Does previous total hip arthroplasty affect the outcomes of total knee arthroplasty? A one- and five-year follow-up registry study in a monocentric hospital.

BACKGROUND: Osteoarthritis in the lower extremities becomes more common as people age. In addition to conservative treatments, hip or knee arthroplasty is often needed. The aim of this study was to evaluate total knee arthroplasty (later TKA) in patients, comparing those who had previously undergone THA (later THA/TKA), with those who had not undergone such procedure. Pain, walking ability and functional capacity were assessed. METHODS: Patients who underwent primary TKA between 1987 and 2017 at a single orthopaedic hospital was included in this study. The patients participated in clinical preoperative and postoperative examinations by an orthopaedic surgeon after one- and five- years. The final study group consisted of 418 patients who had undergone 502 knee arthroplasties. Of these 502 TKA cases, 462 had not undergone previous THA and 40 had undergone previous THA. To evaluate the patients' physical function and walking ability, a structure form for knee arthroplasty based on the Hungerford score was used. The registry data from the Finnish National Institute of Health and Welfare was used. The data included TKA revision(s) and mortality events. RESULTS: At the baseline and after one- and five- years primary TKA, no statistical differences were found in the total Hungerford score between TKA patients and THA/TKA patients. In both groups, the total score increased per surgery year. However, when analysing the relationship between the year of operation and the total score, no statistical differences were found between the groups (TKA and THA/TKA) at five years (p = 0.61). The only statistical difference found between the groups was in walking distance points after one year; THA/TKA patients (mean 83 [SD 17]) could walk remarkably shorter distances than TKA patients (91 [14]) one year after arthroplasty (p < 0.001). CONCLUSIONS: In conclusion, walking distance improved more rapidly in TKA patients than in THA/TKA patients. However, patients who underwent more than one arthroplasty in their lower extremities managed their lives, activities, and pain almost as well as those who underwent only one knee arthroplasty.

Simultaneous bilateral versus unilateral total hip arthroplasty: Pain and physical function in a one- and five-year follow-up - retrospective patients record study.

BACKGROUND: Total hip arthroplasty (THA) decreases pain and improves function in patients with osteoarthritis. In some cases, both hips have been operated simultaneously. Our aim was to report patients' pain and physical function after one- and five-years post-operatively among patients who underwent unilateral THA and those who underwent bilateral THA at the same time in one orthopaedic hospital in Finland. METHODS: The study group consisted of 488 patients retrospectively selected patients from a single centre; 421 of them underwent unilateral THA and 67 underwent simultaneous bilateral THA. The patients had two clinical examinations one and five years postoperatively. Systematic data about pain and physical function were collected using the scaled Orton Hip Score (sOHS). Register data on revisions and mortality events were from the Finnish Institute of Health and Welfare. RESULTS: At the one-year follow-up, total sOHS was improved remarkably from the preoperative situation, both in the unilateral THA (age and gender adjusted mean improvement 42 points (95% CI: 40 to 44, p < 0.001) and in the bilateral THA groups (age and gender adjusted mean improvement 45 [95% CI: 41 to 49], p < 0.001), with no group differences after five-years of operation (age and gender adjusted p = 0.19). Total sOHS was statistically higher in the bilateral THA compared to the unilateral THA after one year (98 vs. 95, p < 0.001) and five years (97 vs. 95, p = 0.003) of operation. CONCLUSIONS: Patients in unilateral THA and bilateral THA groups had increased their physical function, and pain had decreased after one-year follow-up of the primary THA operation, and condition remained after five years of operation. At follow-ups, patients who underwent bilateral THA had slightly better physical function compared to patients who underwent unilateral THA at follow-up; however, this difference had no clinical relevance.

What do Finnish physiotherapists and physiotherapy students know about the neurophysiology of pain? The Finnish version of the revised Neurophysiology of Pain Questionnaire.

BACKGROUND: Understanding the concept of pain and its underlying biological mechanisms is an essential part of physiotherapists' professional knowledge. OBJECTIVES: The first aim of the study was to translate and cross-culturally adapt the revised Neurophysiology of Pain Questionnaire into Finnish (RNPQ-FI) and to evaluate its reliability (internal consistency and test-retest reliability) in a sample of Finnish physiotherapists and physiotherapy students. The second aim was to compare the knowledge of pain neurophysiology between these two groups. METHODS: Translation and cross-cultural adaptation followed the COSMIN Study Design checklist. Participants (202 physiotherapists and 97 physiotherapy students) completed an online survey containing RNPQ-FI. Internal consistency was assessed with Cronbach's alpha and test-retest reliability using Intraclass correlation coefficient (ICC3,1). RESULTS: Cronbach's alpha was 0.44 and ICC was 0.70 (p < .001). The mean percentage of correct responses was 61.4% for physiotherapists and 62.1% for students. Forty-seven percent of the physiotherapists and 35.1% of the students reported difficulties in understanding the items. A higher amount of pain education was associated with higher RNPQ-FI scores. CONCLUSIONS: The RNPQ-FI showed low internal consistency and moderate test-retest reliability among Finnish physiotherapists and physiotherapy students. Physiotherapists and students had equal amount of pain neurophysiology knowledge. Pain education is encouraged.

Longitudinal Associations of High-Volume and Vigorous-Intensity Exercise With Hip Fracture Risk in Men.

Maintenance of vigorous exercise habits from young to old age is considered protective against hip fractures, but data on fracture risk in lifelong vigorous exercisers are lacking. This longitudinal cohort study examined the hazard of hip fractures in 1844 male former athletes and 1216 population controls and in relation to exercise volume and intensity in later years. Incident hip fractures after age 50 years were identified from hospital discharge register from 1972 to 2015. Exercise and covariate information was obtained from questionnaires administered in 1985, 1995, 2001, and 2008. Analyses were conducted using extended proportional hazards regression model for time-dependent exposures and effects. During the mean ± SD follow-up of 21.6 ± 10.3 years, 62 (3.4%) athletes and 38 (3.1%) controls sustained a hip fracture. Adjusted hazard ratio (HR) indicated no statistically significant difference between athletes and controls (0.84; 95% confidence interval [CI], 0.55-1.29). In subgroup analyses, adjusted HRs for athletes with recent high (≥15 metabolic equivalent hours [MET-h]/week) and low (<15 MET-h/week) exercise volume were 0.83 (95% CI, 0.46-1.48) and 1.04 (95% CI, 0.57-1.87), respectively, compared with controls. The adjusted HR was not statistically significant between athletes with low-intensity exercise (<6 METs) and controls (1.08; 95% CI, 0.62-1.85). Athletes engaging in vigorous-intensity exercise (≥6 METs at least 75 minutes/week) had initially 77% lower hazard rate (adjusted HR 0.23; 95% CI, 0.06-0.86) than controls. However, the HR was time-dependent (adjusted HR 1.04; 95% CI, 1.01-1.07); by age 75 years the HRs for the athletes with vigorous-intensity exercise reached the level of the controls, but after 85 years the HRs for these athletes increased approximately 1.3-fold annually relative to the controls. In conclusion, these data suggest that continuation of vigorous-intensity exercise is associated with lower HR of hip fracture up to old age. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

The Current State of Remote Physiotherapy in Finland: Cross-sectional Web-Based Questionnaire Study.

BACKGROUND: The ongoing COVID-19 pandemic has required social, health, and rehabilitation organizations to implement remote physiotherapy (RP) as a part of physiotherapists' daily practice. RP may improve access to physiotherapy as it delivers physiotherapy services to rehabilitees through information and communications technology. Even if RP has already been introduced in this century, physiotherapists' opinion, amount of use, and form in daily practice have not been studied extensively. OBJECTIVE: This study aims to investigate physiotherapists' opinions of the current state of RP in Finland. METHODS: A quantitative, cross-sectional, web-based questionnaire was sent to working-aged members of the Finnish Association of Physiotherapists (n=5905) in March 2021 and to physiotherapists in a private physiotherapy organization (n=620) in May 2021. The questionnaire included questions on the suitability of RP in different diseases and the current state and implementation of RP in work among physiotherapists. RESULTS: Of the 6525 physiotherapists, a total of 9.9% (n=662; n=504, 76.1% female; mean age 46.1, SD 12 years) answered the questionnaire. The mean suitability "score" (0=not suitable at all to 10=fully suitable) of RP in different disease groups varied from 3.3 (neurological diseases) to 6.1 (lung diseases). Between early 2020 (ie, just before the COVID-19 pandemic) and spring 2021, the proportion of physiotherapists who used RP increased from 33.8% (21/62) to 75.4% (46/61; P<.001) in the public sector and from 19.7% (42/213) to 76.6% (163/213; P<.001) in the private sector. However, only 11.7% (32/274) of physiotherapists reported that they spent >20% of their practice time for RP in 2021. The real-time method was the most common RP method in both groups (public sector 46/66, 69.7% vs private sector 157/219, 71.7%; P=.47). The three most commonly used technical equipments were computers/tablets (229/290, 79%), smartphones (149/290, 51.4%), and phones (voice call 51/290, 17.6%). The proportion of physiotherapists who used computers/tablets in RP was higher in the private sector than in the public sector (183/221, 82.8% vs 46/68, 67.6%; P=.01). In contrast, a higher proportion of physiotherapists in the public sector than in the private sector used phones (18/68, 26.5% vs 33/221, 14.9%; P=.04). CONCLUSIONS: During the COVID-19 pandemic, physiotherapists increased their use of RP in their everyday practice, although practice time in RP was still low. When planning RP for rehabilitees, it should be considered that the suitability of RP in different diseases seems to vary in the opinion of physiotherapists. Furthermore, our results brought up important new information for developing social, health, and rehabilitation education for information and communications technologies.

Psychometric properties and factor structure of the Finnish version of the Health Care Providers' Pain and Impairment Relationship Scale.

BACKGROUND: Health care providers' beliefs influence the outcomes of low back pain patients care. OBJECTIVES: The aim of this study was to translate and cross-culturally adapt the Health Care Providers' Pain and Impairment Relationship Scale into Finnish (HC-PAIRS-FI) and to evaluate its psychometric properties and factor structure in a sample of Finnish physiotherapists and physiotherapy students. METHODS: The translation was performed using established guidelines. Participants answered an online survey consisting of HC-PAIRS-FI and the Finnish Tampa Scale of Kinesiophobia adapted for health care providers (TSK-HC-FI). Internal consistency was assessed using Cronbach's alpha. Intraclass correlation coefficient (ICC) was used to determine test-retest reliability. A second round of analysis, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) was performed as the fit indices of the initial CFA were not satisfactory. RESULTS: A sample of 202 physiotherapists and 97 physiotherapy students completed the survey. The second round of analysis EFA and CFA, conducted on a randomly split subsample, revealed and confirmed a three-factor, 11-item HC-PAIRS-FI scale with satisfactory model fit indices. Cronbach's alpha 0.79 and ICC = 0.82 (p < 0.001) indicate good internal consistency and test-retest reliability. The standard error of measurement was 2.12. HC-PAIRS-FI scores correlated moderately with TSK-HC-FI (r = 0.69, p < 0.001). CONCLUSIONS: The 11 items HC-PAIRS-FI appears to be a valid and reliable questionnaire to evaluate Finnish physiotherapists' and physiotherapy students' attitudes and beliefs about the relationship between chronic low back pain and impairment. Future studies are required to validate this scale for other health care providers.

Magnetic resonance imaging findings of the lumbar spine, back symptoms and physical function among male adult patients with Scheuermann's disease.

BACKGROUND: There are only a few studies on untreated Scheuermann's disease and magnetic resonance imaging (MRI) findings in the lumbar spine. The primary aim of this study was to clarify lumbar MRI findings in patients with Scheuermann's disease and to compare with subjects without diagnosed spine disease. METHODS: Twenty-two male adult Scheuermann's patients (mean age 64.7 years (Standard Deviation [SD] 6.4) and 26 males (mean age 59.7 years [SD 7.4]) from a national health survey were included in this study. From MR images, the dimensions of the vertebral bodies, intervertebral discs and the dural sac were measured. Spondylolisthesis, Modic changes (MC), high intensity zone values (HIZ), and Schmorl's nodes were registered from both groups as well as self-reported data concerning general health, quality of life, and back pain symptoms. RESULTS: Significantly more patients with Scheuermann's disease had at least one MC compared to the controls at the level L1/L2 (Odds Ratio [OR] 21.11, 95% Confidence Interval [95% CI] 2.31-192.96), at the level L3/L4 (OR 13.62, 95% CI 1.41-131.26), and at the level L5/S1 (OR 6.11, 95% CI 1.50-24.83). Patients had significantly more Schmorl's nodes compared to the controls (64% vs. 8%, p < 0.001). The area of the dura sac (L3/L4) was larger (mean 201 mm2 vs. 152 mm2, p = 0.017) in the patients compared to controls. At level L1/L2 patients had higher disc than controls (mean 7.9 mm vs. 6.8 mm, p = 0.038). After adjusting for age patients had more commonly constant back pain (OR 9.4, 95% CI 1.56-56.97), and difficulties in walking up one floor without resting (OR 9.8, 95% CI 1.01-95.34) than controls. CONCLUSIONS: Schmorl's nodes and Modic changes on lumbar MRI, back pain and physical function restrictions seem to be more prevalent among patients with Scheuermann's disease than in the general population.

Physiotherapy pain curricula in Finland: a faculty survey.

Background and aims Despite the recognition of pain as a global health problem and advancements achieved in what is known about effective pain management, pain education for undergraduate health care professionals remains insufficient. This study investigated the content of pain curricula and the time allocated to pain education on physiotherapy programs at bachelor's level at Universities of Applied Sciences (UASs) in Finland. Methods A web-based survey questionnaire was sent to the directors of the physiotherapy programs at all the Finnish UASs (n=15) where physiotherapy is taught at bachelor's level. The questionnaire consisted of 14 questions covering basic concepts and the science of pain, pain assessment, pain management, and the adequacy of pain curricula. Each UAS completed one questionnaire i.e. returned one official opinion. Results The response rate was 80% (n=12). The mean for the total number of contact hours of pain education was 74 (standard deviation 34.2). All UASs had integrated pain education. In addition to this 42% (n=5) of the UASs had a separate pain course. The UASs offering such a course over and above the integrated pain education had twice the amount of pain content education compared to those UASs that only had integrated pain education (mean 103 h vs. 53 h, p=0.0043). Most of the education was devoted to conditions where pain is commonly a feature, manual therapy, and electrical agents for pain control. The biopsychosocial model of pain, cognitive behavioral methods of pain management, physician management, and multidisciplinary management were the least covered topics. Five UASs (42%) payed attention to the International Association for the Study of Pain curriculum outline and only 33% (n=4) considered their pain education to be sufficient. Conclusions Our results indicate that more contact hours are devoted to pain education on the Finnish UASs' physiotherapy programs at bachelor's level, than has previously been reported in faculty surveys. A separate pain course is one way to ensure a sufficient amount of pain education. Overall, despite a sufficient time devoted to pain education, some essential pain contents were inadequately covered. Implications The study contributes information on how pain education can be organized on physiotherapy programs at undergraduate level. Besides a sufficient amount of pain education, which can be ensured by a separate pain course, attention should be paid to pain education content being up-to-date. This could help in estimating the different proportions of pain content needed in educational settings. Efforts should also be made at keeping integrated pain education well-coordinated and purposeful. There is a need for further research estimating the effectiveness of pain education according to the different ways in which it is organized. There is also a need to investigate whether more hours allocated to pain education results in better understanding and professional skills.

Diurnal Variations of Depression-Related Health Information Seeking: Case Study in Finland Using Google Trends Data.

BACKGROUND: Some of the temporal variations and clock-like rhythms that govern several different health-related behaviors can be traced in near real-time with the help of search engine data. This is especially useful when studying phenomena where little or no traditional data exist. One specific area where traditional data are incomplete is the study of diurnal mood variations, or daily changes in individuals' overall mood state in relation to depression-like symptoms. OBJECTIVE: The objective of this exploratory study was to analyze diurnal variations for interest in depression on the Web to discover hourly patterns of depression interest and help seeking. METHODS: Hourly query volume data for 6 depression-related queries in Finland were downloaded from Google Trends in March 2017. A continuous wavelet transform (CWT) was applied to the hourly data to focus on the diurnal variation. Longer term trends and noise were also eliminated from the data to extract the diurnal variation for each query term. An analysis of variance was conducted to determine the statistical differences between the distributions of each hour. Data were also trichotomized and analyzed in 3 time blocks to make comparisons between different time periods during the day. RESULTS: Search volumes for all depression-related query terms showed a unimodal regular pattern during the 24 hours of the day. All queries feature clear peaks during the nighttime hours around 11 PM to 4 AM and troughs between 5 AM and 10 PM. In the means of the CWT-reconstructed data, the differences in nighttime and daytime interest are evident, with a difference of 37.3 percentage points (pp) for the term "Depression," 33.5 pp for "Masennustesti," 30.6 pp for "Masennus," 12.8 pp for "Depression test," 12.0 pp for "Masennus testi," and 11.8 pp for "Masennus oireet." The trichotomization showed peaks in the first time block (00.00 AM-7.59 AM) for all 6 terms. The search volumes then decreased significantly during the second time block (8.00 AM-3.59 PM) for the terms "Masennus oireet" (P<.001), "Masennus" (P=.001), "Depression" (P=.005), and "Depression test" (P=.004). Higher search volumes for the terms "Masennus" (P=.14), "Masennustesti" (P=.07), and "Depression test" (P=.10) were present between the second and third time blocks. CONCLUSIONS: Help seeking for depression has clear diurnal patterns, with significant rise in depression-related query volumes toward the evening and night. Thus, search engine query data support the notion of the evening-worse pattern in diurnal mood variation. Information on the timely nature of depression-related interest on an hourly level could improve the chances for early intervention, which is beneficial for positive health outcomes.

Progression of untreated mild thoracic Scheuermann's kyphosis - Radiographic and functional assessment after mean follow-up of 46 years.

BACKGROUND: There is no data available on the radiographic development of the Scheuermann's deformity. Our purpose was to investigate radiographic deformity progression and the relation between kyphosis progression and clinical outcome in patients with untreated Scheuermann's kyphosis. METHODS: Thoracic kyphosis (Th4-Th12) was measured from standing lateral radiographs in 19 patients at baseline and after mean 46-year follow-up. Mean age at baseline was 19.2 and at follow-up 64.7 years. At follow-up, height, weight, hand grip strength, and hamstring tightness were measured, and sit-to-stand and walking tests were performed. Additionally general health and quality of life questionnaires were administered. RESULTS: The mean thoracic kyphosis increased from 46° (range 25°-78°) at baseline to 60° (34°-82°) (p < 0.001) at follow-up. Mean of the vertebrae wedge increased from 8.8° to 9.9° (p = 0.046). There was no correlation between extent of kyphosis progression and function at follow-up. CONCLUSIONS: Among patients with Scheuermann's disease the degree of radiographic deformity progressed slightly during long-term follow-up. Progression did not predict symptoms.

Reliability of Measuring Lower-Limb-Muscle Electromyography Activity Ratio in Activities of Daily Living With Electrodes Embedded in the Clothing.

CONTEXT: Using technical clothes with electrodes embedded in the clothing makes it possible to record the electrical activity produced by the activity of the skeletal muscles in activities of daily living. OBJECTIVE: To investigate the reliability of measuring lower-limb left-right electromyography (EMG) activity ratio with smart shorts during stair descent, stair ascent, and repeated unloaded squats among healthy working-aged subjects. METHODS: Seventeen females (mean age 25.5 y), and 17 males (mean age 29.9 y) participated in this test-retest protocol carried out twice on the same day. RESULTS: Intraclass correlation coefficient (ICC) varied from .65 to .80 in the different activities. Mean difference and limits of agreement (LOA) between the repeated measurements were for descending stairs ­0.8%, LOA ­6.2% to 4.7%; for ascending stairs ­0.9%, ­6.5% to 4.7%; and for squats ­0.2%, ­5.4% to 4.9%. The coefficient of repeatability for descending stairs was 5.6%, for ascending stairs 5.7%, and for squats 5.3%. CONCLUSIONS: Our study among healthy subjects showed that the left-right EMG activity ratio in activities of daily living can be reliably measured with smart shorts. In future research, the feasibility of technical clothes as a follow-up method in rehabilitation should be investigated in greater detail.

[Update on Current Care Guideline: Physical activity and exercise training for adults in sickness and in health]. / KÄYPÄ HOITO -SUOSITUS (Päivitystiivistelmä). Liikunta.

The purpose of the guideline is to promote physical activity in the prevention, treatment and rehabilitation of diseases. Physical activity plays a key role in the management of several chronic noncommunicable diseases. In this guideline, the following diseases are discussed: endocrinological, cardiovascular, musculoskeletal and respiratory diseases, as well as depression and cancer. In addition, physical activity during pregnancy and in senior citizens is reviewed. Exercise counseling should be included as part of disease management and lifestyle guidance.

All-cause and disease-specific mortality among male, former elite athletes: an average 50-year follow-up.

AIM: To investigate life expectancy and mortality among former elite athletes and controls. METHODS: HR analysis of cause-specific deaths sourced from the national death registry for former Finnish male endurance, team and power sports athletes (N=2363) and controls (N=1657). The median follow-up time was 50 years. RESULTS: Median life expectancy was higher in the endurance (79.1 years, 95% CI 76.6 to 80.6) and team (78.8, 78.1 to 79.8) sports athletes than in controls (72.9, 71.8 to 74.3). Compared to controls, risk for total mortality adjusted for socioeconomic status and birth cohort was lower in the endurance ((HR 0.70, 95% CI 0.61 to 0.79)) and team (0.80, 0.72 to 0.89) sports athletes, and slightly lower in the power sports athletes (0.93, 0.85 to 1.03). HR for ischaemic heart disease mortality was lower in the endurance (0.68, 0.54 to 0.86) and team sports (0.73, 0.60 to 0.89) athletes. HR for stroke mortality was 0.52 (0.33 to 0.83) in the endurance and 0.59 (0.40 to 0.88) in the team sports athletes. Compared to controls, the risk for smoking-related cancer mortality was lower in the endurance (HR 0.20, 0.08 to 0.47) and power sports (0.40, 0.25 to 0.66) athletes. For dementia mortality, the power sports athletes, particularly boxers, had increased risk (HR 4.20, 2.30 to 7.81). CONCLUSIONS: Elite athletes have 5-6 years additional life expectancy when compared to men who were healthy as young adults. Lower mortality for cardiovascular disease was in part due to lower rates of smoking, as tobacco-related cancer mortality was especially low.

Reproducibility of regional DEXA examinations of abdominal fat and lean tissue.

OBJECTIVE: The aim of this study was to develop and test the validity of a new repeatable method to delimit abdominal areas for follow-up of fat mass (FM) and lean tissue mass (LM) in DEXA examinations. METHODS: 37 male volunteers underwent two DEXA examinations. Total body FM and LM measurements and corresponding abdominal measurements in a carefully defined region were calculated from the first scan. After repositioning of the subjects and a second scan, the delimited region was copied and the abdominal tissues re-calculated. RESULTS: The mean LM of the abdominal area was 2.804 kg (SD 0.556), and the mean FM was 1.026 kg (SD 0.537). The intra-class correlation coefficient for the repeated abdominal LM, FM, and LM/FM ratio measurements was 0.99. The mean difference (bias) for the repeated abdominal LM measurements was -13 g (95% confidence interval (CI) -193.0 to 166.8), and for the repeated abdominal FM measurements it was -35 g (95% CI -178.9 to 108.5). CONCLUSIONS: The results indicate that regional DEXA is a sensitive method with excellent reproducibility in the measurements of the abdominal fat and lean tissues. The method may serve as a useful tool for evaluation and follow-up of various dietary and training programmes.

The natural course of serratus palsy at 2 to 31 years.

BACKGROUND: The natural course of isolated serratus palsy is obscure. Residual winging, muscle weakness, and fatigability reportedly occur in half of the patients. Because we believed isolated serratus palsy might have a better natural course than earlier thought, we evaluated our long-term records. QUESTIONS/PURPOSES: We determined duration of symptoms and whether scapular winging, ROM, and pain recover or persist after isolated serratus palsy without any particular treatment. METHODS: We retrospectively reviewed 37 patients with isolated serratus palsy treated by observation without any brace or surgery. We determined the degree of scapular winging, ROM, and pain. The minimum followup was 2 years (median, 18 years; range, 2-31 years) after onset of symptoms. RESULTS: The duration of scapular winging averaged 16 months (range, 2-30 months). Winging of the scapula disappeared in 29 (78%) of the patients, flexion recovered to normal in 30 (82%) and abduction in 33 (89%). Of the 37 patients, 11 (30%) were pain-free; pain at rest was absent from 17 (46%), occurred seldom in seven (19%), and was temporary in 12 (32%); one patient had pain at rest continuously. None of the patients desired other treatment such as a brace or surgery. CONCLUSIONS: The natural course of isolated serratus palsy in clinically mild cases is not as favorable as we had expected. Symptoms mostly recover in 2 years, but at least one-fourth of the patients will have long-lasting symptoms, especially pain. We could identify no factors to allow us to appropriately choose patients with serratus palsy for observation only.

Knee arthroscopy and exercise versus exercise only for chronic patellofemoral pain syndrome: 5-year follow-up.

OBJECTIVE: To study the long-term outcome of arthroscopy in patients with chronic patellofemoral pain syndrome (PFPS), the authors conducted a randomised controlled trial. The authors also investigated factors predicting the outcome in patients with PFPS. METHODS: Fifty-six patients with PFPS were randomised into two groups: an arthroscopy group (N=28), treated with knee arthroscopy and an 8-week home exercise programme, and a control group (N=28), treated with a similar 8-week home exercise programme only. The primary outcome was the Kujala score on pain and function at 5-year. Secondary outcomes were visual analogue scales (VASs) to assess activity-related symptoms. RESULTS: According to the Kujala score, both groups showed a marked improvement during the 5-year follow-up: a mean improvement of 14.7 (95% CI 9.9 to 19.4) in the arthroscopy group and 13.5 (95% CI 8.1 to 18.8) in the controls. No differences between the groups in mean improvement in the Kujala score (group difference 1.2 (95% CI -8.4 to 6.1)) or in the VAS scores were found. None of the investigated factors predicted the long-term outcome, but in most of the cases the treatment result immediately after the exercise programme remained similar also after the 5-year follow-up. CONCLUSION: Our RCT, being the first of its kind, indicates that the 5-year outcome in most of the patients with chronic PFPS treated with knee arthroscopy and home exercise programme or with the home exercise programme only is equally good in both groups. Some of the patients in both groups do have long-term symptoms.

The natural history of idiopathic frozen shoulder: a 2- to 27-year followup study.

BACKGROUND: The natural history of spontaneous idiopathic frozen shoulder is controversial. Many studies claim that complete resolution is not inevitable. Based on the 40-year clinical experience of the senior author, we believed most patients with idiopathic frozen shoulder might have a higher rate of resolution than earlier thought. QUESTIONS/PURPOSES: We determined the length of symptoms, whether spontaneous frozen shoulder recovered without any treatment, and whether restored ROM, pain relief, and function persisted over the long term. METHODS: We retrospectively reviewed 83 patients treated for frozen shoulder (84 shoulders; 56 women) 2 to 27 years (mean, 9 years) after initial consultation. The mean age at onset of symptoms was 53 years. Fifty-one of the 83 patients (52 shoulders) were treated with observation or benign neglect only (untreated group), and 32 had received some kind of nonoperative treatment before the first consultation with the senior author (nonoperative group). We also evaluated all 20 patients (22 shoulders; 13 women) with spontaneous frozen shoulder who underwent manipulation under anesthesia during the same time (manipulation group). The mean age of these patients was 49 years. The minimum followup was 2 years (mean, 14 years; range, 2-24 years). We determined duration of the disease, pain levels, ROM, and Constant-Murley scores. RESULTS: The duration of the disease averaged 15 months (range, 4-36 months) in the untreated group, and 20 months (range, 6-60 months) in the nonoperative group. At last followup the ROM had improved to the contralateral level in 94% in the untreated group, in 91% in the nonoperative group, and in 91% in the manipulation group. Fifty-one percent of patients in the untreated group, 44% in the nonoperative group, and 30% in the manipulation group were totally pain free at rest, during the night, and with exertion. Pain at rest was less than 3 on the VAS in 94% of patients in the untreated group, 91% in the nonoperative group, and 90% of the manipulation group. The Constant-Murley scores averaged 83 (86%) in the untreated group, 81 (77%) in the nonoperative group, and 82 (71%) in the manipulation group, reaching the normal age- and gender-related Constant-Murley score. CONCLUSIONS: We found 94% of patients with spontaneous frozen shoulder recovered to normal levels of function and motion without treatment. LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Changing from analog to digital images: does it affect the accuracy of alignment measurements of the lower extremity?

BACKGROUND AND PURPOSE: Medical imaging has changed from analog films to digital media. We examined and compared the accuracy of orthopedic measurements using different media. METHODS: Before knee arthroplasty, full-length standing radiographs of 52 legs were obtained. The mechanical axis (MA), tibio-femoral angle (TFA), and femur angle (FA) were measured and analyzed twice, by 2 radiologists, using (1) true-size films, (2) short films, (3) a digital high-resolution workstation, and (4) a web-based personal computer. The agreement between the 4 media was evaluated using the Bland-Altman method (limits of agreement) using the true-size films as a reference standard. RESULTS: The mean differences in measurements between the traditional true-size films and the 3 other methods were small: for MA -0.20 to 0.07 degrees, and for TFA -0.02 to 0.18 degrees. Also, the limits of agreement between the traditional true-size films and the three other methods were small. INTERPRETATION: The agreement of the alignment measurements across the 4 different media was good. Orthopedic angles can be measured as accurately from analog films as from digital screens, regardless of film or monitor size.

Results of total knee replacement with a cruciate-retaining model for severe valgus deformity--a study of 48 patients followed for an average of 9 years.

The objectives of the present study were to find out the results and the factors affecting survival after primary knee arthroplasty with a cruciate-retaining prosthesis in severe valgus deformity. Forty-eight patients (52 knees) participated in the current follow-up study. All patients were followed at least 5 years or to first revision. Mean follow-up time was 9 years (range, 1 to 17 years).The Kaplan-Meier analysis revealed 79% (95% CI 68% to 91%) survival rate with revision for any reason and 81% (95% CI 70% to 93%) survival rate with revision for instability as an endpoint at 10 years. Preoperatively TFA was 23° (range, 15°-51°) in valgus and 7° (range, 21° valgus-4° varus) in valgus postoperatively. Of the 14 re-operated patients, eight were revised because of progressive postoperative medial collateral ligament instability. All re-operations were performed during the first 4 years of the follow-up. The mean TFA was 15.5° valgus postoperatively for those eight and the odds ratio for a revision was 2 (95% CI 1-3, p = 0.025) when compared to the rest of the study population. The residual valgus deformity increases the risk of re-operation and it should be avoided. If proper soft-tissue balance cannot be achieved or there is no functional medial collateral ligament present more constrained implants should be used. In selected cases where both bony correction and ligament balancing have properly been achieved the use of a cruciate-retaining type of prosthesis is justified.