Linking proximal tibia bone microarchitecture to in vivo dynamic knee joint loads in end-stage knee osteoarthritis

Abstract Objective: Psoriatic arthritis (PA) is an inflammatory rheumatism, mediated in part by TNFα and associated with bone loss. Anti-TNFα treatment should inhibit this phenomenon and reduce the systemic bone loss. Ultra-high field MRI (UHF MRI) may be used to quantify bone microarchitecture (BM) in-vivo. In this study, we quantified BM using UHF MRI in a PA patient and followed up the changes related to anti-TNFα treatment.Patients and methods: A non-treated PA patient with knee arthritis and 7 gender-matched controls were scanned using a gradient re-echo sequence at UHF MRI. After a year of Adalimumab treatment, the patient underwent a second UHF MRI. A PET-FNa imaging was performed before and after treatment to identify and localize the abnormal metabolic areas. BM was characterized using typical morphological parameters quantified in 32 regions of interest (ROIs) located in the patella, proximal tibia, and distal femur. Statistical analysis was assessed performing Student T-tests.Results: Before treatment, the BM parameters were statistically different from controls in 24/32 ROIs with differences reaching up to 38%. After treatment, BM parameters were normalized for 15 out of 24 ROIs. The hypermetabolic areas disclosed by PET-FNa before the treatment partly resumed after the treatment.Conclusion: Thanks to UHF MRI, we quantified in-vivo BM anomalies in a PA patient and we illustrated a major reversion after one year of treatment. Moreover, BM results highlighted that the abnormalities were not only localized in hypermetabolic regions identified by PET-FNa, suggesting that the bone loss was global and not related to inflammation.

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Tibial Condyle Valgus Osteotomy for Ipsilateral Knee Osteoarthritis after Hip Arthrodesis

Case Reports in Orthopedics ◽

10.1155/2021/6443618 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Daisuke Fukuhara ◽

Hiroaki Inoue ◽

Shuji Nakagawa ◽

Yuji Arai ◽

Kenji Takahashi

Keyword(s):

Knee Joint ◽

Knee Osteoarthritis ◽

Mechanical Load ◽

Weight Bearing ◽

Valgus Osteotomy ◽

Hip Arthrodesis ◽

Knee Oa ◽

Early Loosening ◽

Tibial Condyle ◽

End Stage

We report a case of tibial condylar valgus osteotomy (TCVO) for ipsilateral knee osteoarthritis (OA) after hip arthrodesis. A 58-year-old woman developed right purulent hip arthritis at one month of age and underwent right hip fusion at 16 years old. She visited our department at the age of 57 because her right knee joint pain worsened. The range of motion for her right knee was 80° and -5° of flexion and extension, respectively, and she experienced medial weight-bearing pain. A plain X-ray image showed that the right knee joint had end-stage knee OA with a bone defect inside the tibia, and the tibial plateau shape was the pagoda type. There was a marked instability in her right knee with a valgus of 9° and varus of 7° on stress photography. She underwent TCVO on her right knee and was allowed full load four weeks after surgery. Computed tomography imaging showed bone union nine months after surgery. Two years after the operation, there was no correction loss, and she could walk independently without pain. In general, total knee arthroplasty (TKA) is indicated for end-stage knee OA; however, there are problems, such as early loosening due to the increased mechanical load on the knee after hip OA. In this case, since a good course was obtained, TCVO is considered a treatment option for terminal knee OA after hip arthrodesis.

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