BMC Musculoskeletal Disorders最新文献

Background: Few longitudinal studies have explored changes in physical and mental health in individuals prior to and after arthritis diagnosis. This is important for understanding timing of diagnosis in relation to symptoms and their broader health impacts.

Methods: Adults (≥ 16 years) reporting new diagnoses of arthritis between 2010 and 2023 in the UK Household Longitudinal Study (UKHLS) were included in the study (N = 5,258), along with a 1:1 matched sample of arthritis-free individuals. Trajectories of physical health (assessed using the SF-12 physical component summary), mental health (General Health Questionnaire (GHQ-12)) and satisfaction with health were constructed from 8 years prior to 8 years after diagnosis using growth curve models with linear splines. Difference in difference analysis was used to test whether changes in health measures following diagnosis were attributable to arthritis diagnosis.

Results: Physical health decreased from 8 years prior to diagnosis, but began to show a steeper decline from 4 years before diagnosis. There was a small recovery in the year following diagnosis, followed by a continued decline from 4 years post diagnosis. Mental health worsened at 2 years prior to diagnosis and then remained relatively stable. Health satisfaction also decreased around 2 years prior to diagnosis, showing a gradual increase in the 3 years following diagnosis and then remaining stable. Patterns of change were similar by sex, neighbourhood deprivation and living situation. There was some evidence that changes in mental health and health satisfaction were larger and occurred earlier in individuals diagnosed at younger ages (16-49 year olds). Difference in difference models showed consistent findings, with deteriorations across all three outcomes in the arthritis group relative to their matched controls.

Conclusions: Detectable changes in physical and mental health several years prior to diagnosis suggest the need to improve pathways to diagnosis. Persistence of worse mental health, particularly amongst younger people, highlights the importance of considering both physical and mental health in the years following diagnosis.

Background: At present, the threshold defining older adults is 65 years, and this classification has been widely accepted globally. However, with the extension of both life expectancy and healthy life expectancy, there is a need to reconsider this age-based definition. This study compared the characteristics and surgical outcomes of older patients with lumbar spinal stenosis (LSS) between the early and late stages to clarify age diversity in this population.

Methods: Data collected from consecutive patients aged ≥ 65 years who underwent LSS surgery were retrospectively reviewed. All participants completed the Zurich Claudication Questionnaire, Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), and 25-Question Geriatric Locomotive Function Scale preoperatively as well as 6 and 12 months postoperatively. Frailty was evaluated using the 11-point modified frailty index. Polypharmacy was defined as the concomitant use of at least six drugs.

Results: In total, 311 older patients with LSS were enrolled. Among them, 136 patients younger than 75 were categorized into the E group, and 175 patients aged 75 and older were categorized into the L group. Baseline characteristics, including frailty and polypharmacy, significantly differed between the groups. The frequency of effective case of surgical treatment on JOABPEQ was significantly lower for walking ability in the L group. At 1 year after surgery, the incidence of non-improvement in locomotive syndrome stages was higher in the L group than in the E group (relative risk = 1.38, 95% confidence interval [CI] = 1.08-1.78). In addition, when the L group was further divided into three subgroups based on age, the relative risk was 1.32 (95% CI = 0.99-1.76) for patients aged 75 to < 80, 1.42 (95% CI = 1.07-1.88) for those aged 80 to < 85 years, and 1.68 (95% CI = 1.16-2.45) for those aged ≥ 85.

Conclusions: Significant differences were observed in baseline characteristics and postoperative improvement of walking ability and locomotive syndrome based on age among older patients with LSS. Our findings underscore the significant age diversity among older adults, highlighting the necessity of considering each patient in a more nuanced age-specific manner rather than adopting a one-size-fits-all approach.

Background: Determining the most appropriate level of amputation in patients with diabetes mellitus has not been well established. The purpose of this study is to determine whether muscle biopsy reveals predictive information about the success rate of patients undergoing diabetic major lower limb amputation.

Methods: A prospective observational study was conducted among diabetic patients who underwent below-knee amputation. Skin-subcutaneous and muscle biopsy samples were obtained during the operation from 62 patients who undergo major limb amputation. Depending on the complications after surgery, patients were assigned into three groups: Group 1 consisted of patients with adequate wound healing without any complications; Group 2 included patients with prolonged wound healing requiring additional interventions like debridement; and Group 3 consisted of patients who underwent reamputation at a more proximal level. Biopsy samples of the groups were compared regarding degenerative cells, inflammatory cells, and the presence of infection.

Results: There was a significant difference between Groups 1 and 3 regarding the presence of abscess formation and infection (p < 001). Comparison of Groups 1 and 3 revealed significant differences regarding inflammatory cell count, respectively (p < 001). According to the results of the ROC analysis performed for histopathologic cellular evaluation, 15% for inflammatory cell ratio in muscle samples and 25% for degenerative cell ratio both in muscle and skin samples were determined as cut-off values.

Conclusions: The presence of increased degenerative cell count and infection in muscle biopsy areassociated with higher rates of reoperation. The present study revealed that preoperative muscle biopsy has predictive value in patients undergoing major limb amputation.

Level of evidence: Level II, Prospective observational study.

Background: Muscle function deterioration in female patients with severe knee osteoarthritis (KOA) is linked to alterations in muscle morphology, composition, and mechanical properties. This study evaluates thigh muscle features in female patients with severe KOA and explores correlations with knee joint function.

Methods: Ultrasound and shear wave elastography measured physiological cross-sectional area (PCSA), echo intensity (EI), and shear modulus (G) in the rectus femoris (RF), vastus lateralis (VL), vastus medialis (VM), biceps femoris long head (BFL), and semitendinosus (ST) of 24 KOA patients and 24 controls. EI indicates intramuscular fat, while G reflects stiffness. Muscle characteristics were compared between groups, and correlations with knee function scores (WOMAC, KSS, HSS) were analyzed.

Results: In patients, the symptomatic side displayed reduced PCSA for RF, VL, VM, BFL, and ST (15.85[Formula: see text], 28.18[Formula: see text], 21.53[Formula: see text], 11.67[Formula: see text], 6.59[Formula: see text] respectively) vs. controls (19[Formula: see text], 36.32[Formula: see text], 23.37[Formula: see text], 14.15[Formula: see text], 7.12[Formula: see text] respectively). EI was elevated (128.95, 121.12, 105.72, 90.52, 93.15) vs. controls (100.39, 93.97, 88.14, 77.69, 78.73), and G values (9.48 kPa, 7.88 kPa, 6.9 kPa, 7.2 kPa, 9.03 kPa) was higher than controls (8.85 kPa, 5.28 kPa, 5.98 kPa, 6.58 kPa, 6.73 kPa). BFL`s G, ST`s G, and VM`s EI, negatively correlated with knee function, whereas BFL`s PCSA positively correlated. The variable importance of BFL's PCSA and G ranked at the top in all scores.

Conclusions: Compared to controls, PCSAs in muscles on both sides of KOA patients were lowered by up to 22%, indicative of muscle loss and diminished strength. The G value is 20.65% higher, suggesting poor flexibility and elevated passive tension. EI in muscles on both sides of KOA patients was greater, reaching up to 23.88%, possibly reducing contractile components and muscle force. G, PCSA, and EI are closely correlated with function scores, and PCSA and G of BFL are the most significant predictors of knee function. These results may help explain muscle dysfunction in KOA patients.

Clinical trial number: Not applicable.

Background: Repair of the posterior soft tissue via a posterolateral approach following total hip arthroplasty has been reported to mitigate the risk of dislocation. The joint capsule serves as the primary protective barrier, and while previous techniques for closure have been predominantly complex, we present a novel, simplified technique for joint capsule closure.

Methods: A total of 215 patients who underwent primary THA via the posterolateral approach at our hospital from May 2018 to December 2022 were retrospectively enrolled in this study: 111 patients had their joint capsules sutured using traditional methods, while 114 patients had their joint capsules sutured using the new technology.

Results: Compared to the traditional suture group, the novel joint capsular suture group exhibited shorter operation times (p = 0.004) and reduced postoperative drainage volumes (p < 0.001). There were no significant differences in intraoperative blood loss, acetabular anteversion angle and abduction angle between the two groups. Although the Harris scores at 2 weeks, 3 months, and 6 months after surgery were marginally greater in the novel joint capsular suture group than in the traditional suture group, these differences did not reach statistical significance. Regarding adverse reactions observed during follow-up, hematoma occurred in seven patients (6.6%), and dislocation occurred in four patients (3.6%) in the traditional suture group; conversely, within the new joint capsule suture group, there were only two patients (1.8%) of hematoma with no instances of dislocation recorded thus far.

Conclusions: The preliminary results show that this new capsular closure technique allows the joint capsule to close more tightly and is an effective technique for reducing the rate of early postoperative dislocation.

Background: Hallux valgus (HV) poses additional challenges when accompanied by second metatarsophalangeal (MTP) joint dislocation, often requiring complex surgical intervention. This study aimed to analyze HV feet with second MTP joint dislocation using a 2-dimensional coordinate system to better understand the anatomical structure of this condition.

Methods: Weightbearing foot radiographs of 49 HV feet with second MTP joint dislocation (group D), 68 HV feet without second MTP joint dislocation (group W), and 54 control feet (group N) were analyzed. A 2-dimensional coordinate system was used to map standardized points on radiographs into X and Y coordinates, which were compared across groups. Radiographic parameters measured included hallux valgus angle (HVA), intermetatarsal angle (IMA), second toe MTP angle (2MTPA), metatarsus adductus angle (MAA), great toe length, first metatarsal (MT1) length, second toe length, and second metatarsal (MT2) length. The 2MTPA was further analyzed based on the deviation direction (medial, neutral, or lateral).

Results: The proximal phalanx head of the third toe in groups D and W was lateral compared to group N (P <.05 and P <.001, respectively), while the distal point in group D was medial to group W (P <.001). The base of MT1 in group D was significantly medial compared to other groups (P <.001). Additionally, the distal point of the great toe in group D was significantly lateral compared to other groups (P <.01 and P <.001, respectively).

Conclusions: Patients with second MTP joint dislocation exhibited a proximally translated second toe, an adducted third toe, a medialized MT1 base, and a lateralized great toe tip. The M1/2 angle influenced dislocation direction: higher angles led to medial or neutral deviation, while lower angles caused lateral deviation. Radiographic coordinate mapping provided novel insights into foot anatomy in HV with second MTP joint dislocation, laying the groundwork for future research on anatomical risk factors and optimizing surgical approaches to improve patient outcomes.

Background: This study aimed to comprehensively assess the magnitude, temporal trends, and inequalities associated with socioeconomic development in neck pain (NP) based on the Global Burden of Disease Study 2019.

Methods: An assessment of incidence and years of life with disability (YLD) at the global, regional, and country levels by age, sex and year was conducted for NP. Joinpoint regression (JPR) was used to analyze trends between 1990 and 2019. Decomposition analysis was used to explore the extent to which population growth, aging, and epidemiological changes influenced the changes in incidence and YLD. A Bayesian Age-Period-Cohort (BAPC) model was constructed to predict trends over the next 25 years. Concentration curve and concentration index were used to examine the cross-country relative inequality of the burden of NP at the socio-demographic index (SDI) level.

Results: In 2019, the global ASIR and ASDR of NP were 579.085 and 267.348 per 100,000 individuals, respectively. JPR analysis showed that the global ASIR and ASDR have decreased slightly over the past 30 years, although an increase was observed between 2011 and 2019. The BAPC model predicted that this upward trend would continue over the next 25 years. Decomposition analysis showed that the global increase in incidence and YLD in 2019 compared to 1990 was mainly driven by population growth. The burden of NP was higher in the middle-aged, old-age, and female groups, with differences in regional distribution. The analysis of cross-country inequality showed that the burden of NP was disproportionately concentrated in countries with a high SDI, and this phenomenon continued to increase over the 30-year study period.

Conclusions: Globally, NP remains an important public health problem, and governments are urgently required to raise public awareness about NP and its risk factors, implement targeted prevention and control policies, and deliver the necessary health services.

Background: Proximal humerus fractures (PHFs) are among the commonest bony injuries and the majority of them can be managed non-surgically. The aim of our systematic review and meta-analysis was to compare the effectiveness and safety of early versus delayed mobilisation in conservatively treated PHFs.

Methods: A literature search was performed in Medline, EMBASE and clinicaltrials.gov in Januray 2025 aiming to identify all randomised controlled trials (RCTs) comparing early versus delayed (conventional) mobilisation as part of the non-surgical management of PHFs. Primary outcomes were patient-reported function and pain at short-term (3 months), mid-term (6 months) and long-term (12 months) follow-up, and secondary outcomes included secondary fracture displacement and total complications. Meta-analyses produced mean differences (MDs) or standardised MDs (SMDs) for continuous outcomes and odds ratios (ORs) for binary outcomes, with 95% confidence intervals (CI). Certainty of evidence was assessed using the GRADE tool. Recommendations for clinical practice were given only based on results of high or moderate certainty of evidence.

Results: Six (6) RCTs were included that compared early mobilisation (EM; within one week from injury) to delayed mobilisation (DM; after 3 or 4 weeks of immobilisation) with a total of 470 patients with PHFs. There were no differences in patient-reported function (combined or Constant score) or pain between the EM and DM groups at any follow-up time points except for a significant difference in combined function scores favouring EM [SMD 0.4 CI (0.1,0.7), P = 0.006] at 3 months follow-up. There were no significant differences in the incidence of secondary fracture displacement and total complications in the two groups [OR 3.5 CI (0.7,18.2), P > 0.05, and OR 1.2 CI (0.5,2.9), P > 0.05, respectively]. All results were based on moderate or high strength of evidence. The most significant limitations of our study were the small number of pooled studies and inability to perform subgroup analyses for specific fracture types.

Conclusions: Our meta-analysis of RCTs showed that commencement of mobilisation within one week from injury for non-surgically managed PHFs is safe and may confer short-term functional benefits compared to delayed mobilisation.

Background: Applying non-tourniquet technology in total knee arthroplasty (TKA) is becoming increasingly popular. However, there is no consensus on its effect on the service life of knee prostheses. This study examined the effect of tourniquet use on cement penetration and radiolucent line (RLL) to assess whether the use of tournique in TKA affects prosthesis survival.

Methods: We retrospectively analyzed 166 patients admitted to our hospital between January 1, 2014, and June 1, 2015, who met the inclusion criteria. The patients were divided into the tourniquet (80 cases) and non-tourniquet groups (86 cases) according to whether a tourniquet was used during the operation. We compared the preoperative data and related complications between both groups. Hip-knee-ankle (HKA), medial proximal tibial angle (MPTA) and the penetration depth of bone cement on the osteotomy surface was measured according to postoperative imaging data. Furthermore, the probability of occurrence of radio-clear lines around the prosthesis was observed.

Results: A total of 166 patients were enrolled with a mean age of 68.52 ± 4.74 years and a mean follow-up time of 105.67 ± 5.98 years. No significant demographic differences were observed between the two groups (P > 0.05). Revision surgery was performed for one patient in each group due to aseptic loosening of the prosthesis. The preoperative and postoperative knee association function scores (HSS), knee range of motion, HKA, and MPTA between the two groups did not differ significantly (P > 0.05). In the lateral observation of zone femur 3A and the average observation area of the femur, the penetration depth of the osteotomy surface were significantly different between the two groups (P < 0.05). The incidence of radiolucent lines differed slightly between both groups in different observation areas,but the revision rate did not differ significantly between the two groups (P > 0.05).

Conclusion: In the long term, TKA without tournique use can achieve clinical effects comparable to the use of tourniquet in many aspects, such as prosthesis stability, prosthesis survival rate, reoperations rate, knee range of motion, and knee functionality.

Backgrounds: The treatment of complex distal radius fractures, particularly those involving both intra-articular disruption and significant metaphyseal comminution, remains a considerable surgical challenge. While volar locking plates have become a widely accepted standard for stabilizing these fractures, alone they may not address all fracture patterns. This study presents a surgical approach that incorporates the use of a mini-plate to provide targeted support for the metaphyseal region. We hypothesize that combining a mini-plate for metaphyseal stabilization with a volar locking plate for overall fracture fixation will enhance the structural stability and radiologic outcomes of metaphyseal comminuted distal radius fractures.

Subjects and methods: Eight cases of distal radius fractures involving comminution extending to the metaphysis treated surgically at Samsung Changwon Hospital during 2013-2023 were retrospectively analyzed. All patients had distal radius fractures with severe comminution at the metaphysis, where an added mini-plate was used to fix the fragments before applying the final volar locking plate. Using patient medical records, the mechanism of injury; presence of osteoporosis; type of fracture; radiologic parameters, final range of motion of the wrist; Mayo score and Disabilities of the Arm, Shoulder, and Hand (DASH) scores were investigated.

Results: The average age of the participants was 66 years. After a mean follow-up of 30.1 months, all patients achieved proper bone union. The median total range of motion of the wrist joint was 110.6° (40°-170°) at final follow-up. The radiographic parameters showed significant improvement postoperatively compared to preoperatively. The ulnar variance improved from a median of 5 mm to 0.5 mm (P = 0.013), the median teardrop angle increased from 33° to 59° (P = 0.012), and the median lateral palmar tilt improved from - 15.5° to 10.5° (P = 0.033). The median DASH score was 35.6 points, and the median Mayo score was 75.2 points.

Conclusion: By initially securing larger metaphyseal fragments with mini-plates, we transform a comminuted metaphyseal fracture into a simpler fracture pattern. This approach stabilizes the metaphyseal region, maintains radial length, and facilitates subsequent reduction of intra-articular fractures, thereby simplifying the surgical procedure. This method is a valuable addition to the surgical treatment options for managing such challenging fractures.