Knee osteoarthritis has doubled in prevalence since the mid-20th century.

Knee osteoarthritis (OA) is believed to be highly prevalent today because of recent increases in life expectancy and body mass index (BMI), but this assumption has not been tested using long-term historical or evolutionary data. We analyzed long-term trends in knee OA prevalence in the United States using cadaver-derived skeletons of people aged ≥50 y whose BMI at death was documented and who lived during the early industrial era (1800s to early 1900s; n = 1,581) and the modern postindustrial era (late 1900s to early 2000s; n = 819). Knee OA among individuals estimated to be ≥50 y old was also assessed in archeologically derived skeletons of prehistoric hunter-gatherers and early farmers (6000-300 B.P.; n = 176). OA was diagnosed based on the presence of eburnation (polish from bone-on-bone contact). Overall, knee OA prevalence was found to be 16% among the postindustrial sample but only 6% and 8% among the early industrial and prehistoric samples, respectively. After controlling for age, BMI, and other variables, knee OA prevalence was 2.1-fold higher (95% confidence interval, 1.5-3.1) in the postindustrial sample than in the early industrial sample. Our results indicate that increases in longevity and BMI are insufficient to explain the approximate doubling of knee OA prevalence that has occurred in the United States since the mid-20th century. Knee OA is thus more preventable than is commonly assumed, but prevention will require research on additional independent risk factors that either arose or have become amplified in the postindustrial era.

Osteotomy around the knee: evolution, principles and results.

PURPOSE: This article summarises the history and evolution of osteotomy around the knee, examining the changes in principles, operative technique and results over three distinct periods: Historical (pre 1940), Modern Early Years (1940-2000) and Modern Later Years (2000-Present). We aim to place the technique in historical context and to demonstrate its evolution into a validated procedure with beneficial outcomes whose use can be justified for specific indications. MATERIALS AND METHODS: A thorough literature review was performed to identify the important steps in the development of osteotomy around the knee. RESULTS: The indications and surgical technique for knee osteotomy have never been standardised, and historically, the results were unpredictable and at times poor. These factors, combined with the success of knee arthroplasty from the 1980s onward, led to knee osteotomy being regarded as an irrelevant surgical option by many surgeons. Despite its fluctuating reputation, this article demonstrates the reasons for the enduring practice of osteotomy, not least because achieving the appropriate alignment is now recognised as the foundation step when planning any surgical intervention. CONCLUSIONS: With appropriate patient selection, accurate pre-operative planning, modern surgical fixation techniques and rapid rehabilitation, osteotomy around the knee is now an effective biological treatment for degenerative disease, deformity, knee instability and also as an adjunct to other complex joint surface and meniscal cartilage surgery. LEVEL OF EVIDENCE: V.

The classic: modular total knee-replacement arthroplasty. A review of eighty-nine patients. 1976.

Fifty-eight osteoarthritic and thirty-one rheumatoid patients underwent modular total knee-replacement arthroplasty. The major indication for the operation was relief of pain. Contraindications to this resurfacing arthroplasty included varus-valgus instability of over 20 degrees, combined varus-valgus instability with flexion contracture of over 40 degrees, marked recurvatum, and predominant patellofemoral symptoms. In 59 per cent of the osteoarthritic and 58 per cent of the rheumatoid patients, complete relief of pain was evident when they were evaluated twenty-four months after surgery, while another 35 per cent of each group had only mild pain related to inclement weather. Their ability to walk long distances without support or limp was increased. Range of motion and ability to climb stairs were not significantly improved.

The classic: total condylar knee replacement in patients who have rheumatoid arthritis. A ten-year follow-up study. 1990.

Eighty knee replacements with a total condylar prosthesis in patients who had rheumatoid arthritis were followed for ten years. At ten years, nineteen knees needed revision and sixty-one prostheses were still functioning. The major reasons for revision were loosening of the tibial component or late bacteremic seeding from another site. Radiolucency at the bone-cement interface adjacent to the tibial component was statistically related to malposition of the tibial component. According to the system of The Hospital for Special Surgery, the mean scores were 64 points preoperatively and 85 points postoperatively. Synovitis recurred in only 3 per cent of the knees. When revision, pain, or radiographic evidence of loosening were considered an indication of failure, the ten-year cumulative survival was 75 per cent.

Cruciate ligament reconstruction and risk of knee osteoarthritis: the association between cruciate ligament injury and post-traumatic osteoarthritis. a population based nationwide study in Sweden, 1987-2009.

OBJECTIVE: To study the association between Cruciate Ligament (CL) injury and development of post-traumatic osteoarthritis in the knee in patients treated operatively with CL reconstruction compared with patients treated non-operatively. DESIGN: Population based cohort study; level of evidence II-2. SETTING: Sweden, 1987-2009. PARTICIPANTS: All patients aged between 15-60 years being diagnosed and registered with a CL injury in The National Swedish Patient Register between 1987 and 2009. MAIN OUTCOME MEASURES: Knee osteoarthritis. RESULTS: A total of 64,614 patients diagnosed with CL injury during 1987 to 2009 in Sweden were included in the study. Seven percent of the patients were diagnosed with knee OA in specialized healthcare during the follow-up (mean 9 years). Stratified analysis by follow-up showed that while those with shorter follow-up had a non-significant difference in risk (0.99, 95%CI 0.90-1.09 for follow-up less than five years compared with the non-operated cohort), those with longer follow-up had an increased risk of knee OA after CL reconstruction (HR = 1.42, 95%CI 1.27-1.58 for follow-up more than ten years compared with non-operated cohort). The risk to develop OA was not affected by sex. CONCLUSION: CL reconstructive surgery does not seem to have a protective effect on long term OA in either men or women.

[Native or not? Isotope analysis of a female skeleton on the 9th century A.D. from Elsau, Canton Zurich, Switzerland]. / Einheimisch oder fremd? Isotopenanalyse eines Frauenskelettes des 9. Jahrhunderts n. Chr. aus Elsau, Kanton Zürich, Schweiz.

At Elsau near Winterthur (CH), a 9th century AD grave with a female skeleton was found in 2003. This grave was reopened one to six years after burial. After manipulating the partially decayed skeleton, the grave was filled with a layer of rocks and a claw of a sea eagle as well as the paw of a fox was placed on top. At least from this time onwards, the grave was situated in the annex of a church. Because of this special burial site for the 42 year old woman, who suffered from different severe illnesses, it is thought that she belonged to the upper class. The postmortal changes at the grave are exceptional and even after thorough research, no equivalent burial procedures are known from this area. To investigate the possibility if the woman migrated to the region of Elsau, the oxygen and strontium isotope composition of several teeth and one long bone of her skeleton was analysed. The results indicate a certain but restricted mobility within the northern Alpine foreland and as a result changes of the isotope composition of the food and drinking water during her childhood. Immigration from regions in which similar burial customs to those used for the woman persisted into the 9th century AD can be largely excluded based on the isotope composition of her skeletal remains. The mobility in the pre-Alpine region supports the interpretation that the woman belonged to the upper class, whose properties where widely distributed.

Bone graft for tibial defects in total knee arthroplasty. 1986.

Twenty-four knees with bone grafts for tibial defects at the time of either primary or revision total knee arthroplasty were followed for three to six years. With 22 of 24 bone grafts, union and revascularization were seen and no clinical collapse was present. In two, nonunion occurred, accompanied by collapse in one. Failure was attributed to varus alignment of the leg in one (a medial condylar graft) and to insufficient preparation of the bony bed in the second (bleeding bone was not exposed). Evidence for incorporation of the grafts was obtained by tomogram, bone scan, and bone biopsy. Incorporation was present by six months, but the time to complete remodeling was not determined. A bone graft is recommended for tibial defect involving 50% or more of the bony support of either tibial plateau. A bone graft is indicated whenever a cement column under the prosthesis would measure more than 5 mm in height.

Ridges and grooves on the bony surfaces of osteoarthritic joints.

Osteoarthritis (OA) is associated with disruption of the articular cartilage and remodeling of subchondral bone. However, the macroscopic changes seen on the surface of the underlying bone have received little attention. Deep parallel ridges and grooves of the subchondral, eburnated bone have been observed in palaeopathological skeletons with OA. The same phenomenon has been seen in contemporary bones treated to remove soft tissues. Four such specimens were examined in detail and the characteristics of the ridges were documented by reflex microscopy. The depth and peak-to-peak distance of the grooves varied considerably. In each case there was matching of ridges and grooves on the two articulating surfaces of the joint, which fitted together like cog-wheels. This previously undocumented aspect of the pathology of OA may have significance to the function and outcome of an osteoarthritic joint, raises questions on the nature and control of subchrondal bone changes in OA.