Evaluation of the Functions and Radiographic Severity of Osteonecrosis of the Head of Femur in South-west Nigeria

Background: Osteonecrosis of the femoral head is likely to be a complex of diseases rather than a single entity. In sub-Saharan Africa, epidemiological studies on the subject are uncommon. Objectives: To determine hip function, radiographic severity and other characteristics of patients with osteonecrosis of the femoral head (ONFH) at presentation in a sub-Saharan Africa population Methods: A combined prospective clinical survey and retrospective chart review of patients was done. Results: Fifty hips in 44 patients were studied (29 retrospectively and 15 prospectively). The prevalence of ONFH was 1.6%. The mean age was 24.8±13.2 years. The lesion was unilateral in 86.4% and bilateral in 13.6% of the hips. Sickle Cell Disease (SCD) occurred in 43.2%, sickle cell trait in 13.6%, and 20.5% of cases were idiopathic. Overall, 12% of affected hips were presented early, and all the hips were painful at presentation. Of the 18 hips studied prospectively, 72.2% had necrosis >30% and >30% subchondral collapse in 61.1%. The mean combined necrotic angle was moderate size, 197o±29.7o and 177.2o±69.4o for the right and left hips, respectively (p = 0.8). The mean WOMAC scores were 37.2 ±17.4 for function, 10.2±4.3 for pain and 4.2±2.7 for stiffness. Conclusion: Patients with osteonecrosis of the femoral head tended to be young adults and those with SCD. The majority present with large-sized osteonecrosis and subchondral collapse but moderate hip pain and stiffness.

Elevated resting heart rate is associated with increased radiographic severity of knee but not hand joints

Although the resting heart rate (RHR) predicts the clinical outcomes of cardiovascular disease, chronic obstructive lung disease, diabetes mellitus, and the risk of cancer, its role in patients with musculoskeletal diseases, such as osteoarthritis (OA), remains unclear. We explored the association of the RHR with the extents of radiographic changes in the knees and hands of 2369 subjects from the Dong-gu Study. The radiographic hand and knee joint findings were graded semi-quantitatively; we calculated total hand and knee joint scores. Multiple linear regression was performed to examine the associations between the RHR and the radiographic characteristics of these joints. For the knee joints, the RHR was associated positively with the total (p < 0.01), osteophyte (p < 0.01), joint space narrowing (JSN; p < 0.01), and tibial attrition (p = 0.02) scores after adjustment for age, sex, body mass index, smoking status, alcohol consumption, educational and physical activity levels, and comorbidities. For the hand joints, the RHR was associated positively with the JSN (p = 0.01) and subchondral cyst (p < 0.01) scores after such adjustment. The RHR was not associated with the total, osteophyte, sclerosis, erosion, or malalignment score for the hand joints. This study is the first to reveal an association between the RHR and the radiographic severity of knee, but not hand, OA.

Factors Associated With Clinical and Radiographic Severity in People With Osteoarthritis: A Cross-Sectional Population-Based Study

Background: Hip/knee osteoarthritis (HKOA) is a leading cause of disability and imposes a major socioeconomic burden. The aim of this study is to estimate the prevalence of HKOA in Portugal, characterised the clinical severity of HKOA in the population, and identified sociodemographic, lifestyle, and clinical factors associated with higher clinical and radiographic severity.Methods: Participants with a diagnosis of HKOA from the EpiReumaPt study (2011–2013) were included (n = 1,087). Hip/knee osteoarthritis diagnosis was made through a structured evaluation by rheumatologists according to American College of Rheumatology criteria. Clinical severity was classified based on Hip Disability and Osteoarthritis Outcome Scale (HOOS) and Knee Injury and Osteoarthritis Outcome Scale (KOOS) score tertiles. Radiographic severity was classified based on the Kellgren-Lawrence grades as mild, moderate, or severe. Sociodemographic lifestyle and clinical variables, including the presence of anxiety and depression symptoms, were analysed. Factors associated with higher clinical and radiographic severity were identified using ordinal logistic regression models.Results: Hip/knee osteoarthritis diagnosis was present in 14.1% of the Portuguese population [12.4% with knee osteoarthritis (OA) and 2.9% with hip OA]. Clinical severity was similar between people with hip (HOOS = 55.79 ± 20.88) and knee (KOOS = 55.33 ± 20.641) OA. People in the high HOOS/KOOS tertile tended to be older (64.39 ± 0.70 years), female (75.2%), overweight (39.0%) or obese (45.9%), and had multimorbidity (86.1%). Factors significantly associated with higher clinical severity tertile were age [55–64 years: odds ratio (OR) = 3.18; 65–74 years: OR = 3.25; ≥75 years: OR = 4.24], female sex (OR = 1.60), multimorbidity (OR = 1.75), being overweight (OR = 2.01) or obese (OR = 2.82), and having anxiety symptoms (OR = 1.83). Years of education was inversely associated with higher clinical severity. Factors significantly associated with higher radiographic severity were age (65–74 years: OR = 3.59; ≥75 years: OR = 3.05) and being in the high HOOS/KOOS tertile (OR = 4.91). Being a female and live in Lisbon or in the Centre region were inversely associated with the higher radiographic severity.Conclusion: Hip/knee osteoarthritis is present in ~1.1 million of Portuguese people. Age, educational level, and obesity are independently associated with HKOA clinical severity, whereas age, sex, geographic location, and clinical severity are independently associated with radiographic severity.

Superiority of Multiple-Joint Space Width over Minimum-Joint Space Width Approach in the Machine Learning for Radiographic Severity and Knee Osteoarthritis Progression

We compared the prediction efficiency of the multiple-joint space width (JSW) and the minimum-JSW on knee osteoarthritis (KOA) severity and progression by using a deep learning approach. A convolutional neural network (CNN) with ResU-Net architecture was developed for knee X-ray imaging segmentation and has attained a segmentation efficiency of 98.9% intersection over union (IoU) on the distal femur and proximal tibia. Later, by leveraging the image segmentation, the minimum and multiple-JSWs in the tibiofemoral joint were estimated and then validated by radiologist measurements in the Osteoarthritis Initiative (OAI) dataset using Pearson correlation and Bland–Altman plots. The agreement between the CNN-based estimation and radiologist’s measurement of minimum-JSWs reached 0.7801 (p < 0.0001). The estimated JSWs were deployed to predict the radiographic severity and progression of KOA defined by Kellgren-Lawrence (KL) grades using the XGBoost model. The 64-point multiple-JSWs achieved the best performance in predicting KOA progression within 48 months, with the area-under-receiver operating characteristic curve (AUC) of 0.621, outperforming the commonly used minimum-JSW with 0.554 AUC. We provided a fully automated radiographic assessment tool for KOA with comparable performance to the radiologists and showed that the fine-grained measurement of multiple-JSWs yields superior prediction performance for KOA over the minimum-JSW.

Association of patellofemoral morphology and alignment with the radiographic severity of patellofemoral osteoarthritis

Background Risk factors for the severity of patellofemoral osteoarthritis (PFOA) are poorly understood. This research aims to evaluate the association between patellofemoral joint (PFJ) morphology and alignment with the radiographic severity of PFOA. Methods A retrospective analysis of CT scan and lateral radiograph data were acquired in patients with PFOA. The radiographic grade of PFOA and tibiofemoral osteoarthritis (TFOA), lateral and medial trochlear inclination angle, sulcus angle, and the Wiberg classification of patella morphology, the congruence angle, patellar tilt angle, and lateral patellar angles, and tibial tubercle trochlear groove distance (TT-TG) and patella height (i.e., Caton-Deschamps index) were assessed using CT scans and sagittal radiographs of the knee. All the PFJ morphology and alignment data were divided into quarters, and the relationships between each of these measures and the severity of PFOA were investigated. Results By studying 150 patients with PFOA, we found a U-shaped relationship between the Caton-Deschamps index and the severity of PFOA (P < 0.001). A lower value of sulcus angle and lateral patellar angle, a higher value of congruence angle, and type III patella were associated with more severity of lateral PFOA. Compared with the highest quarter of each measure, the adjusted odds ratios (OR) of the severity of PFOA in the lowest quarter of sulcus angle, lateral patellar angle, and congruence angle; and type I patella was 8.80 (p = 0.043), 16.51 (P < 0.001), 0.04 (P < 0.001), and 0.18 (p = 0.048) respectively. Conclusions Extreme value of patella height, a higher value of lateral patellar displacement and lateral patellar tilt, lower value of sulcus angle, and type III patella were associated with more severity of PFOA.

Association of Patellofemoral Morphology and Alignment With the Radiographic Severity of Patellofemoral Osteoarthritis

Background: Risk factors for the progression of patellofemoral osteoarthritis (PFOA) are poorly understood. This research aims to evaluate the association between patellofemoral joint (PFJ) morphology and alignment with the radiographic severity of PFOA.Methods: A retrospective analysis of CT scan and lateral radiograph data were acquired in patients with PFOA. The radiographic severity of PFOA and tibiofemoral OA (TFOA), lateral and medial trochlear inclination angle, sulcus angle and the Wiberg classification of patella morphology, the congruence angle, patellar tilt angle, and lateral patellar angles, and tibial tubercle trochlear groove distance (TT-TG), patella height (i.e., Caton-Deschamps index) were assessed using CT scans and sagittal radiographs of the knee. All the PFJ morphology and alignment data were divided into quarters and the relationship between each measure and the severity of PFOA was investigated.Results: By studying 150 patients with PFOA, we found a U-shaped relationship between the Caton-Deschamps index and the severity of PFOA (P <0.001). A lower value of sulcus angle and lateral patellar angle, a higher value of congruence angle, and type III patella were associated with more severity of lateral PFOA. Compared with the highest quarter of each measure, the adjusted odds ratios (OR) of the severity of PFOA in the lowest quarter of sulcus angle, lateral patellar angle, and congruence angle, and type I patella was 8.80 (p=0.043), 16.51 (P <0.001), 0.04(P <0.001), and 0.18 (p=0.048) respectively.Conclusions: Extreme value of patella height, a higher value of lateral patellar displacement and lateral patellar tilt, lower value of sulcus angle, and type III patella were associated with more severity of PFOA.