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1.
Knee Surg Sports Traumatol Arthrosc ; 28(10): 3279-3286, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31965215

RESUMEN

PURPOSE: Lower limb malalignment is a strong predictor of progression in knee osteoarthritis. The purpose of this study is to identify the individual alignment variables that predict progression in early to moderate osteoarthritis of the knee. METHOD: A longitudinal cohort study using data from the Osteoarthritis Initiative. In total, 955 individuals (1329 knees) with early to moderate osteoarthritis (Kellgren-Lawrence grade 1, 2 or 3) were identified. All subjects had full-limb radiographs analysed using the Osteotomy module within Medicad® Classic (Hectec GMBH) to give a series of individual alignment variables relevant to the coronal alignment of the lower limb. Logistic regression models, with generalised estimating equations were used to identify which of these individual alignment variables predict symptom worsening (WOMAC score > 9 points) and or structural progression (joint space narrowing progression in the medial compartment > 0.7mm) over 24 months. RESULTS: Individual alignment variable were associated with both valgus and varus alignment (mechanical Lateral Distal Femoral Angle, Medial Proximal Tibial Angle and mechanical Lateral Distal Tibial Angle). Only the Medial Proximal Tibial Angle was significantly associated with structural progression and none of the variables was associated with symptom progression. The odds of joint space narrowing progression in the medial compartment occurring at 24 months increased by 21% for every one degree decrease (more varus) in Medial Proximal Tibial Angle (p < 0.001) CONCLUSIONS: Our results suggest that the risk of structural progression in the medial compartment is associated with greater varus alignment of the proximal tibia. LEVEL OF EVIDENCE: Level III, retrospective cohort study.


Asunto(s)
Extremidad Inferior/fisiopatología , Osteoartritis de la Rodilla/fisiopatología , Tibia/fisiopatología , Anciano , Progresión de la Enfermedad , Femenino , Fémur/fisiopatología , Humanos , Articulación de la Rodilla/fisiopatología , Articulación de la Rodilla/cirugía , Estudios Longitudinales , Extremidad Inferior/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/diagnóstico por imagen , Osteoartritis de la Rodilla/cirugía , Osteotomía , Radiografía , Estudios Retrospectivos , Tibia/diagnóstico por imagen , Tibia/cirugía
2.
Knee Surg Sports Traumatol Arthrosc ; 26(4): 1152-1157, 2018 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-28523339

RESUMEN

PURPOSE: Longitudinal cohort studies of knee OA aetiology use MRI to assess meniscal extrusion within the same knee at sequential time points. A validated method of assessment is required to ensure that extrusion is measured at the same location within the knee at each time point. Absolute perpendicular extrusion from the tibial edge can be assessed using the reference standard of segmentation of the tibia and medial meniscus. This is labour intensive and unsuitable for large cohorts. Two methods are commonly used as proxy measurements. Firstly, the apex of the medial tibial spine is used to identify a reproducible MRI coronal slice, from which extrusion is measured. Secondly, the coronal MRI slice of the knee demonstrating the greatest extrusion is used. The purpose of this study was to validate these two methods against the reference standard and to determine the most appropriate method to use in longitudinal cohort studies. We hypothesised that there is no difference in absolute meniscal extrusion measurements between methods. METHODS: Twenty high-resolution knee MRI scans were obtained in asymptomatic subjects. The tibia and medial meniscus were manually segmented. A custom MATLAB program was used to determine the difference in medial meniscal extrusion of the knee using the reference standard compared to the two other methods. RESULTS: Assessing extrusion using the single coronal MRI slice demonstrating the greatest extrusion overestimates the true extrusion of the medial meniscus. It incorrectly places the greatest meniscal extrusion at the anterior part of the tibia. Assessing extrusion using a consistent anatomical landmark, such as the medial tibial spine, most reliably corresponds to the reference of segmentation and measurement of true perpendicular extrusion from the tibial edge. Clinicians and researchers should consider this when assessing meniscal extrusion in the knee, and how it changes over time. CONCLUSION: This study suggests measuring meniscal extrusion on the coronal MRI slice corresponding to the apex of the medial tibial spine as this correlates most closely with the true perpendicular extrusion measurements obtained from manually segmented models. LEVEL OF EVIDENCE: Diagnostic, Level I.


Asunto(s)
Imagen por Resonancia Magnética/métodos , Meniscos Tibiales/diagnóstico por imagen , Osteoartritis de la Rodilla/diagnóstico por imagen , Adulto , Puntos Anatómicos de Referencia/diagnóstico por imagen , Humanos , Masculino , Meniscos Tibiales/patología , Osteoartritis de la Rodilla/patología
3.
Eur J Orthop Surg Traumatol ; 24(3): 323-9, 2014 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-23443744

RESUMEN

OBJECTIVES: To compare clinical outcomes between titanium elastic nails (TENS), open reduction internal fixation (ORIF) and non-operative treatment options at mean 30 months in Allman type 1 fractures of the clavicle. DESIGN: Retrospective case matched. SETTING: Tertiary Trauma Centre, UK. PATIENTS: Treatment method was based on surgeon choice although there was no difference between groups in terms of age or gender. Those treated non-operatively tended to have a less severe fracture pattern. There were 25 patients treated with TENS, 24 with ORIF and 41 treated conservatively. Main outcome measurements are qDASH questionnaire, patient satisfaction question and clinical complication rate. RESULTS: Patients managed with TENS had significantly better clinical outcomes than both plate fixation and non-operatively managed groups. CONCLUSIONS: This study supports the use of TENS fixation of middle third clavicle fractures in significantly displaced Allman type 1 injuries.


Asunto(s)
Clavos Ortopédicos , Clavícula/lesiones , Fijación Interna de Fracturas , Fracturas Óseas/terapia , Titanio , Adulto , Placas Óseas , Estudios de Casos y Controles , Clavícula/diagnóstico por imagen , Femenino , Estudios de Seguimiento , Fracturas Óseas/clasificación , Fracturas Óseas/complicaciones , Humanos , Masculino , Satisfacción del Paciente , Radiografía , Estudios Retrospectivos , Encuestas y Cuestionarios , Resultado del Tratamiento , Adulto Joven
4.
Bone Joint J ; 101-B(12): 1476-1478, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31786999

RESUMEN

This annotation briefly reviews the history of artificial intelligence and machine learning in health care and orthopaedics, and considers the role it will have in the future, particularly with reference to statistical analyses involving large datasets. Cite this article: Bone Joint J 2019;101-B:1476-1478.


Asunto(s)
Inteligencia Artificial/historia , Reglas de Decisión Clínica , Procedimientos Ortopédicos/historia , Inteligencia Artificial/tendencias , Interpretación Estadística de Datos , Predicción , Historia del Siglo XX , Humanos , Aprendizaje Automático/historia , Aprendizaje Automático/tendencias , Procedimientos Ortopédicos/tendencias , Pronóstico , Reino Unido , Estados Unidos
5.
Knee ; 24(6): 1383-1391, 2017 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-28974401

RESUMEN

BACKGROUND: Since 2011, the knee service at the Nuffield Orthopaedic Centre has been offering a neutralising medial opening wedge high tibial osteotomy (HTO) to a specific group of patients with genu varum and early knee osteoarthritis. An observation was made concerning this group of patients and the presence of CAM deformity at the hip. The aim of this study is to establish whether or not any association exists between the OA phenotype shared by our HTO group and the incidence of CAM deformity at the hip. METHODS: A cross-sectional study was designed to estimate the prevalence of CAM-type lesions across different groups of individuals. Our HTO group (n=30) was compared to a pre-arthroplasty group (n=20) and control group (n=20). A total of 70 subjects were identified across the different groups all of whom had long-leg radiographs (LLRs) available for analysis. LLRs were analysed using an in house developed Matlab®-based (Matlab R2009b; MathWorks) software package for hip measurements and MediCAD® (Hectec GmbH, Germany) for lower limb alignment measurements. RESULTS: The HTO group had a significantly higher prevalence of CAM lesions (57%) than both the pre-arthroplasty (40%) and control (30%) groups. This difference was maintained when results were adjusted for potential confounding factors (age, gender and laterality). Across the groups, individuals with tibia vara were more likely to have CAM-deformity of the hip (p=0.021). CONCLUSION: Patients with symptomatic early knee OA and varus deformity of the knee have a high prevalence of CAM deformity in the hip.


Asunto(s)
Pinzamiento Femoroacetabular/diagnóstico por imagen , Genu Varum/complicaciones , Osteoartritis de la Rodilla/complicaciones , Anciano , Estudios de Casos y Controles , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad
6.
Maturitas ; 78(4): 258-62, 2014 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-24974279

RESUMEN

Low back pain is a common symptom in the older person. Whilst the majority of cases are thought to be mechanical or idiopathic and benign in nature, its multiple potential causes and concerns regarding missed diagnosis of less common but more serious underlying pathological diagnoses mean many physicians find the assessment, investigation and treatment of chronic low back pain in older adults challenging. This narrative review describes the classification of low back pain in older adults, discusses both mechanical and sinister causes of pain, highlights the appropriate use of medical imaging and provides an overview of surgical and non-surgical management of these patients.


Asunto(s)
Manejo de la Enfermedad , Dolor de la Región Lumbar , Anciano , Dolor de Espalda , Diagnóstico Diferencial , Humanos , Dolor de la Región Lumbar/diagnóstico , Dolor de la Región Lumbar/etiología , Dolor de la Región Lumbar/terapia
7.
BMJ Open ; 3(8): e003365, 2013 Aug 21.
Artículo en Inglés | MEDLINE | ID: mdl-23965934

RESUMEN

OBJECTIVES: To assess the validity of the Oxford Knee Score (OKS) for use in patients undergoing non-operative management for their knee osteoarthritis (OA) within the National Health Service (NHS). DESIGN: Observational cohort study. SETTING: Single orthopaedic centre in England. PARTICIPANTS: 134 patients undergoing non-operative management for knee OA. MAIN OUTCOME MEASURES: OKS, the Intermittent and Constant Osteoarthritis Pain (ICOAP), the Knee Injury and Osteoarthritis Score-Physical Function Short Form (KOOS-PS), at baseline and 3-month follow-up, transition item of change at 3 months. RESULTS: The OKS summary scale and its pain and functional component subscales demonstrated good test-retest reliability (intraclass correlation coefficient 0.93, 0.91 and 0.92, respectively) and measurement precision which, allows its use with groups of patients with knee OA (research/audit) and with individuals (clinical practice). The results in this study were consistent with a priori set hypotheses about the relationship of OKS with other validated measures (KOOS-PS, ICOAP and short form 12 (SF-12)), which provided evidence of its construct validity and responsiveness. Confirmatory factor analysis confirmed the structural validity of OKS. However, there was a lack of satisfactory evidence of structural validity for ICOAP and KOOS. The minimum detectable change (MDC90) was ±6 for OKS (±16 for the Pain Component Score (OKS-PCS) and ±15 for the Functional Component Score (OKS-FCS)). Minimal important changes were ≈7 for OKS (≈17 for OKS-PCS and ≈11 for OKS-FCS) and minimal important differences were ≈6 for OKS (≈14 for OKS-PCS and ≈10 for OKS-FCS). These values were also calculated for ICOAP and KOOS-PS. CONCLUSIONS: The OKS summary scale, together with its pain and functional component subscales, has excellent measurement properties when used with patients with knee OA undergoing non-operative treatment and is superior to ICOAP and KOOS-PS for this purpose. This evidence provides support for the validity of the use of OKS when used across the spectrum of knee OA disease severity, both in research and clinical practice.

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