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1.
Nuclear Medicine Scans in Total Joint Replacement.
Pinski, JM, Chen, AF, Estok, DM, Kavolus, JJ
The Journal of bone and joint surgery. American volume. 2021;(4):359-372
Abstract
»: A 3-phase bone scan is a potential first-line nuclear medicine study for pain after total joint arthroplasty (TJA) when there is concern for periprosthetic joint infection or aseptic loosening. »: In patients who have a positive bone scintigraphy result and suspected infection of the joint, but where aspiration or other studies are inconclusive, labeled leukocyte scintigraphy with bone marrow imaging may be of benefit. »: Magnetic resonance imaging (MRI), while not a nuclear medicine study, also shows promise and has the advantage of providing information about the soft tissues around a total joint replacement. »: Radiotracer uptake patterns in scintigraphy are affected by the prosthesis (total knee arthroplasty [TKA] versus total hip arthroplasty [THA]) and the use of cement. »: Nuclear medicine scans may be ordered 1 year postoperatively but may have positive findings that are due to normal physiologic bone remodeling. Nuclear studies may be falsely positive for up to 2 years after TJA. »: Single-photon emission computed tomography (SPECT) combined with computed tomography (CT) (SPECT/CT), fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/CT, and MRI show promise; however, more studies are needed to better define their role in the diagnostic workup of pain after TJA.
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2.
The burden of metabolic syndrome on osteoarthritic joints.
Dickson, BM, Roelofs, AJ, Rochford, JJ, Wilson, HM, De Bari, C
Arthritis research & therapy. 2019;(1):289
Abstract
BACKGROUND The prevalence of osteoarthritis (OA) increases with obesity, with up to two thirds of the elderly obese population affected by OA of the knee. The metabolic syndrome (MetS), frequently associated with central obesity and characterised by elevated waist circumference, raised fasting plasma glucose concentration, raised triglycerides, reduced high-density lipoproteins, and/or hypertension, is implicated in the pathogenesis of OA. This narrative review discusses the mechanisms involved in the influence of MetS on OA, with a focus on the effects on macrophages and chondrocytes. MAIN TEXT A skewing of macrophages towards a pro-inflammatory M1 phenotype within synovial and adipose tissues is thought to play a role in OA pathogenesis. The metabolic perturbations typical of MetS are important drivers of pro-inflammatory macrophage polarisation and activity. This is mediated via alterations in the levels and activities of the cellular nutrient sensors 5' adenosine monophosphate-activated protein kinase (AMPK) and mammalian target of rapamycin complex 1 (mTORC1), intracellular accumulation of metabolic intermediates such as succinate and citrate, and increases in free fatty acids (FFAs) and hyperglycaemia-induced advanced glycation end-products (AGEs) that bind to receptors on the macrophage surface. Altered levels of adipokines, including leptin and adiponectin, further influence macrophage polarisation. The metabolic alterations in MetS also affect the cartilage through direct effects on chondrocytes by stimulating the production of pro-inflammatory and catabolic factors and possibly by suppressing autophagy and promoting cellular senescence. CONCLUSIONS The influence of MetS on OA pathogenesis involves a wide range of metabolic alterations that directly affect macrophages and chondrocytes. The relative burden of intra-articular versus systemic adipose tissue in the MetS-associated OA remains to be clarified. Understanding how altered metabolism interacts with joints affected by OA is crucial for the development of further strategies for treating this debilitating condition, such as supplementing existing therapies with metformin and utilising ω-3 fatty acid derivatives to restore imbalances in ω-3 and ω-6 fatty acids.
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3.
Factors associated with upper leg muscle strength in knee osteoarthritis: A scoping review.
de Zwart, AH, Dekker, J, Lems, W, Roorda, LD, van der Esch, M, van der Leeden, M
Journal of rehabilitation medicine. 2018;(2):140-150
Abstract
OBJECTIVE Muscle weakness is common and strongly related to clinical outcome in patients with knee or hip osteoarthritis. To date, there is no clear overview of the information on factors associated with muscle strength in knee and hip osteoarthritis. The aim of this paper is to provide an overview of current knowledge on factors associated with upper leg muscle strength in this population. DESIGN The framework of a scoping review was chosen. MEDLINE database was searched systematically up to 22 April 2017. Studies that described a relationship between a factor and muscle strength in knee or hip osteoarthritis were included. RESULTS A total of 65 studies met the inclusion criteria. In studies of knee osteoarthritis, 4 factors were consistently found to be associated with lower muscle strength. Due to the low number of studies on hip osteoarthritis no conclusions could be drawn on associations. CONCLUSION Lower muscle quality, physical inactivity, more severe joint degeneration, and higher pain are reported to be associated with lower strength in the upper leg muscles in knee osteoarthritis. Future research into knee osteoarthritis should focus on other potential determinants of muscle strength, such as muscle quantity, muscle activation, nutrition and vitamins, and inflammation. In hip osteoarthritis, more research is needed into all potential determinants.
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4.
The impact of sarcopenic obesity on knee and hip osteoarthritis: a scoping review.
Godziuk, K, Prado, CM, Woodhouse, LJ, Forhan, M
BMC musculoskeletal disorders. 2018;(1):271
Abstract
BACKGROUND The progressive, debilitating nature of knee and hip osteoarthritis can result in severe, persistent pain and disability, potentially leading to a need for total joint arthroplasty (TJA) in end-stage osteoarthritis. TJA in adults with obesity is associated with increased surgical risk and prolonged recovery, yet classifying obesity only using body mass index (BMI) precludes distinction of obesity phenotypes and their impact on surgical risk and recovery. The sarcopenic obesity phenotype, characterized by high adiposity and low skeletal muscle mass, is associated with higher infection rates, poorer function, and slower recovery after surgery in other clinical populations, but not thoroughly investigated in osteoarthritis. The rising prevalence and impact of this phenotype demands further attention in osteoarthritis treatment models of care, particularly as osteoarthritis-related pain, disability, and current treatment practices may inadvertently be influencing its development. METHODS A scoping review was used to examine the extent of evidence of sarcopenic obesity in adults with hip or knee osteoarthritis. Medline, CINAHL, Web of Science and EMBASE were systematically searched from inception to December 2017 with keywords and subject headings related to obesity, sarcopenia and osteoarthritis. RESULTS Eleven studies met inclusion criteria, with indications that muscle weakness, low skeletal muscle mass or sarcopenia are present alongside obesity in this population, potentially impacting therapeutic outcomes, and TJA surgical risk and recovery. CONCLUSIONS Consideration of sarcopenic obesity should be included in osteoarthritis patient assessments.
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5.
Prestructural cartilage assessment using MRI.
Link, TM, Neumann, J, Li, X
Journal of magnetic resonance imaging : JMRI. 2017;(4):949-965
Abstract
UNLABELLED Cartilage loss is irreversible, and to date, no effective pharmacotherapies are available to protect or regenerate cartilage. Quantitative prestructural/compositional MR imaging techniques have been developed to characterize the cartilage matrix quality at a stage where abnormal findings are early and potentially reversible, allowing intervention to halt disease progression. The goal of this article is to critically review currently available technologies, present the basic concept behind these techniques, but also to investigate their suitability as imaging biomarkers including their validity, reproducibility, risk prediction and monitoring of therapy. Moreover, we highlighted important clinical applications. This review article focuses on the currently most relevant and clinically applicable technologies, such as T2 mapping, T2*, T1ρ, delayed gadolinium enhanced MRI of cartilage (dGEMRIC), sodium imaging and glycosaminoglycan chemical exchange saturation transfer (gagCEST). To date, most information is available for T2 and T1ρ mapping. dGEMRIC has also been used in multiple clinical studies, although it requires Gd contrast administration. Sodium imaging and gagCEST are promising technologies but are dependent on high field strength and sophisticated software and hardware. LEVEL OF EVIDENCE 5 J. Magn. Reson. Imaging 2017;45:949-965.
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6.
Cryotherapy Treatment After Unicompartmental and Total Knee Arthroplasty: A Review.
Chughtai, M, Sodhi, N, Jawad, M, Newman, JM, Khlopas, A, Bhave, A, Mont, MA
The Journal of arthroplasty. 2017;(12):3822-3832
Abstract
BACKGROUND Cryotherapy is widely utilized to enhance recovery after knee surgeries. However, the outcome parameters often vary between studies. Therefore, the purpose of this review is to compare (1) no cryotherapy vs cryotherapy; (2) cold pack cryotherapy vs continuous flow device cryotherapy; (3) various protocols of application of these cryotherapy methods; and (4) cost-benefit analysis in patients who had unicompartmental knee arthroplasty (UKA) or total knee arthroplasty (TKA). METHODS A search for "knee" and "cryotherapy" using PubMed, EBSCO Host, and SCOPUS was performed, yielding 187 initial reports. After selecting for RCTs relevant to our study, 16 studies were included. RESULTS Of the 8 studies that compared the immediate postoperative outcomes between patients who did and did not receive cryotherapy, 5 studies favored cryotherapy (2 cold packs and 3 continuous cold flow devices). Of the 6 studies comparing the use of cold packs and continuous cold flow devices in patients who underwent UKA or TKA, 3 favor the use of continuous flow devices. There was no difference in pain, postoperative opioid consumption, or drain output between 2 different temperature settings of continuous cold flow device. CONCLUSION The optimal device to use may be one that offers continuous circulating cold flow, as there were more studies demonstrating better outcomes. In addition, the pain relieving effects of cryotherapy may help minimize pain medication use, such as with opioids, which are associated with numerous potential side effects as well as dependence and addiction. Meta-analysis on the most recent RCTs should be performed next.
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7.
Tissue engineering of ligaments for reconstructive surgery.
Hogan, MV, Kawakami, Y, Murawski, CD, Fu, FH
Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 2015;(5):971-9
Abstract
PURPOSE The use of musculoskeletal bioengineering and regenerative medicine applications in orthopaedic surgery has continued to evolve. The aim of this systematic review was to address tissue-engineering strategies for knee ligament reconstruction. METHODS A systematic review of PubMed/Medline using the terms "knee AND ligament" AND "tissue engineering" OR "regenerative medicine" was performed. Two authors performed the search, independently assessed the studies for inclusion, and extracted the data for inclusion in the review. Both preclinical and clinical studies were reviewed, and the articles deemed most relevant were included in this article to provide relevant basic science and recent clinical translational knowledge concerning "tissue-engineering" strategies currently used in knee ligament reconstruction. RESULTS A total of 224 articles were reviewed in our initial PubMed search. Non-English-language studies were excluded. Clinical and preclinical studies were identified, and those with a focus on knee ligament tissue-engineering strategies including stem cell-based therapies, growth factor administration, hybrid biomaterial, and scaffold development, as well as mechanical stimulation modalities, were reviewed. CONCLUSIONS The body of knowledge surrounding tissue-engineering strategies for ligament reconstruction continues to expand. Presently, various tissue-engineering techniques have some potential advantages, including faster recovery, better ligamentization, and possibly, a reduction of recurrence. Preclinical research of these novel therapies continues to provide promising results. There remains a need for well-designed, high-powered comparative clinical studies to serve as a foundation for successful translation into the clinical setting going forward. LEVEL OF EVIDENCE Level IV, systematic review of Level IV studies.
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8.
What is normal? Female lower limb kinematic profiles during athletic tasks used to examine anterior cruciate ligament injury risk: a systematic review.
Fox, AS, Bonacci, J, McLean, SG, Spittle, M, Saunders, N
Sports medicine (Auckland, N.Z.). 2014;(6):815-32
Abstract
BACKGROUND It has been proposed that the performance of athletic tasks where normal motion is exceeded has the potential to damage the anterior cruciate ligament (ACL). Determining the expected or 'normal' kinematic profile of athletic tasks commonly used to assess ACL injury risk can provide an evidence base for the identification of abnormal or anomalous task performances in a laboratory setting. OBJECTIVE The objective was to conduct a systematic review of studies examining lower limb kinematics of females during drop landing, drop vertical jump, and side-step cutting tasks, to determine 'normal' ranges for hip and knee joint kinematic variables. DATA SOURCES An electronic database search was conducted on the SPORTDiscus(TM), MEDLINE, AMED and CINAHL (January 1980-August 2013) databases using a combination of relevant keywords. STUDY SELECTION Studies identified as potentially relevant were independently examined by two reviewers for inclusion. Where consensus could not be reached, a third reviewer was consulted. Original research articles that examined three-dimensional hip and knee kinematics of female subjects during the athletic tasks of interest were included for review. Articles were excluded if subjects had a history of lower back or lower limb joint injury or isolated data from the female cohort could not be extracted. STUDY APPRAISAL AND SYNTHESIS METHODS Two reviewers independently assessed the quality of included studies. Data on subject characteristics, the athletic task performed, and kinematic data were extracted from included studies. Studies were categorised according to the athletic task being examined and each study allocated a weight within categories based on the number of subjects assessed. Extracted data were used to calculate the weighted means and standard deviations for hip and knee kinematics (initial contact and peak values). 'Normal' motion was classified as the weighted mean plus/minus one standard deviation. RESULTS Of 2,920 citations, a total of 159 articles were identified as potentially relevant, with 29 meeting all inclusion/exclusion criteria. Due to the limited number of studies available examining double-leg drop landings and single-leg drop vertical jumps, insufficient data was available to include these tasks in the review. Therefore, a total of 25 articles were included. From the included studies, 'normal' ranges were calculated for the kinematic variables of interest across the athletic tasks examined. LIMITATIONS Joint forces and other additional elements play a role in ACL injuries, therefore, focusing solely on lower limb kinematics in classifying injury risk may not encapsulate all relevant factors. Insufficient data resulted in no normal ranges being calculated for double-leg drop land and single-leg drop vertical jump tasks. No included study examined hip internal/external rotation during single-leg drop landings, therefore ranges for this kinematic variable could not be determined. Variation in data between studies resulted in wide normal ranges being observed across certain kinematic variables. CONCLUSIONS The ranges calculated in this review provide evidence-based values that can be used to identify abnormal or anomalous athletic task performances on a multi-planar scale. This may be useful in identifying neuromuscular factors or specific muscular recruitment strategies that contribute to ACL injury risk.
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9.
Association of obesity and systemic factors with bone marrow lesions at the knee: a systematic review.
Lim, YZ, Wang, Y, Wluka, AE, Davies-Tuck, ML, Hanna, F, Urquhart, DM, Cicuttini, FM
Seminars in arthritis and rheumatism. 2014;(5):600-12
Abstract
OBJECTIVE The objective of this study was to systematically review the literature to determine whether obesity and systemic factors, including age, gender, heritability, dietary factors, smoking, serum and urine biomarkers of cartilage or bone metabolism, bone-related factors, and medication, are associated with knee bone marrow lesions (BMLs) identified on magnetic resonance imaging in asymptomatic pre-osteoarthritis and osteoarthritis populations. METHODS Electronic searches of MEDLINE and EMBASE were performed from January 1, 1996 to September 30, 2012 using the following keywords: bone marrow lesion(s), bone marrow (o)edema, osteoarthritis, and knee. Studies examining obesity and non-biomechanical factors in relation to the presence, incidence, or change in BMLs were included. Two independent reviewers extracted data and assessed methodological quality of selected studies. Due to the heterogeneity of the studies, we performed a best evidence synthesis. RESULTS Among 30 studies, 17 were considered high quality. The study populations were heterogeneous in terms of symptoms and radiographic knee osteoarthritis. There was strong evidence for an association between serum lipids and BMLs and no association between age and BMLs. There was moderate evidence for a relationship between obesity and BMLs. There was limited evidence for gender, smoking, C-telopeptide of type I collagen, anti-bone-resorptive treatments, licofelone, and chondroitin sulfate. There was a paucity of evidence for heritability and conflicting evidence for dietary fatty acids. CONCLUSION There is strong evidence for serum lipids and moderate evidence for obesity as risk factors for knee BMLs. Given the role of BMLs in the pathogenesis of knee osteoarthritis, identification of modifiable risk factors of BMLs and therapeutic interventions targeting BMLs has the potential to reduce the burden of knee osteoarthritis.
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10.
[Osteoarthritis and bone structural changes].
Chiba, K, Osaki, M, Ito, M, Majumdar, S
Clinical calcium. 2013;(7):973-81
Abstract
Bone morphological abnormalities, such as acetabular dysplasia, femoroacetabular impingement (FAI) , and knee varus deformity, are causes of osteoarthritis (OA) . These deformities have complex three-dimensional characteristics, and an accurate image assessment is not always easy. In recent years, statistical shape models (SSM) have been applied to analyzing variations of bone morphology in OA. Bone microstructural changes in OA include bone sclerosis, subchondral cysts, and osteophytes. Recent studies show that various pathological changes in subchondral bone affect the onset and development of OA, becoming targets for new drugs. Quantitative methods to analyze the subchondral trabecular bone of OA patients using MDCT and 3TMRI are currently under development.