Special Issue:
Challenges and Opportunities in Osteoarthritis
Andrew Wells, MS, OTR/L
Utica University School of Health Professions and Education, Utica, NY
Franca Sangiacomo, MS, OTR/L
Mohawk Valley Health System, Utica, NY
Lindsay Brown, MS, OTR/L
Utica Rehabilitation, Utica, NY
Nancy Hollins, PhD
Utica University School of Health Professions and Education, Utica, NY
Abstract
Objectives: The purpose of this research is to review the evidence regarding the impact and effectiveness of orthoses on pain, pinch, and grip strength for individuals diagnosed with carpometacarpal joint osteoarthritis.
Methods: A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and then literature was gathered across nine databases. To be included in this review, studies had to be classified as a level 1 or 2 research study and the studies must include participants who were over 40 years of age, have a diagnosis of carpometacarpal joint osteoarthritis, and must utilize an orthosis for their symptoms. Articles were excluded from the review if participants utilized steroids or have past surgeries on the carpometacarpal joint. Researchers analyzed the quality of studies and extracted evidence pertaining to the effectiveness of various orthosis designs based upon outcomes of pain, pinch, and grip strength for individuals diagnosed with carpometacarpal joint osteoarthritis.
Results and Implications for Future Practice: The evidence strongly supports the use of a custom-made butterfly short opponens orthosis to decrease pain and increase pinch and grip strength. Prefabricated Neoprene and Custom-made Thumb Splint designs are effective for decreasing pain and increasing pinch, only. A Thumb Spica Splint and Colditz Splint are effective for increasing pinch strength. There is moderate evidence to suggest the use of the Ballena Orthosis and Colditz Orthosis to decrease pain. The evidence suggests that the Neoprene Comfort Cool Splint and Custom-made Hybrid splint should not be used to address issues of pain, decreased grip strength, and decreased pinch strength.
Research Question: What is the impact of using orthoses on pain and pinch/grip strength for individuals diagnosed with CMC joint OA?
Leticia A. Shea
Regis University Rueckert-Hartman College for Health Professions, School of Pharmacy, 3333 Regis Blvd, Denver, CO, USA
Bianca Calderon
Regis University, Rueckert-Hartman College for Health Professions, School of Pharmacy, 3333 Regis Blvd H-28 Denver, CO 80221
Joanna Stratton
Regis University Rueckert-Hartman College for Health Professions, Division of Counseling and Family Therapy, 500 E 84th Ave Suite B-12; D-1, Thornton, CO 80229
Courtney Duggan
Regis University, Rueckert-Hartman College for Health Professions, School of Nursing, 3333 Regis Blvd G-6 Denver, CO 80221
Maggie Ehrenfried
RegisCARES Physical Therapy Clinic, Coors Life Direction Center Room 115, 3333 Regis Blvd, Denver, CO 80221
Abstract
Background: An osteoarthritis (OA) pilot was initiated in an interprofessional clinic to provide a learning opportunity for practitioners to provide integrated care in the setting of OA to improve health outcomes and quality of life in patients living with osteoarthritis. This study was a qualitative analysis performed following the completion of the pilot.
Purpose: To determine effective processes that support integrated care to best serve those living with osteoarthritis.
Methods: Flyers and neighborhood mailers were provided to the community to inform patients of the OA pilot. Patients were screened by the nurse practitioner and physical therapists to ensure they met osteoarthritis criteria (> 45 years, were experiencing activity-related joint pain, and had no morning joint-related stiffness, or > 30 minutes of morning stiffness). The interventions included one integrated care visit (in-person) followed by telehealth care thereafter. Telehealth visits obtained patient feedback, provided further patient guidance based on patient-response to care plans, and to evaluate change in function, medication usage, and pain management from baseline. The following questions aided researchers to organize our findings following the 3-month pilot: (1) What methods were utilized to aid in patient function and mobility improvement? (2) What was done to ensure safe and effective medication use? (3) How best to utilize each practitioner so that (a) methods for pilot duplication were determined and (b) integrated care best practices were established?
Results: Function and mobility improvement were exhibited in 100% of the patients. Mental health services were utilized to overcome fear of movement and fear of pain barriers to mobility. Half of the patients were originally performing movement exercises that were harmful to their condition prior to obtaining a consult with the physical therapist. The pharmacist-driven medication review during the initial consult identified 88% of the patients were utilizing suboptimal medications for the management of their OA, and 25% were using unsafe dietary supplements. All unsafe medication and dietary-supplement usage was resolved. Establishing care with a team visit supported integrated healthcare engagement. Telehealth and incorporation of healthcare students for follow-up calls were effective for utilization of all practitioners, patient engagement, and supported improved patient outcomes.
Conclusion: The findings of this study outline best practices that support integrated care, integrated education, and improved patient outcomes.
Nicola Volpi
Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
Abstract
The various Rheumatology/Osteoarthritis Societies (the American College of Rheumatology, the Arthritis Foundation, the European League Against Rheumatism, the National Institute for Health and Care Excellence, the European society for clinical and economic aspects of osteoporosis and osteoarthritis, and the Italian consensus on appropriateness of osteoarthrosis therapies) published specific recommendations for the management of osteoarthrosis affecting hand, hip and knee. These evidence-based guidelines take into account safety and tolerability of pharmacological and non-pharmacological interventions available from the scientific literature as well as the opinions of the clinical specialists to provide complete, clear and transparent recommendations for the management of osteoarthrosis. This article provides an update of the scientific literature for selected treatments of osteoarthrosis focusing on the therapy with symptomatic slow-acting drugs (SYSADOAs) and disease modifying anti-osteoarthrosis drugs (DMOADs) (chondroitin sulfate, glucosamine, diacerein, unsaponifiable soy and avocado extracts). Moreover, the management of osteoarthrosis pain and function, avoidance of adverse events and long-term outcomes by SYSADOAs/DMOADs molecules is considered. Finally, based on the real-world data, the opinion of the various Rheumatology/Osteoarthritis Societies of all over the word is illustrated and discussed also by considering the structure, quality and properties of the SYSADOAs/DMOADs agents used in the treatment of osteoarthrosis. In particular, the results reported in numerous studies are contradictory and not always convincing about the efficacy of chondroitin sulfate and glucosamine as SYSADOAs and DMOADs. The cause of these non-homogeneous results could be due to the use in different studies of chondroitin sulfate and glucosamine preparations of varying quality. It is therefore mandatory to carry out new clinical studies using chondroitin sulfate and glucosamine of pharmaceutical grade or of the best possible quality to ascertain their usefulness as biomolecules in the treatment of osteoarthrosis.
Luiz Henrique Alvarenga, MD
Postgraduate Program in Structural and Functional Interactions in Rehabilitation-University of Marília (UNIMAR) – Marília – SP, Brazil
Gabrielle Gomides Marconato, MD
Department of Biochemistry and Pharmacology, School of Medicine – UNIMAR
Gabriele Garcia Fracaro, MD
Department of Biochemistry and Pharmacology, School of Medicine – UNIMAR
Lucas Fornari Laurindo, MD
Department of Biochemistry and Pharmacology, School of Medicine – UNIMAR
Adriano Cressoni Araujo, Dr, PhD
Postgraduate Program in Structural and Functional Interactions in Rehabilitation-University of Marília (UNIMAR) – Marília – SP, Brazil ; Department of Biochemistry and Pharmacology, School of Medicine – UNIMAR
Claudio José Rubira, Dr, PhD
Hospital Beneficente UNIMAR – São Paulo, Brazil
Jefferson Aparecido Dias, Dr, PhD
Postgraduate Program in Structural and Functional Interactions in Rehabilitation-University of Marília (UNIMAR) – Marília – SP, Brazil; Postgraduate Program in Law – UNIMAR – Marília SP, Brazil
Sandra Maria Barbalho
Postgraduate Program in Structural and Functional Interactions in Rehabilitation-University of Marília (UNIMAR) – Marília – SP, Brazil; Department of Biochemistry and Pharmacology, School of Medicine – UNIMAR; School of Food and Technology of Marilia (FATEC) – São Paulo, Brazil.
Elen Landgraf Guiguer, Dr, PhD
Postgraduate Program in Structural and Functional Interactions in Rehabilitation-University of Marília (UNIMAR) – Marília – SP, Brazil; Department of Biochemistry and Pharmacology, School of Medicine – UNIMAR; School of Food and Technology of Marilia (FATEC) – São Paulo, Brazil.
Abstract
Osteoarthritis (OA) is a joint disorder characterized by chronic, degenerative, and irreversible inflammation leading to pain and disability. The standard drugs are ineffective for many patients and are usually associated with numerous side effects such as gastrointestinal complaints. Curcuma longa and its bioactive compounds have been considered for OA. The objective of this study was to perform a systematic review of the effects of Curcuma longa and its derivatives on OA. Pubmed, Cochrane, and Embase were searched, and PRISMA guidelines were followed to build this review. Only Randomized Clinical Trials (RCTs) that performed placebo-comparison were included. Most included studies showed that Curcuma longa or formulations prepared with curcuminoids can benefit the OA scores such as Visual Analog Scale, Knee injury and Osteoarthritis Outcome Score, Western Ontario and McMaster Universities Osteoarthritis Index; and Lequesne’s pain functional index. The use of Curcuma longa extracts or curcuminoids can benefit patients with OA. Nevertheless, the available RCTs show treatment time, doses, and formulations heterogeneity. Thus, the standardization of RCTs can guide researchers and physicians on the dosages and formulations that are most effective in addressing this condition, which is very prevalent in the world’s populations.
Liborio Ingala Martini, M.D.
Department of Orthopedic Surgery, IVSS Dr. Luis Ortega Hospital, Porlamar, Venezuela.
Ausberto Velasquez, M.D.
Department of Orthopedic Surgery, Clinica Universidad de los Andes, Santiago, Chile; Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
Andres Franco Abache, M.D.
Department of Orthopedic Surgery, Hospital de Especialidades Guayaquil MSP , Guayaquil, Ecuador.
Abstract
Primary glenohumeral joint osteoarthritis is a growing pathology with multifactorial aethiology that affects younger and older population. Treatment must be focused on reducing pain, regaining functionality, and slowing the course of the disease. Surgery and non-operative methods are available for treating it and are a frequent source of controversy, the latter being applied to patients with factors that may relatively contraindicate surgery. Practitioners must be acquainted with the therapeutic choices and the current status of the evidence. Given that nonsurgical therapy may be beneficial in relieving symptoms, it should be considered first-line treatment, particularly in low-demand individuals with symptoms that have shown themselves sub acutely. Literature is lacking of high quality evidence on this matter, and up to date, there have not been any high quality studies comparing different options. Optimal treatment of primary glenohumeral osteoarthritis depends on specifically patient´s needs, therefore a combination of all the resources available could represent the best option and result in better outcomes.
Neslihan Aksu, M.D.
Demiroğlu Bilim University, Faculty of Medicine, Department of Orthopedics and Traumatology, Abide i Hurriyet Cad No 164 Şişli 34381, Istanbul, Turkey
Tomris Duymaz, Pt.
Demiroğlu Bilim University, Faculty of Medicine, Department of Physıcal Theraphy and Rehabilitation, Abide i Hurriyet Cad No 164 Şişli 34381, Istanbul, Turkey
Vefa Atansay, M.D.
Demiroğlu Bilim University, Faculty of Medicine, Department of Orthopedics and Traumatology, Abide i Hurriyet Cad No 164 Şişli 34381, Istanbul, Turkey
Büşra Akgönül, Pt.
Istanbul Florence Nighingale Hospital, Department of Physıcal Theraphy and Rehabilitation Department, Abide i Hurriyet Cad No 164 Şişli 34381, Istanbul, Turkey
Ayhan Nedim Kara, M.D.
Demiroğlu Bilim University, Faculty of Medicine, Department of Orthopedics and Traumatology, Abide i Hurriyet Cad No 164 Şişli 34381, Istanbul, Turkey
Azmi Hamzaoğlu, M.D.
Istanbul Florence Nightingale Hospital, Orthopaedics and Spine Center, Abide i Hurriyet Cad No 164 Şişli 34381, Istanbul, Turkey
Abstract
Background: Due to risks of reinjury and osteoarthritis, the timing of return to sports after surgery is important. Although there are numerous studies on the return to sports (RTS) criteria in athletes who have undergone knee surgery, there are no studies on the return to dance (RTD) criteria after knee surgery in dancers. In this retrospective clinical study, we investigated the rates of osteoarthritis and reinjury after arthroscopic knee surgery and the criteria for RTD.
Materials and Methods: In a professional dance group consisting of 84 members (mean age: 29.8 ± 9.2 range: 18 to 49 years), during an 11 year period (between January 2009 and January 2020), 14 dancers (mean age 29.1±5.7 (20-38) years) sustained knee injuries (3 meniscus tears, 4 Anterior Cruciate Ligament (ACL) tears, 1 Posterior Cruciate Ligament (PCL), 1 patellar dislocation, 1 infrapatellar bursitis, 2 Hoffa’s fat pad syndromes, 2 symptomatic medial plicas) that required arthroscopic surgery. The RTD times after surgery, follow up lenghts, clinical and functional tests used for deciding on RTD were recorded.
Result: The postoperative follow up period was 56.7± 23 (26-108) months. The rate of reinjury was 7.14% after knee surgery. All dancers who underwent knee surgery were evaluated for osteoarthritis according to the Kellgren Lawrence classification, and the ostearthridites were classified as G:0 in 7 patients, G:1 in 3 patients, and G:2 in 4 patients on final knee radiographs.
Conclusion : In dancers who have undergone arthroscopic surgery, the return to dance criteria should assess painless repeated turnout after meniscus repair, and also safe landing and postural contol after ACL reconstruction or PCL reconstruction.
Azad Mohammad, DrPH
Institute for Health and the Environment, University at Albany, Rensselaer, NY 121144
David O. Carpenter, MD
Institute for Health and the Environment, University at Albany, Rensselaer, NY 121144
Abstract
Rheumatoid arthritis is an autoimmune disease, while osteoarthritis is presumed to be a disease due to wear and tear causing damage to joints. Some environmental exposures, such as smoking, air pollution and possibly persistent organic pollutants, are known to increase the risk of both. We have utilized the National Health and Nutrition Examination Survey (NHANES) data to determine associations between self-reported prevalence of any form of arthritis, rheumatoid and osteoarthritis and various polychlorinated biphenyl (PCB) congeners, several chlorinated pesticides and 2.3,7,8-tetrachloro-dibenzo-dioxin (TCDD). We find that there is a statistically significant association between serum PCB levels of more highly chlorinated PCB congeners and both types of arthritis. The associations are stronger with rheumatoid arthritis than with osteoarthritis, and stronger in women than in men.
Abdulsatar J Mathkhor
Basrah Teaching hospital
Abdulnasser H Abdullah
Alsader Teaching Hospital
Ali H Atwan
Basrah Teaching Hospital
Zahraa Mustafa Kamel
Basrah Teaching Hospital
Abstract
Background: Levels of Vitamin D may impact the development and progression of knee osteoarthritis (OA), a disorder common in elderly people The aim of this study was to investigate the association between serum Vitamin D deficiency and knee OA.
Methods: One hundred twenty (40 male and 80 female) consecutive patients were recruited from the rheumatology outpatient clinic for the study. X-rays in two anterior-posterior and lateral views of the knees were performed for all patients. Staging of knee OA was done according to Kellgren-Lawrence criteria and divided into two groups; group A consisting of grades 1 and 2, and group B, consisting of grades 3 and 4. One hundred (30 male and 70 female) healthy individuals without clinical and radiographic signs of the disease were defined as a control group. Hematological and biochemical investigations, including measurement of 25-hydroxyvitamin D serum level, were performed for all participants. Pain intensity using a visual analog scale (VAS) and disease severity using the Western Ontario and McMaster Universities Arthritis Index was measured for all patients.
Results: The mean age of patients and controls were 60±3.5 and 54±2.6 years, respectively. Vitamin D levels of patients and controls were 13±3.3 and 32±2.5, respectively. More severe disease and diseases with prolonged duration were associated with a lower vitamin D level, and low vitamin D levels were associated with high VAS and WOMAC.
Conclusion: Vitamin D deficiency was associated with the development and the severity of knee OA as well as with the disease duration.
Alberto Gobbi, MD
O.A.S.I. Bioresearch Foundation Gobbi N.P.O. Via Amadeo 24, 20133 Milan, Italy
Macarena Morales, MD
O.A.S.I. Bioresearch Foundation Gobbi N.P.O. Via Amadeo 24, 20133 Milan, Italy
Giacomo Valsecchi
O.A.S.I. Bioresearch Foundation Gobbi N.P.O. Via Amadeo 24, 20133 Milan, Italy
Abstract
This article gives a comprehensive review of a two-step single surgical alternative that searches to preserve the patient’s cartilage and joint. It addresses the knee from a 360-degree perspective; First, from the articular side, full-thickness cartilage lesions are treated with hyaluronic acid (HA) scaffold combined with bone marrow aspirate concentrate (BMC), which restores the articular cartilage with a hyaline-like tissue. Then, deep inside the subchondral bone, a minimally invasive procedure called Osteo-Core-Plasty (OCP) is conducted when it is affected. This procedure serves to restore the subchondral bone with structural bone autograft and BMAC derived signaling cells. The HA-BMC cartilage preserving technique with more than ten years of follow-up provides persistent and prothesis sparing surgical results, while OCP offers the further benefits of the new technology for deep joint bone-core treatment and regeneration with significant improvement in clinical score outcomes and magnetic resonance imaging. Given the evidence, these articular preservation techniques can be considered the new paradigm knee arthroplasty surgery as they can achieve a valuable and holistic approach to early osteoarthritis treatment.
A. Cole
University of Leicester, College of Life Sciences, Leicester Medical School, George Davies Centre, 15 Lancaster Road, Leicester, LE1 7HA, UK
R. Maulana
University of Leicester, College of Life Sciences, Leicester Medical School, George Davies Centre, 15 Lancaster Road, Leicester, LE1 7HA, UK
J.P. Whitehead
University of Lincoln, Lincoln School of Life Sciences, College of Science, University of Lincoln, Brayford Pool, Lincoln, LN6 7TS, UK
P.Y.F Lee
MSK Doctors, MSK House, London Road, Willoughby, Sleaford, England, NG34 8NY, UK
Abstract
Background: Polyacrylamide (PAAG) hydrogel is a novel compound that has recently become available in the UK market under the name Arthrosamid to treat osteoarthritis (OA). It adheres to and bulks up the synovial membrane and acts as a scaffold to treat the synovium.
The purpose of this systematic review was to explore all available patient reported outcome measures (PROMs) and adverse events of this novel compound for a management option for knee OA.
Study Design & Methods: We undertook a comprehensive literature review of PubMed, OVID, and MEDLINE databases up until April 2022 for reports of outcomes of PAAG and OA. Using keywords: (“Polyacrylamide” OR “PAAG” OR “Arthrosamid”) AND (“Osteoarthritis” OR “OA”). Study participants were those that had PAAG hydrogel intraarticular injection for knee OA. All results were screened, and relevant papers reviewed in full. This review was performed in accordance with the Preferred Reporting Items of Systematic reviews and Meta-analysis (PRISMA) 2020 statement.
Results: A total combined number of 463 patients’ outcomes were reported and assessed. Statistically significant data was identified in two studies at both 52 weeks and 13 months. Indicating the efficacy of PAAG hydrogel at one year post injection. Further continuation of one of these studies provided statistically significant results at 2 years. In a Randomised Control Trial (RCT) numerically superior data was identified compared to hyaluronic acid. Injection of PAAG hydrogel intraarticularly into the knee has been shown to be safe with no long-lasting adverse events reported.
Conclusion: From the literature this PAAG hydrogel seems to be an efficacious and safe treatment option for knee OA and provides positive results for at least 2 years.
M. Rucci
Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), University of Genoa (UniGe), Genoa (Italy): Koelliker Hospital, Corso G.Ferraris n.247-255, Turin (Italy).
F. Onorato
Koelliker Hospital, Corso G.Ferraris n.247-255, Turin (Italy).
M. Formica
Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), University of Genoa (UniGe), Genoa (Italy).
R. Ferracini
Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), University of Genoa (UniGe), Genoa (Italy).; Koelliker Hospital, Corso G.Ferraris n.247-255, Turin (Italy).
Abstract
Osteoarthritis (OA) is a widespread degenerative joint disease. The knee arthroplasty has represented for about 40 years the main treatment option, when pain and functional decrease became unbearable for the patient. The knee arthroplasty represents a challenging surgical operation, in which, based on current data available, about 20% of the patients are left totally or partially unsatisfied with the clinical result.
A recent therapeutic alternative for mild-to-moderate grade OA (Kellgren-Lawrence grade II to III) in order to delay (or ultimately avoid) the need for prosthetic surgery, is a treatment with Adipose-Derived Stem Cells (or ADSCs). The safety and efficacy in terms of functional improvement, cartilage repair and inflammation reduction were already reported for OA treatment through a single intra-articular injection of Micro-Fragmented Autologous Fat Tissue (M-FAT), which is known to be rich in ADSCs. This efficacy period appears to be ranging from several months to a few years.
Research has shown that the effect of single-dose M-FAT treatment, despite being evident in most cases, is not statistically uniform among the studies now available. This is also due to different treatment protocols, that leave to every research group the ultimate choice of preparation methods, rules and exclusion criteria.
It is possible, because of this, to hypothesize a new kind of treatment protocol based on a single surgical harvesting operation. The extract would then need to be cryopreserved and administered multiple times over a several-years period. We hope, thanks to the subsequent injections of purified extract, to prolong and boost the effect of the treatment.
We tried to elaborate, based on our experience in the field, a new protocol for this multi-injection treatment. This protocol is going to be applied to a small number of patients and evaluated over time, to elaborate the actual benefit from a treatment like this.
Masao Tanaka
Department of Advanced Medicine for Rheumatic Diseases, Graduate School of Medicine, Kyoto University
Abstract
Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic joint inflammation and destruction. The affected synovium becomes the basis of the inflammatory milieu by recruiting immune cells including T cells, B cells, monocytes, macrophages and granulocytes etc., and activates osteoclasts leading to joint destruction and dysfunction. If this inflammatory environment can be restored, destructive arthritis in RA can be prevented.
With the introduction of molecular-targeted agents (MTAs) at the beginning of this century, RA has become a controllable disease. Nevertheless, effective drugs including MTAs require continuous administration. This is because they are still unable to eliminate the cause of the disease. Patients with refractory RA often show a decreased response to treatment over time, suggesting that there underlie the irreversible traits of cytokine dysregulation. For the treatment aiming a closer-to-cure condition, it is necessary to find new approach to restore such traits.
The RA synovium has two abnormalities: morphological and functional ones. The first is the loss of the single-cell-layer structure surrounding the joint cavity followed by abnormal proliferation to form a tumor-like tissue called pannus which is comparable to epithelial-mesenchymal transition (EMT), and the second is the autonomous activation of inflammation-related genes due to epigenetic changes in DNA and the decrease in immune regulatory response due to metabolic changes, etc. Especially, these functional abnormalities seem to be associated with traits of cytokine dysregulation in RA synovium.
Recent chromatin immunoprecipitation sequencing analysis with synovial fibroblasts has shown that EMT-like changes are linked to changes in cytokine production. In RA, compared to osteoarthritis, non-autoimmune joint disease, there were activating histone modifications at the IL-6 locus. Intriguingly, such activation changes were observed also in the loci of EMT marker genes, SNAI1 and COL1A1. These epigenetic changes in the RA synovium seem to be related to irreversible, fixed traits that continue the inflammatory response.
Candidate targets of the trait-restoring therapy for RA include molecules involved in epigenetic plasticity that can restore irreversible changes toward inflammatory nature in the RA synovium.
Philippe Chiron
CHU Toulouse, France
Remi Sylvie
CHU Toulouse, France
Nicolas Reina
CHU Toulouse, France
Louis Courtot
CHU Toulouse, France
Chiron Sylvie Courtot
Reina
Abstract
This is a retrospective, single-operator study which hypothesised that shelf acetabuloplasty for acetabular dysplasia with a centre-edge angle of Wiberg between 0° and 15° and stage 1 or 2 osteoarthritis, has comparable results to periacetabular osteotomy with less severe complications. Patients and methods: 95 hips, mean follow-up of 12.8 years (4-26.4), 70.5% female (67/95), 29.5% male (28/95), mean age of 34.7 years (16-61 years). The surgical technique was minimally invasive, intermuscular between the posterior border of the tensor facia lata muscle and the anterior border of the gluteus medius muscle as described by Chiron in 2007. Survival curves were analysed using the Kaplan Meier method with the Log Rank test; Cox power test: 0.832. Results: Complications: 4 graft lyses (4.2%); 3 non-unions (3.1%); 56.8% (54/95) screw removal; no infection, no lateral femoral cutaneous nerve injury, all low-grade complications with no high-grade.
Total hip replacements: 22.1% (21/95) of which 52.3% (11/21) were in the first 5 years. Age and gender had a significant impact on survival: under 30 years, 13.9% (6/43); over 30 years, 30% (15/50); under 25 years, 0% (0/13; mean follow-up 14.6 years; 9 -26); females, 26.8% (18/67), males, 10.7% (3/28).
Survival: Overall (5 years: 90%, 10 years: 83,5%, 15 years: 77%); according to age: under 30 years (5 years: 95,3%, 10 years: 88,8%, 15 years: 84,3%), over 30 years (5 years: 84%, 10 years: 77,4%, 15 years: 69%), P-value 0.0004; according to gender: females (5 years: 86,3%, 10 years: 77,4%, 15 years: 68,9%), males (5 years: 96%, 10 years: 92,1%, 15 years: 92,1%), p-value: 0,0826; females over 30 years (5 years: 80,4%, 10 years: 75,1%, 15 years: 64,4%), females under 30 years (5 years: 91,6%, 10 years: 87,3%, 15 years: 80%), P-value: 0,1502
Survival rates were similar to those for peri acetabular arthroplasty, with no serious complications. Checking for any associated labral hip tears and arthroscopic treatment beforehand should improve the total hip replacement rate in the first 5 years.
Ideal patients are young males and those at risk are females over 30 years of age, but with results that are still acceptable for group at risk which justify this minimally invasive procedure
Julie Garden-Robinson, JPh.D., R.D., L.R.D., F.A.N.D.*1
Professor and Extension Food and Nutrition Specialist North Dakota State University, Fargo, ND (U.S.A.)’
Abstract
Reaching children with nutrition and health programming remains a timely issue now and in the future. Childhood obesity has more than tripled in the U.S. in the several decades. According to the World Health Organization (2021), 340 million children and adolescents aged 5 to 19 were overweight or obese as of 2016. Obese children are at higher risk for cardiovascular disease, with 70% showing at least one risk factor for cardiovascular disease. Obesity also increases the risk for diabetes, stroke, cancer and osteoarthritis.
Meals eaten as a family at home can save money and tend to include less fat, less soda pop and more fruits and vegetables, and they tend to be higher in calcium, fiber and other essential nutrients. The “On the Move to Better Health Kids Cooking School” and the “Kids Baking School” curricula, both developed at a Midwestern U.S. Land Grant University moved forward in new ways during the pandemic and have reached more than 3,000 children face-to-face and virtually, including the results from 1,600 participants reported in this document. The programs used a variety of new approaches to involve not only children, but also their families at home and our community partners. Children showed increased nutrition and food safety knowledge. They reported increased consumption of fruit, vegetable and whole grains, and increased confidence in using kitchen tools. Parents reported increased fruit and vegetable consumption among their children.
Ulf Andersson
Department of Women’s and Children’s Health, Karolinska Institutet, Tomtebodavägen 18A, 171 77 Stockholm, Sweden
Abstract
The recent insight that the immune system is innervated has initiated a search for neural reflex circuits suitable for therapeutic targeting in human inflammatory diseases. The inflammatory reflex, signaling along the vagus system to maintain immune system homeostasis, is the best characterized such circuit. Proinflammatory molecules, extracellularly released during infectious or sterile injury, are sensed by afferent vagal nerves that transmit this information to the nucleus of tractus solitarius in the brainstem. The afferent signals generate efferent action potentials that travel from the brainstem via efferent vagal nerves to the spleen and other organs. This culminates in T cell release of acetylcholine, which interacts with α7 nicotinic acetylcholine receptors on immunocompetent cells to inhibit proinflammatory cytokine release. These mobile anti-inflammatory T lymphocytes thus operate both inside and outside compartments innervated by the vagus system. Therapeutic proof-of-concept anti-inflammatory studies following surgical implantation of electrical vagus nerve stimulators were first conducted in rheumatoid arthritis and Crohn´s disease. Long term use of these devices was uneventful, while the initial surgical procedure caused adverse effects in some patients. The auricular branch of the vagus nerve reaches superficial parts in the concha and tragus in both ears, enabling transcutaneous electrical auricular vagus nerve stimulation (taVNS) as a safer therapeutic alternative. Invasive VNS and taVNS activate similar parts of the central nervous system indicated by functional imaging methods. Pilot taVNS studies in patients with inflammatory diseases have so far been conducted to treat rheumatoid arthritis, osteoarthritis, lupus, pediatric inflammatory bowel diseases, and pediatric nephrotic syndromes.
