BACKGROUND: Reports on the relationship between osteoporosis and osteoarthritis (OA) have tended to disagree, especially in non-weight bearing joints such as the hand joints. We aimed to investigate the relationship between bone mineral density (BMD) and hand and knee OA in a general Korean elderly population. METHODS: We evaluated femur neck BMD and the hand and knee radiographs of 143 men and 123 women over 65 years of age who participated in a population-based cohort study. The Kellgren-Lawrence criteria for grading OA were implemented, and grade 2 or higher were categorized as radiographic OA. BMD was compared according to the existence of radiographic OA in the hand and knee using analysis of covariance, and correlation analyses were performed to explore the relationship between BMD and radiographic OA grade. RESULTS: After controlling for age and body mass index, there was no significant difference in BMD between participants with and without hand OA (p = 0.717 in male and p = 0.862 in female), between those with and without knee OA (p = 0.974 in male and p = 0.563 in female), and between those with only hand OA and those with only knee OA (p = 0.920 in male and p = 0.961 in female). Furthermore, there was no significant correlation between BMD and the radiographic OA grade of the hands (p = 0.182 in male and p = 0.897 in female) and knees (p = 0.245 in male and p = 0.098 in female). CONCLUSIONS: In our cohort of the general Korean elderly population, no association was found between osteoporosis and OA, regardless of the weight bearing status of the joints.
Aged ; *Bone Density ; Female ; Femur Neck/*radiography ; Hand/*radiography ; Humans ; Male ; Osteoarthritis, Knee/complications/*radiography ; Osteoporosis/complications/*radiography ; Republic of Korea ; Sex Factors

BACKGROUND: This study evaluated the preoperative distractive stress radiographs in order to quantify and predict the extent of medial release according to the degree of varus deformity in primary total knee arthroplasty. METHODS: We evaluated 120 varus, osteoarthritic knee joints (75 patients). The association of the angle on the distractive stress radiograph with extent of medial release was analyzed. The extent of medial release was classified into the following 4 groups according to the stage: release of the deep medial collateral ligament (group 1), release of the posterior oblique ligament and/or semimembranous tendon (group 2), release of the posterior capsule (group 3) and release of the superficial medial collateral ligament (group 4). RESULTS: The mean femorotibial angle on the preoperative distractive stress radiograph was valgus 2.4degrees (group 1), valgus 0.8degrees (group 2), varus 2.1degrees (group 3) and varus 2.7degrees (group 4). The extent of medial release increased with increasing degree of varus deformity seen on the preoperative distractive stress radiograph. CONCLUSIONS: The preoperative distractive stress radiograph was useful for predicting the extent of medial release when performing primary total knee arthroplaty.
Aged ; *Arthroplasty, Replacement, Knee/methods ; Female ; Humans ; Joint Deformities, Acquired/etiology/radiography ; Knee Joint/*radiography ; Ligaments, Articular/radiography ; Male ; Medial Collateral Ligament, Knee/*surgery ; Middle Aged ; Osteoarthritis, Knee/complications/radiography/*surgery

BACKGROUND: We report intra- and postoperative complications of unicompartmental knee arthroplasty (UKA). METHODS: This study was conducted on 246 cases of UKA which were performed for degenerative osteoarthritis confined to the medial compartment, from May 2002 to May 2010, for which follow-up periods longer than one year were available. Complications were divided into intra- and postoperative complications. Pre- and postoperative clinical scores, the range of motion, and radiologic findings were analyzed. RESULTS: Complications developed in a total of 24 cases (9.8%, 24/246). Among them, 6 cases had intraoperative complications while 18 had postoperative complications. Among the 6 intraoperative complications, one fracture of the medial tibial condyle, two fractures of the intercondylar eminence, one rupture of the medial collateral ligament, one widening of the peg hole leading to femoral component malposition and late failure, and one total knee arthroplasty (TKA) conversion of a large bony defect of tibial avascular necrosis were observed. Among the 18 postoperative complications, four cases of aseptic loosening of the femoral component, one soft tissue impingement due to malalignment, nine cases of polyethylene bearing dislocation, one case of suprapatellar bursitis, one periprosthetic fracture, one TKA conversion due to medial component overhanging, and one TKA conversion due to pain of unexplained cause were observed. CONCLUSIONS: The mid-term clinical outcomes of UKA were excellent in our study. However, the incidence of complications was very high (9.8%). To prevent intra- and postoperative complications, proper selection of the patients and accurate surgical techniques are required.
Aged ; Arthroplasty, Replacement, Knee/*adverse effects/methods ; Female ; Humans ; Intraoperative Complications ; Male ; Middle Aged ; Osteoarthritis, Knee/radiography/*surgery ; Postoperative Complications ; Retrospective Studies

OBJECTIVETo study the rotation of femoral component and tibial component with CT and evaluate the relationship between patellofemoral complications and rotational alignment of the components.

METHODSThirty patients with isolated patellofemoral complications after total knee arthroplasty were compared with 20 patients with well functioning total knee replacements free of patellofemoral complications. The epicondylar axis and tibial tubercle were used as references on CT scans to quantify the rotational alignment of the femoral and tibial components.

RESULTSPatients with patellofemoral complications had excessive combined (tibial plus femoral) internal component rotation, which was directly proportional to the severity of the patellofemoral complications. Mild combined internal rotation (1 degree-4 degrees) was correlated with patellar and lateral tracking tilting, moderate rotation (3 degrees-8 degrees) with patellar subluxation, and severe rotation (7 degrees-17 degrees) with early patellar dislocation or late patellar prosthesis failure. The control group had combined external rotation of 10 degrees-0 degree.

CONCLUSIONSThe direct correlation of combined internal component rotation to the severity of the patellofemoral complication suggests that internal component rotation may be the predominant cause of patellofemoral complications in patients with normal axis alignment. CT scans can be used intraoperatively and postoperatively to determine whether the rotational malalignment is present to require revision of one or both components.

Adult ; Aged ; Arthroplasty, Replacement, Knee ; adverse effects ; Female ; Humans ; Male ; Middle Aged ; Osteoarthritis, Knee ; diagnostic imaging ; physiopathology ; surgery ; Postoperative Complications ; etiology ; physiopathology ; Prosthesis Failure ; Radiography ; Rotation

BACKGROUND: This study examined the results of open wedge high tibial osteotomy with using an Aescula open wedge plate and an allogenic bone graft as a surgical technique for the patients who suffer from osteoarthritis of the knee with a genu varum deformity. METHODS: From March 2007 to August 2007, 33 patients (37 cases) with osteoarthritis of the knee and a genu varum deformity underwent a high tibial osteotomy with using an Aescula open wedge plate and an allogenic bone graft. The patients were followed up for more than 1 year. Before and after surgery, the correction angle of the genu varum was measured by the lower extremity scannogram and the posterior tibial slope, the joint space distance and the time to bone union were evaluated. The functional factors were evaluated using the Knee Society Score. RESULTS: The average knee score and function score improved from 52.19 +/- 11.82 to 92.49 +/- 5.10 and 52.84 +/- 6.23 to 89.05 +/- 5.53, respectively (p < 0.001). According to the lower extremity scannogram, the mean preoperative varus angle was -1.86 +/- 2.76degrees, and the average correction angle at the last follow-up was 10.93 +/- 2.50degrees (p < 0.001). The tibial posterior slope before surgery and at the last follow-up were 8.20 +/- 1.80degrees and 8.04 +/- 1.30degrees, respectively (p = 0.437). The joint space distance increased from 4.05 +/- 1.30 mm to 4.83 +/- 1.33 mm (p < 0.001). The average time to complete bone union was 12.69 +/- 1.5 weeks. CONCLUSIONS: An open wedge high tibial osteotomy using an Aescula open wedge plate and an allogeneic bone graft to treat osteoarthritis of the knee with a genu varum deformity showed good results for the precision of the correction angle, the time to bone union and the functional improvement.
Adult ; Arthroscopy ; *Bone Plates ; *Bone Transplantation ; Female ; Humans ; Joint Deformities, Acquired/diagnosis/etiology/radiography/*surgery ; Knee Joint ; Male ; Middle Aged ; Orthopedic Procedures/*methods ; Osteoarthritis, Knee/complications/diagnosis/radiography/*surgery ; Osteotomy/*methods ; Tibia/radiography/*surgery ; Transplantation, Homologous

PURPOSE: To identify the accuracy of postoperative implant alignment in minimally invasive surgery total knee arthroplasty (MIS-TKA), based on the degree of varus deformity. MATERIALS AND METHODS: The research examined 627 cases of MIS-TKA from November 2005 to December 2007. The cases were categorized according to the preoperative degree of varus deformity in the knee joint in order to compare the postoperative alignment of the implant: less than 5degrees varus (Group 1, 351 cases), 5degrees to less than 10degrees varus (Group 2, 189 cases), 10degrees to less than 15degrees varus (Group 3, 59 cases), and 15degrees varus or more (Group 4, 28 cases). RESULTS: On average, the alignment of the tibial implant was 0.2+/-1.4degrees, 0.1+/-1.3degrees, 0.1+/-1.6degrees, and 0.3+/-1.7degrees varus, and the tibiofemoral alignment was 5.2+/-1.9degrees, 4.7+/-1.9degrees, 4.9+/-1.9degrees, and 5.1+/-2.0degrees valgus for Groups 1, 2, 3, and 4, respectively, in the preoperative stage, indicating no difference between the groups (p>0.05). With respect to the accuracy of the tibial implant alignment, 98.1%, 97.6%, 87.5%, and 86.7% of Groups 1, 2, 3, and 4, respectively, had 0+/-3degrees varus angulation, demonstrating a reduced level of accuracy in Groups 3 and 4 (p<0.0001). There was no difference in terms of tibiofemoral alignment, with 83.9%, 82.9%, 85.4%, and 86.7% of each group, respectively, showing 6+/-3degrees valgus angulation (p>0.05). CONCLUSION: Satisfactory component alignment was achieved in minimally invasive surgery in total knee arthroplasty, regardless of the degree of varus deformity.
Aged ; Arthroplasty, Replacement, Knee/*methods ; Bone Anteversion/complications/*radiography ; Bone Malalignment/etiology/*radiography ; Female ; Humans ; Joint Deformities, Acquired/*surgery ; Knee Joint/radiography/*surgery ; Knee Prosthesis ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures/*methods ; Osteoarthritis, Knee/complications/radiography/*surgery ; Postoperative Period ; Preoperative Period ; Range of Motion, Articular ; Tibia/surgery ; Treatment Outcome

OBJECTIVETo observe the long-term outcome of high tibial osteotomy (HTO) in treating medial compartment osteoarthrosis of knees.

METHODSA retrospective study was carried out on 194 patients (215 knees) treated with HTO for medial compartment osteoarthritis at the Orthopaedic Hospital of Kiel University between 1985 and 1996.

RESULTSOne hundred and sixty-one knees (144 patients) were followed up for 1.5-12 years with an average of 7.5 years and their data were reviewed. The proportion of excellent outcome were 97.3%, 93.6% and 78.2% two, five and over five years after HTO, respectively. The revision rate of total knee arthroplasty (TKA) was 11.8% (19 knees retreated with TKA for HTO failure). The survivorship analysis of the 19 knees retreated with TKA showed an expected survival rate of 98.7%, 95.0% and 84.1% 2, 5 and 10 years after HTO, respectively. There were 5.6% complications (12/161), including five superficial wound infections, one deep infection, five delayed bone healing, and one peroneal nerve palsy. Fifty patients (54 knees) missed follow-up, among them 10 patients (11 knees) died.

CONCLUSIONSHTO is an effective method in treating medial compartment osteoarthritis with a varus knee. Appropriate overcorrection of femorotibial alignment is the key for the success of the operation. But as the long-term effect is concerned, there is a trend of deterioration and some of the patients may have a second operation of revision with TKA.

Adult ; Aged ; Bone Malalignment ; complications ; etiology ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Osteoarthritis, Knee ; diagnostic imaging ; surgery ; Osteotomy ; Radiography ; Recurrence ; Tibia ; surgery

OBJECTIVETo reveal the possible mechanism involved in patella-femoral degenerative arthritis (PFDA) in- duced by torsion-deformity of tibia via analyzing the relationship between torsion-deformity of the tibia in patients with PFDA and the disorder of patella-femoral joint under the static and dynamic conditions.

METHODSFrom October 2009 to October 2010, 50 patients (86 knees, 24 knees of male patients and 62 knees of female patients) with PFDA were classified as disease group and 16 people (23 knees, 7 knees of males and 16 knees of females) in the control group. The follow indexes were measured: the torsion-angle of tibia on CT scanning imagings, the patella-femoral congruence angle and lateral patella-femoral angle under static and dynamic conditions when the knee bent at 30 degrees of flexion. Based on the measurement results, the relationship between the torsion-deformity of tibias and the disorders of patella-femoral joints in patients with PFDA were analyzed. Finally,the patients were divided into three groups including large torsion-angle group, small torsion-angle group and normal group according to the size of torsion-angle, in order to analyze the relationship between torsion-deformity and disorders of patella-femoral joint, especially under the dynamic conditions.

RESULTSCompared with patients without PFDA, the ones with PFDA had bigger torsion-angle (30.30 ± 7.11)° of tibia, larger patella-femoral congruence angle (13.20 ± 3.94)° and smaller lateral patella-femoral angle (12.30 ± 3.04)°. The congruence angle and lateral patella-femoral angle under static and dynamic conditions had statistical differences respectively in both too-big torsion-angle group and too-small torsion-angle group. The congruence angle and lateral patella-femoral angle under static and dynamic conditions had no statistical differences in normal torsion-angle group.

CONCLUSIONTorsion-deformity of tibia is the main reason for disorder of patella-femoral joint in the patients with PFDA. Torsion-deformity of tibia is always accompanied by instability of patella-femoral joint,especially under the dynamic condition, thus causing PFDA. It can not only provide arrangement information and degenerative condition of patella-femoral joint,but also provide guidance through the analysis on the relationship for better clinical prevention and early treatment of degenerative bone and joint disease.

Adult ; Female ; Femur ; diagnostic imaging ; Humans ; Male ; Middle Aged ; Osteoarthritis, Knee ; diagnostic imaging ; etiology ; Patella ; diagnostic imaging ; Radiography ; Tibia ; diagnostic imaging ; Torsion Abnormality ; complications ; diagnostic imaging

The purpose of this study was to estimate the prevalence of radiographic and symptomatic knee osteoarthritis (OA) among community residents and to elucidate the relevant risk factors. This prospective, population-based study was conducted on residents over 50 yr of age in Chuncheon. Subjects completed an interview based on a standardized questionnaire and clinical evaluation including standardized weight bearing semiflexed knee A-P radiographs. We defined a subject with the Kellgren and Lawrence grade > or =2 as having radiographic knee OA (ROA). Symptomatic knee OA (SOA) was defined by the presence of both ROA and knee pain. We obtained symptom information and radiographs from 504 subjects. The prevalence of ROA and SOA was 37.3% and 24.2%, respectively. The prevalence of both ROA and SOA was significantly higher among women than among men. Multivariate analysis revealed that the presence of hypertension, and a manual occupation were significantly associated with the presence of ROA and SOA. Lower level of education was significantly associated with the presence of ROA, and female sex with the presence of SOA. In conclusion, both ROA and SOA are common in the aged adult population of Korea, with preponderance for women.
Aged ; Aged, 80 and over ; Female ; Humans ; Hypertension/complications ; Interviews as Topic ; Male ; Middle Aged ; Multivariate Analysis ; Osteoarthritis, Knee/complications/*epidemiology/radiography ; Pain/epidemiology ; Population Surveillance ; Prevalence ; Prospective Studies ; Questionnaires ; Republic of Korea/epidemiology ; Risk Factors ; Sex Factors ; Urban Health

This study investigated the epidemiology (prevalence, risk factors, and impact on quality of life) of knee pain and its severity in elderly Koreans. The subjects (n=3,054) were participants aged > or =50 yr from the fifth Korea National Health and Nutrition Examination Survey, conducted in 2010. Knee pain was defined as pain in the knee lasting > or =30 days during the most recent 3 months; severity was categorized as mild, moderate, or severe. EQ-5D was used to measure quality of life. The prevalence of knee pain was 23.1% (11.7% in men, 31.9% in women). The prevalences of mild, moderate, and severe knee pain were 4.3%, 9.1%, and 9.7%, respectively (2.8%, 5.4%, and 3.5% in men and 5.4%, 12.0%, and 14.4% in women). Old age, female gender, a low level of education, a manual occupation, obesity, and radiographic osteoarthritis were risk factors for knee pain, and were associated with increased severity of knee pain. Excluding men with mild knee pain, people with knee pain had significantly lower quality of life than those without knee pain. Early interventional approaches are needed to reduce the medical, social, and economic burden of knee pain in elderly Koreans.
Age Factors ; Aged ; Asian Continental Ancestry Group ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Obesity/complications ; Odds Ratio ; Osteoarthritis, Knee/complications/epidemiology/radiography ; Pain/*epidemiology/etiology ; Prevalence ; *Quality of Life ; Questionnaires ; Republic of Korea ; Risk Factors ; Severity of Illness Index ; Sex Factors