Letter to Editor Regarding Article,“Improved 2-Year Freedom From Arthroplasty in Patients With High-Risk SIFK Scores and Medial Knee Osteoarthritis Treated With an Implantable Shock Absorber Versus Non-Operative Care”

Dear Editor

Recently, we read an article titled “Improved 2-Year Freedom from Arthroplasty in Patients with High-Risk SIFK Scores and Medial Knee Osteoarthritis Treated with an Implantable Shock Absorber versus Non-Operative Care” published by Ayoosh Pareek et al. The author followed up with 42 patients with Subchondral Insufficiency Fracture of the Knee (SIFK) high-risk score and knee arthritis, of whom 21 were in the implantable shock absorber (ISA) treatment group and 21 were in the non-surgical group. ISA has been shown to reduce knee loading, delaying or replacing the need for arthroplasty in some patients. We affirm that the author’s study has made a positive contribution to the treatment of early knee arthritis, but there are still some issues that need our in-depth discussion.

First of all, different occupations have different activity levels, and the daily activity level may affect the progression of osteoarthritis (OA). About 60% of arthritis patients are of working age. Studies by Joern W.-P. and others have shown that occupational factors also affect the progression of knee arthritis important factor. ¹ Often kneeling or squatting-based work will increase the load on the knee joint, thereby accelerating the progression of knee arthritis. This suggests that the different occupations of the subjects impact the development of knee OA disease. However, this article should have paid more attention to the type of follow-up work of patients, which may affect the accuracy of the results of this study due to occupational factors. At the same time, another point that needs attention is the proportion of female patients in the ISA treatment and control groups. Gender is an essential factor affecting the occurrence and development of knee arthritis. Studies by Jordan et al. ² have shown that the prevalence of knee arthritis in women is significantly higher than in men. This indicates that the sex ratio of the research sample will impact the research results. However, this factor was not considered when the patients were enrolled in this study, fully considering the gender differences in the prevalence of knee arthritis may be more conducive to ensuring the reliability of the results of this study.

At the same time, studies by Barton L. Wise and others have proved that lateral compartment knee arthritis is an essential part of knee OA, ³ however, this study did not consider whether ISA treatment can play a good role in delaying the progression of lateral compartment knee arthritis. Finally, we would like to thank the authors again for their study on the application of ISAs to delay disease progression in patients with high SIFK risk scores and early medial knee arthritis, which will provide a new theoretical basis for implanting ISA.