Cartilage Tissue Engineering: the effect of different biomaterials, cell types and culture methods

Chapter 1 outlines the normal structure and composition of articular cartilage and the inefficient spontaneous healing response after focal damage. Current surgical treatment options are briefly discussed and tissue engineering techniques for the repair of articular cartilage defects are addressed in more detail. The aims of the work presented in this thesis are outlined in Chapter 2: namely to investigate the infl uence of different biomaterials, cell types and culture methods on the tissue engineering process, as well as characteristics of the tissue engineered cartilage

Comparison of KOOS scores of middle-aged patients undergoing total knee arthroplasty to the general Dutch population using KOOS percentile curves: the LOAS study

Background: We aimed to investigate the application of the Knee Injury and Osteoarthritis Outcome Score (KOOS) percentile curves, using preoperative and postoperative data of patients with knee osteoarthritis undergoing total knee arthroplasty (TKA).Methods: We used Longitudinal Leiden Orthopedics Outcomes of Osteo-Arthritis study data of patients between 45 and 65 years and undergoing primary TKA. KOOS scores (0-100) were obtained preoperatively and 6, 12, and 24 months after TKA. Preoperative knee radiographs were assessed according to Kellgren-Lawrence (KL) in a subset (37%) of patients. Comorbidities were self-reported using a standardized questionnaire. The median (interquartile range) population-level KOOS scores were plotted on previously developed population-based KOOS percentile curves. In addition, we assessed the application of the curves on patient level and investigated differences in scores between patients with preoperative KL scores = 3 and presence (vs absence) of comorbidities.Results: The study population consisted of 853 patients (62% women, mean age 59 years, body mass index 30 kg/m(2)) with knee osteoarthritis undergoing primary TKA. Preoperatively, median KOOS scores of all subscales were at or below the 2.5th percentile. Scores increased to approximately the 25th percentile 12 months postoperatively. Greater improvements were observed in pain and less improvements in sport and recreational function and quality of life. Patients with higher preoperative KL scores and without comorbidities showed greater improvements.Conclusion: The KOOS percentile curves provided visual insights in knee complaints of patients relative to the general population. Furthermore, the KOOS percentile curves give insight in how preoperative patient characteristics are correlated with postoperative results. (C) 2021 The Author(s). Published by Elsevier Inc.Clinical epidemiolog

Feasibility of collecting multiple patient-reported outcome measures alongside the Dutch arthroplasty register

Background: Compliance rates with patient-reported outcome measures (PROMs) collected alongside arthroplasty registries vary in the literature. We described the feasibility of a routinely collected set PROMs alongside the Dutch Arthroplasty Register. Methods: The longitudinal Leiden Orthopaedics Outcomes of OsteoArthritis Study is a multicenter (7 hospitals), observational study including patients undergoing total hip or total knee arthroplasty (THA or TKA). A set of PROMs: Short Form-12, EuroQol 5 Dimensions, Hip/Knee injury and Osteoarthritis Outcome Score, Oxford Hip/Knee Score was collected preoperatively and at 6, 12, 24 months, and every 2 years thereafter. Participation rates and response rates were recorded. Results: Between June 2012 and December 2014, 1796 THA and 1636 TKA patients were invited, of whom 1043 THA (58%; mean age 68 years [standard deviation, SD: 10]) and 970 TKA patients (59%; mean age 71 years [SD 9.5]) participated in the study. At 6 months, 35 THA/38 TKA patients were lost to follow-up. Response rates were 90% for THA (898/1000) and 89% for TKA (827/932) participants. At 1 and 2 years, 8 and 18 THA and 17 and 11 TKA patients were lost to follow-up, respectively. The response rates among those eligible were 87% (866/992) and 84% (812/972) for THA and 84% (771/917) and 83% (756/906) for TKA patients, respectively. The 2-year questionnaire was completed by 78.5% of the included THA patients and by 77.9% of the included TKA patients. Conclusions: About 60% of patients undergoing THA or TKA complete PROMs preoperatively, with more than 80% returning follow-up PROMs. To increase the participation rates, more efforts concerning the initial recruitment of patients are needed.Clinical epidemiolog

Are pain, functional limitations and quality of life associated with objectively measured physical activity in patients with end-stage osteoarthritis of the hip or knee?

Objectives: Physical activity is promoted in patients with hip or knee osteoarthritis (OA), yet little is known about its relationship with symptoms, functional limitations and Quality of Life (QoL). We investigated if OA-associated pain, functional limitations and QoL are associated with objectively measured physical activity in patients with end-stage hip/knee OA. Methods: Cross-sectional study including patients scheduled for primary total hip/knee arthroplasty. Patients wore an accelerometer (Activ8) with physical activity assessed over waking hours, and expressed as number of activity daily counts (ADC) per hour, %time spent on physical activity i.e. walking, cycling or running (%PA), and %time spent sedentary (%SB). Pain, functional limitations and joint-specific and general QoL were assessed with the Hip disability/Knee Injury and Osteoarthritis Outcome Score (HOOS/KOOS) and the Short Form (SF)-12. Multivariate linear regression models with the three to Z-scores transformed parameters of physical activity as dependent variables and adjusted for confounding, were conducted. Results: 49 hip and 48 knee OA patients were included. In hip and knee OA patients the mean number of ADC, %PA and %SB were 18.79 ± 7.25 and 21.19 ± 6.16, 14 ± 6.4 and 15 ± 5.0, and 66 ± 10.5 and 68 ± 8.7, respectively. In hip OA, better joint-specific and general QoL were associated with more ADC, (β 0.028; 95%CI:0.007–0.048, β0.041; 95%CI:0.010–0.071). Also, better general QoL was associated with the %PA (β 0.040, 95%CI:0.007–0.073). No other associations were found. Conclusion: Whereas QoL was associated with physical activity in hip OA, pain and functional limitations were not related to objectively measured physical activity in patients with end-stage hip or knee OA