Search Results (264)

Background/Objectives: The present study aimed to evaluate the frequency of neuropathic-like pain (NP) in patients with symptomatic knee osteoarthritis (KOA) and its association with function, disease severity, emotional status, sleep disturbance, and quality of life. Methods: Consecutive patients with symptomatic KOA were included in this cross-sectional study. NP was evaluated using the painDETECT Questionnaire (PD-Q) and DN4. Functional status, disease severity, depression, anxiety, sleep quality, and quality of life were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lequesne Index (LI), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Pittsburgh Sleep Quality Index (PSQI), and Short Form-36 (SF-36), respectively. Results: The frequency of NP was 46% according to the DN4 and 20% according to the PD-Q. Patients with NP had longer symptom duration, higher visual analog scale (VAS), WOMAC, LI, BAI, and PSQI scores, and lower SF-36 scores than patients without NP (all p < 0.05). NP scores correlated positively with VAS, WOMAC, LI, BDI, BAI, and PSQI scores and negatively with SF-36 scores. After adjustment for pain severity and symptom duration, several associations remained significant. Conclusions: NP was significantly associated with function, emotional status, sleep disturbance, and quality of life in patients with KOA. Full article

Objectives: The aim of this study was to determine the differences between groups with and without nocturnal pain (NP) in patients with knee osteoarthritis (KOA) in terms of radiographic stage, disease severity, neuropathic pain, central sensitivity, sleep quality, physical activity level, and number of hospital visits. Methods: The study included 150 patients with KOA (101 women, 49 men; mean age 64 years (IQR: 9; range: 40–81)). Kellgren–Lawrence (KL) grading was used for radiographic staging, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for KOA disease severity, the Douleur Neuropathique 4 (DN-4) questionnaire for neuropathic pain, the Central Sensitization Inventory (CSI) for central sensitization, the Pittsburgh Sleep Quality Index (PSQI) for sleep quality, and the International Physical Activity Questionnaire–Short Form (IPAQ-SF) for physical activity level. Results: In our KOA patient group, the prevalence of NP was found to be 64.7%. A multivariable binary logistic regression analysis was performed as the primary inferential analysis. Age, sex, educational level, body mass index, disease duration, KL grade, and WOMAC total score were entered simultaneously into the model. After adjustment for the included covariates, only the WOMAC total score remained independently associated with NP. Each one-point increase in the WOMAC total score was associated with an 11.7% increase in the odds of NP (adjusted OR = 1.117, 95% CI 1.068–1.168, p < 0.001). Conclusions: Given that it affects more than half of patients with KOA and is associated with higher disease severity, we emphasize the need for careful management of NP in KOA patients. Full article

Bone marrow lesion (BML) volume is an essential biomarker for understanding knee osteoarthritis (KOA). However, automatic BML segmentation remains challenging due to the irregular shapes and indistinct boundaries of these lesions in knee magnetic resonance images (MRI). To improve BML segmentation, this study investigated two established strategies in the specific context of BML segmentation: (1) integrating bone segmentation as an additional output channel in deep neural networks to facilitate BML segmentation, and (2) incorporating test-time augmentation (TTA) to reduce uncertainty during testing. The added bone segmentation channel provides auxiliary anatomical information that may facilitate BML localization. TTA was used to improve boundary alignment and reduce false positives by generating more robust predictions. Multiple State-of-the-Art deep neural networks for segmentation were employed as the baseline models to compare performance before and after implementing the proposed strategies. A 10-fold cross-validation was conducted on a dataset of knee MR scans from 300 participants. Segmentation performance was evaluated using the Dice similarity coefficient (DSC) for overlap accuracy and the 95% Hausdorff Distance (HD95) for boundary alignment. Paired t-tests were used to assess the significance of improvements from the proposed strategies. Both strategies produced improvements in segmentation performance, although the magnitude and statistical significance of the improvements varied across architectures. The DSC improved from 63.1% to 64.8% for Residual U-Net, 64.2% to 65.8% for Swin UNETR, 61.5% to 66.5% for Attention U-Net, and 66.6% to 69.0% for UNet++. These gains were accompanied by improvements in boundary accuracy and reductions in false positives, reflected in lower HD95 values. Comparison with additional medical image segmentation models under the same evaluation framework showed that the dual-channel UNet++ with TTA achieved the highest BML DSC of 69.0%, followed by U-Mamba at 68.6% and nnU-Net at 65.2%, while U-Net + InceptionResNet-v2 achieved 57.7%. These findings support the potential value of dual-channel and TTA strategies for automated BML analysis, while further validation on independent datasets is needed to assess their broader generalizability and clinical utility. Full article

Background/Objectives: Posterior knee pain is a common but often overlooked component of knee osteoarthritis (KOA), especially in advanced stages. Conventional nerve blocks targeting anterior innervation may provide insufficient relief. The IPACK block selectively targets posterior capsular innervation; however, evidence for its effectiveness in chronic KOA-related posterior pain remains limited. Methods: In this multicenter, prospective, single-arm, nonrandomized interventional study, patients aged 50–90 years with Kellgren–Lawrence grade III-IV KOA and predominant posterior knee pain unresponsive to conservative treatment received an ultrasound-guided IPACK block. Pain (NRS), function (WOMAC), and quality of life (SF-12) were assessed at baseline, 1 month, and 3 months. Results: Eighty-four patients (84 knees) were included. Mean NRS decreased from 7.8 ± 1.3 to 3.5 ± 1.5 at 1 month and 6.7 ± 1.3 at 3 months (p < 0.001). WOMAC improved from 71.5 ± 11.0 to 37.3 ± 10.4 and 60.2 ± 10.5 at 1 and 3 months, respectively (p < 0.001). SF-12 physical and mental scores also improved significantly (p < 0.001). Conclusions: Improvements in pain, physical function, and health-related quality-of-life measures were observed during the three-month period following the IPACK block. No serious procedure-related adverse events were recorded during the three-month follow-up period. Full article

Gait analysis is increasingly used as a dynamic functional biomarker for computer-aided diagnosis (CADx), although strong internal performance alone does not establish clinical utility. This targeted narrative review examines Parkinson’s disease (PD) and knee osteoarthritis (KOA) as its primary clinical contexts while treating fall risk and other mobility disorders as contextual extensions. A structured literature search and source-verification process covered studies available through 31 July 2026. The review corpus comprised 118 sources spanning clinical evidence, measurement validation, datasets, algorithmic architectures, and methodological guidance. This review critically compares sensing modalities, public and proprietary datasets, feature-based models, CNN/RNN architectures, graph neural networks, Transformers, state-space models, and trust-supporting approaches, including explainable artificial intelligence, automated machine learning, federated learning, and multimodal fusion. Using an explicit coverage rule, a common validation audit was applied to 15 empirical or measurement-validation studies. The audited evidence did not demonstrate mature independent multisite validation for disease-focused gait CADx. Formal probability calibration and quantitative testing of explanation stability were also absent, while publicly available KOA-specific multimodal benchmarks remained scarce. Based on these findings, this review proposes a six-level validation-readiness ladder in which independent external evidence at Level 3 represents the minimum threshold for initiating a supervised clinical pilot. The framework prioritizes subject-level separation, leakage control, calibration, clinically meaningful reference standards, and prospective workflow evaluation. Full article

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

Background/Objectives: Total knee arthroplasty (TKA) is the standard surgical treatment for end-stage knee osteoarthritis (KOA); however, restoration of normal gait biomechanics remains an important challenge. Objective assessment of gait recovery may provide valuable information beyond conventional clinical outcome measures. This study aimed to evaluate changes in spatiotemporal gait parameters, symmetry restoration, and functional recovery during the first year following primary TKA, and to identify predictors of postoperative gait performance. Methods: A prospective longitudinal cohort study was conducted in 150 patients undergoing primary unilateral TKA for end-stage KOA. Spatiotemporal gait parameters, symmetry-related variables, and functional outcomes were assessed preoperatively and at 3, 6, and 12 months postoperatively. Gait analysis included walking speed, step length, cadence, stance phase symmetry, symmetry index (SI), loading asymmetry, and single-limb support time. Functional evaluation included the Timed Up and Go (TUG) test, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Knee Society Score (KSS). Repeated-measures analysis of variance (ANOVA), Pearson correlation analysis, and multivariate linear regression were performed. Results: Significant improvements were observed in all gait and functional parameters throughout follow-up (all p < 0.001). Walking speed increased from 0.84 ± 0.16 m/s preoperatively to 1.21 ± 0.18 m/s at 12 months, while step length increased from 49.8 ± 7.4 cm to 64.0 ± 6.4 cm and cadence from 91 ± 10 to 108 ± 8 steps/min. SI improved from 73 ± 11% to 93 ± 6%, whereas loading asymmetry decreased from 18.2 ± 6.1% to 4.8 ± 2.3%. Walking speed demonstrated strong correlations with WOMAC score (r = −0.74, p < 0.001) and TUG performance (r = −0.79, p < 0.001). Multivariate regression analysis identified preoperative walking speed (β = 0.47, p < 0.001) as the strongest predictor of postoperative gait recovery, while age and body mass index (BMI) were significant negative predictors. Conclusions: Patients undergoing primary TKA demonstrated substantial improvements in gait biomechanics, symmetry restoration, and functional performance during the first postoperative year. Objective gait assessment was strongly associated with clinical outcomes and may facilitate identification of patients at risk of delayed recovery. Incorporating quantitative gait analysis into postoperative evaluation may support individualized rehabilitation strategies aimed at optimizing functional outcomes following TKA. Full article

Background: Knee osteoarthritis (KOA) is a leading cause of chronic pain and functional disability worldwide. Despite the widespread use of intra-articular (IA) corticosteroids and hyaluronic acid (HA), their long-term efficacy remains limited. Amniotic and chorionic membrane-derived biologics have emerged as promising alternatives owing to their anti-inflammatory, anti-fibrotic, and regenerative properties. Methods: This narrative review employed a structured, transparency-oriented literature search approach across PubMed/MEDLINE, EMBASE, Cochrane CENTRAL, and ClinicalTrials.gov (2015–2025). Studies evaluating intra-articular amniotic or chorionic membrane biologics in knee OA and reporting clinical outcomes were included. Results: Nine studies met the inclusion criteria, encompassing randomized controlled trials, prospective cohort studies, and retrospective analyses. Across studies, IA amniotic and chorionic membrane biologics demonstrated clinically meaningful improvements in pain scores and functional outcomes, with a favorable safety profile and minimal adverse events reported. Conclusions: Intra-articular amniotic and chorionic membrane biologics represent a promising therapeutic option for knee OA, with emerging evidence supporting their anti-inflammatory and potentially chondroprotective effects. Standardized product characterization, rigorous randomized controlled trials, and long-term follow-up studies are needed to establish their definitive clinical role. Full article

Intra-articular platelet-rich plasma (PRP) injections represent a promising biological treatment for early-stage knee osteoarthritis (KOA). As cord blood-derived PRP (CB-PRP) contains higher levels of bioactive mediators, this prospective study aimed to compare the efficacy and safety of CB-PRP versus homologous donor PRP (HD-PRP) in patients with early KOA and to evaluate whether CB-PRP results in greater clinical improvement. Fifty-one patients aged 46–70 years with Kellgren–Lawrence grade 1–2 were randomized to receive either CB-PRP or HD-PRP. Each underwent three intra-articular injections at four-week intervals. Outcomes included pain-related overall health perception assessed by the EuroQol Visual Analogue Scale (EQ-VAS), function measured with the Knee Injury and Osteoarthritis Outcome Score (KOOS), and quadriceps muscle strength evaluated by dynamometry. Assessments were performed at baseline and at 1, 2, 3, 6, and 12 months. Both groups showed improvements in pain and function over 12 months, with no statistically significant between-group differences (p = 0.46). EQ-VAS increased from 59 ± 19 to 83 ± 9 in the CB-PRP group and from 59 ± 18 to 77 ± 18 in the HD-PRP group. KOOS improved from 50 ± 25 to 68 ± 23 and from 38 ± 28 to 59 ± 24, respectively. Quadriceps strength showed no intergroup differences. Adverse events were mild and self-limiting. Both treatments demonstrated comparable clinical benefits and favorable safety profiles. Full article

Background: Knee osteoarthritis (KOA) affects over 300 million people globally, yet current therapies face limitations in efficacy and safety. Chitosan, a natural polysaccharide, has shown conflicting evidence in KOA management. This systematic review evaluates chitosan’s clinical effectiveness and defines its optimal application scenarios. Methods: Randomized controlled trials (RCTs) published before the end of November 2024 on chitosan and knee osteoarthritis were systematically retrieved from PubMed, Web of Science, Cochrane Library, EBSCO, PsycINFO, ClinicalTrials.gov, SINOMED, Chinese Medical Journal Network, CNKI, VIP, Wanfang Data, Embase, and SCOPUS. After screening the references, publications meeting the inclusion and exclusion criteria was selected. RevMan5.4 software was used to perform the meta-analysis of the data. Results: A total of 231 articles were retrieved, and 14 RCTs involving 1504 participants were included. For the primary efficacy outcome, pooled analysis of 10 RCTs showed a significantly higher overall clinical response rate in the chitosan group compared with the control group (OR = 5.43, 95% CI = 3.21, 9.18, p < 0.001), with no observed heterogeneity (I² = 0%). Additionally, meta-analysis of 12 RCTs demonstrated a significant reduction in visual analog scale (VAS) pain scores (MD = −1.06, 95% CI = −1.38, −0.73, p < 0.001) in patients receiving intra-articular chitosan injection. Subgroup analysis of VAS scores showed that pain reduction varied significantly by follow-up duration (I² for subgroup differences = 62.5%, p = 0.03). Conclusions: Intra-articular injection of medical chitosan shows potential benefits for pain relief and clinical efficacy in patients with knee osteoarthritis, with a low incidence of adverse reactions. Nevertheless, the evidence remains promising but preliminary. Full article