Therapeutic significance of insoles in patients with knee osteoarthritis.

OBJECTIVE: The effects of insoles on managing knee osteoarthritis (KOA) symptoms remain controversial. This systematic review provides insights into the therapeutic effects and outcomes of insole use in older adults with KOA. MATERIALS AND METHODS: The PubMed database was reviewed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). The articles' titles, abstracts, and eligibility per the inclusion criteria were screened for relevance. Duplicated articles were removed, and full-text articles were retrieved for further assessment, in accordance with the eligibility criteria. The included articles have been analyzed for general information, participants, and relevant findings, such as painful symptoms, loading rate, and external knee adduction moment (EKAM). RESULTS: The initial search identified 335 articles. Nine studies, including seven randomized controlled trials, one cross-sectional study, and one cohort study, were included for review per the eligibility criteria. There were 639 KOA patients, of which the majority were female, diagnosed with Kellgren-Lawrence grades 2-3, with a mean age of 54.5 years. The lateral wedge insole helped reducing EKAM and loading rates in patients with KOA. We detetced no significant reduction in pain following the use of lateral wedge insoles. However, lateral wedge insoles combined with customized arch support showed significant improvements in pain and physical function in KOA patients. CONCLUSIONS: Lateral wedge insoles with arch support significantly improved pain and physical function in patients with KOA. Other insoles did not provide significant positive outcomes regarding pain reduction or joint deterioration in KOA patients.

Abnormal foot pressure in older adults with knee osteoarthritis: a systematic review.

OBJECTIVE: Knee osteoarthritis (KOA) is a progressive disease affecting the biomechanics of the knee and other parts of the lower extremities, such as the ankle and foot. Little is known about the pathophysiology of plantar pressure in patients with KOA, which could lead to foot disability. This review aimed to provide more in-depth information regarding the pathophysiology of plantar pressure patterns and their related parameters in older adults with KOA. MATERIALS AND METHODS: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the PubMed database was searched with the keywords "foot pressure and knee osteoarthritis" and "center of pressure and knee osteoarthritis". The eligible articles were evaluated based on five characteristics: KOA stages, sample size, country, study tool, and findings. The primary outcomes were plantar pressure and center of pressure (COP) in each area. Other outcomes were also evaluated, such as knee flexion angle, knee abductor moment, and clinical scores. RESULTS: Nine full-text articles were eligible for review, including 495 participants (256 patients with KOA and 239 healthy individuals). The mean age of patients with KOA was 60.2-77 years. Patients with KOA had a higher tendency for pronounced plantar pressure on the medial forefoot, mid-foot, or the foot's central area. The COP patterns were shorter and more lateralized in patients with KOA, reflecting the functional ability, pain, and well-being of patients with KOA. CONCLUSIONS: Abnormalities in plantar pressure and COP were observed in older adults with KOA. This information could be a basis for designing biomedical devices, orthoses, and other realignment osteotomies of the lower extremities that could relieve symptoms at the knee or foot, or reduce KOA progression.

Artificial intelligence assistance in radiographic detection and classification of knee osteoarthritis and its severity: a cross-sectional diagnostic study.

OBJECTIVE: Radiographic interpretation suffers from an ever-increasing workload in orthopedic and radiology departments. The present study applied and assessed the performance of a convolutional neural network designed to assist orthopedists and radiologists in the detection and classification of knee osteoarthritis from early to severe degrees in accordance with the Kellgren-Lawrence (KL) classification system. MATERIALS AND METHODS: In total, 1650 knee joint radiographs (anteroposterior view) were collected from the Osteoarthritis Initiative public resource. Two models were developed: one distinguished normal (KL 0-I) from osteoarthritic knees (KL II-IV), and the other classified the severity as normal (KL 0-I), non-severe (KL II), or severe (KL III-IV). The regions of interest were labeled under the supervision of experts. Our artificial intelligence (AI) models were trained using the You Only Look Once version 3 (YOLOv3) detection algorithm. RESULTS: Our first AI model using YOLOv3 tiny could detect and classify normal and osteoarthritic knees on plain knee joint radiographs with 85% accuracy and 81% mean average precision. The second AI model for classifying severity achieved a total accuracy of 86.7% and mean average precision of 70.6%. CONCLUSIONS: Our proposed deep learning models provided high accuracy and satisfactory precision for the detection and classification of early to severe knee osteoarthritis on anteroposterior radiographs. These models may be used as diagnostic aids by interpreting knee radiographs and guiding the treatment options via each osteoarthritic stage for related physicians and specialists.

Efficacy of intravenous perioperative parecoxib administration in the surgical fixation of unstable ankle fracture: a prospective, double-blinded, randomized, placebo-controlled trial.

OBJECTIVE: Little is known about the efficacy of perioperative intravenous (IV) non-opioid medication administration in patients undergoing orthopedic surgery. The objective of this study was to determine the efficacy of perioperative parecoxib in patients with unstable ankle fractures who were scheduled to undergo surgery. PATIENTS AND METHODS: In this double-blinded, prospective, randomized controlled trial, 40 patients who underwent open reduction and internal fixation for unstable ankle fractures were randomly allocated to the parecoxib group (parecoxib 40 mg IV 30 min before surgery and then 40 mg IV every 12 h for the initial 48 h postoperatively [n=20]) or the placebo group (saline [n=20]). The efficacy of pain control was assessed according to the total morphine used. Pain intensity (at rest/ambulation) and pain relief (at rest/ambulation) were assessed using the verbal numerical rating score (VNRS) and verbal numerical rating percentage (VNRP), respectively. Subjective rating of medication was performed by each patient. All outcomes were recorded by trained personnel who were blinded to the patient group allocation. RESULTS: The mean patient age was 49.3±18.0 years. There were no significant differences between the two groups in terms of pain intensity, pain relief, patients' subjective ratings of the medication at both the preoperative and postoperative periods, total quantity of morphine used, side effects, and acute complications of surgery (p>0.05). The mean length of hospital stay tended to be shorter in the parecoxib group than in the placebo group (6 vs. 9.9 days; p=0.183). CONCLUSIONS: Although the perioperative administration of parecoxib did not provide significantly better postoperative pain control or reduce the opioid requirement relative to placebo, its use led to a shorter hospital stay.

Ankle synovium-derived mesenchymal stem cells for the treatment of osteochondral lesion of the talus: a novel cell harvesting technique and clinical applications.

OBJECTIVE: To describe a novel technique for harvesting mesenchymal stem cells (MSCs) from ankle synovium and demonstrate their multipotency for chondrogenesis and osteogenesis in the treatment of a large osteochondral lesion of the talus (OLT). PATIENTS AND METHODS: MSCs were harvested under local anesthesia from a biopsy of the ankle synovium of a patient with OLT and cultured for 4 weeks. In accordance with the International Society for Cellular Therapy (ISCT) criteria, synovial-derived MSCs were analyzed for cell surface markers using flow cytometry and grown in differentiation induction medium to demonstrate multilineage differentiation potentials in vitro. The patient received an injection of synovial-derived MSCs in a collagen matrix with a fibrin sealant to augment surgery for the lesion. RESULTS: Harvesting of ankle synovium yielded a culture of 30 million spindle-shaped stem cells in 4 weeks. Cell surface marker expression of the MSCs met the ISCT standards. After 21 days, cultured cells could be differentiated into adipocytes, osteocytes and chondrocytes. The patient recovered uneventfully from surgery and showed satisfactory improvements in pain and ankle motion. CONCLUSIONS: Ankle synovium is a potential source of MSCs for the treatment of OLT. We developed a novel harvesting technique that was simple, convenient and had no complications.

Effects of renal function on the intraosseous concentration and inhibitory effect of prophylactic cefazolin in knee arthroplasty.

OBJECTIVE: To compare intraosseous concentrations and inhibitory effects on the growth of Staphylococcus aureus following intravenous administration of 1 or 2 g of the prophylactic cefazolin between patients with decreased renal function vs. intact renal function undergoing total knee arthroplasty. PATIENTS AND METHODS: Ten patients (13 knees) with primary knee osteoarthritis were divided into two groups by creatinine clearance (CrCl) level (intact renal function: CrCl ≥75 mg/mL (four knees); decreased renal function: CrCl <75 mg/mL (nine knees)). Subchondral bone samples (proximal tibia and distal femur) were obtained during the procedure and were analyzed for the intraosseous concentration of cefazolin and the inhibitory effects on the growth of S. aureus using high-performance liquid chromatography and agar disc diffusion bioassays. RESULTS: Different levels of renal function showed no significant associations with mean intraosseous concentration and mean inhibitory effects at the proximal tibia and distal femur in patients administered 1 g cefazolin (p>0.05). For patients administered 2 g cefazolin, mean intraosseous concentration in the decreased renal function group was significantly higher at the proximal tibia (p=0.049) and also higher (but not reaching statistical significance) at the distal femur (p=0.073) compared with the intact renal function group. Mean inhibitory effects in the decreased renal function group were significantly lower than the intact renal function group at the proximal tibia (p=0.003) and distal femur (p=0.003). CONCLUSIONS: Deceased renal function played a role in the increased intraosseous concentration and decreased inhibitory effects in the groups receiving 2 g cefazolin. An excessive intraosseous concentration showed a negative influence on inhibitory effects on the growth of Staphylococcus aureus.