Osteoarthritis: symptoms, signs and source of pain

Kean, Walter F.; Kean, Robert; Buchanan, W. Watson

doi:10.1163/156856004773121347

Cited by 116 publications

(86 citation statements)

References 117 publications

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“…Alternatively, it may be that pain is mediated differently in PTCL, as compared to FTCL. As cartilage does not have a nerve supply, in early osteoarthritis it may be that the pain is predominantly driven by inflammatory mediators as opposed to mechanoreceptors, and as such the response to treatment may be different as the disease progresses 21,22 . Finally, it is known that at post-mortem PTCL is a common finding in the asymptomatic knee and as such it must be acknowledged that despite a complete assessment in some cases of PTCL the pain may be referred other sites and the medial compartment may not be the cause of symptoms.…”

Section: Discussionmentioning

confidence: 99%

Unsatisfactory outcomes following unicompartmental knee arthroplasty in patients with partial thickness cartilage loss

Hamilton

Pandit

Inabathula

et al. 2017

The Bone & Joint Journal

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Aims While medial unicompartmental knee arthroplasty (UKA) is indicated for patients with full-thickness cartilage loss, it is occasionally used to treat those with partial-thickness loss. The aim of this study was to investigate the five-year outcomes in a consecutive series of UKAs used in patients with partial thickness cartilage loss in the medial compartment of the knee. Patients and Methods Between 2002 and 2014, 94 consecutive UKAs were undertaken in 90 patients with partial thickness cartilage loss and followed up independently for a mean of six years (1 to 13). These patients had partial thickness cartilage loss either on both femur and tibia (13 knees), or on either the femur or the tibia, with full thickness loss on the other surface of the joint (18 and 63 knees respectively). Using propensity score analysis, these patients were matched 1:2 based on age, gender and pre-operative Oxford Knee Score (OKS) with knees with full thickness loss on both the femur and tibia. The functional outcomes, implant survival and incidence of re-operations were assessed at one, two and five years post-operatively. A subgroup of 36 knees in 36 patients with partial thickness cartilage loss, who had pre-operative MRI scans, was assessed to identify whether there were any factors identified on MRI that predicted the outcome. Results Knees with partial thickness cartilage loss had significantly worse functional outcomes at one, two and five years post-operatively compared with those with full thickness loss. A quarter of knees with partial thickness loss had a fair or poor result and a fifth failed to achieve a clinically significant improvement in OKS from a baseline of four points or more; double that seen in knees with full thickness loss. Whilst there was no difference in implant survival between the groups, the rate of re-operation in knees with partial thickness loss was three times higher. Most of the re-operations (three-quarters), were arthroscopies for persistent pain. Compared with those achieving good or excellent outcomes, patients with partial thickness cartilage loss who achieved fair or poor outcomes were younger and had worse pre-operative functional scores. However, there were no other differences in the baseline demographics. MRI findings of full thickness cartilage loss, subchondral oedema, synovitis or effusion did not provide additional prognostic information. Conclusion Medial UKA should be reserved for patients with full thickness cartilage loss on both the femur and tibia. Whilst some patients with partial thickness loss achieve a good result we cannot currently identify which these will be and in this situation MRI is unhelpful and misleading. Cite this article: Bone Joint J 2017;99-B:475–82.

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Section: Discussionmentioning

confidence: 99%

Unsatisfactory outcomes following unicompartmental knee arthroplasty in patients with partial thickness cartilage loss

Hamilton

Pandit

Inabathula

et al. 2017

The Bone & Joint Journal

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“…It is mainly considered to be the result of a bio-psychosocial network in which each of many biological, psychological and social factors plays a significant role (2, 3, [71][72][73]. Pain is considered a better predictor of disability than the degree of radiographic damage (74).…”

Section: N Constitutional and Bio-psychosocial Factors Of Osteoarthrimentioning

confidence: 99%

The sources of pain in osteoarthritis: a pathophysiological review

2014

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summaryThe pain of osteoarthritis (OA) has multifaceted etiologies within and outside the joint. It is believed to be driven by both nociceptive and neuropathic mechanisms, as well as abnormal excitability in the pain pathways of the peripheral and central nervous system. Inflammation in the joint triggers a cascade of events that leads to peripheral sensitization, increased sensitivity of nociceptive primary afferent neurons, and hyperexcitability of the nociceptive neurons in the central nervous system. Pain receptors have been found in the synovium, ligaments, capsule, subchondral bone and surrounding tissues, with the exception of articular cartilage. The bone-related causes of pain in OA include subchondral microfractures, bone stretching with elevation of the periosteum due to osteophyte growth, bone remodeling and repair, bone marrow lesions, and bone angina caused by decreased blood flow and increased intra-osseous pressure. Central factors alter pain processing by setting the gain in such a way that, when a peripheral input is present, it is processed against a background of central factors that can enhance or diminish the experience of pain. As a complex phenomenon with a strong subjective component, pain can also be influenced by the nature of the underlying disease, personal predisposition (biological and psychological), and environmental and psychosocial factors. This review examines the current literature regarding the sources and mechanisms of pain in OA.

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“…4 These changes lead to a reduction in the range of motion, and increase in joint stiffness and pain. 5 In addition to the effects on the joint structure and function, OA also has a negative effect on the musculoskeletal system. Patients with knee OA have decreased knee extensor strength compared to healthy subjects [6][7][8][9][10] and compared to the healthy contralateral limb.…”

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confidence: 99%

Neuromuscular electrical stimulation (NMES) reduces structural and functional losses of quadriceps muscle and improves health status in patients with knee osteoarthritis

Vaz¹,

Baroni²,

Geremia³

et al. 2012

Journal Orthopaedic Research

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Knee osteoarthritis (OA) is associated with quadriceps atrophy and weakness, so muscle strengthening is an important point in the rehabilitation process. Since pain and joint stiffness make it often difficult to use conventional strength exercises, neuromuscular electrical stimulation (NMES) may be an alternative approach for these patients. This study was aimed at (1) identifying the associations of knee OA with quadriceps muscle architecture and strength, and (2) quantifying the effects of a NMES training program on these parameters. In phase 1, 20 women with knee OA were compared with 10 healthy female, asymptomatic, age-matched control subjects. In phase 2, 12 OA patients performed an 8-week NMES strength training program. OA patients presented smaller vastus lateralis thickness (11.9 mm) and fascicle length (20.5%) than healthy subjects (14.1 mm; 24.5%), and also had a 23% smaller knee extensor torque compared to the control group. NMES training increased vastus lateralis thickness (from 12.6 to 14.2 mm) and fascicle length (from 19.6% to 24.6%). Additionally, NMES training increased the knee extensor torque by 8% and reduced joint pain, stiffness, and functional limitation. In conclusion, OA patients have decreased strength, muscle thickness, and fascicle length in the knee extensor musculature compared to control subjects. NMES training appears to offset the changes in quadriceps structure and function, as well as improve the health status in patients with knee OA. Keywords: osteoarthritis; muscle architecture; muscle strength; WOMAC; electrical stimulation Osteoarthritis (OA) is one of the major degenerative diseases and it affects elderly women more frequently than elderly men.1,2 The prevalence of OA is expected to increase dramatically in the near future due to the increased life expectancy and an increasing rate of obesity of the world population.3 The knee is the most affected joint with 13.6% of women above 60 years showing radiographic evidence of OA and/or clinical symptoms. 2OA causes erosion of articular cartilage, weakening of subchondral bone, meniscal degeneration, inflammation of the synovium, and intra-articular osteophytes. 4 These changes lead to a reduction in the range of motion, and increase in joint stiffness and pain. 5In addition to the effects on the joint structure and function, OA also has a negative effect on the musculoskeletal system. Patients with knee OA have decreased knee extensor strength compared to healthy subjects 6-10 and compared to the healthy contralateral limb.11,12 Evidence also suggests that the muscle weakness is associated with a decrease in muscle mass. 11,12However, although a reduction in muscle thickness 11 and anatomical cross-sectional area 12 have been described in OA patients, we were unable to find evidence on how muscle weakness was related to changes in other muscle architecture parameters associated with strength, such as fascicle length, and pennation angle.Fascicle length is related to the number of sarcomeres aligned in series in the ...

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Osteoarthritis: symptoms, signs and source of pain

Cited by 116 publications

References 117 publications

Unsatisfactory outcomes following unicompartmental knee arthroplasty in patients with partial thickness cartilage loss

Unsatisfactory outcomes following unicompartmental knee arthroplasty in patients with partial thickness cartilage loss

The sources of pain in osteoarthritis: a pathophysiological review

Neuromuscular electrical stimulation (NMES) reduces structural and functional losses of quadriceps muscle and improves health status in patients with knee osteoarthritis

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