Kensuke Hotta

Background/Objectives: Knee osteoarthritis (KOA) is multifactorial, and longitudinal evidence isolating early predictors remains limited. We investigated predictors of incident KOA in community-dwelling older adult Japanese women. Methods: We analyzed 191 knees from 105 women aged ≥50 years (baseline Kellgren–Lawrence (KL) grade 0–1) and followed them for 8 years. Incident KOA was defined as KL ≥ 2 at the 8-year follow-up. Baseline measures included body mass index (BMI), physical function (one-leg stance, functional reach), Geriatric Locomotive Function Scale (GLFS-25), EuroQol 5-Dimension (EQ-5D) questionnaire, standing lateral whole-spine radiographs (sagittal spinopelvic parameters), and standing full-length anteroposterior (AP) lower-limb radiographs (coronal alignment parameters). Incident KOA was defined as KL ≥ 2 at follow-up. Group comparisons, multivariable logistic regression, and receiver operating characteristic analyses were conducted. Results: Incident KOA occurred in 58/191 knees (mean participant age 69.3 ± 6.1 years). Compared with non-incident knees, incident knees had higher BMI (23.8 vs. 21.1 kg/m²), higher GLFS-25, greater pelvic tilt and pelvic incidence minus lumbar lordosis (PI–LL) mismatch (11.5° vs. 5.3°), and lower EQ-5D, medial proximal tibial angle, and joint line obliquity. BMI was the strongest single predictor (area under the curve [AUC] 0.753). PI–LL mismatch showed limited standalone discrimination (AUC 0.596) but improved discrimination when combined with BMI (AUC 0.803). Conclusions: BMI was the primary predictor of incident KOA in this cohort. PI–LL mismatch, while not strongly discriminative alone, acted as a complementary marker consistent with sagittal-alignment-related mechanical stress. Results suggest that early screening and prevention should prioritize weight management, using spinopelvic parameters to refine risk stratification.

Introduction The success rate of decompression surgery for lumbar spinal stenosis (LSS) has been reported to vary from 60 to 80%. The purpose of this study was to analyze the predictors for clinical outcomes after tubular surgery for endoscopic decompression (microendoscopic decompression) for LSS. Materials and methods A total of 100 patients with degenerative LSS (M/F: 61/39, Age: mean 69.7 years), who underwent microendoscopic decompression and had a minimum 2-year follow-up (FU) after surgery, were reviewed. All patients suffered from leg-related symptoms predominantly without severe mechanical back pain, preoperatively. The presence of chronic arterial occlusion of the lower limbs was ruled out. The primary outcome measure was clinical evaluation at 2-year FU using the Oswestry Disability Index (ODI). Furthermore, numeric rating scales, Japanese Orthopedic Association (JOA) lumbar score and JOA Back Pain Evaluation Questionnaire were used for secondary outcome measures. Based on findings of univariable analyses, multivariable logistic regression analysis was applied to identify preoperative predictors for the clinical outcomes. Results Sixty-eight patients (68%) were assessed as good outcomes, on the basis of minimum clinically important difference of the ODI (13 points ≤) and final ODI score (< 30 points). The secondary outcomes were further support for the primary outcome. In multivariable logistic regression analysis, co-existence of intradiscal vacuum phenomenon with LSS (odds ratio [OR] 8.26; 95% confidence interval [95% CI] 2.32–29.34; p = 0.001) and ischemic cardiovascular comorbidities (OR, 13.3; 95% CI, 1.9–92.57; p = 0.009) were significantly associated with poor clinical outcomes. Conclusions We found co-existence of intradiscal vacuum phenomenon with LSS and ischemic cardiovascular comorbidity to be preoperative predictors of less favorable clinical outcomes after microendoscopic decompression in selected patients of LSS. Although the conclusion obtained from restricted state, the information would be able to help in patient selection of the tubular surgery for endoscopic decompression for LSS.

Background: When a rescuer walks alongside a stretcher and compresses the patient’s chest, the rescuer produces low-quality chest compressions. We hypothesized that a stretcher equipped with wing boards allows for better chest compressions than the conventional method. Methods: In this prospective, randomized, crossover study, we enrolled 45 medical workers and students. They performed hands-on chest compressions to a mannequin on a moving stretcher, while either walking (the walk method) or riding on wings attached to the stretcher (the wing method). The depths of the chest compressions were recorded. The participants’ vital signs were measured before and after the trials. Results: The average compression depth during the wing method (5.40 ± 0.50 cm) was greater than during the walk method (4.85 ± 0.80 cm; p < 0.01). The average compression rates during the two minutes were 215 ± 8 and 217 ± 5 compressions in the walk and wing methods, respectively (p = ns). Changes in blood pressure (14 ± 11 vs. 22 ± 14 mmHg), heart rate (32 ± 13 vs. 58 ± 20 bpm), and modified Borg scale (4 (interquartile range: 2–4) vs. 6 (5–7)) were significantly lower in the wing method cohort compared to the walking cohort (p < 0.01). The rescuer’s size and physique were positively correlated with the chest compression depth during the walk method; however, we found no significant correlation in the wing method. Conclusions: Chest compressions performed on the stretcher while moving using the wing method can produce high-quality chest compressions, especially for rescuers with a smaller size and physique.