Women with knee osteoarthritis have more pain and poorer function than men, but similar physical activity prior to total knee replacement

Background

Osteoarthritis of the knee is a major clinical problem affecting a greater proportion of women than men. Women generally report higher pain intensity at rest and greater perceived functional deficits than men. Women also perform worse than men on function measures such as the 6-minute walk and timed up and go tests. Differences in pain sensitivity, pain during function, psychosocial variables, and physical activity levels are unclear. Further the ability of various biopsychosocial variables to explain physical activity, function and pain is unknown.

Methods

This study examined differences in pain, pain sensitivity, function, psychosocial variables, and physical activity between women and men with knee osteoarthritis (N = 208) immediately prior to total knee arthroplasty. We assessed: (1) pain using self-report measures and a numerical rating scale at rest and during functional tasks, (2) pain sensitivity using quantitative sensory measures, (3) function with self-report measures and specific function tasks (timed walk, maximal active flexion and extension), (4) psychosocial measures (depression, anxiety, catastrophizing, and social support), and (5) physical activity using accelerometry. The ability of these mixed variables to explain physical activity, function and pain was assessed using regression analysis.

Results

Our findings showed significant differences on pain intensity, pain sensitivity, and function tasks, but not on psychosocial measures or physical activity. Women had significantly worse pain and more impaired function than men. Their levels of depression, anxiety, pain catastrophizing, social support, and physical activity, however, did not differ significantly. Factors explaining differences in (1) pain during movement (during gait speed test) were pain at rest, knee extension, state anxiety, and pressure pain threshold; (2) function (gait speed test) were sex, age, knee extension, knee flexion opioid medications, pain duration, pain catastrophizing, body mass index (BMI), and heat pain threshold; and (3) physical activity (average metabolic equivalent tasks (METS)/day) were BMI, age, Short-Form 36 (SF-36) Physical Function, Kellgren-Lawrence osteoarthritis grade, depression, and Knee Injury and Osteoarthritis Outcome Score (KOOS) pain subscale.

Conclusions

Women continue to be as physically active as men prior to total knee replacement even though they have significantly more pain, greater pain sensitivity, poorer perceived function, and more impairment on specific functional tasks.     

Patients with Knee Osteoarthritis Undergoing Total Knee Arthroplasty Have a Lower Risk of Subsequent Severe Cardiovascular Events: Propensity Score and Instrumental Variable Analysis

ObjectiveThis population-based study investigated the subsequent cardiovascular risk of patients with knee osteoarthritis underwent total knee arthroplasty in Taiwan.ResultsPatients with knee osteoarthritis who underwent TKA had a lower 3-year cumulative risk of stroke and acute myocardial infarction (AMI). After adjusting for measured risk and confounding factors, propensity score showed a 0.56 fold (adjusted OR = 0.56; 95% CI, 0.51–0.61; p<0.001) risk for CVD in those with TKA. Use of instrumental variable analysis for adjusting measured and unmeasured factors and two-stage least squares regression model revealed that the average treatment effect of TKA was statistically associated with a decreased 7% risk of CVD events (95% CI, 0.2%–13.6%).ConclusionOur study revealed that patients with knee osteoarthritis who underwent TKA had a lower risk of suffering from a future severe cardiovascular event. This benefit may be attributed to an improvement in physical activity, reduction of psychosocial stress, and/or a decreased use of NSAIDs as a result of having undergone TKA.     

Efficacy of a progressive walking program and glucosamine sulphate supplementation on osteoarthritic symptoms of the hip and knee: a feasibility trial

Introduction  

Management of osteoarthritis (OA) includes the use of non-pharmacological and pharmacological therapies. Although walking is commonly recommended for reducing pain and increasing physical function in people with OA, glucosamine sulphate has also been used to alleviate pain and slow the progression of OA. This study evaluated the effects of a progressive walking program and glucosamine sulphate intake on OA symptoms and physical activity participation in people with mild to moderate hip or knee OA.     

Marked disability and high use of nonsteroidal antiinflammatory drugs associated with knee osteoarthritis in rural China: a cross-sectional population-based survey

Introduction  

The burden of disability, analgesia, and health services use associated with knee pain and osteoarthritis (OA) in developing countries is relatively unknown, despite a high proportion of these populations required to be engaged in heavy occupational physical activity throughout their life span. The aim of this survey was to estimate the burden of disability, analgesia, and health services use associated with knee pain in rural China.     

Genetic mechanisms of knee osteoarthritis: a population-based longitudinal study

To describe the differences in knee structure and non-knee structural factors between offspring having at least one parent with a total knee replacement for severe primary knee osteoarthritis and age- and sex-matched controls with no family history of knee osteoarthritis, a population-based longitudinal study of 163 matched pairs (mean age 45 years, range 26 to 61) was performed at baseline and about 2 years later. Knee cartilage defect score (0 to 4), cartilage volume and bone size were determined with T1-weighted fat saturation magnetic resonance imaging. Body mass index (BMI), lower-limb muscle strength, knee pain, physical work capacity at 170 beats/minute (PWC170) and radiographic osteoarthritis were measured by standard protocols. In comparison with controls, offspring had higher annual knee cartilage loss (-3.1% versus -2.0% at medial tibial site, -1.9% versus -1.1% at lateral tibial site and -4.7% versus -3.7% at patellar site, all P < 0.05), a greater increase in medial cartilage defect score (+0.15 versus -0.01, P < 0.05) and a greater decline in PWC170 (-0.7 watts/kg versus -0.4 watts/kg, P < 0.01). There were no significant differences in change in BMI, lower-limb muscle strength, knee pain or tibial bone area between these two groups; however, the differences in knee cartilage loss and cartilage defect change decreased in magnitude and became non-significant after adjustment for baseline cartilage volume, tibial bone area, BMI and knee pain. This longitudinal study suggests that knee cartilage loss, change in cartilage defects and decrease in physical fitness all have roles in the development of knee osteoarthritis, which is most probably polygenic but may reflect a shared environment. Importantly, the cartilage changes are largely dependent on baseline differences in cartilage volume, tibial bone area, BMI and knee pain, suggesting that these factors might have a role in their initiation.     

Genetic mechanisms of knee osteoarthritis: a population-based longitudinal study

To describe the differences in knee structure and non-knee structural factors between offspring having at least one parent with a total knee replacement for severe primary knee osteoarthritis and age- and sex-matched controls with no family history of knee osteoarthritis, a population-based longitudinal study of 163 matched pairs (mean age 45 years, range 26 to 61) was performed at baseline and about 2 years later. Knee cartilage defect score (0 to 4), cartilage volume and bone size were determined with T1-weighted fat saturation magnetic resonance imaging. Body mass index (BMI), lower-limb muscle strength, knee pain, physical work capacity at 170 beats/minute (PWC170) and radiographic osteoarthritis were measured by standard protocols. In comparison with controls, offspring had higher annual knee cartilage loss (-3.1% versus -2.0% at medial tibial site, -1.9% versus -1.1% at lateral tibial site and -4.7% versus -3.7% at patellar site, all P < 0.05), a greater increase in medial cartilage defect score (+0.15 versus -0.01, P < 0.05) and a greater decline in PWC170 (-0.7 watts/kg versus -0.4 watts/kg, P < 0.01). There were no significant differences in change in BMI, lower-limb muscle strength, knee pain or tibial bone area between these two groups; however, the differences in knee cartilage loss and cartilage defect change decreased in magnitude and became non-significant after adjustment for baseline cartilage volume, tibial bone area, BMI and knee pain. This longitudinal study suggests that knee cartilage loss, change in cartilage defects and decrease in physical fitness all have roles in the development of knee osteoarthritis, which is most probably polygenic but may reflect a shared environment. Importantly, the cartilage changes are largely dependent on baseline differences in cartilage volume, tibial bone area, BMI and knee pain, suggesting that these factors might have a role in their initiation.     

Stem cell application for osteoarthritis in the knee joint: A minireview

Knee osteoarthritis is a chronic, indolent disease that will affect an ever increasing number of patients, especially the elderly and the obese. It is characterized by degeneration of the cartilage substance inside the knee which leads to pain, stiffness and tenderness. By some estimations in 2030, only in the United States, this medical condition will burden 67 million people. While conventional treatments like physiotherapy or drugs offer temporary relief of clinical symptoms, restoration of normal cartilage function has been difficult to achieve. Moreover, in severe cases of knee osteoarthritis total knee replacement may be required. Total knee replacements come together with high effort and costs and are not always successful. The aim of this review is to outline the latest advances in stem cell therapy for knee osteoarthritis as well as highlight some of the advantages of stem cell therapy over traditional approaches aimed at restoration of cartilage function in the knee. In addition to the latest advances in the field, challenges associated with stem cell therapy regarding knee cartilage regeneration and chondrogenesis in vitro and in vivo are also outlined and analyzed. Furthermore, based on their critical assessment of the present academic literature the authors of this review share their vision about the future of stem cell applications in the treatment of knee osteoarthritis.     

Influence of a valgus knee brace on muscle activation and co-contraction in patients with medial knee osteoarthritis

The purpose of this study was to analyse the effect of a valgus knee orthosis designed for patients with knee osteoarthritis on the electromyographic activity (EMG) of seven muscles of the lower limb during gait. Twelve patients with medial knee osteoarthritis walked on a treadmill in three different conditions: without orthosis, with a knee orthosis in 4° valgus adjustment and with an orthosis in a neutral flexible adjustment. Root-mean-square (RMS) was analysed in each condition during a 150 ms pre-activation phase and during the stance phase of gait, which was divided in four sub-phases. In addition, co-contraction ratios (CCRs) were calculated between extensor/flexor, medial/lateral muscles and between agonist and antagonist muscle pairs. Significant decreases in muscle activity and CCRs were observed with the use of the knee orthosis in both adjustments compared to the condition without orthosis. Using the valgus brace, medial/lateral CCR decreased significantly during the late stance and the flexor/extensor CCR decreased significantly during the loading phase and late stance. Decreases of muscle pairs CCRs were observed with the neutral flexible adjustment. The results support the theory of a possible beneficial effect of knee braces in reducing knee loading by decreasing muscle activation and co-contraction levels, which could contribute to decelerate disease progression in patients with knee osteoarthritis.     

Association analysis of the common varieties of IL17A and IL17F genes with the risk of knee osteoarthritis

Osteoarthritis is mediated by various types of cytokines, growth factors, and inflammatory factors that the role of the interleukin-17 family in this disease is becoming increasingly apparent. The aim of this study is to determine the association between the common polymorphisms of IL17A (including rs2275913) and IL17F (including rs2397084 and rs763780) genes with the knee osteoarthritis risk which was followed by a bioinformatics approach. In a case-control study, 254 participants consisting of 127 healthy individuals and 127 subjects with knee osteoarthritis referring to Shahid Beheshti Hospital dependents on Kashan University of Medical Sciences (Kashan, Iran) were enrolled. After samples collection, the polymorphisms genotyping was determined by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Finally, some bioinformatics tools were used to analyze the molecular effects of the three studied polymorphisms. Data analysis showed a significant association between rs2275913-GA genotype and the decreased risk of knee osteoarthritis (OR = 0.57, 95% CI = 0.33-0.97, P = .040). However, rs763780-AG genotype (OR = 2.29, 95%CI = 1.11-4.69, P = .024) and rs763780-G allele (OR = 2.01, 95% CI = 1.09-3.72, P = .026) were associated with an increased risk of knee osteoarthritis. However, no significant associations were found between the rs2397084 polymorphism and knee osteoarthritis risk. Our structural analysis revealed that the rs2275913 polymorphism could create a new binding site for TFII-I at the promoter region of IL17A. Also, rs2397084 and rs763780 could significantly affect the function and structure of IL17A. Based on our findings, rs2275913 and rs763780 could be considered as protective and risk factors for knee osteoarthritis, respectively. Therefore, these polymorphisms can be considered as biomarkers for the screening of knee osteoarthritis susceptible persons.     

Jumping height in former elite athletes

To evaluate lower-limb explosive strength with respect to lifetime athletic activity, we measured vertical jumping height on a contact mat in former male runners (n = 28). soccer players (n = 31), weightlifters (n = 29) and shooters (n = 29) (age range 45 68 years). There were no statistically significant age-adjusted sport-group differences in jumping height, but differences by sport were evident among the subgroup of athletes without hip or knee osteoarthritis (n = 65) (P < 0.05). Thus, sports that increased jumping height also predisposed to lower-limb osteoarthritis. After adjustment for age and sport, the subjects without osteoarthritis jumped higher than those with osteoarthritis (n = 33) (P < 0.01). In a multiple linear regression analysis, age, reported hip and knee disability, and knee pain reduced jumping height. Hours spent in team-training during the past 12 months and the hours spent during their lifetime in power training were associated with improved vertical jumping height and together explained 41% of the difference among the subjects. The ability to jump even among athletes with hip or knee osteoarthritis would suggest that former elite athletes possess advanced lower limb muscle function.     

全膝关节置换术治疗骨关节炎

目的 探讨人工全膝关节置换术治疗骨关节病的临床疗效。方法 对31例人工全膝关节置换术进行临床分析和总结,并应用HSS膝关节评分系统进行分析。结果 手术优良率为93．6％,患者术后在疼痛、功能及关节活动度等方面都有明显改善。结论 全膝关节置换术是治疗骨关节病的有效方法。     

Quadriceps activity and physical activity profiles over long durations in patients with osteoarthritis of the knee and controls

Exercise is recommended as a non-pharmacological, non-invasive intervention for osteoarthritis (OA) of the knee. Physiological data concerning the duration and intensity of muscle activity or physical activity profiles during normal daily activity for this population is lacking. Our aim was to explore this using surface Electromyography (EMG) and accelerometer-based activity monitoring. Thirty-four patients with knee OA, mean (SD) age 63.2 (9.8) years and 30 aged-matched asymptomatic controls 64.1 (10.9) years participated. The duration of recording was similar in knee OA and control groups – median (IRQ range) 12:34 (10:11–14:17) h and 13:10 (12:02–14:56) h, respectively (p = 0.514). VM and VL were quiescent for 81.8 (75.3–91.0) to 89.2 (81.5–94.7)% of the time. VM was active for significantly longer durations than VL in the highest intensity band for those with knee OA (p = 0.00), and for longer durations in those with knee OA compared to controls (p = 0.027). The median (IRQ range) percentage of the total recording time spent in an upright posture was 32.4 (28.3–43.9)% and 38.8 (33.6–45.8)%, and time spent stepping or walking was 12.7 (9.7–16.4)% and 16.0 (11.9–19.6)% for those with knee OA and controls respectively. These novel data may prove useful for designing therapeutic exercise programmes and lifestyle changes for those with knee OA.     

关节镜下有限清理术治疗膝关节骨性关节炎的体会

目的:探讨关节镜下有限清理术治疗膝关节骨性关节炎的疗效。方法:自2005年6月至2009年10月对62例81膝膝关节骨性关节炎患者进行关节镜下有限清理术,对其临床疗效进行分析。结果:本组病例均获随访,时间12~36个月。优28膝,良39膝,可10膝,差4膝,优良率82.7%。结论:关节镜下有限清理术治疗膝关节骨性关节炎可以有效改善病人的症状,明显改善生活质量。     

探讨肠道菌群对膝骨关节炎治疗的影响

膝骨关节炎是一种中老年人常见的慢性疾病,因其发病率及致残率高,严重影响患者的生存质量。膝骨关节炎不仅增加了患者及其家庭乃至社会的经济压力,而且还加重了心理负担。治疗方案虽然多,但目前尚无根治方法,而且疗效也参差不齐。肠道菌群作为人体巨大的微生物宝库,拥有着很大的潜力,这使之成为了科研领域一个新的研究热点,其对膝骨关节炎的影响也成为了人们关注的焦点。本文通过查阅相关文献,从慢性炎症、代谢性疾病、成骨细胞以及破骨细胞这四个方面来阐述和总结肠道菌群与膝骨关节炎的关系,以期为临床上治疗膝骨关节炎提供新的方法与思路。     

Gait Variability before Surgery and at Discharge in Patients Who Undergo Total Knee Arthroplasty: A Cohort Study

This study aimed to determine gait ability at hospital discharge in patients undergoing total knee arthroplasty (TKA) as an indicator of the risk of falling. Fifty-seven patients undergoing primary TKA for knee osteoarthritis participated in this study. Gait variability measured with accelerometers and physical function including knee range of motion (ROM), quadriceps strength, walking speed, and the Timed Up and Go (TUG) test were evaluated preoperatively and at discharge from the hospital (1 month before and 5 days after surgery). All patients were discharged directly home at 5 days after surgery. Knee flexion of ROM, quadriceps strength, walking speed, and the TUG test results were significantly worse at hospital discharge than preoperatively (p < 0.001). However, gait variability was not significantly different before and after TKA. This result indicated that patients following TKA surgery could walk at hospital discharge as stably as preoperatively regardless of the decrease in physical function, including knee ROM, quadriceps strength, and gait speed after surgery.     

Mechanisms of quadriceps muscle weakness in knee joint osteoarthritis: the effects of prolonged vibration on torque and muscle activation in osteoarthritic and healthy control subjects

Introduction  

A consequence of knee joint osteoarthritis (OA) is an inability to fully activate the quadriceps muscles, a problem termed arthrogenic muscle inhibition (AMI). AMI leads to marked quadriceps weakness that impairs physical function and may hasten disease progression. The purpose of the present study was to determine whether γ-loop dysfunction contributes to AMI in people with knee joint OA.     

骨关节炎软骨细胞发生内质网应激

目的：研究骨关节炎软骨细胞是否发生内质网应激现象。方法：对关节置换术后的人类骨关节炎软骨标本和正常关节软骨标本切片进行内质网应激标志分子免疫球蛋白重链结合蛋白（BiP）的免疫组织化学检测;对小鼠膝关节进行半月板切断术诱发实验性骨关节炎,在术后1、3和6周取材,对组织切片进行番红花“O”染色、Mankin评分及BiP的免疫组织化学检测。结果：所有人类骨关节炎标本中软骨细胞BiP的表达明显升高。番红花“O”染色结果表明,在小鼠骨关节炎模型中,全部手术侧关节表面发生磨损,且随着术后时间延长关节表面磨损范围逐步扩大,手术侧Mankn分值显著高于对照侧;此外,手术侧的软骨细胞内BiP呈阳性表达,且表达量随术后时间延长而增加。结论：在人类骨关节炎标本和实验性小鼠骨关节炎模型中,关节软骨细胞均发生明显的内质网应激现象。     

Risk of severe knee and hip osteoarthritis in relation to level of physical exercise: a prospective cohort study of long-distance skiers in Sweden

Background

To complete long-distance ski races, regular physical exercise is required. This includes not only cross-country skiing but also endurance exercise during the snow-free seasons. The aim of this study was to determine whether the level of physical exercise is associated with future risk of severe osteoarthritis independent of previous diseases and injuries.

Methodology/Principal Findings

We used a cohort that consisted of 48 574 men and 5 409 women who participated in the 90 km ski race Vasaloppet at least once between 1989 and 1998. Number of performed races and finishing time were used as estimates of exercise level. By matching to the National Patient Register we identified participants with severe osteoarthritis, defined as arthroplasty of knee or hip due to osteoarthritis. With an average follow-up of 10 years, we identified 528 men and 42 women with incident osteoarthritis. The crude rate was 1.1/1000 person-years for men and 0.8/1000 person-years for women. Compared with racing once, participation in ≥5 races was associated with a 70% higher rate of osteoarthritis (multivariable-adjusted hazard ratio (HR) 1.72, 95% confidence interval (CI) 1.33 to 2.22). The association was dose-dependent with an adjusted HR of 1.09, 95% CI 1.05 to 1.13 for each completed race. A faster finishing time, in comparison with a slow finishing time, was also associated with an increased rate (adjusted HR 1.51, 95% CI 1.14 to 2.01). Contrasting those with 5 or more ski races and a fast finish time to those who only participated once with a slow finish time, the adjusted HR of osteoarthritis was 2.73, 95% CI 1.78 to 4.18.

Conclusions/Significance

Participants with multiple and fast races have an increased risk of subsequent arthroplasty of knee and hip due to osteoarthritis, suggesting that intensive exercise may increase the risk.     

Leukotriene B4 and prostaglandin E2-like activity in synovial fluid in osteoarthritis

LTB4 and PGE2-like activity in synovial fluid samples from patients with osteoarthritis of the knee joint were determined and found to be significantly higher than in samples obtained from normal patients. The results suggest that leukotrienes and prostaglandins may have a role in the pathogenesis of osteoarthritis.     

Knee joint kinematics during walking influences the spatial cartilage thickness distribution in the knee

The regional adaptation of knee cartilage morphology to the kinematics of walking has been suggested as an important factor in the evaluation of the consequences of alteration in normal gait leading to osteoarthritis. The purpose of this study was to investigate the association of spatial cartilage thickness distributions of the femur and tibia in the knee to the knee kinematics during walking. Gait data and knee MR images were obtained from 17 healthy volunteers (age 33.2 ± 9.8 years). Cartilage thickness maps were created for the femoral and tibial cartilage. Locations of thickest cartilage in the medial and lateral compartments in the femur and tibia were identified using a numerical method. The flexion-extension (FE) angle associated with the cartilage contact regions on the femur, and the anterior-posterior (AP) translation and internal-external (IE) rotation associated with the cartilage contact regions on the tibia at the heel strike of walking were tested for correlation with the locations of thickest cartilage. The locations of the thickest cartilage had relatively large variation (SD, 8.9°) and was significantly associated with the FE angle at heel strike only in the medial femoral condyle (R(2)=0.41, p<0.01). The natural knee kinematics and contact surface shapes seem to affect the functional adaptation of knee articular cartilage morphology. The sensitivity of cartilage morphology to kinematics at the knee during walking suggests that regional cartilage thickness variations are influenced by both loading and the number of loading cycles. Thus walking is an important consideration in the analysis of the morphological variations of articular cartilage, since it is the dominant cyclic activity of daily living. The sensitivity of cartilage morphology to gait kinematics is also important in understanding the etiology and pathomechanics of osteoarthritis.