The prevalence of osteoarthritis: Higher risk after transfemoral amputation?-A database analysis with 1,569 amputees and matched controls.

BACKGROUND: Several studies have shown that patients with a unilateral amputation have an increased risk of developing osteoarthritis (OA) in the knee of their sound leg. OBJECTIVE: The first objective was to investigate whether amputees are more frequently affected by gon-, cox- or polyarthritis as well as back pain or spinal disorders. We hypothesized that mobile and active transfemoral amputees more often experience OA and spinal disorders than non-amputees. The second objective was to compare the mean age of the patients with OA. PATIENTS: Patients with a unilateral transfemoral amputation (n = 1,569) and five abled-body control groups (each n = 1,569) matched in terms of age and gender resulting in total of 9,414 participants. METHODS: Groups were analyzed regarding the prevalence of six selected diagnoses regarding musculoskeletal disorders. RESULTS: A significantly decreased prevalence of OA and specific disorders of the spine in transfemoral amputees compared to a control group was found. The amputees with OA are significantly younger than patients with OA in the control group. CONCLUSION: The results from the presented study contradict previously published literature. Apparently circumstances of life play an important role, like physical work and strenuous activities which are likely to be underrepresented in the amputee group. The results of the study need to be used cautiously due to the major limitation of the study which is the lack of detail in individual patients caused by the methodology.

[Hip dysplasia and spinal osteochondritis (Scheuermann's disease) in a girl with type II manifesting collagenopathy]. / Hüftdysplasie und Morbus Scheuermann bei einem Mädchen mit Typ-II-Kollagenopathie.

OBJECTIVES: This paper describes the natural course of irritable hip pain associated with spinal rigidity and pain in the thoracic region with subsequent development of mild kyphosis in a girl with a mutation in the collagen 2 alpha 1 gene (type II collagenopathy). METHODS: Phenotypic and genotypic characterization was carried out in a 14-year-old girl to identify the underlying pathology of severe irritable hip pain associated with thoracic spinal rigidity and pain. Detailed clinical examination, skeletal survey and genetic testing were performed accordingly. Bernese periacetabular osteotomy was used to alleviate pain and to improve the anatomical correlation of the acetabular and femoral heads. RESULTS: Short stature associated with acetabulo-femoral dysplasia, spinal osteochondritis (Scheuermann's disease) and mild thoracic kyphosis were the most prominent abnormalities. Genetic analysis showed a heterozygous mutation in the collagen type II gene (COL2A1-c.1636G>A, p. G546S). A Bernese periacetabular osteotomy was performed to improve the clinical status of the patient. There was significant improvement in the extrusion index, the acetabular index and the lateral center-edge angle. CONCLUSIONS: Hip dysplasia and Scheuermann's osteochondritis have never been reported in connection with a mutation in COL2A1 (collagenopathy type II). Awareness is needed for careful phenotypic and genotypic characterization in patients with irritable hip pain and spinal stiffness.

[Rehabilitative treatment of spine osteochondropathies in children and adolescents].

Vertebral osteochondropathies are socially significant conditions. The use of neurorehabilitation techniques may improve their clinical and vital prognosis. These methods include postural correction, traction therapy, breathing exercises, sculptural gymnastics, hypoxic barotherapy, and proprioreceptive neuromuscular facilitation.

Artificial disc versus spinal fusion in the treatment of cervical spine degenerations in tetraplegics: a comparison of clinical results.

STUDY DESIGN: Comparative prospective study. OBJECTIVES: To determine functionality of the cervical spine when using ProDisc C in comparison with the conventional method of treatment (decompression and fusion) in paraplegics. SETTING: Spinal Cord Injury Centre in Germany. METHODS: Two homogeneous groups were studied. The patients were treated with ventral decompression and either had a fusion with an iliac bone graft and plate (group 1) or had received a disc replacement (group 2). Pre- and postoperatively, the subjective scores of SF 36 and Neck Disability Score were determined. Also, objective data of the Spinal Cord Independence Measure (SCIM) III and mobility of the cervical spine, using the neutral-0-method, were evaluated. Prosthesis implementation and union or fusion were monitored by X-rays. Complications and alterations of the neurology were recorded according to the American Spinal Injury Association Score. RESULTS: Neurological remissions of the radicular syndrome that caused the operation were observed. In one case, the dislocation of the prosthesis necessitated an alternative treatment. Mobility of the cervical spine after 6 months was higher in group 2. Both groups showed signs of improvement in the Neck Disability Score and in SF 36. None of the two groups had changes in their SCIM score. One case in group 2 showed ventral blocking; all cases of group 1 fused successfully. CONCLUSION: Usage of prostheses results in improved total mobility of the cervical spine in comparison with the outcomes of a fusion. This study also confirmed these results in tetraplegics.