Osteoarthritis and cartilage open最新文献_第5页

Advancing deep learning based knee cartilage segmentation in MRI: Innovations, challenges and applications 在MRI中推进基于深度学习的膝关节软骨分割：创新、挑战和应用

IF 2.8

Osteoarthritis and cartilage open

Pub Date : 2025-11-12 DOI: 10.1016/j.ocarto.2025.100702

Sheheryar Khan , Muhammad Ammar Khawer , Junru Zhong , Rizwan Qureshi , Muhammad Asim , Weitian Chen

Objective

Recent advancements in deep learning (DL) have advanced knee cartilage segmentation in Magnetic Resonance Imaging (MRI), offering scalable, automated solutions that markedly reduce reader time and address the limitations of traditional manual approaches. Automated segmentation can substantially aid osteoarthritis (OA) assessment using MRI, facilitating consistent, reproducible quantification across large longitudinal cohorts, reduces inter-/intra-observer variability, capabilities that are impractical with manual workflows.

Method

This study presents a concise review of state-of-the-art DL-based approaches for knee cartilage segmentation, focusing on the evaluation of various architectures, techniques, and their adaptability to diverse datasets and imaging protocols. This review highlights key challenges in knee cartilage segmentation, including data scarcity, domain shifts, and imaging variability, while also discussing proposed solutions such as semi-supervised learning, domain adaptation, augmentation strategies, and foundation models. Additionally, the clinical significance of knee cartilage segmentation is underscored through its diverse applications.

Results

The study highlights substantial improvements against conventional methods in segmentation accuracy and efficiency using DL-based methods, given challenging scenarios of knee MRI. Solutions to key challenges are presented, and clinical applications showcase the potential of automated segmentation for cartilage thickness mapping and OA assessment.

Conclusion

DL-based segmentation is advancing musculoskeletal imaging by offering reliable and automated solutions. Despite persistent challenges such as data scarcity, domain shifts, and imaging variability, advancements in areas like semi-supervised learning, domain adaptation, augmentation strategies, and foundation models present significant opportunities to enhance model robustness and expand clinical applicability.

深度学习（DL）的最新进展在磁共振成像（MRI）中实现了先进的膝关节软骨分割，提供了可扩展的自动化解决方案，显着减少了阅读时间，并解决了传统人工方法的局限性。自动分割可以在很大程度上帮助骨关节炎（OA）的MRI评估，促进在大型纵向队列中一致、可重复的量化，减少观察者之间/内部的可变性，这些能力在人工工作流程中是不切实际的。方法本研究简要回顾了最新的基于dl的膝关节软骨分割方法，重点评估了各种架构、技术及其对不同数据集和成像协议的适应性。这篇综述强调了膝关节软骨分割的主要挑战，包括数据稀缺、领域转移和成像变异性，同时也讨论了提出的解决方案，如半监督学习、领域适应、增强策略和基础模型。此外，膝关节软骨分割的临床意义是通过其不同的应用强调。结果该研究强调了基于dl的方法在分割精度和效率方面对传统方法的实质性改进，给出了具有挑战性的膝关节MRI场景。提出了关键挑战的解决方案，临床应用显示了软骨厚度映射和OA评估的自动分割的潜力。结论基于dl的图像分割为肌肉骨骼成像提供了可靠、自动化的解决方案。尽管存在诸如数据稀缺、领域转移和成像可变性等持续的挑战，但在半监督学习、领域适应、增强策略和基础模型等领域的进步为增强模型稳健性和扩大临床适用性提供了重要机会。

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引用次数: 0

M2a macrophages identified as a potential therapeutic candidate for intervertebral disc herniation regression M2a巨噬细胞被确定为椎间盘突出症消退的潜在治疗候选者

IF 2.8

Osteoarthritis and cartilage open

Pub Date : 2025-11-07 DOI: 10.1016/j.ocarto.2025.100701

Zorica Buser , Catarina Correia , Melissa Baker , Catarina Meireles , Tiago Castanheira , Pedro Santos Silva , Paulo Pereira , Michael Gerling , Gabriel Courties , Mário A. Barbosa , Hans-Joerg Meisel , Carla Cunha

Objective

Lumbar disc herniation (LDH) is one of the most common spine pathologies and its spontaneous regression has been attributed to the activation of immune cells by inflammatory processes and extracellular matrix remodelling. This study aims to identify a macrophage candidate with potential for physiological treatment of LDH.

Study design

In vitro co-culture model of phagocytosis using human surgical hernia explants and monocyte-derived macrophages. Lumbar disc hernia tissues were collected from patients who underwent discectomy for LDH and co-cultured in transwell assays with M0, M1, M2a and M2d macrophages derived from blood monocytes. The macrophage phenotypes and phagocytic activity were analyzed by flow cytometry using pHrodo™ BioParticles™ conjugates and immunostaining for classical M1 and M2 markers. Explants were analyzed histologically with Alcian blue/Sirius red.

Results

A total of 21 samples were included, patient's average age was 48.8 ± 12.9 years and the most common levels were L4-5 (42.9 %) and L5-S1 (33.3 %). After three days co-culture with monocyte-derived macrophages, explants maintained the structure and high proteoglycans/collagen ratio. Flow cytometry analysis revealed that the explants modified the immune profile of macrophages, increasing the proportion of pro-inflammatory CD86⁺ cells, while reducing the percentage of anti-inflammatory CD163⁺ cells. Additionally, the M2a phenotype presented larger cells and had the highest phagocytic profile towards the explants.

Conclusions

M2a macrophages showed the highest potential towards the design of a macrophage-based therapy for LDH. This study holds great promise for translational medicine aimed at accelerating spontaneous LDH using a physiological treatment that could prevent need for surgical intervention.

目的腰椎间盘突出症（LDH）是最常见的脊柱疾病之一，其自发消退归因于炎症过程和细胞外基质重塑对免疫细胞的激活。本研究旨在鉴定一种具有LDH生理治疗潜力的巨噬细胞候选者。研究设计人手术疝外植体与单核细胞源性巨噬细胞体外共培养吞噬模型。从因LDH而行椎间盘切除术的患者收集腰椎间盘突出组织，并与来自血液单核细胞的M0、M1、M2a和M2d巨噬细胞共同培养。使用pHrodo™BioParticles™偶联物和经典M1和M2标记物的免疫染色，通过流式细胞术分析巨噬细胞表型和吞噬活性。用Alcian蓝/Sirius红对外植体进行组织学分析。结果共纳入21例样本，患者平均年龄为48.8±12.9岁，以L4-5（42.9%）和L5-S1（33.3%）最为常见。与单核细胞来源的巨噬细胞共培养3天后，外植体保持了结构和较高的蛋白聚糖/胶原比。流式细胞术分析显示，外植体改变了巨噬细胞的免疫谱，增加了促炎CD86+细胞的比例，同时降低了抗炎CD163+细胞的比例。此外，M2a表型细胞较大，对外植体的吞噬能力最强。结论sm2a巨噬细胞在设计以巨噬细胞为基础的LDH治疗方案中表现出最大的潜力。这项研究为转化医学带来了巨大的希望，旨在通过生理治疗加速自发性LDH，从而避免手术干预的需要。

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引用次数: 0

Long-term impact of acute knee injury with hemarthrosis: Osteoarthritis incidence and patient-reported outcomes in a large consecutive cohort over 12 years 急性膝关节损伤合并血肿的长期影响：在一项超过12年的大型连续队列中，骨关节炎的发病率和患者报告的结果

IF 2.8

Osteoarthritis and cartilage open

Pub Date : 2025-11-01 DOI: 10.1016/j.ocarto.2025.100700

Anders Isacsson , Aleksandra Turkiewicz , Ola Olsson , Jamie S. Brown , Johan Hesslow , Patrik Bengtsson , Armaghan Mahmoudian , Richard B. Frobell , Jaanika Paemre , Martin Englund

Objective

To estimate the 12-year risk of radiographic and/or symptomatic knee osteoarthritis following different MRI-confirmed soft-tissue knee injuries.

Design

Prospective cohort study including 814 (70 %) of 1129 consecutive patients after acute knee trauma with hemarthrosis in a single hospital. Injuries were classified by sub-acute knee MRI. Follow-up comprised bilateral knee radiography and Knee injury and Osteoarthritis Outcome Score. The main outcomes were radiographic and symptomatic knee osteoarthritis. We estimated differences between injury types and injured versus contralateral knees.

Results

The incidence proportion of radiographic knee osteoarthritis was 34 % (95 % confidence interval 30 to 37) in injured knees and 18 % (15, 20) in contralateral knees. Knees with hemarthrosis but no structural injury developed radiographic osteoarthritis and symptomatic osteoarthritis in 6 % and 4 %, respectively, as compared to 36 % and 21 % of those with structural injury, with risk ratios (95 % confidence interval) of 8 (3, 21) for radiographic osteoarthritis and 6 (2, 20) for symptomatic osteoarthritis. The risk ratio of tibiofemoral osteoarthritis in the injured knee compared to the contralateral knee was 2.2 (1.7, 2.8), with the highest ratio of 3.1 (2.1, 4.6) observed after combined anterior cruciate ligament (ACL) and meniscus injury. Overall, 81 % (78, 84) reported satisfaction with their knee function, though satisfaction was lower following patellar dislocation.

Conclusions

Structural soft-tissue knee injury doubled the risk of radiographic and symptomatic knee osteoarthritis versus the contralateral knee over 12 years with significant variation based on injury type. ACL rupture combined with meniscus tear conferred the highest risk while hemarthrosis alone the lowest.

目的评估不同mri证实的膝关节软组织损伤后12年内发生影像学和/或症状性膝骨关节炎的风险。前瞻性队列研究包括一家医院1129例急性膝外伤合并关节血肿患者中的814例（70%）。通过亚急性膝关节MRI对损伤进行分类。随访包括双侧膝关节x线摄影和膝关节损伤及骨关节炎结局评分。主要结果为影像学和症状性膝骨关节炎。我们估计了损伤类型和损伤与对侧膝盖之间的差异。结果膝关节骨性关节炎在损伤膝的发生率为34%(95%可信区间30 ~ 37)，在对侧膝的发生率为18%（15,20）。膝关节有血肿但无结构性损伤的患者发生影像学骨关节炎和症状性骨关节炎的比例分别为6%和4%，而结构性损伤的患者分别为36%和21%，影像学骨关节炎的风险比（95%可信区间）为8(3,21)，症状性骨关节炎的风险比为6（2,20）。损伤膝关节与对侧膝关节发生胫股骨关节炎的风险比为2.2(1.7,2.8)，前交叉韧带（ACL）与半月板联合损伤后风险比最高，为3.1（2.1,4.6）。总体而言，81%（78,84）的患者对其膝关节功能表示满意，尽管髌骨脱位后满意度较低。结论：与对侧膝关节相比，结构性膝关节软组织损伤在12年内发生影像学和症状性膝骨关节炎的风险增加了一倍，且损伤类型存在显著差异。前交叉韧带破裂合并半月板撕裂的风险最高，而单纯关节出血的风险最低。

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引用次数: 0

Minimal important change of the knee injury and osteoarthritis outcome score in patients with mild to moderate knee osteoarthritis – using three different anchor-based methods 轻度至中度膝骨关节炎患者膝关节损伤和骨关节炎预后评分的微小重要变化-使用三种不同的基于锚定的方法

IF 2.8

Osteoarthritis and cartilage open

Pub Date : 2025-10-29 DOI: 10.1016/j.ocarto.2025.100699

Henriette Killingrød Lundquist , Britt Elin Øiestad , Joseph Sexton , May Arna Risberg , Nina Østerås

Objective

To estimate Minimal Important Change (MIC) for improvement in the Knee injury and Osteoarthritis Outcome Score (KOOS) in patients with mild to moderate knee osteoarthritis (OA), using three recommended anchor-based methods, and examine how methodological choices influence these estimates.

Design

Secondary analysis of a three-arm randomized controlled trial. KOOS and a Global Rating of Change (GROC) scale were collected at baseline and 4-month follow-up. MIC values were estimated using predictive modeling, Mean Change, and Receiver Operating Characteristic (ROC) methods. Sensitivity analyses assessed the impact of different anchor cut-offs.

Results

Data were available for 131 patients undergoing non-surgical treatment (mean age 57.4 years, 50 % female). At follow-up, 19 % reported important improvement. Using the predictive modeling method, which allows adjustment for the low proportion of patients reporting important improvement, MICs were 11.3 (Pain), 12.1(Symptoms), 10.2 (ADL), 15.5 (Sport/Rec) and 13.2 (QoL). The Mean Change method yielded comparable MICs (range 10.6–16.1), but due to its reliance on a small subgroup, it is generally considered less robust and showed wider CIs in our sample. ROC-based MICs ranged from −0.4 to 12.5 and were associated with wide CIs, and high misclassification rates. Sensitivity analyses showed lower MICs with broader improvement definitions were used.

Conclusion

MIC estimates for KOOS varied considerably by method. Predictive modeling yielded the most precise MIC estimates and should be considered for future research, particularly when the proportion of improved patients deviates from 50 %. These results also highlight the importance of methodological transparency for interpreting PROMs in non-surgical knee OA treatment.

目的：使用三种推荐的基于锚定的方法，评估轻度至中度膝骨关节炎（OA）患者膝关节损伤和骨关节炎结局评分（oos）改善的最小重要改变（MIC），并检查方法学选择如何影响这些评估。设计：三组随机对照试验的二次分析。在基线和4个月随访时收集oos和全球变化评级（GROC）量表。MIC值采用预测建模、平均变化和受试者工作特征（ROC）方法估计。敏感性分析评估了不同锚固截止点的影响。结果131例患者接受非手术治疗，平均年龄57.4岁，女性占50%。在随访中，19%的人报告了重要的改善。使用预测建模方法，允许对报告重要改善的患者比例低进行调整，mic为11.3（疼痛），12.1（症状），10.2 (ADL), 15.5（运动/运动）和13.2（生活质量）。平均变化方法产生了可比的mic（范围10.6-16.1），但由于它依赖于一个小的亚组，它通常被认为不太健壮，并且在我们的样本中显示出更宽的ci。基于roc的mic范围为- 0.4至12.5，与较宽的ci和较高的误分类率相关。敏感性分析显示，使用了较低的mic和更广泛的改进定义。结论不同方法对kos的mic估计差异很大。预测模型产生了最精确的MIC估计，应该在未来的研究中加以考虑，特别是当改善患者的比例偏离50%时。这些结果也强调了在非手术治疗膝关节OA中解释PROMs的方法透明度的重要性。

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引用次数: 0

Willingness to participate in a randomized trial of surgical vs. nonoperative care among patients with meniscal tear and knee pain after a course physical therapy 在半月板撕裂和膝关节疼痛患者经过一个疗程的物理治疗后，是否愿意参加手术与非手术治疗的随机试验

IF 2.8

Osteoarthritis and cartilage open

Pub Date : 2025-10-29 DOI: 10.1016/j.ocarto.2025.100698

Katharine B. Fox , Kyna Long , Jon Dhani , Faith Selzer , Andrea L. Carland , Paul M. Oh , Nomi S. Weiss-Laxer , Jeffrey N. Katz

Objective

Randomized controlled trials (RCTs) frequently fail to meet sample size requirements within their proposed timeline. Prospective preference assessments (PPAs) estimate the number of eligible individuals likely to enroll. The COSMIC Trial (Conservative care or Surgery for Meniscal tear after IneffeCtive physical therapy), currently in planning stages, will compare arthroscopic partial meniscectomy (APM) to non-operative treatment among those with meniscal tear who experience knee pain following a course of physical therapy (PT). We conducted a PPA to estimate willingness to enroll in the hypothetical trial and identify factors associated with willingness.

Method

We invited eligible patients 45–85 years old with meniscal tear who were prescribed PT to participate in the PPA. Participants completed up to two questionnaires: one prior to a course of PT (Baseline questionnaire), and another following 10 weeks of PT (End of PT questionnaire). Both questionnaires assessed willingness to enroll in the COSMIC trial and knee treatment preferences.

Results

In total, 94 participants completed both questionnaires, and 50 completed the End of PT questionnaire only. For those who completed both questionnaires, willingness to enroll in the hypothetical COSMIC RCT fell from 62 % at Baseline to 46 % in the End of PT questionnaires. Respondents’ strongest preference was to avoid APM (47 %). Preference for APM at baseline was associated with willingness to enroll.

Conclusions

Our findings suggest that about half of eligible patients would be willing to participate in the COSMIC RCT and that, except for APM, participants’ preference for treatments was not strongly related to willingness to participate.

目的随机对照试验（rct）经常不能在其规定的时间内满足样本量要求。前瞻性偏好评估（PPAs）估计可能注册的符合条件的个人数量。目前处于计划阶段的COSMIC试验（物理治疗无效后半月板撕裂的保守治疗或手术治疗）将比较关节镜半月板部分切除术（APM）和非手术治疗在物理治疗（PT）后经历膝关节疼痛的半月板撕裂患者。我们进行了PPA来估计参加假设试验的意愿，并确定与意愿相关的因素。方法邀请45 ~ 85岁经PT治疗的半月板撕裂患者参加PPA。参与者最多完成两份问卷：一份在治疗前（基线问卷），另一份在治疗后10周（治疗结束问卷）。两份问卷都评估了参加COSMIC试验的意愿和膝关节治疗偏好。结果共94名参与者完成了两份问卷，50名参与者只完成了治疗结束问卷。对于那些完成了两份问卷的人来说，参加假设的COSMIC RCT的意愿从基线时的62%下降到PT结束时的46%。受访者最强烈的偏好是避免APM（47%）。基线时对APM的偏好与入组意愿相关。结论我们的研究结果表明，约有一半的符合条件的患者愿意参加COSMIC RCT，除APM外，参与者对治疗的偏好与参与意愿不强相关。

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引用次数: 0

Erratum to ‘Causal association between subtypes of osteoarthritis and common comorbidities: A Mendelian randomisation study’ [Osteoarthritis and Cartilage Open 5 (2023) 100414] 骨关节炎亚型与常见合共病之间的因果关系：一项孟德尔随机研究[osteoarthritis and Cartilage Open 5(2023) 100414]的勘误

IF 2.8

Osteoarthritis and cartilage open

Pub Date : 2025-10-26 DOI: 10.1016/j.ocarto.2025.100660

Will Thompson , Subhashisa Swain , Sizheng Steven Zhao , Anne Kamps , Carol Coupland , Changfu Kuo , Sita Bierma-Zeinstra , Jos Runhaar , Michael Doherty , Weiya Zhang

引用次数: 0

Comparison of three different therapeutic interventions in the management of knee osteoarthritis: Randomized controlled parallel group pilot trial 膝关节骨性关节炎三种不同治疗干预措施的比较：随机对照平行组先导试验

IF 2.8

Osteoarthritis and cartilage open

Pub Date : 2025-10-17 DOI: 10.1016/j.ocarto.2025.100697

Vilma Dudonienė , Daumantas Bitinas , Laura Žlibinaitė

Objective

The study aimed to compare the effectiveness of different physical interventions on pain intensity, knee function, and quality of life in patients with knee osteoarthritis (OA).

Methods

This pilot trial involved 63 patients (45–55 yrs) in a rehabilitation center. Patients were randomly assigned to three groups: therapeutic exercise alone (TE, n = 21), TE and cryotherapy (TE-Cr, n = 21), and TE and joint mobilization (TE-JM, n = 21). The primary outcome was pain intensity, secondary outcomes included knee joint function (WOMAC), muscle strength, knee joint range of motion (ROM), and quality of life (SF-36). Data were collected at baseline and after 18 days of inpatient rehabilitation.

Results

There were no significant between-group differences in the primary outcome at baseline. After 18 days, all intervention groups showed significant improvements (p < 0.05). The TE-JM group reported lower (p < 0.05) pain levels (3.24 ± 1.04) compared to the TE-only (4.76 ± 0.77) and TE-Cr (4.86 ± 0.57) groups. The TE-Cr group had a lower (p < 0.05) SF-36 total score (52.81 ± 10.50) than the TE (62.00 ± 9.74) and TE-JM (66.62 ± 2.87) groups. No significant between-group differences were observed in ROM or muscle strength. The WOMAC total score was lower (p < 0.05) in the TE-JM group (27.3 ± 13.9) compared to the TE-Cr group (40.1 ± 10.7).

Conclusion

Although all three interventions had beneficial short-term effects, leading to reductions in knee pain and improvements in physical function and quality of life, but no single intervention demonstrated superior effectiveness across all assessed outcomes.

Trial registration

ClinicalTrials.gov, http://www.clinicaltrials.gov, NCT05636059.

目的比较不同物理干预对膝关节骨性关节炎（OA）患者疼痛强度、膝关节功能和生活质量的影响。方法本试验纳入康复中心63例患者（45-55岁）。患者随机分为三组：单纯运动治疗组（TE, n = 21）、TE联合冷冻治疗组（TE- cr, n = 21）、TE联合关节活动组（TE- jm, n = 21）。主要终点是疼痛强度，次要终点包括膝关节功能（WOMAC）、肌肉力量、膝关节活动范围（ROM）和生活质量（SF-36）。在基线和住院康复18天后收集数据。结果两组间基线时主要转归无显著差异。18 d后，各干预组均有显著改善（p < 0.05）。TE-JM组疼痛水平（3.24±1.04）低于单纯te组（4.76±0.77）和TE-Cr组（4.86±0.57）（p < 0.05）。TE- cr组SF-36总分（52.81±10.50）低于TE组（62.00±9.74）和TE- jm组（66.62±2.87）（p < 0.05）。在ROM和肌力方面，组间无显著差异。TE-JM组WOMAC总分（27.3±13.9）低于TE-Cr组（40.1±10.7），差异有统计学意义（p < 0.05）。结论：虽然这三种干预措施都有短期效果，可以减少膝关节疼痛，改善身体功能和生活质量，但没有一种干预措施在所有评估结果中都显示出优越的效果。临床试验注册：clinicaltrials.gov, http://www.clinicaltrials.gov, NCT05636059。

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引用次数: 0

Methodology and predictive accuracy of the prospective preference assessment for randomized trial enrollment: A literature review 随机试验入组前瞻性偏好评估的方法学和预测准确性：文献综述

IF 2.8

Osteoarthritis and cartilage open

Pub Date : 2025-10-15 DOI: 10.1016/j.ocarto.2025.100696

Jon S. Dhani , Faith Selzer , Jamie E. Collins , Katharine B. Fox , Paul Oh , Elena Losina , Jeffrey N. Katz

Objective

The success of a randomized controlled trial (RCT) depends, in part, on the willingness to participate (WTP) of eligible subjects. Prospective preference assessments (PPA) offer insights into future RCT enrollment by evaluating eligible individuals’ WTP in the RCT. We sought to summarize the methods and findings of published PPAs and to compare the WTP estimates of published PPAs to the actual enrollment rates from these trials.

Design

We performed a systematic literature search using PubMed for studies that assessed eligible participants’ WTP in a hypothetical trial. We abstracted sample size, proposed interventions, WTP response options, WTP percentage, presence of qualitative analyses, and assessment of trial feasibility from each publication. We defined WTP as a response of “probably” or “definitely” willing in the PPA; in sensitivity analyses, we included only “definitely” willing responses. We searched for registered and published RCTs connected to each PPA and extracted enrollment data from the corresponding trial publications where available.

Results

We identified 40 PPAs. The median WTP across all PPAs was 54.9 % (range: 13 %–92.4 %), and 42.1 % (range: 7 %–90.2 %) when including only “definitely willing” responses. We found ten registered RCTs; five are completed and one is ongoing. Four PPAs with a RCT provided both “definitely willing” and “total willing” estimates. In three of these four RCTs, the actual enrollment fell between the “definitely willing” and “total willing” PPA estimates.

Conclusion

“Definitely willing” and “total willing” findings in a PPA may provide useful upper and lower boundaries on participation for future trial planning.

目的一项随机对照试验（RCT）的成功在一定程度上取决于受试者的参与意愿（WTP）。前瞻性偏好评估（PPA）通过评估符合条件的个体在RCT中的WTP，为未来的RCT入组提供洞见。我们试图总结已发表的PPAs的方法和发现，并将已发表的PPAs的WTP估计与这些试验的实际入组率进行比较。设计我们使用PubMed进行了系统的文献检索，以评估假设试验中符合条件的参与者的WTP。我们从每份出版物中提取样本量、建议的干预措施、WTP反应选项、WTP百分比、存在定性分析和试验可行性评估。我们将WTP定义为PPA中“可能”或“肯定”愿意的响应；在敏感性分析中，我们只包括“绝对”愿意的反应。我们检索了与每个PPA相关的已注册和已发表的rct，并从相应的试验出版物中提取了可用的入组数据。结果共鉴定出40个ppa。在所有ppa中，WTP的中位数为54.9%（范围：13% - 92.4%），当只包括“绝对愿意”的回应时，WTP的中位数为42.1%（范围：7% - 90.2%）。我们找到了10个已注册的随机对照试验；五个已经完成，一个正在进行中。带有随机对照试验的四个ppa提供了“绝对愿意”和“完全愿意”的估计。在这四项随机对照试验中，有三项的实际入学人数介于“绝对愿意”和“完全愿意”的PPA估计之间。结论：PPA中“绝对自愿”和“完全自愿”的结果可以为今后的试验规划提供有用的参与上限和下限。

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引用次数: 0

Radiographic prevalence and associated factors of hallux rigidus in a large-scale population-based cohort 在大规模人群为基础的队列中，拇僵直的放射学患病率及相关因素

IF 2.8

Osteoarthritis and cartilage open

Pub Date : 2025-10-11 DOI: 10.1016/j.ocarto.2025.100695

Yuko Yagi , Takumi Matsumoto , Akihiro Uchio , Ryutaro Takeda , Toshiko Iidaka , Chiaki Horii , Hiroyuki Oka , Shigeyuki Muraki , Hiroshi Hashizume , Hiroshi Yamada , Munehito Yoshida , Kozo Nakamura , Sakae Tanaka , Noriko Yoshimura

Objective

Hallux rigidus (HR), a form of osteoarthritis (OA) affecting the first metatarsophalangeal joint, significantly impairs mobility and quality of life. Despite its clinical importance, large-scale epidemiological studies on radiographic HR prevalence and associated factors remain limited. This study investigated the radiographic prevalence of HR and its associated factors in a large, population-based Japanese cohort.

Design

Data were obtained from 1998 participants (654 men, 1344 women) in the fifth survey of the nationwide Research on Osteoarthritis/Osteoporosis Against Disability (ROAD) study. Non-weight-bearing dorsoplantar foot radiographs were assessed using the Hattrup and Johnson classification (grade 1: mild, grade 2: moderate, and grade 3: severe); HR was defined as grade ≥1. Multivariable logistic regression assessed associated factors, and the Cochran-Armitage trend test evaluated severity-related trends.

Results

The mean age was 64.2 ± 12.7 years. The overall HR prevalence was 23.5 % (25.1 % in men, 22.8 % in women), with no significant sex difference. Unilateral and bilateral HR were 6.6 % and 17.0 % of participants, respectively. HR was classified as mild (13.3 %), moderate (7.0 %), or severe (3.3 %). Multivariable analysis identified older age, coastal residence, gout history, and knee OA as independent factors associated with HR. HR severity showed significant linear trends with both gout and knee OA.

Conclusions

This study determined the radiographic prevalence of HR of 23.5 % in a Japanese population. Independent factors associated with HR included older age, coastal residence, gout, and knee OA. Findings indicate that HR is multifactorial and highlight the need to explore geographic and lifestyle-related factors in addition to medical conditions.

趾刚性（HR）是一种影响第一跖趾关节的骨关节炎（OA），严重影响活动能力和生活质量。尽管具有临床重要性，但对放射学HR患病率及其相关因素的大规模流行病学研究仍然有限。本研究调查了日本人群中HR的放射学患病率及其相关因素。设计数据来自1998名参与者（654名男性，1344名女性），参与了全国性的骨关节炎/骨质疏松症抗残疾研究（ROAD）的第五次调查。采用Hattrup和Johnson分级（1级：轻度，2级：中度，3级：重度）评估非负重背跖足x线片；HR定义为≥1级。多变量logistic回归评估相关因素，Cochran-Armitage趋势检验评估严重程度相关趋势。结果患者平均年龄64.2±12.7岁。总体HR患病率为23.5%（男性25.1%，女性22.8%），无显著性别差异。单侧和双侧HR分别为6.6%和17.0%。HR分为轻度（13.3%）、中度（7.0%）和重度（3.3%）。多变量分析发现，年龄较大、沿海居住、痛风史和膝关节OA是与HR相关的独立因素。HR严重程度与痛风和膝关节OA均呈显著的线性趋势。结论：本研究确定了日本人群中HR的放射学患病率为23.5%。与HR相关的独立因素包括年龄较大、沿海居住、痛风和膝关节OA。研究结果表明，人力资源是多因素的，除了医疗条件外，还需要探索地理和生活方式相关因素。

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引用次数: 0

Changes in knee pain and walking speed following primary, unilateral total knee arthroplasty and their association: A systematic review and meta-analysis 原发性单侧全膝关节置换术后膝关节疼痛和步行速度的变化及其相关性：一项系统回顾和荟萃分析

IF 2.8

Osteoarthritis and cartilage open

Pub Date : 2025-10-10 DOI: 10.1016/j.ocarto.2025.100694

Nico Faber , Matej Skrobot , Georg N. Duda, Nicholas M. Brisson

Objective

To quantify changes in knee pain and walking speed following primary, unilateral total knee arthroplasty (TKA) for knee osteoarthritis, and to examine their relationship during recovery. Walking speed is a key indicator of functional recovery and long-term health, but whether pain relief translates into improved mobility remains unclear.

Design

A systematic review and meta-analysis was conducted following PRISMA guidelines. PubMed was searched to September 2025 for studies reporting pre- and post-TKA values of knee pain (WOMAC-pain or KOOS-pain) and self-selected walking speed in adults undergoing primary, unilateral TKA. Pooled changes were calculated using inverse-variance weighted random-effects models. Meta-regression explored associations between pain and walking speed, adjusting for covariates.

Results

Eighteen studies (n = 819; 64.1 % female; age 65.1 ± 8.3 years; body mass index 28.4 ± 5.9 kg/m²) were included. Knee pain significantly decreased by 27–36 points (WOMAC-pain) and 19–40 points (KOOS-pain), exceeding minimal clinically important differences. Walking speed increased by +0.12 m/s at 3 months and +0.18 m/s at 12 months, both exceeding the +0.1 m/s threshold for clinically relevant change. No significant change in speed occurred before 3 months, and a non-significant decline appeared beyond 12 months. Meta-regression revealed greater knee pain (β = −0.005, p < 0.001) and use of WOMAC-pain (vs. KOOS-pain) (β = −0.224, p < 0.001) predicted slower walking speed (R² = 0.48, p < 0.001).

Conclusions

TKA yields substantial pain relief and improved walking speeds by 3–12 months. However, mobility gains are not sustained beyond one year and are influenced by pain. Postoperative care should support both symptoms and mobility to improve long-term outcomes.

目的量化原发性单侧全膝关节置换术（TKA）治疗膝关节骨性关节炎后膝关节疼痛和步行速度的变化，并探讨其在康复过程中的关系。步行速度是功能恢复和长期健康的关键指标，但疼痛缓解是否转化为活动能力的改善尚不清楚。DesignA系统评价和荟萃分析遵循PRISMA指南。PubMed检索到2025年9月，研究报告了原发性单侧TKA成人膝关节疼痛（womac疼痛或koos疼痛）的术前和术后膝关节疼痛值和自我选择的步行速度。使用反方差加权随机效应模型计算合并变化。元回归探讨了疼痛和步行速度之间的关系，调整了协变量。结果共纳入18例研究（819例，女性64.1%，年龄65.1±8.3岁，体重指数28.4±5.9 kg/m2）。膝关节疼痛明显减少27-36分（WOMAC-pain）和19-40分（KOOS-pain），超过最小的临床重要差异。行走速度在3个月时增加+0.12 m/s，在12个月时增加+0.18 m/s，均超过了临床相关变化的+0.1 m/s阈值。速度在3个月前无显著变化，12个月后无显著下降。meta回归显示膝关节疼痛加重（β = - 0.005, p < 0.001），使用WOMAC-pain（与KOOS-pain相比）（β = - 0.224, p < 0.001）预测步行速度减慢（R2 = 0.48, p < 0.001）。结论：3-12个月后，stka可显著缓解疼痛，提高步行速度。然而，活动能力的提高不能持续超过一年，并且受到疼痛的影响。术后护理应支持症状和活动能力，以改善长期预后。

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