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Knee Osteoarthritis: Clinical Updates and Perspectives
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Knee Osteoarthritis: Clinical Updates and Perspectives

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

Deadline for manuscript submissions: 28 February 2025 | Viewed by 11218

Special Issue Editors

Dr. Yoshitomo Saita

E-Mail Website1 Website2
Guest Editor
Regenerative Medicine for Locomotive Organ, Juntendo University School of Medicine, Tokyo 113-0033, Japan
Interests: knee osteoarthritis; prevention; pharmacological care; surgical intervention; physiotherapy; biotherapy; stem cell therapy
Special Issues, Collections and Topics in MDPI journals
Dr. Shinnosuke Hada

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Guest Editor
Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo 113-0033, Japan
Interests: knee surgery; osteoarthritis; sports medicine; regenerative medicine

Special Issue Information

Dear Colleagues,

I'm excited to announce that I will be serving as the Guest Editor for the upcoming Special Issue titled "Knee Osteoarthritis: Clinical Updates and Perspectives". I believe that the ultimate goal in the treatment of knee osteoarthritis is to extend the "healthy lifespan." There are diverse approaches to achieve this goal.

From a preventive standpoint, lifestyle improvements such as diet and exercise are crucial. Approaching populations at a higher risk of developing knee osteoarthritis in the future, considering genetic and anatomical factors, represents a novel concept. Additionally, knee-preserving osteotomies aiming for "joint preservation" have seen significant progress in recent years.

In the field of biotherapy, cell therapies using autologous platelet-rich plasma and mesenchymal stem cells, as well as treatments utilizing liquid factors such as extracellular vesicles and exosomes, have undergone explosive development. However, when considering the goal of extending a healthy lifespan, it is essential not to persist in conservative treatments unnecessarily but to perform joint replacement surgery at the appropriate time.

In the complex realm of knee joint care, where the causes of pain are intricate, the most crucial premise is to thoroughly assess the patient's physical condition and, in conjunction with imaging diagnostics, appropriately evaluate the causes of pain for effective intervention.

For this Special Issue, I aim to gather insights from specialists at the forefront of these clinical updates and perspectives. Contributions are welcomed from clinical research, basic research with clinical relevance, animal experiments, literature reviews or any other relevant fields. I encourage submissions that share cutting-edge knowledge aimed at extending the healthy lifespan of patients.

Dr. Yoshitomo Saita
Dr. Shinnosuke Hada
Guest Editors

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • knee osteoarthritis
  • diagnosis
  • cell therapy
  • platelet-rich plasma
  • exosome
  • knee osteotomy
  • arthroplasty
  • physiotherapy
  • conservative treatment
  • surgical treatment

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Published Papers (8 papers)

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Research

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13 pages, 951 KiB  
Article
Reliability of the Star Excursion Balance Test with End-Stage Knee Osteoarthritis Patients and Its Responsiveness Following Total Knee Arthroplasty
by Bodor Bin Sheeha, Ahmad Bin Nasser, Anita Williams, Malcolm Granat, David Sands Johnson, Omar W. Althomali, Nouf H. Alkhamees, Zizi M. Ibrahim and Richard Jones
J. Clin. Med. 2024, 13(21), 6479; https://doi.org/10.3390/jcm13216479 - 29 Oct 2024
Viewed by 529
Abstract
Background/Objectives: The Star Excursion Balance Test (SEBT) is a simple and feasible tool for assessing dynamic balance in individuals with knee osteoarthritis (KOA). It has an advantage as it replicates dynamic balance better than other static balance tools. This study aims to determine [...] Read more.
Background/Objectives: The Star Excursion Balance Test (SEBT) is a simple and feasible tool for assessing dynamic balance in individuals with knee osteoarthritis (KOA). It has an advantage as it replicates dynamic balance better than other static balance tools. This study aims to determine how reliable SEBT is among people with end-stage KOA, as well as how responsive it is and how well it correlates with performance-based outcome measures after TKA. Methods: Patients on the waiting list for TKA performed SEBT in the anterior, posteromedial and posteriorlateral directions twice within 7 days. The measurements were repeated 6 and 12 months after TKA. The participants completed performance-based outcome measurements (PBOMs) and the Oxford Knee Score (OKS) before and after TKA to estimate correlation. Results: In all directions, the intraclass correlation coefficient range (ICC) was 0.998–0.993, and there were no significant differences between the test and re-test mean SEBT scores. The standard error of measurement (SEM) ranged from 0.37% to 0.68%, and the minimum detectable change (MDC) ranged from 1.02% to 1.89%. The post TKA SEBT results show significant improvement, with a large effect size. There were large-to-medium correlations between SEBT and PBOMs before and after TKA, while OKS correlated only before surgery. The magnitude of change in SEBT, PBOMs and OKS did not correlate. Conclusions: SEBT is an extremely reliable tool for assessing dynamic balance in all three directions of severe KOA patients. It is sensitive enough to detect balance changes at 6 and 12 months post TKA. SEBT cannot be used to reflect the change in functional outcome improvement after TKA. Full article
(This article belongs to the Special Issue Knee Osteoarthritis: Clinical Updates and Perspectives)
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11 pages, 677 KiB  
Article
Gait, Quality of Life, and Knee Function in Advanced Knee Osteoarthritis: A Single-Center, Prospective, Observational Study
by Valentín Freijo, Claudia Navarro and Jordi Villalba
J. Clin. Med. 2024, 13(18), 5392; https://doi.org/10.3390/jcm13185392 - 12 Sep 2024
Viewed by 861
Abstract
Background/Objectives: Treatment of advanced knee osteoarthritis with total knee arthroplasty typically results in an improvement in function, gait, and quality of life, which tend to be affected by the condition. It is, however, necessary to determine the baseline factors that could influence [...] Read more.
Background/Objectives: Treatment of advanced knee osteoarthritis with total knee arthroplasty typically results in an improvement in function, gait, and quality of life, which tend to be affected by the condition. It is, however, necessary to determine the baseline factors that could influence the patients’ postoperative outcome. Methods: This is a single-center prospective observational study of patients with advanced knee osteoarthritis (Kellgren–Lawrence grade 3 or 4) treated with total knee arthroplasty. Gait parameters were recorded at baseline and at various postoperative time points using a wireless device. Progression of function was assessed using the Knee Society Score questionnaire and quality of life by means of the EQ-5D and Knee Injury and Osteoarthritis Outcome Score questionnaires. Progression of gait and quality of life was analyzed in all patients, distinguishing between those where baseline velocity was < 1 m/s and those where it was ≥1 m/s. The potential correlation between baseline and postoperative parameters was also evaluated. Results: All 119 patients showed a significant improvement in their gait, function, and quality of life parameters at one year from the procedure (p < 0.05). No statistically significant differences were found in any of the postoperative subscales, regardless of baseline velocity (< o ≥ 1 m/s) or between any of the baseline or postoperative parameters (r < 0.29). Conclusions: Baseline gait parameters in patients with advanced knee osteoarthritis do not appear to bear a statistically significant relationship with function or quality of life outcomes following total knee arthroplasty. Such parameters exhibit a significant improvement one year after surgery. Full article
(This article belongs to the Special Issue Knee Osteoarthritis: Clinical Updates and Perspectives)
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16 pages, 1196 KiB  
Article
Linking Intra-Articular Inflammatory Biomarkers with Peripheral and Central Sensitization in Late-Stage Knee Osteoarthritis Pain: A Pilot Study
by Sofie Puts, Rose Njemini, Thomas Bilterys, Nina Lefeber, Thierry Scheerlinck, Jo Nijs, David Beckwée and Ivan Bautmans
J. Clin. Med. 2024, 13(17), 5212; https://doi.org/10.3390/jcm13175212 - 2 Sep 2024
Viewed by 1801
Abstract
Background/Objectives: To investigate if intra-articular biomarkers relate to peripheral and central sensitization in patients with late-stage knee osteoarthritis (KOA). Methods: A total of 17 (6M, 11F) patients (aged 69 ± 10 years) were assessed for peripheral (pressure pain thresholds (PPT)) and [...] Read more.
Background/Objectives: To investigate if intra-articular biomarkers relate to peripheral and central sensitization in patients with late-stage knee osteoarthritis (KOA). Methods: A total of 17 (6M, 11F) patients (aged 69 ± 10 years) were assessed for peripheral (pressure pain thresholds (PPT)) and central (temporal summation (TS) and conditioned pain modulation (CPM)) sensitization the day before total knee arthroplasty. Synovial fluid was collected during surgery and assayed for IL-6, IL-8, IL-10, TNF-α, CXCL-10, BDNF, NGF, CCL2, CCL5, VEGF, IL-1RI, MMP-1, MMP-7, IL-1β, and CXCL-9. Associations of biomarkers and their combinations reflecting chronic (CXCL-9) and acute ((CCL2×CXCL-10)/IL-10)) inflammation, cartilage degeneration (MMP-1×MMP-7), and neurotrophy (NGF×BDNF) with PPT, TS, and CPM were analyzed by bivariate correlations and by multiple linear regression analyses corrected for BMI, sex, and age. Results: The medial joint line and the superior medial joint region showed the lowest PPT. Higher acute inflammation related significantly to worse pressure tenderness at the superior medial joint region (R2 = 0.642; p = 0.010). Cartilage degeneration and chronic inflammation were associated with both absolute (R2 = 0.827; p = 0.001) and relative CPM (R2 = 0.882; p < 0.001). Acute inflammation and neurotrophy were related to relative TS at the m. tibialis anterior (R2 = 0.728; p = 0.02). Conclusions: This study demonstrates that increased levels of intra-articular biomarkers of acute inflammation are related to peripheral sensitization and that biomarkers of cartilage degeneration and chronic inflammation are associated with central sensitization. These results may be a stepping-stone toward a better understanding of the working mechanism of peripheral and central sensitization in KOA pain and the development of more targeted therapeutic interventions. Full article
(This article belongs to the Special Issue Knee Osteoarthritis: Clinical Updates and Perspectives)
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13 pages, 892 KiB  
Article
Implications of Stabilometric Assessment in Determining Functional Deficits in Patients with Severe Knee Osteoarthritis: Observational Study
by Marius Neculăeș, Pablo Hernandez-Lucas and Paul Lucaci
J. Clin. Med. 2024, 13(11), 3181; https://doi.org/10.3390/jcm13113181 - 29 May 2024
Cited by 1 | Viewed by 787
Abstract
Background: Osteoarthritis is one of the most frequent joint disorders in the world. The specialists in the field strongly support the role of physical exercise as a key component in the holistic management of arthrosis. The aim of the current study was [...] Read more.
Background: Osteoarthritis is one of the most frequent joint disorders in the world. The specialists in the field strongly support the role of physical exercise as a key component in the holistic management of arthrosis. The aim of the current study was to identify and assess the functional deficit of these patients and to identify means to alleviate it through pre-surgery physiotherapy programs. Methods: The study was conducted on two samples of patients: a witness sample, encompassing 126 subjects without pathologies at the level of their lower limbs, and a study sample, formed of 116 subjects diagnosed with severe gonarthrosis with total knee arthroplasty indication. The assessment protocol was accomplished with the GPS 400 stabilometric platform. Results: The barycenter differences within the support polygon, recorded for the two samples within sagittal deviation, emphasize that the barycenter shifting mainly towards the healthy lower limb will demand, from the individual, more intense rebalancing postural reactions that will place the center-of-gravity projection in the sagittal plane, closer to the central area of the support polygon. Conclusions: In the case of gonarthrosis and other joint disorders, the use of functional testing to assess body weight distribution and center-of-gravity imbalances represents a promising direction in the research on and management of these disorders, providing essential information for functional diagnosing and thus enabling the elaboration and monitoring of individualized functional rehabilitation plans. Full article
(This article belongs to the Special Issue Knee Osteoarthritis: Clinical Updates and Perspectives)
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15 pages, 1276 KiB  
Article
Injection of Autologous Adipose Stromal Vascular Fraction in Combination with Autologous Conditioned Plasma for the Treatment of Advanced Knee Osteoarthritis Significantly Improves Clinical Symptoms
by Markus Klingenberg, Antoniya Dineva, Annika Hoyer, Barbara Kaltschmidt, Philipp Leimkühler, Thomas Vordemvenne, Andreas Elsner and Dirk Wähnert
J. Clin. Med. 2024, 13(11), 3031; https://doi.org/10.3390/jcm13113031 - 22 May 2024
Viewed by 1516
Abstract
(1) Background: Osteoarthritis (OA) is the most common joint disease in the world. It is chronic, systemic, progressive and disabling. Orthobiologics have the potential to positively alter the course of this disease. Therefore, the aim of this study is to evaluate the efficacy [...] Read more.
(1) Background: Osteoarthritis (OA) is the most common joint disease in the world. It is chronic, systemic, progressive and disabling. Orthobiologics have the potential to positively alter the course of this disease. Therefore, the aim of this study is to evaluate the efficacy of SVF/ACP in the treatment of advanced osteoarthritis of the knee in an unfiltered patient population. We hypothesize that this therapy can improve the symptoms associated with osteoarthritis of the knee. We also hypothesize that there are patient-related factors that influence the efficacy of therapy. (2) Methods: Two hundred and thirteen patients with moderate to severe OA of the knee and SVF/ACP injection were recruited for this study. Patients were excluded if they did not provide informed consent or were not receiving SVF/ACP therapy. Pain, function, symptoms and quality of life were assessed using standardized scores (KOOS, WOMAC) before and after treatment. (3) Results: The VAS pain score was significantly reduced by at least 30% (p < 0.001). Knee function, as measured by the KOOS daily activity and sport scores, showed significant increases of 21% and 45%, respectively, at 6 months (p < 0.04). (4) Conclusions: Treatment of knee OA with SVF/ACP injection positively modifies the disease by significantly reducing pain and improving function. Full article
(This article belongs to the Special Issue Knee Osteoarthritis: Clinical Updates and Perspectives)
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Review

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29 pages, 488 KiB  
Review
A Review of Current Approaches to Pain Management in Knee Osteoarthritis with a Focus on Italian Clinical Landscape
by Stefano Giaretta, Alberto Magni, Alberto Migliore, Silvia Natoli, Filomena Puntillo, Gianpaolo Ronconi, Luigi Santoiemma, Cristiano Sconza, Ombretta Viapiana and Gustavo Zanoli
J. Clin. Med. 2024, 13(17), 5176; https://doi.org/10.3390/jcm13175176 - 31 Aug 2024
Viewed by 2315
Abstract
The global cases of knee osteoarthritis (KOA) are projected to increase by 74.9% by 2050. Currently, over half of patients remain dissatisfied with their pain relief. This review addresses unmet needs for moderate-to-severe KOA pain; it offers evidence and insights for improved management. [...] Read more.
The global cases of knee osteoarthritis (KOA) are projected to increase by 74.9% by 2050. Currently, over half of patients remain dissatisfied with their pain relief. This review addresses unmet needs for moderate-to-severe KOA pain; it offers evidence and insights for improved management. Italian experts from the fields of rheumatology, physical medicine and rehabilitation, orthopedics, primary care, and pain therapy have identified several key issues. They emphasized the need for standardized care protocols to address inconsistencies in patient management across different specialties. Early diagnosis is crucial, as cartilage responds better to early protective and structural therapies. Faster access to physiatrist evaluation and reimbursement for physical, rehabilitative, and pharmacological treatments, including intra-articular (IA) therapy, could reduce access disparities. Concerns surround the adverse effects of oral pharmacological treatments, highlighting the need for safer alternatives. Patient satisfaction with corticosteroids and hyaluronic acid-based IA therapies reduces over time and there is no consensus on the optimal IA therapy protocol. Surgery should be reserved for severe symptoms and radiographic KOA evidence, as chronic pain post-surgery poses significant societal and economic burdens. The experts advocate for a multidisciplinary approach, promoting interaction and collaboration between specialists and general practitioners, to enhance KOA care and treatment consistency in Italy. Full article
(This article belongs to the Special Issue Knee Osteoarthritis: Clinical Updates and Perspectives)

Other

Jump to: Research, Review

10 pages, 768 KiB  
Project Report
Radiographic Knee Osteoarthritis Is a Risk Factor for the Development of Dementia: Locomotive Syndrome and Health Outcomes in the Aizu Cohort Study
by Yuji Endo, Hiroshi Kobayashi, Kazuyuki Watanabe, Koji Otani, Kenichi Otoshi, Hironori Numazaki, Miho Sekiguchi, Mari Sato, Takuya Nikaido, Rei Ono, Shin-ichi Konno and Yoshihiro Matsumoto
J. Clin. Med. 2024, 13(16), 4956; https://doi.org/10.3390/jcm13164956 - 22 Aug 2024
Viewed by 1052
Abstract
Objective: Osteoarthritis is linked to dementia, but no longitudinal studies have established this connection. This prospective cohort study from the Locomotive Syndrome and Health Outcome in Aizu Cohort Study (LOHAS) aimed to determine if knee osteoarthritis (KOA) independently predicts dementia in adults aged [...] Read more.
Objective: Osteoarthritis is linked to dementia, but no longitudinal studies have established this connection. This prospective cohort study from the Locomotive Syndrome and Health Outcome in Aizu Cohort Study (LOHAS) aimed to determine if knee osteoarthritis (KOA) independently predicts dementia in adults aged 65 and above. Methods: Participants were classified by the Kellgren–Laurence scale into no/minimal KOA (grades 0 and I) and definitive KOA (grade II or higher). We analyzed dementia incidence from 2009 to 2015 using long-term care insurance data, adjusting for age, sex, vascular risks, depressive symptoms, and activity levels. Results: Out of 1089 participants (58.9% female, average age 72.5), 72.0% had definitive KOA. Dementia occurrence was significantly higher in the definitive group (8.4%) compared to the no/minimal group (3.0%) (p < 0.001). A log-rank test and Cox regression analysis confirmed these findings, showing an adjusted hazard ratio of 2.29 (confidence interval: 1.12–4.68) for dementia in those with definitive KOA. Conclusions: These results suggest that KOA is a significant risk factor for dementia, highlighting the importance of addressing contributing factors in KOA patients to potentially slow the progression of dementia. Full article
(This article belongs to the Special Issue Knee Osteoarthritis: Clinical Updates and Perspectives)
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13 pages, 661 KiB  
Systematic Review
The Relevance of Implanted Percutaneous Electrical Nerve Stimulation in Orthopedics Surgery: A Systematic Review
by Sarthak Parikh, Alexandra C. Echevarria, Brandon R. Cemenski and Travis Small
J. Clin. Med. 2024, 13(13), 3699; https://doi.org/10.3390/jcm13133699 - 25 Jun 2024
Viewed by 1501
Abstract
Background: Percutaneous peripheral nerve stimulation (PNS) is a form of neuromodulation that involves the transmission of electrical energy via metal contacts known as leads or electrodes. PNS has gained popularity in orthopedic surgery as several studies have supported its use as a [...] Read more.
Background: Percutaneous peripheral nerve stimulation (PNS) is a form of neuromodulation that involves the transmission of electrical energy via metal contacts known as leads or electrodes. PNS has gained popularity in orthopedic surgery as several studies have supported its use as a pain control device for patients suffering from pain due to orthopedic pathologies involving the knee, shoulder, and foot. The purpose of this systematic review is to summarize the literature involving peripheral nerve stimulation in orthopedic surgery. The existing body of literature provides support for further research regarding the use of PNS in the management of knee pain, hip pain, shoulder pain, foot pain, and orthopedic trauma. Notably, the evidence for its efficacy in addressing knee and shoulder pain is present. Methods: This study was conducted following PRISMA guidelines. Seven hundred and forty-five unique entries were identified. Two blinded reviewers assessed each article by title and abstract to determine its relevance and categorized them as “include”, “exclude”, and “maybe”. After a preliminary review was completed, reviewers were unblinded and a third reviewer retrieved articles labeled as “maybe” and those with conflicting labels to determine their relevance. Twenty-eight articles were included, and seven hundred and seventeen articles were excluded. Articles discussing the use of PNS in the field of orthopedic surgery in patients > 18 years of age after 2010 were included. Exclusion criteria included neuropathic pain, phantom limb pain, amputation, non-musculoskeletal related pathology, non-orthopedic surgery related pathology, spinal cord stimulator, no reported outcomes, review articles, abstracts only, non-human subjects. Results: A total of 16 studies analyzing 69 patients were included. All studies were either case series or case reports. Most articles involved the application of PNS in the knee (8) and shoulder (6) joint. Few articles discussed its application in the foot and orthopedic trauma. All studies demonstrated that PNS was effective in reducing pain. Discussion: Peripheral nerve stimulation can be effective in managing postoperative or chronic pain in patients suffering from orthopedic pathology. This systematic review is limited by the scarcity of robust studies with substantial sample sizes and extended follow up periods in the existing literature. Full article
(This article belongs to the Special Issue Knee Osteoarthritis: Clinical Updates and Perspectives)
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