Does Advanced Osteoarthritis Mimic Neuropathic Joint?

Area of Science:

• Orthopedics
• Rheumatology
• Pathology

Background:

• Osteoarthritis (OA) is a common degenerative joint disease causing pain and functional decline, particularly in the elderly.
• Radiographic findings in advanced OA do not always correlate with symptom severity.
• Some advanced OA cases exhibit histopathological features similar to neuropathic joints.

Purpose of the Study:

• To investigate the clinicopathological and histopathological correlations between advanced OA and neuropathic joints.
• To explore potential clinical similarities between these conditions.

Main Methods:

• Retrospective study of 43 patients with advanced knee OA (Ahlbach grade IV+) undergoing total knee arthroplasty (2016-2020).
• Clinical, radiological, and histopathological evaluations were conducted.
• Functional Knee Society Score (KSS) and numerical rating scale (NRS) assessed severity; statistical analyses included univariate and binary logistic regression.

Main Results:

• Over half (53.49%) of advanced OA cases showed histopathological findings consistent with neuropathic joints.
• Significant correlations were found between histopathology and KSS, Ahlbach grade, and NRS score (p < 0.01).
• KSS (<40) and NRS score (<7) were significant predictors of neuropathic joint features (p < 0.001).

Conclusions:

• Advanced knee OA can mimic neuropathic joint pathology, especially in patients with diminished knee function.
• Distinguishing between primary OA and neuropathic joint pathology requires thorough assessment for precise management.
• Findings suggest considering constrained prostheses and long stems for potentially improved outcomes in such cases.