Sarcopenia and Sarcopenic Obesity in Patients Undergoing Orthopedic Surgery

BACKGROUND: The purpose of this retrospective study was to determine the prevalence of sarcopenia and sarcopenic obesity among patients who underwent orthopedic surgery (OS). METHODS: A total of 222 patients were reviewed immediately after or prior to OS. In the control group, 364 patients from outpatient departments (OPDs) who did not have any OS were enrolled. Whole-body dual-energy X-ray absorptiometry was used to analyze body composition. Skeletal muscle mass was adjusted for height squared, total body weight, and height and fat mass (residuals). Obesity was defined as body mass index (BMI) > 25.0 kg/m2. RESULTS: The prevalence of sarcopenia in the OS group was 25.7%, 44.1%, and 26.6%, respectively, according to the 3 different criteria. The prevalence was significantly lower in the OPD group (6.0%, 33.1%, and 14.8%, respectively). The highest rates of sarcopenia with height-adjusted definition were seen in patients with a femoral neck fracture. In the multivariate analysis, factors associated with sarcopenia were male gender, older age, and lower BMI (odds ratio [OR]: 28.38, 1.03, and 1.83, respectively) when muscle mass was adjusted for height, whereas male gender, older age, and higher BMI were associated with sarcopenia (OR: 1.04, 2.57, and 1.83, respectively) when adjusted for weight. When residuals were used as a cutoff, decreased BMI and total hip bone mineral density (0.1 g/cm2) were independent risk factors associated with sarcopenia (OR: 1.09 and 1.05). The prevalence of sarcopenic obesity ranged from 1.8% to 21.2%. CONCLUSIONS: Our study demonstrated a high prevalence of sarcopenia among OS patients.

Sarcopenia and Sarcopenic Obesity in Patients Undergoing Orthopedic Surgery

BACKGROUND: The purpose of this retrospective study was to determine the prevalence of sarcopenia and sarcopenic obesity among patients who underwent orthopedic surgery (OS). METHODS: A total of 222 patients were reviewed immediately after or prior to OS. In the control group, 364 patients from outpatient departments (OPDs) who did not have any OS were enrolled. Whole-body dual-energy X-ray absorptiometry was used to analyze body composition. Skeletal muscle mass was adjusted for height squared, total body weight, and height and fat mass (residuals). Obesity was defined as body mass index (BMI) > 25.0 kg/m2. RESULTS: The prevalence of sarcopenia in the OS group was 25.7%, 44.1%, and 26.6%, respectively, according to the 3 different criteria. The prevalence was significantly lower in the OPD group (6.0%, 33.1%, and 14.8%, respectively). The highest rates of sarcopenia with height-adjusted definition were seen in patients with a femoral neck fracture. In the multivariate analysis, factors associated with sarcopenia were male gender, older age, and lower BMI (odds ratio [OR]: 28.38, 1.03, and 1.83, respectively) when muscle mass was adjusted for height, whereas male gender, older age, and higher BMI were associated with sarcopenia (OR: 1.04, 2.57, and 1.83, respectively) when adjusted for weight. When residuals were used as a cutoff, decreased BMI and total hip bone mineral density (0.1 g/cm2) were independent risk factors associated with sarcopenia (OR: 1.09 and 1.05). The prevalence of sarcopenic obesity ranged from 1.8% to 21.2%. CONCLUSIONS: Our study demonstrated a high prevalence of sarcopenia among OS patients.

Sarcopenia and Osteoporosis / 대한고관절학회지

Public health strategies designed to accomodate the ever-increasing human lifespan are urgently required. A good clinical understanding of frailty, as well as knowledge regarding how to prevent it, will therefore be required in order to overcome this challenge. Sarcopenia is an important component of the frailty syndrome, and its association with osteoporosis can lead to fractures and incident disability. Therefore, this review examined the literatuire pertaining to the association of sarcopenia with osteoporosis in order to assess preventive strategies.

Advantage of Minimal Anterior Knee Pain and Long-term Survivorship of Cemented Single Radius Posterior-Stabilized Total Knee Arthroplasty without Patella Resurfacing

BACKGROUND: The single radius total knee prosthesis was introduced with the advantage of reduced patellar symptoms; however, there is no long-term follow-up study of the same. The purpose of this study was to determine the survival rate of single radius posterior-stabilized total knee arthroplasty and patellofemoral complication rates in a consecutive series. METHODS: Seventy-one patients (103 knees) who underwent arthroplasty without patellar resurfacing using a single radius posterior-stabilized total knee prosthesis were followed up for a minimum 10 years. Clinical evaluation using Knee Society knee and function scores and radiologic evaluation were performed at regular intervals. Anterior knee pain as well as patellofemoral complications were evaluated with a simple questionnaire. The Kaplan-Meier product-limit method was used to estimate survival. RESULTS: Seventeen patients (23 knees) were excluded due to death (12 knees) or lost to follow-up (11 knees). Of the 80 knees enrolled, all femoral components and 78 tibial components were well fixed without loosening at final follow-up. Two revisions were performed because of tibial component loosening and periprosthetic joint infection. One patient with tibial component loosening refused to have revision surgery. No obvious tibial insert polyethylene wear was observed. The survivorships at 132 months were 96.7% using revision or pending revision as end points. Anterior knee pain was present in 6 patients (6 knees, 7.5%) at the latest follow-up. No patellofemoral complication requiring revision was encountered. CONCLUSIONS: The single radius posterior-stabilized total knee prosthesis demonstrated an excellent minimum 10-year survivorship. The low rates of implant loosening and 7.5% of anterior knee pain as a patellofemoral complication are comparable with those reported for other modern total knee prosthesis.

Three Dimensional CT-based Virtual Patellar Resection in Female Patients Undergoing Total Knee Replacement: A Comparison between Tendon and Subchondral Method

BACKGROUND: Due to its small size, variable shape, and lack of distinct anatomical landmarks, osteoarthritic knees make a precise patellar resection extremely difficult. METHODS: We performed virtual patellar resection with digital software using three dimensional computed tomography scans of knees from 49 patients who underwent primary total knee replacement at our hospital. We compared 2 commonly used resection methods, the tendon method (TM) and the subchondral method, to determine an ideal resection plane with respect to the symmetry and thickness of the patellar remnant. RESULTS: The TM gave a thicker resected patella, and a less oval cut surface shape, which gives better coverage for a domed prosthesis. Both methods, however, gave a symmetric resection both superior-inferiorly, as well as mediolaterally. CONCLUSIONS: Although TM appears statistically better with respect to the thickness and cut surface shape, only further intraoperative studies with long-term clinical follow-up may provide us with the most appropriate patellar resection method.

Little Impact of Antiplatelet Agents on Venous Thromboembolism after Hip Fracture Surgery

Since the late 1980s, low dose aspirin has been used to prevent stroke and ischemic heart disease. However, prophylactic effect of antiplatelets against venous thromboembolism (VTE), in patients who undergo hip fracture surgery (HFS) is controversial. Our purpose was to determine the incidence of symptomatic VTE after HFS and to evaluate whether antiplatelets reduce the development of symptomatic VTE following HFS. We retrospectively reviewed 858 HFS in 824 consecutive patients which were performed from May 2003 to April 2010 at an East Asian institute. We compared the incidence of symptomatic VTE in antiplatelet users and non-users using multivariate logistic regression analyses. Overall incidences of symptomatic pulmonary embolism including fatal pulmonary embolism, and symptomatic deep vein thrombosis in this study were 2.4% (21/858), and 3.5% (30/858), respectively. The incidence of symptomatic VTE was 4.8% (12/250) in antiplatelet users and 4.3% (26/608) in non-users (P = 0.718). It is suggested that antiplatelet agents are not effective in prevention of symptomatic VTE after HFS.

Effect of a Long-term, Oral Fixed Dose with a Combination of Aledronate and Cacitriol on the Cancellous Bone Microarchitecture in Ovariectomized Rats / 대한정형외과연구학회지

PURPOSE: To study the effect of a long-term, oral, fixed dose with a combination of alendronate and calcitriol on the cancellous bone microarchitecture in an ovariectomized rat model. MATERIALS AND METHODS: Twenty eight female Sprague-Dawley rats were divided into 2 equal groups: a non-medication group (OVX), and a medication group (ALD). The ALD group was treated with an oral daily fixed dose with a combination of alendronate and calcitriol for six months, starting from 4 weeks after ovariectomy, while the OVX group was given only a placebo. After six months, all animals were sacrificed, and an in vitro micro-CT analysis of the the distal femur was performed. The bone volume fraction (BV/TV), trabecular thickness (Tb.Th), trabecular separation (Tb.Sp), trabecular number (Tb.N), structure model index (SMI), connectivity density (Conn.D), and bone mineral density (BMD) were assessed. RESULTS: The ALD group had significantly higher BV/TV, Tb N, BMD and Conn.D and it also had significantly lower Tb Sp and SMI than the OVX group. CONCLUSION: A long term, daily, oral fixed dose with a combination of alendronate and calcitriol could significantly reduce the osteoporotic changes in this ovariectomized rat model.

Clinical Efficacy of Korean FRAX(R) Model in Patients with Hip Fracture / 대한골다공증학회지

OBJECTIVES: We aimed to examine clinical efficacy of Korean FRAX model with respect to prediction of osteoporotic fracture risk and eligibility of osteoporosis treatment in Korean patients with hip fractures. MATERIALS & METHODS: In 41 elderly patients with a proximal femoral fracture (mean age=78.7 years, range: 63~99 years), fracture probabilities were calculated using FRAX models from Korea and Japan. We then performed comparative analyses between ten-year probabilities of major / hip osteoporotic fractures and the osteoporosis treatment eligibilities based on the FRAX model from Korea and Japan. RESULTS: The mean ten-year probabilities of major osteoporotic fractures and hip fractures using the Korean FRAX model (11.5% and 5.9%, respectively) were significantly lower than those using the Japanese FRAX model (21.5% and 9.2%, respectively, P<0.001). In addition, based on the National Osteoporosis Foundation guideline, pharmacological treatment of osteoporosis would be recommended in 38 patients (92.7%) by the Japanese FRAX model, while only in 30 patients (73.2%) by the Korean FRAX model (P=0.037). CONCLUSIONS: Our results suggest that the Korean FRAX model might underestimate osteoporotic fracture probabilities and eligibility of osteoporosis treatment in Korean patients with hip fracture.