Joint space narrowing, body mass index, and knee pain: the ROAD study (OAC1839R1).

OBJECTIVE: The objective of the present study was to clarify the association of joint space narrowing with knee pain in Japanese men and women using a large-scale population-based cohort of the Research on Osteoarthritis/osteoporosis Against Disability (ROAD) study. METHODS: This study examined the association between minimum joint space width (mJSW) in the medial compartment and pain at the knee. mJSW was measured in the medial and lateral compartments of the knee using a knee osteoarthritis (OA) computer-aided diagnosis system. RESULTS: From the 3040 participants in the ROAD study, the present study analyzed 2733 participants who completed the radiographic examinations and questionnaires regarding knee pain (975 men and 1758 women; mean age, 69.9 ± 11.2 years). Subjects with lateral knee OA were excluded. After adjustment for age and Body mass index (BMI), medial mJSW, as well as medial mJSW/lateral mJSW, was significantly associated with knee pain. Sex and BMI affected the association of medial mJSW with knee pain. The threshold of medial mJSW was approximately 3 mm in men and 2 mm in women, while that of medial mJSW/lateral mJSW was approximately 60% in both men and women. BMI was found to have a distinct effect on the association of mJSW with pain. CONCLUSION: The present cross-sectional study using a large-scale population from the ROAD study showed that joint space narrowing had a significant association with knee pain. The thresholds of joint space narrowing for knee pain were also established.

Physical performance, bone and joint diseases, and incidence of falls in Japanese men and women: a longitudinal cohort study.

SUMMARY: This study examined whether physical performance and bone and joint diseases were risk factors for falls in 745 men and 1,470 women from the Research on Osteoarthritis/osteoporosis Against Disability (ROAD) study (mean, 69.7 years). Slower walking speed was a risk factor for falls in men and women. Knee pain was a risk factor for falls in women. INTRODUCTION: The objective of the present study was to clarify the incidence of falls by sex and age and to determine whether physical performance and bone and joint diseases are risk factors for falls in men and women using a large-scale population-based cohort of the ROAD. METHODS: A total of 745 men and 1,470 women were analyzed in the present study (mean age, 68.5 years). A questionnaire assessed the number of falls during 3 years of follow-up. Grip strength and walking speed were measured at baseline. Knee and lumbar spine radiographs were read by Kellgren-Lawrence (KL) grade; radiographic knee osteoarthritis and lumbar spondylosis were defined as KL = 3 or 4. Knee and lower back pain were estimated by an interview. RESULTS: During a mean follow-up of 3 years, 141 (18.9 %) men and 362 (24.6 %) women reported at least one fall. Slower walking speed was a risk factor for falls in men (0.1 m/s decrease; odds ratio [OR], 1.15; 95 % confidence interval [CI], 1.09-1.23) and women (0.1 m/s decrease; OR, 1.05; 95 % CI, 1.01-1.10). Knee pain was also a risk factor for falls (OR, 1.38; 95 % CI, 1.03-1.84) in women, but lower back pain was not. CONCLUSION: We examined the incidence and risk factors for falls in men and women. Slower walking speed was a risk factor for falls in men and women. Knee pain was a risk factor for falls in women.

Incidence and risk factors for radiographic lumbar spondylosis and lower back pain in Japanese men and women: the ROAD study.

OBJECTIVE: To determine the incidence of radiographic lumbar spondylosis (LS)and lower back pain, and their risk factors in Japan using a large-scale population from the nationwide cohort Research on Osteoarthritis/osteoporosis Against Disability (ROAD) Study. METHODS: Participants in the ROAD study who had been recruited between 2005 and 2007 were followed up with lumbar spine radiography for 3 years. A total of 2,282 paired radiographs (75% of the original sample) were scored using Kellgren and Lawrence (KL) grades, and the incidence and progression rate of radiographic LS was analyzed. The incidence of lower back pain was also examined. In addition, associations between risk factors and incident and progressive radiographic LS as well as incident lower back pain were tested. RESULTS: Given a 3.3-year follow-up, the incidence of KL≥2 radiographic LS was 50.0% and 34.4% (15.3% and 10.5% per year), while that of KL≥3 LS was 15.3% and 23.7% (4.6% and 7.2% per year) in men and women, respectively. The progression rate of LS was 20.5% and 27.4% (6.2% and 8.3% per year) in men and in women, respectively. In addition, the incidence of lower back pain was 28.3% and 31.2% (8.6% and 9.5% per year) in men and women. Lower back pain was not significantly associated with incident radiographic LS, while a more severe KL grade at baseline was associated with incident lower back pain. CONCLUSION: The present longitudinal study revealed a high incidence of radiographic LS in Japan.

Association of radiographic and symptomatic knee osteoarthritis with health-related quality of life in a population-based cohort study in Japan: the ROAD study.

OBJECTIVE: Knee osteoarthritis (OA) is a major public health issue causing chronic pain and disability. However, there is little information on the impact of this disease on quality of life (QOL) in Japanese men and women. The objective of the present study was to clarify the impact of radiographic and symptomatic knee OA on QOL in Japan. METHODS: This study examined the association of radiographic and symptomatic knee OA with QOL parameters such as the Medical Outcomes Study Short Form-8 (SF-8), EuroQOL (EQ-5D) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Radiographic knee OA was defined according to Kellgren/Lawrence (KL) grades, and symptomatic knee OA was defined as KL=3 or 4 with knee pain. We also examined the independent association of symptomatic knee OA and grip strength with QOL. RESULTS: From the 3040 participants in the Research on Osteoarthritis Against Disability (ROAD) study, the present study analyzed 2126 subjects older than 40 years who completed the questionnaires (767 men and 1359 women; mean age, 68.9+/-10.9 years). Subjects with KL=3 or 4 had significantly lower physical QOL as measured by the physical component summary (PCS) score of the SF-8 and pain domains of the WOMAC, whereas mental QOL, as measured by the mental component summary (MCS) score of the SF-8, was higher in subjects with KL=3 or 4 than KL=0 or 1. Symptomatic knee OA was significantly more likely than radiographic knee OA without pain to be associated with physical QOL loss as measured by the PCS score and physical domains of the WOMAC. Symptomatic knee OA and grip strength were independently associated with physical QOL. CONCLUSION: This cross-sectional study revealed that subjects with symptomatic knee OA had significantly lower physical QOL than subjects without it.

Conservative treatment of Garden stage I femoral neck fracture in elderly patients.

We reviewed 38 patients aged 65 years and older with fresh Garden stage I femoral neck fractures treated nonsurgically to determine factors that influence fracture union. The mean follow-up period was 20 (range 6-86) months. Twenty-three (61%) fractures united within 6 months after injury, while 15 (39%) failed to unite. The percentage of united fractures was considerably higher (p < 0.01) in patients who began bed-to-wheelchair transfer training 14 days or later after injury than in those who began training within 13 days. The incidence of union was considerably higher (p < 0.05) in patients who began ambulation 20 days or later after injury than in those who began within 19 days. There was no statistical difference in the amount of valgus or retroversion of the femoral head between patients whose fractures united and those whose fractures did not. Patients without severe dementia regained the ability to walk significantly more frequently than did patients with severe dementia (p < 0.05).

Operative results of canal-expansive laminoplasty for cervical spondylotic myelopathy in elderly patients.

STUDY DESIGN: The study involved elderly patients (age > or = 65), who underwent treatment for cervical spondylotic myelopathy by canal-expansive laminoplasty. OBJECTIVES: To determine the factors that influence the operative results of canal-expansive laminoplasty for treatment of cervical spondylotic myelopathy in elderly patients. SUMMARY OF BACKGROUND DATA: Although there have been previous reports of many operative procedures, to the authors' knowledge there are no reports on the results of surgical treatment for cervical spondylotic myelopathy in elderly patients, treated by a unified surgical procedure. To date, no attempts have been made to predict the results of these procedures. METHODS: Forty-seven patients (age > or = 65) who underwent canal-expansive laminoplasty were reviewed in this study. The severity of the clinical picture and the quality of operative results were graded according to the Japanese Orthopaedic Association scoring system. RESULTS: Of the 13 patients whose period of disability persisted for less than 3 months before the operation, 12 were able to walk after surgery. The operative results of patients more than 80 years of age were not significantly different from those of patients aged between 65 and 79 years. Results of multiple regression analysis indicate that the predictive probability of the postoperative motor function score of the lower extremities was 70%. CONCLUSIONS: The severity of the clinical picture and the duration of symptoms influenced the outcome of the operation. Despite the advanced age of some patients (> 80), the operation increased the chance of recovery from the disease.

Direct interaction of lignin and lignin peroxidase from Phanerochaete chrysosporium.

Binding properties of lignin peroxidase (LiP) from the basidiomycete Phanerochaete chrysosporium against a synthetic lignin (dehydrogenated polymerizate, DHP) were studied with a resonant mirror biosensor. Among several ligninolytic enzymes, only LiP specifically binds to DHP. Kinetic analysis revealed that the binding was reversible, and that the dissociation equilibrium constant was 330 microM. The LiP-DHP interaction was controlled by the ionization group with a pKa of 5.3, strongly suggesting that a specific amino acid residue plays a role in lignin binding. A one-electron transfer from DHP to oxidized intermediates LiP compounds I and II (LiPI and LiPII) was characterized by using a stopped-flow technique, showing that binding interactions of DHP with LiPI and LiPII led to saturation kinetics. The dissociation equilibrium constants for LiPI-DHP and LiPII-DHP interactions were calculated to be 350 and 250 microM, and the first-order rate constants for electron transfer from DHP to LiPI and to LiPII were calculated to be 46 and 16 s-1, respectively. These kinetic and spectral studies strongly suggest that LiP is capable of oxidizing lignin directly at the protein surface by a long-range electron transfer process. A close look at the crystal structure suggested that LiP possesses His-239 as a possible lignin-binding site on the surface, which is linked to Asp-238. This Asp residue is hydrogen-bonded to the proximal His-176. This His-Asp...proximal-His motif would be a possible electron transfer route to oxidize polymeric lignin.

Recurrent dislocation of the patella in Kabuki make-up syndrome.

Three patients with Kabuki make-up syndrome (KMS) who had recurrent dislocation of the patella are reported. In all, dislocation of the patella developed in adolescence, and they had generalized ligamentous laxity and dysplasia of the patellofemoral joints. In two of the three patients, surgical intervention was required; the operation was successful in one, but yielded poor results in the other. In the third patient, cardiac complications precluded operation. Orthopedists should be aware of this possible complication when treating patients with KMS.