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23 (1.02, 1.49)] and to a less significant degree with whole knee cartilage morphology worsening [1.21 (0.98, 1.49)]. In men, greater combined hamstring coactivation was associated with increased risk for whole knee [1.59 (1.06, 2.39)] and patellofemoral [1.38 (1.01, 1.88)] cartilage morphology worsening and point estimates suggested association between medial hamstring coactivation and medial tibiofemoral cartilage morphology worsening. No significant associations were detected between greater hamstring coactivation and cartilage morphology worsening in women.
These findings suggest a longitudinal relationship between antagonist hamstring coactivation during isokinetic knee extensor testing and worsening of cartilage morphology over 24 months in men with or at risk for knee OA.
These findings suggest a longitudinal relationship between antagonist hamstring coactivation during isokinetic knee extensor testing and worsening of cartilage morphology over 24 months in men with or at risk for knee OA.
To determine the incidence and prevalence of hip osteoarthritis (OA) in electronic health records (EHRs) of Dutch general practices by using narrative and codified data.
A retrospective cohort study was conducted using the Integrated Primary Care Information database. An algorithm was developed to identify patients with narratively diagnosed hip OA in addition to patients with codified hip OA. Incidence and prevalence estimates among people aged ≥30 were assessed from 2008 to 2019. The association of comorbidities with codified hip OA diagnosis was analysed using multivariable logistic regression.
Using the hip OA narrative data algorithm (positive predicted value=72%) in addition to codified hip OA showed a prevalence of 1.76-1.95 times higher and increased from 4.03% in 2008 to 7.34% in 2019. The incidence was 1.83-2.41 times higher and increased from 6.83 to 7.78 per 1000 person-years from 2008 to 2019. Among codified hip OA patients, 39.4% had a previous record of narratively diagnosed hip OA, on average approximately 1.93 years earlier. Hip OA patients with a previous record of spinal OA, knee OA, hypertension, and hyperlipidaemia were more likely to be recorded with a hip OA code.
This study using Dutch EHRs showed that epidemiological estimates of hip OA are likely to be an underestimation. Using our algorithm, narrative data can be added to codified data for more realistic epidemiological estimates based on routine healthcare data. However, developing a valid algorithm remains a challenge, possibly due to the diagnostic complexity of hip pain in general practice.
This study using Dutch EHRs showed that epidemiological estimates of hip OA are likely to be an underestimation. Using our algorithm, narrative data can be added to codified data for more realistic epidemiological estimates based on routine healthcare data. However, developing a valid algorithm remains a challenge, possibly due to the diagnostic complexity of hip pain in general practice.
In light of the role of immune cells in OA pathogenesis, the development of sophisticated animal models closely mimicking the immune dysregulation during the disease development and progression could be instrumental for the preclinical evaluation of novel treatments. Among these models, immunologically humanized mice may represent a relevant system, particularly for testing immune-interacting DMOADs or cell therapies before their transfer to the clinic. click here Our objective, therefore, was to develop an experimental model of OA by destabilization of the medial meniscus (DMM) in humanized mice.
Irradiated 5-week-old NOD/LtSz-scid IL2Rγ
(NSG) mice were humanized by intravenous injection of CD34
human hematopoietic stem cells. The engraftment efficiency was evaluated by flow cytometry 17 weeks after the humanization procedure. Humanized and non-humanized NSG mice underwent DMM or sham surgery and OA development was assessed 1, 6, and 12 weeks after the surgery.
120 days after the humanization, human T and B lymphocytes, macrophages and NK cells, were present in the blood and spleen of the humanized NSG mice. The DMM surgery induced articular cartilage and meniscal alterations associated with an increase in OA and the meniscal score. Moreover, the surgery triggered an inflammatory response that was sustained at a low grade in the DMM group.
Our study shows for the first time the feasibility of inducing OA by DMM in humanized mice. This novel OA model could constitute a useful tool to bridge the gap between the preclinical and clinical evaluation of immune interacting DMOADs and cell-based therapies.
Our study shows for the first time the feasibility of inducing OA by DMM in humanized mice. This novel OA model could constitute a useful tool to bridge the gap between the preclinical and clinical evaluation of immune interacting DMOADs and cell-based therapies.
Patients undergoing lower limb arthroplasty who are severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive at the time of surgery have a high risk of mortality. The National Institute for Health and Clinical Care Excellence and the British Orthopaedic Association advise self-isolation for 14 days preoperatively in patients at a high risk of adverse outcomes due to COVID-19. The aim of the study is to assess whether preoperative polymerase chain reaction (PCR) for SARS-CoV-2 could be performed at between 48 and 72 hours preoperatively with specific advice about minimizing the risk of SARS-CoV-2 restricted to between PCR and admission.
A multicentre, international, observational cohort study of 1,000 lower limb arthroplasty cases was performed. The dual primary outcomes were 30-day conversion to SARS-CoV-2 positive and 30-day SARS-CoV-2 mortality. Secondary outcomes included 30-day SARS-CoV-2 morbidity.
Of the 1,000 cases, 935 (94%) had a PCR between 48 and 72 hours preoperatively. All caseVID-free pathway is safe for patients undergoing primary and revision hip and knee arthroplasty. Preoperative SARS-CoV-2 PCR test alone may be safe but further adequately powered studies are required. This information is important for shared decision making with patients during the current pandemic.
Diaphyseal fixation remains the mainstay of revision THA. The stability of diaphyseal fixation can be quantified by the extent of contact between the stem and the endosteal cortex. This is highly affected by the morphology of the proximal femur. The purpose of this study was to examine factors affecting diaphyseal contact in the revision THA and to identify preoperative predictors of adequate fixation.
Three-dimensional femur models were created from CT scans of 33 Dorr B and C femora. The proximal 120 mm of the femur was omitted to mimic proximal bone deficiency. A tapered fluted stem (3 degrees, 150 mm) model was virtually implanted after reaming of the medullary canal. The contact length between stem and endosteal cortex was measured, in addition to other variables. The relationship between variables was evaluated using Spearman's correlation, and logistic regression analysis was used to identify predictors of the contact length (P < .05).
The contact length varied widely between specimens (66.5 ± 16.6 mm, range 21-98 mm). Contact increased with the depth of the isthmus below the lesser trochanter (range 55-155 mm; r
= 0.473, P= .005) and the distance between the isthmus and the distal edge of the damage zone (range-9 to 96 mm; r
= 0.508, P= .002). Stepwise regression identified the reaming length, distance between fracture and the isthmus, and isthmus diameter as independent predictors of contact length (r= 0.643).
Contact is limited in specimens where the isthmus is more proximally located. In these cases, supplementary fixation using plating and/or longer, curved prosthesis may be considered.
Contact is limited in specimens where the isthmus is more proximally located. In these cases, supplementary fixation using plating and/or longer, curved prosthesis may be considered.
Hip range of motion precautions are often considered a requirement for patients after total hip replacement. Few studies have attempted to estimate hip motion during activities of daily living. The purpose of this study is to evaluate hip range of motion and gait during real-life activities in healthy individuals with a novel tracking wearable sensor.
Thirty subjects used a hip motion tracking device during a series of tested activities. Healthy volunteers were selected, and subjects were excluded if they reported symptoms in the limb or known deviation in their gait. Hip flexion was evaluated during common activities of daily living.
Hip range of motion during walking averaged minimum to maximum hip flexion of 9.9°-49.3°, respectively. During stair ascent, the average flexion arc widened from minimum 19.6° to maximum 67.8° flexion. Stair descent had the most narrow arc of 26.2°-52.4° hip flexion. Squatting averaged 120.0° of hip flexion, with the transition from sitting to standing averaging 103.0°. Getting on and off of the toilet averaged maximum 112.6°, while tying shoes averaged 126.1° maximum hip flexion.
Hip precautions are often enforced after total hip arthroplasty without knowing normal arcs of motion during real-life activities. Knowledge of hip motion during activities of daily living in healthy individuals is useful information in setting goals and in educating total hip arthroplasty patients. This technology can be useful in guiding postoperative precautions and also in monitoring patients after hip replacement with real-time monitoring.
Hip precautions are often enforced after total hip arthroplasty without knowing normal arcs of motion during real-life activities. Knowledge of hip motion during activities of daily living in healthy individuals is useful information in setting goals and in educating total hip arthroplasty patients. This technology can be useful in guiding postoperative precautions and also in monitoring patients after hip replacement with real-time monitoring.
We sought to understand the magnitude of the shift in care settings (hospital inpatient, hospital outpatient, or ambulatory surgery center) for primary total joint arthroplasty (TJA) and its economic impact on surgeons and hospitals.
We measured the shift in care settings for primary TJAs using national 100% sample Medicare fee-for-service (FFS) claims data from January 2017 through March 2021. We also measured the percent of case being discharged the same day over time. We calculated the national average hospital payment rate by setting and the weighted average hospital payment rates based on the mix of inpatient and outpatient cases over time. We compared average facility and physician payment rate changes over time across common types of surgeries.
By the first quarter of 2021, 29% of Medicare FFS primary TJAs were performed hospital inpatient (down from 100% in 2017), 64% were performed hospital outpatient, and about 7% in an ambulatory surgery center. The percent of hospital-based primary TJAs that for outpatient cases.
Extended oral antibiotic prophylaxis (EOA) has been shown to potentially reduce infection rates after high-risk primary total knee arthroplasties (TKAs) and reimplantations. However, data is limited regarding EOA after aseptic revision TKAs. This study evaluated the impact of EOA on infection-related outcomes after aseptic revision TKAs.
904 aseptic revision TKAs from 2014-2019 were retrospectively identified. Patients who received EOA >24hours perioperatively (n= 267) were compared to those who did not (n= 637) using an inverse probability of treatment weighting model. Mean age was 66 years, mean BMI was 33 kg/m
, and 54% were female. Outcomes included cumulative probabilities of any infection, periprosthetic joint infection (PJI), superficial infection, and re-revision or reoperation for infection.
The cumulative probability of any infection after aseptic revision TKA was 1.9% at 90 days, 3.5% at 1 year, and 8.1% at 5 years. Patients without EOA had a higher risk of any infection at 90 days (HR= 7.
