Search Results (107)

Background and Objectives: Osteoarthritis (OA) is the most common degenerative joint disease and a leading cause of pain and disability worldwide. Increasing evidence indicates that dysregulated iron metabolism contributes to joint degeneration by promoting inflammation, oxidative stress, and cartilage damage. Hemophilic arthropathy (HA), a severe complication of hemophilia caused by recurrent hemarthroses, represents a unique model of iron-driven joint degeneration. This narrative review summarizes current evidence on the contribution of iron deposition to the pathogenesis of hemophilic arthropathy and discusses its relevance to knee osteoarthritis (KOA). Materials and Methods: The literature was reviewed using the PubMed, Scopus, and Web of Science databases, focusing on published studies addressing iron deposition, synovial inflammation, angiogenesis, oxidative stress, cartilage degeneration, subchondral bone remodeling, and dysregulated iron metabolism. Results: Current evidence indicates that iron stored primarily as hemosiderin promotes persistent synovial inflammation and progressive joint destruction. Several pathological pathways associated with iron accumulation, including chronic low-grade inflammation, extracellular matrix degradation, and altered bone remodeling, are shared by HA and KOA. Conclusions: These findings suggest that iron-mediated mechanisms may provide important insights into OA pathogenesis and support further investigation of iron as a potential diagnostic and therapeutic target in degenerative joint diseases. Full article

Knee osteoarthritis (KOA) is a degenerative joint disease characterized by inflammatory reactions and bone lesions within the joint, which is mainly caused by the degeneration of articular cartilage. This disease primarily affects middle-aged and elderly populations, especially those over 50 years old; however, a distinct trend of younger onset has been observed in recent years, which is closely associated with factors such as sports-related injuries and obesity. Astaxanthin (AST), a ketone carotenoid belonging to the xanthophyll family, exhibits extremely strong antioxidant and broad-spectrum anti-inflammatory activities with no obvious toxic and side effects due to its unique molecular structure, thus showing great potential in the prevention and treatment of KOA. This article reviews the research evidence and action mechanisms of AST in the prevention and treatment of KOA from multiple aspects, including alleviating joint pain, reducing cartilage structural damage, resisting oxidative stress, inhibiting inflammatory responses, and regulating cartilage metabolism and functional disorders, while exploring the key factors and signaling pathways involved. On this basis, a strategy combining AST with exercise intervention for the prevention and treatment of KOA is proposed, which provides a certain reference for the clinical treatment and scientific research of KOA. Full article

Background: Knee osteoarthritis (KOA) in people with overweight or obesity is clinically heterogeneous, reflecting mechanical loading, synovial and systemic inflammation, metabolic dysfunction, structural severity, and pain-related factors. We evaluated multidomain outcomes after semaglutide initiation and characterized clinically relevant response patterns. Methods: This retrospective, self-controlled cohort included 93 adults treated in routine rheumatology care; 88 completed a six-month follow-up. There was no untreated concurrent comparator; within-patient changes and exposure–outcome associations were therefore interpreted as non-causal. Changes in pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function, anthropometry, inflammatory markers, glycated hemoglobin (HbA1c), lipids, dose exposure, and safety were evaluated. Joint multivariable models included percentage weight loss and maximum achieved dose. Exploratory K-means phenotyping integrated dose, weight loss, body mass index (BMI) decrease, visual analog scale (VAS) and WOMAC improvement, and C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and HbA1c reductions, with candidate solutions and resampling stability examined. Results: At six months, mean weight decreased by 10.88 kg, VAS pain score by 2.47 points, WOMAC total by 22.50 points, CRP by 2.67 mg/L, ESR by 7.62 mm/h, and HbA1c by 0.51 percentage points (all p < 0.001). Weight loss remained independently associated with WOMAC improvement, while achieved dose retained positive adjusted associations with pain, function, inflammatory, and metabolic changes. Exploratory clustering identified five clinically interpretable patterns along a broader response-intensity gradient, including high-burden multidomain response, high-dose concordant response, dose-modified intermediate response, inflammation-preserved response despite moderate weight loss, and dose-limited graded response. These observational coefficients and clusters cannot distinguish treatment-related effects from residual confounding or co-interventions. Conclusions: Substantial within-patient improvements were observed, but the uncontrolled design precludes causal attribution. The exploratory patterns may be compatible with contributions from baseline disease burden, dose exposure, mechanical unloading, and residual inflammatory variation; they do not establish weight-independent pharmacologic effects or validated patient subtypes. Prospective controlled, multicenter validation is required. Full article

Intra-articular drug injection is a key therapeutic strategy for knee osteoarthritis (KOA), and its efficacy is closely associated with the spatial distribution of the injected fluid within the joint cavity. In this study, an anatomically realistic knee joint cavity model was first reconstructed from patient CT images. Because sodium hyaluronate injectable drugs exhibit non-instantaneous, memory-dependent viscoelastic relaxation, a fractional Maxwell constitutive equation was introduced to characterize their mechanical behavior and was coupled with the governing equations of incompressible miscible two-phase flow. The finite volume method and the L1 discretization scheme were then used to solve the governing equations. Numerical simulations were conducted to analyze the effects of fractional order and relaxation time on the effective drug coverage and volume fraction distribution. The results show that increasing the fractional order improves the effective coverage of the target region and enhances drug retention near the joint cavity boundary, whereas a longer relaxation time makes the drug distribution more localized and reduces the late-stage effective coverage. This study provides a theoretical reference for analyzing intra-articular drug transport in KOA and for optimizing individualized injection parameters. Full article

Intra-articular drug injection is a key therapeutic strategy for knee osteoarthritis (KOA), and its efficacy is closely associated with the spatial distribution of the injected fluid within the joint cavity. In this study, an anatomically realistic knee joint cavity model was first reconstructed from patient CT images. Because sodium hyaluronate injectable drugs exhibit non-instantaneous, memory-dependent viscoelastic relaxation, a fractional Maxwell constitutive equation was introduced to characterize their mechanical behavior and was coupled with the governing equations of incompressible miscible two-phase flow. The finite volume method and the L1 discretization scheme were then used to solve the governing equations. Numerical simulations were conducted to analyze the effects of fractional order and relaxation time on the effective drug coverage and volume fraction distribution. The results show that increasing the fractional order improves the effective coverage of the target region and enhances drug retention near the joint cavity boundary, whereas a longer relaxation time makes the drug distribution more localized and reduces the late-stage effective coverage. This study provides a theoretical reference for analyzing intra-articular drug transport in KOA and for optimizing individualized injection parameters. Full article

The pathogenesis of knee osteoarthritis (KOA) involves bone homeostasis imbalance induced by inflammation, metabolism, age, mechanical stress, joint injury and other factors. Recently, Type H vessels (CD31^hiEMCN^hi endothelial cells) have emerged as a specialized endothelial cell subset that couples angiogenesis with osteogenesis. Type H angiogenesis in the diaphysis was found to be beneficial for maintaining bone homeostasis, while the abnormal proliferation of type H vessels in subchondral bone can lead to chondrocyte hypertrophy and osteophyte formation. However, the mechanism by which the abnormal proliferation of type H vessels induces KOA has not been elucidated in detail. In this review, we summarize the latest evidence on the role of type H endothelial cell function in the pathogenesis and progression of osteoarthritis (OA). We review the role of type H angiogenesis at different sites in the development and progression of OA and focus on the potential mechanisms that regulate type H angiogenesis in OA and the potential therapeutic value and significance of targeting type H angiogenesis in promoting bone regeneration and maintaining bone homeostasis. Finally, we discuss key obstacles and future directions for studying type H vessel regulation in KOA, offering an endothelial cell-based framework for understanding bone homeostasis and improving OA. Full article

With the acceleration of global population aging, the incidence of knee osteoarthritis (KOA) has risen significantly, placing unprecedented pressure on healthcare resources and creating an urgent need for automated segmentation technologies to enhance clinical diagnostic efficiency. Therefore, this paper proposes a novel multi-target tissue segmentation network for knee joints, SwMrNet, which integrates improved Swin Transformer units and a proposed multi-scale residual module within the decoder to enhance both segmentation accuracy and robustness. Firstly, a sliding-window mechanism is used to iteratively exchange feature information, allowing for the extraction of global tissue features. Then, features are extracted at multiple scales, with residual connections preserving the fine details of each tissue type. Through the repeated fusion of global and local features, the SwMrNet segmentation performance and robustness are significantly enhanced. Finally, the proposed model was evaluated on a public knee MRI dataset and a local clinical knee MRI dataset. On the public dataset, the model achieved a Dice score of 98.2%, with Dice scores for all segmented tissues exceeding 94%. On the local clinical dataset, the model showed visually consistent segmentation results, suggesting its potential as an efficient multi-tissue segmentation tool for automated knee joint analysis and auxiliary clinical assessment. Full article

Background: Knee osteoarthritis (KOA) is a degenerative joint disorder characterized by chronic pain, functional limitation, and low-grade inflammation. While platelet-rich plasma (PRP) has gained traction as a biologic therapy, the relationship between short-term clinical outcomes and systemic inflammatory biomarker dynamics remains poorly understood in routine clinical settings. Methods: This prospective observational study evaluated 40 patients with grade 2–3 KOA receiving a single ultrasound-guided intra-articular PRP injection. Clinical outcomes via the Visual Analog Scale (VAS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Short Form-36 (SF-36), alongside serum inflammatory markers (IL-1β, IL-8, IL-18, TNF-α, erythrocyte sedimentation rate, and C-reactive protein), were assessed at baseline and 4 weeks post-injection using paired tests and multivariable regression. Results: At 4 weeks, clinical scores improved significantly (all p < 0.001). Circulating IL-8 and TNF-α levels decreased significantly (p = 0.009 and p = 0.014, respectively), whereas IL-1β and IL-18 variations were non-significant. Baseline cytokines did not predict clinical outcomes, but a significant association emerged between ΔIL-18 and ΔWOMAC (p = 0.032). Conclusions: A single intra-articular PRP injection was associated with short-term clinical improvements and selected reductions in circulating IL-8 and TNF-α, although the clinical significance of these biomarker changes remains uncertain. Given the observational design and short follow-up, these preliminary findings require confirmation in larger controlled trials. Full article

Background: Knee osteoarthritis (KOA) alters the performance of daily activities, such as stair negotiation, by compromising lateral stability and neuromuscular control. This pilot study aimed to evaluate the feasibility of a 10-week Dynamic Neuromuscular Stabilization (DNS) program and to explore its preliminary biomechanical effects during stair ascent and descent in middle-aged women with KOA. Methods: Twenty-six participants were randomly assigned to a DNS group (n = 13) or a control group (n = 13). The DNS group completed a 10-week intervention (twice weekly). Feasibility was assessed via recruitment, retention, and adherence. Primary outcomes were mediolateral (ML) center of pressure (COP) parameters, while secondary outcomes included anteroposterior (AP) COP parameters and lower limb range of motion (ROM). Effect sizes (η²_p) were estimated using 3D motion analysis and force plates. Results: The intervention showed high potential feasibility, with 100% recruitment and retention rates and 98.5% compliance. No adverse events occurred. Large effect sizes were observed for reduced ML COP velocity (ascent: η²_p = 0.79; descent: η²_p = 0.62) and RMS (descent: η²_p =0.16). Secondary outcomes, including AP COP parameters and joint ROM (increased sagittal flexion and decreased coronal instability), also demonstrated large effect sizes. Conclusions: This pilot study suggests that progressive DNS training appears to be feasible and safe for patients with KOA. The preliminary effect sizes observed in COP control and lower kinetic chain mechanics may serve as useful foundational data for designing future adequately powered clinical trials to further examine the efficacy and underlying biomechanical mechanisms of DNS training. Full article

Background/Objectives: Knee osteoarthritis (KOA) is increasingly recognized as a function-limiting condition in which pain, neuromuscular impairment, and reduced physical activity interact with sarcopenic vulnerability to accelerate functional decline. This review reappraises commonly used oral nutraceuticals through a muscle–joint framework and examines whether they can be conservatively positioned as adjuncts that reduce symptom-related barriers to exercise-based care rather than as disease-modifying therapies. Methods: This review was conducted as a structured narrative synthesis informed by SANRA principles, using a structured and transparent search process and dual-independent study selection, without quantitative meta-analysis or formal certainty-of-evidence grading. PubMed/MEDLINE, Embase, and the Cochrane Library were searched for English-language studies published from January 2000 to March 2026, supplemented by reference screening of key reviews and international guidelines. Results: Mechanistic and clinical evidence supports a plausible pathway linking KOA pain, arthrogenic muscle inhibition, reduced loading, physical inactivity, and sarcopenic vulnerability. Across glucosamine/chondroitin, collagen peptides, omega-3 fatty acids, curcumin, and Boswellia, symptomatic benefits were modest, heterogeneous, and formulation-dependent, with no consistent evidence of structural disease modification. Direct evidence that nutraceuticals improve exercise adherence or long-term physical activity remains limited; however, selected exercise-integrated or function-oriented studies show participation-relevant signals in gait speed, activity volume, and performance-based outcomes. Conclusions: Nutraceuticals should be interpreted as optional, time-limited adjuncts within exercise-centered KOA management. Their potential value lies in modest symptom support that may facilitate rehabilitation participation in selected patients, not in stand-alone treatment of KOA or sarcopenia. Full article

Knee Osteoarthritis (KOA) is a leading contributor to global physical disability, where delayed diagnosis often results in irreversible joint damage and socio-economic cost. Early diagnosis remains challenging due to subtle radiographic biomarkers and limited access to specialized expertise, particularly in distributed healthcare settings. Within the evolving landscape of the Future Internet, characterized by Internet of Medical Things (IoMT), edge–cloud computing, and intelligent digital health infrastructures, there is an increasing demand for scalable, low-latency, and explainable AI-driven diagnostic solutions. In this work, we propose a Dual-Stream Wavelet Fusion Network (DS-WFN) alongside a distributed edge-cloud architectural roadmap tailored for deployment in distributed and edge-enabled healthcare ecosystems. The framework integrates a spatial morphological stream with a spectral wavelet stream, augmented by an Adaptive Wavelet Selection Mechanism (AWSM). The AWSM dynamically selects optimal frequency bases (Haar, Symlet, Daubechies) to preserve fine-grained diagnostic features typically lost in conventional CNN architectures. An Adaptive Spatial Alignment (ASA) module further ensures efficient fusion of heterogeneous representations, enabling robust feature integration across computational nodes. Experimental results across a five-fold patient-isolated cross-validation protocol demonstrate that the DS-WFN achieves a mean classification accuracy of 76.3% (95% CI: 71.6–80.8%) and a macro-averaged F1-score of 0.747 (95% CI: 0.697–0.795), consistently outperforming single-stream baselines while preventing patient-level data leakage. Furthermore, Grad-CAM visualizations provide interpretable outputs aligned with clinical diagnostic criteria, supporting trustworthy AI integration into digital healthcare workflows. Furthermore, we disclose a methodological framework for edge-based implementation, highlighting how localized inference ensures data sovereignty and real-time clinical support. By combining multiscale signal processing with deep learning under a Future Internet paradigm, this work contributes a scalable, explainable, and edge-ready diagnostic framework for early KOA detection, enabling intelligent, connected, and resource-efficient healthcare services. Full article

Background and Objectives: Knee osteoarthritis (KOA) is a degenerative joint disease that affects quality of life through pain, impaired functional performance, and altered gait patterns. Hydrotherapy is a well-tolerated form of physical rehabilitation, especially suitable for patients with severe pain, as water’s properties support movement while reducing joint load. Its effects have been widely studied, primarily focusing on patient-reported outcomes, with limited synthesis of functional performance and gait-related outcomes. Materials and Methods: A systematic search was conducted in PubMed, Web of Science, Cochrane, PEDro, SpringerLink, ScienceDirect, and Google Scholar, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search strategy included a combination of Medical Subject Headings (MeSH) terms and keywords. For example, the PubMed search strategy was as follows: (“knee osteoarthritis” OR “knee OA”) AND (“hydrotherapy” OR “aquatic therapy” OR “water-based exercise”) AND (“gait” OR “walking” OR “functional performance”). Randomized controlled trials (RCTs) from the last 10 years involving patients with KOA undergoing aquatic therapy were included. Primary outcomes included functional performance assessed by measures such as the 6 min walking test (6MWT), the Timed Up and Go (TUG) test, the five sit-to-stand (5 STS) and stair climb (SC) tests, and by using gait-related parameters (e.g., speed, cadence, and step length) assessed clinically or using technology. Patient-reported outcomes, including the Visual Analog Scale (VAS), Western Ontario and McMaster University’s Osteoarthritis Index (WOMAC), and Knee Injury and Osteoarthritis Outcome Score (KOOS), were analyzed as a secondary objective. Results: A total of 479 studies were identified, of which 13 met the eligibility criteria. The results revealed improvements in functional performance, with increases in 6MWT in five studies, the TUG test in four trials, and better performance in the 5-STS and SC tests in five studies. Benefits in gait parameters were noted in four studies. Additionally, one of the articles reported improvements in static and dynamic balance, another showed enhanced proprioception, and a third described more efficient muscle activation during gait following hydrotherapy. Consistent benefits in pain reduction, joint stiffness, and activities of daily living, as reflected by VAS, WOMAC, and KOOS, were also noted immediately and maintained at follow-up. The variability in outcome measures and intervention characteristics limited the possibility of data integration and the calculation of effect sizes. Conclusions: Hydrotherapy as a rehabilitation intervention may be associated with improvements in functional capacity, mobility, and self-reported physical ability in patients with KOA, with some evidence supporting a beneficial effect on gait; however, the certainty of evidence remains low to moderate due to heterogeneity among studies and limited sample sizes. These findings should be interpreted in light of the methodological limitations identified across the included trials. Full article

Background: Medial-compartment knee osteoarthritis (KOA) carries substantial disability and long-term cost. High tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) are key joint-preserving or joint-replacing options for selected patients, but their comparative economic ranking remains uncertain. Methods: This critical narrative review synthesized comparative economic evidence on HTO versus UKA for isolated medial-compartment KOA. PubMed and Web of Science were searched as primary sources for English-language studies published from 1 January 2000 to 15 January 2026, while Google Scholar and citation tracking were used supplementarily to identify potentially missed records. Eligible studies were direct economic evaluations or comparative cost/resource studies with clear decision relevance to the HTO–UKA choice. Burden and cost-of-illness studies were used for contextual framing only and were not included in the core comparative synthesis. Results: The direct evidence base was small and methodologically heterogeneous and was dominated by decision-analytic models that differed in perspective, time horizon, utility metric, and assumptions regarding reoperation, revision, and conversion to total knee arthroplasty (TKA). These structural differences largely explain why a U.S. lifetime societal model favored HTO, a UK age-stratified 10-year model produced age-dependent findings, and a recent Canadian public-payer model favored UKA. Observational studies suggest that UKA episode costs can fall substantially in outpatient or ambulatory pathways, whereas HTO costs may rise when reoperations and technique-specific resource use are explicitly captured. Conclusions: Current evidence does not support a context-free economic ranking of HTO and UKA. Because the available studies are heterogeneous and incremental utility differences are often small, the findings should be interpreted cautiously and as scenario-dependent rather than definitive. Future comparative analyses should use contemporary pathway data, transparent and standardized costing, and explicit downstream event definitions for both procedures. Full article

Knee osteoarthritis (KOA) is a leading cause of pain and disability worldwide, and current treatments remain largely symptomatic, with no disease-modifying therapy established for routine use. This narrative review evaluates extracellular vesicles (EVs) as biological nanocarriers and a cell-free alternative to mesenchymal stromal cell therapy for KOA by examining the biological rationale, preclinical evidence, clinical studies, and current methodological and regulatory requirements. Preclinical findings indicate that EVs may exert immunomodulatory, anti-inflammatory, and chondroprotective effects, supporting their potential to influence joint homeostasis. The review also summarizes current recommendations for EV nomenclature, characterization, and quality control in accordance with the Minimal Information for Studies of EVs 2023 guidelines and highlights key translational challenges, including scalable manufacturing, potency assessment, and regulatory compliance. Clinical evidence to date suggests a favorable safety profile, but efficacy data remain limited and inconsistent; a randomized placebo-controlled trial showed no superiority over placebo, whereas small early human studies suggested possible benefit in selected cases. Overall, EVs represent a promising cell-free strategy for KOA, but current evidence is insufficient to support routine clinical use, emphasizing the need for standardized production, validated potency assays, and robust randomized clinical trials. Full article

Background: Elderly women face significant health challenges, including knee osteoarthritis (KOA) and balance disorders. Artificial intelligence (AI)-assisted exercise intervention can address limitations of traditional intervention methods, such as low compliance and high economic costs. Objective: This randomized controlled trial (RCT) evaluated the effects of AI-assisted Baduanjin exercise on physical health (balance and knee function) in elderly women, comparing it with offline manual guidance and health education. The group of 79 elderly women (60–74 years) were randomly assigned into three groups: AI-assisted Baduanjin (AI group, n = 25), offline instructor-led Baduanjin (Offline group, n = 27), and health education (Education group, n = 27). Methods: Interventions lasted 12 weeks, with three 45-min sessions per week. Two outcome measures were evaluated pre- and post-interventions: postural stability assessed by the unipedal stance test and knee function measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). This study considers two measurement methods. One is a two-way repeated-measures analysis of variance used to evaluate the effects on the three intervention groups. The other is an independent-samples t-test, with post hoc testing (Bonferroni), used to assess differences among the three groups. Results: Both the AI and Offline groups showed significant improvements in WOMAC pain and function scores at 12 weeks (p < 0.05), with the Offline group demonstrating greater functional improvement (decrease in WOMAC function score: 6.7 points, Cohen’s d = 1.23, 95% CI 0.81–1.65). No serious adverse events (e.g., falls, exacerbation of joint pain) were reported in any group. The Offline group also showed immediate balance enhancement (closed-eye stance improvement, effect size d ≈1.57), while the AI group exhibited progressive pain relief. The Education group showed minimal improvements. Inter-group comparisons showed the AI and Offline groups outperformed the Education group in balance and knee function (p < 0.05). Conclusions: AI-assisted and offline Baduanjin interventions effectively improve balance and knee function in elderly women, with offline guidance offering improvement of balance ability. AI intervention is suitable for rural elderly women with low digital literacy, as it provides simplified operation and voice prompts to ensure adherence. Full article