Background:
Platelet-rich plasma (PRP) has emerged as the forerunner among disease-modifying treatment options for early osteoarthritis (OA) of the knee. However, no consensus is available regarding ...optimum dosing schedules.
Purpose:
To determine whether multiple injections of PRP (3 injections) provide better short-term and long-term results than a single injection of PRP in a guinea pig model of knee OA.
Study Design:
Controlled laboratory study.
Methods:
36 Dunkin-Hartley guinea pigs (weighing ~600-800 g) were chosen for this study. The animals were assigned to group DC (disease control group), group G1 (single-PRP group), and group G2 (multiple-PRP group) containing 10, 10, and 12 animals, respectively. Another 4 animals were used for preparation of allogenic PRP. Groups G1 and G2 received 1 and 3 injections of PRP, respectively, at weekly intervals in the intervention knee while the contralateral knee was injected with normal saline. Group DC received no intervention in either knee. Half of the animals from each group (subgroups DC.3, G1.3, and G2.3) were sacrificed at 3 months, and the remaining half (subgroups DC.6, G1.6, and G2.6) were sacrificed at 6 months after intervention. Both knee joints were harvested for histological assessment of articular cartilage and synovium.
Results:
The mean synovial scores for groups G1 and G2 were significantly better than those for group DC at 3 months. No difference was found between groups G1 and G2 at 3 months. At 6 months, group G2 had significantly better mean synovial scores than group G1 and group DC. The mean articular cartilage scores in group G2 were significantly better than those in group DC at 3 months. However, at 6 months, no significant difference was found among any of the groups in terms of mean articular scores.
Conclusion:
Both single and multiple injections of PRP exert similar anti-inflammatory effects on the synovium in the short term. However, this effect is sustained in the long term only for multiple injections. Multiple injections of PRP exert a chondroprotective effect, but only in the short term. This effect is not seen with a single injection of PRP.
Clinical Relevance:
This study provides insight into the histological basis for the superiority of multiple injections of PRP.
Knee disorders are common among the human population. Knee osteoarthritis (OA) is the most widespread knee joint disorder, which may require surgical treatment. The detection and diagnosis of knee ...joint disorders from medical images demand enormous human effort and time. The development of a computer‐aided diagnosis (CAD) system can notably minimise the burden of medical experts and remove the intra‐observer and inter‐observer variations. To achieve the goal, the highly challenging research problem of knee image segmentation has been frequently paid attention in past years, which can be efficiently applied in the development of the CAD system. Knee image segmentation is a challenging task owing to the image contrasts, intensity variations, shape irregularities, and the presence of thin cartilage structures. Therefore, this paper presents a literature review of automated segmentation approaches mainly focused on the segmentation of knee cartilage and bone, with respect to the underlying technical aspects, datasets used, and the performance reported. The paper also presents the growth from classical segmentation approaches towards the deep learning approaches in the knee image segmentation. Owing to the varying quality and complexity of different knee image datasets, this paper abstains from doing a rigorous comparative evaluation of image segmentation approaches.
As a nutshell, an early diagnosis of Knee Osteoarthritis (KOA) enhances the likelihood of an individual receiving treatment at its onset and prevents joint replacement surgery. ...Computer‐Aided‐Diagnosis (CAD) from the radiograph images have gained a wide‐spread attention in automated grading of KOA severity. But radiograph images have certain limitations, such as presence of too much noise and uneven contrast distribution across the image that impacts the accuracy and reliability of CAD systems. Therefore, a novel three‐stage pre‐processing method has been proposed using a combination of different techniques applied at sequential stages such as noise‐reduction using gaussian‐filter, normalization using pixel‐centering method, and balanced contrast enhancement technique. A transfer‐learning based VGG16 architecture has been used for severity classification. Our classification framework outperforms the existing state‐of‐the‐art methods achieving an excellent accuracy of 89.95\%. Therefore, our system can be used by the radiologists and physicians as a decision‐support tool in their daily diagnosis procedure.
Background: Synovitis is the underlying pathology in various arthritis, and sometimes, it is difficult to differentiate various arthritis clinically or even by imaging. The purpose of our study was ...to use shear wave elastography (SWE) to evaluate rheumatoid arthritis (RA) and tubercular (TB) arthritis and to differentiate them using synovial stiffness. Methods: The prospective study was performed on Supersonic Imagine Aixplorer Ultrasound (USG) machine using a linear array probe SL10-2 (2-10 MHz). A total of 29 participants, 15 of RA (ACR/EULAR criteria) and 14 of proven TB arthritis were included. Region of interest of 1 mm was applied on the hypertrophied synovium and quantitative SWE data in form of elasticity (kPa) and velocity (m/s) were measured. Discrete categorical data were presented as n (%). Mean values were recorded along with standard deviation and the range of values. To find a maximal cutoff value of elasticity and velocity - receiver operating characteristic curve were plotted. Results: The mean elasticity and velocity values were 54.81 ± 10.6 kPa and 4.2 m/s ± 0.42 for RA and 37 ± 10 kPa and 3.4 ± 0.47 m/s for TB group. Significant difference (P < 0.001) was seen in elastic modulus values between rheumatoid and TB group with cutoff of 43.6 kPa to differentiate the two groups (sensitivity - 86.7% and specificity - 80%). Similar significant (P < 0.001) results were seen with velocity values, with cutoff of 3.76 m/s (sensitivity - 86.7% and specificity - 80%). Conclusion: SWE shows the potential to be a useful adjunct to gray scale and color Doppler USG in differentiating various arthritis on the basis of elastic properties of the synovium. Elastic modulus and velocity are useful SWE quantitative parameters for synovial evaluation and can differentiate RA and TB arthritis.
The poor prognosis in patients with floating knee injuries is mainly contributed to articular involvement (Fraser’s type Ⅱ). This study aims to evaluate and compare the functional outcomes among ...different Fraser’s type Ⅱ floating knee injuries after surgical management.
Twenty-seven patients with Fraser’s type Ⅱ floating knee injuries (54 fractures) between September 2014 and December 2015 were enrolled prospectively in this study and were distributed according to Fraser’s floating knee classification into three different groups as type ⅡA (ipsilateral femoral shaft and tibial intra-articular involvement, n = 11), type ⅡB (ipsilateral tibial shaft and femoral intra-articular involvement, n = 9) and type ⅡC (both femoral and tibial intra-articular involvement, n = 7). The differences among the groups were evaluated and compared. The functional outcomes of these injuries at one year were analyzed using Knee Injury and Osteoarthritis Outcome Score (KOOS) which covers 5 subscales of pain, other symptoms, activities of daily living, sports and recreation, and quality of life. The result was also compared with standardized age-sex matched healthy population using paired samples t-test.
All the patients were male, and the injury mechanism was solely roadside accident. The mean age was 29.8 years and injury severity score 17.9 (comparable in all the three groups). Most injuries were observed on the right side (20 cases, 74.1%). Based on paired samples t-test, the KOOS score of patients with Fraser’s type ⅡA was found to be better than that of type ⅡB and type ⅡC. Compared with the reference age-sex matched control group, patients with Fraser’s type ⅡB and ⅡC fractures had significantly lower mean score in all KOOS subscales (all p < 0.01). However, Fraser’s type ⅡA only revealed significant difference regarding the subscales of activities of daily living (p < 0.0001), sports and recreation (p < 0.0001), and quality of life (p < 0.0001).
The results of this study show that patients with Fraser’s type ⅡA fractures had a better functional outcome as compared to those with type ⅡB and ⅡC fractures. This might be due to the open intra-articular involvement of the distal femur of the latter two fracture types.
Patellar dislocation is a disorder in the human knee where patella slips out of its expected position. The orthopedic experts need to manually measure the parameters indicating patellar instability ...from knee scans, which is a laborious and time‐consuming task. An automated method for measuring these parameters can resolve the issue of inter‐observer and intra‐observer variations and significantly lessen the burden of the experts. Therefore, in this work, a two‐step approach has been proposed for the automated measurement of the sulcus angle from knee magnetic resonance (MR) images to assist the experts in the diagnosis of patellar dislocation. Firstly, a variant of U‐Net architecture has been proposed harnessing the capabilities of the residual network to segment the region of interest (ROI) from the axial knee MR images. Secondly, the contour of ROI is used for the detection of key points required to compute sulcus angle. A T2‐weighted knee magnetic resonance imaging dataset of 50 patients obtained from Post Graduate Institute of Medical Education & Research, Chandigarh, has been used. Out of 50 patients, the randomly selected knee MR images of 25 patients have been used to train the segmentation model. The intersection over union and dice similarity coefficient values of 94.71% and 97.28%, respectively, were achieved for the proposed segmentation model. The automated measurement of the sulcus angle resulted in a mean error of 2.52 ± 1.52° when tested on another set of axial knee MR images of 25 patients. The proposed framework produced results comparable to the manual expert measurements.
Background
Evaluation of the ortho-anesthetic geriatric care pathway for patients with proximal femur fracture in a tertiary care referral center was done by reporting the peri-operative morbidity ...and mortality. Clinical and demographic predictors of mortality were also identified in this cohort.
Material and Methods
This prospective observational study was conducted between August 2017 and November 2018. Demographic, anesthetic and surgical characteristics were recorded. Telephonic post-discharge follow-up was done for a period of 2 years. Factors predicting mortality were estimated using multivariate logistic regression.
Results
The cohort was characterized by frailty, high ASA physical status, NYHA class and Charlson co-morbidity index. The delay in presentation to hospital and subsequent surgical fixation was 7 (1–8) and 8 (5–13) days, respectively. The 30, 60, 90-day, 1-year and 2-year mortality was 13.6%, 21.8%, 25.45%, 36.5% and 44%, respectively. Intra-operative blood transfusion was a predictor of 30-day mortality (OR 9.2, 95% CI 1.02–83.17;
p
= 0.048). Pre-operative respiratory dysfunction predicted 60-day (OR 11.245, 95% CI 1.38–91.58;
p
= 0.024) and 90-day (OR 11.654, 95% CI 1.91–71.1;
p
= 0.008) mortality. Post-operative morbidity was reported in 31 (28.1%) patients; incidence of pneumonia (
n
= 9), sepsis (
n
= 8), MI (
n
= 6), PTE (
n
= 5) and ARF (
n
= 3) were 8.18%, 7.27%, 5.45%, 4.54% and 2.72%, respectively.
Conclusion
Existing pathway facilitated surgical fixation with median delay of 8 days which should be shortened to 48 h. High mortality in our cohort needs to be decreased by preventing admission delays and aggressively managing co-morbidities. Acceptable benchmark goals for pre-operative optimization of lung disease and decrease in intra-operative blood transfusion need to be incorporated in existing care pathway.
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