What Are Culturally Relevant Activities of Daily Living in the Asian-Indian Population? A Survey of 402 Patients With Knee Pain.

BACKGROUND: Patient-reported outcome measures are essential tools in assessing clinical outcomes. Although several patient-reported outcome measures such as the Oxford Knee Score and Knee Injury and Osteoarthritis Outcome Score have been developed and validated, their applicability in the Asian-Indian population may be limited; key cultural differences including varying functional demands, ethnicity-specific necessities, and social expectations represent a unique collection of needs. Such differences include preferences toward ground-level activities and those favoring the manual completion of tasks. QUESTIONS/PURPOSES: (1) Which activities of daily living (ADLs) do patients in an Asian-Indian population consider the most important? (2) How do the categories of ADLs (personal care, household, work, travel, and recreation) vary among patients of different gender (men and women) and age (< 60 and > 60 years) groups? METHODS: A cross-sectional study was conducted in October 2019 at a hospital in Mumbai, India. We developed a questionnaire with five domains for physical activity (personal care, household, work, travel, and recreation) formulated from a review and modification of existing categories identified by the WHO and the American Heart Association. Forty key ADLs were identified according to input obtained from detailed interviews of healthcare providers involved in the care of patients with orthopaedic illness, based on established domains. Respondents were instructed to identify the ADLs that were the most relevant to their lifestyle and culture. Responses from 402 patients (mean age 60 ± 12 years; 51% [206 of 402] were women) were analyzed to identify the most commonly selected ADLs. Responses were further evaluated to understand the impact of gender and age on these preferences by comparing men and women, as well as younger (age < 60 years) and older (age > 60 years) patients. RESULTS: The three most frequently reported ADLs in each domain, representing the ADLs that were the most important to the Asian-Indian population, were standing without assistance (82% [331 of 402]), getting up with support (81% [324 of 402]), and toilet use (74% [298 of 402]) in the personal activity category; climbing stairs (80% [322 of 402]), sitting cross-legged (80% [320 of 402]), and praying (79% [319 of 402]) in the household activity category; going to the market (72% [291 of 402]), long-distance walking (62% [250 of 402]), and carrying a shopping bag (60% [242 of 402]) in the work activity category; walking on an uneven surface (66% [266 of 402]), using a taxi (61% [247 of 402]), and traveling by train (59% [239 of 402]) in the travel activity category; and yoga (67% [269 of 402]), playing with children (66% [264 of 402]), and indoor games (63% [252 of 402]) in the recreational activity category. The order of importance of ADL domains was identical in the men versus women groups as well as in the younger age versus older age groups; ADL domains with the highest number of selected ADLs in order of decreasing importance were household care, personal care, work, travel, and recreation when analyzed by individual gender and age groups. Women were more likely than men to report the following ADLs as being important: climbing stairs (84% [172 of 206] of women and 77% [150 of 196] of men), getting up without support (83% [171 of 206] of women and 78% [153 of 196] of men), going to the market (74% [152 of 206] of women and 71% [139 of 196] of men), walking on uneven surfaces (67% [139 of 206] of women and 65% [127 of 196] of men), and playing with children (72% [148 of 206] of women and 59% [116 of 196] of men). CONCLUSION: The findings of this study aim to help providers engage in personalized and socioculturally relevant discussions about knee arthritis. Highlighted areas of importance may facilitate a more comprehensive preoperative discussion of total joint arthroplasty expectations in the context of the needs and demands of Asian-Indian patients. The findings of this study could establish the groundwork for the development of ethnicity-specific patient-reported outcome measures by incorporating the identified ADLs in novel metrics with validation of face and content validity.Level of Evidence Level III, prognostic study.

Biological Reconstruction of the Coracoclavicular Ligament with Semitendinosus Autograft and Repair of Distal Clavicle Fractures.

Most of the options available to treat distal clavicle fractures involve hardware-related complications and high failure rates. This study aims to determine the outcome of distal clavicle fractures treated by a technique that combines biological reconstruction of the coracoclavicular ligament with semitendinosus autograft with reinforced fibrous tissue tapes. In this retrospective study, 8 patients with displaced distal third clavicle fracture cho's IIB or II C were operated on with the described surgical technique between 2018 and 2021. The results were assessed by comparing the preoperative Constant Murley score and the postoperative DASH score. In addition to these variables, several other variables were also assessed, such as the coracoclavicular distance, the time until union, and all intraoperative and postoperative complications. The study included eight patients with an average age of 36.5 years, and the average time from surgery to recovery was five days. According to Cho's classification, all eight patients achieved radiographic union within 89 days. Of the eight cases, six were classified as II C and two as II B. The follow-up period was an average of 13 months. During the postoperative period, the Constant Murley score score increased from 22.2 preoperatively to 92.2 postoperatively. The mean DASH score was 89.6, and the mean postoperative DASH score was 7.75. In terms of the coracoclavicular distance, the mean preoperative was 20.2 mm, and the mean postoperative was 10.3 mm. One patient experienced a minor wound complication after surgery, treated with secondary suturing after the operation. No intraoperative complications occurred. There was no donor site morbidity observed in the patients. It has been demonstrated that the use of this technique in displaced unstable distal clavicle fractures using a fiber tape and a semitendinosus autograft results in a satisfactory union and excellent clinical outcomes with very few complications.

An alternate technique of performing total cavopulmonary connection without cardiopulmonary bypass.

Total cavopulmonary connection (Fontan) without using cardiopulmonary bypass (CPB) may be superior to Fontan on CPB. In the experience of many, a Fontan operation without CPB may be associated with a reduced need for inotropic support, improved outcomes in the postoperative phase including faster time to termination of mechanical ventilatory support, reduced intensive care unit stay, lower volume of pleural and peritoneal effusions, and decreased hospital stay, thereby rendering it more cost-effective. However, the operation is technically more difficult to perform than Fontan on CPB and requires significant modifications of surgical technique and alteration in overall management strategy. In this article, an alternative technique of performing total cavopulmonary connection without CPB is described. Its advantages are briefly discussed.

Results of an Audit of Orthopaedic Operation Notes from a Tertiary Care Centre: Are We Doing It Right and Can We Do More?

Introduction: The Royal College of Surgeons (RCS) published the Good Surgical Practice guidelines in 2008 and subsequently revised them in 2014. Essentially, they outline the basic standards that need to be met by all surgical operation notes. The objective of the present study was to retrospectively audit the orthopaedic operation notes from a tertiary care hospital in Mumbai (between October 2020 to March 2021) against the recommended RCS Good Surgical Practice guidelines published in 2014. Method: In the present study a total of 153 orthopaedic operation notes of 200 patients were audited by a single reviewer. During the period between October 2020 and March 2021, the data collection took place. All notes were typed on the standard operative proforma available on the hospital patient management software (SAP). Results: Overall, the mandated fields in the EMR had excellent documentation. Documentation was excellent for the date and time of surgery, name of the surgeon, the procedure performed (100%), operative diagnosis (99.35%), an extra procedure performed (100%), and details of antibiotic prophylaxis (99.35); Inadequate for details of incision (94.77%), details of operative findings (92.16%), details of prosthesis (97.37%), DVT prophylaxis (96.08%) and detailed post-operative instructions (93.46%) and poor for tourniquet time (41.83%;), estimated blood loss (59.48%), closure details (16.99%), documentation of complications or lack of (51.63%) and setting of surgery elective or emergency (0%). Conclusion: Compliance for completion and documentation of operative procedures was high in some areas; improvement is needed in documenting tourniquet time, prosthesis and incision details, and the location of operative diagnosis and postoperative instructions. With wider adoption of electronic medical record systems, there is a scope of improving documentation by mandating certain fields.

Obturator Internus Bursitis Mimicking Groin Pain in a Football Player: A Case Report.

Introduction: Traumatic groin pain (GP) is frequently the result of acute trauma, often an indirect muscle injury. The most affected muscles in traumatic GP are the rectus abdominis, adductors, and iliopsoas. The obturator internus bursitis as a cause of GP is very rare. Case Presentation: The present case describes a rare indirect injury of obturator internus bursitis in a 22-year-old male football player who reported GP that used to worsen with sprinting and change in directions. The pain was relieved with rest and sprinting at 80% capacity. The patient had been diagnosed clinically and on magnetic resonance imaging (MRI) as a case of obturator internus insertional tendinopathy with bursitis. His symptoms resolved after ultrasound-guided injection in the inflamed tendon sheath at its insertion point. After 2 years, the patient was followed up with a triumphant return to professional football with no recurrence and a good prognosis in a relatively short recovery time. Conclusion: Clinical diagnosis of obturator injuries is often tricky. GP not responding to conservative management presents a unique challenge to the physician and the rehabilitation team. MRI must follow the radiological investigations and ultrasound if the reports were inconclusive of the diagnosis. In the present case study, the usual causes of such pain (osteitis pubis, and adductor muscle strains/tendinosis) were ruled out, and a specific unique condition was diagnosed with the help of the MRI.

Effectiveness of Covid-19 vaccines (CovishieldTM and Covaxin ®) in healthcare workers in Mumbai, India: A retrospective cohort analysis.

BACKGROUND: India started its vaccination programme for Coronavirus-19 infection (COVID-19) on 16 January 2021 with CovishieldTM (Oxford/Astra Zeneca vaccine manufactured by Serum Institute of India) and Covaxin ® (Bharat Biotech, India). We designed the present study to study the effectiveness of vaccines for COVID-19 in prevention of breakthrough infections and severe symptomatic cases among health care workers in a real-life scenario in Mumbai, India. Furthermore, we also wanted to study the factors associated with this effectiveness. METHODS: This is cohort analysis of secondary data of 2762 individuals working in a tertiary health care setting in Mumbai, India (16 January 2021 to 16 October 2021). Vaccination records of all groups of health care staff (including the date of vaccination, type of vaccine taken, and date of positivity for COVID-19) were maintained at the hospital. The staff were tested for COVID-19 at least once a week and when symptomatic. The observation time for everyone was divided into unvaccinated, partially vaccinated (14 days after the first dose); and fully vaccinated (14 days after the second dose). If the individual was found to be positive, the day of positivity was considered the 'day of the event' for that individual. We combined unvaccinated/partially vaccinated into one group and completely vaccinated in the other group. We estimated hazard ratios (HR) and their 95% confidence intervals. The vaccine effectiveness (VE) was assessed as (1-HR)*100. RESULTS: The mean age (SD) of the study participants was 32.3 (8.3) years; majority of these individuals had taken Covishield TM (99.0%) and only 0.9% (n = 27) had taken Covaxin ®. The incidence rate in the overall population was 0.067/100 person-days (PD). The incidence rate was significantly higher in the unvaccinated/partially vaccinated group compared with the fully vaccinated group (0.0989 / 100 PD vs 0.0403/100 PD; p < 0.001). The adjusted HR (aHR) in the fully vaccinated group compared with the unvaccinated/partially vaccinated group in the complete cohort was 0.30 (95% CI: 0.23, 0.39). Thus, the vaccine effectiveness (VE) for full vaccination was 70% (95% CI: 61%, 77%). It remained the same in the Covishield TM only cohort. The VE in completely vaccinated and with a history of previous infection was 88% (95% CI: 80%, 93%). Only 11 health care workers required hospitalization over the entire observation period; the incidence rate in our cohort was 0.0016 / 100 PD. None of the HCWs reported any severe adverse events after vaccination. CONCLUSIONS: In this real-world scenario, we did find that complete vaccination reduced the rate of infection, particularly severe infection in health care personnel even during the severe delta wave in the country. Even among those infected, the hospitalisation rates were very low, and none died. We did not record any major side effects of vaccination in these personnel. Previous infection with COVID-19 and complete vaccination had a significantly higher effectiveness in prevention of infection.

It's the Biology Orthopods! Heralding a Reconstructive Revolution Through Musculoskeletal Tissue Banks (MSTB) in India.

Background: A tissue bank is an establishment that aids in retrieval, processing, storage, and distribution  of human tissue for transplantation. For many years, such banks have been dispensing tissue to orthopaedic surgeons, performing reconstructive surgeries. Methodology: The retrieval, preparation, and delivery of musculoskeletal tissue used for transplantation is an intricate process  involving varying practices among different musculoskeletal tissue banks. Results: Musculoskeletal allografts are used in various orthopaedic surgeries ranging from primary bone defects, trauma, and carcinoma to congenital disabilities. Every decade brings in paradigm shifts and new hope for treating challenging cases with the aid of newer devices and materials. Conclusion: This review article outlines various technical, regulatory and quality enhancement steps involved in tissue banking. Also, it discusses the road ahead and the research avenues for developing novel allograft products with the synergy of tissue banks and clinicians. Supplementary Information: The online version contains supplementary material available at 10.1007/s43465-022-00661-0.

Evaluation of artificial intelligence models for osteoarthritis of the knee using deep learning algorithms for orthopedic radiographs.

BACKGROUND: Deep learning, a form of artificial intelligence, has shown promising results for interpreting radiographs. In order to develop this niche machine learning (ML) program of interpreting orthopedic radiographs with accuracy, a project named deep learning algorithm for orthopedic radiographs was conceived. In the first phase, the diagnosis of knee osteoarthritis (KOA) as per the standard Kellgren-Lawrence (KL) scale in medical images was conducted using the deep learning algorithm for orthopedic radiographs. AIM: To compare efficacy and accuracy of eight different transfer learning deep learning models for detecting the grade of KOA from a radiograph and identify the most appropriate ML-based model for the detecting grade of KOA. METHODS: The study was performed on 2068 radiograph exams conducted at the Department of Orthopedic Surgery, Sir HN Reliance Hospital and Research Centre (Mumbai, India) during 2019-2021. Three orthopedic surgeons reviewed these independently, graded them for the severity of KOA as per the KL scale and settled disagreement through a consensus session. Eight models, namely ResNet50, VGG-16, InceptionV3, MobilnetV2, EfficientnetB7, DenseNet201, Xception and NasNetMobile, were used to evaluate the efficacy of ML in accurately classifying radiographs for KOA as per the KL scale. Out of the 2068 images, 70% were used initially to train the model, 10% were used subsequently to test the model, and 20% were used finally to determine the accuracy of and validate each model. The idea behind transfer learning for KOA grade image classification is that if the existing models are already trained on a large and general dataset, these models will effectively serve as generic models to fulfill the study's objectives. Finally, in order to benchmark the efficacy, the results of the models were also compared to a first-year orthopedic trainee who independently classified these models according to the KL scale. RESULTS: Our network yielded an overall high accuracy for detecting KOA, ranging from 54% to 93%. The most successful of these was the DenseNet model, with accuracy up to 93%; interestingly, it even outperformed the human first-year trainee who had an accuracy of 74%. CONCLUSION: The study paves the way for extrapolating the learning using ML to develop an automated KOA classification tool and enable healthcare professionals with better decision-making.

Application of deep learning algorithm in automated identification of knee arthroplasty implants from plain radiographs using transfer learning models: Are algorithms better than humans?

Aim: In preoperative planning of a revision knee arthroplasty, it can be challenging to identify an implant manufacturer type from a primary knee arthroplasty due to the inability to identify the implants in time. It has been shown that deep learning improves diagnosis with each iteration in the medical field. The problem of identifying the manufacturer and model of knee arthroplasty prostheses has been solved using automated deep learning models. In our study, we have developed deep learning algorithm to identify knee arthroplasty, implant manufacturer type. The current study also aimed to determine the best of the seven machine learning-based model for detecting knee implants according to different manufacturing types from plain radiographs based on their efficacy and accuracy. Material and methods: Plain radiographs of 521 knee arthroplasty implants of six different manufacturers were taken from the anteroposterior and lateral perspectives to train, validate, and test the implants. Among 521 radiographs images, 70% were used in the initial training process, 10% in testing the models, and 20% in determining the accuracy and validity of the models. The study explored the transfer learning technique to develop models. The advantage of transfer learning for knee implant detection is that if existing models are already trained on a large enough and general dataset, these models can be used to fulfil the study's objectives. In addition, to establish the efficacy of these knee implants, two orthopaedic consultants specialised in arthroplasty independently identified these manufacturers types. Results: The performance and network of the model resulted in high accuracy for identifying knee implant types out of seven models, five of which had more than 90% accuracy. After 20 training epochs on all seven models, based on the validation dataset, VGG-16 produces the best results with an accuracy of 95.5% and a precision of 98.4%. However, the study asserted that machine learning outperformed two human expert, who achieved an average accuracy of 78%. Conclusion: This study may lead to the development of an automated implant identification tool that could improve the accuracy and speed of decision made by healthcare professionals.

Surgeon administered direct adductor canal block is as good as ultrasound guided adductor canal block in pain management in knee replacements- A retrospective case-control study.

Aim: The aim of this study is to assess the feasibility of the DACB in a clinical setting and compare the efficacy of postoperative pain relief after TKR in the patients administered DACB versus USG guided ACB. Also to see efficacy and safety of USACB in patients operated with medial parapatellar and subvastus approach. Material and methods: 250 consecutive patients operated with TKR between Jan 2019 to March 2022 were included. Group A included patients operated with medial parapatellar approach and received USACB, Group B included patients operated with medial parapatellar approach and received DACB while Group C included patients operated with subvastus approach and received USACB. VAS scores between three groups were compared at 12 and 24 h. All three groups of patients were otherwise treated identically in the hospital. Results: The mean age and BMI was not statistically significant between the three groups. The mean VAS pain score at rest at 12 h was 3.06 ± 1.49 (Group A) vs 1.58 ± 1.19 (Group B) [p < 0.0001] and 3.06 ± 1.49 (Group A) vs 1.88 ± 1.18 (Group C) [p < 0.0001]; and at 24 h was 1.88 ± 1.31 (Group A) vs 2.39 ± 1.27 (Group B) [p = 0.023] and 1.88 ± 1.31 (Group A) vs 2.19 ± 1.29 (Group C) [p = 0.16]. The mean theatre time was 151.9 ± 11.37 min (Group A) vs 141.02 ± 19.46 min (Group B) (p = 0.0003) and 151.9 ± 11.37 min (Group A) vs 150.4 ± 28.74 min (Group C) (p = 0.72). Hospital stay was 3.82 ± 0.80 (Group A) vs 4.0 ± 1.09 (Group B) [p = 0.30] and 3.82 ± 0.80 (Group A) vs 2.7 ± 0.69 (Group C) [p < 0.0001]. Group B and Group C had one complication each. Conclusion: USG ACB irrespective of approach used remains the gold standard in providing consistent pain relief and thereby facilitating early discharge. However, increased operating room turnover time and repeated top-ups remain a disadvantage. Both the quantum of pain relief and the potential downsides remained the same irrespective of the surgical approach used and whether or not steroid was added to the cocktail used for infiltration. On the other hand, DACB provides a short lasting (24 h) adequate pain relief after TKR with similar low complication rates. The technique of DACB may have a potential for a wider use especially in centres where outpatient arthroplasties are performed, if newer longer acting anaesthetic/analgesic combinations are devised.

Augmented Intelligence in Joint Replacement Surgery: How can artificial intelligence (AI) bridge the gap between the man and the machine?

Robot-assisted arthroplasty is likely to grow exponentially in the years to come. While most surgeons recognize their superiority in refining alignment and improving component positioning accuracy, the universal adaptability of robots remains slow due to certain technological and behavioural gaps. Endoprosthesis robots currently suffer from increased reaction time, lack of natural adaptation to the surgeon's abilities, and unavailability and inapplicability in different surgical contexts. As humans and machines have to move forward into the next phase of their relationship, robots enabled with artificial intelligence (AI) may become more advanced and an alternative to overcome existing challenges like cost, training, and improve performance based on feedback provided by surgeons. Augmented intelligence is perhaps a more apt word than artificial, as it reflects more human-machine fusion and several areas are already proactively adopting the terminology. Arthroplasty robots can benefit from AI by using computer vision models, applying sensors, and integrating feedback and loop execution. All of this would help achieve a technical superiority to the surgeon alone. This brief perspective on how humans and machines are likely to benefit from the integration of AI outlines the technical side of this enablement.

Fibrodysplasia ossificans progressiva or Munchmeyer's disease: A rare case report.

Fibrodysplasia ossificans progressiva (FOP) is a rare autosomal dominant disease. It is characterized by widespread soft tissue ossification and congenital stigmata of the extremities, affecting all ethnic backgrounds. The worldwide reported prevalence is approximately 1/2,000,000. Based on history and clinicoradiological findings, FOP should be diagnosed as early as possible and noninvasively. The hallmark of diagnosis of FOP is bilateral great toe anomaly present from birth. Misdiagnosis may lead to inadvertent managements, such as manipulations, biopsies, and surgery. Surgery, till now, does not seem to have any role in the management of this condition and may lead to further trauma and disease progression. FOP may be precipitated due to trauma to muscle. In masticatory muscle, it mainly affects masseter muscle and presents with symptom of trismus. Herein, we present a case of FOP which presented to us with trismus after wooden thorn injury and immobility of the left leg. This article also emphasize on diagnosis, precaution, and treatment of disease.

Dignity at the Workplace: Evolution of the Construct and Development of Workplace Dignity Scale.

Concerns about workplace dignity (WPD) have long driven researchers and practitioners to explore ways of measuring it. It is essential for organizations to understand, how employees perceive the WPD for positive employee outcomes. The paper reviews literature, traces the development of WPD and finds the gap. The purpose of this paper is to evolve and operationalize the construct of 'WPD,' and develop and standardize a measure for it which will pave the way for future studies to empirically test the role of WPD on organizational outcomes such as employee engagement, retention and the like. This is perhaps the maiden attempt for conceptualization and operationalization of the construct of WPD, thus it contributes to the extant knowledge and has implications for academics and practitioners.

Oral myiasis in paralytic patients with special needs: A report of three cases.

Oral myiasis is invasion of the soft tissues of oral cavity by the parasitic larvae of the flies. This condition affects debilitated, mentally challenged individuals. These patients are not physically or mentally endowed to ward off flies or complain about worms burrowing their way into oral wounds. This study describes three cases of orofacial myiasis, removal of the live maggots, supportive treatment, and management of the cases with application of turpentine oil and also highlights oral health care in the patients with special needs.

A Prospective Randomized Clinical Trial Comparing 3D and Standard Miniplates in Treatment of Mandibular Symphysis and Parasymphysis Fractures.

PURPOSE: To compare the efficacy of the 3D miniplates to standard miniplates in the osteosynthesis of mandibular symphysis and parasymphysis fractures on the basis of clinical parameters and radiographic evaluation. PATIENTS AND METHODS: A prospective randomized clinical trial was conducted to treat consecutive mandibular symphysis and parasymphysis fractures. The patients were randomly divided into 2 groups. The patients underwent osteosynthesis in group A with 3D titanium miniplates and in group B with conventional titanium miniplates. The cause of trauma, the number of days from injury to surgery, average age and gender were all reviewed. The assessment of the patients was done at 1, 3, and 6 weeks and 3 months using the clinical parameters and radiographic evaluation. RESULTS: Eighty patients with isolated symphysis or parasymphysis fracture met the inclusion criteria. In our study, a statistically significant difference was not found in the clinical parameters such as pain, swelling, infection, paresthesia, hardware failure, and mobility between the fracture segments. Similarly Radiological evaluation did not show any statistically significant difference in reduction between the 2 groups. 3D plates are difficult to adapt and use sometimes, but operative time is less with them in treatment of symphysis and parasymphysis fractures. CONCLUSION: The use of 3D miniplates for symphysis and parasymphysis fracture fixation was efficacious enough to bear the masticatory load during osteosynthesis of the fracture. Although 3D miniplate system is difficult to adapt and difficult to use in cases of fractures involving the mental nerve, they provide the advantage of less operative time and less implant material in treatment of symphysis and parasymphysis fracture, with clinical results almost similar to those seen with conventional miniplate osteosynthesis.

Extra-articular ankylosis after zygoma fracture; A case report & review of literature.

Extra-articular temporomandibular bony ankylosis between the coronoid process and the zygoma is quite uncommon. In this paper we present a case of fusion of the left coronoid to the zygomatic bone in a 23-year-old male. This bony ankylosis was the result of five-week-old untreated zygomatic complex fracture. Ankylosis developed secondary to heterotopic bone formation following trauma. Zygomatico-coronoid ankylosis of the mandible is a complication which rarely occurs if fractures of the middle third of the facial skeleton have been adequately treated. The patient was treated by intraoral coronoidectomy. The rationale for clinical and radiographic diagnosis and treatment is reviewed.

Assessing the risk of lower extremity amputations using an administrative data-based foot risk index in elderly patients with diabetes.

BACKGROUND: The aims of the present study were to derive a foot risk index using administrative data similar to the International Working Group on the Diabetic Foot clinical risk classification scheme and to evaluate its association with the risk of initial lower extremity (through foot or above) amputation (ILEA). METHODS: Merged Veterans Health Administration administrative and Medicare inpatient and outpatient claims data for a historical cohort of Veterans Health Administration users with diabetes were analyzed. Individuals with diabetes, aged ≥67 years in 1999, were classified into seven foot risk categories (where 0=no foot risk conditions; and 6=severe foot conditions). The outcome variable was the incidence of an ILEA over the period 2000-2004. Foot risk was derived from 1998 to 1999, and other independent variables were derived from 1999. The associations between foot risk category and risk of ILEA were evaluated using Cox proportional hazards regression models. RESULTS: Of 255,534 individuals with diabetes, 54.8% had a documented foot condition in 1999 and 6869 (26.9 per 1000) had an ILEA over the period 2000-2004. We found increased rates of ILEAs as foot risk increased. Based on a Cox regression model containing all independent variables, the hazard ratios for risk of amputation increased progressively from 1.13 (95% CI 1.00-1.28) for the lowest foot risk category to 6.75 (95% CI 6.31-7.23) for the highest foot risk category, compared with individuals without defined foot conditions. CONCLUSIONS: An administrative data-derived foot risk category was associated with risk of ILEA in a risk level-dependent pattern.