Subchondral bone condition and total knee arthroplasty in patients with knee osteoarthritis

Background: 6% of adults suffer from knee joint osteoarthritis. In some cases, the method of choice of treatment is knee arthroplasty. The etiology of osteoarthritis remains largely unclear, but the question of involving the subchondral bone in the pathological process is beyond doubt. One of the causes of pain and other adverse effects after knee replacement may be subchondral bone pathology of the femur and tibia. Aims: To study the changes in the condyles of the tibia in osteoarthritis and to determine the possible impact of these changes on the development of instability of the knee joint endoprosthesis. Methods: From December 2014 to February 2016, 56 patients were examined. They underwent total arthroplasty of the knee joint. The average age of the patients was 63 years (from 55 to 78 years). Women were 52 (93%), men - 4 (7%). A histological examination of the resected tibial condyles was carried out to reveal bone pathology. Results: Typical changes for osteoarthritis were found microscopically. In all cases the signs of osteoporosis were present. A clear histological picture of osteomalacia in the non-calcinated bone was found in 15 women. Conclusions: Having studied the subchondral bone in these patients we can conclude that the knee endoprosthesis is implanted into a weakened bone, which can lead to adverse effects. To improve the long-term results of surgical treatment, medical correction of bone tissue pathology in the perioperative period is suggested

Assessing routine healthcare pattern for type 2 diabetes mellitus in Russia: the results of рharmacoepidemiological study (FORSIGHT-DM2)

Rationale. The rising incidence of type 2 diabetes mellitus (T2DM) allows researchers to conduct observational multicentre studies and obtain objective information about the epidemiology of diabetes and its complications and evaluate the efficacy of different therapies and diagnostic strategies designed to identify systemic vascular complications. Aims. To analyse epidemiological and socio-demographic parameters, the quality of glycaemic control, diagnostic monitoring and therapeutic measures typical among patients with T2DM living in Russian towns of different populations. Materials and methods. FORSIGHT-DM2 is an all-Russian multicentre observational epidemiological study that involves 2014 patients with T2DM from 45 different towns in the Russian Federation (RF). All patients have had T2DM for at least 1 year. They received glucose-lowering therapy and primary medical care from RF public outpatient health institutions between 01.01.2014 and 31.12.2014. For comparative analysis of the typical treatment for patients with T2DM, we stratified patients into groups based on the number of residents. Results. The data reveal a lack of glycaemic control (average НbА1с 7.9% ± 1.9%), with НbА1с  8% in 36% of patients. The frequency of T2DM complications was high and the prevalence of retinopathy was 63.2%, nephropathy was 34.4% (7.8% had chronic kidney disease G3a-G5), peripheral polyneuropathy was 63.3%, ‘diabetic foot’ syndrome was 13.7% and osteoarthropathy was 5%. The number of T2DM-related complications is correlated with the HbA1c level and disease duration. Moreover, simultaneous influence of these factors led to a significant increase in the number of chronic complications associated with T2DM (r = 0.338 for T2DM duration, r = 0.262 for HbA1c; р 0.001). Despite the high frequency of patient consultations with endocrinologists (83%) and a large percentage of hospitalisations in the current year (46%), the screening of chronic complications of T2DM in 2014 is insufficient. Conclusion. The results indicate insufficient glycaemic control among patients with T2DM and a higher prevalence of chronic complications compared with the national register of diabetic patients