Search Results (260)

Gait analysis is increasingly used as a dynamic functional biomarker for computer-aided diagnosis (CADx), although strong internal performance alone does not establish clinical utility. This targeted narrative review examines Parkinson’s disease (PD) and knee osteoarthritis (KOA) as its primary clinical contexts while treating fall risk and other mobility disorders as contextual extensions. A structured literature search and source-verification process covered studies available through 31 July 2026. The review corpus comprised 118 sources spanning clinical evidence, measurement validation, datasets, algorithmic architectures, and methodological guidance. This review critically compares sensing modalities, public and proprietary datasets, feature-based models, CNN/RNN architectures, graph neural networks, Transformers, state-space models, and trust-supporting approaches, including explainable artificial intelligence, automated machine learning, federated learning, and multimodal fusion. Using an explicit coverage rule, a common validation audit was applied to 15 empirical or measurement-validation studies. The audited evidence did not demonstrate mature independent multisite validation for disease-focused gait CADx. Formal probability calibration and quantitative testing of explanation stability were also absent, while publicly available KOA-specific multimodal benchmarks remained scarce. Based on these findings, this review proposes a six-level validation-readiness ladder in which independent external evidence at Level 3 represents the minimum threshold for initiating a supervised clinical pilot. The framework prioritizes subject-level separation, leakage control, calibration, clinically meaningful reference standards, and prospective workflow evaluation. Full article

Background and Objectives: Osteoarthritis (OA) is the most common degenerative joint disease and a leading cause of pain and disability worldwide. Increasing evidence indicates that dysregulated iron metabolism contributes to joint degeneration by promoting inflammation, oxidative stress, and cartilage damage. Hemophilic arthropathy (HA), a severe complication of hemophilia caused by recurrent hemarthroses, represents a unique model of iron-driven joint degeneration. This narrative review summarizes current evidence on the contribution of iron deposition to the pathogenesis of hemophilic arthropathy and discusses its relevance to knee osteoarthritis (KOA). Materials and Methods: The literature was reviewed using the PubMed, Scopus, and Web of Science databases, focusing on published studies addressing iron deposition, synovial inflammation, angiogenesis, oxidative stress, cartilage degeneration, subchondral bone remodeling, and dysregulated iron metabolism. Results: Current evidence indicates that iron stored primarily as hemosiderin promotes persistent synovial inflammation and progressive joint destruction. Several pathological pathways associated with iron accumulation, including chronic low-grade inflammation, extracellular matrix degradation, and altered bone remodeling, are shared by HA and KOA. Conclusions: These findings suggest that iron-mediated mechanisms may provide important insights into OA pathogenesis and support further investigation of iron as a potential diagnostic and therapeutic target in degenerative joint diseases. Full article

Knee osteoarthritis (KOA) is a degenerative joint disease characterized by inflammatory reactions and bone lesions within the joint, which is mainly caused by the degeneration of articular cartilage. This disease primarily affects middle-aged and elderly populations, especially those over 50 years old; however, a distinct trend of younger onset has been observed in recent years, which is closely associated with factors such as sports-related injuries and obesity. Astaxanthin (AST), a ketone carotenoid belonging to the xanthophyll family, exhibits extremely strong antioxidant and broad-spectrum anti-inflammatory activities with no obvious toxic and side effects due to its unique molecular structure, thus showing great potential in the prevention and treatment of KOA. This article reviews the research evidence and action mechanisms of AST in the prevention and treatment of KOA from multiple aspects, including alleviating joint pain, reducing cartilage structural damage, resisting oxidative stress, inhibiting inflammatory responses, and regulating cartilage metabolism and functional disorders, while exploring the key factors and signaling pathways involved. On this basis, a strategy combining AST with exercise intervention for the prevention and treatment of KOA is proposed, which provides a certain reference for the clinical treatment and scientific research of KOA. Full article

Background: Knee osteoarthritis (KOA) in people with overweight or obesity is clinically heterogeneous, reflecting mechanical loading, synovial and systemic inflammation, metabolic dysfunction, structural severity, and pain-related factors. We evaluated multidomain outcomes after semaglutide initiation and characterized clinically relevant response patterns. Methods: This retrospective, self-controlled cohort included 93 adults treated in routine rheumatology care; 88 completed a six-month follow-up. There was no untreated concurrent comparator; within-patient changes and exposure–outcome associations were therefore interpreted as non-causal. Changes in pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function, anthropometry, inflammatory markers, glycated hemoglobin (HbA1c), lipids, dose exposure, and safety were evaluated. Joint multivariable models included percentage weight loss and maximum achieved dose. Exploratory K-means phenotyping integrated dose, weight loss, body mass index (BMI) decrease, visual analog scale (VAS) and WOMAC improvement, and C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and HbA1c reductions, with candidate solutions and resampling stability examined. Results: At six months, mean weight decreased by 10.88 kg, VAS pain score by 2.47 points, WOMAC total by 22.50 points, CRP by 2.67 mg/L, ESR by 7.62 mm/h, and HbA1c by 0.51 percentage points (all p < 0.001). Weight loss remained independently associated with WOMAC improvement, while achieved dose retained positive adjusted associations with pain, function, inflammatory, and metabolic changes. Exploratory clustering identified five clinically interpretable patterns along a broader response-intensity gradient, including high-burden multidomain response, high-dose concordant response, dose-modified intermediate response, inflammation-preserved response despite moderate weight loss, and dose-limited graded response. These observational coefficients and clusters cannot distinguish treatment-related effects from residual confounding or co-interventions. Conclusions: Substantial within-patient improvements were observed, but the uncontrolled design precludes causal attribution. The exploratory patterns may be compatible with contributions from baseline disease burden, dose exposure, mechanical unloading, and residual inflammatory variation; they do not establish weight-independent pharmacologic effects or validated patient subtypes. Prospective controlled, multicenter validation is required. Full article

Intra-articular drug injection is a key therapeutic strategy for knee osteoarthritis (KOA), and its efficacy is closely associated with the spatial distribution of the injected fluid within the joint cavity. In this study, an anatomically realistic knee joint cavity model was first reconstructed from patient CT images. Because sodium hyaluronate injectable drugs exhibit non-instantaneous, memory-dependent viscoelastic relaxation, a fractional Maxwell constitutive equation was introduced to characterize their mechanical behavior and was coupled with the governing equations of incompressible miscible two-phase flow. The finite volume method and the L1 discretization scheme were then used to solve the governing equations. Numerical simulations were conducted to analyze the effects of fractional order and relaxation time on the effective drug coverage and volume fraction distribution. The results show that increasing the fractional order improves the effective coverage of the target region and enhances drug retention near the joint cavity boundary, whereas a longer relaxation time makes the drug distribution more localized and reduces the late-stage effective coverage. This study provides a theoretical reference for analyzing intra-articular drug transport in KOA and for optimizing individualized injection parameters. Full article

Intra-articular drug injection is a key therapeutic strategy for knee osteoarthritis (KOA), and its efficacy is closely associated with the spatial distribution of the injected fluid within the joint cavity. In this study, an anatomically realistic knee joint cavity model was first reconstructed from patient CT images. Because sodium hyaluronate injectable drugs exhibit non-instantaneous, memory-dependent viscoelastic relaxation, a fractional Maxwell constitutive equation was introduced to characterize their mechanical behavior and was coupled with the governing equations of incompressible miscible two-phase flow. The finite volume method and the L1 discretization scheme were then used to solve the governing equations. Numerical simulations were conducted to analyze the effects of fractional order and relaxation time on the effective drug coverage and volume fraction distribution. The results show that increasing the fractional order improves the effective coverage of the target region and enhances drug retention near the joint cavity boundary, whereas a longer relaxation time makes the drug distribution more localized and reduces the late-stage effective coverage. This study provides a theoretical reference for analyzing intra-articular drug transport in KOA and for optimizing individualized injection parameters. Full article

The pathogenesis of knee osteoarthritis (KOA) involves bone homeostasis imbalance induced by inflammation, metabolism, age, mechanical stress, joint injury and other factors. Recently, Type H vessels (CD31^hiEMCN^hi endothelial cells) have emerged as a specialized endothelial cell subset that couples angiogenesis with osteogenesis. Type H angiogenesis in the diaphysis was found to be beneficial for maintaining bone homeostasis, while the abnormal proliferation of type H vessels in subchondral bone can lead to chondrocyte hypertrophy and osteophyte formation. However, the mechanism by which the abnormal proliferation of type H vessels induces KOA has not been elucidated in detail. In this review, we summarize the latest evidence on the role of type H endothelial cell function in the pathogenesis and progression of osteoarthritis (OA). We review the role of type H angiogenesis at different sites in the development and progression of OA and focus on the potential mechanisms that regulate type H angiogenesis in OA and the potential therapeutic value and significance of targeting type H angiogenesis in promoting bone regeneration and maintaining bone homeostasis. Finally, we discuss key obstacles and future directions for studying type H vessel regulation in KOA, offering an endothelial cell-based framework for understanding bone homeostasis and improving OA. Full article

Background/Objectives: Total knee arthroplasty (TKA) is the standard surgical treatment for end-stage knee osteoarthritis (KOA); however, restoration of normal gait biomechanics remains an important challenge. Objective assessment of gait recovery may provide valuable information beyond conventional clinical outcome measures. This study aimed to evaluate changes in spatiotemporal gait parameters, symmetry restoration, and functional recovery during the first year following primary TKA, and to identify predictors of postoperative gait performance. Methods: A prospective longitudinal cohort study was conducted in 150 patients undergoing primary unilateral TKA for end-stage KOA. Spatiotemporal gait parameters, symmetry-related variables, and functional outcomes were assessed preoperatively and at 3, 6, and 12 months postoperatively. Gait analysis included walking speed, step length, cadence, stance phase symmetry, symmetry index (SI), loading asymmetry, and single-limb support time. Functional evaluation included the Timed Up and Go (TUG) test, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Knee Society Score (KSS). Repeated-measures analysis of variance (ANOVA), Pearson correlation analysis, and multivariate linear regression were performed. Results: Significant improvements were observed in all gait and functional parameters throughout follow-up (all p < 0.001). Walking speed increased from 0.84 ± 0.16 m/s preoperatively to 1.21 ± 0.18 m/s at 12 months, while step length increased from 49.8 ± 7.4 cm to 64.0 ± 6.4 cm and cadence from 91 ± 10 to 108 ± 8 steps/min. SI improved from 73 ± 11% to 93 ± 6%, whereas loading asymmetry decreased from 18.2 ± 6.1% to 4.8 ± 2.3%. Walking speed demonstrated strong correlations with WOMAC score (r = −0.74, p < 0.001) and TUG performance (r = −0.79, p < 0.001). Multivariate regression analysis identified preoperative walking speed (β = 0.47, p < 0.001) as the strongest predictor of postoperative gait recovery, while age and body mass index (BMI) were significant negative predictors. Conclusions: Patients undergoing primary TKA demonstrated substantial improvements in gait biomechanics, symmetry restoration, and functional performance during the first postoperative year. Objective gait assessment was strongly associated with clinical outcomes and may facilitate identification of patients at risk of delayed recovery. Incorporating quantitative gait analysis into postoperative evaluation may support individualized rehabilitation strategies aimed at optimizing functional outcomes following TKA. Full article

Background: Knee osteoarthritis (KOA) is a leading cause of chronic pain and functional disability worldwide. Despite the widespread use of intra-articular (IA) corticosteroids and hyaluronic acid (HA), their long-term efficacy remains limited. Amniotic and chorionic membrane-derived biologics have emerged as promising alternatives owing to their anti-inflammatory, anti-fibrotic, and regenerative properties. Methods: This narrative review employed a structured, transparency-oriented literature search approach across PubMed/MEDLINE, EMBASE, Cochrane CENTRAL, and ClinicalTrials.gov (2015–2025). Studies evaluating intra-articular amniotic or chorionic membrane biologics in knee OA and reporting clinical outcomes were included. Results: Nine studies met the inclusion criteria, encompassing randomized controlled trials, prospective cohort studies, and retrospective analyses. Across studies, IA amniotic and chorionic membrane biologics demonstrated clinically meaningful improvements in pain scores and functional outcomes, with a favorable safety profile and minimal adverse events reported. Conclusions: Intra-articular amniotic and chorionic membrane biologics represent a promising therapeutic option for knee OA, with emerging evidence supporting their anti-inflammatory and potentially chondroprotective effects. Standardized product characterization, rigorous randomized controlled trials, and long-term follow-up studies are needed to establish their definitive clinical role. Full article

Intra-articular platelet-rich plasma (PRP) injections represent a promising biological treatment for early-stage knee osteoarthritis (KOA). As cord blood-derived PRP (CB-PRP) contains higher levels of bioactive mediators, this prospective study aimed to compare the efficacy and safety of CB-PRP versus homologous donor PRP (HD-PRP) in patients with early KOA and to evaluate whether CB-PRP results in greater clinical improvement. Fifty-one patients aged 46–70 years with Kellgren–Lawrence grade 1–2 were randomized to receive either CB-PRP or HD-PRP. Each underwent three intra-articular injections at four-week intervals. Outcomes included pain-related overall health perception assessed by the EuroQol Visual Analogue Scale (EQ-VAS), function measured with the Knee Injury and Osteoarthritis Outcome Score (KOOS), and quadriceps muscle strength evaluated by dynamometry. Assessments were performed at baseline and at 1, 2, 3, 6, and 12 months. Both groups showed improvements in pain and function over 12 months, with no statistically significant between-group differences (p = 0.46). EQ-VAS increased from 59 ± 19 to 83 ± 9 in the CB-PRP group and from 59 ± 18 to 77 ± 18 in the HD-PRP group. KOOS improved from 50 ± 25 to 68 ± 23 and from 38 ± 28 to 59 ± 24, respectively. Quadriceps strength showed no intergroup differences. Adverse events were mild and self-limiting. Both treatments demonstrated comparable clinical benefits and favorable safety profiles. Full article

Background: Knee osteoarthritis (KOA) affects over 300 million people globally, yet current therapies face limitations in efficacy and safety. Chitosan, a natural polysaccharide, has shown conflicting evidence in KOA management. This systematic review evaluates chitosan’s clinical effectiveness and defines its optimal application scenarios. Methods: Randomized controlled trials (RCTs) published before the end of November 2024 on chitosan and knee osteoarthritis were systematically retrieved from PubMed, Web of Science, Cochrane Library, EBSCO, PsycINFO, ClinicalTrials.gov, SINOMED, Chinese Medical Journal Network, CNKI, VIP, Wanfang Data, Embase, and SCOPUS. After screening the references, publications meeting the inclusion and exclusion criteria was selected. RevMan5.4 software was used to perform the meta-analysis of the data. Results: A total of 231 articles were retrieved, and 14 RCTs involving 1504 participants were included. For the primary efficacy outcome, pooled analysis of 10 RCTs showed a significantly higher overall clinical response rate in the chitosan group compared with the control group (OR = 5.43, 95% CI = 3.21, 9.18, p < 0.001), with no observed heterogeneity (I² = 0%). Additionally, meta-analysis of 12 RCTs demonstrated a significant reduction in visual analog scale (VAS) pain scores (MD = −1.06, 95% CI = −1.38, −0.73, p < 0.001) in patients receiving intra-articular chitosan injection. Subgroup analysis of VAS scores showed that pain reduction varied significantly by follow-up duration (I² for subgroup differences = 62.5%, p = 0.03). Conclusions: Intra-articular injection of medical chitosan shows potential benefits for pain relief and clinical efficacy in patients with knee osteoarthritis, with a low incidence of adverse reactions. Nevertheless, the evidence remains promising but preliminary. Full article

Background: Knee osteoarthritis (KOA) is often framed as degenerative knee pain, yet behaves as a decades-long care pathway in which medication, injections, comorbidity, productivity loss, and surgery accumulate into a major economic footprint. This critical narrative review synthesizes pharmacoeconomic and pharmacoepidemiologic evidence across that pathway. Methods: Structured source identification was conducted in PubMed, Web of Science, Scopus, and Google Scholar for publications from 2000 to 2026, with citation tracking. Sources were appraised against predefined critical-interpretation domains and mapped narratively rather than pooled; no meta-analysis was performed. Results: Global Burden of Disease 2019 estimates approximately 364.6 million prevalent KOA cases worldwide. Reported evidence indicates that KOA spending is highly concentrated: in a large U.S. claims analysis, knee arthroplasty was performed in approximately 8.8% of patients yet accounted for 61.5% of KOA-related costs, whereas hyaluronic acid represented 3.0% of overall costs; the remaining pathway burden was distributed across years of outpatient care, analgesics, injections, and other nonsurgical utilization. Medication and injection findings were stage- and phenotype-dependent, and observational studies associated opioid exposure with higher fall risk, healthcare utilization, and cost. Intra-articular hyaluronic acid was repeatedly associated with longer time to arthroplasty, interpreted here as an association limited by confounding and immortal-time bias, not a causal effect; platelet-rich plasma value remained price- and durability-sensitive. Conclusions: KOA economics resembles an iceberg—arthroplasty is the visible peak, while the submerged mass is years of pathway-level care. Value-based policy should measure the full pathway, not the surgical episode, using linked claims, registries, patient-reported outcomes, and productivity data. Full article

Segmentation of bone marrow lesions (BML) is vital for quantifying lesion volume, a biomarker associated with cartilage damage and pain in knee osteoarthritis (KOA). Manual segmentation is challenging due to low contrast and variable lesion locations. We propose an automated deep learning method featuring a dual-stream encoder that integrates global image-level and local patch-level features. The study included 300 participants from the Osteoarthritis Initiative (OAI) database, each with approximately 36 intermediate-weighted fat-suppressed (IWFS) magnetic resonance (MR) images. The ground truth masks were manually annotated by trained research staff. With physical batch size 32, the model achieved a 2D Dice similarity coefficient (DSC) of 0.68, 3D DSC of 0.62, Intersection over Union (IoU) of 0.51, precision of 0.76, sensitivity of 0.62, and Pearson’s correlation coefficient (r) of 0.85 between manually labelled and automatically generated volumes. Using an effective batch size of 64 via gradient accumulation, the model achieved 2D DSC of 0.63, 3D DSC of 0.65, IoU of 0.48, precision of 0.75, sensitivity of 0.6, and r of 0.98 for volume correlation. The model outperformed baselines at batch size 32 across almost all evaluated metrics and remained robust at batch size 64, with strong volumetric correlation and improved 3D DSC, IoU, and sensitivity. Full article

With the acceleration of global population aging, the incidence of knee osteoarthritis (KOA) has risen significantly, placing unprecedented pressure on healthcare resources and creating an urgent need for automated segmentation technologies to enhance clinical diagnostic efficiency. Therefore, this paper proposes a novel multi-target tissue segmentation network for knee joints, SwMrNet, which integrates improved Swin Transformer units and a proposed multi-scale residual module within the decoder to enhance both segmentation accuracy and robustness. Firstly, a sliding-window mechanism is used to iteratively exchange feature information, allowing for the extraction of global tissue features. Then, features are extracted at multiple scales, with residual connections preserving the fine details of each tissue type. Through the repeated fusion of global and local features, the SwMrNet segmentation performance and robustness are significantly enhanced. Finally, the proposed model was evaluated on a public knee MRI dataset and a local clinical knee MRI dataset. On the public dataset, the model achieved a Dice score of 98.2%, with Dice scores for all segmented tissues exceeding 94%. On the local clinical dataset, the model showed visually consistent segmentation results, suggesting its potential as an efficient multi-tissue segmentation tool for automated knee joint analysis and auxiliary clinical assessment. Full article

Background and Objectives: Musculoskeletal ultrasound (MSUS) is increasingly used to assess structural changes in knee osteoarthritis (KOA), although measurement reproducibility may vary with examination protocol and operator experience. This pilot study aimed to evaluate intra- and inter-observer reliability for assessing cartilage thickness, osteophyte dimensions and meniscal displacement in supine and weight-bearing conditions in patients with KOA. Material and Methods: This prospective reliability study included patients with KOA stages 2–3 on the Kellgren–Lawrence (K-L) scale. Ultrasound (US) evaluation of cartilage thickness and osteophytes was performed in the supine position, while medial and lateral meniscal extrusion was additionally assessed in bipedal and single-leg conditions using a standardized protocol. Intra- and inter-reproducibility were evaluated through the intraclass correlation coefficient (ICC), agreement analysis and kappa statistics. The analysis was performed using Microsoft Excel (version 2019) and IBM SPSS version 26 software. Results: Both inter-reliability and intra-reliability were evaluated, with intra-rater agreement being constantly higher than inter-rater agreement. From the inter-rater reliability, ICC values ranged from 0.48 to 0.88 for quantitative ultrasound measurements, whereas osteophyte assessment showed Cohen’s k values ranging from 0.71 to 0.86, indicating substantial to almost perfect agreement. Both evaluators identified a higher number of knees with medial meniscal extrusion > 3 mm under weight-bearing conditions than in the supine position. Conclusions: Standardized US evaluation demonstrated at least good reproducibility for structural abnormalities in KOA. Medial and lateral meniscal displacement increased under loading conditions, highlighting the added value of dynamic weight-bearing assessment. However, the clinical significance of load-dependent meniscal extrusion requires further investigation. Full article