Search Results (41)

Background/Objectives: Osteoarthritis is a slowly evolving joint disorder defined by cartilage degradation, synovial inflammation, subchondral bone hardening, and the growth of osteophytes. Increasing evidence highlights the role of metabolic factors in osteoarthritis onset and progression. This study investigated the link between metabolic syndrome and the level of knee impairment in postmenopausal respondents suffering from knee osteoarthritis. Methods: A total of 200 participants aged 60–75 years with knee pain were enrolled in this observational cross-sectional study conducted between 2022 and 2023. The case group comprised 120 women with radiographically verified knee osteoarthritis (Kellgren–Lawrence grades II–IV), while 80 age-matched women without radiographic changes served as controls. Clinical and anthropometric measures, metabolic indicators, and radiographic findings were collected. Functional status was assessed using the Lower Extremity Functional Scale and the Lequesne Index. Results: The groups differed significantly with respect to the presence of metabolic syndrome, diastolic blood pressure, and fasting glucose level (p < 0.05). The metabolic syndrome showed modest but significant associations with radiographic knee damage (effect size 4.7%). After adjusting for smoking status and physical activity level, metabolic syndrome remained significantly associated with radiographic damage (effect sizes: 4.8 and 2.2%, respectively). Participants with osteoarthritis but without metabolic syndrome had better functional knee status compared to those with metabolic syndrome (p < 0.05). Conclusions: In postmenopausal women, metabolic syndrome is independently associated with radiographic knee damage and contributes to poorer functional outcomes in participants with knee osteoarthritis, underscoring its potential role as a modifiable risk factor. Full article

Background/Objectives: Spinal osteoarthritis (sOA) is a degenerative condition marked by pain, inflammation, and restricted mobility. While surgical interventions such as spinal decompression and stabilization are common, their impact on redox status and inflammatory markers remains underexplored. This study aimed to assess the effects of surgery on clinical, hematological, biochemical, and redox parameters in patients with sOA. Methods: A total of 25 patients diagnosed with sOA underwent spinal decompression and stabilization surgery. Preoperative and postoperative assessments included hematological and biochemical analyses, redox status evaluation (TAS, TOS, GSH, AOPP, SOD), and inflammatory markers such as IL-6. Disease severity was graded using the Kellgren–Lawrence (K-L) system. Results: Postoperatively, there was a significant decrease in neutrophil count (p = 0.014) and AOPP levels (p < 0.001), with a corresponding increase in lymphocyte count (p = 0.016), erythrocyte count (p = 0.036), and IL-6 levels (p = 0.008). TAS levels decreased (p = 0.006), while enzymatic antioxidants, such as SOD increased (p = 0.031). Erythrocyte GSH remained low, with a non-significant postoperative decrease. Patients with higher K-L grades exhibited greater redox imbalance, with reduced preoperative GSH and elevated postoperative superoxide anion, TOS, and SOD levels. More severe cases also showed decreased postoperative erythrocyte, hemoglobin, and PTH levels, and increased TAS and AOPP levels. Factorial analysis highlighted clusters associated with oxidative stress, inflammation, and clinical performance. Conclusions: The results underscore the complex relationship between inflammation, oxidative stress, and recovery in sOA. These findings suggest the importance of targeted postoperative strategies to support redox homeostasis and modulate inflammation in sOA patients. Full article

Background/Objectives: This Phase 3, randomised, double-blind, multicentre trial evaluated the efficacy and safety of a novel hyaluronic acid hydrogel cross-linked with hexamethylenediamine (HMDA-HA) compared to a conventional 1,4-butanediol diglycidyl ether cross-linked HA (BDDE-HA) in patients with mild-to-moderate knee osteoarthritis (OA). Methods: A total of 223 adults (mean age 63.5 years; 167 women) with Kellgren–Lawrence (KL) grade I–III knee OA were randomised 1:1 to receive two intra-articular injections of HMDA-HA or BDDE-HA at baseline and at 24 weeks. The primary endpoint was changes from baseline in weight-bearing pain (WBP) on a 100 mm visual analogue scale (VAS) at Week 12, assessed in the per-protocol population. A non-inferiority margin of 10 mm was predefined. Secondary outcomes included global assessments, Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index scores, responder rates, and rescue medication use [ClinicalTrials.gov: NCT06307847]. Results: At Week 12, least squares mean change (standard error [SE]) in WBP was −23.72 (1.88) mm in the HMDA-HA group (n = 83) and −25.99 (1.76) mm in the BDDE-HA group (n = 95), yielding a difference of 2.26 mm (95% confidence interval [CI]: −2.83 to 7.34; p = 0.3825), thus demonstrating the non-inferiority of HMDA-HA to BDDE-HA. Secondary outcomes were comparable between groups. A total of 136 adverse events were reported: 44 (41.1%) in the HMDA-HA group and 32 (28.1%) in the BDDE-HA group, with no treatment-related adverse drug reactions. Conclusions: A single-injection intra-articular regimen of HMDA-HA was effective and safe for the treatment of adult patients with mild-to-moderate knee OA. Full article

Background: Osteoarthritis (OA) is one of the common joint diseases. Hematologic markers have been investigated to determine its severity and predict the prognosis of joint diseases. In this study, we investigated whether the systemic immune-inflammatory index (SII) is a marker for assessing the severity of OA. Methods: The records of patients diagnosed with OA at various stages between 1 January 2020 and 1 January 2022 were retrospectively analyzed. Patients aged 18–75 years with complete blood count within the last 15 days and not taking anti-inflammatory drugs were included in the study. Patients were classified according to the Kellgren–Lawrance classification as stage 1-2-3 mild to moderate OA (Group I) and stage 4 severe OA (Group II). A total of 1580 patients were diagnosed with knee OA and 946 were included in the study. Of the patients, 246 (26%) were male and 700 (74%) were female. The mean age of the patients was 61.00 (53.00–68.00) years. Results: There were 449 (47.5%) patients in Group I and 497 (52.5%) patients in Group II. Statistically significant differences were found between the groups in age, gender, hemoglobin, lymphocytes, and SII (p < 0.05). An SII value of 627.9 was found to distinguish severe OA from mild–moderate OA with 42.5% sensitivity and 70.6% specificity. Conclusions: Although this study is the first in the literature, it shows that SII has limited predictive value in assessing the severity of knee OA. Future research should focus on longitudinal studies to establish causality and explore therapeutic implications. Full article

Background: Some evidence suggests that combining hyaluronic acid (HA) with platelet-rich-plasma (PRP) may offer synergistic benefits by enhancing the biological and mechanical properties of joints. However, data on the combination of HA+PRP vs. HA alone in the management of knee osteoarthritis (OA) remain limited. Methods: A double-blinded randomized controlled trial was conducted at an outpatient clinic and enrolled 58 patients with Kellgren–Lawrence grade 2–3 knee OA. They were randomly allocated to receive either intra-articular PRP combined with HA (n = 29 knees) or HA alone (n = 29 knees). The primary outcome was pain, assessed using a visual analog scale (VAS). Secondary outcomes included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), health-related quality of life (EQ-5D-5L), and structural changes on MRI, measured by the Whole-Organ MRI Score (WORMS). The VAS, WOMAC, and EQ-5D-5L were evaluated at baseline and at months 1, 3, 6, and 12. MRI WORMS was assessed at baseline and 12 months. Results: The baseline characteristics were comparable between the HA+PRP and HA groups. Both interventions showed improvements in pain and function at 12 months. However, the between-group difference in VAS at 12 months—the primary outcome—was not statistically significant (p = 0.102) and did not exceed the minimal clinically important difference (MCID) of 20 mm. The HA group demonstrated significantly greater VAS score reductions at 1 month (−31.1 [95% CI: −38.9 to −23.2] vs. −14.3 [95% CI: −22.2 to −6.4], p = 0.003) and at 6 months (−32.1 [95% CI: −40.1 to −24.1] vs. −19.2 [95% CI: −27.1 to −11.3], p = 0.024), compared to the HA+PRP group, although these differences did not reach clinical significance. No significant between-group differences were observed in the WOMAC scores, EQ-5D-5L, or total WORMS scores at all time points (p > 0.05). At 12 months, MRI assessment revealed a significant decrease in bone marrow edema in the HA+PRP group (−0.7 [95% CI: −1.6 to 0.2]) compared to the HA group (0.7 [95% CI: −0.2 to 1.6], p = 0.030). Conclusions: Both HA+PRP and HA treatments were effective in reducing pain and improving function in patients with knee OA over 12 months. While HA demonstrated greater early pain relief, the addition of PRP was associated with a significant reduction in bone marrow edema at 12 months. These findings suggest potential structural benefits of HA+PRP, although clinical superiority over HA alone was not established. Full article

Background: Knee osteoarthritis (OA) is a progressive joint disorder characterized by pain, stiffness, and functional impairment. Platelet-rich plasma (PRP) has been widely studied as a biological treatment for OA, with autologous PRP (A-PRP) being the most commonly used formulation. Recently, umbilical cord-derived PRP (C-PRP) has emerged as a potential alternative due to its hypothesized higher regenerative potential. However, evidence supporting its superiority over A-PRP remains limited. This study aims to compare the efficacy and safety of C-PRP and A-PRP in terms of pain relief and functional improvement over a 12-month follow-up period. Methods: This prospective cohort study included 84 patients with mild-to-moderate knee OA (Kellgren–Lawrence grades I–III), into two groups: 44 patients received a single intra-articular injection of C-PRP, and 40 received A-PRP. Pain and functional outcomes were assessed at baseline, 3, 6, 9, and 12 months using the Visual Analog Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Knee Injury and Osteoarthritis Outcome Score (KOOS). Statistical analysis was performed using the Mann–Whitney U, Exact Fisher test, repeated measures general linear model (GLM) and multivariate logistic regression. Results: Both C-PRP and A-PRP led to significant pain reduction and functional improvement over 12 months (p < 0.01 for both groups). Short-term analysis (3–6 months) showed slightly greater pain relief in the C-PRP group (VAS, p = 0.03 at 3 months), but this difference diminished at later time points. By 9 and 12 months, no significant differences were observed between the two groups in any clinical outcome measures (VAS, WOMAC, KOOS; p > 0.05). No serious adverse events were reported, and both treatments were well tolerated. Conclusions: This study found no long-term superiority of C-PRP over A-PRP in terms of pain relief or functional improvement in knee OA. While C-PRP showed a transient advantage in early pain relief, both treatments demonstrated similar clinical outcomes at 12 months. Given the limited scientific evidence supporting C-PRP and its higher logistical costs, A-PRP should remain the preferred PRP therapy for knee OA. Further randomized controlled trials with longer follow-up periods are needed to confirm these findings. Full article

Background/Objectives: Medial open wedge high tibial osteotomy (MOWHTO) has led to favorable clinical results since the introduction of locking plates. Surgical indications, techniques, and postoperative alignment are crucial for achieving favorable clinical outcomes. This study analyzed the clinical outcomes of patients after >5 years of post-MOWHTO follow-up to identify the influential factors. Methods: Thirty-nine patients (48 knees) underwent MOWHTO for medial compartment knee osteoarthritis or -necrosis and were followed up for >5 years. The targeted postoperative % mechanical axis (%MA) was 62.5% (Fujisawa point). The Japanese Orthopaedic Association (JOA) Knee Disease Outcome Criteria score; Kellgren–Lawrence classification; hip-knee-ankle, medial proximal tibial, mechanical lateral distal femoral, and joint line convergence angles (JLCA); and %MA were evaluated preoperatively, at implant removal, and at the final follow-up. Total knee arthroplasty (TKA) was the survival endpoint. Uni- and multivariate analyses were performed to identify the factors influencing survival rates. Results: The mean JOA score improved from preoperative to implant removal and was sustained at 102 months. Four of the 48 knees required TKA, resulting in a 10-year survival rate of 82%. Body mass index, preoperative JLCA, and Δ%MA influenced the post-MOWHTO survival rate. The Δ%MA was significantly greater in the group with a %MA < 62.5% at implant removal. Conclusions: MOWHTO with a target %MA of 62.5% yielded favorable long-term outcomes. Additionally, preoperative obesity and high joint instability negatively influenced post-MOWHTO survival. Furthermore, a postoperative %MA of < 62.5% is associated with difficulty maintaining stable alignment and an increased risk of conversion to TKA. Full article

Background: Knee osteoarthritis (OA) is a prevalent condition among adults that leads to knee joint pain and dysfunction. Over the past two decades, local intra-articular knee injection therapy has gained popularity due to the advent of platelet-rich plasma (PRP), hyaluronic acid (HA), and the novel peripheral blood-derived mononuclear cells (PBMNCs). This study aimed to compare the therapeutic efficacy of intra-articular injections of PBMNCs, HA, and PRP combined with hyaluronic acid (PRP-HA) for treating degenerative knee OA classified as stages II and III, according to the Kellgren and Lawrence (KL) scale. Methods: This retrospective observational study involved adults with moderate-to-moderately severe knee OA treated at the University Hospital of Catania, Italy. The subjects were divided into three groups and treated with intra-articular injections of HA, PRP-HA, or PBMNCs. The outcome measures assessed were as follows: the Numerical Rating Scale, the Western Ontario and McMaster Universities Arthritis Index, the Timed Up and Go, the International Knee Documentation Committee score, a 10-meter walking test, and the Physical score and the Mental score on the SF-12. This study included a total of 46 adults, 30 females and 16 males, with a mean age of 63.7 ± 10.9 years. Results: HA, PRP-HA, and PBMNCs demonstrated comparable effectiveness for improving the NRS score and all the other outcomes at 6 months. Additionally, PRP-HA and PBMNCs also enhanced knee flexion and the International Knee Documentation Committee score. However, none of the three treatments led to a significant improvement on the 10-meter walking test. No serious adverse effects were reported. Conclusions: In this study, injections of HA, PRP-HA, and PBMNCs all demonstrated positive outcomes for up to 6 months post-treatment in the subjects suffering from knee OA. Full article

Background/Objectives: Osteoarthritis (OA) is a chronic and progressive joint disease, leading to functional limitations and significantly impairing the quality of life. Muscle weakness, reduced mobility, and compensatory biomechanical changes are common consequences, further exacerbating functional decline. The aim of this study was to assess the impact of hip osteoarthritis on muscle functionality and to evaluate the effectiveness of hip arthroplasty using the MyotonPro device to measure key biomechanical parameters, i.e., tension, stiffness, and flexibility. Methods: This cohort study included 40 patients (17 women and 23 men; mean age 64.55 ± 10.49 years) with advanced hip OA (Kellgren–Lawrence grade III–IV) undergoing hip arthroplasty. Measurements of muscle tension (F), stiffness (S), and flexibility (D) in the gluteus maximus, rectus femoris, and biceps femoris were performed at three time points: before surgery, on postoperative days 8–10, and one month after hospital discharge. Pain (VAS), balance (Tinetti scale), and functional ability (WOMAC index) were also assessed. Results: Hip arthroplasty significantly reduced pain levels (VAS: 6.38 ± 0.28 preoperatively to 1.88 ± 0.22 postoperatively, p < 0.001) and improved functional ability (WOMAC: p < 0.001). Muscle tension and stiffness of the gluteus maximus initially increased after surgery (tension: 11.57 ± 0.32 to 12.15 ± 0.38, p = 0.009), reflecting compensatory stabilization but decreased by the final evaluation. Flexibility improved significantly over time (p = 0.014). The biceps femoris muscle exhibited a significant reduction in tension one month postoperatively (p = 0.015), alongside decreased stiffness (p = 0.015) and enhanced flexibility. The rectus femoris muscle showed minor changes in biomechanical properties, with no statistically significant differences detected. Conclusions: Osteoarthritis significantly impacts muscle function, reducing the gluteus muscle tension and stiffness, which compromises joint stability and triggers compensatory activity in the rectus femoris and biceps femoris muscles. Postoperative rehabilitation is essential for improving flexibility and addressing compensatory muscle tension. Full article

Background: Knee osteoarthritis (OA) is the most prevalent form of osteoarthritis and a leading cause of chronic pain in adults. This study aimed to compare the short-term effects of extracorporeal shock wave therapy (ESWT), low-level laser therapy (LLLT), and pulsed electromagnetic field therapy (PEMF) on pain, function, and quality of life in patients with knee OA. Methods: A hundred and twenty patients with Kellgren–Lawrence grade 2–3 knee OA were randomized into four groups: ESWT (once a week for three sessions), LLLT (twice a week for eight sessions), PEMF (twice a week for eight sessions), and a control group with 30 patients in each group. All participants were instructed in a daily exercise program, including knee joint range of motion, stretching, and strengthening exercises (3 × 10 repetitions). Outcome measures, including the visual analog scale (VAS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Short Form-36 (SF-36), and the Timed Up and Go (TUG) test, were assessed at baseline after treatment and at the third month. Results: There were no significant differences between groups at baseline regarding VAS, WOMAC, SF-36, and TUG scores (p > 0.05). Significant improvements were observed in all parameters post-treatment for all groups (p < 0.001). However, the improvements in the PEMF group were significantly lower than in the ESWT and LLLT groups, particularly for VAS, WOMAC pain, and SF-36 physical function scores (p < 0.05). No significant differences were found between ESWT and LLLT (p > 0.05). Conclusions: In the short-term, ESWT, LLLT, and PEMF effectively reduce pain, improve physical function, and enhance quality of life in patients with knee OA, though PEMF showed less pronounced improvements. Full article

Objective. To investigate the relationships among neuropathic pain (NP), pain catastrophizing (PC), and central sensitization (CS) in relation to functional status and radiological damage in patients with knee osteoarthritis (OA). Methods. This cross-sectional study included knee OA patients derived from an observational cohort. The Spearman correlation test was used to analyze the relationship between the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the PainDetect Questionnaire (PDQ), Central Sensitization Inventory (CSI), and Pain Catastrophizing Scale (PCS). The Kruskal–Wallis test was employed to compare WOMAC scores according to CSI categories. A multivariate analysis was conducted to identify predictors of functional ability, with the WOMAC score as the dependent variable and the independent variables including pain-related indices such as PCS, PDQ, and CSI, along with Kellgren–Lawrence (K-L) grading and demographic characteristics. Results. This study included 149 patients (76.5% female; mean age 71.5 years; mean duration of pain 8.1 years). In total, 23.5% exhibited NP, 30.9% showed PC, and 33.6% had CS. Higher mean values of WOMAC were correlated with CSI categories (p < 0.0001). WOMAC showed a significant relationship with CSI (rho = 0.791; p < 0.0001), PDQ (rho = 0.766; p < 0.0001), and PCS (rho = 0.536; p < 0.0001). In the multiple regression analysis, WOMAC was independently associated with CSI (p < 0.0001), PDQ (p < 0.0001), and PC (p = 0.0001). No association was observed between the K-L grading and the other variables. Conclusions. A reduced functional capacity in patients with knee OA is correlated with the presence of NP, PC and CS, without being significantly associated with radiological damage. Full article

Purpose: To investigate the effects of total knee arthroplasty (TKA) on muscle mass and bone density in end-stage knee osteoarthritis (OA). Methods: This prospective study was conducted on 111 patients with Kellgren–Lawrence grade 4 knee OA who underwent TKA after failing to respond to conservative treatment for more than 3 months at a single institution from June 2022 to May 2023. Appendicular lean mass index (ALMI) and bone mineral density (BMD) were measured using dual-energy X-ray absorptiometry before and every 6 months after surgery. The average follow-up period was 15.5 ± 2.31 months (range, 11.6–24 months). Results: During the follow-up period after TKA, the ALMI increased relatively continuously and consistently. The BMD of the L-spine and proximal femur did not change significantly until 12 months after TKA surgery but began to increase steeply after 12 months and slowed down after 18 months. The increase in muscle mass showed a significant positive correlation with the increase in BMD. Conclusions: Muscle mass gradually increased after TKA for end-stage knee OA, whereas bone density also increased but not until 12 months after surgery. The significant positive correlation between the increase in muscle mass and bone density suggests that the increase in muscle mass after TKA may be one of the causes of the increase in bone density. Full article

Background/Objectives: 3′-Sialyllactose (3′-SL), a human milk oligosaccharide, has anti-inflammatory effects and is demonstrated to have protective effects against osteoarthritis (OA) in vitro and in vivo. However, this hypothesis remains to be investigated in a clinical setting. Herein, we investigated the effects of 3′-SL on pain and physical function in patients with knee OA. Methods: Sixty patients with knee OA with Kellgren and Lawrence grades (KL-grades) 1–4 and Korean Western Ontario and McMaster Universities Osteoarthritis Index (KWOMAC) scores ≥30 were randomly assigned to the placebo (n = 20), 3′-SL 200 mg (n = 20), and 3′-SL 600 mg (n = 20) groups. For 12 weeks, 3′-SL or placebo was administered to patients once a day. Clinical efficacy was evaluated using a visual analog scale (VAS) for pain and KWOMAC for physical function at baseline and at 6 and 12 weeks. Adverse effects were assessed for 12 weeks. Results: Significant reductions in VAS and KWOMAC scores were observed at 12 weeks compared with the baseline in the 3′-SL group. No severe adverse effects were observed over 12 weeks. Conclusions: 3′-SL reduced pain in patients with knee OA, improved daily life movements, and was safe, suggesting that 3′-SL might be an effective treatment for knee OA without severe side effects. Full article

Background/Objective: This study aimed to compare the functional outcomes, such as knee muscle strength, dynamic postural stability, pain scores, and physical activity, in patients with knee osteoarthritis (OA) on stair climbing training with and without interferential electrotherapy (IFE) for 12 weeks. Methods: A total of 40 knee OA patients with Kellgren–Lawrence (K–L) grade ≤ 2 were enrolled (20 stair-climbing training with IFE vs. 20 stair-climbing training without IFE). The knee quadriceps and hamstring muscle strengths were measured using an isokinetic device. The dynamic postural stability was assessed using postural stabilometry. The pain score was evaluated using the visual analog scale (VAS). Physical activity was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Results: The WOMAC score was significantly different (p < 0.019) between stair-climbing training with and without IFE in patients with knee OA, while knee muscle strength, dynamic postural stability, or pain score were not (all p > 0.05). Conclusion: Stair-climbing training with IFE was more beneficial for physical activity recovery than stair-climbing training without IFE. Therefore, clinicians and therapists should be aware that stair climbing, which can be practiced in daily life for the management of patients with knee OA, and the addition of IFE may improve physical activity. Full article

Background: Platelets and lymphocytes levels are important in assessing systemic disorders, reflecting inflammatory and immune responses. This study investigated the relationship between blood parameters (platelet count (PLT), mean platelet volume (MPV), lymphocyte count (LINF), and platelet-to-lymphocyte ratio (PLR)) and osteoarthritis (OA) severity, considering age, sex, and body mass index (BMI). Methods: Patients aged ≥40 years were included in this cross-sectional study and divided into groups based on knee OA severity using the Kellgren–Lawrence (KL) grading system. A logistic regression model, adjusted for confounders, evaluated the ability of PLT, MPV, LINF, and PLR to categorize OA severity. Model performance in terms of accuracy, sensitivity, and specificity was assessed using ROC curves. Results: The study involved 245 OA patients (51.4% female, 48.6% male) aged 40–90 years, 35.9% with early OA (KL < 3) and 64.1% moderate/severe OA (KL ≥ 3). Most patients (60.8%) were aged ≥60 years, and BMI was <25 kg/m² in 33.9%. The model showed that a 25-unit increase in PLR elevates the odds of higher OA levels by 1.30 times (1-unit OR = 1.011, 95% CI [1.004, 1.017], p < 0.005), while being ≥40 years old elevates the odds by 4.42 times (OR 4.42, 95% CI [2.46, 7.95], p < 0.0005). The model’s accuracy was 73.1%, with 84% sensitivity, 52% specificity, and an AUC of 0.74 (95% CI [0.675, 0.805]). Conclusions: Higher PLR increases the likelihood of moderate/severe OA, suggesting that monitoring these biomarkers could aid in early detection and management of OA severity. Further research is warranted to cross-validate these results in larger populations. Full article