人工髌股关节置换术的早中期随访研究

目的探讨人工髌股关节置换术治疗重度髌股关节骨关节炎的早中期疗效。方法回顾性分析2013年1月至2020年12月行髌股关节置换术的严重髌股关节骨关节炎患者64例(80膝), 男9例(12膝)、女55例(68膝);年龄(60.50±8.82)岁(范围27～82岁)。术前膝关节X线片提示髌股关节退变均为Kellgren-Lawrence Ⅳ级, 内外侧胫股间室无明显退变。单侧髌股关节置换48例, 双侧髌股关节置换16例, 其中同期双侧髌股关节置换9例、分次行双侧髌股关节置换7例。对术后随访5年以上的患者采用疼痛视觉模拟评分(visual analogue scale, VAS)、纽约特种外科医院(Hospital for Special Surgery, HSS)膝关节评分及牛津膝关节评分(Oxford knee score, OKS)评估临床疗效;测量手术前后膝关节髌骨轴位X线片上髌骨倾斜角和站立位双下肢全长正位X线片上髋-膝-踝角;观察有无切口感染、假体周围感染、深静脉血栓形成、假体松动、磨损及胫股间室严重骨关节炎等并发症。结果 64例患者随访(4.31±1.79)年(范围1.5～8.2...     

膝骨关节炎临床症状与X线表现相关性研究

目的:探讨膝骨关节炎临床症状与X线片表现的相关性,为临床诊疗提供依据.方法:收集门诊78例(108膝)膝骨关节炎患者,年龄41～77岁;女65例(89膝),男13例(19膝).对所有病例进行严重性指数(Lequesne膝关节指数)问卷调查,计算严重性指数,并将病例分成轻度组(Lequesne指数≤8)和重度组(Lequesne指数>8).摄负重站立位膝关节正侧位、髌股关节Skyline位X线片,分部位观察评价关节间隙狭窄、骨赘生成、软骨下骨硬化、软骨下囊变,测量下肢力线角及外侧髌股角.对膝骨关节炎严重性与各X线表现进行相关性及回归分析.结果:膝骨关节炎轻度组和重度组在外侧胫股关节间隙、内侧髌股关节间隙狭窄程度、内侧胫骨骨赘、内侧股骨骨赘、外侧胫骨骨赘、外侧股骨骨赘、内侧滑车骨赘、外侧髌骨骨赘、外侧滑车骨赘、胫骨髁问骨赘程度等方面的差异有统计学意义(P<0.05).Logistic回归分析结果显示外侧股骨骨赘的相伴概率(0.009)最小,Wald值最大(6.779),提示外侧股骨骨赞为判断膝骨关节炎严重性最重要的放射学表现.结论:评价膝骨关节炎严重性时,关节间隙狭窄与骨赘生成是最有意义的X线表现,其中外侧胫股关节间隙狭窄、内侧髌股关节间隙狭窄、内侧胫骨骨赘、内侧股骨骨赘、外侧胫骨骨赘、外侧股骨骨赘、内侧滑车骨赘、外侧髌骨骨赘、外侧滑车骨赘、胫骨髁问骨赘更加应该予以重视.     

乌鲁木齐地区2711例骨密度调查研究

目的了解新疆乌鲁木齐地区正常汉族人群骨密度(BMD)的变化规律和骨质疏松症(OP) 的患病率。方法应用法国DMS公司生产的CHALLENGER型双能X线骨密度仪对乌鲁木齐地区汉族人群共2711名20～80岁居民进行腰椎2～4及股骨近端的骨密度测定。结果乌鲁木齐地区汉族人群男性、女性的腰椎及股骨近端的BMD峰值均出现在20～29岁年龄组,峰值后随着年龄的增长,而骨密度BMD降低,女性在50～59岁明显加速下降,男性没有加速下降现象。乌鲁木齐地区40岁以后OP患病率男性28．3％,女性OP患病率45．2％。男女性50～59岁以上,组间患病率有显著差异(P<0．05)。结论通过对乌鲁木齐地区汉族人群的骨密度变化规律及患病率研究, 为乌鲁木齐地区汉族人群的骨质疏松症诊断及治疗提供客观有效的依据。     

武川县农村居民膝关节骨关节炎患病率调查

目的 评估内蒙古武川县居民膝关节骨关节炎的患病率,并与北京及弗雷明汉(美国马萨诸塞州)地区研究数据进行比较.方法 利用扩大免疫规划整体抽样的方法,抽取内蒙古武川县当地50岁及以上居民1025名,大多数为重体力劳动者.受调查者在完成统一的骨关节炎问卷后接受双膝负重半屈曲后前位X线检查.结果 武川县居民有影像学表现的膝关节骨关节炎患病率与北京居民接近.武川县男性居民有重度影像学表现与有疼痛症状的膝关节骨关节炎患病率均高于北京居民,患病率比率分别为2.48和1.91,95%CI分别为(1.62,3.78)和(1.25,2.91);武川县女性居民有重度影像学表现与有疼痛症状的膝关节骨关节炎患病率也高于北京居民,患病率比率分别为1.42和1.55,95%CI分别为(1.03,1.97)和(1.17,2.05).在武川研究和北京研究中,双侧骨关节炎和单间室骨关节炎的患病率均为弗雷明汉研究中相关结果的2～3倍.结论 武川县农村人口中有疼痛症状的膝关节骨关节炎的患病率高于北京城市人口及弗雷明汉地区居民.武川地区和北京地区双侧及单间室骨关节炎的高患病率是其独特的骨关节炎表型.这一结果将有助于未来医疗资源的分配和疾病的预防工作.     

武川县农村居民膝关节骨关节炎患病率调查

目的 评估内蒙古武川县居民膝关节骨关节炎的患病率,并与北京及弗雷明汉(美国马萨诸塞州)地区研究数据进行比较.方法 利用扩大免疫规划整体抽样的方法,抽取内蒙古武川县当地50岁及以上居民1025名,大多数为重体力劳动者.受调查者在完成统一的骨关节炎问卷后接受双膝负重半屈曲后前位X线检查.结果 武川县居民有影像学表现的膝关节骨关节炎患病率与北京居民接近.武川县男性居民有重度影像学表现与有疼痛症状的膝关节骨关节炎患病率均高于北京居民,患病率比率分别为2.48和1.91,95%CI分别为(1.62,3.78)和(1.25,2.91);武川县女性居民有重度影像学表现与有疼痛症状的膝关节骨关节炎患病率也高于北京居民,患病率比率分别为1.42和1.55,95%CI分别为(1.03,1.97)和(1.17,2.05).在武川研究和北京研究中,双侧骨关节炎和单间室骨关节炎的患病率均为弗雷明汉研究中相关结果的2～3倍.结论 武川县农村人口中有疼痛症状的膝关节骨关节炎的患病率高于北京城市人口及弗雷明汉地区居民.武川地区和北京地区双侧及单间室骨关节炎的高患病率是其独特的骨关节炎表型.这一结果将有助于未来医疗资源的分配和疾病的预防工作.     

广州地区中老年人症状性膝关节骨关节炎流行病学的调查研究

目的了解广州地区中老年人症状性膝关节骨关节炎(OA)的患病率及其相关因素。方法抽取广州地区具有当地正式户口的40岁及以上居民进行膝关节OA的流行病学问卷调查。对有症状者进行X线拍照,摄取膝关节正侧位片。症状性膝关节OA的最终诊断为最严重节段有膝关节OA临床症状合并影像学KellgrenLawrence分级2级及以上者。结果共分析1339例40岁以上人群资料,症状性膝关节OA总患病率为15.0%,女性多于男性(20.5%vs9.1%,P0.001)。膝关节OA的患病率随年龄增长而升高(P0.001);髌股关节OA的发病率为12.4%,高于周围节段;月经[OR=4.187,95%CI(2.419,7.246)]及跑步[OR=2.689,95%CI(1.018,7.100)]是膝关节OA的好发因素,文职类工作[OR=0.160,95%CI(0.037,0.068)]则为保护性因素。结论调查结果说明广州地区症状性膝关节OA患病率较高,严重影响中老年人生活质量,应当引起重视。     

髌股关节置换（一）

一般认为单纯性髌股关节骨关节炎在人群发病率为5%左右,发病年龄大多在40~50岁。髌股关节骨关节炎是引起膝前疼痛的主要原因之一,中年以上人群尤其是女性患病率高,患者表现为上下楼及下蹲困难,并伴有屈膝位疼痛,关节镜检查发现髌骨及股骨滑车软骨退变、     

膝外摆步态对膝内翻患者股骨-胫骨角及胫股关节外侧间隙的影响

目的探讨膝外摆(lateralthrust)步态对膝内翻患者股骨-胫骨角及胫股关节外侧间隙的影响及其临床意义。方法膝内翻伴膝外摆步态患者44例,男10例,女34例;年龄31～60岁,平均41岁。分别在静态单足和双足站立位膝关节正位X线片上测量股骨-胫骨角度数和胫股关节外侧间隙宽度。双足站立位模拟步态周期中双支撑相,即膝外摆早期;单足站立位模拟步态周期中单支撑相,即膝外摆后期,两种体位X线片上的股骨-胫骨角及胫股关节外侧间隙的改变反映了膝外摆过程中胫骨和股骨对应关系的改变。结果单足较双足支撑相的股骨-胫骨角增大(角度分别为188.50°±4.48°和185.50°±4.46°),胫股关节外侧间隙增宽[距离分别为(9.92±0.86)mm和(7.70±0.78)mm]。结论膝外摆步态中股骨-胫骨角增大、胫股关节外侧间隙增宽,使膝内翻患者的膝内侧间室承重增加,膝外侧稳定结构不稳,最终可能导致膝内翻加重及发生内侧间室骨关节炎。     

关节清理术结合外侧支持带松解治疗膝关节骨关节炎

目的 探讨关节镜下关节清理术结合外侧支持带松解治疗膝关节骨关节炎的方法及其效果.方法 对34例伴有髌股关节对线不良的膝关节骨关节炎患者进行关节清理术结合外侧支持带松解.结果 34例获6个月～2年随访,参照Lysholm膝关节评分标准:85分以上26例,70～85分7例,65分1例.结论 关节清理术结合外侧支持带松解治疗伴有髌股关节对线不良的膝关节骨关节炎具有肯定的疗效.     

膝关节单髁置换术的发展研究进展

<正>1单髁置换术发展史随着人们对膝关节骨关节炎认识的加深,对于全关节严重破坏的患者,认为应用全膝关节表面置换(total knee arthroplasty,TKA)的手术方法可有效治疗骨关节炎。但临床工作中发现,许多骨关节炎患者仅一侧间室出现了明显的破坏,研究者开始考虑一种治疗单侧胫股关节间室病变的术式—膝关节单髁置换术     

IGF-1基因5’端功能性SNP与中国汉族人群膝关节骨关节炎的相关性研究

背景：骨关节炎（osteoarthritis,OA）是最常见的关节炎,尤其在老年人群中发病率更高,它是包括遗传因素在内的多因素致病疾病。已有多项研究发现,许多基因与OA的易感性有密切关系。胰岛素样生长因子1（insulin likegrowth factor 1,IGF-1）可以促进软骨细胞合成软骨中的细胞外基质。IGF一1及其受体在软骨的发育及成年后重塑阶段均具有重要功能,并可能与OA的病因具有相关性。目的：IGF-1基因启动子区域-1245C／T位点（rs35767）单核苷酸多态性（single nucleotide polymorphisms,SNP）与膝关节OA的关系。方法：采用序列特异性引物PCR及探针法,检测中国汉族人群中具有临床症状且有影像学证据的524例原发性膝关节OA患者与540例健康对照者IGF-1基因启动子区域-1245C／T位点等位基因分布,分析-1245C／T位点等位基因与膝关节OA的相关性。结果：OA组与正常对照组比较,IGF-1基因启动子区域-1245C／T位点的基因型频率及等位基因频率分布无显著性差异（P=0．35、0．14）。按OA严重程度分组（中重度组患者均为K／L分级3、4级,轻度组为K／L分级2级）,中重度组与正常对照组比较,基因型分布无显著性差异（P=0．10）,等位基因频率分布有显著性差异（P=0．04）;但CC型与其它基因型（TT、TC）分布有显著性差异（P=0．03）。正常对照组中TT＋TC所占比例较中重度OA组多,OR=1．36,CI=[1．03,1．80]。逻辑回归分析示,上述差异为年龄、BMI及性别差异所致,与m35767的等位基因、基因型频率分布无显著相关性。结论：中国汉族人群的OA易感性与年龄、BMI、性别构成相关,与IGF-1基因启动子区域-1245C／T位点（rs35767）基因多态性可能无关。     

Factors affecting the prevalence of osteoarthritis in healthy middle-aged women: data from the longitudinal Melbourne Women's Midlife Health Project

The prevalence of osteoarthritis (OA) is greater in women then men. Weight, a factor strongly associated with osteoarthritis, is significantly increased over the menopausal transition. Despite the high prevalence of osteoarthritis, a disabling disease with limited treatment options, there is a paucity of studies in women. The longitudinal phase of the Melbourne Women's Midlife Health Project, is a population-based prospective study of 438 Australian born women who have been followed annually over 11 years. 257 (59%) of these women remained in longitudinal assessment at 11th year of follow-up and 224 of these women agreed to undergo X-rays of their knees and hands. In this study, X-rays were scored for evidence of osteoarthritis using a validated scale, by two investigators who were blinded to questionnaire results. Information on hormone therapy use, physical activity, smoking, BMI and age were obtained by both self-administered and face-to-face questionnaires. Results showed that one hundred and twenty-eight women (56%) had evidence of radiological OA. Forty-nine (21.6%) had evidence of radiological knee OA. One hundred and one (44.5%) had evidence of radiological hand OA. Compared to baseline, at 11th year of follow-up participants had put on weight (4 kg range -14 to 25 kg) and a larger proportion (25% vs. 40%) reported exercising frequently (P = 0.005). Physical activity and BMI were associated with higher prevalence of osteoarthritis in the final year of follow-up. Smoking was associated with a lower prevalence of radiological knee OA. The prevalence was 61% among never smokers compared to only 39% among those who smoked (P < 0.05). Total OA was associated with never having used hormone therapy (odds ratio 2.7; CI 1.1-6.9). There was a trend for increasing level of physical activity at ages 20-29 to be associated with an increased risk of knee OA (P value 0.03 for trend). In conclusion increasing age, BMI and history of more frequent physical activity in younger years were risk factors for radiological knee OA. In contrast, smoking appeared to be associated with less knee OA. Never having used hormone therapy was a risk factor for radiological hand and knee OA. Further work will be needed to determine whether modification of these factors can prevent the development of OA.     

膝骨关节炎周围血供变化的影像学观察

目的:对比观察膝骨关节炎患者和正常人群膝关节周围血供变化。方法:2014年6月至2015年6月,纳入诊治的膝骨关节炎患者30例,健康成年人30例。膝骨关节炎组男9例,女21例,年龄53~82岁,平均(65.967±7.132)岁,平均动脉压(93.462±7.633)mm Hg;对照组男9例,女21例,年龄50~75岁,平均(62.867±6.356)岁,平均动脉压(92.122±9.675)mm Hg。检查方法包括彩超和下肢CTA;观察指标包括侧支循环,动脉迂曲,动脉畸形,管腔狭窄和动脉壁斑块形成情况。根据动脉的狭窄程度不同分为5级:1级为无狭窄,2级为轻度狭窄(1%~49%),3级为中度狭窄(50%~70%),4级为重度狭窄(70%~99%),5级为完全闭塞。测量两组的腘动脉、胫前动脉、胫后动脉内径的大小以及血流动力情况,并将膝骨关节炎组与对照组进行比较。结果:无剔除或脱落病例。膝骨关节炎组3例形成侧支循环,对照组4例;膝骨关节炎组0例动脉迂曲,对照组2例;两组均无动脉畸形。膝骨关节炎组动脉无狭窄0例,轻度14例,中度7例,重度9例,闭塞0例;对照组动脉无狭窄9例,轻度10例,中度6例,重度4例,闭塞1例;两组比较差异有统计学意义,膝骨关节炎组动脉狭窄比对照组严重。膝骨关节炎组30例动脉形成斑块,对照组20例形成斑块,两组比较差异有统计学意义,膝骨关节炎组动脉斑块形成比例高于对照组。膝骨关节炎组斑块钙化率100%,对照组63%。胫前动脉直径差异有统计学意义,膝骨关节炎组胫前动脉直径较大。两组腘动脉流速差异有统计学意义,膝骨关节炎组流速更快。胫后动脉流速差异有统计学意义,膝骨关节炎组流速更快。动脉流量方面,3条动脉数据比较差异均无统计学意义。结论:膝骨关节炎局部血管主要病理改变为狭窄和斑块形成,而局部动脉血流总量大致不变。临床治疗中改善局部血管病变的方法可能优于加速血流速度的方法,进一步针对局部血管异常改变的介入治疗也将为骨关节炎的临床治疗提供一个新的思路与方法。     

Gender and prevalence of knee osteoarthritis types in elderly Koreans

We undertook to document sex differences in the prevalence of knee osteoarthritis (OA) at different disease stages in an elderly Korean population. Prevalence of 3 stages of knee OA (radiographic OA, severe radiographic OA, and candidacy for total knee arthroplasty [TKA]) was investigated in 696 elderly (≥65 years old) Korean subjects. Multivariate logistic regression was performed to evaluate associations between the risk factors of OA at these 3 disease stages. The overall prevalence of knee OA was 38.1% for radiographic OA, 26.4% for severe radiographic OA, and 6.5% for advanced OA warranting TKA. Women had much higher prevalence for all 3 stages. Female sex was found to be the strongest predictor for all 3 disease stages, but this was most remarkable for TKA candidates. This study documents that knee OA is highly prevalent among Korean elderly and that elderly Korean women are at much greater risk of requiring TKA.     

中国广东地区膝骨关节炎患者与健康人群肠道菌群差异性分析

目的比较中国广东地区骨关节炎(osteoarthritis,OA)患者与健康人群肠道菌群的宏基因组,初步分析其差异性及差异特征。方法选取我院从2017年6～12月收集的29名健康人群,66例膝OA患者粪便样本,其中膝OA患者根据K-L分型分为轻度OA组17例,重度OA组49例。检测前进行对基线比较。样本提取DNA后,使用Simpson多样性指数分析群落多样性,使用LEf Se分析对群落关键物种进行筛选;差异物种GO分析及Pathway分析进行差异性菌群代谢功能预测。结果 3组在身高、年龄及体重上没明显差异(P0.05); Simpson多样性指数分析表明轻度OA患者与健康人群肠道菌群多样性无显著差异,重度OA患者肠道微生物多样性显著低于健康人群。LEf Se分析发现,寡养单胞菌属(Stenotrphomonas)、黄单胞菌属(Xanthomonadacease)等18种菌群在膝骨关节炎患者人群中显著高丰度,毛螺旋菌属(Lachnospiraceae)、瘤胃球菌属(Ruminococcus)等6种菌群在膝骨关节炎患者人群中显著低丰度。寡养单胞菌属、黄单胞菌属两类菌群可以显著区分轻重型膝骨关节炎。差异物种GO分析提示寡养单胞菌属、黄单胞菌属等菌群的显著升高,对代谢类疾病、感染性疾病、心血管类疾病、免疫性疾病的发病具有增加的趋势。结论广东地区膝骨关节炎患者肠道菌群丰度和某些菌群与健康人群有显著差异,寡养单胞菌属、黄单胞菌属两类菌群可以显著区分轻重型膝骨关节炎。     

Efficacy of a combination of FCHG49 glucosamine hydrochloride, TRH122 low molecular weight sodium chondroitin sulfate and manganese ascorbate in the management of knee osteoarthritis

OBJECTIVES: The objective of this study was to evaluate the oral combination of glucosamine HCl, sodium chondroitin sulfate and manganese ascorbate for the treatment of osteoarthritis (OA) of the knee. DESIGN: A randomized placebo-controlled study design was implemented. We recruited 93 patients with OA of the knee from a single center. The intervention group received 1000 mg FCHG49 glucosamine HCl, 800 mg TRH122 low molecular weight sodium chondroitin sulfate and 152 mg manganese ascorbate twice daily (Cosamin DS). Patients were evaluated initially and then every 2 months for 6 months. The primary outcome was the Lesquene Index of severity of osteoarthritis of the knee (ISK). RESULTS: Patients with radiographically mild or moderate OA (N=72) in the intervention group showed significant improvement in the ISK at 4 and 6 months (P=0.003 and P=0.04, respectively). The response rate to the medication was 52% vs a 28% response rate to placebo. Patients with radiographically severe osteoarthritis (N=21) did not show significant improvements in the ISK. There was a 17% incidence of adverse events in the intervention group and 19% in the placebo group. CONCLUSIONS: The studied combination of glucosamine HCl, sodium chondroitin sulfate and manganese ascorbate was found to be effective for the treatment of radiographically mild to moderate OA of the knee as measured by the ISK. This is the first U.S. study of these agents.     

Ultrasonographic findings in knee osteoarthritis: a comparative study with clinical and radiographic assessment

OBJECTIVE: To compare ultrasonographic (US) findings with clinical and radiographic assessment in knee osteoarthritis (OA). METHODS: Fifty patients with primary knee OA were studied. Clinical assessment of both knees was performed by the same rheumatologist who recorded a visual analogue scale (VAS) for pain (VASP). All patients underwent a US examination of their knees by a second blinded rheumatologist. Weight-bearing anteroposterior and lateral knee radiographs were read by a third blinded rheumatologist who assessed the Kellgren and Lawrence (K-L) grade, the femorotibial (FT) space width and the presence of patello-femoral degenerative signs. RESULTS: Forty patients had bilateral symptomatic knee OA and 10 unilateral symptomatic OA. All knees showed radiographic FT degenerative signs. US findings in symptomatic knees were effusion (47%), protrusion of the medial meniscus (MMP) with displacement of the medial collateral ligament (MCLD) (61%) and Baker's cyst (22%). US effusion, MMP and MCLD were associated with a significantly higher VAS score for pain (P<0.05). MMP was associated with medial FT space width (P<0.05). Patients who had a difference between VAS score for pain in each knee greater than 30 (28 patients) showed significantly more unilateral effusion, MMP, MCLD and worse K-L grade in the more symptomatic knee than those with a difference lesser than 30 (22 patients). CONCLUSION: Knee effusion and MMP with MCLD are associated with pain in knee OA. In addition, MMP may contribute to the radiographic medial FT space narrowing. We propose US for assessing periarticular and intraarticular abnormalities involved in the pathophysiology of knee OA.     

Femoral sulcus angle and increased patella facet cartilage volume in an osteoarthritic population

OBJECTIVE: The patellofemoral joint is an example of an incongruent articulation commonly affected by osteoarthritis (OA). The relationship between femoral sulcus angle and the development and progression of patellofemoral OA is unclear. The aim of this study was to examine the relationship between the femoral sulcus angle at baseline and patella cartilage volume at baseline and at 2-year follow-up among community based adults with established knee OA. METHODS: One hundred subjects had magnetic resonance imaging of their symptomatic knee at baseline and at 2-year follow-up. From these images, patella cartilage volume was determined. Radiographic skyline views of the patellofemoral joint were taken at baseline to measure the femoral sulcus angle. RESULTS: For every 1 degrees increase in the femoral sulcus angle (i.e., as the sulcus angle became more shallow) there was an associated 9.1mm3 (95% CI 3.1, 15.0) increase in medial patella cartilage volume at baseline (P=0.003). There was a similar trend that approached statistical significance between the femoral sulcus angle and the lateral patella facet cartilage volume at baseline (P=0.09). There was no association between the femoral sulcus angle at baseline and the change in patella cartilage volume over 2 years in either patellofemoral compartment. CONCLUSION: These results infer that the femoral sulcus angle is a cross-sectional determinant of the amount of patella cartilage, but is not a major determinant of the annual change of patella cartilage volume among people with knee OA. These data suggest that a shallower sulcus in the context of established OA may be an advantageous anatomical variant. Further longitudinal studies are required to determine the role of the femoral sulcus angle in OA.     

The progression of radiological hand osteoarthritis over ten years: a clinical follow-up study

The natural history of hand osteoarthritis (OA) is poorly understood. The aim of the study was to ascertain the extent and pattern of radiological progression of hand OA over a 10-year period. A follow-up study was carried out on 169 consecutive patients who initially presented with OA of the hands or knees between 1975-1977. Fifty-nine subjects (45 women and 14 men) were recontacted who had paired hand radiographs, a mean of 10 years apart, and were a mean 69 (range 53-86) years old at follow-up. X-rays were scored blind, in three joint areas--distal and proximal interphalangeal joints (DIP and PIP) and first carpo-metacarpal (CMC) joints--using the method of Kellgren and Lawrence (K&L) (0-4), and for osteophytes and narrowing (0-3). Using the highest score for right and left hands (N = 118), K&L changes at the three areas were similar with 47-50% deteriorating, 45-46% unchanged, and 6-8% improving. Similar deterioration was seen when scoring the three joint areas for osteophytes (38-39%) and narrowing (39-48%). New osteophytes appeared in 48% of DIP joints during the 10 years. There was a weak correlation between progression at the DIP and PIP joints, but no relationship between DIP and CMC, or CMC and PIP. Virtually all subjects (97%) deteriorated when the total scores of all joints were calculated. No significant differences were seen between 'severe progressors' and 'minor' in terms of age or body mass index (BMI). A nonsignificant increase in the proportion of knee progressors in the severe progressor hand group was seen and there was a higher rate of baseline DIP OA in knee progressors. These results suggest that the majority of patients with OA of the hands attending a rheumatology outpatients clinic deteriorate radiologically over a 10-year period, about half developing new changes in DIP joints. There were no obvious features distinguishing those with rapid deterioration, although DIP OA appears to be a risk factor for knee progression.     

Influence of foot characteristics on the site of lower limb osteoarthritis

BACKGROUND: Foot structure and range of motion have been linked to lower limb musculoskeletal injuries in sports medicine,(11,14,41) and recently there have been attempts to establish a connection between the foot and lower limb osteoarthritis (OA)(19,13). Considering the fact that OA of the knee and hip are the most important causes of pain and disability in older people,(12,25) it is surprising that there has been no research comparing the foot types of those with knee OA and those with hip OA. To evaluate an apparent difference in the feet and gaits of patients with hip OA and medial compartment OA of the knee that was noted during routine clinical assessment, a prospective observation study was undertaken. METHODS: The study included patients with OA either of the hip or the medial compartment of the knee and a control group of healthy subjects. There were 60 in each group determined by sample size calculation. The groups were matched for age and gender. Dorsiflexion and plantarflexion of the ankle, calcaneal angle, and navicular height in both sitting and standing were measured. Results were analyzed by ANOVA and linear regression analysis. RESULTS: There were significant differences among all three groups, particularly in ankle dorsiflexion (p < 0.001) and calcaneal angle (p < 0.001). CONCLUSIONS: Differences in foot type between patients with OA of hip and knee were confirmed. These two groups also were different from the control group of healthy subjects. The lack of ankle dorsiflexion and high arches of patients with OA of the hip contrasted with the ample dorsiflexion and flatfeet of patients with OA of the knee.