Search Results (1,289)

Background/Objectives: Curved periacetabular osteotomy (CPO) is an effective joint-preserving procedure for osteoarthritis of the hip; however, postoperative weight-bearing restrictions may influence muscle quality and functional recovery. This study aimed to examine longitudinal changes in muscle mass, muscle quality assessed by phase angle (PhA), and physical function after CPO and explored their postoperative interrelationships. Methods: This prospective longitudinal study included 35 female patients (mean age 34.9 ± 13.4 years) undergoing CPO. Assessments were conducted preoperatively, at full weight-bearing (FWB), and 12 months postoperatively. Lower-limb muscle mass and PhA were measured using multifrequency bioelectrical impedance analysis. Physical function was evaluated using Timed Up and Go (TUG), body weight-normalized ground reaction force during sit-to-stand (F/w), and operated-side weight-bearing capacity. Results: Operated-side muscle mass decreased at FWB and partially recovered by 12 months. In contrast, PhA declined markedly at FWB on the operated side (5.21 ± 0.69° to 4.15 ± 0.67°, p < 0.001) and remained significantly lower than baseline at 12 months. Functional measures declined during restricted loading and recovered to levels comparable to baseline by 12 months. At FWB, PhA was independently associated with TUG, F/w, and power generation indices. The reduction in PhA was greater than that observed for muscle mass, and contralateral PhA also declined. Conclusions: CPO is associated with a transient decline in muscle quality and functional performance during postoperative loading restriction. Although functional measures recover within 12 months, muscle quality remains partially impaired. Early strategies aimed at preserving muscle quality may support postoperative recovery. Full article

Background: Knee arthrodesis markedly alters lower limb biomechanics and creates a challenging scenario when associated with end-stage ankle osteoarthritis. No prior reports have specifically described treatment with total ankle replacement (TAR) in the presence of an ipsilateral fused knee. This study evaluated the feasibility and mid-term outcomes of TAR in this rare condition. Methods: Two patients with post-traumatic end-stage ankle osteoarthritis and long-standing knee arthrodesis underwent TAR using a lateral transfibular approach with a Zimmer Trabecular Metal™ implant. Surgical planning aimed to restore coronal and sagittal alignment. Postoperative management and rehabilitation were specifically adapted to the absence of knee motion, with emphasis on gait re-education. Clinical and radiographic follow-up was performed up to 36 months. Results: At final follow-up, both patients showed substantial pain reduction, improved ankle range of motion, and recovery of a stable, functional gait compatible with knee fusion. Imaging demonstrated well-aligned, stable components without loosening or subsidence. No major complications or reoperations occurred. Conclusions: Lateral transfibular TAR appears feasible and effective for end-stage ankle osteoarthritis in patients with ipsilateral knee arthrodesis, preserving ankle motion and supporting functional ambulation in this complex setting. Full article

Background: Vascular injury after total knee arthroplasty (TKA) is rare but may be limb-threatening. Popliteal artery branch pseudoaneurysm is an uncommon complication that can present with nonspecific symptoms, potentially mimicking postoperative hematoma, infection, or deep venous thrombosis (DVT). Case presentation: A 79-year-old man underwent primary left TKA for advanced osteoarthritis (OA). Seven months later, he sustained a low-energy fall closed reduction and bracing were implemented. Due to recurrent episodes of instability with spontaneous self-reduction, a constrained revision TKA (R-TKA) was performed. Eighteen days after revision, the patient was readmitted because of persistent pain-related functional impairment. Duplex Doppler ultrasonography revealed a partially thrombosed pseudoaneurysm measuring 33 × 37 mm arising from a popliteal/genicular branch. Computed tomography angiography (CTA) confirmed a partially thrombosed pseudoaneurysm with a contrast-filled component within a larger periarticular fluid collection. This suggested a second, smaller pseudoaneurysm along the feeding vessel; hemarthrosis and soft-tissue edema were also present. After multidisciplinary evaluation, selective catheter angiography via left common femoral access was performed, and the injured branch was occluded using coil embolization combined with n-butyl cyanoacrylate tissue adhesive. Completion angiography demonstrated successful exclusion of the pseudoaneurysm without complications. Conclusions: Delayed pseudoaneurysm of a popliteal artery branch should be considered after revision TKA in patients with atypical swelling, hemarthrosis, or disproportionate pain. Duplex ultrasound and CTA are complementary diagnostic tools, and endovascular embolization provides a minimally invasive, effective, and low-morbidity treatment option when the lesion involves a branch vessel. Full article

Background: Knee osteoarthritis, which is prevalent among older adults, often necessitates total knee arthroplasty (TKA) to alleviate pain and improve function. Postoperative pain and functional limitations remain significant challenges. Brief guided imagery (GI), a non-pharmacological intervention, shows promise in pain management but is underexplored in TKA patients. Aim: The aim of this study is to evaluate the effect of brief GI on postoperative pain, functional outcomes, and anxiety in patients undergoing their first elective TKA. Methods: Randomized controlled trial: 52 patients scheduled for first elective TKA were randomized to an intervention (brief GI plus standard care, n = 19) or control (standard care only, n = 23) group. Brief GI consisted of daily 2-min audio-guided exercises for up to 6 weeks after the operation. Outcome measures included pain intensity (NPRS), functional capacity (NFRS; WOMAC), and state anxiety (STAI). Assessments were conducted preoperatively (baseline), on the first postoperative day, weekly during the first five postoperative weeks, and again at the routine 5–6-week postoperative follow-up visit. Results: Of 52 enrolled participants, 42 completed the study. The intervention group reported significantly lower pain levels (NPRS) at weeks 2 (mean difference: 1.26, p = 0.042) and 5 (mean difference: 1.86, p = 0.004) compared to the control group, with a moderate effect size (Cohen’s d = 0.69–1.02). Functional outcomes (NFRS) were significantly better in the intervention group from week 1 through week 6 (p < 0.01). No significant differences were observed in WOMAC scores or STAI anxiety levels between groups. Conclusions: Brief GI, when integrated into postoperative care for TKA patients, significantly reduces pain and enhances functional outcomes over 6 weeks, though it does not affect anxiety levels. These findings support brief GI as a feasible adjunctive intervention for TKA recovery. Full article

Articular cartilage is a highly specialized connective tissue essential for joint function, providing load-bearing capacity, shock absorption, and near-frictionless motion. Due to its avascular nature, articular cartilage has a limited intrinsic healing capacity, and focal injuries often progress to degenerative joint diseases such as osteoarthritis, leading to chronic pain and functional impairment. This review examines current and emerging scientific, clinical, and technological strategies for articular cartilage repair and regeneration, with particular emphasis on their translational relevance. This narrative review integrates data from peer-reviewed literature, clinical trial registries, and patent databases. Preclinical and clinical approaches are discussed, including orthobiologics, cell-based therapies, advanced biomaterials, and three-dimensional tissue-engineered scaffolds. Bibliometric and keyword network analyses are used to identify dominant research themes, technological trends, and emerging innovations. The findings reveal a clear paradigm shift from conventional surgical interventions, often associated with fibrocartilage formation and suboptimal biomechanical performance, to multifactorial regenerative strategies combining cells, bioactive signals, and biomimetic scaffolds designed to recapitulate the native extracellular matrix. This convergence of regenerative medicine, tissue engineering, and biomaterials science is reflected in growing clinical translation efforts and intellectual property activity. Overall, although articular cartilage repair remains a significant clinical challenge, integrated regenerative approaches show great potential for achieving durable and functional cartilage regeneration. Full article

Osteoarthritis (OA) is a prevalent degenerative joint disease which affects millions of patients across the globe. The infrapatellar fat pad (IPFP) harbors diverse cell types with intricate intercellular interactions. Its mesenchymal stem cells (MSCs) and extracellular vesicles (EVs) possess significant biological functions and hold promising applications in regenerative medicine. IPFP exhibits active secretory capacity, releasing adipokines including leptin and adiponectin, along with various cytokines. Furthermore, it contains a rich neural network playing a crucial role in knee pain perception and sensation. Moreover, IPFP and synovium can be considered an integrated unit, exhibiting interactions both with each other and with cartilage. In imaging applications, IPFP is gaining widespread attention as an emerging biomarker. In clinical practice, the decision to resect or preserve IPFP remains a controversial topic. This article will review the latest research regarding the mechanism of IPFP in OA, and discuss its clinical applications, providing a theoretical basis for the prevention and treatment of OA. Full article

Knee osteoarthritis is a leading cause of pain and functional limitation in older adults, and exercise is widely recommended as a core component of conservative management; however, the optimal frequency of aerobic and strengthening exercise remains unclear. This cross-sectional study aimed to examine the association between exercise frequency, pain, and functional outcomes in older adults with knee osteoarthritis. Participants aged ≥60 years with a clinical diagnosis of knee osteoarthritis were recruited from a tertiary university hospital in Thailand. Exercise frequency over the previous four weeks was categorized as none, 1–2 times per week, 3–6 times per week, or every day. Outcomes were assessed using the Thai version of the modified Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Brief Pain Inventory. Nonparametric analyses and multivariable regression analyses adjusted for age, body mass index, and comorbidities were performed. A total of 140 participants were included, of whom 68.6% reported engaging in aerobic exercise, and 56.4% performed knee-strengthening exercises. Higher frequency of aerobic exercise was significantly associated with lower pain severity, reduced pain interference, and better WOMAC total and subdomain scores (p < 0.05). A graded association pattern was observed, with the greatest benefits seen in participants performing aerobic exercise 3–6 times per week. No significant associations were identified between knee strengthening exercise frequency and pain and functional outcomes. These findings suggest that frequent aerobic exercise is associated with reduced pain and improved function in older adults with knee osteoarthritis, supporting its role in primary care and rehabilitation management. Full article

Shoulder pain and shoulder surgery are increasingly prevalent and encompass a broad spectrum of pathologies, including rotator cuff disease, glenohumeral osteoarthritis, and shoulder instability. Growing evidence suggests that gender-related factors influence disease presentation, patient-reported outcomes, and postoperative recovery; however, these effects remain inconsistently reported across the literature. This current concepts review synthesizes available evidence on the influence of gender on pre-operative characteristics, non-operative management, and postoperative outcomes following common shoulder procedures, including rotator cuff repair, anatomic and reverse shoulder arthroplasty, and surgical stabilization for instability. A comprehensive literature search of PubMed, the Cochrane Library, and Google Scholar was performed for studies published through October 2025, with outcomes assessed using validated instruments such as the Western Ontario Rotator Cuff Index, American Shoulder and Elbow Surgeons score, Constant–Murley score, Simple Shoulder Test, Visual Analog Scale, and Shoulder Pain and Disability Index. Across shoulder pathologies, female patients consistently demonstrated worse pre-operative functional scores, higher pain levels, and greater perceived disability despite similar structural disease severity. Postoperatively, both genders experienced meaningful clinical improvement; however, females often reported higher early postoperative pain and lower absolute functional outcomes, particularly following shoulder arthroplasty for glenohumeral osteoarthritis and surgical treatment of multidirectional instability. In contrast, outcomes following rotator cuff repair and anterior instability stabilization were largely comparable between genders. Recognition of these gender-related differences is essential for individualized patient counseling, expectation setting, and optimization of management strategies, and highlights the need for future studies with robust gender-disaggregated analyses. Full article

Fluoride-induced osteoarthritis (F-OA) is a debilitating manifestation of endemic fluorosis, with limited preventive or therapeutic strategies. Rosa roxburghii juice (RRJ), a traditional medicinal/edible product, has shown protective effects against skeletal fluorosis, yet its active constituents and molecular mechanisms are not fully understood. In this study, an integrated strategy combining bioinformatics analysis, network pharmacology, molecular docking and dynamics simulations, limited proteolysis–mass spectrometry (LiP–MS), and in vitro experiments was employed to systematically elucidate the protective mechanisms of RRJ against F-OA. Forty-four core F-OA-associated genes were identified, with TP53 and the p53 signaling pathway emerging as central regulatory hubs. Quercetin, Epicatechin, Emodin, and Ellagic acid were screened as key bioactive components of RRJ and demonstrated strong binding affinity toward core targets, including TP53. Cellular experiments showed that these compounds significantly attenuated sodium fluoride-induced cellular injury. LiP–MS analysis further revealed widespread protein conformational remodeling following treatment, with TP53 exhibiting pronounced structural sensitivity. Mechanistically, these active compounds mitigated fluoride-induced pathological changes by suppressing p53 mRNA expression and restoring proteasome-mediated p53 degradation. This study provides systematic pharmacological evidence supporting Rosa roxburghii fruit as a promising functional food for the prevention and management of skeletal fluorosis and F-OA. Full article

Osteoarthritis is the most common musculoskeletal disorder. It primarily affects people in their mid-40s and older. As the disease progresses, degenerative changes occur in the synovial membrane, subchondral bone, and cartilage. Ultimately, the entire joint and its surrounding tissues become structurally and functionally impaired. Several sets of biochemical markers have been proposed to enable timely diagnosis and anticipate disease progression. However, only a few of these markers are routinely used to evaluate disease activity in subgroups. We conducted a cross-sectional, single-center cohort study of 72 patients with knee osteoarthritis. Diagnoses were established based on clinical data and radiological findings. We examined two Wnt/β-catenin signaling inhibitors, serum DKK-1 and sclerostin, and two bone/cartilage metabolic regulatory factors, RANKL and OPG, correlating these with disease activity and pain scores (WOMAC, VAS, and KOFUS), radiographic stage, inflammatory molecules and indices, and bone mineral density. DKK-1 levels were higher in the intensive pain group (VAS > 5) and positively correlated with the KOFUS throughout the study. This correlation was stronger in individuals with a BMI < 30. Serum DKK-1 levels were higher in patients with lower bone mineral density. No significant modifications in SOST, RANKL, or OPG levels were found in any of the above settings. In our patient cohort with mild-to-moderate knee osteoarthritis (OA), sclerostin, osteoprotegerin (OPG), and receptor activator of nuclear factor kappa-B ligand (RANKL) were not related to pain or disease activity. In contrast, DKK-1 was an indicator of pain and low-grade flare-ups. Furthermore, DKK-1 was associated with the KOFUS and impaired bone turnover in non-obese subgroups. Confirming these relationships in larger groups of patients would contribute to more efficient use of DKK-1 in disease stratification algorithms. Full article

Background: Emerging evidence links the gut microbiome to chronic pain processing. Inulin, a prebiotic fibre, modulates the gut microbiome, while physiotherapy-supported exercise (PSE) improves pain and function. We evaluated the effects of inulin supplementation with and without PSE on knee osteoarthritis (OA) pain. Methods: In a 2 × 2 factorial RCT, 117 community-dwelling adults with knee OA received 6 weeks of: (A) 20 g/day inulin, (B) digital PSE (Joint Academy™), (C) inulin +PSE, or (D) 10 g/day maltodextrin. Primary outcome: pain (Numerical Rating Scale). Secondary: 30 s sit-to-stand (30-CST), timed up and go (TUG), grip strength, and quantitative sensory testing. Serum short-chain fatty acids (SCFAs) and glucagon-like peptide-1 (GLP-1) were measured. The study was not powered to detect synergistic interaction. Results: A total of 117 participants (58.1% female; mean ± SD age = 67.5 ± 9.4 years; BMI = 29.5 ± 5.3 kg/m²; NRS = 3.96 ± 2.67) completed the trial. Pain improved with inulin (baseline-adjusted between-group mean difference (Δ) = −1.11 [95%CI −2.18, −0.04], p = 0.045) and PSE (Δ = −1.55 [95%CI −2.52, −0.58], p = 0.002) compared to placebo, with no synergistic effect. PSE improved TUG (p = 0.02) and 30-CST (p = 0.0004), while inulin improved grip strength (p = 0.002), pressure pain thresholds (p = 0.009) and temporal summation (p = 0.025) compared to placebo and had significantly lower dropout rates (3.6%) compared with PSE (21% p < 0.01). Only inulin increased SCFA butyrate (p = 0.0248) and GLP-1 (p = 0.0109), and higher GLP-1 was associated with improved grip strength, suggesting a gut–muscle link. Conclusions: Inulin and PSE each produced meaningful pain reductions. Only inulin improved pain sensitivity and grip strength, the latter paralleled by increased GLP-1, and had much higher rates of retention compared to PSE. Full article

Background/Objectives: The clinical superiority of rotating-bearing (RB) versus fixed-bearing (FB) total knee arthroplasty (TKA) remains controversial despite the proposed biomechanical advantages of mobile-bearing designs. Objective gait assessment with inertial measurement units (IMUs) provides a measurable view of functional recovery that may complement patient-reported outcome measures (PROMs). This study compared spatiotemporal gait parameters between FB and RB TKA over 24 months. Methods: This prospective longitudinal comparative study enrolled 57 patients undergoing primary unilateral TKA for end-stage knee osteoarthritis. Spatiotemporal gait parameters (gait velocity, cadence, and stance-phase duration) were measured using wireless IMUs (G-WALK system) at 6, 12, and 24 months post-surgery. WOMAC and the 10-point Geriatric Locomotive Function Scale (GLFS-10P) were assessed at 12 and 24 months. Group, time, and Group × Time effects were analyzed using linear mixed-effects models. Results: Both groups improved during follow-up, with performance largely plateauing between 12 and 24 months. At 24 months, there were no significant differences between groups in gait velocity (FB 1.17 vs. RB 1.16 m/s; p = 0.65), cadence (99.8 vs. 97.4 steps/min; p = 0.72), or stance-phase duration (59.3% vs. 59.0%; p = 0.82). Group × Time interactions were not significant across gait outcomes. WOMAC and GLFS-10P improved similarly in both groups (p > 0.05). Cadence was inversely correlated with the WOMAC function subscale at 24 months (rho = −0.563; p = 0.036). Conclusions: FB and RB bearing designs showed similar objective gait recovery trajectories and PROM improvements through 24 months after primary TKA, suggesting no intermediate-term functional advantage from bearing design. Full article

Retinol-binding protein 4 (RBP4), an adipokine secreted by adipose tissues, has been implicated in metabolic inflammation and insulin resistance. Type 2 diabetes (T2D) is a recognized risk factor for osteoarthritis, with both conditions characterized by chronic low-grade inflammation, suggesting potential links between metabolic disorder and joint degeneration. This study aimed to investigate whether inflammatory and metabolic stresses regulate RBP4 expression and function in joint-related cells. Murine immature chondrocyte cells (iMACs) and the mouse AT805 teratocarcinoma cell line, clone 5, that differentiates into chondrogenic cells (ATDC5), were used as in vitro models for chondrocyte cells. Rbp4 mRNA expression increased during differentiation of iMACs, with 3.6- and 2.2-fold elevations observed on days 7 and 14, respectively (p < 0.01 vs. undifferentiated controls). Inflammatory stimulation with interleukin-6 (IL-6) significantly increased Rbp4 mRNA expression in ATDC5 cells (p < 0.05 vs. vehicle), along with elevated expression of catabolic and inflammatory mediators, including monocyte chemoattractant protein-1 (Mcp1), cyclooxygenase-2 (Cox2), and matrix metalloproteinase-3 (Mmp3) (p < 0.05 vs. vehicle). Pharmacological inhibition of RBP4 using fenretinide (FEN) attenuated chondrogenic differentiation marker expression, reduced glycosaminoglycan synthesis during chondrogenic differentiation, and mitigated high-glucose-induced catabolic responses, as indicated by reduced Mcp2 (p = 0.04) and Mmp13 (p = 0.01) expression in ATDC5 cells treated with FEN compared with cells treated with the vehicle under high-glucose conditions. Furthermore, in RAW 264.7 cells, a murine macrophage cell line commonly used as an in vitro model for osteoclastogenesis, FEN significantly reduced the expression of osteoclast differentiation markers, dendritic cell-specific transmembrane protein (DC-Stamp), nuclear factor of activated T-cells, cytoplasmic 1 (Nf-atc1), cathepsin k (Cath.k), and tartrate-resistant acid phosphatase (Trap) under osteoclastogenic conditions (p < 0.01 vs. vehicle). Collectively, these findings suggest that RBP4 functions as a metabolic–inflammatory mediator influencing both cartilage and bone-remodeling processes. This study reveals a previously unrecognized role of RBP4 in regulating osteoclast-associated pathways. Targeting RBP4 may, therefore, represent a promising therapeutic strategy for delaying or preventing osteoarthritis progression, particularly in metabolically compromised conditions. Full article

Background and Objectives: Knee osteoarthritis (OA) is a leading cause of pain and disability, with radiographic severity influenced by age, biomechanical alignment, and structural joint features. Data describing the association between common radiographic parameters and OA severity in Eastern European clinical populations remain limited. This study aimed to evaluate the associations between radiographic OA severity and coronal alignment, patellar height, and chondrocalcinosis in a Romanian clinical cohort. Materials and Methods: This single-center cross-sectional study included adult patients undergoing knee radiography for knee-related symptoms and/or functional assessment at a rehabilitation hospital between 2023 and 2025. Radiographs were obtained in the supine, non-weight-bearing position and included anteroposterior and lateral views. OA severity was graded using the Kellgren–Lawrence (KL) classification. Coronal alignment was assessed using the femorotibial angle, patellar height using the Insall–Salvati ratio (ISR), and chondrocalcinosis was recorded as present or absent. Associations between radiographic parameters and KL grade were analyzed using non-parametric statistics. Receiver operating characteristic (ROC) analyses were performed for exploratory assessment of limited separation between distributions. Results: Moderate to severe OA (KL ≥ 3) was present in 49% of patients. KL grade showed a moderate positive correlation with age (r = 0.50, p < 0.001) and differed significantly across coronal alignment categories (p < 0.001). Varus/valgus and pathological alignment classifications demonstrated moderate sensitivity (0.69–0.85) and variable specificity (0.52–0.85) for higher KL grades. ROC analyses of continuous alignment and ISR measures yielded area under the curve values ranging from approximately 0.65 to 0.68, indicating limited separation between distributions. Radiographically detected chondrocalcinosis was present in 5.3% of patients and showed no significant association with OA severity, and neither did patellar height. Conclusions: In this single-center Romanian clinical cohort, radiographic OA severity was associated with coronal plane alignment but not with patellar height or chondrocalcinosis. Alignment measures demonstrated limited discriminative ability and should be interpreted as complementary rather than diagnostic indicators of OA severity. These findings provide descriptive radiographic data from an Eastern European clinical population and highlight the need for longitudinal and population-based studies incorporating mechanical axis assessment and functional outcomes. Full article

Background/Objectives: The benefit of patellar resurfacing (PR) in total knee arthroplasty (TKA) remains controversial. No previous study has examined the impact of PR in valgus osteoarthritis (OA) with compromised patellofemoral joint (PFJ) status. Methods: We retrospectively reviewed 2250 primary TKAs performed between 2011 and 2025. Among 152 valgus OA cases, 87 had compromised PFJ status, defined as Outerbridge grade 3–4 chondral damage or patellar tilt >10° on Merchant-view radiographs. Two surgeons with identical protocols operated during overlapping periods; one typically performed PR (n = 47) and the other did not (n = 40). Primary outcomes included the American Knee Society (AKS) score and Kujala Anterior Knee Pain Scale. Secondary outcomes included radiologic measures (HKA angle, patellar tilt, and lateral patella shift) and patellar-related complications (crepitus, fracture, subluxation, and maltracking). Results: At a mean follow-up of 7.1 years in the non-PR group and 6.5 years in the PR group, no significant differences were observed between groups in KSS function scores (non-PR 92.4 ± 3.5 vs. PR 93.0 ± 4.6, p = 0.54) or Kujala scores (non-PR 76.9 ± 3.5 vs. PR 77.7 ± 4.2, p = 0.33). Both patellar tilt and lateral patella shift showed slight postoperative reductions, but no significant difference was observed between groups (patellar tilt: non-PR 5.4° ± 0.8° vs. PR 5.7° ± 0.6°, p = 0.11; lateral patella shift: non-PR 2.4 ± 0.6 mm vs. PR 2.3 ± 0.7 mm, p = 0.75). Patellar-related complications were infrequent and showed no significant differences. Conclusions: Overall, PR did not demonstrate superior outcomes compared with non-PR in valgus OA patients with compromised PFJ status at mid-term follow-up. Full article