Explore the vast range of titles available.

Pain, the primary symptom of osteoarthritis (OA), reduces both the quality and quantity of life for patients. The pathophysiology of OA pain is complex and often difficult to explain solely by radiological structural changes. One reason for this discrepancy is pain sensitization (peripheral sensitization [PS] and central sensitization [CS]) in OA. Thus, an understanding of pain sensitization is important when considering treatment strategies and development for OA pain. In recent years, pro-inflammatory cytokines, nerve growth factors (NGFs), and serotonin have been identified as causative agents that induce peripheral and central sensitization and are becoming therapeutic targets for OA pain. However, the characteristics of the clinical manifestations of pain sensitization elicited by these molecules remain unclear, and it is not well understood who among OA patients should receive the therapeutic intervention. Thus, this review summarizes evidence on the pathophysiology of peripheral and central sensitization in OA pain and the clinical features and treatment options for this condition. While the majority of the literature supports the existence of pain sensitization in chronic OA pain, clinical identification and treatment of pain sensitization in OA are still in their infancy, and future studies with good methodological quality are needed.

Cervical ossification of the posterior longitudinal ligament (OPLL) is a contributing factor to spinal cord injury or trauma-induced myelopathy in the elderly. To reduce the incidence of these traumas, it is essential to diagnose OPLL at an early stage and to educate patients how to prevent falls. We thus evaluated the ability of our convolutional neural network (CNN) to differentially diagnose cervical spondylosis and cervical OPLL. We enrolled 250 patients with cervical spondylosis, 250 patients with cervical OPLL, and 180 radiographically normal controls. We evaluated the ability of our CNN model to distinguish cervical spondylosis, cervical OPLL, and controls, and the diagnostic accuracy was compared to that of 5 board-certified spine surgeons. The accuracy, average recall, precision, and F1 score of the CNN for classification of lateral cervical spine radiographs were 0.86, 0.86, 0.87, and 0.87, respectively. The accuracy was higher for CNN compared to any expert spine surgeon, and was statistically equal to 4 of the 5 experts and significantly higher than that of 1 expert. We demonstrated that the performance of the CNN was equal or superior to that of spine surgeons.

The collar of a cementless stem in total hip arthroplasty (THA) improves fixation and stability by connecting with the femoral calcar. Proper attachment is essential for reducing micromotion and preventing periprosthetic fractures of the femur. However, gaps between the femoral calcar and stem collar can occur during surgery, and it is unclear what degree of gap can be tolerated. This study evaluated 156 patients who received primary THA with the CORAIL stem. Medial and lateral gap distance were measured by frontal X-ray of the hip joint at 1 week and 1, 3, 6, 12, 24, and 36 months after THA. Clinical outcomes were assessed using Japanese Orthopaedic Association hip scores, and radiographic assessments included femoral morphology and stem subsidence. Gaps were initially observed in 55 patients, with 42 showing complete gap disappearance within 36 months. On logistic regression analysis, lateral gap distance was shown to significantly influence gap disappearance, with an optimal cut-off of 5.5 mm by receiver operating characteristic curve analysis. A smaller lateral gap was correlated with quicker closure. Our findings suggest that a lateral gap ≤ 5.5 mm allows postoperative bone remodeling to close the gap, contributing to long-term implant stability in THA using the CORAIL stem.

IntroductionThe significance of the relationship between the spine and hip joints has been frequently discussed. However, the relationship between acetabular coverage and spinal sagittal alignment has not been fully elucidated as previous studies did not adequately control for factors that might affect the spinopelvic alignment. The aim of this study was to elucidate the impact of acetabular coverage on spinal sagittal alignment by comparing patient groups matched on sex, age, and the presence of hip and anterior impingement pain.Materials and methodsWe prospectively enrolled 30 women undergoing periacetabular osteotomy (PAO) for developmental dysplasia of the hip (DDH) and 30 women undergoing hip arthroscopic surgery (HAS) for labral tears. The lateral centre edge angle was measured on hip radiographs. In addition, the sagittal vertical axis, pelvic tilt, pelvic incidence, sacral slope (SS), and lumbar lordosis (LL) were measured on preoperative plain radiographs of the whole spine to assess the sagittal spinal alignment. Clinical and radiologic data were compared between the two groups (PAO vs. HAS).ResultsThe patient groups did not differ in age and body mass index. The mean SS was significantly greater in the PAO group (41.6° ± 1.6°) than in the HAS group (35.3° ± 1.5°; P = 0.0039). Additionally, the mean LL was significantly greater in the PAO group (54.5° ± 2.0°) than in the HAS group (45.1° ± 1.9°; P = 0.0015).ConclusionsThe SS and LL were greater in patients with DDH than in patients with hip pain, but without DDH. Patients with DDH might show lumbar hyperlordosis to rotate the pelvis anteriorly, increasing the anterosuperior acetabular coverage.

Background Labral tear can be the initiating factor in the onset of hip osteoarthritis (HOA). However, the physiopathology of labral tear is not fully understood. Our aim was to compare synovial tissue inflammatory cytokine levels between patients with labral tear and late-stage HOA. Methods Synovial tissue from sites showing the greatest inflammation was harvested from 106 hips from 100 subjects during hip surgery. RNA was extracted, and levels of TNFA , IL1B , IL6 and COX2 mRNA were compared among all patients using real-time PCR. Additionally, we examined whether femoroacetabular impingement (FAI) was associated with elevated levels of inflammatory cytokines in patients with labral tear. To analyze the effects of TNF-α on inflammatory mediators in hip synovial tissue, synovial fibroblasts were extracted from hip synovial tissue of patients with labral tear and late-stage HOA ( n  = 5 each). Mononuclear cells were extracted from synovial tissue, cultured for 7 days, and stimulated with control or 10 ng/mL human recombinant TNF-α for 1 day. mRNA was extracted from stimulated cells and IL1B , IL6 , and COX2 levels were determined using real-time PCR. Results TNFA , IL1B, and COX2 expression in synovial tissue were significantly higher in patients with labral tear than late-stage HOA ( TNFA , p  <  0.001; IL1B , p  <  0.001; COX2 , p  = 0.001). There were no differences in expression between patients with labral tear with and without FAI ( TNFA , p  = 0.546; IL1B , p  = 0.559; IL6 , p  = 0.599; COX2 , p  = 0.124). Compared to vehicle control, TNF-α stimulation significantly elevated IL1B , IL6, and COX2 expression in synovial fibroblasts collected from patients with labral tear and late-stage HOA ( IL1B , p  = 0.043 and p  = 0.043; IL6 , p  = 0.043 and 0.043; COX2 , p  = 0.043 and p  = 0.080, respectively). Conclusions TNFA , IL1B, and COX2 expression were elevated in the synovial tissue of patients with labral tear. Further investigations are needed to reveal the relationship between inflammatory cytokine levels and various aspects of labral tear pathology, including pain and the onset and progression of OA.

Background Suction drainages are commonly used after total knee arthroplasty (TKA) procedures; however, their use is somewhat controversial. Recently, some reports have claimed that the administration of tranexamic acid (TXA) may prevent postoperative bleeding following TKAs. Although numerous studies have reported regarding different dosages, timings of administration, or drain clamping times for intravenous and intra-articular TXA injections (IA-TXAs), few have examined whether suction drainage is necessary when TXA is administered. In this study, we compared using suction drainage without TXA administration and IA-TXA without suction drainage and aimed to examine the need for suction drainage during IA-TXA. Methods This retrospective study was conducted on 217 patients who had received TKA for osteoarthritis; 104 were placed on suction drainage after TKA without TXA (Group A), whereas the remaining 113 received IA-TXA immediately after surgery without suction drainage (Group B). Our clinical evaluation included assessments of the need for transfusion, presence of postoperative complications, incidence of deep vein thrombosis (DVT), and changes in hemoglobin (Hb), hematocrit (Hct), and D-dimer levels. Results No significant differences were observed in terms of postoperative complications and preoperative Hb, Hct, or D-dimer levels between the two groups. Although the prevalence of DVT was significantly higher in Group B ( p  < 0.05), all cases were asymptomatic. Hb and Hct levels were significantly lower in Group A than in Group B at 1, 3, 7, and 14 days postoperatively ( p  < 0.05), although none of the cases required blood transfusions. D-dimer levels were significantly higher in Group A than in Group B at 1 and 3 days postoperatively ( p  < 0.05). Conclusion Suction drainage might not be necessary when IA-TXA is administered after TKA procedures.

Background Research suggests that vascular endothelial growth factor (VEGF) levels in the synovial fluid of knee osteoarthritis (KOA) patients are positively correlated with KOA severity. The relationship between synovial VEGF levels and pain in human KOA patients is not fully understood, and the role of VEGF in the pain pathway remains unclear. Methods We harvested synovial membrane (SM) from 102 patients with radiographic evidence of KOA (unilateral Kellgren/Lawrence [K/L] grade 2–4) during total knee arthroplasty. Patients scored their pain on a 0 to 10 cm visual analog scale (VAS). VEGF levels in the SM of KOA patients with strong/severe (VAS ≥ 6) and mild/moderate pain (VAS < 6) were compared. Correlations between VAS and VEGF mRNA expression were investigated. To investigate a possible mechanism for VEGF-induced pain, the distribution of VEGF and the neuropeptide apelin was determined by immunohistochemical analyses. To investigate the role of VEGF in regulating apelin expression, SM cells were exposed to VEGF. Results VEGF expression in the VAS ≥ 6 group was significantly greater than expression in the VAS < 6 group. Expression levels of VEGF were also positively correlated with VAS. VEGF-positive cells were identified in the lining of the SM. Expression of apelin mRNA and protein were significantly elevated in SM cells treated with exogenous VEGF compared to those treated with vehicle. Conclusion Synovial VEGF may be involved in pain pathways in KOA and its action may be mediated by apelin.

The incidence of surgical site infection (SSI) is higher in spinal surgeries than in general orthopedic operations. In this study, we aimed to develop a scoring system with reduced health care costs for detecting spinal surgery patients at high risk for SSI. Retrospective cohort study. In total, 824 patients who underwent spinal surgery at 2 university hospitals from September 2005 to May 2011. We reviewed the medical records of 824 patients, and we examined 19 risk factors to identify high-risk patients. After narrowing down the variables by univariate analysis, multiple logistic analysis was performed for factors with P values <.2, using SSI as a dependent variable. Only factors that showed P values <.05 were included in the final models, and each factor was scored based on the β coefficient values obtained. The clinical prediction rules were thereby prepared. \"Emergency operation,\" \"blood loss >400 mL,\" \"presence of diabetes,\" \"presence of skin disease,\" and \"total serum albumin value <3.2 g/dL\" were detected by multivariable modeling and were incorporated into the risk scores. Applying these 5 independent predictive factors, we were able to predict the infection incidence after spinal surgery. Our present study could aid physicians in making decisions regarding prevention strategies in patients undergoing spinal surgery. Stratification of risks employing this scoring system will facilitate the identification of patients most likely to benefit from complex, time-consuming and expensive infection prevention strategies, thereby possibly reducing healthcare costs.

Background Total hip arthroplasty (THA) is widely used to treat hip osteoarthritis (HOA), particularly in elderly patients. However, the associated costs and complications highlight the need for strategies to shorten hospital stays and optimise postoperative outcomes. This study aimed to investigate the effect of preoperative nutritional status and postoperative dietary intake on the discharge outcomes of patients with unilateral HOA who underwent THA. Methods A retrospective analysis of 57 patients without significant comorbidities out of 172 THA procedures performed by the same surgeon was conducted. Propensity score matching was used to compare the early discharge group ( n  = 14), discharged within 2 weeks, with the delayed discharge group ( n  = 14), hospitalised for longer. The assessed factors included preoperative Controlling Nutritional Status (CONUT) scores, postoperative dietary intake (staple foods and side dishes), and complications. Results Preoperative malnutrition, as assessed using the CONUT score, showed no significant difference between the groups. The early discharge group exhibited a higher intake of staple foods (rich in carbohydrates) in the early postoperative phase than the delayed discharge group, potentially influencing earlier discharge. No significant difference was observed in side dish intake between the two groups. The incidence of complications did not differ between the two groups. Conclusion Higher intake of staple foods in the early postoperative period may positively impact metabolic demands and wound healing, suggesting the importance of dietary strategies in postoperative rehabilitation. Ensuring adequate hospital meal consumption and implementing effective dietary guidance and education are crucial for optimising recovery and reducing hospital stay. This study highlights that postoperative feeding strategies, especially staple food intake, may have a positive impact on early discharge in THA patients. Future studies should explore the benefits of long-term nutritional interventions and the role of continuous dietary education in enhancing postoperative recovery.

Obesity is a risk factor for knee osteoarthritis (KOA). Neuromedin U (NMU) and NMU receptors (NMUR1 and NMUR2) are associated with obesity-related disorders and found in mast cells (MCs), which are elevated in osteoarthritis. However, NMU/NMUR expression was not examined in the synovial membrane (SM) or synovial MCs of obese osteoarthritis patients. We compared expression of NMU, NMUR1, NMUR2, and the mast cell (MC) marker, CPA3, in the SM of KOA patients categorized as normal weight (NW; BMI < 25 kg/m2, n = 79), overweight (OW; BMI ≥ 25 and <30 kg/m2, n = 87), and obese (OB; ≥30 kg/m2, n = 40). To study NMU/NMUR expression in MCs, we compared the MC-rich fraction (MC-RF), CD88(+) MC-RF, and CD88(−) MC-RF, extracted using magnetic isolation, with the MC-poor fraction (MC-PF). While NMU and NMUR2 expression were comparable, NMUR1 was significantly elevated in OW and OB compared to NW. Moreover, CPA3 levels were significantly greater in OB than NW. NMUR1 and CPA3 expression were significantly higher in both the CD88(+) and CD88(−) MC-RF than MC-PF. Therefore, NMUR1 expression was elevated in the SM of OB KOA patients, and its expression was found in MCs. Further investigation to analyze the NMU/NMUR1 pathway in MC may provide a link between obesity and KOA pathology.