High prevalence of sarcopenia in Asian female patients awaiting primary total knee arthroplasty: Application of updated diagnostic tools from the Asian working group for sarcopenia.

INTRODUCTION: Sarcopenia, a loss of muscle mass and strength with aging, is associated with various TKA-related complications. In 2020, the AWGS published an undated guideline (AWGS 2019) based on studies from East and Southeast Asia. The purpose of this study was to determine the prevalence of sarcopenia in Asian female patients awaiting primary total knee arthroplasty due to advanced knee osteoarthritis using the updated AWGS criteria. MATERIALS AND METHODS: The present study included 138 female patients who scheduled for primary TKA with severe osteoarthritis. The included patients were assessed with use of an AWGS 2019 diagnostic criteria based on muscle strength, physical performance, and appendicular skeletal muscle mass. Clinical parameters related to sarcopenia were collected and knee status assessed using the Knee Society scoring system. To better define the association with age, patients were stratified into following four groups: <60, 60-69, 70-79, ≥80. The prevalence of sarcopenia was identified, and the association between sarcopenia and clinical variables was analyzed. RESULTS: The prevalence of sarcopenia and severe sarcopenia in this cohort according to the updated AWGS criteria was 35.5% and 21.7%. Prevalence of sarcopenia and severe sarcopenia significantly increased with advancing age (p = .003, p = .040, respectively). Although not statistically significant, the proportion of severe sarcopenia among sarcopenia also increased with age. Multivariate logistic regression analysis revealed that lower BMI and lower 25-OH-vitamin D3 level were independent risk factors associated with sarcopenia in women awaiting TKA. CONCLUSIONS: In conclusion, our study confirmed that sarcopenia is more prominent amongst female patients awaiting primary TKA than the general population. Therefore, orthopedic surgeons should consider sarcopenia prevention and intervention in this group. Further studies are needed to investigate the effect of TKA on sarcopenia, and the difference of TKA outcomes between groups with or without underlying sarcopenia.

Evaluation of the Effusion within Biceps Long Head Tendon Sheath Using Ultrasonography.

BACKGROUND: Many shoulder diseases are related to glenohumeral joint synovitis and effusion. The purpose of the present study is to detect effusion within the biceps long head tendon sheath as the sign of glenohumeral joint synovitis using ultrasonography, and to evaluate the clinical meaning of effusion within the biceps long head tendon sheath. METHODS: A consecutive series of 569 patients who underwent ultrasonography for shoulder pain were reviewed retrospectively and ultimately, 303 patients were included. The authors evaluated the incidence and amount of the effusion within the biceps long head tendon sheath on the ultrasonographic short axis view. Furthermore, the authors evaluated the correlation between the amount of effusion within the biceps long head tendon sheath and the range of motion and the functional score. RESULTS: The effusion within the biceps long head tendon sheath was detected in 58.42% of the patients studied: 69.23% in adhesive capsulitis, 56.69% in rotator cuff tear, 41.03% in calcific tendinitis, and 33.33% in biceps tendinitis. The average amount of the effusion within the biceps long head tendon sheath was 1.7 ± 1.6 mm, and it was measured to be the largest in adhesive capsulitis. The amount of effusion within biceps long head tendon sheath showed a moderate to high degree of correlation with the range of motion, and a low degree of correlation with the functional score and visual analogue scale for pain in each type of shoulder disease. CONCLUSIONS: The effusion within the biceps long head tendon sheath is closely related to the range of motion and clinical scores in patients with painful shoulders. Ultrasonographic detection of the effusion within the biceps long head tendon sheath might be a simple and easy method to evaluate shoulder function.

Are delayed operations effective for patients with rotator cuff tears and concomitant stiffness? An analysis of immediate versus delayed surgery on outcomes.

PURPOSE: The purpose of this study was to compare the clinical outcomes of immediate rotator cuff repair with capsular release and those of rotator cuff repair after the stiffness was treated with rehabilitative therapy. METHODS: Between June 2007 and December 2010, we recruited 63 patients with rotator cuff tears and stiffness. In 33 patients arthroscopic rotator cuff repair was performed with capsular release simultaneously (group I). In 30 patients arthroscopic rotator cuff repair was performed after 6 months of preoperative rehabilitation for stiffness (group II). The American Shoulder and Elbow Surgeons score, Simple Shoulder Test score, Constant score, and visual analog scale score for pain and range of motion (ROM) were assessed at the start of the study; at 3, 6, and 12 months; and at the last visit. The postoperative cuff tendon integrity was assessed between 6 and 12 months using magnetic resonance or ultrasound images. RESULTS: There were no significant differences in preoperative demographic data between the groups (P > .05). The mean follow-up period was 21.54 months. After treatment, there was significant improvement in ROM and functional scores in both groups, as measured at the last follow-up (P < .05). No statistical differences were found in clinical scores and ROM at the last follow-up (P > .05). On assessment of the magnetic resonance or ultrasound images taken 6 to 12 months postoperatively, the retear rate for the repaired cuff tendon in each group was 12.1% in group I and 13.4% in group II. CONCLUSIONS: In the treatment of rotator cuff tears with stiffness, satisfactory results can be achieved either by repairing the tear with simultaneous capsular release or by waiting to perform the repair after preoperative rehabilitation for stiffness. Because a delayed rotator cuff repair after improving ROM offered no clear advantage over an immediate operation, we recommend surgically treating rotator cuff tears with concomitant stiffness early using a simultaneous capsular release method to save time and to avoid unnecessary rehabilitation. LEVEL OF EVIDENCE: Level II, prospective comparative study.