Are biomechanical factors,meniscal pathology,and physical activity risk factors for bone marrow lesions at the knee? A systematic review

Objective

To systematically review the literature to determine whether biomechanical factors, meniscal pathology, and physical activity are risk factors for bone marrow lesions (BMLs) at the knee identified from magnetic resonance imaging in pre-osteoarthritis and osteoarthritis populations.

Methods

Electronic searches of MEDLINE and EMBASE were performed from January 1, 1996 to October 31, 2012 using the keywords of bone marrow lesion(s), bone marrow (o)edema, osteoarthritis, and knee. Studies examining biomechanical factors, meniscal pathology, or physical activity in relation to the presence, incidence, or change in BMLs at the knee were included. Two independent reviewers extracted the data and assessed the methodological quality of selected studies. Due to the heterogeneity of the studies, we performed a best evidence synthesis.

Results

Fifteen studies were included in this review, of which 9 were considered high quality. The study populations were heterogeneous in terms of the symptoms and radiographic knee osteoarthritis. There was strong evidence for relationships of mechanical knee alignment and meniscal pathology with BMLs in osteoarthritis populations. There was a paucity of evidence for a relationship between physical activity and BMLs.

Conclusion

Despite the heterogeneity of included studies, these data suggest that mechanical knee alignment and meniscal pathology are risk factors for BMLs in knee osteoarthritis. It suggests that BMLs in individuals with osteoarthritis are more susceptible to mechanical knee alignment. Given the role of BMLs in the pathogenesis of knee osteoarthritis, identifying strategies to modify these risk factors will be important in slowing the progression and reducing the burden of knee osteoarthritis.     

Assessing physical function and activity for survivors of a critical illness: A review of instruments

Background

Functional outcomes and health-related quality of life are important measures for survivors of a critical illness. Studies have demonstrated debilitating physical effects for a significant proportion of surviving patients, particularly those with intensive care unit-acquired weakness. Contemporary practice changes include a focus on the continuum of critical illness, with less sedation and more physical activity including mobility while in ICU, and post-ICU and post-hospitalisation activities to support optimal recovery. How to best assess the physical function of patients at different phases of their recovery and rehabilitation is therefore important.

Purpose

This narrative review paper examined observational and functional assessment instruments used for assessing patients across the in-ICU, post-ICU and post-hospital continuum of critical illness.

Methods

Relevant papers were identified from a search of bibliographic databases and a review of the reference list of selected articles. The clinimetric properties of physical function and HRQOL measures and their relevance and utility in ICU were reported in narrative format.

Findings

The review highlighted many different instruments used to measure function in survivors of ICU including muscle strength testing, functional tests and walk tests, and patient centred outcomes such as health related quality of life. In general, the sensitivity and validity of these instruments for use with survivors of a critical illness has not yet been established.

Conclusion

Based on findings from the review, screening of patients using reliable and valid instruments for ICU patients is recommended to inform both practice and future studies of interventions aimed at improving recovery and rehabilitation.     

Prevalence and correlates of falls in a middle-aged population with osteoarthritis: Data from the Osteoarthritis Initiative

People with osteoarthritis (OA) are at a higher risk of falls and fall-related injuries. However, there is limited knowledge of the burden and correlates of falls in middle-aged people with OA. Using data from the Osteoarthritis Initiative, this study aimed to determine the prevalence and correlates of falls among middle-aged people with OA. A total of 1,019 adults aged 45–64 years with OA were included in this cross-sectional analysis. The prevalence of self-reported falls in the past 12 months was calculated and relationships between demographic and clinical characteristics and falls history were explored via univariable and multivariable logistic regression. Of the study population (61.7% female), 43.7% (445/1,019) reported having had a fall in the last 12 months. In multivariable models, female sex (odds ratio [OR] 2.09, 95% confidence interval [CI] 1.50–2.90), Charlson score ≥1 (OR 1.90, 95% CI 1.42–2.55) and opioid use (OR 2.68, 95% CI 1.77–4.06) were associated with a higher likelihood of falls. Higher depression score, being White/Caucasian and higher educational attainment were also associated with a greater likelihood of falls. Having knee and hip OA was associated with a higher likelihood of falls (OR 1.79, 95% CI 1.24–2.59), compared to knee OA alone. In summary, previous falls history is concerningly common among middle-aged adults with OA, with modifiable risk factors including depression and opioid use. Greater attention to falls prevention is therefore needed for this patient group, including screening for falls and tailoring existing falls prevention interventions.     

Tissue “valve-over-valve” implantation in previous mechanical Bentall

Multiple studies have reported the adverse impact of audible clicks from mechanical heart valves on the quality of life. Sadly, this can become a lifelong liability in younger patients necessitating explantation. Bioprosthetic valve replacement is the treatment for this distressing condition associated with an isolated mechanical valve. However, patients who have undergone a mechanical Bentall's procedure represent a unique surgical challenge. In view of the significant complications associated with a redo aortic root operation, the alternative of a “valve-over-valve” implantation is an attractive option that might present reduced morbidity. We report a unique case of valve noise intolerance in a patient who underwent a bioprosthetic valve-over-valve replacement following previous Bentall's procedure with a mechanical valved conduit.