Epidemiology of Osteoarthritis

Objective of this study was to investigate the effects of physical exercise on muscle function of the knee, pain and quality of life in postmenopausal women with knee osteoarthritis (OA). An electronic search was conducted of the PubMed, Embase, Web of Science, Cochrane Library, LILACS and PEDro databases for relevant articles published up to September 2023. Only randomized clinical trials with interventions involving physical exercise of any modality in postmenopausal women with knee OA were included. This review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Cochrane Recommendations. Methodological quality of the studies selected was assessed using the PEDro scale and the evidence was synthesized using the Grading of Recommendations, Assessment, Development and Evaluation scale. Among the 169 articles identified, five were included in the present systematic review and enabled meta-analysis of the outcomes physical function, pain and stiffness. The findings demonstrated the effectiveness of physical exercise in improving physical function, assessed through the Six-Minute Walk Test and the WOMAC scale's physical function domain, compared to the control group. However, no significant differences were observed in pain or stiffness outcomes between the treatment and control groups. Unfortunately, insufficient data precluded a meta-analysis for knee muscle function and quality of life outcomes. Despite the potential of physical exercise to enhance physical function in postmenopausal women with knee OA, the study highlights a lack of standardization in assessment tools and tests, limiting the feasibility of meta-analysis.

CRD42022316476.

The global impact of osteoarthritis is growing. Currently no disease modifying osteoarthritis drugs/therapies exist, increasing the need for preventative strategies. Knee injuries have a high prevalence, distinct onset, and strong independent association with post-traumatic osteoarthritis (PTOA). Numerous groups are embarking upon research that will culminate in clinical trials to assess the effect of interventions to prevent knee PTOA despite challenges and lack of consensus about trial design in this population. Our objectives were to improve awareness of knee PTOA prevention trial design and discuss state-of-the art methods to address the unique opportunities and challenges of these studies.

An international interdisciplinary group developed a workshop, hosted at the 2023 Osteoarthritis Research Society International Congress. Here we summarize the workshop content and outputs, with the goal of moving the field of PTOA prevention trial design forward.

Workshop highlights included discussions about target population (considering risk, homogeneity, and possibility of modifying osteoarthritis outcome); target treatment (considering delivery, timing, feasibility and effectiveness); comparators (usual care, placebo), and primary symptomatic outcomes considering surrogates and the importance of knee function and symptoms other than pain to this population.

Opportunities to test multimodal PTOA prevention interventions across preclinical models and clinical trials exist. As improving symptomatic outcomes aligns with patient and regulator priorities, co-primary symptomatic (single or aggregate/multidimensional outcome considering function and symptoms beyond pain) and structural/physiological outcomes may be appropriate for these trials. To ensure PTOA prevention trials are relevant and acceptable to all stakeholders, future research should address critical knowledge gaps and challenges.

Ground reaction forces (GRFs) and center of pressure trajectories (CoPs) are required for a comprehensive biomechanical analysis. They are also important outcome measures in sports sciences or clinical areas. GRFs and CoPs are usually measured by force plates, which are rarely equipped on staircases in laboratories. We present a one-dimensional convolutional neural network for estimating GRFs and CoPs during stair ascent and descent using multi-level kinematics as input. We collected a dataset of 3782 trials from 172 subjects for training and validating this model. The recruited subjects include healthy subjects and individuals with knee osteoarthritis or moderate-to-high risk of cardiovascular diseases. Our model achieves the state-of-the-art estimating performance with nRMSE of $2.755\text{\%}\sim 7.633\text{\%}$, Pearson correlation of $0.950\sim 0.996$ on GRFs estimation, and with nRMSE of $5.519\text{\%}\sim 14.669\text{\%}$, Pearson correlation of $0.918\sim 0.991$ on CoPs estimation. With our proposed model, GRFs and CoPs during stair walking can be estimated without force-plate-embedded staircases.

Chitin is the second most abundant biopolymer and its inherent biological characteristics make it ideal to use for tissue engineering. For many decades, its properties like non-toxicity, abundant availability, ease of modification, biodegradability, biocompatibility, and anti-microbial activity have made chitin an ideal biopolymer for drug delivery. Research studies have also shown many potential benefits of chitin in the formulation of functional therapy for cartilage regeneration. Chitin and its derivatives can be processed into 2D/3D scaffolds, hydrogels, films, exosomes, and nano-fibers, which make it a versatile and functional biopolymer in tissue engineering. Chitin is a biomimetic polymer that provides targeted delivery of mesenchymal stem cells, especially of chondrocytes at the injected donor sites to accelerate regeneration by enhancing cell proliferation and differentiation. Due to this property, chitin is considered an interesting polymer that has a high potential to provide targeted therapy in the regeneration of cartilage. Our paper presents an overview of the method of extraction, structure, properties, and functional role of this versatile biopolymer in tissue engineering, especially cartilage regeneration.

Knee osteoarthritis, a common degenerative disease that causes a huge socioeconomic burden, is characterized by gradual deterioration of the articular cartilage, often leading to pain, stiffness, and impaired joint function. Addressing a significant public health concern, this study suggests that the combined effect of characteristic knee cartilage thickness—presumably a consequence of bipedal evolution—and the modern sedentary lifestyle has given rise to a distinctive osteoarthritis endotype referred to as ‘stagnant cartilage syndrome’. This bombastic term highlights the challenges associated with thick cartilage: the physiological demands for its maintenance. The hypothesis posits that physical inactivity contributes to knee osteoarthritis development by promoting a stagnant diffusion barrier at the synovial fluid-cartilage interface. Such a surface phenomenon may lead to a limiting depth of cartilage, hindering nutrient supply and leading to waste accumulation, disruption of cell homeostasis, and progressive tissue degradation. If validated, this approach could enhance our understanding of knee osteoarthritis pathogenesis, emphasizing the need to address the relationship between cartilage thickness and sedentary behavior in developing effective evidence-based preventive strategies.

Periprosthetic joint infection (PJI) is a significant post-arthroplasty complication for diabetic patients, with uncontrolled diabetes identified as a PJI risk factor. Taiwan's Diabetes Shared Care Program (DSCP) was established for holistic diabetes care.

To evaluate the DSCP's impact on PJI incidence and patients' medical costs.

Data were analysed from Taiwan's National Health Insurance Research Database from 2010 to 2020, focusing on type 2 diabetes mellitus (DM) patients who had undergone arthroplasty. The study group involved DSCP participants, while a comparison group comprised non-participants with matched propensity scores for age, sex, and comorbidities. The primary outcome was the PJI incidence difference between the groups; the secondary outcome was the medical expense difference.

The study group consisted of 11,908 type 2 DM patients who had arthroplasty and joined the DSCP; PJI occurred in 128 patients. Among non-participants, 184 patients had PJI. The PJI incidence difference between the groups was statistically significant (1.07% vs 1.55%). The study group's medical costs were notably lower, regardless of PJI incidence. Multivariate regression showed higher PJI risk in patients in comparison group, aged >70 years, male, or who had obesity, anaemia.

The study indicates that DSCP involvement reduces PJI risks and decreases annual medical costs for diabetic patients after arthroplasty. Consequently, the DSCP is a recommendable option for such patients who are preparing for total joint arthroplasty.