 30(5): 885-893, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32096249

RESUMO

BACKGROUND: Patellofemoral pain (PFP) patients show increased prevalence of patellar malalignment. Structural and alignment abnormalities of the patellofemoral joint (PFJ) may play a role in development of PFP and patellofemoral osteoarthritis (PFOA). OBJECTIVES: Evaluating associations of patellofemoral alignment and femoral geometry with bony and cartilaginous abnormalities in PFP patients and healthy control subjects. METHODS: Data from a case-control study were used (64 PFP subjects, 70 control subjects, 57% female, age 23.2 (6.4)). Alignment and femoral geometry measures in the PFJ were determined using MRI. Structural abnormalities in the PFJ associated with OA (bone marrow lesions, osteophytes, minor cartilage defects and Hoffa-synovitis), quantified cartilage composition (T1ρ relaxation times) in the PFJ and perfusion within the patellar bone were examined using different MRI techniques. Associations were analyzed using regression analyses, adjusted for potential confounders. RESULTS: Lateral patellar tilt was negatively associated with presence of osteophytes on both patella (OR 0.91; 95% CI 0.84 to 0.98), anterior femur (OR 0.92; 95% CI 0.84 to 0.99) and minor cartilage defects on patella (OR 0.91; 95% CI 0.84 to 0.99). Patella alta was positively associated with the presence of bone marrow lesions in the patella and minor cartilage defects (OR 48.33; 95% CI 4.27 to 547.30 and OR 17.51; 95% CI 1.17 to 262.57, respectively). Patella alta and medial patellar translation were positively associated with T1ρ relaxation times within trochlear cartilage (ß 5.2; 95% CI 0.77 to 9.58, and 0.36; 95% CI 0.08 to 0.64, respectively). None of the alignment and geometry measures were associated with bone perfusion. CONCLUSION: Our study implies that associations between patellofemoral alignment and geometry and structural joint abnormalities linked to OA are already present in both PFP patients and healthy control subjects.


Assuntos
Artralgia/fisiopatologia , Fêmur/fisiopatologia , Osteoartrite do Joelho/fisiopatologia , Articulação Patelofemoral/fisiopatologia , Adolescente , Adulto , Artralgia/diagnóstico por imagem , Estudos de Casos e Controles , Feminino , Fêmur/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Osteoartrite do Joelho/diagnóstico por imagem , Articulação Patelofemoral/diagnóstico por imagem , Adulto Jovem
14.
Arthritis Rheumatol ; 72(7): 1103-1110, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32039565

RESUMO

OBJECTIVE: Osteoarthritis (OA) and pain are both made more severe by low-grade inflammation. This study was undertaken to examine whether visceral fat, a major source of inflammatory cytokines and adipokines, is associated with an increased risk of knee OA or musculoskeletal pain. METHODS: Subjects in the Multicenter Osteoarthritis Study cohort, who were age 50-79 years and had or were at high risk of knee OA, underwent whole-body dual x-ray absorptiometry (DXA) at baseline. At baseline, 30 months, and 60 months radiographs and magnetic resonance images (MRIs) of the knees were obtained, and patients were asked to score the severity of their knee pain and to identify sites of joint pain using a body homunculus. Baseline DXA scans were used to measure total body fat and visceral and subcutaneous fat in the torso. The association of fat depot size with structural outcomes (incident radiographic OA and cartilage loss and synovitis on MRI) and with pain outcomes (worsening knee pain, number of painful joints, and widespread pain) was assessed. Regression analyses were adjusted for age, sex, race, education level, smoking status, physical activity, body mass index (BMI), and depressive symptoms. RESULTS: Of the 2,961 participants at baseline, 60.7% were women. The mean age was 62.5 years and mean BMI was 30.5 kg/m2 . After adjustment for covariates, no fat measures were associated with any structural outcomes. However, total and visceral, but not subcutaneous, fat were positively associated with worsening knee pain (P = 0.0005 for total fat and P = 0.007 for visceral fat) and widespread pain (P = 0.001 for total fat and P = 0.02 for visceral fat), and the amount of visceral fat was associated with the number of painful joints (P = 0.07). CONCLUSION: Our findings indicate that visceral fat is associated with an increased risk of musculoskeletal and widespread pain.


Assuntos
Artralgia/epidemiologia , Dor Musculoesquelética/epidemiologia , Obesidade Abdominal/epidemiologia , Osteoartrite do Joelho/epidemiologia , Absorciometria de Fóton , Idoso , Feminino , Humanos , Gordura Intra-Abdominal/diagnóstico por imagem , Articulação do Joelho/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Obesidade Abdominal/diagnóstico por imagem , Osteoartrite do Joelho/diagnóstico por imagem , Radiografia , Gordura Subcutânea/diagnóstico por imagem , Sinovite/diagnóstico por imagem , Sinovite/epidemiologia
15.
Ann Rheum Dis ; 79(4): 525-528, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32098758

RESUMO

OBJECTIVES: In the phase II FGF-18 Osteoarthritis Randomized Trial with Administration of Repeated Doses (FORWARD) study, sprifermin demonstrated cartilage modification in the total femorotibial joint and in both femorotibial compartments by MRI in patients with knee osteoarthritis. Here, we evaluate whether sprifermin reduces cartilage loss and increases cartilage thickness, independent of location. METHODS: Patients were randomised 1:1:1:1:1 to three once-weekly intra-articular injections of 30 µg sprifermin every 6 months (q6mo); 30 µg sprifermin every 12 months (q12mo); 100 µg sprifermin q6mo; 100 µg sprifermin q12mo; or placebo. Post-hoc analysis using thinning/thickening scores and ordered values evaluated femorotibial cartilage thickness change from baseline to 24 months independent of location. Changes were indirectly compared with those of Osteoarthritis Initiative healthy subjects. RESULTS: Thinning scores were significantly lower for sprifermin 100 µg q6mo versus placebo (mean (95% CI) difference: 334 µm (114 to 554)), with a cartilage thinning score similar to healthy subjects. Thickening scores were significantly greater for sprifermin 100 µg q6mo, 100 µg q12mo and 30 µg q6mo versus placebo (mean (95% CI) difference: 425 µm (267 to 584); 450 µm (305 to 594) and 139 µm (19 to 259), respectively) and more than doubled versus healthy subjects. CONCLUSIONS: Sprifermin increases cartilage thickness, and substantially reduces cartilage loss, expanding FORWARD primary results. TRIAL REGISTRATION NUMBER: NCT01919164.


Assuntos
Cartilagem Articular/diagnóstico por imagem , Fatores de Crescimento de Fibroblastos/uso terapêutico , Osteoartrite do Joelho/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Cartilagem Articular/patologia , Método Duplo-Cego , Feminino , Humanos , Injeções Intra-Articulares , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/patologia
16.
Int J Comput Assist Radiol Surg ; 15(3): 403-413, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31927688

RESUMO

PURPOSE: The quantitative analysis of weight-bearing articular cartilage superficial to subchondral abnormality is important in osteoarthritis (OA) progression studies. The current study aimed to address the challenges of a semi-automatic segmentation of tibiofemoral cartilage in MR images of OA patient with and without subchondral bone abnormalities (SBA). METHODS: In this study, knee MRI data [fat-suppressed proton density-weighted, multi-echo T2-weighted (CartiGram) images] of 29 OA patients, acquired at 3.0T MR scanner, were retrospectively collected. Out of 29 data, 9 had SBA in femur bone. Initially, a semi-automatic femur cartilage segmentation based on radial intensity search approach by Akhtar et al. was implemented in-house. This algorithm was considered as the radial-search method for further comparison. In this current study, the reported radial-search (RS)-based semi-automatic cartilage segmentation method was modified using thresholding, connected component labelling, convex-hull operation and spline-based curve fitting for the improved segmentation of tibiofemoral cartilage. Cartilage was manually segmented by two experienced radiologists, and inter-reader variability was estimated using coefficient of variation (CV). The segmentation results were validated using dice coefficient (DC), Jaccard coefficient (JC) and sensitivity index measurements. RESULTS: DC values for segmented femur cartilage in patients with SBA were 64.6 ± 7.8% and 81.4 ± 2.8% using reported RS method and modified radial-search method, respectively. DC values for segmented femur cartilage in patients without SBA were 82.5 ± 4.5% and 84.8 ± 2.0% using RS method and modified radial method, respectively. Similarly, DC values for tibial cartilage in all OA patients were 80.4 ± 1.6% and 81.9 ± 2.4% using RS method and modified radial method, respectively. Similar segmentation results were also obtained from the T2-weighted images. Inter-reader variability result based on CV in femur cartilage was 3.40 ± 2.12% (without SBA) and 4.18 ± 3.18% (with SBA). CONCLUSION: In the current study, a semi-automated segmentation of tibiofemoral cartilage was presented. Modified radial-search approach can successfully segment tibiofemoral cartilage, and the results were tested and validated on knee MRI data of OA patients with and without SBA.


Assuntos
Cartilagem Articular/diagnóstico por imagem , Articulação do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/diagnóstico por imagem , Adulto , Algoritmos , Feminino , Fêmur/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tíbia/diagnóstico por imagem , Adulto Jovem
17.
Int J Comput Assist Radiol Surg ; 15(3): 457-466, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31938993

RESUMO

PURPOSE: Knee osteoarthritis (OA) is a common disease that impairs knee function and causes pain. Radiologists usually review knee X-ray images and grade the severity of the impairments according to the Kellgren-Lawrence grading scheme. However, this approach becomes inefficient in hospitals with high throughput as it is time-consuming, tedious and also subjective. This paper introduces a model for automatic diagnosis of knee OA based on an end-to-end deep learning method. METHOD: In order to process the input images with location and classification simultaneously, we use Faster R-CNN as baseline, which consists of region proposal network (RPN) and Fast R-CNN. The RPN is trained to generate region proposals, which contain knee joint and then be used by Fast R-CNN for classification. Due to the localized classification via CNNs, the useless information in X-ray images can be filtered and we can extract clinically relevant features. For the further improvement in the model's performance, we use a novel loss function whose weighting scheme allows us to address the class imbalance. Besides, larger anchors are used to overcome the problem that anchors don't match the object when increasing the input size of X-ray images. RESULT: The performance of the proposed model is thoroughly assessed using various measures. The results show that our adjusted model outperforms the Faster R-CNN, achieving a mean average precision nearly 0.82 with a sensitivity above 78% and a specificity above 94%. It takes 0.33 s to test each image, which achieves a better trade-off between accuracy and speed. CONCLUSION: The proposed end-to-end fully automatic model which is computationally efficient has the potential to achieve the real automatic diagnosis of knee OA and be used as computer-aided diagnosis tools in clinical applications.


Assuntos
Diagnóstico por Computador , Redes Neurais de Computação , Osteoartrite do Joelho/diagnóstico por imagem , Radiografia/métodos , Aprendizado Profundo , Humanos , Sensibilidade e Especificidade
18.
Knee ; 27(1): 45-50, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31926675

RESUMO

OBJECTIVES: Adipokines have gained much interest in osteoarthritis (OA) pathogenesis studies over the past years in that they play crucial roles in bone and cartilage homeostasis. Obesity is known to be one of the well-recognized and modifiable causes of OA burden. Key mediators in this metabolic link between obesity and OA could be resistin, among other cytokines secreted by the adipose tissue. We aimed to evaluate the association of serum resistin with obesity, and inflammation in female patients with knee OA. METHODS: One hundred female participants, aged above 40 years, with symptomatic primary knee OA were matched for age with 100 apparently healthy females in a case-control study design. All study participants were subjected to clinical examination, laboratory investigations and radiological examination. RESULTS: Patients with primary knee OA had elevated levels of serum resistin compared with healthy controls. We demonstrated that elevated serum resistin positively correlated with adiposity measures, inflammatory markers and WOMAC index. High sensitivity C reactive protein was found to be an independent predictor of serum resistin levels after adjustment for confounder factors. CONCLUSIONS: These results indicate that resistin may play an important role in the progression of knee OA and may serve as a novel and reliable biomarker for reflecting disease severity, with the potential to contribute to the fundamental processes underlying the pathogenesis of knee OA.


Assuntos
Tecido Adiposo/diagnóstico por imagem , Inflamação/sangue , Articulação do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/sangue , Resistina/sangue , Adulto , Biomarcadores/sangue , Estudos de Casos e Controles , Progressão da Doença , Feminino , Humanos , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico por imagem , Radiografia
19.
J Nippon Med Sch ; 87(4): 191-196, 2020 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-31902856

RESUMO

BACKGROUND: Total knee arthroplasty (TKA) aims to correct the rotation, as well as the alignment and articulation, of the osteoarthritic knee. We hypothesized that, in addition to improving knee kinematics, TKA affects hip rotational movement. The objective of this study was to evaluate variation in lower extremity alignment and hip rotational range of motion (ROM) after TKA. METHODS: A total of 47 patients (53 knees) with primary varus knee osteoarthritis who were scheduled for primary TKA at our center were enrolled. Hip rotational ROM was measured with the patient in supine position with 90° flexion of the hip and knee before and 3 weeks after TKA. Plain radiography and computed tomography were used to compare variations in tibial axis alignment and femoral axis alignment after bone resection, which was defined as changes in the joint lines of the distal femur and the proximal tibia. RESULTS: Average internal ROM, and the sum of internal and external hip rotational ROM, increased significantly; however, external hip rotational ROM did not significantly differ after TKA. Imaging findings showed that the axis of the lower leg externally rotated by 2.5°, with a 4° internal rotation of the distal femur and a 6.5° correction of the varus deformity. CONCLUSION: TKA changed the neutral position of hip rotational movement and increased hip rotational ROM.


Assuntos
Artroplastia do Joelho , Quadril/fisiopatologia , Osteoartrite do Joelho/fisiopatologia , Osteoartrite do Joelho/cirurgia , Amplitude de Movimento Articular , Idoso , Idoso de 80 Anos ou mais , Feminino , Fêmur/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico por imagem , Tíbia/diagnóstico por imagem , Resultado do Tratamento
20.
PLoS One ; 15(1): e0227975, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31968005

RESUMO

OBJECTIVES: Knee joint distraction (KJD) has been evaluated as a joint-preserving treatment to postpone total knee arthroplasty in knee osteoarthritis patients in three clinical trials. Since 2014 the treatment is used in regular care in some hospitals, which might lead to a deviation from the original indication and decreased treatment outcome. In this study, baseline characteristics, complications and clinical benefit are compared between patients treated in regular care and in clinical trials. METHODS: In our hospital, 84 patients were treated in regular care for 6 weeks with KJD. Surgical details, complications, and range of motion were assessed from patient hospital charts. Patient-reported outcome measures were evaluated in regular care before and one year after treatment. Trial patients (n = 62) were treated and followed as described in literature. RESULTS: Patient characteristics were not significantly different between groups, except for distraction duration (regular care 45.3±4.3; clinical trials 48.1±8.1 days; p = 0.019). Pin tract infections were the most occurring complication (70% regular care; 66% clinical trials), but there was no significant difference in treatment complications between groups (p>0.1). The range of motion was recovered within a year after treatment for both groups. WOMAC questionnaires showed statistically and clinically significant improvement for both groups (both p<0.001 and >15 points in all subscales) and no significant differences between groups (all differences p>0.05). After one year, 70% of patients were responders (regular care 61%, trial 75%; p = 0.120). Neither regular care compared to clinical trial, nor any other characteristic could predict clinical response. CONCLUSIONS: KJD as joint-preserving treatment in clinical practice, to postpone arthroplasty for end-stage knee osteoarthritis patient below the age of 65, results in an outcome similar to that thus far demonstrated in clinical trials. Longer follow-up in regular care is needed to test whether also long-term results remain beneficial and comparable to trial data.


Assuntos
Articulação do Joelho/cirurgia , Osteoartrite do Joelho/cirurgia , Osteogênese por Distração/métodos , Osteogênese por Distração/normas , Adulto , Antibacterianos/administração & dosagem , Artroplastia do Joelho , Cartilagem Articular/diagnóstico por imagem , Cartilagem Articular/fisiopatologia , Cartilagem Articular/cirurgia , Ensaios Clínicos como Assunto/normas , Fixadores Externos , Feminino , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/normas , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/epidemiologia , Osteoartrite do Joelho/fisiopatologia , Amplitude de Movimento Articular/fisiologia , Resultado do Tratamento
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