P324 RADIOGRAPHIC KNEE OSTEOARTHRITIS IS ASSOCIATED WITH AN INCREASE IN TRABECULAR BUT NOT CORTICAL BONE MINERAL DENSITY USING PERIPHERAL QUANTITATIVE CT

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Predictors of Patient-Reported Pain and Functional Outcomes Over 10 Years After Primary Total Knee Arthroplasty: A Prospective Cohort Study.

Background This study aimed to identify preoperative predictors of patient-reported outcomes after total knee replacement (TKR) and to investigate their association with the outcomes over time. Methods We used data from 2,080 patients from the Knee Arthroplasty Trial (KAT) who received primary TKR in the UK between July 1999 and January 2003. The primary outcome measure was the Oxford Knee Score (OKS) collected annually over 10 years after TKR. Preoperative predictors included a range of patient characteristics and clinical conditions. Mixed-effects linear regression model analysis of repeated measurements was used to identify predictors of OKS overall score, pain and function subscale scores over 10 years, separately. Results Worse preoperative OKS score, worse mental well-being, BMI>35 kg/m^2, living in the most deprived areas, higher American Society of Anaesthesiologists grade, presence of comorbidities, and history of previous knee surgery were associated with worse OKS overall score over 10 years after surgery. The same predictors were identified for pain and function subscale scores, and for both long-term (10 years) and short-/mid-term outcomes (1 and 5 years). However, fitted models explained more variations in function and shorter-term outcomes than in pain and longer-term outcomes, respectively. Conclusion The same predictors were identified for pain and functional outcomes over both short-tomedium term and long term after TKR. Within the factors identified, functional and shorter-term outcomes were more predictable than pain and longer-term outcomes, respectively. Regardless of their preoperative characteristics, on average, patients achieved substantial improvement in pain over time, though improvement for function was less prominent. </p

Investigation of laparoscopic therapy in 56 cases of duodenal ulcer perforation

We report six patients with adult congenital biliary dilatation treated by surgery. Of the six cases, five were female and the patients' age at diagnosis ranged from 19 to 51 years old. By Todani's classification for bile duct dilatation, three were categorized as Ⅰa, one as Ⅰb, and two as Ⅳa. All six cases had anomalous arrangement of the pancreatobiliary duct. Resection of the cystic portion and hepaticojejunostomy (Roux-Y) were performed in all. After surgery, one patient classified as Ⅰa and one as Ⅳa had complications of cholangitis and intrahepatic stones. We removed the stones by the percutaneous transhepatic route with dilatation of the stenotic anastomosis, but cholangitis recurred in the Ⅳa patient. Although surgical resection of the cystic portion and reconstruction of biliary tract is considered to be a standard treatment for adult congenital biliary dilatation, this Ⅳa case had complications after surgical treatment. Thus short-term follow-up is necessary to prevent or diagnose stenotic anastomosis following the operation

The consultation of rugby players in co-developing a player health study:feasibility and consequences of sports participants as research partners

Background Public involvement in the UK has increased in accordance with funding requirements and patient-centred health policy initiatives and the reporting of the positive impact of public involvement for those involved, research and researchers. However, public involvement has not been implemented equally across all disease areas and populations. The aim of this process was to involve rugby players as sports participants across the research cycle of a player health study, ensure the study is player-centred, and that players had approved and informed the design of the study and its questionnaire from their playing experiences. Methods Two fora were undertaken with current students who were playing rugby at a Collegiate University. All male and female University rugby players and two College rugby teams were approached to become involved. Sessions were chaired by a player-lead using a topic guide and were audio-recorded and transcribed. Player suggestions were extracted by the player lead and discussed within the study team for inclusion in the player health study and its questionnaire. Results Players readily engaged with the sessions and made many contributions to the development of the study and the questionnaire. Players discussed whether certain topics were being collected satisfactorily, and whether the questionnaire would encompass their playing experiences or that of other players. Players suggested where answers might be less reliable, and ways in which this could be improved. Players recommended additions to the questionnaire, and questioned researchers on the choice of language, motivation for question inclusion and if measures were standardised or novel. Conclusions Involving a group of sports participants in the design of a player health study and questionnaire was not an arduous process and was rewarding for researchers. The process resulted in numerous alterations to the questionnaire and its functionality, which may improve response rate but will more importantly improve the experience of players participating in this study. Player involvement in research was feasible to implement and improved not only the questionnaire but also researcher confidence in the project and that player experience was being accurately captured and leading a reliable, optimal data collection process in this unique population. </p

Prevalence of and Risk Factors for Total Hip and Knee Replacement in Retired National Football League Athletes

Background: Osteoarthritis is a substantial cause of disability. Joint replacement prevalence relates to the burden of severe osteoarthritis, and identifying risk factors for end-stage disease may indicate intervention opportunities. American football has high youth and elite participation, and determining risk factors for severe osteoarthritis may support future morbidity prevention. Purpose: To (1) determine the prevalence of hip and knee replacement in retired National Football League (NFL) athletes, (2) examine risk factors for replacement, and (3) identify the association between knee injuries and knee replacement. Study Design: Case-control study; Level of evidence, 3. Methods: Retired NFL athletes who participated in a general health survey were included. This historical cohort included those playing between 1929 and 2001. The association between self-reported playing or injury history, and replacement after retirement, was assessed with prevalence ratios (PRs). Models were adjusted for potential confounders of age and weight. Results: Data for 2432 retired male NFL players (69.3% response rate) who had participated in football for a mean 15.2 years were included, in which 277 players reported replacement after retirement (11.4%). More participants reported knee replacement (7.7%) than hip replacement (4.6%). The majority of participants reported previous severe knee injury (53%), and the most prevalent was meniscal tear (32.2%). In multivariable models, age (10-year increase, PR, 2.23; 95% CI, 1.99-2.51), current weight (PR, 1.10; 95% CI, 1.06-1.14), and reporting 1 (PR, 1.78; 95% CI, 1.14-2.77), 2 (PR, 1.91; 95% CI, 1.16-3.15), or ≥3 knee injuries (PR, 3.44; 95% CI, 2.33-5.09) were associated with knee replacement. Age (10-year increase, PR, 1.86; 95% CI, 1.59-2.18), linemen (PR, 1.62; 95% CI, 1.03-2.55), and reporting 1 (PR, 1.72; 95% CI, 1.05-2.80), 2 (PR, 2.77 95% CI, 1.58-4.84), or ≥3 (PR, 2.44; 95% CI, 1.52-3.91) hip injuries were associated with hip replacement. Each reported knee injury type was cross-sectionally associated with replacement after retirement (P <.05). Conclusion: Knee replacement was more prevalent than hip replacement. Risk factors differed between the hip and the knee, with age and severe joint injury associated with hip and knee replacement, weight with knee replacement, and playing position associated with hip replacement. Joint injury and weight management may be prevention opportunities to reduce morbidity and end-stage osteoarthritis in this population

Socio-economic status and the risk of developing hand, hip or knee osteoarthritis: a region-wide ecological study

SummaryObjectiveTo determine the association between socio-economic status (SES) and risk of hand, hip or knee osteoarthritis (OA) at a population level.DesignRetrospective ecological study using the System for the Development of Research in Primary Care (SIDIAP) database (primary care anonymized records for >5 million people in Catalonia (Spain)). Urban residents >15 years old (2009–2012) were eligible. Outcomes: Validated area-based SES deprivation index MEDEA (proportion of unemployed, temporary workers, manual workers, low educational attainment and low educational attainment among youngsters) was estimated for each area based on census data as well as incident diagnoses (ICD-10 codes) of hand, hip or knee OA (2009–2012). Zero-inflated Poisson models were fitted to study the association between MEDEA quintiles and the outcomes.ResultsCompared to the least deprived, the most deprived areas were younger (43.29 (17.59) vs 46.83 (18.49), years (Mean SD), had fewer women (49.1% vs 54.8%), a higher percentage of obese (16.2% vs 8.4%), smokers (16.9% vs 11.9%) and high-risk alcohol consumption subjects (1.5% vs 1.3%). Compared to the least deprived, the most deprived areas had an excess risk of OA: age-sex-adjusted Incidence Rate Ratio (IRR) 1.26 (1.11–1.42) for hand, 1.23 (1.17–1.29) hip, and 1.51 (1.45–1.57) knee. Adjustment for obesity attenuated this association: 1.06 (0.93–1.20), 1.04 (0.99–1.09), and 1.23 (1.19–1.28) respectively.ConclusionsDeprived areas have higher rates OA (hand, hip, knee). Their increased prevalence of obesity accounts for a 50% of the excess risk of knee OA observed. Public health interventions to reduce the prevalence of obesity in this population could reduce health inequalities

Patellar cartilage volume of the back leg versus the higher loaded front leg in current elite male english cricket fast bowlers

Patellar cartilage volume of the back leg versus the higher loaded front leg in current elite male english cricket fast bowler

Anti-Osteoporosis Medication Prescriptions and Incidence of Subsequent Fracture Among Primary Hip Fracture Patients in England and Wales:An Interrupted Time-Series Analysis

In January 2005 the National Institute for Health and Care Excellence (NICE) in England and Wales provided new guidance on the use of anti-osteoporosis therapies for the secondary prevention of osteoporotic fractures. This was shortly followed in the same year by market authorisation of a generic form of alendronic acid. We here set out to estimate the actual practice impact of these events among hip fracture patients in terms of anti-osteoporosis medicationprescribing and subsequent fracture incidence using primary care data (Clinical Practice Research Datalink) from 1999-2013. Changes in level and trend of prescribing and subsequent fracture following publication of NICE guidance and availability of generic alendronic acid were estimated using an interrupted time series analysis. Both events were considered in combination within a 1-year ‘intervention period’. We identified 10,873 primary hip fracture patients between April 1999 and Sept 2012. Taking into account prior trend, the intervention period was associated with an immediate absolute increase of 14.9% (95% C.I. 10.9 – 18.9) for incident anti-osteoporosis prescriptions and a significant and clinically important reduction in subsequent major and subsequent hip fracture: -0.19% (95% C.I.-0.28 to -0.09) and -0.17% (95% C.I. -0.26 to -0.09) per six months, respectively. This equated to an approximate 14% (major) and 22% (hip) reduction at three years post-intervention relative to expected values based solely on pre-intervention level and trend. We conclude that among hip fracture patients, publication of NICE guidance and availability of generic alendronic acid was temporally associated with increased prescribing and a significant decline in subsequent fractures

Development of a Prediction Model for Stress Fracture During an Intensive Physical Training Program:The Royal Marines Commandos

Background Stress fractures (SF) are one of the more severe overuse injuries in military training and therefore knowledge of potential risk factors is needed to assist in developing mitigating strategies. Purpose To develop a prediction model for risk of SF in Royal Marines (RM) recruits during an arduous military training program. Study Design Cohort study Methods 1,082 recruits (age range: 16-33 years) enrolled between September 2009 and July 2010, were prospectively followed through the 32-week RM training program. SF diagnosis was confirmed from a positive X-Ray or Magnetic Resonance Imaging (MRI) scan. Potential risk factors assessed at week-1 included recruit characteristics, anthropometric assessment, dietary supplement use, lifestyle habits, fitness assessment, blood samples, 25(OH)D, bone strength as measured by heel Broadband Ultrasound Attention (BUA), history of physical activity, and previous and current food intake. A logistic least absolute shrinkage selection operator (LASSO) regression with 10-fold cross-validation method was used to select potential predictors among 47 candidate variables. Model performance was assessed using measures of discrimination (c-index) and calibration. Bootstrapping was used for internal validation of the developed model and to quantify optimism. Results A total of 86 (8%) volunteer recruits presented with at least one SF during training. Twelve variables were identified as the most important risk factors of SF. Variables strongly associated with SF were age, body weight, pre-training weight bearing (WB) exercise, pre-training cycling and childhood intake of milk and milk products. The c-index for the prediction model was 0.73 (optimism-corrected c-index 0.68), which represents the model performance in future volunteers. Although 25(OH)D and VO2max had only a borderline statistical significant association with SF, the inclusion of these factors improved the performance of the model. Conclusion These findings will assist in identifying recruits at greater risk of SF during training, and support interventions to mitigate this injury risk. However, external validation of the model is still required.</p