Response to Letter to the Editor: ‘Is subchondral bone mineral density associated with nocturnal pain in knee osteoarthritis patients?’

Burnett, Wadena D.; Kontulainen, Saija; McLennan, Christine E.; Hazel, Diane; Talmo, Carl T.; Hunter, David J.; Wilson, David R.; Johnston, James D.

doi:10.1016/j.joca.2015.06.015

Cited by 3 publications

(8 citation statements)

References 15 publications

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“…We also included CT-measured knee alignment in our analysis. Knee alignment was categorized as varus, neutral, or valgus and measured using coronal and sagittal CT reconstructions to determine an estimate of mechanical alignment [3]. In brief, medial and lateral joint space widths were evaluated at equal distances from the tibial spine permitting an estimation of alignment between the femoral and tibial axes.…”

Section: Methodsmentioning

confidence: 99%

“…In brief, medial and lateral joint space widths were evaluated at equal distances from the tibial spine permitting an estimation of alignment between the femoral and tibial axes. Neutral alignment was defined as 178° ± 2 o (i.e., 176-180 o ) [3]. We defined an angle less than 176 o as varus alignment and an angle greater than 180 o as valgus alignment.…”

Section: Methodsmentioning

confidence: 99%

“…Knee osteoarthritis (OA) is a painful and debilitating disease characterized by cartilage deterioration and altered subchondral bone. Recently, there has been increasing interest in the role of subchondral bone cysts in OA progression; in particular how subchondral bone cysts may influence pain [1–3], or how subchondral bone cysts influence subchondral bone mechanical behaviour [4].…”

Section: Introductionmentioning

confidence: 99%

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Knee osteoarthritis patients with more subchondral cysts have altered tibial subchondral bone mineral density

Burnett

Kontulainen

McLennan

et al. 2019

BMC Musculoskelet Disord

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BackgroundSubchondral bone cysts are a widely observed, but poorly understood, feature in patients with knee osteoarthritis (OA). Clinical quantitative computed tomography (QCT) has the potential to characterize cysts in vivo but it is unclear which specific cyst parameters (e.g., number, size) are associated with clinical signs of OA, such as disease severity or pain. The objective of this study was to use QCT-based image-processing techniques to characterize subchondral tibial cysts in patients with knee OA and to explore relationships between proximal tibial subchondral cyst parameters and subchondral bone density as well as clinical characteristics of OA (alignment, joint space narrowing (JSN), OA severity, pain) in patients with knee OA.MethodsThe preoperative knee of 42 knee arthroplasty patients was scanned using QCT. Patient characteristics were obtained, including OA severity, knee pain, JSN, and alignment. We used 3D image processing techniques to obtain cyst parameters including: cyst number, cyst number per proximal tibial volume, cyst volume per proximal tibial volume, as well as maximum and average cyst volume across the proximal tibia, as well as regional bone mineral density (BMD) excluding cysts. We used Spearman’s correlation coefficients to explore associations between patient characteristics and cyst parameters.ResultsAt both the medial and lateral compartments of the proximal tibia, greater cyst number and volume were associated with higher BMD. At the lateral region, cyst number and volume were also associated with lateral OA severity, lateral JSN, alignment and sex. Pain was not associated with any cyst parameters at any region.ConclusionCyst number and volume were associated with BMD at both the medial and lateral compartments. Lateral cyst number and volume were also associated with joint alignment, OA severity, JSN and sex. This is the first study to use clinical QCT to explore subchondral tibial cysts in patients with knee OA and provides further evidence of the relationships between subchondral cysts and clinical OA characteristics.Electronic supplementary materialThe online version of this article (10.1186/s12891-018-2388-9) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Knee osteoarthritis patients with more subchondral cysts have altered tibial subchondral bone mineral density

Burnett

Kontulainen

McLennan

et al. 2019

BMC Musculoskelet Disord

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“…Fourth, as higher BMD appears to be focused in subchondral regions (<10 mm from the tibial surface) [ 13 ], joint load may be primarily transferred through the subchondral cortical endplate and subchondral trabecular bone to the peripheral cortex, off-loading epiphyseal and metaphyseal trabecular bone, thus explaining lower BMD in these regions. However, this explanation warrants further research given that we did not find association between pain and alignment [ 36 ]. Studies using subject-specific FE modeling are needed to investigate load transmission and subchondral bone stiffness at different stages of pain severity and disease progression.…”

Section: Discussionmentioning

confidence: 95%

“…We [ 13 ], and others [ 30 ], however, have questioned whether our previously observed trend toward low medial BMD was due to the presence of cysts or diminished bone architecture and/or mineralization. Subsequent follow-up analyses indicated that both cysts and BMD were independently associated with pain [ 36 ]. The novelty of this study was that we focused our analyses in epiphyseal and metaphyseal trabecular regions largely void of cysts to determine any potential independent associations between BMD and pain.…”

Section: Discussionmentioning

confidence: 99%

Proximal tibial trabecular bone mineral density is related to pain in patients with osteoarthritis

et al. 2017

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BackgroundOur objective was to examine the relationships between proximal tibial trabecular (epiphyseal and metaphyseal) bone mineral density (BMD) and osteoarthritis (OA)-related pain in patients with severe knee OA.MethodsThe knee was scanned preoperatively using quantitative computed tomography (QCT) in 42 patients undergoing knee arthroplasty. OA severity was classified using radiographic Kellgren-Lawrence scoring and pain was measured using the pain subsection of the Western Ontario and McMaster Universities Arthritis Index (WOMAC). We used three-dimensional image processing techniques to assess tibial epiphyseal trabecular BMD between the epiphyseal line and 7.5 mm from the subchondral surface and tibial metaphyseal trabecular BMD 10 mm distal from the epiphyseal line. Regional analysis included the total epiphyseal and metaphyseal region, and the medial and lateral epiphyseal compartments. The association between total WOMAC pain scores and BMD measurements was assessed using hierarchical multiple regression with age, sex, and body mass index (BMI) as covariates. Statistical significance was set at p < 0.05.ResultsTotal WOMAC pain was associated with total epiphyseal BMD adjusted for age, sex, and BMI (p = 0.013) and total metaphyseal BMD (p = 0.017). Regionally, total WOMAC pain was associated with medial epiphyseal BMD adjusted for age, sex, and BMI (p = 0.006).ConclusionThese findings suggest that low proximal tibial trabecular BMD may have a role in OA-related pain pathogenesis.Electronic supplementary materialThe online version of this article (doi:10.1186/s13075-017-1415-9) contains supplementary material, which is available to authorized users.

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Comparison of clinical‐CT segmentation techniques for measuring subchondral bone cyst volume in glenohumeral osteoarthritis

et al. 2023

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Purpose This study aimed to assess the accuracy and reproducibility of four common segmentation techniques measuring subchondral bone cyst volume in clinical-CT scans of glenohumeral OA patients. Methods Ten humeral head osteotomies collected from cystic OA patients, having undergone total shoulder arthroplasty, were scanned within a micro-CT scanner, and corresponding preoperative clinical-CT scans were gathered. Cyst volumes were measured manually in micro-CT and served as a reference standard (n = 13). Respective cyst volumes were measured on the clinical-CT scans by two independent graders using four segmentation techniques: Qualitative, Edge Detection, Region Growing, and Thresholding. Cyst volume measured in micro-CT was compared to the different clinical-CT techniques using linear regression and Bland–Altman analysis. Reproducibility of each technique was assessed using intraclass correlation coefficient (ICC). Results Each technique outputted lower volumes on average than the reference standard (-0.24 to -3.99 mm3). All linear regression slopes and intercepts were not significantly different than 1 and 0, respectively (p < 0.05). Cyst volumes measured using Qualitative and Edge Detection techniques had the highest overall agreement with reference micro-CT volumes (mean discrepancy: 0.24, 0.92 mm3). These techniques showed good to excellent reproducibility between graders. Conclusions Qualitative and Edge Detection techniques were found to accurately and reproducibly measure subchondral cyst volume in clinical-CT. These findings provide evidence that clinical-CT may accurately gauge glenohumeral cystic presence, which may be useful for disease monitoring and preoperative planning. Level of evidence Retrospective cohort Level 3 study.

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Response to Letter to the Editor: ‘Is subchondral bone mineral density associated with nocturnal pain in knee osteoarthritis patients?’

Cited by 3 publications

References 15 publications

Knee osteoarthritis patients with more subchondral cysts have altered tibial subchondral bone mineral density

Knee osteoarthritis patients with more subchondral cysts have altered tibial subchondral bone mineral density

Proximal tibial trabecular bone mineral density is related to pain in patients with osteoarthritis

Comparison of clinical‐CT segmentation techniques for measuring subchondral bone cyst volume in glenohumeral osteoarthritis

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