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Objective: To evaluate the reliability and validity of the Thai version of the modified Japanese Orthopaedic Association scale. Methods: The modified Japanese Orthopaedic Association scale was translated into Thai language to create the Thai version of the Modified Japanese Orthopaedic Association (Thai-mJOA) scale. Translation was performed according to international standards using a forward-backward translation protocol. Translation was performed by 2 expert translators and 1 physician, and the final version was approved by an expert committee. Thai patients with cervical spondylosis with myelopathy were enrolled and evaluated using the Thai-mJOA scale, Nurick Grading, the Thai version of the Neck Disability Index (Thai-NDI), and the Thai version of the Short Form-36 (Thai-SF-36). Reliability and validity of the Thai-mJOA were assessed via comparison with the Nurick Grading and the Thai-NDI. Results: Ninety-two patients were included. The most common compression level was C5-C6 vertebral disc. Cronbach’s alpha of the total Thai-mJOA showed excellent internal consistency (0.991). The intraclass correlation coefficient (ICC) for test-retest reliability was 0.981 (95% confidence interval [CI]: 0.972-0.988). Regarding concurrent validity, the motor dysfunction score of the lower extremities and the total score of the Thai-mJOA were strongly correlated with Nurick Grading (r=0.825, r=0.712, respectively). The total score of the Thai-mJOA was moderately correlated with the Thai-NDI (r=0.670). Conclusion: The Thai-mJOA was found to be a valid and reliable tool for evaluating symptom severity in Thai patients with cervical spondylosis with myelopathy.

Inappropriate intervertebral height restoration caused by nonoptimal choice of cage size is common in anterior cervical discectomy and fusion. The purpose of this study was to evaluate the radiological and clinical outcomes of cervical intervertebral distraction performed in prediscectomy under the strain limitation of the intact disc in a procedure defined as disc-limited intervertebral distraction.A total of 61 patients were enrolled. Japanese Orthopaedic Association score, Neck Disability Index, and visual analog scale score for neck pain were evaluated. The parameters of the degenerative intervertebral space height, mean value of the adjacent intervertebral space heights, preoperative and postoperative day 3 segmental height, regional sagittal alignment and global sagittal alignment were measured on plain radiographs. The change in the degenerative intervertebral space height, postoperative day 3 degenerative intervertebral space height, and intervertebral distraction ratio were calculated according to the parameters measured on radiographs.The change in the degenerative intervertebral space height and distraction ratio in the study group were both significantly lower than those in the control group (both P0.001). In the study group, there was no significant difference between postoperative day 3 degenerative intervertebral space height and mean value of the adjacent intervertebral space heights (P = 0.752). The Japanese Orthopaedic Association score improved significantly in both groups, with similar recovery rates. There were significant differences in neck pain score and Neck Disability Index between the groups at the 3 days and 1 month follow-ups (P0.001).Disc-limited intervertebral distraction is beneficial in avoiding overestimation of the cage size when performing anterior cervical discectomy and fusion and physiologically restoring intervertebral space height.

We sought to compare the clinical and radiologic outcomes after anterior cervical surgery between zero-profile (Zero-P) cage and plate-cage construct (PCC).One-hundred and sixteen patients with single-level cervical disk herniation who underwent anterior cervical diskectomy and fusion between May 2015 and March 2017 were enrolled. They were divided into a Zero-P group (61 cases) and a PCC group (55 cases). At 1, 6, 12, and 24 months after the operation, routine follow-up evaluation was recommended including visual analog scale score and Japanese Orthopaedic Association score. The lateral x-ray film was performed at 1 and 24 months postoperatively.All 116 patients successfully completed the operation and achieved bone fusion. While there was no significant difference in the amount of bleeding between the 2 groups, the operation time of the Zero-P group was significantly shorter than that of the PCC group with statistically difference. The visual analog scale score and Japanese Orthopaedic Association score of the 2 groups at each follow-up interval postoperatively were significantly improved compared with that before operation; the difference was statistically significant (P0.05, respectively). While all the C2-7 cervical curvature, segmental Cobb angle, and height of adjacent vertebral body were lost at the 24-month follow-up, the significant difference was observed in the Zero-P group (P0.05, respectively).Compared with the Zero-P system, the PCC system provides a comparable clinical outcome. Although it showed the disadvantages in controlling the operation time and surgical bleeding, the radiologic outcome was better at the 2-year follow-up.

Purpose Degenerative cervical myelopathy (DCM) is the most common non-traumatic cause of spinal cord dysfunction. Prediction of the neurological outcome after surgery is important. The aim of this study was to analyze the relationship between first symptoms of DCM and the neurological outcome after surgery. Methods A retrospective analysis over a period of 10 years was performed. First symptoms such as cervicobrachial neuralgia, sensory and motor deficits and gait disturbances were evaluated regarding the postoperative neurological outcome. The modified Japanese Orthopedic Association Score (mJOA Score) was used to evaluate neurological outcome. Results In total, 411 patients (263 males, 64%) with a median age of 62.6 ± 12.1 years were included. Cervicobrachial neuralgia was described in 40.2%, gait disturbance in 31.6%, sensory deficits in 19% and motor deficits in 9.2% as first symptom. Patients with cervicobrachial neuralgia were significantly younger (median age of 58 years, p = 0.0005) than patients with gait disturbances (median age of 68 years, p = 0.0005). Patients with gait disturbances and motor deficits as first symptom showed significantly lower mJOA Scores than other patients (p = 0.0005). Additionally, motor deficits and gait disturbance were negative predictors for postoperative outcome according to the mJOA Score. Conclusion Motor deficits and gait disturbances as the first symptom of DCM are negative predictors for postoperative neurological outcome. Nevertheless, patients with motor deficits and gait disturbance significantly profit from the surgical treatment despite poor preoperative mJOA Score.

For two decades, many scores, questionnaires, and rating systems have been used to evaluate the functional outcome of children with an upper extremity fracture (UEF). However, only a few of these were created specifically for children, and many assess only elbow function. In the absence of any published review on this topic, we set out to identify and categorize different scores used to evaluate the clinical and functional outcomes of surgically treated pediatric UEFs. A literature search was performed, and 38 studies were identified. The scores used more often were the shortened version of the Disability of the Arm, Shoulder and Hand questionnaire and the Mayo Elbow Performance Score/Index. In a lower number of studies, authors used other scoring systems, including the Mayo Wrist Score, the Patient-Rated Wrist Evaluation, the Patient-Rated Elbow Evaluation, the Metaizeau functional scoring system, the Oxford Elbow Score, the Price and Flynn criteria, the Hardacre Functional Score, the Neer Shoulder Score, the Constant-Murley Shoulder Score, the Modified Orthopedic Trauma Association Score, the Medical Outcomes Study Short Form-36, and the Pediatric Outcomes Data Collection Instrument. Some specific pediatric scoring systems to evaluate the functional outcome of children with a UEF have been suggested, but a single tool that is valid and reliable for skeletally immature patients of all ages is not yet available. Further studies are needed to identify specific pediatric measurements to increase validity, responsiveness, sensitivity, and interpretability of upper limb functional outcome scores in common clinical practice.

INTRODUCTION AND OBJECTIVE:Accurate prediction of competing risks of mortality is a key component of prostate cancer treatment decision-making. We sought to compare the Prostate Cancer Comorbidity ...

Hanahan and Weinberg introduced the “hallmarks of cancer” and typified essential biological abilities acquired by human cancer. Since then, a growing understanding of hallmark principles associated with breast cancer has assisted knowledge-based therapeutics development; however, despite the rapidly increasing number of targeted therapeutics, enduring disease-free responses for most forms of breast cancer is rare. Invasion and metastasis are the most defining feature of breast cancer malignancy and the leading cause of patient mortality. Hence, we propose a modified hallmarks model adapted to breast cancer, in which invasion and metastasis are shifted to the center of attention, thereby emphasizing it as a potentially superior therapeutic target. Although the scientific community highly appreciates the importance of the invasion and metastasis hallmark, as can be demonstrated by the growing number of publications on breast cancer metastasis, very few clinical trials concentrate on testing anti-metastasis inhibitors and even fewer trials focus on inhibitors for breast cancer metastasis. Here, we discuss the obstacles of applying research on invasion and metastasis therapeutics into the clinic and present current developments that could provide a potential solution to this dilemma.

Summary Purpose To assess the quality of YouTube™ videos on keratoconus as an information resource for patients. Methods The words “Keratoconus”, “Crosslinking”, and “Keratoconus treatment for patients” were used as search terms on the official YouTube™ website ( http://www.youtube.com ). All cookies were disabled, the search history of the web browser was deleted just prior to the search, and no additional changes were made to the standard YouTube™ search preferences. The first 180 videos were downloaded. A total of 116 videos were evaluated according to DISCERN score, Journal of the American Medical Association score, and Global Quality Score. Videos were also assessed based on the presence or absence of 10 criteria proposed by two ophthalmologists. Results One hundred and sixteen videos were analyzed after the exclusion of 54 videos that were either duplicates, irrelevant, or in languages other than English. The mean DISCERN, Journal of the American Medical Association and Global Quality scores were 43.25 ± 11.52, 1.30 ± 0.90, 3.05 ± 0.96 respectively. Fifty-six (48.3%) videos had been uploaded by physicians, 23 (19.8%) by healthcare organizations, 23 (19.8%) by patients, and 14 (12.1%) by other entities such as independent organizations and YouTube™ health channels. The most commonly satisfied criterion was information on treatment modalities (82.7%). Conclusion Keratoconus is a disease of youth, therefore YouTube™ videos would seem to be an easily accessible, informative and educational source, especially for younger patients. However, these videos are not useful as information resources and overall do not offer any additional benefit to patients.

To study pattern and rate of neurological functional recovery after surgery for cervical spondylotic myelopathy (CSM).This prospective study comprised 25 patients with CSM who underwent surgical decompression at our institution. Upper limb, lower limb, and sphincter functions were assessed using the modified Japanese Orthopaedic Association score (mJOA). Assessment was done before the operation and at 1 month, 3 months, and 1 year after surgery.The mJOA score did not significantly increase at 1 month after surgery (P = 0.051); however, increase in mJOA score was statistically significant at 3 and 1 year after surgery (P0.001 and P0.001, respectively). Upper limb motor dysfunction improved in 65% of patients, lower limb motor dysfunction improved in 52% of patients, upper limb sensory dysfunction improved in 48% of patients, and sphincter dysfunction improved in 14.2% of patients. There was a significant positive correlation between preoperative and postoperative mJOA score at 1 month, 3 months, and 1 year after surgery.Minimal improvement occurred in the first month after CSM surgery to reach a peak at 3 months after surgery and steady improvement up to 1 year after surgery. Upper limbs recovered better and earlier than lower limbs and sphincter function. Preoperative severity of CSM is one of the main predictors of postoperative neurological outcome.

Introduction: The modified Japanese Orthopaedic Association (mJOA) score is considered to be among the most comprehensive scores in the assessment of patients with cervical myelopathy. Hence, providing reliable, translated, and cross-culturally adapted versions in different languages is required to standardize the evaluation of patients. This study aimed to translate a reliable Arabic version of the mJOA score. Methods: A total of 65 patients of variable age and with etiologies for compressive cervical myelopathy were recruited. Both forward and backward translations were performed. Then, intraobserver and interobserver reliabilities were measured using the intraclass correlation coefficient and Cronbach's alpha coefficient. Results: The mean age of the patients was 58.08 years, and most of them were male (69.2%). The intraobserver and interobserver reliabilities were almost in perfect agreement for the different sections and the total score, which were 96.8% and 97.4%, respectively. Conclusions: In this study, a reliable, cross-culturally adapted Arabic version of the mJOA score for patients with cervical myelopathy is provided. Although the study was conducted on Egyptian patients, we believe that it could be implemented in majority of the Arabic-speaking population.

This paper presents a novel framework for fraud detection in healthcare systems which self-learns from the historical medical data. Historical medical records are required for training and testing of machine learning models. The main problem being faced by both private and government health supported schemes is a rapid rise in the amount of claims by beneficiaries mostly based on fraudulent billing. Detection of fraudulent transactions in healthcare systems is a strenuous task due to intricate relationships among dynamic elements including doctors, patients, service. In light of aforementioned challenges in health support programs, there is a need to develop intelligent fraud detection models for tracing the loopholes in procedures which may lead to successful reimbursement of fraudulent medical bills. In order to address the issue of fraud in healthcare programs our solution proposes a framework based on three entities (patient, doctor, service). Firstly, the framework computes association scores for three elements of the healthcare ecosystem namely patients, doctors or services. The framework filters out identified cases using association scores. The Confidence values, after G-means clustering of transactional data, are computed for each service in each specialty. Rules are generated based on the confidence values of services for each specialty. Then, an evaluation of identified cases is done using rule engine. The framework classifies cases into fraudulent activities based on the similarity bit&rsquo, s value. The validation of framework is performed on local hospital employees transactional data which includes many reported cases of fraudulent activities in addition to some introduced anomalies.

Cumulative experimental studies have demonstrated the critical roles of microRNAs (miRNAs) in the diverse fundamental and important biological processes, and in the development of numerous complex human diseases. Thus, exploring the relationships between miRNAs and diseases is helpful with understanding the mechanisms, the detection, diagnosis, and treatment of complex diseases. As the identification of miRNA-disease associations via traditional biological experiments is time-consuming and expensive, an effective computational prediction method is appealing. In this study, we present a deep learning framework with variational graph auto-encoder for miRNA-disease association prediction (VGAE-MDA). VGAE-MDA first gets the representations of miRNAs and diseases from the heterogeneous networks constructed by miRNA-miRNA similarity, disease-disease similarity, and known miRNA-disease associations. Then, VGAE-MDA constructs two sub-networks: miRNA-based network and disease-based network. Combining the representations based on the heterogeneous network, two variational graph auto-encoders (VGAE) are deployed for calculating the miRNA-disease association scores from two sub-networks, respectively. Lastly, VGAE-MDA obtains the final predicted association score for a miRNA-disease pair by integrating the scores from these two trained networks. Unlike the previous model, the VGAE-MDA can mitigate the effect of noises from random selection of negative samples. Besides, the use of graph convolutional neural (GCN) network can naturally incorporate the node features from the graph structure while the variational autoencoder (VAE) makes use of latent variables to predict associations from the perspective of data distribution. The experimental results show that VGAE-MDA outperforms the state-of-the-art approaches in miRNA-disease association prediction. Besides, the effectiveness of our model has been further demonstrated by case studies.

Background: The purpose of this study is to investigate the quality and reliability of YouTube videos regarding developmental dysplasia of the hip (DDH).YouTube is one of the most popular websites used as a source of information, but the variety in authorship and lack of a peer-review process are problems.Methods: The search string “developmental dysplasia of the hip” was inputted to the YouTube search engine, and the first 52 videos returned as a response were assessed. The Video Power Index (VPI) (like ratio*view ratio/100) was used to assess the popularity of the videos. Global Quality Score (GQS) and developmental dysplasia of the hip scores (DDHS) were used to evaluate the quality and educational quality of the videos, and The Journal of the American Medical Association Score (JAMAS) was used to evaluate the accuracy of the source of information.Results: According to our research, the mean duration time of the videos was 526 s (SD: 813), and the average view count of the videos was 34,644. The mean time since upload was 1907 days (SD: 1137). On average, the videos received 10.9 comments, 210.3 likes, and 6.8 dislikes. The mean like ratio and VPI were 92.9 (SD: 19.57) and 25.8 (SD: 53.43), respectively. The mean JAMAS, GQS, and DDHS of all videos evaluated were 1.37 (SD: 0.7), 2.46 (SD: 1.09), and 4.63 (SD: 5.00), respectively. The DDHS and GQS were positively correlated (p:0.001 r: 65.8%). The GQS and the DDHS were higher in the academic group than in the commercial group (p:0.01). (p:0.037).Conclusions: The videos regarding DDH on YouTube generally had poor quality. As a result, to maintain an optimal parent–physician or patient–physician relationship, we suggest that international health societies make their own educational videos for parents, patients, and fellow physicians.

Background Spondylotic cervical myelopathy (SCM) is a common cause of spinal-related disability in elderly patients. The assessment of this disability is a challenging task and depends on the subjective evaluation of the investigator. As a widespread-used scale, the modified version of the Japanese Orthopaedic Association score (mJOA) should be translated and culturally adapted in the Brazilian Portuguese language (i.e., mJOA-Br) to provide its clinical and research use. This study aimed to perform translation, transcultural adaptation, and validation of the mJOA into Brazilian Portuguese. Methods Following the transcultural adaptation model described by Guillemin et al., the scale as translated into Brazilian Portuguese and back-translated to English. Afterwards, questionnaires were applied in consecutive patients with SCM and compared with a control group (without SCM). The final scale was compared with the Brazilian version of Neck Disability Index for validation. Results Sixty patients were submitted to the translated version of mJOA. There was a strong correlation between mJOA-Br scores and Neck Disability Index scores to evaluate SCM symptoms (R = −0.75). Conclusions mJOA-Br was considered a valid and reliable tool to evaluate patients with SCM.

Objective: The purpose of this study was to evaluate the clinical results of arthroscopic rotator cuff repair with a tape-attached anchor: The HEALICOILRG with ULTRATAPE. We hypothesised that performing arthroscopic rotator cuff repair with tape-attached anchors would result in better clinical outcomes and reduce the retear rate compared with conventional suture anchors. Methods: We included 83 patients treated by arthroscopic rotator cuff repair with a minimum 1-year follow-up. We divided them into two groups: Use of the HEALICOILRG with ULTRATAPE (group T: 41 shoulders; mean patient age, 64.3 years) and use of the conventional suture anchor (group S: 42 shoulders; mean patient age, 68.9 years). We compared the University of California Los Angeles scores, Japanese Orthopaedic Association scores, range of motion, and retear rate between the two groups. The Student t test and chi-square test were used in statistical analyses. Results: At the 1-year postoperative follow-up, both groups showed improvement in the average University of California Los Angeles score, Japanese Orthopaedic Association score, and range of motion, although no significant difference was found in the retear rate between the two groups. Conclusions: Results of arthroscopic rotator cuff repair with the HEALICOILRG with ULTRATAPE were generally good. However, our results could not demonstrate efficacy of the HEALICOILRG with ULTRATAPE. Further detailed studies are needed to determine its treatment result.

Objective Patients are increasingly referring to the Internet after a diagnosis of vascular disease. This study was performed to quantitatively define the accuracy and reliability of information on YouTube regarding abdominal aortic aneurysms (AAA). Methods A systematic search of YouTube was conducted using multiple AAA-specific keywords. The default YouTube search setting of “relevance” was used to replicate an average search attempt, and the first 50 results from each keyword search were reviewed and analyzed by two independent reviewers. Descriptive characteristics, Journal of the American Medical Association Score, modified DISCERN score, Video Power Index, and a novel scoring system for the management of AAAs, the AAA-Specific Score (AAASS), were used to record data. Inter-rater agreement was analyzed using intraclass correlation coefficient estimates and the Kruskal-Wallis test was used for intergroup comparisons. Results Fifty-one videos were included for analysis. The mean Journal of the American Medical Association Score, DISCERN, and AAASS values among videos were 1.74/4.00 (standard deviation [SD], 0.84), 2.37/5.00 (SD, 0.97), and 6.63/20.00 (SD, 3.23), respectively. Of all the included videos, 78% were educational in nature, 14% were patient testimonials, and 8% were news programs. Based on the AAASS, the majority of analyzed videos fell into the poor category (41%), followed next by the very poor (31%), moderately useful (25%), very useful (2%), and exceptional (0%) categories. Videos by nonphysicians were significantly more popular (P Conclusions Although variable in source and content, the completeness and reliability of information offered on YouTube for AAA diagnosis and treatment is poor. Patients watching YouTube for information on their AAA diagnosis are receiving an incomplete and perhaps misleading picture of available diagnostic and treatment options. Given that vascular surgeons are likely to be affected by unrealistic treatment expectations from patients accessing online materials regarding AAA, it is important to acknowledge the nature of content on these platforms.

To evaluate surgical outcomes of homogeneous spinal-shortening axial decompression (HSAD) for reoperation in pediatric patients with tethered cord syndrome.Twenty consecutive pediatric patients (≤18 years old, 7 boys, 13 girls) who underwent HSAD after untethering surgery between June 2012 and May 2015 were included. The Japanese Orthopaedic Association score and visual analog scale were used to evaluate preoperative and postoperative neurologic function and pain. The International Consultation on Incontinence Questionnaire-Short Form and urodynamics were used to evaluate urinary function. The Rintala score was used to evaluate stool function.Mean age of patients was 13.4 ± 3.6 years (range, 7-18 years). The mean duration of follow-up was 31.2 ± 12.7 months (range, 12-48 months). The Japanese Orthopaedic Association score was increased from 13.31 ± 4.03 preoperatively to 19.15 ± 4.17 at final follow-up (P0.01). The visual analog scale score was decreased from 5.25 ± 1.78 preoperatively to 2.21 ± 1.63 at final follow-up (P0.01). The International Consultation on Incontinence Questionnaire-Short Form score was decreased from 14.94 ± 4.15 preoperatively to 7.63 ± 4.40 at final follow-up (P0.01). All urodynamics parameters improved compared with before the operation. The Rintala score improved from 5.26 ± 3.45 preoperatively to 12.32 ± 3.43 at final follow-up (P0.01).Outcomes of HSAD for revision surgery of tethered cord syndrome were satisfactory. HSAD improved neurologic function of patients significantly. HSAD could become an alternative surgical treatment of reoperation for tethered cord syndrome.

A retrospective analysis.The aim of this study was to elucidate the psychometric properties of the original Japanese Orthopaedic Association (JOA) score, including the minimum detectable change (MDC), minimum clinically important difference (MCID), and patient-accepted symptom state (PASS).Despite the worldwide popularity of modified JOA score (mJOA), the original JOA score is still commonly used in East Asian countries, including Japan. However, unlike mJOA score, the psychometric properties of JOA score remain poorly understood.We retrospectively reviewed a consecutive series of laminoplasty for degenerative cervical myelopathy patients in a single academic institution. Pre- and postoperative JOA scores were collected, and the recovery rate was calculated. Anchor-based methods were used to determine the cut-off values by a receiver operating characteristic (ROC) curve analysis. The patients were also asked to answer an anchor question analyzing their postoperative health transition used for the MDC and another question assessing the patient satisfaction used for the MCID and PASS.A total of 101 patients were included in the analysis. The mean preoperative JOA score was 10.3 [standard deviation (SD): 2.4), and the mean postoperative JOA score was 13.4 (SD: 2.5). The mean recovery rate was 44%. A total of 68% of the patients admitted that their health condition was at least "somewhat better" than their preoperative condition, and 66% were at least "somewhat satisfied" with the treatment results. On the basis of ROC curve analyses, the MDC and MCID for JOA score in degenerative cervical myelopathy patients were calculated to be 2.5. The PASS was estimated to be 14.5, and the MCID for JOA recovery rate was 52.8%.The MDC, MCID, and PASS for JOA score for degenerative cervical myelopathy patients were reported by anchor-based ROC curve analyses.4.

Posterior atlantoaxial pedicle screw fixation is an effective technique for atlantoaxial instability (AAI). However, because of the complex anatomy of the cranio-cervical junction, it remains challenging to insert atlantoaxial pedicle screw precisely and safely. A novel drill guide template was designed for atlantoaxial pedicle screw placement in this study. The purpose of this study is to quantitatively evaluate the accuracy of atlantoaxial pedicle screw placement using the novel drill guide template. Between June 2014 and September 2015, 32 consecutive patients with AAI were included. Using the Mimics v17.0 and 3-matic v9.0 softwares, a novel drill guide template with two location holes and guide rods was designed. All patients underwent posterior atlantoaxial pedicle screw fixation assisted by the novel drill guide template. After surgery, the entry point and directions of actual and ideal screw trajectories were measured and compared. All patients underwent surgery successfully assisted by the novel drill guide template. A total of 128 atlantoaxial pedicle screws were placed for 32 AAI patients. Postoperative CT scans showed two screws in atlas deviated medially from the pedicle cortex and entered the spinal canal about 1 mm but without symptoms. For both atlas and axis, there were no significant differences in entry point or directions between the ideal and actual screw trajectories (P > 0.05). Significant differences were found in preoperative and postoperative Japanese Orthopaedic Association score and Visual Analogue Score (P

There is increasing interest in scoring systems to prioritize patients for hip and knee arthroplasty. The purpose of this study was to determine the effectiveness of the New Zealand Orthopaedic Association (NZOA) score and compare it with patient-reported scores of patients listed for hip and knee arthroplasty.Over a 1-year period, all patients listed for primary hip and knee arthroplasty were scored by a prioritization nurse. The NZOA score, outcome, preoperative Oxford hip or knee score (OHKS) and reduced Western Ontario McMaster osteoarthritis index (WOMAC) score (RWS) were collected.Overall, 608 patients were listed for hip (319) or knee (289) arthroplasty. The mean scores for knees were all better than hips (P.001). On initial scoring, 324 patients (53%) were given certainty (mean NZOA, 80.5; OHKS, 10.0; RWS, 35.1), 90 (15%) given clinical over-ride (NZOA, 69.6; OHKS, 12.0; RWS, 33.2), and 194 (32%) returned to general practitioner (NZOA, 64; OHKS, 14.2; RWS, 30.8). Knees (38%) were more likely to be returned than hips (26%; P = .002). Fifty (26%) were re-referred during the study period (mean, 5 months) and given certainty or over-ride. The difference at final outcome between patients with certainty and clinical over-ride was NZOA, 10.3 points; Oxford, 1.6 points; and RWS, 1.4 points. The difference between clinical over-ride and returned to general practitioner was NZOA, 7.2; Oxford, 4.4; RWS, 5.3.The NZOA score is an effective tool for rationing for joint arthroplasty. Patients around the threshold score of 70 may not have a clinically important difference compared with those above threshold.

The modified Japanese orthopaedic association scale (mJOA) is considered one of the most appropriate outcome measures for the assessment of cervical spondylotic myelopathy (CSM). Moreover, mJOA has been recognised among the key predictors of surgical outcome at a global level. To apply the mJOA successfully at an international level, it should be translated and culturally adapted in the native language of the investigators using this scale. A translated version of the mJOA or any other functional scale has never been studied within an Italian population affected by CSM. The aim of this study has been to describe translation, cultural adaptation and psychometric properties of the Italian version of the mJOA (mJOA-IT). The mJOA-IT was developed following a forward–backward translation procedure. Psychometric properties were assessed on a cohort of patients with CSM undergone anterior or posterior decompression associated with stabilisation in lordosis. The mJOA-IT proved to be a reliable outcome measure for CSM (internal consistency 0.60, test–retest stability 0.910, P

The objective of this study was to validate the efficacy of Takeuchi classification for lateral hinge fractures (LHFs) in open wedge high tibial osteotomy (OWHTO). In all 74 osteoarthritic knees (58 females, 16 males; mean age 62.9 years, standard deviation 7.5, 42 to 77) were treated with OWHTO using a TomoFix plate. The knees were divided into non-fracture (59 knees) and LHF (15 knees) groups, and the LHF group was further divided into Takeuchi types I, II, and III (seven, two, and six knees, respectively). The outcomes were assessed pre-operatively and one year after OWHTO. Pre-operative characteristics (age, gender and body mass index) showed no significant difference between the two groups. The mean Japanese Orthopaedic Association score was significantly improved one year after operation regardless of the presence or absence of LHF (p = 0.0015, p < 0.001, respectively). However, six of seven type I cases had no LHF-related complications; both type II cases had delayed union; and of six type III cases, two had delayed union with correction loss and one had overcorrection. These results suggest that Takeuchi type II and III LHFs are structurally unstable compared with type I.Cite this article: Bone Joint J 2015;97-B:1226–31.

International audience; We propose a method for joint unsu-pervised discovery of multiword expressions (MWEs) and their translations from parallel corpora. First, we apply independent monolingual MWE extraction in source and target languages simultaneously. Then, we calculate translation probability , association score and distributional similarity of co-occurring pairs. Finally, we rank all translations of a given MWE using a linear combination of these features. Preliminary experiments on light verb constructions show promising results.

Background: There are a number of surgical treatment options for cervical spondylotic myelopathy (CSM). In this study, the authors present their clinical results with cervical laminectomy and fusion for the treatment of patients with CSM. Methods: This retrospective study included 58 consecutive patients who underwent cervical laminectomy and fusion for CSM. There were 38 males and 20 females, with a mean age of 64 (range 42-92) years. The Japanese orthopedic association score (mJOA) scale was used as the functional outcome measurement. Both the absolute increase in mJOA and the neurological recovery rate of mJOA were analyzed. The mean clinical follow-up was 17 months (range 5-52 months). Results: There was a statistically significant improvement between mean preoperative (13.2, range 7-17) and postoperative (16.1, range 11-18) mJOA scores following surgery. The average improvement in mJOA score was 2.9 points. The mean neurological recovery rate was 56.6%. Overall 85.5% of patients improved with surgery (n = 51) and the remaining 14.5% of patients had no change in their mJOA score after surgery (n = 7). Fusion was documented in all 58 patients. There was a 10.3% overall complication rate (n = 6). The most common complications were C5 nerve palsies which occurred in 6.9% of the cohort (n = 4); all completely resolved. Conclusion: Cervical laminectomy and fusion is a safe and efficacious procedure for the treatment of CSM. The clinical outcomes appear to be quite reproducible, and this technique is an important part of a spine surgeon's armamentarium.

Purpose: To evaluate the prognostic factors that affect the surgical outcome of laminoplasty in patients with cervical compressive myelopathy. Methods: This is a retrospective review of 43 cases of multi-level cervical compressive myelopathy treated operatively with expansive laminoplasty (Itoh surgical technique), from June 1989 to August 2008. The mean follow-up duration was 7 years. The Japanese Orthopaedic Association score, Hirabayashi recovery rate and improvement of Pavlov's ratio were used to assess the clinical results after laminoplasty. Results: The mean Japanese Orthopaedic Association score improved from 9.7 to 13.7 points after laminoplasty (p

To present the surgical technique, clinical outcomes, and poor prognostic factors of arthroscopic retrograde osteochondral autograft transfer of the tibial plateau.Twelve patients (6 men, 6 women; mean age, 38.7 years) with tibial plateau osteochondral lesions underwent surgery. The primary diseases were osteonecrosis in 4 cases, cartilage injuries in 6, and postfractures of the tibial plateau in 2. Clinical outcomes were evaluated preoperatively and postoperatively according to the International Knee Documentation Committee score and the Japanese Orthopaedic Association score. The International Cartilage Repair Society score was recorded in 7 cases who underwent second-look arthroscopies postoperatively. Statistical analyses were performed to identify prognostic factors associated with the clinical outcomes.The mean International Knee Documentation Committee and Japanese Orthopaedic Association scores were both significantly improved from 39.0 (range, 13.0-57.1) to 72.4 (range, 33.3-100) (P = .0022) and from 65.8 (range, 30.0-85.0) to 85.8 (range, 50.0-100) (P = .0022.05), respectively. In 2 cases, secondary operations were performed because of knee pain (1 varus osteotomy of the femur and 1 total knee replacement). The mean International Cartilage Repair Society scores were significantly worse in the 2 cases who required a secondary operation (3.5; abnormal) than in the 5 cases who did not (10.6; nearly normal). The secondary operation rate was significantly higher in cases with lesion size ≥400 mmMost clinical scores improved significantly postoperatively. The results indicate that arthroscopic retrograde osteochondral autograft transfer is an effective procedure to achieve sufficient cartilage congruity for osteochondral lesions of the tibial plateau400 mmLevel IV, therapeutic case series.

Introduction: The purpose of this study was to elucidate the feasibility of microendoscopic discectomy (MED) for the treatment of lumbar disc herniation in elderly patients over the age of 65. Methods: The elderly group consisted of 44 patients (27 men and 17 women; mean age, 69.6 years; mean follow-up, 27.7 months) with sciatic pain caused by lumbar disc herniation who were treated using MED. The younger group was comprised of 44 sex-matched patients younger than 65 years. The younger group also had lumbar disc herniation treated with MED and served as the control group. The clinical outcomes were evaluated using the Japanese Orthopaedic Association score for low back pain (JOA score). Results: The results revealed that the good surgical outcomes achieved in the younger group were also achieved in the elderly group (JOA scores: 14.8 ± 4.1 in the younger group before surgery versus 13.0 ± 3.2 in the elderly group; 26.0 ± 2.4 at follow-up versus 25.5 ± 2.7; recovery rates of JOA scores: 78.3 ± 17.8% versus 77.9 ± 16.6%, respectively). The mean surgical time was 78.3 ± 31.0 min in the elderly group and 69.2 ± 22.9 min (P=0.12) in the younger group; the blood loss was 33.9 ± 71.9 cc and 28.0 ± 37.8 cc (P=0.63), respectively. Complications included a dural tear in two elderly patients, and postoperative discitis and hematoma in one elderly patient each: all of these complications were managed successfully. Conclusion: The results of this study demonstrated that MED is a feasible minimally invasive surgical option for elderly patients with lumbar disc herniation.

Introduction: The purpose of this study is to elucidate the feasibility of microendoscopic discectomy (MED) for the treatment of recurrent lumbar disc herniation. Methods: Thirty-six patients with recurrent lumbar disc herniation were treated using MED (30 men and six women; mean age: 45.7 years, range: 26–80 years; mean follow-up: 24.4 months, range: 12–52 months; mean duration between the primary and revision surgery: 65.9 months, range: 1–320 months) (recurrent group). Sex- and age-matched patients with primary lumbar disc herniation treated by MED served as the control group (primary group). The clinical outcomes were evaluated using the Japanese Orthopaedic Association score for low back pain and questionnaires regarding MED. Results: The average Japanese Orthopaedic Association scores before surgery and at the final follow-up were significantly lower in the recurrent group than in the primary group (10.8 ± 3.4 versus 15.0 ± 4.0 before surgery, P=0.001 and 25.4 ± 2.6 versus 26.8 ± 1.9 at follow-up, P=0.013), while the average recovery rates were not significantly different between the two groups (80.3 ± 14.1% versus 84.5 ± 14.6, P=0.22). The surgical time was significantly longer for the recurrent group than for the primary group (83.0 ± 41.8 min versus 67.1 ± 18.1 min,P=0.042). Of the 18 questionnaire respondents, 17 answered that postoperative pain was milder after MED than after a standard discectomy. Conclusion: MED is a feasible surgical option for recurrent lumbar disc herniation, yielding surgical outcomes comparable to those obtained in primary lumbar disc herniation.

The purpose of this study was to elucidate the feasibility of microendoscopic discectomy (MED) for the treatment of lumbar disc herniation with a bony fragment due to apophyseal separation. Eighteen patients with low back pain and unilateral sciatic pain due to lumbar disc herniation with a bony fragment were treated by MED using the unilateral approach (15 males and three females; mean age, of 28.9 years; mean follow-up period, 21.1 months); 18 age-and sex-matched patients with lumbar disc herniation without a bony fragment treated by MED served as the control group. The clinical outcomes were evaluated using the Japanese Orthopedic Association Score for Low Back Pain (JOA scores; maximum score, 29 points). Evaluation of the results revealed that good surgical outcomes equivalent to those in the control group were obtained in the subjects of LDH with a bony fragment (JOA scores; 14.1+/-3.5 in the patient group vs.15.4+/-2.6 in the control group before surgery; 26.3+/-1.8 in the patient group vs. 26.9+/-1.3 at follow-up after the surgery). Although the mean surgical time was significantly longer in the patient group, there were no intra- or postoperative complications in either group. We conclude that MED using the unilateral approach is a feasible minimally invasive surgical option for patients of lumbar disc herniation with an apophyseal bony fragment.

Aims In this prospective observational study, we investigated the time-dependent changes and correlations of upper arm performance tests (ten-second test and Simple Test for Evaluating Hand Function (STEF), the Japanese Orthopaedic Association (JOA) score, and the JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) in 31 patients with cervical myelopathy who had undergone surgery. Patients and Methods We hypothesised that all the indices correlate with each other, but show slightly different recovery patterns, and that the newly described JOACMEQ is a sensitive outcome measure. Results Peak recoveries were achieved one month post-operatively in the ten-second test and JOACMEQ upper extremity function (UEF) subscale, and at three months in the JOA and STEF scores. The recoveries of all indices were maintained until six months post-operatively. The upper extremity function (UEF) subscale in the JOACMEQ showed the strongest correlation with STEF although all the indices correlated with each other. Patients with ≥ 20 and < 20 acquired points in the UEF subscale were classified into the UEF-improved and UEF-unimproved groups. Comparisons between the groups showed that pre-operative evaluation of “coordinated motion” of the STEF was significantly low in the UEF-unimproved group. Conclusion These results indicate that the JOACMEQ is a concise, sensitive, patient-based outcome measure for evaluating functional recovery in patients with cervical myelopathy who have undergone surgery. Cite this article: Bone Joint J 2016;98-B:990–6.

STUDY DESIGN Cross-cultural translation and cross-sectional psychometric testing were performed. OBJECTIVES To cross-culturally translate the Oswestry Disability Index (ODI) and the Roland-Morris Disability Questionnaire (RMDQ) into Japanese, and to compare the Japanese Orthopaedic Association (JOA) score with the ODI and the RMDQ score. SUMMARY OF BACKGROUND DATA The two most widely used back-specific measures, the ODI and the RMDQ, have not been translated into Japanese. The JOA score has been used extensively in Japan. However, this score has not been tested in terms of its reliability and validity. METHODS The ODI and RMDQ were translated into Japanese using the process of forward translation, synthesis of translation, backward translation, expert committee, test of the prefinal version, and submission of the documentation to the developers. The JOA score, ODI, and RMDQ were tested with 97 patients who had degenerative lumbar spinal disorders (average age, 51 years). The correlation among the three disease-specific measures (JOA score, ODI, and RMDQ) and eight subscales of a generic health measure, the Medical Outcomes Survey Short-Form 36 (SF-36), was calculated. The reproducibility of the JOA score also was investigated. RESULTS Reliability, as estimated by internal consistency, reached a Cronbach alpha of 0.83 for the ODI and 0.86 for the RMDQ. The calculated test-retest reliability was 0.93 (P < 0.01; n = 20) for the ODI and 0.95 (P < 0.01; n = 20) for the RMDQ. The correlation of the JOA score with the ODI was -0.647 (P < 0.01), and with RMDQ was -0.568 (P < 0.01). There also was a significant correlation between the ODI and the RMDQ (r = 0.785; P < 0.01). There was a significant correlation between the three disease-specific measures (JOA score, ODI, and RMDQ) and all the subscales of the SF-36 (P < 0.01). The calculated reproducibility of the JOA score was as follows: interobserver error (r = 0.92, P < 0.01), test-retest reliability (r = 0.91, P < 0.01). CONCLUSIONS The Japanese versions of the ODI and the RMDQ were reliable and valid. The use of these translated instruments can be recommended for future clinical trials in Japan. The results also showed the JOA score had acceptable psychometric properties of reliability and construct validity, suggesting that this score is reliable and valid. Further studies are needed to verify the validity and responsiveness of the JOA score.

This study evaluated the reliability of three rating systems for total knee arthroplasty. Twenty-nine patients were assessed by six observers with the American Knee Society Score, the British Orthopaedic Association Score, and the Oxford 12-item questionnaire. The inter- and intraobserver variations were calculated for the American Knee Society Score and the British Orthopaedic Association Score, as was the reproducibility of the Oxford 1 2-item questionnaire. Components of the scores were evaluated for agreement using Kappa statistics. The British Orthopaedic Association Score had smaller interobserver variation compared to the American Knee Society Score, and the greatest reproducibility of the three systems. This was attributed to the equal weighting of its component variables. The Oxford 1 2-item questionnaire, a self-administered questionnaire that eliminates interobserver error, emerged as the most reliable system. Observer experience affected the reliability of the American Knee Society Score and the British Orthopaedic Association Score. Subjective variables were more reliable and reproducible than the objective components.

Purpose: To clarify the cut-off value of the Japanese Orthopaedic Association (JOA) score corresponding to rotator cuff tear outcome as evaluated by the Constant score. Methods: The subjects were 230 patients with rotator cuff tear. The Constant and JOA scores on the first examination in our hospital were evaluated. After investigation of the correlation between the Constant and JOA scores, the cut-off JOA score was calculated, corresponding to excellent, good and fair outcomes as evaluated by the Constant score. Results: The Constant and JOA scores on the first examination were 49.64 ± 12.84 and 72.52 ± 12.84, respectively, with a strong correlation ( r = 0.87, p < 0.01). Receiver operating characteristic analysis revealed that the cut-off JOA score was 87.0 for excellent outcome (area under the curve, AUC: 0.93; sensitivity: 100%; specificity: 88.6%; p < 0.01), 84.0 for good outcome (AUC: 0.94; sensitivity: 100%; specificity: 83.4%; p < 0.01) and 78.0 for fair outcome (AUC: 0.88; sensitivity: 100%; specificity: 71.3%; p < 0.01). Conclusions: In patients with rotator cuff tear, good outcome as judged by a Constant score of ≥80 corresponds to a JOA score cut-off of 84.0. Judgement of the treatment outcomes and evaluation of the surgical method may be more accurate when using clear cut-off values for the scoring system employed, such as those determined in our study.

We reviewed ninety-two patients who were more than forty years old when they underwent arthroscopic meniscectomy. Their mean age was 56.7 years (range: 40 to 80 years). These patients were evaluated using the Japanese Orthopaedic Association Score for meniscus injuries. There was no correlation between age, grade of osteoarthritis on preoperative radiograghs, grade of articular cartilage degeneration, and surgical results. Arthroscopic meniscectomy was proven to be an effective procedure for patients over the age of 40.

We investigated 4 cases of femoral fractures after bipolar hemiarthroplasty and total hip arthroplasty. All 5 cases were female ranging in age from 55 to 90 years (average, 75 years). According to Johansson's classification, 2 cases were type 2; and the others were type 3. Peroprosthetic fractures in 4 femurs were fixed using a plate with cables, long stem with CCG band, supracondylar plate with cables, and Mennen plate with kuntcher nail. After operation, X-ray revealed that all casess resulted in union. The Postoperative Japanese Orthopedic Association score ranged from 46 to 65 points (average: 55.3 points).Open reducation can be a good choice for the treatment of periprosthetic fractures.

The purpose of this study was to investigate the relationship between the restoration of the spinal cord just after decompression surgery and preoperative MRI findings. 13 patients underwent posterior decompression surgery at the cervical and thoracic level. The frontal diameter of the spinal cord was measured using pre-operative MRI and intra-operative ultrasonography. The restoration rate was calculated according to Kataoka's method from the pre and intra-operative diameters. Clinical results were also recorded using the Japanese Orthopedic Association score. Correlation between the restoration rate, clinical results, and MRI findings was evaluated. Significant correlation was observed between the restoration rate and clinical results (R=0.61). Also the spinal cord which indicated high signal intensity on the T2 WI preoperative MRI had a tendency to show a low restoration rate. These results suggest that the combination of the low restoration rate and high signal intensity of the spinal cord indicates severe spinal cord damage.

40 primary uncemeneted total knee arthroplasties (MG II) were performed in 32 patients with osteoarthritis. The average age was 73.0 years at the time of surgery. The follow-up period was an average of 5.6 years (range; 5 to 6.6 years). Clinical evaluations based on the Japanese Orthopedic Association score indicated significant improvements from preoperative to the most recent follow-upexamination. There was no evidence of rentogenographic failure in the femoraland tibial component. None of the knees required revision surgery. The flexion angle at the last follow-up correlated well with the last clinical score, especially in the ability of stairs. The clinical score of patients with flexionangle over 110° was significantly better than that under 110°. These mid-term results of uncemented MG II TKAs proved satisfactory in osteoarthritis. However, a longer follow-up period is necessary for problems related to the patellarcomponent even in MG II TKAs, because mal-alignment of the patella-femoral jointhas been observed in 4 knees.

ObjectiveTo determine functional outcome of anterior cervical decompression and fusion using tricortical iliac bone graft (ACDF) for degenerative cervical spondylotic myelopathy with modified Japan...

Contains fulltext : 87513.pdf (Publisher’s version ) (Closed access) BACKGROUND: Although the Japanese Orthopaedic Association (JOA) originally developed in Japan, the modified English version (mJOA) has become widely used and is arguably now the accepted standard. OBJECTIVE: In order to apply the mJOA successfully at an international level, we have translated it with a validated approach into Dutch to pave the way for other translated versions. METHODS: After a thorough forward and backward translation procedure, a final Dutch version of the mJOA was developed. This translated version was used to assess the interobserver reliability among 2 independent examiners by using a cohort of patients with neurological impairment due to spinal pathology. RESULTS: The mJOA grading scale was used by 2 independent examiners in 25 patients with a variety of spinal diseases. Initially, the interobserver reliability expressed as kappa was 0.56 +/- 0.11. Then, instructions were given to the instructors to refrain from providing patients with an interpretation of the symptoms. Patients were asked to restrict themselves to the questionnaire and select the most appropriate score without bias from the examiner. Kappa increased to 0.78 +/- 0.05. This difference reached statistical significance (P < .001). CONCLUSION: We present a streamlined approach to translate the mJOA into a language other than English. The approach resulted in a Dutch version of the mJOA that had a high degree of interobserver reliability. 01 mei 2010

Eighty-two patients underwent discectomy for herniated nucleus pulposus between 1985 and 1989. Of these, 49 patients were diagnosed having a ruptured disc herniation. All ruptured disc herniations were removed from the posterior approach without fusion. The average improvement rate by the Japanese Orthopedic Association Score was 79.7%. We consider the surgical treatment should be done as early as possible after clinical and imaging assessment of ruptured disc herniation. This attributes a good result.

Lumbar disc herniation in aged patients is relatively rare. Eighteen cases of lumbar disc herniation over 60 years of age treated by Love's operation were evaluated.Pre-operative clinical findings were relatively severe. All patients complained of lumbago and pain of the lower extremity. The average improvement rate by the Japanese Orthopaedic Association Score was 62 percent.

Study Design Prospective cohort study. Purpose To identify differences in time-dependent perioperative changes between the Japanese Orthopaedic Association (JOA) score and the JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) score in patients with cervical spondylotic myelopathy (CSM) and posterior longitudinal ligament (OPLL) who underwent cervical laminoplasty. Overview of Literature The JOA score does not take into consideration patient satisfaction or quality of life. Accordingly, the JOACMEQ was designed in 2007 as a patient-centered assessment tool. Methods We studied 21 patients who underwent cervical laminoplasty. We objectively evaluated the time-dependent changes in JOACMEQ scores and JOA scores for all patients before surgery and at 2 weeks, 3 months, 6 months, and 1 year after surgery. Results The average total JOA score and the recovery rate improved significantly after surgery in both groups, with a slightly better recovery rate in the OPLL group. Cervical spine function improved significantly in the CSM group but not in the OPLL group. Upper- and lower-extremity functions were more stable in the CSM group than in the OPLL group. The effectiveness rate of the JOACMEQ for measuring quality of life was quite low in both groups. In both groups, the Spearman contingency coefficients were dispersed widely except for upper- and lower-extremity function. Conclusions Scores for upper- and lower-extremity function on the JOACMEQ correlated well with JOA scores. Because the JOACMEQ can also assess cervical spine function and quality of life, factors that cannot be assessed by the JOA score alone, the JOACMEQ is a more comprehensive evaluation tool.

How does a shared lexicon arise in population of agents with differing lexicons, and how can this shared lexicon be maintained over multiple generations? In order to get some insight into these questions we present an ALife model in which the lexicon dynamics of populations that possess and lack metacommunicative interaction (MCI) capabilities are compared. We suggest that MCI serves as a key component in the maintenance of a linguistic interaction system. We ran a series of experiments on mono-generational and multi-generational populations whose initial state involved agents possessing distinct lexicons. These experiments reveal some clear differences in the lexicon dynamics of populations that acquire words solely by introspection contrasted with populations that learn using MCI or using a mixed strategy of introspection and MCI. Over a single generation the performance between the populations with and without MCI is comparable, in that the lexicon converges and is shared by the whole population. In multi-generational populations lexicon diverges at a faster rate for an introspective population, eventually consisting of one word being associated with every meaning, compared with MCI capable populations in which the lexicon is maintained, where every meaning is associated with a unique word.

High tibial osteotomy (HTO) is a general procedure for the treatment of degenerative gonarthrosis. In recent years, it has been reported that opening wedge high tibial osteotomy (OWHTO) has become widespread with good results. Despite these facts, HTOs tend to be avoided due to the need for long-term postoperative treatment. To investigate the treatment period for total recovery (healing period) after OWHTO and the factors affecting it. There were 47 cases of medial type degenerative gonarthrosis who underwent OWHTO from 2008 through 2011. The definition of the healing period was based on the time-dependent changes of the Japanese Orthopaedic Association score, focusing especially on pain on walking and pain on ascending/descending stairs. This score was defined as the Ability score. In this study, the healing period ended when the Ability score reached its maximum or when it showed a perfect score. Patients’ characteristics were examined to determine their effect on the healing period. The Ability score was 36.7 ± 10.1 (mean ± SD) before surgery and 51.6 ± 5.4 12 months after OWHTO. The healing period was 6.3 ± 3.9 months. Factors correlated with a longer healing period included female sex (correlation coefficient −0.35) and high BMI (correlation coefficient 0.33). Our study suggested that the healing period after OWHTO is approximately 6 months, and patients’ BMI and sex appear to be related to this period. This information is expected to be helpful for counseling patients undergoing treatment for gonarthrosis. Level of evidence Therapeutic study, Level IV.