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Latest Advances in Clinical Diagnosis and Treatment of Hip and Knee Osteoarthritis

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: 31 July 2024 | Viewed by 11956

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Prof. Dr. Gunther Maderbacher

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Department of Orthopedic Surgery, University of Regensburg, Bad Abbach, Regensburg, Germany
Interests: hip; knee; joint arthroplasty; foot and ankle surgery
Special Issues, Collections and Topics in MDPI journals

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Dear Colleagues,

Degenerative osteoarthritis of the hip and knee joints represents an enormous socioeconomic burden for all humankind. Current research shows a multifactorial genesis with complex intra- and extra-articular changes. Despite intensive scientific efforts, prophylactic therapy to prevent the development of osteoarthritis is not currently available. Accordingly, current therapeutic strategies usually aim at treating the damage that has already occurred.

Localized damage can be addressed very well with regenerative procedures. Appropriately differentiated and accurate preoperative imaging can pave the way for this.

For terminal degenerative changes, endoprosthetic replacement is still considered the gold standard.

This Special Issue is dedicated to the latest findings in the development, diagnosis and therapy of degenerative joint diseases, especially of the hip and knee joint. We would like to invite authors to support us with original articles or reviews including, but not limited to, the following topics:

Pathomechanisms for the development of osteoarthritis;
Imaging in degenerative joint disease;
Joint-preserving therapy options for degenerative joint diseases of the hip and knee;
Joint Replacement of hip and knee.

Prof. Dr. Gunther Maderbacher
Guest Editor

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Keywords

hip
knee
joint arthroplasty
diagnosis
treatment
regenerative therapy

Published Papers (11 papers)

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13 pages, 708 KiB

Open AccessArticle

A Cross-Sectional Study of Factors Predicting the Duration of the Efficacy of Viscosupplementation in Knee Osteoarthritis

by Charles Rapp, Feriel Boudif, Charlotte Bourgoin, Anne Lohse and Thierry Conrozier

J. Clin. Med. 2024, 13(7), 1949; https://doi.org/10.3390/jcm13071949 - 27 Mar 2024

Viewed by 469

Abstract

Background: An advanced radiological stage and obesity are predictive of poorer and shorter responses to viscosupplementation in patients with knee osteoarthritis (OA). Very little is known regarding the impact of other factors such as sport practice, comorbidities, or anatomical features of OA. Methods: This study aimed to investigate patients’ and OA characteristics associated with the duration of the effectiveness (DE) of viscosupplementation in patients with knee OA. It was a cross-sectional, single-centre clinical trial in patients with knee OA treated with intra-articular (IA) hyaluronic acid (HA) injection(s) within the previous 3 years. The investigators collected data regarding demographic and radiographic features (Kellgren–Lawrence grade and involved knee compartments), dosing regimen (single or repeat injections), the presence and volume of joint effusion, previous or concomitant IA corticosteroid injection, the number of previous viscosupplementations, and comorbidities. Patients completed a questionnaire including the self-assessment of DE (the number of weeks during which viscosupplementation was effective on symptoms), the activity level (sedentary, active, or athletic), and the level of sport activity (light, moderate, or intensive). Predictors of the DE were studied in bivariate and multivariate analyses. Results: In total, 105 patients (149 knees) were analysed (62% women, mean age 66.1 ± 13.2 years, mean BMI 27.5 ± 7.5 kg/m²). The mean DE was 48.2 ± 24.8 weeks. In bivariate analysis, the predictors of a shorter DE were BMI > 27.5 kg/m², more than three previous viscosupplementations, Kellgren–Lawrence grade 4, sedentary patients, and multicompartmental involvement. In the multivariate analysis, four independent factors remained associated with a shorter DE: BMI > 27.5 kg/m², multicompartmental knee involvement, number of viscosupplementations >3, and sedentary lifestyle. A statistically significant association between a longer DE and arterial hypertension was found, suggesting a beneficial effect of certain antihypertensive medications. Conclusions: This study confirms that being overweight significantly reduces the duration of the effectiveness of viscosupplementation. It also shows that viscosupplementation is more lastingly effective in unicompartmental OA and among active or athletic patients. The duration of effectiveness decreases when the treatment is repeated more than three times. Full article

(This article belongs to the Special Issue Latest Advances in Clinical Diagnosis and Treatment of Hip and Knee Osteoarthritis)

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12 pages, 453 KiB

Open AccessArticle

Return to Work after Primary Total Knee Arthroplasty: The First Polish Pilot Retrospective Study

by Mariusz Drużbicki, Łucja Kitrys, Jarosław Jabłoński, Damian Filip, Lidia Perenc and Agnieszka Guzik

J. Clin. Med. 2024, 13(7), 1902; https://doi.org/10.3390/jcm13071902 - 25 Mar 2024

Viewed by 458

Abstract

(1) Background: Total knee arthroplasty (TKA) performed on working-age patients significantly affects the participation of such patients in social life. A retrospective study was conducted to determine the return to work (RTW) rate after TKA. The goal of this study was to provide reference data for the Polish population and identify the factors impacting patients’ decisions to return to or resign from work, relative to their functional performance. (2) Methods: This retrospective study involved 48 patients. An interview related to RTW was carried out to identify the factors impacting a patient’s decision to return to or resign from work. Functional performance was assessed using the Knee Outcome Survey–Activities of Daily Living (KOS-ADL) scale. (3) Results: Before TKA, 15 individuals (31.25%) qualified for the study did not work and were receiving welfare benefits. After the surgery, 23 individuals (47.9% of those working prior to TKA) did not return to work. The number of those who did not work after TKA increased to 38 (79.17%), which was a significant change. The mean level of functional performance after TKA assessed using KOS-ADL was 75.89. (4) Conclusions: The findings show that the rate of RTW after TKA in Poland is significantly lower than that in other countries. The reasons for this situation, as shown in the study, may be related to the lack of an occupational rehabilitation system, resulting in a paucity of information about the possibility to return to work and about opportunities for retraining. Full article

(This article belongs to the Special Issue Latest Advances in Clinical Diagnosis and Treatment of Hip and Knee Osteoarthritis)

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11 pages, 453 KiB

Open AccessArticle

Impact of a Semi-Rigid Knee Orthotic Intervention on Pain, Physical Activity, and Functional Capacity in Patients with Medial Knee Osteoarthritis

by Bernd J. Stetter, Janis Fiedler, Michèle Arndt, Thorsten Stein and Stefan Sell

J. Clin. Med. 2024, 13(6), 1535; https://doi.org/10.3390/jcm13061535 - 7 Mar 2024

Viewed by 865

Abstract

Background: The effectiveness of knee orthoses as part of conservative treatment for patients with medial knee osteoarthritis has not been fully explored. The purpose of this study was to evaluate the effects of a novel semi-rigid knee orthosis on pain, physical activity, and functional capacity. Methods: Pain levels, physical activity, and functional capacity were assessed in 24 participants experiencing symptomatic medial knee osteoarthritis one week before (i.e., pretest) initiating a six-week orthosis intervention and again during the final week of the intervention (i.e., post-test). Results: Night pain, pain during walking, pain during stair climbing, and pain during sitting consistently decreased by 41% to 48% while wearing the knee orthosis. Device-based measured physical activity showed a 20.2-min increase in vigorous physical activity during the post-test, while light and moderate physical activity did not show significant changes. After six weeks of orthosis application, there was a 5% increased distance for the six-minute walk test, and participants reported fewer limitations both in everyday and athletic activities, as well as an enhanced quality of life. Conclusions: These findings highlight the potential effectiveness of a semi-rigid knee orthosis to enhancing functional capacity and quality of life. More extensive and longer clinical trials are needed to improve confidence in these findings and understand their impact on disease progression. Full article

(This article belongs to the Special Issue Latest Advances in Clinical Diagnosis and Treatment of Hip and Knee Osteoarthritis)

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9 pages, 1513 KiB

Open AccessArticle

The Trochlear Paradox in Native Knees and Its Potential Impact on Total Knee Arthroplasty: An MRI-Based Correlation Study Investigating the Effect of Varying Posterior Femoral Condyle Angles on the Patellofemoral Joint

by Timon Röttinger, Leonard Lisitano, Johanna Abelmann-Brockmann, Kim Rau, Nora Koenemann, Annabel Fenwick, Edgar Mayr and Heinz Röttinger

J. Clin. Med. 2024, 13(3), 790; https://doi.org/10.3390/jcm13030790 - 30 Jan 2024

Viewed by 600

Abstract

Background: Since the beginning of total knee arthroplasty, implant alignment has been a central point of discussion. As diverse as the discussed alignment theories are, as uniform is the implant design, which is supposed to be based on the “average knee.” Steady upgrades in prosthesis design and modern alignment theories have achieved improvements. However, knee arthroplasty continues to be burdened by a significant percentage of dissatisfied patients. In current knee arthroplasty, femoral implant alignment is referenced by the dorsal and distal condylar axes. The patellofemoral joint variance is not sufficiently considered. Predominantly dorsal and distal referencing at the femoral condyle determines the postoperative shape of the anterior knee joint. The present study investigated a possible relationship between dorsal and distal joint parameters and the patellofemoral joint. Methods: In this explorative retrospective monocentric study, MRI cross-sectional images of 100 native knee joints were evaluated. By determining parametric correlations according to Pearson, the study investigates whether the independent variables “posterior femoral condyle angle” and “lateral distal femoral angle” are related to “lateral trochlear inclination”, “patella tilt”, and “bisect offset”. Results: The posterior condylar angle significantly correlates with lateral trochlear inclination, patella tilt, and bisect offset. There is a positive correlation with patella tilt and bisect offset but a negative correlation with lateral trochlear inclination. The lateral distal femoral angle did not correlate with the studied parameters. Conclusion: The lateral trochlear inclination decreases with an increased posterior femoral condylar angle. The posterior referencing of the femoral component in total knee arthroplasty simultaneously establishes the shape of the anterior knee joint. Our results indicate that increasing posterior condyle angles significantly correlate with flattened lateral trochlear inclinations in native knees and suggest a systematic biomechanical conflict in total knee arthroplasty. Full article

(This article belongs to the Special Issue Latest Advances in Clinical Diagnosis and Treatment of Hip and Knee Osteoarthritis)

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13 pages, 2373 KiB

Open AccessArticle

Impact of the Body Composition on Knee Osteoarthritis Assessed Using Bioimpedance Analysis

by Jaromir Jarecki, Bartosz Potoczniak, Artur Dziedzic, Teresa Małecka-Masalska, Tomasz Skrzypek, Waldemar Kazimierczak, Marcin Skowronek, Magdalena Wójciak, Sławomir Dresler, Marcin Waśko and Ireneusz Sowa

J. Clin. Med. 2023, 12(22), 7037; https://doi.org/10.3390/jcm12227037 - 10 Nov 2023

Viewed by 931

Abstract

Osteoarthritis (OA) ranks among the most prevalent inflammatory diseases affecting the musculoskeletal system and is a leading cause of disability globally, impacting approximately 250 million individuals. This study aimed to assess the relationship between the severity of knee osteoarthritis (KOA) and body composition in postmenopausal women using bioimpedance analysis (BIA). The study included 58 postmenopausal females who were candidates for total knee arthroplasty. The control group consisted of 25 postmenopausal individuals with no degenerative knee joint changes. The anthropometric analysis encompassed the body mass index (BMI), mid-arm and mid-thigh circumferences (MAC and MTC), and triceps skinfold thickness (TSF). Functional performance was evaluated using the 30 s sit-to-stand test. During the BIA test, electrical parameters such as membrane potential, electrical resistance, capacitive reactance, impedance, and phase angle were measured. Additionally, body composition parameters, including Total Body Water (TBW), Extracellular Water (ECW), Intracellular Water (ICW), Body Cellular Mass (BCM), Extracellular Mass (ECM), Fat-Free Mass (FFM), and Fat Mass (FM), were examined. The study did not find any statistically significant differences in the electrical parameters between the control (0–1 grade on the K–L scale) and study groups (3–4 grade on the K–L scale). However, statistically significant differences were observed in BMI, fat mass (FM), arm circumference, triceps skinfold thickness, and sit-to-stand test results between the analyzed groups. In conclusion, the association between overweight and obesity with KOA in postmenopausal women appears to be primarily related to the level of adipose tissue and its metabolic activity. Full article

(This article belongs to the Special Issue Latest Advances in Clinical Diagnosis and Treatment of Hip and Knee Osteoarthritis)

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7 pages, 261 KiB

Open AccessArticle

by Maximiliano Barahona, Felipe Bustos, Tomás Navarro, Pablo Chamorro, Macarena Alejandra Barahona, Sebastián Carvajal, Julian Brañes, Jaime Hinzpeter, Cristian Barrientos and Carlos Infante

J. Clin. Med. 2023, 12(18), 6096; https://doi.org/10.3390/jcm12186096 - 21 Sep 2023

Cited by 2 | Viewed by 726

Abstract

Background: Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are effective treatments for severe knee and hip osteoarthritis. Historically, TKA has been associated with lower satisfaction than THA, but recent advances in knee surgery have led to lower dissatisfaction rates. This study aimed to compare the satisfaction and self-reported improvement in the quality of life of two cohorts of patients who underwent TKA and THA, respectively. Methods: This observational study compared two previously published cohorts of patients who underwent THA and TKA in a single university center. The Goodman scale was used to assess satisfaction and self-perception of improved quality of life after TKA and THA at a minimum one-year follow-up. Propensity score matching was used to balance age, gender, and follow-up between groups. Significance was set at 0.05. Results: The study included a total of 105 THAs and 131 TKAs. Both groups had high levels of satisfaction with pain relief, ability to do house/yard work, and overall satisfaction, with above 90% satisfaction rates. Regarding improvement in quality of life, both groups had 86% of patients reporting improvement as “much better.” After propensity score matching, no significant difference was found between THA and TKA for any of the comparisons made using the Goodman scale. Conclusions: The study showed that both TKA and THA resulted in high levels of satisfaction and improvement in quality of life. There was no significant difference in satisfaction rates between TKA and THA, contrary to the historical trend of lower satisfaction rates for TKA. Full article

(This article belongs to the Special Issue Latest Advances in Clinical Diagnosis and Treatment of Hip and Knee Osteoarthritis)

15 pages, 2861 KiB

Open AccessArticle

The Role and Efficiency of an AI-Powered Software in the Evaluation of Lower Limb Radiographs before and after Total Knee Arthroplasty

by Stefano Pagano, Karolina Müller, Julia Götz, Jan Reinhard, Melanie Schindler, Joachim Grifka and Günther Maderbacher

J. Clin. Med. 2023, 12(17), 5498; https://doi.org/10.3390/jcm12175498 - 24 Aug 2023

Cited by 2 | Viewed by 793

Abstract

The rapid evolution of artificial intelligence (AI) in medical imaging analysis has significantly impacted musculoskeletal radiology, offering enhanced accuracy and speed in radiograph evaluations. The potential of AI in clinical settings, however, remains underexplored. This research investigates the efficiency of a commercial AI tool in analyzing radiographs of patients who have undergone total knee arthroplasty. The study retrospectively analyzed 200 radiographs from 100 patients, comparing AI software measurements to expert assessments. Assessed parameters included axial alignments (MAD, AMA), femoral and tibial angles (mLPFA, mLDFA, mMPTA, mLDTA), and other key measurements including JLCA, HKA, and Mikulicz line. The tool demonstrated good to excellent agreement with expert metrics (ICC = 0.78–1.00), analyzed radiographs twice as fast (p < 0.001), yet struggled with accuracy for the JLCA (ICC = 0.79, 95% CI = 0.72–0.84), the Mikulicz line (ICC = 0.78, 95% CI = 0.32–0.90), and if patients had a body mass index higher than 30 kg/m² (p < 0.001). It also failed to analyze 45 (22.5%) radiographs, potentially due to image overlay or unique patient characteristics. These findings underscore the AI software’s potential in musculoskeletal radiology but also highlight the necessity for further development for effective utilization in diverse clinical scenarios. Subsequent studies should explore the integration of AI tools in routine clinical practice and their impact on patient care. Full article

(This article belongs to the Special Issue Latest Advances in Clinical Diagnosis and Treatment of Hip and Knee Osteoarthritis)

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13 pages, 2634 KiB

Open AccessArticle

Investigating Knee Joint Proprioception and Its Impact on Limits of Stability Using Dynamic Posturography in Individuals with Bilateral Knee Osteoarthritis—A Cross-Sectional Study of Comparisons and Correlations

by Abdullah Raizah, Ravi Shankar Reddy, Mastour Saeed Alshahrani, Jaya Shanker Tedla, Snehil Dixit, Kumar Gular, Ajay Prashad Gautam, Irshad Ahmad and Praveen Kumar Kandakurti

J. Clin. Med. 2023, 12(8), 2764; https://doi.org/10.3390/jcm12082764 - 7 Apr 2023

Cited by 6 | Viewed by 2335

Abstract

(1) Background: Proprioception and limits of stability can significantly impact static and dynamic balance. Knee proprioception and limits of stability may be impaired in individuals with knee osteoarthritis (KOA). Impaired knee proprioception may impact the limits of stability, and understanding the associations between these factors is important for formulating treatment strategies in this population. The objectives of this study are to (a) compare the knee joint position error (JPE) and limits of stability between KOA and asymptomatic individuals and (b) assess the correlation between knee JPE and the limits of stability in KOA individuals. (2) Methods: This cross-sectional study included 50 individuals diagnosed with bilateral KOA and 50 asymptomatic individuals. Knee JPE was measured using a dual digital inclinometer at 25° and 45° of knee flexion (in the dominant and nondominant legs). The limits of stability variables, including reaction time (s), maximum excursion (%), and direction control (%), were evaluated using computerized dynamic posturography. (3) Results: The magnitude of the mean knee JPE is significantly larger in KOA individuals (p < 0.001) compared to asymptomatic individuals assessed at 25° and 45° of knee flexion in both the dominant and nondominant legs. The limits of stability test showed that KOA group individuals had a longer reaction time (1.64 ± 0.30 s) and reduced maximum excursion (4.37 ± 0.45) and direction control (78.42 ± 5.47) percentages compared to the asymptomatic group (reaction time = 0.89 ± 0.29, maximum excursion = 5.25 ± 1.34, direction control = 87.50 ± 4.49). Knee JPE showed moderate to strong correlations with the reaction time (r = 0.60 to 0.68, p < 0.001), maximum excursion (r = −0.28 to −0.38, p < 0.001) and direction control (r = −0.59 to −0.65, p < 0.001) parameters in the limits of stability test. (4) Conclusions: Knee proprioception and limits of stability are impaired in KOA individuals compared to asymptomatic individuals, and knee JPE showed significant relationships with the limits of stability variables. These factors and correlations may be considered when evaluating and developing treatment strategies for KOA patients. Full article

(This article belongs to the Special Issue Latest Advances in Clinical Diagnosis and Treatment of Hip and Knee Osteoarthritis)

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12 pages, 1308 KiB

Open AccessArticle

Walking with Different Insoles Changes Lower-Limb Biomechanics Globally in Patients with Medial Knee Osteoarthritis

by Guillaume Jaques, Baptiste Ulrich, Laurent Hoffmann, Brigitte M. Jolles and Julien Favre

J. Clin. Med. 2023, 12(5), 2016; https://doi.org/10.3390/jcm12052016 - 3 Mar 2023

Cited by 1 | Viewed by 1415

Abstract

Using insoles to modify walking biomechanics is of keen interest for the treatment of medial-compartment knee osteoarthritis. So far, insole interventions have focused on reducing the peak of the knee adduction moment (pKAM) and have led to inconsistent clinical outcomes. This study aimed to evaluate the changes in other gait variables related to knee osteoarthritis when patients walk with different insoles to provide insights into the necessity to enlarge the biomechanical analyses to other variables. Walking trials were recorded for 10 patients in four insole conditions. Changes among conditions were computed for six gait variables, including the pKAM. The associations between the changes in pKAM and the changes in the other variables were also assessed individually. Walking with different insoles had noticeable effects on the six gait variables, with high heterogeneity among patients. For all variables, at least 36.67% of the changes were of medium-to-large effect size. The associations with the changes in pKAM varied among variables and patients. In conclusion, this study showed that varying the insole could globally influence ambulatory biomechanics and that limiting measurement to the pKAM could lead to an important loss of information. Beyond the consideration of additional gait variables, this study also encourages personalized interventions to address inter-patient variability. Full article

(This article belongs to the Special Issue Latest Advances in Clinical Diagnosis and Treatment of Hip and Knee Osteoarthritis)

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Review

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22 pages, 602 KiB

Open AccessReview

Knee Cartilage Lesion Management—Current Trends in Clinical Practice

by Jaromir Jarecki, Marcin Krzysztof Waśko, Wojciech Widuchowski, Agnieszka Tomczyk-Warunek, Magdalena Wójciak, Ireneusz Sowa and Tomasz Blicharski

J. Clin. Med. 2023, 12(20), 6434; https://doi.org/10.3390/jcm12206434 - 10 Oct 2023

Viewed by 1338

Abstract

Many patients, particularly those aged above 40, experience knee joint pain, which hampers both sports activities and daily living. Treating isolated chondral and osteochondral defects in the knee poses a significant clinical challenge, particularly in younger patients who are not typically recommended partial or total knee arthroplasty as alternatives. Several surgical approaches have been developed to address focal cartilage defects. The treatment strategies are characterized as palliation (e.g., chondroplasty and debridement), repair (e.g., drilling and microfracture), or restoration (e.g., autologous chondrocyte implantation, osteochondral autograft, and osteochondral allograft). This review offers an overview of the commonly employed clinical methods for treating articular cartilage defects, with a specific focus on the clinical trials conducted in the last decade. Our study reveals that, currently, no single technology fully meets the essential requirements for effective cartilage healing while remaining easily applicable during surgical procedures. Nevertheless, numerous methods are available, and the choice of treatment should consider factors such as the location and size of the cartilage lesion, patient preferences, and whether it is chondral or osteochondral in nature. Promising directions for the future include tissue engineering, stem cell therapies, and the development of pre-formed scaffolds from hyaline cartilage, offering hope for improved outcomes. Full article

(This article belongs to the Special Issue Latest Advances in Clinical Diagnosis and Treatment of Hip and Knee Osteoarthritis)

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Other

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12 pages, 302 KiB

Open AccessPerspective

What We Should Expect from an Innovative Intra-Articular Hyaluronic Acid Product: Expert Opinion Based on a Comprehensive Review of the Literature

by Alberto Migliore, Emmanuel Maheu, Luca Saccone, Gustavo C. de Campos, Lyudmila Alekseeva, Xavier Chevalier, Thierry Conrozier, Sergio Crimaldi, Demirhan Diracoglu, Gabriel Herrero-Beaumont, Giovanni Iolascon, Ruxandra Ionescu, Jörg Jerosch, Jorge Laíns, Souzi Makri, Natalia Martusevich, Marco Matucci Cerinic, Karel Pavelka, Robert J. Petrella, Umberto Tarantino and Raveendhara R. Bannuru Show full author list Hide full author list

J. Clin. Med. 2023, 12(23), 7422; https://doi.org/10.3390/jcm12237422 - 30 Nov 2023

Viewed by 1073

Abstract

Background: Intra-articular hyaluronic acid (IAHA) products are often used in the treatment of adults with mild-to-moderate knee osteoarthritis (KOA). The International Symposium on Intra-Articular Treatment (ISIAT) convened a multidisciplinary technical expert panel to define characteristics for an innovative IAHA product that should answer unmet needs in the clinical management of adults with mild-to-moderate KOA. Methods: An initial set of evidence-based statements was developed based on data extracted from articles identified through a comprehensive literature search. A Delphi panel comprising 19 experts in KOA voted in 3 rounds to rate their degree of agreement with accepted statements. Results: The final set of 13 accepted statements focus on the effect of an innovative IAHA across 5 key domains of nociceptive pain, joint function, quality of life, joint structure and integrity, and adverse effects. The statements set thresholds for clinically meaningful improvements that exceed those generally achievable by currently available IAHA products. Conclusion: The characteristics described by these statements from the ISIAT set new standards for what should be expected from an innovative IAHA. These statements should serve as a framework for driving the development of innovative IAHA products that will surpass the actual outcomes achieved by current viscosupplements in patients with mild-to-moderate KOA. Full article

(This article belongs to the Special Issue Latest Advances in Clinical Diagnosis and Treatment of Hip and Knee Osteoarthritis)

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