Physical exercise and risk of severe knee osteoarthritis requiring arthroplasty

OBJECTIVES: To examine the association between physical exercise and the risk of severe knee osteoarthritis requiring arthroplasty. SUBJECTS and METHODS: A case-control study was carried out in which the cases were men (n=55) and women aged 55-75 yr (n=226) receiving knee arthroplasty for primary osteoarthritis at the Kuopio University Hospital. Controls (n=524) were selected randomly from the population of Kuopio province. Lifetime physical exercise was assessed retrospectively. Cumulative exercise hours were calculated and divided into two classes by mean (low/high). RESULTS: The risk of knee osteoarthritis requiring arthroplasty decreased with increasing cumulative hours of recreational physical exercise. After adjustment for age, body mass index, physical work stress, knee injury and smoking, the odds ratios (with 95% confidence intervals) of knee arthroplasty were 0.91 (0.31-2.63) in men with a low number of cumulative exercise hours and 0.35 (0.12-0.95) in those with a high number of cumulative exercise hours, with a history of no regular physical exercise as the reference. For the women, the corresponding odds ratios were 0.56 (0.3-0.93) and 0.56 (0.32-0.98). CONCLUSION: Moderate recreational physical exercise is associated with a decrease in the risk of knee osteoarthritis.     

The risk of contralateral total knee arthroplasty after knee replacement for osteoarthritis

OBJECTIVE: Osteoarthritis (OA) is the most common indication for total knee arthroplasty (TKA), but the rate of contralateral disease progression after unilateral TKA as well as risk factors that may predict progression have not been determined. We assessed the overall rate of contralateral knee replacement after initial TKA for OA as a marker of progression to advanced symptomatic OA. METHODS: A total of 117 consecutive patients undergoing unilateral TKA for OA between 1983 and 1988 were evaluated and followed longitudinally for up to 14 years. Evaluation of potential risk factors for progression to contralateral TKA included age, sex, side of surgery, body mass index (BMI), and Kellgren-Lawrence (K-L) grade. RESULTS: The contralateral knee progressed to TKA in 31 patients, yielding an overall 10-year risk of contralateral TKA of 37.2%. The baseline K-L grade of the contralateral knee was strongly correlated with future risk of TKA (p < 0.001). Mean survival times were similar for those with grade II (131.7 mo) and grade III (127.6 mo); patients with grade IV, however, had a mean survival of 80.5 months, with an overall 10-year risk of TKA of 62.7%. Age, sex, side of initial TKA, and BMI were not risk factors for progression to contralateral TKA. CONCLUSION: In this cohort, the K-L grading scale was a highly significant predictor for progression of contralateral OA to TKA. These data may provide important information to patients undergoing TKA, and shed light on the natural history of contralateral OA after TKA.     

Revision total knee arthroplasty in patients with osteoarthritis

Total knee replacement (TKR) is a technically demanding surgical procedure, which is becoming more reliable and durable than total hip replacements. The authors describe the mechanisms of failure, the clinical evaluation of the painful TKR, the surgical planning techniques, and the overall results of revision TKR to date.     

Comparison of femoral sagittal axis between navigated total knee arthroplasty and conventional total knee arthroplasty in patients with knee osteoarthritis

To compare femoral sagittal axis between navigated total knee arthroplasty (TKA) and conventional TKA.A total of 136 cases were assigned to group 1 (navigated TKA) and 77 cases were assigned to group 2 (conventional TKA). Specifically, this study targeted patients with degenerative osteoarthritis. Only patients with primary TKA were analyzed. Hip knee ankle angle and lateral femoral bowing were measured using preoperative scanogram. Anterior femoral bowing was measured using preoperative femoral lateral X rays. The presence of anterior femoral notching and the insertion angle of the femoral implant with respect to the anatomical sagittal plane of the distal femur were checked using postoperative lateral knee X rays. Student t-test was used to compare the difference in the position of the sagittal plane of the femoral implant between the navigated TKA group and the conventional TKA group.When comparing the 2 groups, the sagittal axis of the femoral implant was more extended than the anatomical sagittal plane axis of the distal femur in group 1 than in group 2 (P = .01). There was a significant negative correlation between the value of anterior femoral bowing and the degree of flexion to the sagittal plane of the femoral implant in group 1 (correlation coefficient: –0.40, P = .01). The occurrence of anterior femoral notching was significantly higher in group 1 than in group 2.During navigated TKA, imageless navigation does not consider the anatomical variation of the femoral shaft. Therefore, surgeons should take into consideration that when performing navigated TKA, a femoral implant could be inserted more extended for the anatomical sagittal axis of the distal femur than for the conventional TKA. Also, surgeon should know that the degree of extension insertion of the femoral implant increases as femoral anterior bowing increases.     

Balance impairments in individuals with symptomatic knee osteoarthritis: a comparison with matched controls using clinical tests

OBJECTIVES: To compare balance in individuals with symptomatic knee osteoarthritis (OA) and in age-, gender- and body-mass-matched controls using simple clinical measures. METHODS: Thirty-three people with OA and 33 controls participated. Static postural sway [antero-posterior (AP), lateral and total] was measured using a swaymeter on two different surfaces and under two visual conditions. Dynamic standing balance was assessed using the 'step test'. RESULTS: Both groups displayed similar postural sway on most variables measured. Significantly greater sway was noted in the OA group on a firm surface in both lateral (eyes open) and AP directions (eyes closed), as well as total sway (eyes closed) (P < 0.05). Poorer dynamic standing balance was observed in the OA group as evidenced by the step test (P < 0.0001). CONCLUSIONS: Balance deficits can be identified in the osteoarthritic population using simple, inexpensive measures. However, the clinical relevance of the small deficits identified remains unknown and warrants further investigation.     

Genetic mechanisms of knee osteoarthritis: a population based case-control study

OBJECTIVE: To compare subjects who had at least one parent with a total knee replacement for severe primary knee osteoarthritis with age and sex matched controls who had no family history of knee osteoarthritis DESIGN: Population based case-control study of 188 matched pairs (mean age 45 years, range 26 to 60). METHODS: Articular cartilage volume and bone size were determined at the patella and at the medial tibial and lateral tibial compartments by processing images acquired using T1 weighted, fat saturated magnetic resonance imaging. Radiographic osteoarthritis (ROA) was assessed from a standing semiflexed radiograph scored for joint space narrowing and osteophytosis. Knee pain was assessed by questionnaire. Height, weight, body mass index (BMI), lower limb muscle strength, and endurance fitness were measured by standard protocols. RESULTS: Compared with the controls, index offspring had higher BMI (27.8 v 26.0 kg/m(2), p = 0.02), weaker lower limb muscles (127 v 135 kg, p = 0.006), more knee pain (47% v 22%, p<0.001), and greater medial tibial bone area (17.6 v 17.1 cm(2), p = 0.01). With the exception of BMI, these differences persisted in multivariate analysis. There was a non-significant trend to higher cartilage volume at tibial sites and increased ROA in the offspring in the total and subgroup analyses, but no difference in height and endurance fitness. CONCLUSIONS: BMI, muscle strength, knee pain, and medial tibial bone area, but not cartilage volume, appear to play a role in the genetic regulation and development of knee osteoarthritis.     

Risk factors for knee osteoarthritis in Japanese men: a case-control study

Risk of knee osteoarthritis (OA) was assessed in a population-based case-control study of Japanese men. The study covered three health districts in Wakayama and Osaka prefectures, Japan. Subjects were male individuals ≥45 years old diagnosed radiographically with knee OA, and who did not display any established causes of secondary OA. Controls selected randomly from the general population were individually matched to cases for age, sex, and residential district. Subjects were interviewed using structured questionnaires to determine medical history, physical activity, socio-economic factors, and occupation. Interviews were obtained from 37 cases and 37 controls. In univariate analysis, heaviest weight in the past and physical work such as factory, construction, agricultural, or fishery work as the principal occupation significantly raised the risk of male knee OA (P < 0.05). Odds ratios (OR) were determined using conditional logistic regression analysis mutually adjusted for potential risk factors using the results of univariate analysis. Heaviest weight in the past (OR 6.01, 95% confidence interval (CI) 1.18–30.5, P < 0.05), past knee injury (OR 6.25, 95% CI 1.13–34.5, P < 0.05), and physical work as the principal occupation (OR 6.20, 95% CI 1.40–27.5, P < 0.05) represented independent factors associated with knee OA after controlling for other risk factors. Physical work is associated with knee OA, demonstrating the influence of working activity on the development of OA. The present study suggests that risk factors for knee OA in men resemble those in women.     

Risk factors for knee osteoarthritis in Japanese men: a case-control study

Abstract

Risk of knee osteoarthritis (OA) was assessed in a population-based case-control study of Japanese men. The study covered three health districts in Wakayama and Osaka prefectures, Japan. Subjects were male individuals ≥45 years old diagnosed radiographically with knee OA, and who did not display any established causes of secondary OA. Controls selected randomly from the general population were individually matched to cases for age, sex, and residential district. Subjects were interviewed using structured questionnaires to determine medical history, physical activity, socio-economic factors, and occupation. Interviews were obtained from 37 cases and 37 controls. In univariate analysis, heaviest weight in the past and physical work such as factory, construction, agricultural, or fishery work as the principal occupation significantly raised the risk of male knee OA (P < 0.05). Odds ratios (OR) were determined using conditional logistic regression analysis mutually adjusted for potential risk factors using the results of univariate analysis. Heaviest weight in the past (OR 6.01, 95% confidence interval (CI) 1.18–30.5, P < 0.05), past knee injury (OR 6.25, 95% CI 1.13–34.5, P < 0.05), and physical work as the principal occupation (OR 6.20, 95% CI 1.40–27.5, P < 0.05) represented independent factors associated with knee OA after controlling for other risk factors. Physical work is associated with knee OA, demonstrating the influence of working activity on the development of OA. The present study suggests that risk factors for knee OA in men resemble those in women.     

Genetic risk of knee osteoarthritis: a sibling study

OBJECTIVES: To determine whether there is a genetic contribution to knee osteoarthritis (OA) as defined by structural change on plain radiographs. DESIGN: Sibling study. Comparison of knee OA prevalence in the community with knee OA prevalence among siblings of index cases with knee OA. SUBJECTS: 490 knee OA index cases listed for total knee replacement and 737 of their siblings aged >40 years, 1729 community subjects aged >40 years. MAIN OUTCOME MEASURE: Odds ratio for radiographic knee OA in siblings v community participants. RESULTS: The age, sex, and knee pain adjusted odds ratios in siblings were 2.9 (95% confidence interval 2.3 to 3.7) for tibiofemoral OA and 1.7 (1.4 to 2.2) for patellofemoral OA. This difference remained after adjustment for important environmental risk factors. The heritability estimate for knee OA was 0.62. CONCLUSIONS: Siblings are at increased risk of knee OA in comparison with the general population. This is likely to be due to genetic factors.     

Novel risk factors for hospital-acquired hyponatraemia: a matched case-control study

BACKGROUND: Hospital-acquired hyponatraemia is a common and potentially serious condition. Risk factors for hospital-acquired hyponatraemia have not been studied in a controlled fashion. Methods From 1501 patients in whom serum sodium (S(Na)) was determined, 50 cases with hospital-acquired hyponatraemia (in-hospital decrease in S(Na)>or= 7 mmol/l to < 136 mmol/l) were identified. They were matched by age, gender and department to 69 normonatraemic controls. RESULTS: In the 50 cases, S(Na) fell from 141 +/- 2 to 130 +/- 4 mmol/l, while controls remained normonatraemic. During the development of hyponatraemia, C-reactive protein (CRP) increased in cases (median from 23 to 146 mg/l), whereas it decreased in controls (median from 31 to 24 mg/l, P = 0.008). Additional factors associated with hospital-acquired hyponatraemia included diabetes mellitus (16/50 vs. 10/69, P = 0.009) and the use of insulin (12/50 vs. 4/69, P = 0.007), antibiotics (41/50 vs. 38/69, P = 0.006) and opioids (32/50 vs. 27/69, P = 0.005). Multivariate conditional logistic regression showed that the use of insulin [odds ratio (OR) 10.5, 95% confidence interval (CI) 1.5-72.4], antibiotics (OR 4.5, 95% CI 1.4-14.6) and opioids (OR 2.9, 95% CI 1.1-7.8) was also independently associated with hospital-acquired hyponatraemia. Mortality (6/50 vs. 1/69, P = 0.04) and intensive care admission (15/50 vs. 7/69, P = 0.008) were higher in cases. CONCLUSIONS: An increase in CRP and the use of insulin, antibiotics and opioids are novel risk factors for hospital-acquired hyponatraemia. These factors represent interesting new clues regarding the pathophysiology of hospital-acquired hyponatraemia, suggesting that the acute-phase response, pain and/or direct drug effects could be involved in the release of antidiuretic hormone.     

单髁膝置换术与全膝关节置换术治疗膝关节内侧间室骨关节炎的近期疗效比较

目的探讨单髁膝置换术(UKA)与全膝关节置换术(TKA)治疗膝关节内侧间室骨关节炎的近期疗效。方法回顾性分析2017-01～2017-10对因膝关节内侧间室骨关节炎行UKA治疗患者15例(15膝),选取同期行TKA治疗患者30例(34膝)作为对照组。术前评估并记录两组患者的疼痛视觉模拟评分(VAS)、美国特种外科医院(HSS)评分、膝关节活动度(ROM),记录手术时间、术中出血量、术后3 d血红蛋白(Hb)下降量、术后3个月及1年VAS评分、HSS评分、ROM。结果所有患者手术顺利完成。两组患者年龄、体重指数(BMI)比较差异无统计学意义(P0.05)。UKA组手术时间、术中出血量、术后3 d Hb下降量、VAS评分均低于TKA组,而HSS评分、ROM高于TKA组,差异均有统计学意义(P0.05)。结论膝关节内侧间室骨关节炎的手术治疗选择UKA更优于TKA,UKA具有手术时间短、术中出血量少、术后恢复快、功能恢复良好等优点,能够取得良好的近期疗效。     

Weight changes and the risk of knee osteoarthritis requiring arthroplasty

OBJECTIVE: To examine the effect of weight changes between 20 and 50 years of age on the risk of severe knee osteoarthritis (OA) requiring arthroplasty. SUBJECTS AND METHODS: Cases were 55-75 year old men and women (n = 220) having had knee arthroplasty for primary osteoarthritis at the Kuopio University Hospital in 1992-93. Controls (n = 415) were randomly selected from the population of Kuopio Province. Weight at the age of 20, 30, 40, and 50 years was collected retrospectively with a postal questionnaire. RESULTS: After adjustment for age, sex, history of physical workload, recreational physical activity, and previous knee injury, weight gain resulting to a shift from normal body mass index (BMI < or =25 kg/m(2)) to overweight (BMI >25 kg/m(2)) was associated with a higher relative risk of knee OA requiring arthroplasty than persistent overweight from 20-50 years of age, compared with those with normal relative weight during the corresponding age period. The odds ratios (OR) were 3.07 (95% confidence interval 1.87 to 5.05) for those with normal weight at the age of 20 years and overweight at two or three of the ages 30, 40 or 50 years, 3.15 (1.85 to 5.36) for those with overweight from the age of 30 years, and 2.37 (1.21 to 4.62) for those with overweight from the age of 20 years, respectively. CONCLUSION: In adult life, a shift from normal to overweight may carry a higher risk for knee OA requiring arthroplasty than does constant overweight.     

Coronal tibiofemoral subluxation in patients with osteoarthritis was corrected after total knee arthroplasty

The objective of this study was to investigate the effect of preoperative coronal tibiofemoral subluxation (CTFS) on postoperative mechanical alignment in patients undergoing total knee arthroplasty (TKA) for primary knee osteoarthritis (OA) and to investigate whether TKA can correct preoperative CTFS. We hypothesized that TKA would correct CTFS in patients with knee OA. A retrospective analysis of 102 patients with knee OA who underwent TKA was performed. The preoperative and postoperative CTFS and mechanical alignment were measured and compared. At the same time, the baseline values of CTFS and mechanical alignment in “normal” patients were measured and compared with those in the operation group. Eighty patients were eventually enrolled in the study. Mechanical alignment was corrected from 7.3 ± 5.2°, preoperatively, to 1.6 ± 2.3° postoperatively, while the tibiofemoral subluxation was corrected from 5.3 ± 2.6 mm, preoperatively, to 2.3 ± 2.7 mm postoperatively. There was no significant correlation between preoperative CTFS and gender (r = 0.03), BMI (r = −0.09), age (r = 0.05), or preoperative mechanical alignment (r = 0.09). In addition, there was no correlation between the degree of correction of CTFS and the degree of correction of overall mechanical alignment (r = 0.14). The difference between the value for CTFS in the “normal” patients and the preoperative value for arthritis cohorts were statistically significant (P = .004). However, no significant difference was appreciated between the value for CTFS in the “normal” patients and the postoperative value for TKA cohorts (P = .25). Preoperative CTFS does not affect postoperative mechanical alignment. Excellent TKA can correct preoperative CTFS in OA patients to reduce prosthesis wear and improve postoperative patient satisfaction.     

Ventilator-associated pneumonia caused by high risk microorganisms: a matched case-control study

To determine the impact of ventilator-associated pneumonia (VAP) caused by high risk microorganisms (HRM) on patient outcome. DESIGN: Matched case-control study. The study was conducted in a medical intensive care unit (ICU) of a university hospital. Thirty-five patients with VAP caused by HRM, including Pseudomonas aeruginosa, Acinetobacter spp., Stenotrophomonas maltophilia and/or methicillin-resistant Staphylococcus aureus were accepted as the case the patients. Thirty-five control patients, who did not develop VAP were matched to the case patients, according to APACHE II score, age, date of admission and duration of mechanical ventilation (MV). ICU and hospital mortality rates were similar between the case and the control patients (p= 0.58 and p= 1.00, respectively). However, length of ICU stay was longer in the case patients than in the control patients [20 (11-30) days (median-interquartile range-) and 13 (8-19) days, respectively; p< 0.01]. Length of hospital stay was also longer in the case patients than in the control patients [29 (20-44) days and 22 (13-37) days, respectively; p= 0.05]. In addition, duration of MV was longer in the case patients than in the control patients [18 (10-25) days and 8 (6-11) days, respectively; p< 0.01]. VAP caused by HRM independently prolonged ICU (OR: 6) and hospital stay (OR: 4) and duration of MV (OR: 11). VAP caused by HRM was not significantly associated with mortality. However, it was an independent risk factor, increasing length of ICU stay and hospital stay by seven days, and duration of MV by 10 days.     

Gender differences of venous thromboembolism risk after total hip and total knee arthroplasty: a meta-analysis

We performed a meta-analysis to evaluate gender differences of venous thromboembolism (VTE) risk after total hip (THA) and total knee arthroplasty (TKA). We searched PubMed and Web of Knowledge from their beginning to 25 July 2015. Pooled odds ratio (OR) and 95 % confidence interval (CI) for VTE risk were calculated. Twenty studies with 7,892,585 patients were included in our study. The VTE incidence ranged from 0.27 to 61.0 %. The sex ratio (male/female) was 0.623 (3,016,648/4,839,785) in no VTE group versus 0.492 (11,926/24,226) in VTE group. The pooled OR was 1.184 (95 % CI 1.070–1.310; Z = 3.28, P = 0.001). The Begg’s test (z = 1.46, P = 0.144) and the Egger’s test (t = 0.58, P = 0.571), and the funnel plot suggested there was no significant publication bias. Sensitivity analysis by omitted a study with largest simple size showed the pooled OR was 1.166 (95 % CI 1.051–1.294; Z = 2.91, P = 0.004) by random-effects model. Meta-regression showed VTE risk was not related with THA and TKA incidence (t = 0.35, P = 0.732). Our meta-analysis showed female patients have slightly higher risk of VTE than male patients after THA and TKA.     

Physical activity and incident clinical knee osteoarthritis in older adults

Objective

To study the relationship between 4 components of physical activity and the 12‐year incidence of clinical knee osteoarthritis (OA) among older adults.

Methods

Longitudinal data from 1,678 men and women, ages 55–85 years, were collected in the Longitudinal Aging Study Amsterdam. Incident clinical knee OA was defined by an algorithm using self‐report and general practitioner data. Physical activity was assessed by a validated questionnaire from which 4 physical activity component scores were created: muscle strength, intensity, mechanical strain, and turning actions. Cox proportional hazards models were conducted to examine the relationship between these scores and incident knee OA and reported as hazard ratios (HRs) with 95% confidence intervals (95% CIs).

Results

During 12 years of followup, 463 respondents (28%) developed clinical knee OA. A high mechanical strain score (HR 1.43, 95% CI 1.15–1.77) and a low muscle strength score (HR 1.30, 95% CI 1.01–1.68) were associated with an increased risk of knee OA after adjustment for age, sex, region of living, education, lifetime physical work demands, lifetime general physical activity, body mass index, current total physical activity level, and depression. No association was observed in the intensity and turning actions components. The results were similar for men and women, and for obese and nonobese respondents.

Conclusion

Older adults who perform low muscle strength activities or activities causing high mechanical strain had an increased risk of clinical knee OA. These results suggest that specific components of physical activity may influence the development of knee OA.