Coping with long-term musculoskeletal pain and its consequences: is gender a factor?

We did a descriptive study of 121 patients (71 women and 50 men) to explore the role of gender in coping with long-term intractable pain of the neck, shoulder and back and to determine the consequences of pain. Questionnaires used to assess the dependent variables were the Coping Strategy Questionnaire (CSQ) and the Multidimensional Pain Inventory (MPI). Distinctions were found between men and women. In particular, the coping strategies used by women were those which in previous research had been found to be associated with dysfunction and poor outcome in terms of rehabilitation. Moreover, considering the consequences of pain on daily living, a more complex pattern of related factors was found in women rather than men. Given the high proportion of working women in Sweden with long-term musculoskeletal pain and considering recent observations in controlled studies showing that the benefits of cognitive behaviourally based treatments are confined to women, our findings suggest the need to tailor rehabilitative strategies differently for men and women and point to a research agenda which pays more attention to the distinctive challenges of women in the workplace when they are affected by chronic ailments.

Occupation and osteoarthrosis of the hip and knee: a register-based cohort study.

A register-based cohort study was performed to investigate if men and women in certain occupations with high physical workload had increased risks of developing severe symptomatic osteoarthrosis of the hip and knee, resulting in hospital care. The study population consisted of 250,217 people from the 1980 census, in blue-collar occupations, who had reported the same occupation in the 1960 and 1970 censuses. The study population was followed for hospital care for osteoarthrosis of the hip and knee during 1981-1983 by linkage to the Swedish Hospital Discharge Register. Different blue-collar occupations were classified as high or low with regard to exposure to forces acting on the hip and knee and the frequencies of the outcomes were compared. Male farmers, construction workers, firefighters and some food processing workers had an excess risk of hospitalization due to osteoarthrosis of the hip. Male farmers, construction workers and firefighters also had increased risks of osteoarthrosis of the knee. Female mail carriers had an excess risk of osteoarthrosis of the hip, and female cleaners, of osteoarthrosis of the knee. The findings support the hypothesis that heavy physical work load contributes to osteoarthrosis of the hip and knee.

In vitro biocompatibility testing of polymers for orthopaedic implants using cultured fibroblasts and osteoblasts.

The biocompatibility of two polymers for potential use as orthopaedic implant materials in an isoelastic hip prosthesis was investigated. The interactions of polyetheretherketone (PEEK) and epoxy resin polymers (with and without carbon fibre reinforcement) with both fibroblasts and osteoblasts were tested using cell protein, intracellular reduced glutathione (GSH), leakage of lactate dehydrogenase and the MTT assay as indices of cellular cytotoxicity. The epoxy resin polymer was slightly cytotoxic to and inhibited the growth rate of fibroblasts (as assessed by total cell protein), and depleted GSH in both cell types. In contrast, the PEEK material did not display overt signs of cytotoxicity and, in fact, increased osteoblast cell protein content. This suggests that, of these two materials, PEEK would be the one of choice for development of an isoelastic implant and, in view of its stimulatory effect on osteoblast protein content, it may encourage ingrowth of bone around the prosthesis and thus minimize joint loosening.

Sports and osteoarthrosis of the hip. An epidemiologic study.

To investigate if participation in sports increases the risk of developing osteoarthrosis of the hip, we did a case-control study on the sports activities of 233 men (up to age 49) who were recent recipients of a prosthesis because of severe idiopathic osteoarthrosis of the hip and 302 men randomly selected from the general population. Assessments of sports, job history, and health status were made by an interview. Men with high exposure to sports of all kinds combined (in hours) had a relative risk to develop osteoarthrosis of the hip of 4.5 compared to those with low exposure. Track and field sports and racket sports seemed to be the most hazardous to the hip joint. Men who had been exposed to high physical loads both from their occupation and sports had a relative risk of 8.5 to develop osteoarthrosis of the hip compared to those with low physical load in both activities. Potential confounding factors, such as age, body mass index, and smoking, were considered. Long-term exposure to sports among men seems to be a risk factor for developing severe osteoarthrosis of the hip; this is increased when combined with heavy load from occupation.

Shoulder tendinitis and its relation to heavy manual work and exposure to vibration.

Three categories of construction industry workers (54 bricklayers, 55 rockblasters, and 98 foremen) were compared in a cross-sectional study. In a structured interview they reported exposure to loads lifted, vibration, and years of manual work. They were also subjected to a clinical investigation including medical history and a detailed shoulder examination. Among the rockblasters 33% had signs of tendinitis in the left and 40% in the right shoulder. Among the bricklayers and foremen 8-17% had signs of shoulder tendinitis. In a multiple logistic regression being a rockblaster compared with being a foreman showed an odds ratio (OR) of 3.33 for left-sided and 1.71 for right-sided shoulder tendinitis. Vibration exposure yielded an OR of 1.84 and 1.66 for the left and right sides, respectively. Vibration exposure or work as a rockblaster seemed to be risk indicators for tendinitis of the shoulders.

Coxarthrosis and physical work load.

A case-referent study was performed on the possible relationship between physical work loads and an increased risk of developing coxarthrosis. The cases were 239 male recipients of a hip prosthesis as a result of severe idiopathic coxarthrosis; the referents were 302 men randomly selected from the general population. The work load was assessed through an interview and a self-administered questionnaire on the men's specific work periods. Men highly exposed to dynamic or static work loads had an increased relative risk of 2.42 (95% confidence interval 1.45-4.04) for developing coxarthrosis when compared with men with low exposure. Men with high exposure to heavy lifting between the ages of 30 and 49 years had the highest relative risk, 3.31 (95% confidence interval 1.97-5.57). Long-time exposure to physical work loads seems to be a risk factor for severe coxarthrosis among men.

Intertrochanteric osteotomy for osteoarthritis of the hip. A radiological assessment of non-compressive and compressive methods.

A radiological review of two groups of intertrochanteric osteotomies of the femur for primary osteoarthritis of the hip has been made. Each group oroginally consisted of forty-one hips. In one group a Wainwright straight V-spline without compression had been used for fixation, and in the other group an AO angled plate with compression. The time for bony union was equal in the two groups but the incidence of non-union was lower in the AO group. Regression of cysts and of bone sclerosis was more frequent in the Wainwright group, possible as a consequence of the greater medial displacement and varus angulation.

[Regeneration of synovial tissue in rheumatoid arthritis following synovectomy (author's transl)]. / Die Kapselregeneration bei der rheumatoiden Arthritis nach Synovektomie.

A study was carried out on 83 knee joints which had been subjected to synovectomy for rheumatoid arthritis. The morphological changes in the synovial tissue were divided into two types, Type I or hypertrophic and Type II or hypotrophic. Type I (hypertrophic) exhibited oedema, hypervascularization, fibrinous layers, large amounts of villi and granulationlike tissue, lymphocytes and plasma cells. Type II (hypotrophic) contained all the above elements, but to a much lesser degree, and fibrosis was the dominant feature. Regenerated synovial tissue was removed one to three years after the original synovectomy by arthrotomy or biopsy in 26 patients who were symptom-free. The tissue was thinner and hardly any villi were seen. The typical inflammatory elements were seen, but were not as pronounced as in the original tissue, irrespective of type. A heavy fibrosis was most frequently seen, but apart from this the regenerated tissue greatly resembled the original.