Abstract

Establishing disease biomarkers has been a long-sought after goal to improve Osteoarthritis (OA) diagnosis, prognosis, clinical and pharmaceutical interventions. Given the role of the synovium in contributing to OA, a meta-analysis was performed to determine significant synovial biomarkers in human OA tissue, compared to non-OA patients. Outcomes will direct future research on marker panels for OA disease modelling in vitro/in vivo, aiding clinical research into OA disease targets.

A PRISMA compliant search of databases was performed to identify potential biomarker studies analysing human, OA, synovial samples compared to non-OA/healthy participants. The Risk of Bias In Non-Randomised Studies of Interventions (ROBINS-I) tool assessed methodological quality, with outcome analysed by Grading of Recommendations Assessment, Development and Evaluation (GRADE). Meta-analyses were conducted for individual biomarkers using fixed or random effect models, as appropriate. Where three or more studies included a specific biomarker, Forest Plot comparisons were generated.

3230 studies were screened, resulting in 34 studies encompassing 25 potential biomarkers (1581 OA patients and 695 controls). Significant outcomes were identified for thirteen comparisons. Eleven favoured OA (IL-6, IL-10, IL-13, IP-10, IL-8, CCL4, CCL5, PIICP, TIMP1, Leptin and VEGF), two favoured non-OA controls (BMP-2 and HA). Notably, PIICP showed the largest effect (SMD 6.11 [3.50, 8.72], p <0.00001, I² 99%), and TIMP1 resulted critically important (0.95 [0.65, 1.25], p <0.00001, I² 82%). Leptin and CCL4 showed lower effects (SMD 0.81 [0.33, 1.28], p =0.0009; 0.59 [0.32, 0.86], p <0.0001, respectively).

Thirteen significant synovial biomarkers showed links with OA bioprocesses including collagen turnover, inflammatory mediators and ECM components. Limitations arose due to bias risk from incomplete or missing data, publication bias of inconclusive results, and confounding factors from patient criteria. These findings suggest markers of potential clinical viability for OA diagnosis and prognosis that could be correlated with specific disease stages.

Abstract

Abstract

Introduction and Objective

Kinesiophobia, the fear of physical movement and activity related to injury vulnerability, has been linked to sub-optimal outcomes following total knee replacement (TKR). This systematic review has two aims: to define the relationship between kinesiophobia and functional outcomes, pain and range of motion following TKR, and to evaluate published treatments for kinesiophobia following TKR.

Aims

To explore staff experiences of a multicentre pilot randomized controlled trial (RCT) comparing intramedullary nails and circular frame external fixation for segmental tibial fractures.

Aims

Urinary catheter use in the peri-operative and post-operative phase following arthroplasty may be associated with increased risk of urinary tract infection (UTI) and deep prosthetic joint infection (PJI). These can be catastrophic complications in joint arthroplasty. We performed a systematic review of the evidence on routine use of antibiotics for urinary catheter insertion and removal following arthroplasty.

Patellofemoral osteoarthritis (PFOA) affects 32% men and 36% women over the age of 60years and is associated with anterior knee pain, stiffness, and poor mobility. Patellofemoral arthroplasty (PFA) is a bone-sparing treatment for isolated PFOA. This study set out to investigate the relationship between patient-related outcome measures (PROMs) and measurements obtained from gait analysis before and after PFA. There are currently no studies relating to gait analysis and PFA available in the literature

A prospective cohort study was conducted of ten patients known to have isolated PFOA who had undergone PFA compared to a gender and age matched control group. The patients were also asked to complete questionnaires (Oxford knee score (OKS), EQ-5D-5L) before surgery and one year after surgery. Gait analysis was done on an instrumented treadmill comparing Ground reaction force parameters between the control and pre and post-operative PFA patients

The average age 60 (49–69) years with a female to male ratio of 9:1. Patient and healthy subjects were matched for age and gender, with no significant difference in BMI. Post-op PFA improvement in gait seen in ground reaction force at 6.5km/h. Base support difference was statistically significant both on the flat P=0.0001 and uphill P=0.429 (5% inclination) and P=0.0062 (10% inclination). PROMS response rate was 70%(7/10) pre-operative and 60%(6/10) post-operative. EQ-5D-5L scores reflected patient health state was better post-operatively.

This study found that gait analysis provides an objective measure of functional gait and reflected by significant quality-of-life improvement of patients post PFA. Literature lacks studies relating to gait-analysis and PFA. Valuable information provided by this study highlights that PFA has a beneficial outcome reflected by PROMs and improvement in vertical ground reaction force and gait

Further research is needed to assess how care-providers may use gait-analysis as part of patient care plans for PFOA patients.

A risk factor for patellofemoral instability is trochlear dysplasia. Trochleoplasty is a surgical procedure used to reshape the trochlear groove to improve patellar stability. This study seeks to compare pre-op MRI measurements and post operative MRI measurements for patients who have undergone trochleoplasty in correlation with their clinical outcomes scores.

Data was collected from a database of patients known to have trochlear dysplasia who underwent trochleoplasty. Radiological Data was collected pre-op and subsequent post op MRI data collected included TT-TG, Patella Tilt, IS, sulcus angle. Data score sheets pre-op and post op trochleoplasty completed by patients were also collected.

10 patients had pre and post op MRI's documented. 80%(8/10) females and 20%(2/10) males, average age of 30 years old (range 23 – 32 years old). Average MRI pre-op scores: IS ratio: 1.2, Patella tilt: 24.14, sulcus angle 160.13, and TT-TG distance of 16.94. 1 year average MRI post-op scores: IS ratio: 1.28, Patella tilt 15.56, sulcus angle 148.66 and TT-TG distance 16.78. 1 year post op Kujala and Norwich instability scores patient reported improved stability, function and confidence post op compared to pre-op.

Subjective and objective scores reflected an improvement of stability. MRI demonstrated a deeper trochlear groove post-operatively which should provide resistance against lateral patella movement and patellar dislocations. TT-TG pre and post op remained constant. Pre op and post op Kujala scores reflected improved function. The Norwich instability scores pre and post op reflected satisfaction of treatment.

There are not a lot of studies published on trochleoplasty. Based on this study it is clear that patients with patellofemoral instability with severe trochlear dysplasia will benefit from trochleoplasty. The sample size of the data analysis was only 10. However it reflected that function 1 year post procedure remained stable.

Introduction: Patellofemoral instability (PFI) is a disabling condition that occurs in adolescence. Recurrence after patellar dislocation has been reported in 2–50% of cases. This study aimed to compare the shape of the distal femur in PFI to a normal cohort.

Method: 108 CT scans from 54 subjects with PFI were compared to 197 CT scans from 102 normal subjects. Outlines of the trochlear groove and lateral condyle were extracted from CT scans using Interactive Data Language version 5.0 image manipulation software. The shapes were aligned using a modified Procrustes analysis and interpolation performed with a basic cubic spline. A statistical method from the field of functional data analysis was used to quantify shape. A discriminant analysis was then used to provide a tool for deciding which patients had abnormal grooves thus improving patient selection for trochleoplasty.

Results: Mathematical quantification showed a significant difference at the 0.001 level using an independent t-test between the normal and PFI groups for the shape of the trochlear groove with PFI knees having a more complex shape than normal. The second largest source of variation is in the position of the trochlear groove minimum with respect to the coronal plane together with variation in the shape of the medial condyle. The trochlear groove is situated more medially, with a shallower medial condyle, in PFI. In contrast the trochlear groove is situated more laterally, with a more prominent medial condyle in normal knees. Analysis of shape of the lateral condyle showed that in PFI, it is shorter and broader.

Conclusion: Principal components analysis can be used to quantify the variation in shape of the distal femur and allow a discriminant function analysis to be performed comparing PFI knees to normal knees. This quantification of shape can be applied to diagnosis of instability, operative planning for trochleoplasty and implant design.

Introduction and Aims: Dysplasia of the femoral sulcus is one component that may be present in patients presenting with patellar instability. Rarely the dysplasia is so severe that a dome rather than groove is present. Dejour has reported an operation that deepens the groove, unlike the Albee which elevates it. This study reports the development of a modification of the Dejour trochleoplasty reporting the clinical and radiological results.

Method: A consecutive case series of the first 15 patients (17 knees) who underwent a trochleoplasty with a minimum one-year follow-up. There were 11 females and four males with an age range from 15 to 47 years old. Nine patients had had previous operations. The pre-operative length of symptoms ranged from one to 30 years. The patellar instability was managed operatively using the Dejour protocol measuring the patellar height, boss height, tibial tubercle-trochlear groove distance and patellar tilt angle. The Kujala score was used for functional assessment and a subjective assessment was also made. CT scans as well as plain films were used for radiological assessment. The operative technique changed in the light of experience from metallic to absorbable screws as the former abraded the patella.

Results: The boss height was reduced from an average of 7.5mm to 1mm (normal 0mm). Tracking became normal in 11 knees and had a slight J-shape in six. Seven knees had a mild residual apprehension. Five patients were very satisfied, eight were satisfied, and two were disappointed. The Kujala score improved from an average of 48 to 73 out of 100. Three patients returned to full sports. Eight patients required further operations apart from the removal of metallic screws in 10 knees. Five of these were arthrolysis for stiffness at about six weeks post-operatively. As a result, patients were placed on a continuous passive motion machine for three to four days to avoid this. One patient went on to have autologous chondrocyte implantation for a defect on the lateral femoral condyle involving the tibial surface. This was after a new injury following a return to sports and not in the area affected by the trochleoplasty.

Conclusion: Trochleoplasty for severe dysplasia of the femoral sulcus is a developing procedure. It requires careful attention to detail. For a rare condition the results have been gratifying with an acceptable level of complications. It is not recommended that this procedure be performed by general orthopaedic surgeons.