{
  "abstract": "Background: Osteoarthritis is a highly prevalent and debilitating joint disease. Some patients continue to experience substantial symptoms despite recommended, well-conducted treatment, but the absence of a widely accepted definition of “refractory OA” complicates their identification and management.\n\nObjective: To establish an international, multidisciplinary consensus-based clinical definition of refractory knee osteoarthritis (OA).\n\nDesign: Systematic literature review followed by a two-round Delphi consensus study. Data Sources and Methods: PubMed, MEDLINE, PreMEDLINE, and Embase were searched without language or publication date restrictions to identify definitions and operational criteria for refractory, difficult-to-treat, or treatment-failure OA. The findings informed 15 statements developed by a 13-member international, multidisciplinary Technical Expert Panel, supported by a methodologist and a scientific librarian. Two anonymous voting rounds were conducted between June and August 2025, with consensus predefined as at least 85% of ratings within the same three-point region of a nine-point Likert scale. In round 1 participants could propose additional statements for voting. Final statements were discussed at the 8th International Symposium on Intra-Articular Treatment Congress in October 2025.\n\nResults: Of 3047 records identified, 98 were screened and 43 publications (27 original articles and 16 reviews) were included. Consensus was achieved for 13 of 15 statements: nine in round 1 with unanimous agreement and four after revision in round 2. Osteoarthritis (OA) was assessed considering its causes, features, and impact on daily life. Experts took into account symptoms, progression, and treatment response, highlighting the need for optimal management. Refractory OA was defined as: persistent symptoms (at least 3-6 months) and altered quality of life despite optimized, guideline-based multimodal conservative OA therapy.\n\nConclusions: A consistent definition of refractory knee OA (ROA) can identify patients with high unmet needs, support medical and surgical decision-making, and standardize eligibility for future research.",
  "abstract_shown": true,
  "affiliations": [
    "Rheumatology Unit, San Pietro Fatebenefratelli Hospital, Rome, Italy",
    "Department of Rheumatology and Medical Sciences, Clinical Rheumatology Unit, ASST Gaetano Pini-CTO, Milan, Italy",
    "Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium",
    "Department of Orthopedics, Antwerp University Hospital, Edegem, Belgium",
    "Rehabilitation Hospital, Sheikh Tahnoun Bin Mohammed Medical City, Al Ain, UAE",
    "Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy",
    "Department of Rheumatology, University UPEC Paris XII, Creteil, France",
    "Department of Physical Medicine and Rehabilitation, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey",
    "Medical Magnus Clinic, Lodz, Poland",
    "Polyclinique saint Odilon, Moulins, France",
    "Hospices Civils de Lyon, Hôpital Lyon Sud, Chirurgie Orthopédique et Traumatologique, Lyon, France",
    "Claude Bernard University, Lyon, France",
    "Gustave Eiffel University, IFSTTAR, LBMC UMR_T9406, F69622, Lyon, France",
    "Jefe de Servicio de Cirugia Ortopédica y Traumatología Hospital Universitario Dr. Peset, Valencia, Spain",
    "Departamento Cirugia, Universidad de Valencia, Valencia, Spain",
    "Ortho4Sport, Sportorthopädische Privatpraxis, Köln-Rodenkirchen, Germany",
    "musculoSKeletal Innovative research lab (mSKIL), University of Liège, Liège, Belgium"
  ],
  "article_type": "review article",
  "arxiv": null,
  "author_total": 13,
  "authors": [
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        0
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      "name": "Alberto Migliore",
      "orcid": "0000-0002-3397-6478"
    },
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      ],
      "name": "Orazio De Lucia",
      "orcid": "0000-0003-2304-6661"
    },
    {
      "affs": [
        2,
        3
      ],
      "name": "Christiaan Heusdens",
      "orcid": "0000-0003-0385-8128"
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    {
      "affs": [
        4
      ],
      "name": "Abdulla Alrahoomi"
    },
    {
      "affs": [
        5
      ],
      "name": "Francesco Benazzo"
    },
    {
      "affs": [
        6
      ],
      "name": "Xavier Chevalier"
    },
    {
      "affs": [
        7
      ],
      "name": "Demirhan Diracoglu"
    },
    {
      "affs": [
        8
      ],
      "name": "Marek Krochmalski"
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    {
      "affs": [
        9
      ],
      "name": "Bernard Maillet"
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    {
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        11,
        12
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      "name": "Thomas Neri"
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    {
      "affs": [
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        14
      ],
      "name": "Jose Luis Rodrigo"
    },
    {
      "affs": [
        15
      ],
      "name": "Oliver Tobolski"
    },
    {
      "affs": [
        16
      ],
      "name": "Yves Henrotin",
      "orcid": "0000-0003-1073-449X"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/4dg6fwj061ty6.bib",
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  "doi": "10.1177/1759720x261485403",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13724848/",
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  "language": "en",
  "licence": "CC-BY-NC-4.0",
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  "pdf_url": "https://europepmc.org/articles/PMC13724848?pdf=render",
  "pmcid": "PMC13724848",
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  "published": "2026-09-15",
  "publisher": "SAGE Publications",
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  "subjects": [
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      "origin": "hal:0.sdv",
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  "title": "Towards a consensus definition of “refractory osteoarthritis”. A systematic review",
  "title_text": "Towards a consensus definition of “refractory osteoarthritis”. A systematic review",
  "type": "peer-reviewed",
  "updated_at": "2026-11-07T12:20:25Z",
  "url": "https://research.draconitic.com/paper/4dg6fwj061ty6",
  "venue": "Therapeutic Advances in Musculoskeletal Disease",
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