Joint mobility is dependent on comfort, thus pain is associated with mobility. This study examined the relationship between pain perception and joint mobility in arthritis patients before and after total knee arthroplasty. Pain perception was indicated by pain intensity, pain distress and pain expectation; joint mobility was represented by the degree of knee joint flexion. Visual analogue scales were used for pain intensity, pain distress and pain expectation; knee joint flexion as measured using a goniometer. Data were collected on 24 subjects preoperatively (T1), immediately postoperatively (T2) and forty-eight to seventy-two hours postoperatively (T3). Twenty-four subjects participated in the study. Significant paired t-test resulted for joint flexion at T1 and T3 and pain expectation at T2 and T3. Pearson product-moment correlation coefficients were significant for pain intensity and pain distress at all three times, pain intensity and joint flexion at T1 and pain intensity at T1 and at T2.

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Osteoarthritis (OA) of the knee affects between 5.4% and 38% of older adults and this prevalence is increasing as the population ages and becomes more obese. As health costs rise, it is important to have accurate and cost-effective methods to assess knee OA and the risk for OA. One risk factor for progression of knee OA is lower extremity (LE) frontal-plane malalignment. The first goal of this thesis was to assess the suitability of knee radiographs and LE photographs for the estimation of frontal-plane LE alignment. In the first study, several versions of the femoral shaft-tibial shaft (FS-TS) angle, assessed from knee radiographs, were compared to the hip-knee-ankle (HKA) angle, assessed from full-length radiographs. We concluded that the FS-TS angle is not a recommended substitute for the HKA angle, because the association between the two measures differs depending on alignment, OA severity and the method of determining the FS-TS angle. In the second study, the hip-knee-ankle angle determined from a pelvis-to-ankle photograph (HKA-P) was assessed for its ability to estimate the HKA angle. The HKA-P angle was reliable and highly correlated to the HKA. It therefore shows promise as an accurate and cost-effective assessment tool for the estimation of LE alignment. Commonly-used grading scales for the severity of knee OA seen on a radiograph emphasize just one feature of OA; therefore the second goal of this thesis was to assess the psychometric properties of the unicompartmental osteoarthritis grade (UCOAG), a composite scale which grades several features of OA in the tibiofemoral (TF) compartment. In the third and fourth studies, the reliability, validity and sensitivity to change of the UCOAG scale was assessed and compared to two commonly-used scales (Kellgren-Lawrence and Osteoarthritis Research Society International joint space narrowing). The UCOAG scale showed moderate to excellent reliability. All three scales demonstrated comparable validity and sensitivity to change. The UCOAG is therefore recommended for the assessment of OA severity and change over time. This research provides evidence for the use of accurate and cost-effective measures to assess LE alignment using photographs, and TF OA severity using radiographs, for clinical assessment and research purposes. / Thesis (Ph.D, Rehabilitation Science) -- Queen's University, 2013-09-26 13:21:06.097

The Oxford Unicompartmental Knee Replacement (UKR) is a commonly performed procedure, with a good clinical outcome at 15 years, however, radiolucent lines are commonly found beneath the tibial tray. With the projected increase in knee arthroplasty, particularly in younger patients, implant longevity is of paramount importance. The aim of this thesis is to understand how fixation is achieved with the Oxford UKR and how it can be improved. A histological study demonstrated that in the presence of a radiolucent line the tibial bone-cement interface is made up of a combination of direct bony contact, fibrocartilage and fibrous tissue. The radiolucency is more marked when there is more soft tissue. However in all cases there is some direct bony contact. Cemented and cementless fixation was compared in a randomised controlled study using radiostereometric analysis and fluoroscopic imaging of the interfaces. In the first year the cementless tibial component subsided on average 0.28 mm and had an increased posterior slope of 0.40°, whereas the cemented component only subsided 0.09 mm, with a 0.10° increase in slope. In the second year both components had very little further subsidence (mean<0.05 mm) and no increase in posterior slope. In the second year a single cementless tibial component subsided greater than 0.15 mm, whereas four cemented components, all with radiolucencies, subsided more than 0.15 mm. At two years the cemented components had a significantly higher prevalence of radiolucency (62% v 29%), with 24% having a complete radiolucency, whereas no cementless components had a complete radiolucency. Two designs of lateral UKR were also compared. These had a flat tibial component that predominantly transmits compressive loading, and a domed component that also transmits shear. There was a lower prevalence of radiolucency in the domed tibia (13% v 60%), even though there was a similar amount of migration as the cemented medial tibial component. In conclusion radiolucent lines, both partial and complete, are common with cemented components, and may, in part, be a result of compressive loading. They are associated with good long-term results and direct bone cement contact indicating satisfactory fixation. However, they are also associated with increased migration and soft tissue at the interface suggesting that the fixation, although satisfactory, is suboptimal. The cementless components had no complete radiolucencies and low levels of migration in the second year. This suggests that bone ingrowth and secure fixation occurs reliably, and therefore that cementless fixation may be better than cemented for the Oxford UKR.

Anteromedial osteoarthritis of the knee (AMOA) has been defined anatomically, histologically and radiologically and yet little is known about the epidemiology of the disease or the risk factors involved in the development of the disease. The broad aim of this thesis was to combine clinical insight with the utilisation of modern, large epidemiological datasets to provide information to inform better the clinical management of patients with AMOA. Specifically, the prevalence and incidence of AMOA, the time taken to progress from early disease to severe disease that may require surgical intervention, the radiological characterisation of disease and the assessment of mechanical risk factors implicit in the development of this pattern of disease are investigated. A cross-sectional study of the radiological prevalence of AMOA in a symptomatic cohort in a specialist secondary care knee clinic showed that AMOA was the commonest pattern of knee OA, present in more than 60&percnt; of symptomatic subjects. Less than 25% of subjects with AMOA presented with advanced or 'bone-on-bone' disease, emphasising the clinical importance of understanding the progression from earlier stages of disease to this advanced stage. A 20-year longitudinal radiographic study was performed on 1000 women to describe the prevalence, incidence and progression of AMOA. The prevalence of AMOA was 43&percnt; and the incidence over 20-years was 0.4. Life table analysis showed that the risk of developing advanced AMOA in a previously normal knee was 2.6&percnt;. Of those subjects with early radiological AMOA, 11&percnt; progressed to advanced 'bone-on-bone' disease within 10 years and 37% within 20 years. The role of mechanical risk factors in the development of AMOA showed that both anatomical limb and proximal tibial alignment were significantly more varus aligned in those that developed AMOA at 20-years. Assessment of the shape of the medial tibial plateau in a longitudinal MRI study showed that the angle of the upslope at the anterior aspect of the plateau was significantly increased in the group that subsequently developed AMOA. To enable AMOA to be studies in future MRI studies, the MRI description of the disease was defined. In summary, AMOA was shown to be the most common pattern of knee OA both in symptomatic surgical cohorts and in the community. The progression of the disease from an early stage to an advanced stage, which may require surgical intervention, was described for the first time. To enable better the recognition of AMOA in modern epidemiological studies, the MRI description of AMOA was defined and the clinical relevance of modern MRI was discussed. The anatomical alignment of the limb, the alignment of the proximal tibia and the morphology of the tibial plateau were all shown to have a role in the development of AMOA. Addressing these mechanical factors may provide a therapeutic surgical target for the management of patients with AMOA.

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Title: The influence of pharmacological substances from the SYSADOA group on knee osteoarthritis. Objectives: The aim of this work is to determine the effect of three - month usage of pharmacological substances from the SYSADOA group on the subjective perception of the difficulties associated with the knee osteoarthritis and on the reological changes in the joint. Methods: In collaboration with rehabilitation and orthopedic centres 18 probands with knee osteoarthritis in the second degree were obtained. These probands were divided into two groups - the experimetal group (including those who have taken Proenzi 3 plus) and the control group (including those who have taken placebo). With all the pacients the input clinical examination and the medical history were done. Probands had been using these preparations for twelve weeks. After this time, the changes in the subjective perception using the WOMAC test and reological changes in the joint were evaluated, using a special knee rheometer. Results: The results of objectively measured parameters clearly proved that the Proenzi 3 plus has a positive effect on the rheological properties of the knee osteoarthritis. The experimental group had a statistically significant improvement in both of these parameters, as opposed to the control group. Concerning...