Knee Arthroplasty: Disabilities in Comparison to the General Population and to Hip Arthroplasty Using a French National Longitudinal Survey

International audienceBACKGROUND: Knee arthroplasty is increasing exponentially due to the aging of the population and to the broadening of indications. We aimed to compare physical disability and its evolution over two years in people with knee arthroplasty to that in the general population. A secondary objective was to compare the level of disabilities of people with knee to people with hip arthroplasty. METHODOLOGY/PRINCIPAL FINDINGS: 16,945 people representative of the French population were selected in 1999 from the French census and interviewed about their level of disability. This sample included 815 people with lower limb arthroplasty. In 2001, 608 of them were re-interviewed, among whom 134 had knee arthroplasty. Among the other participants re-interviewed, we identified 68 who had undergone knee arthroplasty and 145 hip arthroplasty within the last two years (recent arthroplasty). People with knee arthroplasty reported significantly greater difficulties than the general population with bending forward (odds ratio [OR] = 4.7; 95% confidence interval [CI]: 1.7, 12.6), walking more than 500 meters (OR = 6.0; 95% CI: 1.5, 24.7) and carrying 5 kg kilograms for 10 meters (OR = 4.6; 95% CI: 1.3, 16.4). However, the two years evolution in disability was similar to that in the general population for most activities. The level of mobility was similar between people with recent knee arthroplasty and those with recent hip arthroplasty. Nevertheless, people with recent knee arthroplasty reported a lower level of disability than the other group for washing and bending forward (OR = 0.3; 95% CI: 0.1, 0.6 and OR = 0.4; 95% CI: 0.1, 0.9, respectively). CONCLUSIONS/SIGNIFICANCE: People with knee arthroplasty reported a higher risk of disability than the general population for common activities of daily living but a similar evolution. There was no relevant difference between recent knee and hip arthroplasties for mobility

Measuring body composition in overweight individuals by dual energy x-ray absorptiometry

BACKGROUND: Dual energy x-ray absorptiometry (DXA) is widely used for body composition measurements in normal-weight and overweight/obese individuals. The limitations of bone densitometers have been frequently addressed. However, the possible errors in assessing body composition in overweight individuals due to incorrect positioning or limitations of DXA to accurately assess both bone mineral density and body composition in obese individuals have not received much attention and are the focus of this report. DISCUSSION: We discuss proper ways of measuring overweight individuals and point to some studies where that might not have been the case. It appears that currently, the most prudent approach to assess body composition of large individuals who cannot fit under the scanning area would be to estimate regional fat, namely the regions of thigh and/or abdomen. Additionally, using two-half body scans, although time consuming, may provide a relatively accurate measurement of total body fat, however, more studies using this technique are needed to validate it. SUMMARY: Researchers using bone densitometers for body composition measurements need to have an understanding of its limitations in overweight individuals and address them appropriately when interpreting their results. Studies on accuracy and precision in measurements of both bone and soft tissue composition in overweight individuals using available densitometers are needed

Psychotropic drugs and the risk of fractures in old age: a prospective population-based study

<p>Abstract</p> <p>Background</p> <p>There is evidence that the use of any psychotropic and the concomitant use of two or more benzodiazepines are related to an increased risk of fractures in old age. However, also controversial results exist. The aim was to describe associations between the use of a psychotropic drug, or the concomitant use of two or more of these drugs and the risk of fractures in a population aged 65 years or over.</p> <p>Methods</p> <p>This study was a part of a prospective longitudinal population-based study carried out in the municipality of Lieto, South-Western Finland. The objective was to describe gender-specific associations between the use of one psychotropic drug [benzodiazepine (BZD), antipsychotic (AP) or antidepressant (AD)] or the concomitant use of two or more psychotropic drugs and the risk of fractures in a population 65 years or over. Subjects were participants in the first wave of the Lieto study in 1990-1991, and they were followed up until the end of 1996. Information about fractures confirmed with radiology reports in 1,177 subjects (482 men and 695 women) during the follow-up was collected from medical records. Two follow-up periods (three and six years) were used, and previously found risk factors of fractures were adjusted as confounding factors separately for men and women. The Poisson regression model was used in the analyses.</p> <p>Results</p> <p>The concomitant use of two or more BZDs and the concomitant use of two or more APs were related to an increased risk of fractures during both follow-up periods after adjusting for confounding factors in men. No similar associations were found in women.</p> <p>Conclusions</p> <p>The concomitant use of several BZDs and that of several APs are associated with an increase in the risk of fractures in older men. Our findings show only risk relations. We cannot draw the conclusion that these drug combinations are causes of fractures.</p

Vojta method in the treatment of developmental hip dysplasia &ndash; a case report

Wojciech Kiebzak,1,2 Arkadiusz Żurawski,2 Michał Dwornik3 1Center for Pediatrics, Regional Hospital in Kielce, Kielce, Poland; 2Department of Physiotherapy, Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland; 3Department of Osteopathic Medicine and Physiotherapy, Medical College of Podkowa Lesna, Podkowa Lesna, Poland Background: Developmental dysplasia of the hip joint is one of the most common congenital defects and often results in functional and structural disorders. Such cases particularly demand optimizing therapeutic effects and maximally reducing the duration of therapy. Purpose: The aim of this case report is to present the therapeutic process in a child with developmental hip dysplasia. Case report: This is a case report of a female child with a birth weight of 2,800 g and an Apgar score of 9 points born to a gravida 3 para 3 mother at 37 weeks. The child was delivered by cesarean section, and the pregnancy was complicated by oligohydramnios. Subluxation of the left hip joint was diagnosed by an orthopedist in the third month of life. The treatment followed was the Vojta method (the first phase of reflex turning and reflex crawling). Results: During the 6&nbsp;weeks of the Vojta treatment, the left half of the femoral head was centralized, and the process of formation of the hip joint acetabulum was influenced effectively enough to change the acetabulum&rsquo;s Graff type from the baseline D to IIb after 41&nbsp;days of treatment. Conclusion: The diagnostic work-up of congenital hip joint dysplasia should involve a physiotherapist who will investigate the child&rsquo;s neuro&shy;muscular coordination, in addition to a neonatologist and a pediatrician. The therapy for a disorder of hip joint development of neuromotor origin should involve the application of global patterns according to Vojta. Children with congenital dysplasia of the hip joint should commence rehabilitation as early as possible. Keywords: global pattern, neuromuscular coordination, centralization of the the femoral hea

Wplyw bocznej elektrycznej powierzchniowej elektrostymulacji [LESS] na deformacje kregoslupa w skoliozie idiopatycznej

Clinical studies were carried out in the period of 2003-2008 at the Provincial Children’s Rehabilitation Hospital in Ameryka near Olsztyn (Poland). The study involved a group of children and youths exhibiting spinal deformity progression in idiopathic scoliosis (IS) of more than 5o per year according to the Cobb scale. Four hundred and fifty patients between 4 and 15 years of age were divided into three groups (n = 150). Group I received 2-hour and group II 9-hour treatment of Lateral Electrical Surface Stimulation (LESS), respectively, whereas group III (control) was treated only with corrective exercises for 30 minutes twice a day. LESS was performed as 24-month treatment with the use of a battery-operated SCOL-2 stimulator manufactured by Elmech, Warsaw, Poland. The effectiveness of this method was confirmed in the treatment of spinal IS in children and adolescent patients, especially when the initial spinal deformity does not exceed 20o according to the Cobb scale. A short-duration electrostimulation – 2 hours daily – was found to produce results similar to those obtained after overnight, 9-hour electrostimulation. Moreover, the analysis of the Harrington prognostic index F confirms the positive effect of LESS in both groups of patients (2 h and 9 h of LESS).Badania kliniczne prowadzono w latach 2003-2008, w Wojewódzkim Szpitalu Rehabilitacyjnym dla Dzieci w Ameryce k. Olsztyna, w grupie dzieci i młodzieży wykazującej progresję skrzywienia w skoliozie idiopatycznej (SI) powyżej 5O wg Cobba w skali rocznej. Badaniami objęto 450 pacjentów, w wieku od 4 do 15 lat, podzielonych na 3 grupy (n = 150). W grupie I stosowano 2-godzinną terapię metodą Bocznej Elektrycznej Powierzchniowej Elektrostymulacji (Lateral Electrical Surface Electrostimulation – LESS), w grupie II – 9-godzinną, a w grupie III (kontrolnej) – tylko leczenie za pomocą ćwiczeń korekcyjnych wykonywanych 2 razy po 30 min dziennie. Elektrostymulację typu LESS stosowano, w 24-miesięcznym leczeniu za pomocą bateryjnego stymulatora SCOL-2, wytwarzanego w zakładach elektromechaniki medycznej Elmech w Warszawie. Efektywność tej metody oceniano podczas leczenia SI kręgosłupa u dzieci i młodzieży, zwłaszcza w przypadkach, gdy początkowe skrzywienie kręgosłupa nie przekraczało 20o wg metody Cobba. Elektrostymulacja LESS skrócona do 2-godzinnej terapii dziennie wywoływała podobnie korzystne rezultaty do osiąganych podczas elektrostymulacji całonocnej – 9-godzinnej. Także wykonana analiza współczynnika prognostycznego F Harringtona potwierdziła pozytywne efekty oddziaływania metody LESS w obydwu grupach pacjentów (I i II)

Czynniki srodowiskowe predysponujace do zespolow bolowych kregoslupa w populacji dziewczat ze skolioza idiopatyczna

Idiopathic scoliosis (IS), despite multidirectional therapy, involves a significant impairment of the quality of life of the patients. It is caused by pain syndromes frequently accompanying IS, the etiology of which has not been entirely discovered. The present research on environmental factors predisposing to pain syndromes in girls with IS involved analysis of 54 girls under ambulatory care, aged 14-17 (on average 15.3-years-old ±0.99). The patients’ natural environment was analysed, including time spent in a sedentary position during the day, sleeping time, time spent on physical activity during the week, regularity of meals consumed, as well as the quantitative composition of the diet. The research also concerned the location and characteristics of ailment reported, as well as pain intensity on the Numerical Rating Scale (NRS). It was found that the most frequent locations of back pain were: lumbar section – in 28 persons (51.9% of the examined population), and thoracic section of the spine – in 21 persons (38.9% of the examined population). Pain occurring at the same time in the cervical, thoracic and lumbar sections of the spine was reported for 4 persons (7.4% of the examined population). Fifty girls (92.6%) were aware of controlling their body posture, and 23 persons (42.6%) were able to correct it. The group of girls under examination suffering from pain in the lumbar section of the spine was characterized by a longer period of retaining a sedentary position, less time dedicated to any therapeutic rehabilitation programme, higher intensity of pain, and a higher average age than the group with pain in the thoracic section of the spine. The research proved that patients with pain syndrome located in the lumbar part of the spine were characterized by more time spent in a sedentary position, less time spent on a therapeutic rehabilitation programme, higher intensity of pain and a higher average age than the group suffering from pain in the thoracic section of the spine. The lifestyles of the patients under examination and their lack of awareness of the need to control the body posture can affect the type and intensity of pain.Idiopatyczna skolioza kręgosłupa (ISK), pomimo wielokierunkowej terapii, wiąże się z istotnym obniżeniem jakości życia chorych. Przyczyną tego są często towarzyszące IKS zespoły bólowe, których etiologia nie jest jeszcze całkowicie poznana. Realizując badania nad wskazaniem czynników środowiskowych predysponujących do zespołów bólowych kręgosłupa u dziewcząt z ISK, poddano analizie 54 objęte opieką ambulatoryjną dziewczęta w wieku od 14 do 17 lat (średnio 15,3 lat ±0,99). Dokonano analizy środowiska naturalnego pacjentek, m.in.: czasu przebywania w pozycji siedzącej w ciągu doby, czasu trwania snu, ilości czasu przeznaczonego na aktywność ruchową w ciągu tygodnia oraz regularności spożywanych posiłków, a także składu ilościowego diety. Przedmiotem badań była też lokalizacja i charakterystyka zgłaszanych dolegliwości oraz ocena intensywności bólu według skali numerycznej NRS (Numerical Rating Scale). Stwierdzono, że najczęstszymi lokalizacjami bólu pleców były odcinki: lędźwiowy u 28 osób (51,9% populacji badanej) oraz piersiowy kręgosłupa u 21 osób (38,9% populacji badanej). Ból obejmujący jednocześnie odcinki szyjny, piersiowy oraz lędźwiowy kręgosłupa występował u 4 osób (7,4% populacji badanej). Świadomość kontroli postawy ciała miało 50 badanych dziewcząt (92,6%), a skorygować ją potrafiły 23 osoby (42,6%). Grupa badanych dziewcząt z bólem odcinka lędźwiowego kręgosłupa dłuższy czas przebywała w pozycji siedzącej, mniej czasu poświęcała na program usprawniania terapeutycznego, skarżyła się na większą intensywność bólu i miała wyższą średnią wieku niż grupa z bólem odcinka piersiowego kręgosłupa. W badaniach wykazano, że pacjenci z zespołem bólowym zlokalizowanym w części lędźwiowej kręgosłupa dłuższy czas przebywali w pozycji siedzącej, mniej czasu poświęcali na program usprawniania terapeutycznego oraz zgłaszali większą intensywność bólu i mieli wyższą średnią wieku w porównaniu z grupą z bólem odcinka piersiowego kręgosłupa. Tryb życia chorych objętych badaniem i brak świadomości kontroli postawy może mieć wpływ na rodzaj i intensywność dolegliwości bólowych