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Bringing knee osteoarthritis research into clinical practice


For people who suffer the pain and disability of knee osteoarthritis (OA), Tufts Medical Center not only has one of the nation’s largest and most respected research programs, but its multidisciplinary physician-scientists also care for OA patients – streamlining the application of research findings to real-world clinical practice.

“Osteoarthritis is a common disorder that currently has no disease-modifying treatments,” says Timothy McAlindon, MD, Chief of Rheumatology at Tufts Medical Center. “Our research focuses on interventions to address the structural progression of OA.”

Two major clinical studies currently are enrolling patients. The first is testing the structural effect of intra-articular corticosteroids injected into the knee joint.

“We’re using dGEMRIC – delayed gadolinium-enhanced MRI of cartilage – to measure regional changes in bone density around the knee joint,” McAlindon explains. “It enables us to measure cartilage volume in three dimensions with considerable precision.”

A second trial, led by Chenchen Wang, MD, MSc, is evaluating the physical and psychological effect of tai chi and strength training and education on knee OA. It’s funded by the National Institute of Health’s National Center for Complementary and Alternative Medicine.

Another NIH-funded study to determine if vitamin D taken once a day helps to slow the progression of knee OA is just wrapping up, and an industry-sponsored phase I trial is getting underway to test an injected growth factor called bone morphogenic protein 7 to determine if it will help restore bone or cartilage to knee joints.

Eric Smith, MD, Chief of the Arthroplasty Service in the Department of Orthopaedics, also is involved in knee OA research with a surgical bent.

“Most of our current studies are retrospective,” he says. “Right now, our biggest push is looking at patients who’ve undergone bariatric surgery who go on to need total knee replacement. We’re also comparing alignment outcomes in computer-assisted versus conventional total knee arthroscopy, and investigating ways to enhance the effectiveness and longevity of prosthetic knee replacements by minimizing angulation errors.”

“In addition, we’re doing a prospective, randomized trial comparing the traditional suture method against a barbed suture to see if the latter could lead to a reduction in the cost of total joint arthroplasty by reducing time spent in the operating room,” he notes.

It all comes together in a new multidisciplinary Osteoarthritis Clinic at Tufts Medical Center.

“We apply the treatments shown in trials to be beneficial to patient populations with OA through our clinic,” says its director, rheumatologist William Harvey, MD, MSc, FACR. “We know that knee replacement currently is the most effective treatment, and refer patients to Orthopedics when appropriate. But we also offer non-operative, evidence-based treatment of knee OA, including weight management, physical therapy, and complementary and alternative medicine, particularly for patients who don’t want surgery or wish to delay surgery. And we can refer them to appropriate clinical trials.”

“Part of our overall goal is to engage in comparative effectiveness research of proven therapies, always coming back to evidence-based care,” he adds.

“Our research gets translated into clinical care,” Smith affirms.  “And a non-operative approach has been shown to be the first mainstay of treatment.”