L’arthrose est la maladie articulaire la plus fréquente pouvant être responsable d’une perte d’autonomie et d’un handicap fonctionnel majeur. Du fait du vieillissement de la population et de la prévalence de l’obésité, le nombre de personnes ayant une arthrose des membres inférieurs va augmenter dans les années à venir et entrainer une explosion des dépenses de santé. La cohorte « Knee and Hip OsteoArthritis Long-term Assessment » (KHOALA) est une cohorte française multicentrique représentative de patients atteints d’arthrose symptomatique de hanche et/ou de genou.Les objectifs de ce projet étaient d’établir une revue de la littérature sur les conséquences économiques de l'arthrose de hanche et/ou du genou. Puis à partir de la cohorte KHOALA, nous avons décrit la consommation de soins ; identifié les facteurs associés aux trajectoires d'utilisation des ressources de santé et estimé les coûts annuels totaux. Enfin nous avons réalisé une analyse systématique de la littérature sur les analyses coût-efficacité des anti-arthrosiques d’action lente et de l’acide hyaluronique intra articulaire dans l’arthrose de genoux.La revue systématique a objectivé une hétérogénéité des couts totaux par patient (de 0,7 à 12 k€/an). Les données de KHOALA ont démontré que la majorité des patients consultait son médecin généraliste et une minorité de patients consultait un spécialiste. Le seul facteur clinique indépendant prédictif des consultations des professionnels de la santé était l'état de santé mentale. Le coût total annuel moyen par patient sur la période d'étude de 5 ans était de 2180 ± 5 305 €. En France, les coûts médians pourraient atteindre 2 milliards € / an (IQR 0,7–4,3). / Osteoarthritis is the most common joint disease that can be responsible for a loss of autonomy and a major functional disability. With the aging of the population and the prevalence of obesity, the number of people with lower limb osteoarthritis will increase in the coming years and lead to an explosion of health spending. The "Knee and Hip OsteoArthritis Long-term Assessment" cohort (KHOALA) is a representative French multicenter cohort of patients with symptomatic hip and / or knee osteoarthritis.The aims of this thesis were to provide an overview of the economic consequences of hip and knee osteoarthritis worldwide. Then from the KHOALA cohort, we described health care resources use in the KHOALA cohort, we identified factors associated with trajectories of healthcare use and we estimated the annual total costs. Finally, we conducted a systematic review of the literature on the cost effectiveness of intra-articular hyaluronic acid and disease-modifying osteoarthritis drugs used in the treatment of knee OA.The systematic review showed a heterogeneity of the total costs per patient (from 0.7 to 12 k € / year). KHOALA data showed that primary care physicians have a central role in osteoarthritis care, mental health state was the only independent predictive factor of healthcare professional consultations. The mean annual total cost per patient over 5 years was 2180 ± 5,305 €. In France, median annual total costs would be approximately 2 billion €/year (IQR 0.7-4.3).

Introduction: Arthroscopic partial resection of degenerative meniscal injuries has previously been frequently performed but has been questioned in recent years. However, contradictory data exist. Aim: We aimed to asses patient- reported outcome in patients over 40 years of age after arthroscopic surgery due to degenerative meniscal injury. We further aimed to compare women and men due to diagnosis and to examine the number of patients that have needed knee arthroplasty during the follow-up period. Methods: Patients > 40 years of age who underwent arthroscopic surgery of the knee in the years of 2011-2013 were studied using validated questionnaire KOOS (Knee Injury and Osteoarthritis Outcome Score) along with a self-constructed questionnaire. Results: In all subjects, the highest median score was seen in all daily living (Women:93, Men: 96) and knee pain (Women: 86, Men: 92). The lowest score was seen in sports and recreation (Women: 55, Men: 65). Men had an overall higher KOOS-score in every subscale compared to women (p>0.05). No significant difference was seen between women and men divided by diagnosis (p>0.05). 72% women and 80% men experienced improved knee function today compared to before surgery. 22% women and 14% men experienced deterioration in knee function. 6% women and men experienced unaltered knee function. 24 patients (9.5%) had got a knee arthroplasty. Conclusions: This study showed that most middle-age patients experienced increased knee function and high satisfaction rate after partial meniscectomy when suffering from degenerative meniscal injury.

Disregard for patient-specific joint-level variability may be related to decreased functional ability, poor implant longevity and dissatisfaction post-TKA. The purpose of this study was to, 1) compare pre and post-implant intraoperative passive knee adduction angle kinematic patterns and characterize the effect of surgical intervention on each pattern, 2) examine the association between passive pre and post-implant knee kinematics measured intraoperatively and dynamic knee kinematics and kinetics pre and post-TKA measured during gait, and 3) compare dynamic post-TKA kinematic and kinetic patterns between patient-specific knee recipients and traditional TKA recipient. Patients received a TKA using the Stryker Precision Knee navigation system capturing pre/post-implant kinematics through a passive range of flexion. One-week prior and 1-year post-TKA patients underwent three-dimensional gait analysis. Knee joint waveforms were calculated according to the joint coordinate system. Principal component analysis (PCA) was applied to frontal plane gait angles, moments and navigation angles. Paired two- tailed t-tests were used to compare principal component (PC) scores between pre and post-implant patterns, and a one-way ANOVA was used to test if post-implant patterns were significantly different from zero. Two-tailed Pearson correlation coefficients tested for associations between navigation and gait PCscores, and an un-paired two-tailed t-test was used to compare PCscores between patient-specific and traditional TKA groups. Six different passive kinematic phenotypes were captured pre-implant. Although some waveform patterns persisted at small magnitudes post-implant (PC1 and PC3: p<0.001), curves remained within the clinically acceptable alignment range through passive motion. A positive correlation was found between navigation adduction angle PC1 and gait adduction moment PC1 pre and post-TKA (p<0.001, r=0.79; p<0.01 r=0.67), and a negative correlation between navigation adduction angle PC1 and gait adduction angle PC1 post-TKA (p=0.03, r=-0.53). The patient-specific group showed significantly lower PC2 scores than the traditional TKA group (p=0.03), describing a lower flexion moment magnitude during early stance phase, possibly representing a functional limitation or non- confidence during gait. These results were an important first step to assess patient- specific approaches to TKA, suggesting possible applications for patient-specific intraoperative kinematics to aid in surgical decision-making and influence functional outcomes.

Background Osteoarthritis (OA) is a long-term chronic disease that affects the joints and creates stiffness, pain and impaired movement. Knee osteoarthritis is the most common form of OA and affects all tissues of the joint, including bone, muscles, synovia, and cartilage. Previously, OA was accepted as only an age- or mechanical stress-related degenerative joint disease, but more recent studies suggest that OA is a heterogenous disease including inflammatory, hormonal and metabolic factors such as abdominal obesity (visceral fat), lipids (cholesterol, HDL, LDL and triglycerides) and glucose.    Aim The aim was to investigate the association of metabolic factors including fasting blood glucose, HbA1c, triglycerides, cholesterol, LDL, HDL, visceral fat, CRP and radiographic KOA in patients with symptomatic knee osteoarthritis. Methods Data were acquired from 91patients in the ages 30 – 63 experiencing symptomatic knee osteoarthritis. All subjects where divided into two groups depending on their level of fasting glucose, high versus low. Group I (n=26) had high glucose levels ≥5,6 mg/L and group II (n=65) had low glucose levels &lt;5,6 mg/L.  Levels of HbA1c, lipids, visceral fat, CRP and radiographic KOA were then compared between the groups. Levels of fasting glucose, HbA1c and lipids (triglycerides, cholesterol, LDL, HDL) were analyzed by an accredited laboratory at the hospital of Halmstad by the department for labmedicine. CRP levels &lt; 1 mg/L were manually analyzed with the sandwich ELISA method (enzyme-linked immunosorbent assay), which measures high-sensitive CRP (hsCRP) in serum. Visceral fat area was measured through bioelectrical impedance analysis (BIA) with InBody 770 and radiographs of the knees to obtain information about OA. Results There was a significant difference between the two groups in HbA1c, triglycerides, cholesterol and LDL p&lt;0,05. Group I with high fasting glucose levels showed higher significant values of HbA1c, triglycerides, cholesterol and LDL than group II with low fasting glucose levels. 23% of all subjects met the requirement for metabolic syndrome according to IDF. Conclusion The findings in this study is in line with previous research and suggest that high glucose levels are associated with elevation of other metabolic factors in patients with knee osteoarthritis. However, there are several other interacting factors beyond the scope of this study, which may explain causalities. According to the findings in this study and previous research, obesity and metabolic syndrome could explain some of the connections between metabolic factors and knee osteoarthritis. Thus, further research is necessary to understand how all these metabolic factors are associated with osteoarthritis and obtain deeper knowledge about the pathogenesis and pathophysiology of the disease. / Detection and prediction of disease course in symptomatic knee osteoarthritis

Made available in DSpace on 2016-12-12T17:32:56Z (GMT). No. of bitstreams: 1 Resumo-Bruna Wageck.pdf: 213390 bytes, checksum: ec00404166281fe05d5d9eee8840a8e5 (MD5) Previous issue date: 2014-07-18 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Background: Knee osteoarthritis (OA) is one of the most prevalent injuries in elderly people. This injury causes pain, reduction of the strength, edema, articular function deficit and issues with life quality. There are many possible treatments for knee OA, one that is becoming popular is the Kinesio Taping (KT) technique. This technique appears to improve muscle strength, reduce pain and edema. Objectives: Verify the effect of the KT technique on edema, pain and muscle strength in elderly with knee OA. Methods: 76 subjects with knee OA were first assessed for quadriceps muscular strength (isokinetic dynamometer) , pain (pressure algometry), edema (volumetry), knee function (Lysholm questionnaire) and quality of life (WOMAC). After the baseline evaluation, the subjects were randomly divided into two groups: Intervention (IG) and Placebo (PG). The IG group received KT on the quadriceps muscle, following the Y technique from origin to insertion, also received KT for lymphatic correction and space correction. The GP received elastic tapes without any therapeutic indication. All subjects kept the tapes on for 4 days. After that they returned to post-application evaluation and 15 days after that the subjects were assessed for follow up. Results: No statistically significant differences were found between groups on the post-treatment or follow up for any of the variables investigated. Conclusion: KT technique provided no beneficial effects on pain, muscle strength, edema, knee function and life quality in elderly with knee OA. / Introdução: A osteoartrose (OA) de joelho é uma das doenças mais prevalente nos idosos, ocasionando dor, diminuição da força muscular, edema, perda de função e alteração na qualidade de vida desses indivíduos. Dentre os diversos possíveis tratamentos para a OA de joelho as bandagens vem sendo muito utilizadas. A técnica Kinesio Taping (KT) sugere entre os seus efeitos a diminuição da dor, edema e melhora da força muscular. Objetivo: Verificar o efeito da técnica KT como forma de tratamento da OA de joelho em indivíduos idosos . Métodos: 76 participantes com OA de joelho foram avaliados quanto a força muscular de quadríceps (dinamômetro isocinético), dor (algometria de pressão), edema (volumetria), funcionalidade de joelho (questionário Lysholm) e Qualidade de vida (questionário WOMAC). Após a avaliação os participantes foram randomizados em dois grupos, intervenção (GI) e placebo (GP). O GI recebeu KT com intuído de relaxamento de quadríceps, drenagem de edema e abertura de espaço subcutâneo; já o GP recebeu a bandagem elástica sem indicação terapêutica. Os participantes de ambos os grupos mantiveram as fitas durante 4 dias e retornaram para reavaliação imediatamente após 4 dias e após 15 dias pós-intervenção. Resultado: Foi observado não houve diferença entre grupos para nenhuma variável analisada, seja no momento imediatamente após a intervenção (4 dias) ou na avaliação após 15 dias da intervenção. Conclusão: Os resultados do presente estudo demonstraram que a utilização da técnica KT não tem efeito significativo na dor, na força muscular, no edema, na qualidade de vida e na funcionalidade de joelhos de idosos com OA de joelho após 4 dias de utilização da técnica.

La connaissance des effets biomécaniques induits par les orthèses plantaires représente un enjeu important afin de faire reconnaitre le rôle du podologue dans le traitement des pathologies ostéo-articulaires et musculo-tendineuses de l'appareil locomoteur. Ainsi, ce travail de thèse consiste à modéliser, par la biomécanique, l'appareil locomoteur afin d'évaluer les effets du port des orthèses plantaires durant la marche. Avant toute chose, une étude méthodologique a été menée afin de vérifier la reproductibilité des données biomécaniques de la marche. Les principaux résultats montrent que ces données biomécaniques peuvent présenter une variabilité importante, principalement causée par des erreurs de positionnement des capteurs sur le sujet, rendant parfois difficile l'interprétation clinique. Toutefois, la deuxième partie de cette étude a montré que l'utilisation d'une méthodologie de correction segmentaire à partir d'une position statique imposée permettait de réduire cette variabilité. Une étude clinique a donc été menée sur les répercussions de l'utilisation d'une orthèse plantaire de supination sur la correction instantanée du pied valgus. Les principales conclusions montrent que les données cinématiques et dynamiques, notamment du pied et de la cheville, sont impactées. Enfin, afin de démontrer l'intérêt d'utiliser la méthodologie de correction segmentaire pour l'interprétation des effets biomécaniques du traitement par orthèses plantaires à plus ou moins long terme, deux cas cliniques ont été analysés, l'un concernait un patient atteint d'un syndrome de loge de la jambe et l'autre d'une gonarthrose. Les principales conclusions indiquent que les orthèses plantaires ont une action sur des pathologies de la cheville et du genou mais que l'interprétation de cette action peut être erronée si la variabilité des données biomécaniques de la marche n'est pas prise en considération / The knowledge of the biomechanical effects induced by foot orthotics is an important issue in order to recognize the role of the podiatrist in the treatment of osteoarticular and musculotendinous disorders of the musculoskeletal system. So, this work consists in modeling, by the biomechanics, the musculoskeletal system to assess the effects of wearing foot orthotics during walking. A first study was conducted to check the reproducibility of gait biomechanical data through two different sessions. The results show that these biomechanical data may show significant variability, mainly caused by errors in the positioning of sensors on the subject, making it difficult clinical interpretation. However, the second part of this study showed that the use of a methodology for segmental correction, from a static position imposed, allowed reducing this variability. Thus, a study was conducted on the impact of the use of supinated foot orthotics on immediate correction of valgus foot. The main findings show that the kinematic and dynamic data, notably the foot and ankle, are impacted. Before being able to estimate if this correction lasts over time, a second study was conducted. Thus, to demonstrate the benefits of using this methodology for the interpretation of the biomechanical effects of treatment with foot orthotic in the longer term, two clinical cases were analyzed, one involved a patient with compartment syndrome of the leg and the other with knee osteoarthritis. The main findings indicate that the insoles have an impact on diseases of the ankle and knee but that the interpretation of these actions may be wrong if the variability of gait biomechanical data is not considered

Bakgrund: Osteoartrit (OA) är en ledsjukdom och en av de främsta orsakerna till funktionsnedsättning bland världens befolkning. I rekommendationer för rehabiliteringen ingår bland annat styrketräning. Kliniska erfarenheter visar att programmens innehåll kan sakna principer för progression avseende intensitet, volym och frekvens.  Syfte: Syftet med studien var att utföra en systematisk litteraturöversikt och jämföra styrketräningsprogrammens sammansättning hos individer med OA i knäleden enligt utfallsmåtten egenskattad smärta, egenskattad funktion och fysisk funktion.  Metod: För datainsamlingen genomfördes sökningarna i databaserna PubMed, SPORTDiscus och Cinahl. Inklusionskriterier var individer med diagnostiserad symptomatisk OA i knäleden där interventionen var styrketräning. Studiedesignen var randomiserade kontrollerade studier där båda könen studerades. Efter urvalsarbete kvarstod 10 artiklar. Resultat: Programmen pågick från 6 till 16 veckor och innefattade utrustning såsom gummiband, fria vikter och styrketräningsmaskiner. Jämfört mot kontrollgruppen visade majoriteten av översiktens interventioner signifikanta förbättringar för The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) och fysisk funktion mellan baseline och slutet av interventionen. Antalet övningar varierade från 1 till 7, intensiteten var både låg och hög och utfördes från 1 till 10 set med 2 - 15 reps. Alla studier redovisade inte principer för progression.   Slutsats: Styrketräning reducerar smärta och tillför ökad funktion hos individer med OA i knäleden.  Träningen kan innefatta olika upplägg av motstånd, antal övningar, intensitet, set och reps och kan utföras i hemmiljö eller på gym med handledning av fysioterapeut. / Background: Osteoarthritis (OA) is a joint disease and one of the leading causes of disability among the world's population. Rehabilitation recommendations include resistance training. Clinical experience shows that the content of exercise lacks principles for progression according to intensity, volume and frequency. Aim: A systematic literature review was conducted comparing the composition of resistance training programs according to outcome measures for self-rated pain, self-rated function and capacity in physical function in individuals with knee OA.  Method: The databases PubMed, SPORTDiscus and Cinahl were searched for articles. Inclusion criteria of the study were individuals with diagnosed symptomatic OA in the knee joint where the intervention was resistance exercise. The study designs were randomized controlled trials in which both genders were given access. After selection 10 articles remained. Results: Programs lasted from 6 to 16 weeks and included equipment such as elastic bands, weights, and resistance exercise machines. The majority of the interventions showed significant improvements for The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and physical function between baseline and the end of the intervention compared to the control group. Number of exercises varied from 1 to 7, intensity could be both low and high, 1 to 10 sets and 2-15 reps. Some studies did not report principles for progression. Conclusion: Strength training reduces pain and increases function in individuals with OA in the knee joint. Strength training programs of different designs may be successful and the application of training variables (e.g. type of resistance, number of exercises, intensity, set x reps) may vary. Further, strength training can be performed in a home environment or in a gym with the support of a physiotherapist.

Knee osteoarthritis is a growing problem due to increasing risk factors such as age and obesity. It is a common task for a radiologist to grade osteoarthritis in three compartments (medial tibiofemoral (MTF), lateral tibiofemoral (LTF) and patellofemoral (PF)) in a knee from different image views of X-ray images, to decide if osteoarthritis is the cause of pain for the patient. Reasons for automating this process are to decrease subjectivity, time for diagnosis and reduce workload for radiologists. The aim with this project was to grade osteoarthritis using machine learning by training convolutional neural networks on around 5000 double annotated examinations by radiologists and one orthopaedic surgeon at Nyköping Hospital. Different methods were evaluated and the models were then optimised with hyperparameter tuning. The aim with the project is to contribute to a future software that could be tested at Nyköping Hospital. The project found that using transfer learning with DenseNet for MTF and PF, and using a MTF model as transfer learning model for the LTF model was the best performing transfer learning networks to use. Also, cropping the images around the region of interest for MTF and LTF improved the models. The best method to make predictions from the model outputs appeared to be to train a model on a merged set of training- and validation data for making predictions. Comparisons of final models with the radiologist initial annotations showed that the MTF and LTF models give fewer misclassifications of more than one grade, if compared to the disagreements of more than one grade by the two radiologists. While for the PF model the radiologists still have an advantage and more data is probably needed for both the PF model and the LTF model since grade 0 is very overrepresented for those grades.

Knee osteoarthritis (KOA) is the primary cause of chronic immobility in populations over the age of 65. It is a joint degenerative disease in which the articular cartilage in the knee joint wears down over time, leading to symptoms of pain, instability, joint stiffness, and misalignment of the lower extremities. Without intervention, these symptoms gradually worsen over time, decreasing the overall knee range of motion (ROM) and ability to walk. Current clinical interventions include offloading braces, which mechanically realign the lower extremities to alleviate the pain experienced in the medial compartment of the knee joint. Though these braces have proven effective in pain management, studies have shown a significant decrease in knee ROM while using the brace. Concurrently, development of active exoskeletons for rehabilitative gait has increased within recent years in efforts to provide patients with a more effective intervention for dealing with KOA. Though some developed exoskeletons are promising in their efficacy of fostering gait therapy, these devices are heavy, tethered, difficult to control, unavailable to patients, or costly due to the number of complicated components used to manufacture the device. However, the idea that an active component can improve gait therapy for patients motivates this study. This study proposes the design of an adjustable lower extremity exoskeleton which features a single linear actuator adapted onto a commercially available offloading brace. This design hopes to provide patients with pain alleviation from the brace, while also actively driving the knee through flexion and extension. The design and execution of this exoskeleton was accomplished by 3D computer simulation, 3D CAD modeling, and rapid prototyping techniques. The exoskeleton features 3D printed, ABS plastic struts and supports to achieve successful adaptation of the linear actuator to the brace and an electromechanical system with a rechargeable operating capacity of 7 hours. Design validation was completed by running preliminary gait trials of neutral gait (without brace or exoskeleton), offloading brace, and exoskeleton to observe changes between the different gait scenarios. Results from this testing on a single subject show that there was an observed, significant decrease in average knee ROM in the offloading brace trials from the neutral trials and an observed, significant increase in average knee ROM in the exoskeleton trials when compared to the brace trials as hypothesized. Further evaluation must be completed on the clinical efficacy of this device with a larger, and clinically relevant sample size to assess knee ROM, pain while using the device, and overall comfort level. Further development of this design could focus on material assessment, cost analysis, and risk mitigation through failure mode analysis.

Knee osteoarthritis affects approximately 25 million adults. In severe cases, total knee arthroplasty (TKA) is the most common solution. TKA is effective at addressing pain and reducing continued degeneration of articular cartilage. However, effective physical therapy (PT) following TKA is vital for a full functional recovery. Despite the importance of PT, half of patients never achieve a full functional recovery. Decreases in proprioceptive feedback, severe atrophy, and pain inhibition all likely contribute to the variability in effectiveness. Surface electromyography-based biofeedback (sEMGBF) may allow clinicians to address some of these barriers by supplementing proprioceptive feedback and targeting small muscle contractions before eventually increasing the contraction requirement. Using a between group design, we compare the effectiveness of sEMGBF (7) to neuromuscular stimulation (NMES) (6), and a control group (6) in recovery following TKA. Effectiveness was evaluated across 4 metrics (quadriceps strength, range of motion, functional improvement, and quality of life) in a pre-test/post-test fashion. At the statistical level this study suggest that sEMGBF leads to greater improvements in quadriceps strength relative to the NMES and control group. Additionally, visual analysis suggests that sEMGBF may also lead to greater improvements in range of motion, and functional improvement relative to the NMES and control group. The results for quality of life are mixed. Overall, the study provides initial clinical support for the utility of sEMGBF following TKA.