Gender Differences in Osteoarthritis of Knee: An Indian Perspective.

INTRODUCTION: The global burden of knee osteoarthritis (KOA) is on the rise with advancing age, as life expectancy is improving worldwide. The literature shows a higher prevalence and incidence of KOA in women. The gender differences are seen not only in the developing world but also in the developed world. KOA at advanced stage can be quite disabling affecting the individuals' functioning capacity. The available treatment modalities can improve the quality of life significantly. The aim of this review is to study the gender differences in epidemiological and clinical aspects of KOA in Indian population. METHODS: The keywords "knee osteoarthritis, Gender, India," "knee osteoarthritis, Sex, India," and "knee osteoarthritis, Prevalence, India" are used for data search for retrieving data from Indian studies in MEDLINE and Google Scholar. The broad inclusion criteria were clinical and radiological diagnosis of KOA, inclusive of both men and women and excluded articles with rheumatoid arthritis, inflammatory arthritis, and secondary causes of arthritis. RESULTS: A total of 18 articles were found to fulfill the broad inclusive criteria. Majority of the articles were cross-sectional prevalence studies either done in a community setup or in tertiary care hospitals. The overall prevalence of KOA in these studies ranges from 27.1% to 66.1%, depending on the lower age limit of the study population. Postmenopausal women are affected more than premenopausal women. High body mass index, hypertension, diabetes mellitus, and osteoporosis were the common comorbid conditions. DISCUSSION & CONCLUSION: The gender difference in the incidence and prevalence is seen in several cross-sectional studies and case series in the Indian literature. However, there is a paucity of data on clinical presentation, progression of the diseases, disability scoring at various stages of the KOA, and management.

Spontaneous thigh compartment syndrome.

A young man presented with a painful and swollen thigh, without any history of trauma, illness, coagulopathic medication or recent exertional exercise. Preliminary imaging delineated a haematoma in the anterior thigh, without any fractures or muscle trauma. Emergent fasciotomies were performed. No pathology could be identified intra-operatively, or on follow-up imaging. A review of thigh compartment syndromes described in literature is presented in a table. Emergency physicians and traumatologists should be cognisant of spontaneous atraumatic presentations of thigh compartment syndrome, to ensure prompt referral and definitive management of this limb-threatening condition.

Tibial compartment syndrome and the cavovarus foot.

Compartment syndrome of the leg is an orthopedic emergency that requires a high index of suspicion for diagnosis and a low threshold for surgical management to prevent devastating complications. Where the clinical findings are subtle, continuous monitoring of compartment pressures, with clinical correlation, is the key to diagnosis. Surgical management should include decompression of all four compartments and early rehabilitation to prevent ischemic contracture. If contracture develops, it may cause varying degrees of equinocavovarus deformity of the foot and ankle. Appropriate evaluation and careful surgical planning that considers all components of this complex deformity are essential for obtaining good clinical results.