OBJECTIVES: People who have chronic diseases, as well as gait imbalance or psychiatric drug use, may be susceptible to injuries from falls and slips. The purpose of this study was to evaluate the effect of musculoskeletal diseases on incidental fall-related injuries among adults in Korea. METHODS: We analyzed data from the 4th Korea National Health and Nutrition Examination Survey (2007-2009), which are national data obtained by a rolling survey sampling method. The 1-year incidence of fall-related injuries was defined by health service utilization within the last year due to injury occurring after a slip and fall, and musculoskeletal diseases included osteoarthritis, rheumatoid arthritis, osteoporosis, and back pain. To evaluate the effects of preexisting musculoskeletal diseases, adults diagnosed before the last year were considered the exposed group, and adults who had never been diagnosed were the unexposed group. RESULTS: The weighted lifetime prevalence of musculoskeletal disease was 32 540 per 100 000 persons. Musculoskeletal diseases were associated with a higher risk of fall-related injury after adjustment for sex, age, residence, household income, education, occupation, visual disturbance, paralysis due to stroke, and medication for depression (odds ratio [OR], 1.41; 95% confidence interval [CI], 1.03 to 1.93). As the number of comorbid musculoskeletal diseases increased, the risk of fall-induced injuries increased (p-value for trend <0.001). In particular, patients who had any musculoskeletal condition were at much higher risk of recurrent fall-related injuries (OR, 6.20; 95% CI, 1.06 to 36.08). CONCLUSIONS: One must take into account the risk of fall-related injuries and provide prevention strategies among adults who have musculoskeletal diseases.
Accidental Falls/*statistics & numerical data ; Adolescent ; Adult ; Age Factors ; Aged ; Arthritis, Rheumatoid/complications/epidemiology ; Back Pain/complications/epidemiology ; Female ; Health Surveys ; Humans ; Incidence ; Male ; Middle Aged ; Musculoskeletal Diseases/*complications ; Osteoarthritis/complications/epidemiology ; Osteoporosis/complications/epidemiology ; Republic of Korea/epidemiology ; Risk Factors ; Sex Factors ; Socioeconomic Factors ; Young Adult

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

INTRODUCTIONLocal data on revision total knee arthroplasty (TKA) are limited. This study aims to assess the causes and outcomes of revision TKA in a single institution, with a 2-year follow-up.

MATERIALS AND METHODSA retrospective review of case records of patients who underwent revision TKA in 2008 and 2009 in the authors' institution was performed. Outcome was assessed using SF-36, Oxford knee score and Knee Society Clinical Rating System preoperatively, at 6 months and at 2 years' follow-up.

RESULTSForty-one patients (41 knees) were included in the study. Indications for revision were aseptic loosening in 13 (31.7%), mechanical wear/component failure in 10 (24.4%), infection in 9 (22.0%), malalignment in 4 (9.8%), instability in 3 (7.3%), periprosthetic fracture in 1 (2.4%) and persistent stiffness in 1 (2.4%). Significant improvements were seen postoperatively in all 3 instruments used to evaluate clinical outcome. These improvements were seen at 6 months after surgery, and were maintained through the 2-year follow-up period. There were no significant changes in all scores between 6 months and 2 years follow-up. There was 100% survivorship of the implants with no postoperative complications requiring surgical intervention.

CONCLUSIONIndications for revision TKA locally are similar to those in other large centres. Revision total knee arthroplasty results in significantly improved function and quality of life for patients, which is maintained over a 2-year follow-up period. In our series, we obtained 100% implant survivorship.

Aged ; Arthroplasty, Replacement, Knee ; Female ; Follow-Up Studies ; Humans ; Incidence ; Knee Prosthesis ; Male ; Middle Aged ; Osteoarthritis, Knee ; surgery ; Postoperative Complications ; epidemiology ; Prosthesis Failure ; Reoperation ; Retrospective Studies ; Singapore ; epidemiology ; Time Factors

To evaluate the efficacy of operative and non-operative treatment for three- or four-part proximal humeral fractures in elderly patients by meta-analysis.The literature search was performed in Cochrance Library, Medline, Embase, SinoMed, CNKI, Wanfang data and CQVIP databases for operative and non-operative treatment of three- or four-part proximal humeral fractures in elderly patients, and searches of conference proceedings were also conducted. The data were extracted and a meta-analysis was performed using RevMan 5.3. The outcome measures included Constants score, pain and incidence rates of AVN, reoperation, osteoarthritis, nonunion.Six randomized controlled trials involving 264 patients were included in the meta-analysis. The differences of Constant scores (=0.47, 95%:-4.35-5.28,=0.85), incidence of ANV (=0.56, 95%:0.25-1.24,=0.15), incidence of osteoarthritis (=0.56, 95%:0.19-1.68,=0.30), incidence of nonunion (=0.43, 95%:0.13-1.43,=0.17) between operative group and non-operative group were not statistically significant. Operative treatment was better in pain score (=1.01, 95%:0.12-1.19,=0.03) and had statistically significant higher reoperative rate (=3.97, 95%:1.45-10.92,=0.007).No evidence support that there is difference in Constant score and incidence rate of ANV, osteoarthritis, nonunion between operative and non-operative treatment for three- or four-part proximal humeral fractures in elderly patients. More high quality randomized controlled trials are required to determine which treatment is more efficient.
Aged ; Comparative Effectiveness Research ; Fracture Healing ; Fractures, Multiple ; complications ; therapy ; Fractures, Ununited ; epidemiology ; Humans ; Humerus ; injuries ; surgery ; Orthopedic Procedures ; adverse effects ; methods ; statistics & numerical data ; Osteoarthritis ; epidemiology ; Osteonecrosis ; epidemiology ; Randomized Controlled Trials as Topic ; Reoperation ; statistics & numerical data ; Shoulder Fractures ; complications ; therapy ; Treatment Outcome

BACKGROUNDSince knee osteoarthritis (KOA) is one of the common diseases, identification of its associated risk factors is of preventive significance. This investigation was designed to investigate the prevalence of KOA in Taiyuan, and identify the associated risk factors of KOA.

METHODSA population sample was surveyed of 2188 adults aged from 35 to 64 years, living in 6-story buildings without elevators. The protocol of Asia Pacific League of Associations for Rheumatology (APLAR) Community Oriented Program for Control of Rheumatic Diseases (COPCORD) core questionnaire was implemented. The data on knee pain and KOA were collected and analyzed. Variables such as sex, age, body mass index (BMI), waist circumference (WC), education level, and smoking history, were included in binary logistic regression model for further analysis.

RESULTSThe prevalence rates of knee pain and KOA were 13.6% and 10.9%, respectively, significantly higher than those in Shantou of south China and similar to those in Beijing of north China. The prevalence of KOA was significantly higher in women than in men (18.3% versus 8.7% and 15.1% versus 6.3%), with a tendency of increase with age. The prevalence was increased more obviously in women after 40 years old and in men after 45 years old. BMI in KOA group was significantly higher than that in non-KOA group. Binary Logistic regression revealed that age, sex, and BMI were significantly associated with KOA, whereas no significant correlation was seen between KOA and other factors such as climbing stairs, WC, time length of occupation service, education level, smoking history and religious belief.

CONCLUSIONGeography, age, sex, and BMI might be the risk factors of KOA, but climbing stairs, WC, time length of occupation service, education level, smoking history and religious belief are not correlated with KOA. Prevention of KOA should be initiated before the middle-age, especially in female adults, and weight control is necessary. Other factors might also contribute to the development of KOA, but further study is needed to elucidate the role of these factors.

Adult ; Age Distribution ; Age Factors ; Body Mass Index ; China ; epidemiology ; Educational Status ; Female ; Health Surveys ; Humans ; Knee Joint ; pathology ; radiation effects ; Logistic Models ; Male ; Middle Aged ; Obesity ; complications ; Osteoarthritis, Knee ; epidemiology ; etiology ; Pain ; epidemiology ; etiology ; Prevalence ; Risk Factors ; Sex Factors ; Smoking ; adverse effects

INTRODUCTIONThere is considerable controversy regarding the best method to prevent venous thromboembolism. In 2008, the American College of Chest Physicians (ACCP) published specific guidelines recommending the use of ow-molecular-weight heparin or warfarin, and a target international normalised ratio of 2.0-3.0 for a duration of at least 7-10 days, after elective knee arthroplasties. Many orthopaedic surgeons believe that these recommendations are biased toward reducing deep venous thrombosis (DVT), but neglect the implicated possibility of a higher incidence of wound complications. In order to enable an objective evaluation of the fit of the ACCP recommendations to the needs of our local cohort of patients, we aimed to look at the incidence of DVT in our local population.

METHODSThis study was a prospective observational study involving existing local patients in Singapore General Hospital, Singapore, who underwent total knee arthroplasty (TKA) and were on a short course of chemothromboprophylaxis (< 7 days) after the operation. The incidence of DVT in patients was evaluated using DVT imaging 4-6 days after the operation and at one month after the operation.

RESULTSIn our study cohort, the prevalence of DVT during the period between postoperative Days 4 and 6 was 12% (11% were distal DVT and 1% was proximal DVT). Only 9% of the patients had DVT one month after the operation. Using chi-square analysis, we found that there was no significant increase in the number of DVT and pulmonary embolism cases 4-6 days and 1 month after the operation (p > 0.05).

CONCLUSIONContrary to the ACCP guidelines, a short course of chemothromboprophylaxis post TKA, lasting no more than 7 days, is safe and adequate in the low-risk Asian population.

Adult ; Aged ; Aged, 80 and over ; Anticoagulants ; therapeutic use ; Arthroplasty, Replacement, Knee ; adverse effects ; Drug Administration Schedule ; Female ; Follow-Up Studies ; Heparin, Low-Molecular-Weight ; therapeutic use ; Humans ; Incidence ; Male ; Middle Aged ; Osteoarthritis, Knee ; surgery ; Postoperative Complications ; Prognosis ; Prospective Studies ; Singapore ; epidemiology ; Treatment Outcome ; Venous Thrombosis ; epidemiology ; etiology ; prevention & control ; Warfarin ; therapeutic use

Aged ; Arthroplasty, Replacement, Knee ; adverse effects ; methods ; Case-Control Studies ; Female ; Follow-Up Studies ; Humans ; Incidence ; Intraoperative Care ; instrumentation ; methods ; Male ; Middle Aged ; Osteoarthritis, Knee ; surgery ; Postoperative Complications ; diagnosis ; epidemiology ; etiology ; prevention & control ; Recovery of Function ; Risk Assessment ; Singapore ; epidemiology ; Tourniquets ; adverse effects ; Treatment Outcome

INTRODUCTIONPatients suffering from bilateral knee osteoarthritis often require bilateral total knee arthroplasty (TKA) to alleviate symptoms. There is controversy surrounding the approach to the surgical treatment of such patients. We asked if Asian patients undergoing staged-bilateral TKA had any difference in their short-term functional outcomes, comparing the first TKA to the second one and if the interval between the 2 surgeries had any impact of functional outcomes.

MATERIALS AND METHODSWe identified 100 patients from a single surgeon from 2006 to 2010 who had staged-bilateral TKA and had at least 2 years of follow-up for each TKA. The time interval between the first and second TKA ranged from 6 months to 1 year. Range of motion, Oxford knee questionnaire scores, knee scores and function scores at 6 months and 2 years of follow-up were then compared between the first and second TKA using the Student's T-test.

RESULTSAlthough length of stay was reduced and time to ambulation was shorter for the second TKA, there were no significant differences in functional outcomes at 2 years. There was also no difference in outcome when patients were stratified according to time interval between TKAs.

CONCLUSIONStaged-bilateral TKA continues to be a good option for patients presenting with severe bilateral knee osteoarthritis. The second arthroplasty has similar functional outcomes as the first arthroplasty. Our results can be used in preoperative counselling of patients undergoing staged-bilateral TKA.

Adult ; Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Knee ; methods ; Asian Continental Ancestry Group ; Female ; Humans ; Length of Stay ; statistics & numerical data ; Male ; Middle Aged ; Operative Time ; Osteoarthritis, Knee ; surgery ; Postoperative Complications ; epidemiology ; Range of Motion, Articular ; Retrospective Studies ; Singapore ; Time Factors ; Treatment Outcome ; Walking