{"title":"Does Advanced Osteoarthritis Mimic Neuropathic Joint?","authors":"Shubhranshu Shekhar Mohanty, Ashraf Shaikh, Ajinkya Desale, Prashant Kamble, Rudra Prabhu","doi":"10.1007/s43465-025-01347-z","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Osteoarthritis (OA) is a prevalent condition among the elderly and leads to pain and functional limitations. Radiographic imaging often fails to correlate with symptom severity, and advanced OA may exhibit features reminiscent of neuropathic joints. This study explored the clinicopathological and histopathological correlations between advanced OA and neuropathic joints, hypothesizing clinical similarities.</p><p><strong>Methods: </strong>A retrospective study involving 43 patients who underwent total knee arthroplasty for advanced knee OA was conducted from 2016 to 2020. Clinical, radiological, and histopathological evaluations were performed. Advanced OA was defined as an Ahlbach grade IV or above. The functional Knee Society Score (KSS) was used to assess clinical severity, and histopathology was considered \"significant\" if the results were consistent with the neuropathic joint findings. The statistical analyses included univariate and binary logistic regression analyses.</p><p><strong>Results: </strong>The mean age was 57.63 ± 17.13 years, and most patients were females (69.77%). A total of 53.49% of the grading systems yielded histopathological findings resembling those of neuropathic joints. Univariate analysis revealed significant correlations between histopathology and the functional KSS, Ahlbach grade, and NRS score (<i>p</i> < 0.01). Binary logistic regression confirmed that KSS (< 40) and NRS score (< 7) were significant predictors (<i>p</i> < 0.001, Nagelkarke <i>R</i> <sup><i>2</i></sup> = 0.576).</p><p><strong>Conclusion: </strong>Patients with advanced knee OA may exhibit characteristics resembling those of neuropathic joints, particularly individuals with a poorer functional knee. Thorough assessments are crucial for distinguishing between primary OA and neuropathic joint pathology and for carrying out more precise management strategies. This study provides valuable insights into the complex presentation of advanced knee OA and highlights the importance of using more constrained prosthesis and long stem components for potentially better outcomes.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 5","pages":"667-672"},"PeriodicalIF":1.1000,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12043532/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Indian Journal of Orthopaedics","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s43465-025-01347-z","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/5/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction: Osteoarthritis (OA) is a prevalent condition among the elderly and leads to pain and functional limitations. Radiographic imaging often fails to correlate with symptom severity, and advanced OA may exhibit features reminiscent of neuropathic joints. This study explored the clinicopathological and histopathological correlations between advanced OA and neuropathic joints, hypothesizing clinical similarities.
Methods: A retrospective study involving 43 patients who underwent total knee arthroplasty for advanced knee OA was conducted from 2016 to 2020. Clinical, radiological, and histopathological evaluations were performed. Advanced OA was defined as an Ahlbach grade IV or above. The functional Knee Society Score (KSS) was used to assess clinical severity, and histopathology was considered "significant" if the results were consistent with the neuropathic joint findings. The statistical analyses included univariate and binary logistic regression analyses.
Results: The mean age was 57.63 ± 17.13 years, and most patients were females (69.77%). A total of 53.49% of the grading systems yielded histopathological findings resembling those of neuropathic joints. Univariate analysis revealed significant correlations between histopathology and the functional KSS, Ahlbach grade, and NRS score (p < 0.01). Binary logistic regression confirmed that KSS (< 40) and NRS score (< 7) were significant predictors (p < 0.001, Nagelkarke R2 = 0.576).
Conclusion: Patients with advanced knee OA may exhibit characteristics resembling those of neuropathic joints, particularly individuals with a poorer functional knee. Thorough assessments are crucial for distinguishing between primary OA and neuropathic joint pathology and for carrying out more precise management strategies. This study provides valuable insights into the complex presentation of advanced knee OA and highlights the importance of using more constrained prosthesis and long stem components for potentially better outcomes.
骨关节炎（OA）是老年人的一种常见疾病，导致疼痛和功能限制。x线影像通常与症状严重程度不相关，晚期OA可能表现出与神经性关节相似的特征。本研究探讨了晚期OA和神经性关节之间的临床病理和组织病理学相关性，并假设了临床相似性。方法：对2016年至2020年43例晚期膝关节OA患者行全膝关节置换术进行回顾性研究。进行临床、放射学和组织病理学评估。高级OA被定义为Ahlbach IV级或以上。膝关节功能社会评分（KSS）用于评估临床严重程度，如果结果与神经性关节发现一致，则认为组织病理学“显著”。统计分析包括单变量和二元逻辑回归分析。结果：患者平均年龄57.63±17.13岁，以女性居多（69.77%）。共有53.49%的分级系统产生与神经性关节相似的组织病理学结果。单因素分析显示，组织病理学与功能性KSS、Ahlbach评分和NRS评分之间存在显著相关性（p p R 2 = 0.576）。结论：晚期膝关节OA患者可能表现出与神经性关节相似的特征，尤其是膝关节功能较差的患者。全面的评估对于区分原发性骨关节炎和神经性关节病理以及实施更精确的治疗策略至关重要。该研究为晚期膝关节OA的复杂表现提供了有价值的见解，并强调了使用更多受限假体和长柄部件的重要性，以获得潜在的更好结果。
期刊介绍：
IJO welcomes articles that contribute to Orthopaedic knowledge from India and overseas. We publish articles dealing with clinical orthopaedics and basic research in orthopaedic surgery. Articles are accepted only for exclusive publication in the Indian Journal of Orthopaedics. Previously published articles, articles which are in peer-reviewed electronic publications in other journals, are not accepted by the Journal. Published articles and illustrations become the property of the Journal. The copyright remains with the journal. Studies must be carried out in accordance with World Medical Association Declaration of Helsinki.
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