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Osteoarthritis: Diagnosis and Therapeutic Approaches

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

Deadline for manuscript submissions: closed (25 September 2023) | Viewed by 17500

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Special Issue Editors

Dr. Qiang Liu

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Guest Editor

Associate Professor, Arthritis Clinic and Research Center, Peking University People's Hospital, No.11 Xizhimen South Street, Beijing 100044, China
Interests: osteoarthritis; cartilage; femoral head necrosis; pain; exercise therapy for joint diseases; arthroplasty

Dr. Zeyu Huang

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Guest Editor

Associate Professor, Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610000, China
Interests: mechanisms regulating homeostasis of articular cartilage and pathogenesis of osteoarthritis

Special Issue Information

Dear Colleagues,

Osteoarthritis is a leading cause of disability worldwide. With an aging population and increasing prevalence of obesity, this syndrome has become more prevalent in the past few decades. The pathogenesis of osteoarthritis is believed to involve an interplay between mechanical stress and systematic and peripheral inflammation, and clinical diagnosis is often recommended. Imaging such as MRI and ultrasound may provide valuable information on structural changes that occur in cartilage, synovia, and subchondral bone. Subtypes of osteoarthritis may facilitate individualized management. Nonetheless, validated biomarkers that can be used to monitor progression are still warranted. Guidelines recommend a set of core treatments, including patient education, exercise, and weight loss. Although the effectiveness and efficacy of these core treatments have been well documented, there is still a gap between clinical practice and guidelines. New drugs targeting various pathological changes are under active research and ongoing development in phases 1, 2, or 3. Joint replacement has been proved to represent successful treatment for end-stage knee and hip osteoarthritis. However, there remains a lack of intervention that can effectively cure the disease or postpone its progression. Therefore, diagnostic and interventional approaches are areas that need to be targeted in various research endeavors.

Dr. Qiang Liu
Dr. Zeyu Huang
Guest Editors

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Keywords

osteoarthritis
cartilage
pain
pathogenesis
imaging
epidemiology
randomized controlled trial
cost-effectiveness
platelet rich plasma
stem cells
exercise therapy
arthroplasty
biomaterials

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Published Papers (6 papers)

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Research

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12 pages, 255 KiB

Open AccessArticle

Difficulties Experienced by Patients with Knee Osteoarthritis during the Conservative Treatment Process: A Qualitative Study

by Seçkin Özcan and Hakan Yurten

J. Clin. Med. 2023, 12(20), 6523; https://doi.org/10.3390/jcm12206523 - 14 Oct 2023

Cited by 1 | Viewed by 1272

Abstract

Background and Objectives: This study aimed to investigate the difficulties faced by patients with knee osteoarthritis during the conservative treatment process. Materials and Methods: We included twenty-one patients who were diagnosed with knee osteoarthritis and admitted to the orthopedics and traumatology outpatient clinic of the hospital where the researcher worked between January 2022 and April 2022. We interviewed each patient using semi-structured face-to-face interviews. To analyze the interviews, the researcher used the directed content analysis method. Data were analyzed using the NVIVO 10 software package. The authors and the expert trained in qualitative research who generously supported the authors continued the analysis independently of each other until they reached a consensus. Results: After analysis of the interviews held with the participants, the following three main themes emerged: lack of information about conservative treatment, frequent change of physicians, and non-compliance with lifestyle changes. Two sub-themes were identified within the theme of frequent change of physicians: distrusting health personnel, and not being able to make an appointment. In addition, most of the patients were not knowledgeable enough about either the definition of the disease or the treatment process. These patients stated that they were confused because they had to change physicians frequently; thus, they distrusted physicians because each physician they visited made a different plan for the treatment process. Conclusions: At the end of the study, we determined that during the conservative treatment process of patients with knee osteoarthritis, a multidisciplinary approach should be adopted, and orthopedic surgeons, physical therapy and rehabilitation physicians, dietitians, and physiotherapists should be in harmony with the patient. In addition, health personnel should provide patients with detailed information to eliminate questions they have during the conservative treatment process. In order for healthcare team members to establish a trusting relationship between the patients, they should allocate enough time to the patient. Full article

(This article belongs to the Special Issue Osteoarthritis: Diagnosis and Therapeutic Approaches)

11 pages, 874 KiB

Open AccessArticle

Office-Based Intraosseous Infiltrations of PRGF as an Effective Treatment for Knee Osteoarthritis: A Retrospective Observational Clinical Study

by Antonio Ríos Luna, Homid Fahandezh-Saddi Díaz, Manuel Villanueva Martínez, Roberto Iglesias, Roberto Prado, Sabino Padilla and Eduardo Anitua

J. Clin. Med. 2023, 12(13), 4512; https://doi.org/10.3390/jcm12134512 - 6 Jul 2023

Cited by 2 | Viewed by 2117

Abstract

The aim of this study was to explore and assess office-based ultrasound-guided intraosseous and intra-articular infiltrations of plasma rich in growth factors (PRGF) in patients with moderate and severe knee osteoarthritis (KOA). Seventy-nine patients (30 women and 49 men) with grade 3–4 KOA according to the Kellgren–Lawrence classification participated in the study. All patients were treated with a minimally invasive technique using local anesthesia WALANT (wide-awake local anesthesia no tourniquet) in the ambulatory setting. A PRGF intra-articular infiltration and two intraosseous infiltrations in the tibial plateau and femoral condyle were performed weekly for a total of three sessions. The evaluation of the results was carried out using knee injury and osteoarthritis outcome score (KOOS) at baseline and post-treatment. After a follow-up period of 11 months (median) [interquartile range, 7–14], all the KOOS domains showed statistically significant improvement (p < 0.001). Moreover, 88% of the patients showed a pain reduction of at least 10 points (minimally clinically important improvement) from pre- to post-treatment. Our retrospective study using the in-office procedure of ultrasound-guided combination of intra-articular and intraosseous infiltrations of PRGF is a safe and efficacious approach for the treatment of grade 3–4 knee osteoarthritis. Full article

(This article belongs to the Special Issue Osteoarthritis: Diagnosis and Therapeutic Approaches)

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Review

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17 pages, 1373 KiB

Open AccessReview

SuperPATH—Current Status of Evidence and Further Investigations: A Scoping Review and Quality Assessment

by Nikolai Ramadanov

J. Clin. Med. 2023, 12(16), 5395; https://doi.org/10.3390/jcm12165395 - 19 Aug 2023

Cited by 2 | Viewed by 1523

Abstract

Background: SuperPATH is a novel minimally invasive technique for hip replacement that is gaining increasing attention. The aim of this review was to determine the nature, extent, and quality of current research evidence on SuperPATH and to identify areas for further investigations. Methods: A bibliometric search was conducted in PubMed up to 1 August 2023 using the search term “SuperPATH”. Data extraction and quality assessment were performed for relevant articles. Results: The bibliometric search yielded 51 articles on SuperPATH, 9 of which were meta-analyses, 11 were randomized controlled trials (RCTs), 4 were prospective non-RCTs, 12 were retrospective comparative studies, 11 were case series, and 4 were other article types. Most articles were published between 2015 and 2023, with a steady increase in publications per year. The articles originated from 13 countries, of which China was the most productive (35%). The quality assessment of the meta-analyses showed that 22.2% were of moderate quality, 66.7% were of low quality, and 11.1% were of critically low quality. The quality assessment of the RCTs showed that 36.4% had a low risk of bias (RoB), 27.2% revealed some concerns, and 36.4% had a high RoB. All studies were evaluated for content and taken into account in the formulation of recommendations and conclusions. Conclusions: The SuperPATH evidence varies from low to high quality. There is a steady increase in SuperPATH publications in the English-language literature and an uneven distribution of the article origins, with most articles coming from China. Consistent terminology should be used in the future, referring to the surgical approach as the direct superior approach (DSA) and to the surgical technique as SuperPATH. This review provides further concrete suggestions for future investigations and recommendations to improve study quality. Full article

(This article belongs to the Special Issue Osteoarthritis: Diagnosis and Therapeutic Approaches)

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18 pages, 705 KiB

Open AccessReview

Recent Advances in Small Molecule Inhibitors for the Treatment of Osteoarthritis

by Jianjing Lin, Shicheng Jia, Weifei Zhang, Mengyuan Nian, Peng Liu, Li Yang, Jianwei Zuo, Wei Li, Hui Zeng and Xintao Zhang

J. Clin. Med. 2023, 12(5), 1986; https://doi.org/10.3390/jcm12051986 - 2 Mar 2023

Cited by 12 | Viewed by 3660

Abstract

Osteoarthritis refers to a degenerative disease with joint pain as the main symptom, and it is caused by various factors, including fibrosis, chapping, ulcers, and loss of articular cartilage. Traditional treatments can only delay the progression of osteoarthritis, and patients may need joint replacement eventually. As a class of organic compound molecules weighing less than 1000 daltons, small molecule inhibitors can target proteins as the main components of most drugs clinically. Small molecule inhibitors for osteoarthritis are under constant research. In this regard, by reviewing relevant manuscripts, small molecule inhibitors targeting MMPs, ADAMTS, IL-1, TNF, WNT, NF-κB, and other proteins were reviewed. We summarized these small molecule inhibitors with different targets and discussed disease-modifying osteoarthritis drugs based on them. These small molecule inhibitors have good inhibitory effects on osteoarthritis, and this review will provide a reference for the treatment of osteoarthritis. Full article

(This article belongs to the Special Issue Osteoarthritis: Diagnosis and Therapeutic Approaches)

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17 pages, 2504 KiB

Open AccessReview

Subchondral Bone Cyst Development in Osteoarthritis: From Pathophysiology to Bone Microarchitecture Changes and Clinical Implementations

by Angelos Kaspiris, Argyris C. Hadjimichael, Ioanna Lianou, Ilias D. Iliopoulos, Dimitrios Ntourantonis, Dimitra Melissaridou, Olga D. Savvidou, Evangelia Papadimitriou and Efstathios Chronopoulos

J. Clin. Med. 2023, 12(3), 815; https://doi.org/10.3390/jcm12030815 - 19 Jan 2023

Cited by 8 | Viewed by 5906

Abstract

Osteoarthritis is a degenerative joint disease affecting middle-aged and elderly patients. It mainly involves weight-bearing joints such as the hip, knee and spine as well as the basilar joint of the thumb, causing dysfunction and painful symptoms. Often, joint arthritis is accompanied by cartilage defects, joint space narrowing, osteophytes, bone sclerosis and subchondral bone cysts (SBC). The aim of the present study was to explore the pathophysiology responsible for the development of SBCs as well as the association between SBCs and disease progress, the level of clinical symptoms and their impact on postoperative outcomes and risk of possible complications following joint replacements if left untreated. A literature review on PubMed articles was conducted to retrieve and evaluate all available evidence related to the main objective mentioned above. A few theories have been put forth to explain the formation process of SBCs. These involve MMPs secretion, angiogenesis, and enhanced bone turnover as a biological response to abnormal mechanical loads causing repeated injuries on cartilage and subchondral tissue during the development of arthritis. However, the application of novel therapeutics, celecoxib-coated microspheres, local administration of IGF-1 and activated chondrocytes following surgical debridement of SBCs hinders the expansion of SBCs and prevents the progression of osteoarthritis. Full article

(This article belongs to the Special Issue Osteoarthritis: Diagnosis and Therapeutic Approaches)

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Other

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17 pages, 3647 KiB

Open AccessSystematic Review

A Worldwide Analysis of Adipose-Derived Stem Cells and Stromal Vascular Fraction in Orthopedics: Current Evidence and Applications

by Robert Ossendorff, Alessandra Menon, Frank A. Schildberg, Pietro S. Randelli, Sebastian Scheidt, Christof Burger, Dieter C. Wirtz and Davide Cucchi

J. Clin. Med. 2023, 12(14), 4719; https://doi.org/10.3390/jcm12144719 - 17 Jul 2023

Cited by 5 | Viewed by 2200

Abstract

The biological enhancement of tissue regeneration and healing is an appealing perspective in orthopedics. We aimed to conduct a systematic review to describe the global distribution of studies investigating the use of adipose tissue derivates in orthopedics and to provide information on their quality and on the products available. The quality of the included studies was assessed using the modified Coleman Methodology Score (mCMS) and the Cochrane risk-of-bias tool for randomized trials. Eighty-two studies were included, with a total of 3594 patients treated. In total, 70% of the studies investigated the treatment of knee disorders, predominantly osteoarthritis; 26% of all studies dealt with expanded adipose-derived stem/stromal cells (ADSCs), 72% of which had stromal vascular fraction (SVF); 70% described the injection of adipose tissue derivates into the affected site; and 24% described arthroscopies with the addition of adipose tissue derivates. The mean mCMS for all studies was 51.7 ± 21.4 points, with a significantly higher score for the studies dealing with expanded ADSCs compared to those dealing with SVF (p = 0.0027). Our analysis shows high heterogeneity in terms of the types of performed procedures as well as the choice and processing of adipose tissue derivates. Full article

(This article belongs to the Special Issue Osteoarthritis: Diagnosis and Therapeutic Approaches)

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