IntroductionWe tested the hypothesis that there exist relationships between the onset of early stage radiographically defined knee osteoarthritis (OA), pain and changes in biomarkers of joint metabolism.MethodsUsing Kellgren-Lawrence (K/L) grading early radiographic knee OA (K/L 2) was detected in 16 of 46 patients. These grades (K/L 1 is no OA and K/L 2 is early OA) were divided into two groups according to the presence or absence of persistent knee pain. Sera (s) and urines (u) were analysed with biomarkers for cartilage collagen cleavage (sC2C and uCTX-II) and synthesis (sCPII), bone resorption (uNTx) and synovitis (hyaluronic acid: sHA).ResultssCPII decreased and sC2C/sCPII, uCTX-II/sCPII and sHA increased with onset of OA (K/L 2 versus K/L 1) irrespective of joint pain. In contrast, sC2C and uCTX-II remained unchanged in early OA patients. Of the patients with K/L grades 1 and 2 sC2C, sCPII, sHA, uNTX and uCTX-II were all significantly increased in patients with knee pain independent of grade. Among the K/L grade 2 subjects, only uCTX-II and uCTX-II/sCPII were increased in those with knee pain. In grade 1 patients both sC2C and sCPII were increased in those with knee pain. No such grade specific changes were seen for the other biomarkers including sHA.ConclusionsThese results suggest that changes in cartilage matrix turnover detected by molecular biomarkers may reflect early changes in cartilage structure that account directly or indirectly for knee pain. Also K/L grade 1 patients with knee pain exhibit biomarker features of early OA.

In this study, the effect of low-intensity pulsed ultrasound (LIPUS) on cartilage was evaluated in a rat osteoarthritis (OA) model using serum biomarkers such as CTX-II (type II collagen degradation) and CPII (type II collagen synthesis) as well as histological criteria (Mankin score and immunohistochemical type II collagen staining). OA was surgically induced in the knee joint of rats by anterior cruciate/ medial collateral ligament transection and medial meniscus resection (ACLT þ MMx). Animals were divided into three groups: shamoperated group (Sham), ACLT þ MMx group without LIPUS (ÀLIPUS), and ACLT þ MMx group with LIPUS (þLIPUS; 30 mW/cm 2 , 20 min/ day for 28 days). CTX-II levels were elevated in both ÀLIPUS and þLIPUS groups compared to that in the Sham group after the operation, but there was no significant difference between þLIPUS and ÀLIPUS groups, suggesting that LIPUS does not affect the degradation of type II collagen in this model. In contrast, CPII was significantly increased in þLIPUS group compared to ÀLIPUS and Sham. Moreover, histological damage on the cartilage (Mankin score) was ameliorated by LIPUS, and type II collagen was immunohistochemically increased by LIPUS in the cartilage of an OA model. Of interest, mRNA expression of type II collagen was enhanced by LIPUS in chondrocytes. Together these observations suggest that LIPUS is likely to increase the type II collagen synthesis in articular cartilage, possibly via the activation of chondrocytes and induction of type II collagen mRNA expression, thereby exhibiting chondroprotective action in a rat OA model. ß

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Abstract. to investigate the involvement of oxidative stress in the pathogenesis of osteoarthritis (Oa), we evaluated the relationship between oxidative stress and articular cartilage degradation by measuring the serum levels of malondialdehyde (mda, an oxidative stress marker), ctx-ii (a type ii collagen degradation marker) and cpii (a type ii collagen synthesis marker) in obese and hyperlipidemic Str/Ort (Str) and control cBa mice. Seven-week-old osteoarthritic Str male mice (n=10) and control cBa male mice (n=10) were fed standard laboratory food ad libitum. at 35 weeks of age, the mice were sacrificed, and the serum levels of mda, ctx-ii and cpii were determined. Furthermore, histopathological changes were evaluated in the knee joints. most of the Str mice spontaneously developed Oa (18 of the 20 knees). By contrast, the cBa mice developed Oa in only 4 of the 20 knees. importantly, the serum levels of mda, ctx-ii and cpii were elevated to a greater extent in the Str mice compared to levels in the cBa mice. notably, the level of mda was correlated with that of ctx-ii, but not of cpii. Moreover, the MDA levels were significantly correlated with the serum lipid (total cholesterol and triglyceride) levels as well as body weight. together these observations suggest that oxidative stress is likely involved in the degradation of type ii collagen in articular cartilage, thereby possibly contributing to the development of Oa in obese and hyperlipidemic Str mice.

Introduction: The purpose of this study was to investigate revision with a Kerboull-type plate through the posterior approach (PA) and direct anterior approach (DAA) and compare the clinical outcome. Subjects and methods: Fifty-four patients (56 hip joints) underwent revision surgery in which acetabular reconstruction was performed concomitantly using the Kerboull-type plate and allogeneic bone. Revision surgery through DAA was performed in 21 hip joints and these were compared with 34 hip joints treated through PA. There was no significant difference in the patient demographics between the DAA and PA. Results: There was no significant difference between the operative times in the DAA and PA groups (203.2 ± 43.5 and 211.7 ± 41.8 min). There was a significant difference between the intraoperative blood loss in the DAA and PA groups (503.9 ± 223.7 mL and 703.8 ± 329.6 mL, respectively, p < 0.05). There was no significant difference between the modified Harris Hip Score in the DAA and the PA groups. The loosening of the acetabular component was observed in four cases (11.8%) in the PA group. In the DAA and PA groups, the 5-year survival rates were 100 and 85.7%, respectively. Recurrent dislocation of the hip was observed in six cases (one case in the DAA group (4.8%) and five cases in the PA group (14.7%)). Conclusions: It was verified that the difference in the surgical approach of acetabular reconstruction concomitantly using the Kerboull-type plate and allogeneic bone graft influenced the postoperative outcome.

THA with the DMC using the DAA was as effective for femoral neck facture as it was for elective THA in patients with osteoarthritis.

Introduction: When the postoperative outcome of primary total hip arthroplasty (THA) was compared with the direct anterior approach (DAA) and the posterior approach (PA), there was no significant difference of the clinical outcome at 6 months to 1 year after surgery in many studies. This study was performed to compare the medium-term outcome of THA via the DAA or PA and clarify which approach achieves better quality of life (QOL).Methods: We investigated 61 hips receiving primary THA (30 via DAA and 31 via PA), using hip function scores such as the Harris Hip Score (HHS) and patient-reported outcomes such as the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ), and the Forgotten Joint Score-12 (FJS).Results: The mean duration of postoperative follow-up was 36.8 months in the DAA group and 40.5 months in the PA group. There was no difference in preoperative or postoperative HHS between the two groups. Although there was no difference of postoperative WOMAC and JHEQ, the postoperative FJS-12 score was significantly higher in the DAA group than in the PA group (75.2 ± 15.9 versus 60.1 ± 24.4, p = 0.01).Conclusion: When forgetting the artificial joint in daily life is the target, better QOL can be achieved by performing THA via the DAA.

Abstract. Serum undercarboxylated osteocalcin (s-ucOC) is a marker for vitamin K metabolism (deficiency). The aim of this study was to investigate the serum levels of ucOC in patients with bilateral knee osteoarthritis (K-OA), and the correlation between ucOC and other biomarkers for K-OA. A total of 25 patients (22 women, 3 men, mean age 76.0±7.8, range 54-88 years, mean BMI 24.9±4.7) with a Kellgren-Lawrence grade of 3 or 4 for bilateral knee were enrolled in this study. The levels of s-ucOC and other biomarkers were measured. The levels of s-ucOC (5.66±4.70 ng/ml) as well as other cartilage metabolism markers, were elevated in the patients; however, bone metabolism markers were within the normal ranges. Of interest, there was a significant correlation between s-ucOC and serum hyaluronan (a marker for synovitis) (P<0.05). Our findings suggest that vitamin K metabolism may be associated with synovitis in patients with K-OA, and s-ucOC could be a biomarker for K-OA.