Topics

Role of Bone in Knee Osteoarthritis (OA)

2014-07-24 14:14:13 | BioPortfolio

Summary

The purpose of the study is to investigate the density, architecture, and perfusion of bone marrow lesions (BMLs) in knee osteoarthritis. We will perform MRI's and QCT's on subjects prior to total knee replacement to identify the location of BMLs. Connective tissues including tendon, ligament, and meniscus specimens normally discarded from total joint replacements will be used for live cell harvest, and protein and gene expression analyses of tissue or cultured cells.

Description

BACKGROUND AND SIGNIFICANCE:

Although the presence of bone marrow lesions (BML) on MRI is strongly associated with osteoarthritis (OA) progression and pain in some studies, the mechanism for this relation and the underlying pathology is not well established. The lack of knowledge on what these lesions constitute hampers their clinical utility both with regards to measurement and targeting for therapeutic intervention. In addition, prior studies in the hip have suggested that OA is associated with increased intraosseous pressures, which was thought to be the result of obstruction of venous drainage from the affected bone. It has been suggested that elevated intraosseous pressure is responsible for the pain, bone-remodeling as well as the necrosis of bone occurring in patients who have these diseases.

Our preliminary data has localized specific changes in bone mineralization, remodeling and defects within BML features that are adjacent to the subchondral plate. BMLs appear to be sclerotic compared to unaffected regions; however, the mineral density in these lesions is reduced and may render this area to be mechanically compromised, and thus susceptible to attrition. Areas of bone affected by BML in knee OA appear to be associated with altered perfusion and intraosseous venous hypertension in both the tibial plateau and femur while increased permeability was observed in the tibial plateau only. These alterations in bone perfusion and hypertension may be responsible for rest pain as well as the bone-remodeling and the necrosis of bone occurring in patients with knee OA. Limited histological analysis of BMLs reveal thrombi, diffuse fibrinoid necrosis and hyperplasia of blood vessel walls - all indicative of infarction-like pathology.

The aim of this research proposal is confirm our preliminary data obtained by pilot studies in a larger sample set and extend these findings to create more specific targets and improve our understanding of the pathology in BMLs and their relation to pain.

Specific Aim 1:

- To examine the relation of BML perfusion to rest and night pain.

Specific Aim 2:

- To evaluate the relation of BML size to BML perfusion and pain severity.

Specific Aim 3:

- To evaluate the relation between BML size and perfusion, bone density, and histomorphometry.

Specific Aim 4:

- To collect tissue to evaluate protein and gene expression of these tissues and cultured cells.

Study Design

Observational Model: Case Control, Time Perspective: Prospective

Conditions

Osteoarthritis, Knee

Intervention

MRI with gadolinium infusion, Computer Tomography (CT), Total Knee Replacement

Location

New England Baptist Hospital
Boston
Massachusetts
United States
02120

Status

Active, not recruiting

Source

The New England Baptist Hospital

Results (where available)

View Results

Links

Published on BioPortfolio: 2014-07-24T14:14:13-0400

Clinical Trials [4376 Associated Clinical Trials listed on BioPortfolio]

Computer Assisted Total Knee Replacement

The purpose of this study is to determine whether intraoperative computer-assisted navigation improves prosthetic implant positioning as compared to conventional intraoperatve instrumentat...

CT Assessment of Minimally Invasive Surgery and Computer Assisted Navigation in Total Knee Arthroplasty

The functional flexion axis of the knee can be established by computer-assisted intra-operative data, through range of motion techniques, not specific landmarks such as epicondyles.

Total Knee Replacement With the Attune vs. the Press Fit Condylar (PFC) Sigma.

100 knees with primary osteoarthritis and scheduled for a total knee replacement (TKR) will be recruited from our waiting list. The patients will be randomized to become operated with the ...

Orthopilot Elite Post-Market Clinical Follow-Up

Prospective, multicenter, observational, comparative clinical trial on the equivalence of two different OrthoPilot® navigation system generations applied for computer-assisted total knee ...

A Comparison Between Signature Personalised Patient Care to Conventional Total Knee Arthroplasty (TKA) and Computer Assisted Navigation

This is a prospective, randomised clinical outcomes study comparing the Signature Personalised Patient Care, Conventional Total Knee Arthroplasty and Computer Assisted Navigation, using Va...

PubMed Articles [10497 Associated PubMed Articles listed on BioPortfolio]

Examining Timeliness of Total Knee Replacement Among Patients with Knee Osteoarthritis in the U.S.: Results from the OAI and MOST Longitudinal Cohorts.

Patients with knee osteoarthritis may undergo total knee replacement too early or may delay or underuse this procedure. We quantified these categories of total knee replacement utilization in 2 cohort...

Lower extremity gait kinematics outcomes after knee replacement demonstrate arthroplasty-specific differences between unicondylar and total knee arthroplasty: A pilot study.

The aim of the present study is to compare sagittal gait kinematics of ankle, knee and hip joints between subjects with unicondylar and total knee arthroplasty and age matched healthy controls. Since ...

Revision Rates and Functional Outcomes Among Severely, Morbidly, and Super-Obese Patients Following Primary Total Knee Arthroplasty: A Systematic Review and Meta-Analysis.

Obesity has been associated with a greater burden of symptomatic knee osteoarthritis. There is some evidence that patients with a very high body mass index (BMI) may have a higher risk of complication...

Association of Preoperative Opioid Use With Mortality and Short-term Safety Outcomes After Total Knee Replacement.

Prescription opioid use is common among patients with moderate to severe knee osteoarthritis before undergoing total knee replacement (TKR). Preoperative opioid use may be associated with worse clinic...

The projected burden of knee osteoarthritis in New Zealand: healthcare expenditure and total joint replacement provision.

To estimate the healthcare costs and demand for total knee replacement (TKR) associated with knee osteoarthritis in New Zealand over the period 2013-2038 and the contribution of increasing obesity rat...

Medical and Biotech [MESH] Definitions

Replacement of the knee joint.

Replacement for a knee joint.

Partial or total replacement of a joint.

Tomography using single-photon emitting RADIONUCLIDES to create images that are captured in times corresponding to various points in the cardiac cycle.

Partial or total replacement of one or more FINGERS, or a FINGER JOINT.

More From BioPortfolio on "Role of Bone in Knee Osteoarthritis (OA)"

Quick Search

Relevant Topics

Osteoporosis
Osteoporosis is a disease in which the bones become extremely porous, are subject to fracture, and heal slowly, occurring especially in women following menopause and often leading to curvature of the spine from vertebral collapse. Follow and track&n...

Arthritis
Arthritis is by definition the inflammation of one or more joints, characterized by swelling, pain, warmth, redness and diminished range of joint movement (Oxford Medical Dictionary). There are many different types; Noninflammatory; Osteoarthritis, N...

Radiology
Radiology is the branch of medicine that studies imaging of the body; X-ray (basic, angiography, barium swallows), ultrasound, MRI, CT and PET. These imaging techniques can be used to diagnose, but also to treat a range of conditions, by allowing visuali...


Searches Linking to this Trial