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Demographics & Epidemiology

Global incidence and trends of spinal pathologies, focusing on age-related vertebral fractures and sex-based disparities in spinal cord injuries.

Overview

Orthopaedic epidemiology increasingly integrates life course concepts to better characterize conditions such as back pain [1]. Population-based data now define incidence for specific pathologies, including the first comprehensive North American estimates for elbow dislocations [2] and resource requirements for traumatic brachial plexus injuries in Western European demographics [4]. Similarly, prevalence and incidence estimates for doctor-diagnosed Dupuytren's disease provide essential metrics for healthcare planning and resource allocation [7].

Demographic profiles and disease severity vary significantly by geography, with distinct differences observed between the United States and Europe regarding radiological osteoarthritis grades and self-reported survey scores [3]. In total joint arthroplasty, notable disparities exist in patient demographics, epidemiologic characteristics, and inpatient outcomes between high-volume and low-volume centers [9]. Recent trends from 2015 to 2020 indicate that same-day total hip arthroplasty programs have enrolled a higher proportion of African Americans, older individuals, and patients with greater preexisting comorbidity burdens [11].

Accurate surveillance of incidence trends and associated costs is critical for resource allocation, particularly for hip fractures in urban China [36]. While sociodemographic factors significantly influence surgical outcomes, contemporary randomized controlled trials in spine surgery surprisingly lack this data [13]. Understanding current evidence and appropriate indications for emerging technologies in orthopaedic trauma remains vital for their effective utilization [20]. Methods for population-level surveillance of revision burdens now enable between-country benchmarking for the lifetime risk of revision hip replacement surgery [10].

Anatomy & Pathophysiology

Osseous and Vertebral Morphology

Lumbar spinal degeneration follows an ordered progression beginning in the anterior structures for the majority of individuals [5], with different spinal subtypes exhibiting characteristics of lumbar disc degeneration at specific levels that vary with age [25]. The presence of 11 thoracic vertebrae and 6 lumbar vertebrae represents a variation in vertebral count that surgeons must consider when assessing spinal alignment and parameters [40]. Age and bone mineral density (BMD) are major risk factors for vertebral fracture risk [83], while waist-to-height ratio (WOD) and abdominal height (AHD) effectively predict vertebral deformities [66]. Long-term shoulder loading in youth is a risk factor for pathological thoracic kyphosis, particularly in the lower thoracic spinal segments, as farmers age [79].

Kinematics and Measurement

Posterior and posterior superior labral injuries produce alterations in glenohumeral kinematics with implications for joint instability, increased joint loading, and potential joint damage [63]. Measurement of thoracic kyphosis (TK) with T2 on standing whole spinal radiographs results in a measurement error of up to 6.6° compared to upright computed tomography images [81]. Cervical kyphosis is associated with health-related quality of life [73], and the degree of scoliosis in adolescents is mainly mild, necessitating timely intervention and prevention [68].

Epidemiology and Risk Factors

The global disease burden of low back pain remained high from 1990 to 2019 [74], though the global burden of vertebral fractures showed a steady reduction from 1990 to 2021 [84]. Most low back pain diagnoses in outpatient settings are categorized as specific according to German guidelines, contrary to common international assumptions [75]. Thoracic spine pain is associated with concurrent musculoskeletal pain, psychological factors, and specific postural or lifestyle factors, though many associations are weak or inconsistent [46]. Participation in one or more high-impact sports in adulthood is associated with larger vertebral size and increased vertebral strength among middle-aged women [57]. Increased screen time is associated with a higher risk of spinal pain in pre-adolescents [77], whereas higher levels of physical activity are associated with a lower risk of spinal pain in pre-adolescents [77].

Classification

Life Course Epidemiology: Adoption of concepts and methods from life course epidemiology could facilitate the study of back pain [1].

Elbow Dislocation: The study provides the first comprehensive North American population-based incidence of elbow dislocations [2].

Osteoarthritis (OA): Patient demographics and disease severity according to radiological OA grade and self-reported survey scores vary between the United States and Europe [3]. The age-standardized incidence, prevalence, and YLDs of global hip OA have been on the rise from 1992 to 2021 [54]. Predictions indicate that age-standardized incidence, prevalence, and YLDs of global hip OA may continue to significantly increase in the future [54].

Lumbar Spinal Degeneration: The observed epidemiology of lumbar spinal degeneration in the community-based population is consistent with an ordered progression beginning in the anterior structures for the majority of individuals [5].

Posterior Shoulder Instability: Incidence rates of posterior shoulder instability peaked between 1999 and 2003 [8]. Incidence rates of posterior shoulder instability were lowest in the most recent period (2010-2015) [8].

Rotator Cuff Lesions: There were no significant differences in incidence between sexes for degenerative rotator cuff-related lesions [42]. Rural areas had a 1.4-fold higher incidence rate than urban areas for degenerative rotator cuff-related lesions [42].

Distal Radius Fracture: In both sexes, the incidence of distal radius fractures was highest in the age group of 80 years and older [44].

Ankle Fracture: Men and women differed substantially in age, lifestyle factors, comorbidities, accident type, and type of ankle fracture [50].

Congenital Upper-Limb Anomalies: The updated OMT classification system is reasonably practical for precise classification of congenital upper-limb anomalies [41].

Shoulder Injury (Collegiate Football): There are definitive trends in the types of shoulder injuries per player position in elite collegiate football players [45].

Other Considerations: The study provides prevalence and incidence estimates useful for healthcare planning and resource allocation [7]. The study provides epidemiological data and resource requirements representative of Western European countries with similar demographics [4]. These methods can be utilized for population-level surveillance of revision burden and to enable between-country benchmarking [10]. The current risk stratification method based on DRG code, geography, and the presence of a fracture is helpful but there remains substantial room for improvement [43]. The current risk stratification method requires adjustment based on demographics, comorbidities, and procedure type [43].

Clinical Presentation

Epidemiological frameworks from life course studies facilitate the investigation of back pain [1], while the first comprehensive North American population-based incidence data now exists for elbow dislocations [2]. Distinct demographic and disease severity patterns, stratified by radiological osteoarthritis grade and self-reported scores, vary between the United States and Europe [3]. In Italy, females constituted the majority of patients undergoing shoulder replacement from 2009 to 2019 [31].

Demographic & Risk Factors: Age, occupation, cause of injury, treatment options, and complications influence prognosis for pelvic fractures [17]. Overweight or obesity is a major characteristic in boys with slipped capital femoral epiphysis, where knee pain as an initial symptom often delays diagnosis [33]. Comorbidities are associated with poorer care for low back pain [32].

Incidence & Prevalence Trends: The incidence of shoulder stabilization increased by 18% between 1994 and 2006, accompanied by a significant increase in average patient age and a shift toward largely outpatient procedures [18]. Incidence rates of posterior shoulder instability peaked between 1999 and 2003 and were lowest in the most recent period (2010-2015) [8]. The annual consultation prevalence for shoulder pain conditions was 1%, similar in women and men, with about two thirds of patients consulting a doctor only once [34].

Specific Pathology Prevalence: The prevalence of acetabular ossicles in the general population is 3.46%, rising significantly to 8.65% in the symptomatic group compared to 3.33% in the general population [16]. Ultrasound features of osteoarthritis have been assessed for prevalence in a population-based sample for the first time [15]. Doctor-diagnosed Dupuytren's disease has established prevalence and incidence estimates useful for healthcare planning [7].

Special Populations & Outcomes: Patients with fractures and COVID-19 tend to present with more severe clinical characteristics and early prognosis than adult patients with COVID-19 without fracture [6]. Notable differences exist in demographics, epidemiologic characteristics, and inpatient outcomes between high-volume and low-volume centers for total joint arthroplasty [9]. Epidemiological data for traumatic brachial plexus injuries in Western European countries with similar demographics have been established [4]. The first epidemiological study of unselected primary care patients seeking healthcare for back and leg pain has been completed [14].

Oncology Classification: Musculoskeletal oncology involves the diagnosis and management of neoplastic conditions affecting the musculoskeletal system, including benign tumors, sarcomas, and metastatic carcinoma [35]. Classification of these neoplastic conditions is based on histomorphology to yield insight into behavior and prognosis [35].

Investigations

Plain radiography: Vertebral fractures are frequently identified on chest radiographs yet are often overlooked by radiologists [55]. In adolescent idiopathic scoliosis, a significant volume of missing or inadequate radiographs necessitates repeat radiation exposure [37]. Radiographic parameters significantly influence the observed prevalence of hip dysplasia among 19-year-old Norwegians [39]. While major primary complications and a high incidence of radiographic degenerative changes occur after 8.8 years, Judet's bipolar prosthesis for radial head arthroplasty yields mainly good clinical results [30].

MRI: A prospective clinical observational cohort will integrate self-reported data, comprehensive clinical assessment, and MRI evaluation to describe the course, healthcare usage, patient experiences, and prognostic indicators in adults presenting to primary care with low back and leg pain [56]. There is a high prevalence of both acute and chronic shoulder injuries in Olympic athletes undergoing shoulder MRI [69].

Other Considerations: Elbow dislocations have a documented comprehensive North American population-based incidence in a 3-year study [2]. Patient demographics and disease severity regarding radiological osteoarthritis grade and self-reported survey scores differ between the United States and Europe [3]. The epidemiology of lumbar spinal degeneration in a community-based population follows an ordered progression beginning in anterior structures for most individuals [5]. Clinical characteristics and early prognosis of COVID-19 in patients with fractures tend to be more severe than in adult patients without fracture [6]. Race-related disparities in spine care require individual, institutional, and national initiatives as the literature remains limited in understanding the causes of these outcome trends [12]. This represents the first study to assess the prevalence of ultrasound features of osteoarthritis in a population-based sample [15]. The prevalence of acetabular ossicles in the general population is 3.46%, rising significantly to 8.65% in the symptomatic group compared to 3.33% in the general population [16]. Different spinal subtypes exhibit characteristics of lumbar disc degeneration at specific levels relative to age [25]. Among patients with malignant fibrous neoplasms of long bones, age greater than 60 years, tumour size greater than 10 cm, distant stage, and non-surgical treatment are factors associated with poor survival [27]. The overall incidence rate of severe low back pain in young male military recruits is 0.05% [29]. Tandem ossification is not uncommon in individuals with ossification of the spinal ligaments, and there is a high incidence of multiple-regional ossification of the posterior longitudinal ligament throughout the whole spine [61]. The overall midterm risk of revision after reverse shoulder arthroplasty for cuff tear arthropathy is low at 5% [67].

Treatment

Non-Operative

Conservative management remains a primary consideration for specific pathologies; a conservative approach facilitates a quicker return to competition for shoulder dislocations in professional male football, despite similar frequency and time to redislocation regardless of treatment [78]. For childhood coxa vara, moderate nonprogressive deformity often does not require surgery [80]. While corticosteroid and hyaluronic acid injections remain common treatment modalities in the Medicare population for osteoarthritis of the knee, there is a lack of clear evidence supporting their efficacy [48].

Operative

Indications: Surgical intervention is indicated for progressive, painful, unilateral deformity or leg-length discrepancy in childhood coxa vara [80]. In the context of osteonecrosis of the femoral head, surgical interventions, particularly total hip arthroplasty, serve as the primary modality of treatment with limited use of other surgical and nonsurgical management [60]. For meniscal injuries, 34.9% of all cases offer the potential for repair according to current standard indications, a figure that rises to 55.6% when accompanied by anterior cruciate ligament damage [47].

Surgical Approach / Technique: Total joint replacements are frequent amongst elderly women with osteoarthritis, making it feasible to conduct event-driven clinical trials where total joint replacement is the endpoint demonstrating clinical benefit of a novel disease-modifying osteoarthritis drug [49]. Understanding the current evidence and appropriate indications of emerging technologies in orthopaedic trauma is of critical importance for their utilization [20].

Implant Selection: Specific factors such as older age, female sex, higher comorbidity, and prior meniscectomy lowered survival rates of high tibial osteotomy to total knee arthroplasty [82].

Setting of Care: More African Americans, older aged individuals, and patients with higher preexisting comorbidity burden enrolled in same-day total hip arthroplasty programs between 2015 and 2020, reflecting more inclusive selection criteria [11]. There are notable differences in the demographics, epidemiologic characteristics, and inpatient outcomes of patients undergoing total joint arthroplasty at high-volume centers versus low-volume centers [9]. The incidence of shoulder stabilization increased by 18% between 1994 and 2006, with a shift to largely outpatient procedures and a significant increase in average patient age [18].

Other Considerations: Patient demographics and disease severity according to radiological OA grade and self-reported survey scores vary between the United States and Europe [3]. In the United States, blacks and individuals with low income undergo total knee replacement less frequently and generally have higher rates of adverse outcomes following primary knee replacement [21]. Efforts to mitigate race-related disparities in spine care require individual, institutional, and national initiatives [12]. Contemporary randomized controlled trials in spine surgery identify a surprising absence of sociodemographic data, which potentially biases the generalizability of outcome data [13]. The overall rate of death was higher in the non-osteoarthritis cohort compared to the osteoarthritis cohort after elective total hip arthroplasty [71]. Among patients with malignant fibrous neoplasms of long bones, age greater than 60 years, tumour size greater than 10 cm, distant stage, and non-surgical treatment are factors for poor survival [27]. Age, occupation, cause of injury, treatment options, and complications were factors affecting patient prognosis in pelvic fractures [17]. In a setting of equal access to healthcare, associated survival hazards can be attributed to patient and provider factors rather than disparities in healthcare [19]. The study on traumatic brachial plexus injuries provides epidemiological data and resource requirements representative of Western European countries with similar demographics [4]. The study on Dupuytren's disease provides prevalence and incidence estimates useful for healthcare planning and resource allocation [7]. Adoption of concepts and methods from life course epidemiology could facilitate the study of back pain [1]. Further research is needed to optimize treatment protocols and improve functional outcomes for distal humerus fractures [23]. The demographics and practice patterns of orthopaedic surgeons caring for populations at the highest social risk remained consistent between years [76].

Complications

Other Considerations: The clinical characteristics and early prognosis of COVID-19 in patients with fracture tended to be more severe than those reported for adult patients with COVID-19 without fracture [6]. Incidence rates of posterior shoulder instability peaked between 1999 and 2003 and were lowest in the most recent period (2010-2015) [8]. More African Americans, older aged individuals, and patients with higher preexisting comorbidity burden enrolled in same-day total hip arthroplasty programs from 2015 to 2020 [11]. Considering the equality of care provided in the Dutch setting, associated survival hazards can be attributed to patient and provider factors rather than disparities in healthcare [19]. In the United States, blacks and individuals with low income undergo total knee replacement less frequently and generally have higher rates of adverse outcomes following primary knee replacement [21]. Women were generally more likely to report pain than men, and while pain was reported as more long-lasting in older groups, prevalence estimates changed surprisingly little over age [26]. Despite major primary complications and a high incidence of radiographic signs of degenerative changes after 8.8 years, mainly good clinical results were achieved with Judet's bipolar prosthesis [30]. Gender, rheumatoid arthritis, and long-term (>1 year) corticosteroid use affect surgical site infection risk after shoulder arthroplasty [58]. The global burden of knee osteoarthritis has shown a consistent upward trend from 1990 to 2021, primarily driven by population growth and aging demographics [65]. Medication history and age-specific gender differences must be considered in bone turnover and metabolic clinical research [70].

Recovery

Light activity (weeks): Evidence does not specify a discrete week range for light activity or return to desk work; however, a history of concussion and a preexisting clinical relationship with the department are associated with a shorter time to evaluation after injury [28].

Full activity (months): The evidence does not provide specific month ranges for full activity, manual work, or sport return. While early reimplantation (abbreviated two-stage) provides similar outcomes to traditional two-stage exchange, optimal timing and selection criteria for this approach remain undefined [86].

Complete recovery / outcome plateau (months): Patient-reported outcome measures at the 1-year follow-up deteriorated significantly more for patients with Parkinson's disease than in controls, with these patients experiencing more problems with reoperations, pain, mobility, and carrying out usual activities [62]. Pain was reported as more long-lasting in older groups, though prevalence estimates of pain changed surprisingly little over age [26]. For medial knee overload or arthritis, patients with a preoperative symptomatic duration of two years or greater do not experience inferior PRO or clinical outcomes compared to those with a symptom duration of less than 2 years at mid-term follow-up [64].

Rehabilitation protocol: The evidence does not detail specific PT phasing, immobilisation durations, or weight-bearing progressions. Further research is needed to optimize treatment protocols and improve functional outcomes for distal humerus fractures [23]. Early diagnosis, combined with an appropriate treatment course, ensures that both chemotherapy and surgical interventions yield satisfactory outcomes for spinal tuberculosis [87].

Functional milestones: The Musculoskeletal Function Assessment Questionnaire was more responsive than the SF-36 and was more efficient in measuring changes in function between baseline and follow-up values [59]. Women were generally more likely to report pain than men [26].

Other Considerations: The long-term clinical implications of findings regarding bone turnover and bone mineral density in HIV-1 infected Chinese taking highly active antiretroviral therapy remain unclear at this time [22]. The clinical characteristics and early prognosis of COVID-19 in patients with fracture tended to be more severe than those reported for adult patients with COVID-19 without fracture [6]. Travel distance did not influence disease presentation or survival outcomes in soft-tissue sarcoma patients treated at a centralized sarcoma centre [88]. Average age of surgical intervention did not change significantly over the 7-year time span for any diagnosis in adolescent sports injuries [85]. Incidence rates of posterior shoulder instability peaked between 1999 and 2003 and were lowest in the most recent period (2010-2015) [8]. The observed epidemiology of lumbar spinal degeneration in a community-based population is consistent with an ordered progression beginning in the anterior structures for the majority of individuals [5]. Adoption of concepts and methods from life course epidemiology could facilitate the study of back pain [1]. This is the first epidemiological study of unselected primary care patients seeking healthcare for back and leg pain [14]. This multicenter, prospective, longitudinal cohort is one of the largest FAI cohorts to date [24].

Key Evidence

  • [L5] Adoption of concepts and methods from life course epidemiology could facilitate this. (10.1186/1471-2474-11-23)
  • [L4] The study provides the first comprehensive North American population-based incidence of elbow dislocations, highlighting the clinical burden and raising questions about outcomes. (10.1111/j.1758-5740.2010.00084.x)
  • [L3] This study provides epidemiological data and resource requirements representative of Western European countries with similar demographics. (10.1177/17531934231209661)
  • [L3] The observed epidemiology of lumbar spinal degeneration in the community-based population is consistent with an ordered progression beginning in the anterior structures, for the majority of individuals. (10.1186/1471-2474-12-202)
  • [L4] The clinical characteristics and early prognosis of COVID-19 in patients with fracture tended to be more severe than those reported for adult patients with COVID-19 without fracture. (10.2106/jbjs.20.00390)
  • [L3] The study provides prevalence and incidence estimates useful for healthcare planning and resource allocation. (10.1177/1753193416687914)
  • [L3] Incidence rates peaked between 1999 and 2003 and were lowest in the most recent period (2010-2015). (10.1016/j.jse.2018.08.046)
  • [L3] There are notable differences in the demographics, epidemiologic characteristics, and inpatient outcomes of patients undergoing TJA at HVCs versus LVCs. (10.5435/jaaos-d-22-00665)
  • [L4] These methods can be utilized for population-level surveillance of revision burden and to enable between-country benchmarking. (10.2106/jbjs.20.01235)
  • [L3] More African Americans, older aged individuals, and patients with higher preexisting comorbidity burden enrolled in the program over this period, reflecting more inclusive selection criteria. (10.5435/jaaos-d-23-00762)
  • [L5] Efforts to mitigate race-related disparities in spine care require individual, institutional, and national initiatives, as the musculoskeletal spine literature is limited in its understanding of the causes of race-related outcome trends. (10.2106/jbjs.22.01155)
  • [L2] Despite evidence of the importance of sociodemographic factors on surgical outcomes, this study identifies a surprising absence of sociodemographic data within contemporary RCTs in spine surgery, which potentially biases the generalizability of outcome data. (10.5435/jaaos-d-22-00838)
  • [L4] This is the first epidemiological study of unselected primary care patients seeking healthcare for back and leg pain. (10.1186/s12891-015-0787-8)
  • [L4] This is the first study to assess prevalence of ultrasound features of OA in a population-based sample. (10.1186/1471-2474-15-162)
  • [L3] The prevalence of acetabular ossicles in the general population is 3.46%, with a significantly higher prevalence found in the symptomatic group (8.65% vs 3.33%). (10.1016/j.arthro.2019.11.123)
  • [L4] Age, occupation, cause of injury, treatment options and complications were factors affecting patient prognosis. (10.1186/s12891-023-06632-2)
  • [L4] The incidence increased by 18% between 1994 and 2006, with a shift to largely outpatient procedures and a significant increase in average patient age. (10.1016/j.arthro.2017.08.289)
  • [L2] Considering the equality of care provided by this study setting, the associated survival hazards can be attributed to patient and provider factors, rather than disparities in healthcare. (10.1371/journal.pone.0191464)
  • [L2] In the United States, blacks and individuals with low income undergo total knee replacement less frequently and generally have higher rates of adverse outcomes following primary knee replacement. (10.2106/jbjs.d.02546)
  • [L3] The long-term clinical implications of these findings remain unclear at this time. (10.1186/1471-2474-14-224)
  • [L4] Further research is needed to optimize treatment protocols and improve functional outcomes. (10.1016/j.jseint.2025.01.005)
  • [L3] This multicenter, prospective, longitudinal cohort is one of the largest FAI cohorts to date. (10.1177/0363546513488861)
  • [L3] Different spinal subtypes have characteristics of lumbar disc degeneration at specific levels with age. (10.1186/s13018-019-1537-7)
  • [L4] Women were, generally, more likely to report pain than men, and while pain was reported as more long-lasting in older groups, prevalence estimates changed surprisingly little over age. (10.1186/1471-2474-10-39)
  • [L3] Among patients with MFN of long bones, age (> 60 years), tumour size (> 10 cm), distant stage, and non-surgical treatment are factors for poor survival. (10.1186/s12891-019-2971-8)
  • [L3] A history of concussion and having a preexisting clinical relationship with the department were associated with a shorter time to evaluation after concussion. (10.1177/23259671231186430)
  • [L3] The lower than expected overall incidence rate of 0.05% reflects that severe LBP occurrences are not common in this age group. (10.1186/s12891-016-1136-2)
  • [L4] Despite major primary complications and high incidence of radiographic signs of degenerative changes after 8.8 years, mainly good clinical results were achieved with Judet's bipolar prosthesis. (10.1016/j.jse.2010.05.022)
  • [L3] Overall, in Italy, females represented the majority of patients. (10.1186/s12891-022-05849-x)
  • [L3] The presence of comorbidities is associated with poorer care for low back pain. (10.1186/s12891-018-2316-z)
  • [L3] Overweight or obesity is a major characteristic for boys with SCFE, while knee pain as an initial symptom causes a delay in diagnosis. (10.1186/s12891-017-1665-3)
  • [L3] The annual consultation prevalence for shoulder pain conditions (1%) was similar in women and men, and about two thirds of patients consulted a doctor only once. (10.1186/1471-2474-13-238)
  • [L2] The study highlights the need for accurate information about trends in incidence and associated costs to ensure appropriate allocation of healthcare resources. (10.1371/journal.pmed.1003180)
  • [L4] A large number of missing or inadequate radiographs led to repeat radiation exposure in this cohort. (10.5435/jaaos-d-17-00142)
  • [L3] Although there appears to be a high prevalence of hip dysplasia among 19-year-old Norwegians, this is dependent on the radiological parameters applied. (10.1302/0301-620x.95b2.30744)
  • [L4] The authors encourage spinal surgeons and researchers to be aware of such variations when performing thoracic- and lumbar-level surgery and assessing spinal alignment and parameters. (10.1186/s13018-018-0835-9)
  • [L4] The updated OMT classification system is reasonably practical for precise classification of these anomalies. (10.1016/j.jhsa.2023.05.016)
  • [L3] There were no significant differences in incidence between sexes, but rural areas had a 1.4-fold higher incidence rate than urban areas. (10.1007/s00167-017-4626-3)
  • [L3] The current risk stratification method based on DRG code, geography, and the presence of a fracture is helpful but there remains substantial room for improvement, particularly by adjusting based on demographics, comorbidities, and procedure type. (10.1016/j.arth.2018.04.006)
  • [L3] In both sexes, the incidence was highest in the age group of 80 years and older. (10.1186/1471-2474-8-48)
  • [L3] There are definitive trends in the types of injuries per player position. (10.1177/0363546505274718)
  • [L2] The review identified numerous associated and risk factors for thoracic spine pain across biopsychosocial categories, including concurrent musculoskeletal pain, psychological factors, and specific postural or lifestyle factors, though many associations were weak or inconsistent across studies. (10.1186/1471-2474-10-77)
  • [L4] According to current standard indications, 34.9% of all meniscal injuries offer the potential for repair, rising to 55.6% when accompanied by anterior cruciate ligament damage. (10.1016/j.arthro.2018.08.051)
  • [L2] TJRs are frequent amongst elderly women with OA and it is, therefore, feasible to conduct event-driven clinical trials where TJR is the endpoint demonstrating clinical benefit of a novel disease-modifying OA drug (DMOAD). (10.1186/s12891-019-2680-3)
  • [L3] Men and women differed substantially in age, lifestyle factors, comorbidities, accident type, and type of ankle fracture. (10.1186/s12891-021-04144-5)
  • [L2] The age-standardized incidence, prevalence, and YLDs of global hip OA have been on the rise from 1992 to 2021, with predictions indicating that these metrics may continue to significantly increase in the future. (10.1186/s12891-025-09126-5)
  • [L4] Vertebral fracture is common on chest radiographs but it is often ignored by radiologists. (10.1186/s12891-018-2171-y)
  • [L4] This prospective clinical observational cohort will combine self-reported data, comprehensive clinical and MRI assessment, together with qualitative enquiries, to describe the course, health care usage, patients' experiences and prognostic indicators in an adult population presenting in primary care with LBP and leg pain with or without nerve root involvement. (10.1186/1471-2474-13-4)
  • [L2] Participation in one or more high-impact sports in adulthood is associated with larger vertebral size, and thus increased vertebral strength, among middle-aged women. (10.1186/s12891-017-1794-8)
  • [L3] Gender, rheumatoid arthritis, and long-term (>1 year) corticosteroid use affect SSI risk after shoulder arthroplasty. (10.1016/j.jse.2017.04.006)
  • [L3] It was more responsive than the SF-36 and more efficient in measuring changes in function between baseline and follow-up values. (10.2106/00004623-199709000-00006)
  • [L3] Surgical interventions, particularly THA, are the primary modality of treatment, with limited use of other surgical and nonsurgical management. (10.1016/j.arth.2025.06.002)
  • [L4] Tandem ossification is not uncommon in people with OSL, and there is a high incidence of multiple-regional OPLL in the whole spine. (10.1186/s12891-019-2569-1)
  • [L3] Patient-reported outcome measures at the 1 year follow-up deteriorated significantly more for patients with Parkinson's disease than in controls, and patients with Parkinson's disease also experienced more problems with reoperations, pain, mobility and carrying out their usual activities. (10.1177/17531934251349674)
  • [L5] The PPS injury produces alterations in GH kinematics with implications for GH joint instability, increased GH joint loading, and potential joint damage. (10.1016/j.jse.2024.12.023)
  • [L4] Patients with a preoperative duration of symptomatic medial knee overload/arthritis of two years or greater do not experience inferior PRO or clinical outcomes than patients with a symptom duration of less than 2 years at mid-term follow-up. (10.1016/j.jisako.2022.03.003)
  • [L1] The global burden of KOA has shown a consistent upward trend from 1990 to 2021, primarily driven by population growth and aging demographics. (10.1186/s13018-025-06140-0)
  • [L4] Both WOD and AHD effectively predicted vertebral deformities. (10.1186/1471-2474-9-157)
  • [L3] The overall midterm risk of revision after RSA for CTA was low (5%). (10.1016/j.jse.2018.02.060)
  • [L1] In addition, the degree of scoliosis is mainly mild, and timely intervention and prevention are necessary. (10.1186/s13018-024-05077-0)
  • [L4] The study demonstrated a high prevalence of both acute and chronic shoulder injuries in the Olympic athletes receiving shoulder MRI. (10.1186/s12891-018-2224-2)
  • [L4] Medication history and age-specific gender differences must be considered in bone turnover and metabolic clinical research. (10.1186/s12891-020-03610-w)
  • [L3] The overall rate of death was higher in the non-OA cohort compared to the OA cohort. (10.1016/j.arth.2021.05.026)
  • [L3] Cervical kyphosis is associated with health-related quality of life. (10.1186/s13018-019-1351-2)
  • [L2] From 1990 to 2019, the global disease burden of LBP remained high. (10.1186/s12891-023-06772-5)
  • [L4] Most LBP diagnoses were categorized as specific according to the German guideline on specific LBP, contrary to common international assumptions. (10.1186/s12891-025-08514-1)
  • [L3] However, the demographics and practice patterns of the orthopaedic surgeons caring for populations at the highest social risk remained consistent between years. (10.2106/jbjs.24.01419)
  • [L2] Increased screen time was associated with a higher risk of spinal pain in pre-adolescents, while higher levels of physical activity were associated with a lower risk of spinal pain. (10.1186/s12891-021-04263-z)
  • [L3] A conservative treatment leads to a quicker return to competition, while frequency and time to redislocation were similar regardless of treatment. (10.1002/ksa.12199)
  • [L3] Long-term shoulder loading in youth is a risk factor for pathological thoracic kyphosis especially in the lower thoracic spinal segments when farmers getting older. (10.1186/s13018-020-01698-3)
  • [L5] Surgical management is indicated for progressive, painful, unilateral deformity or leg-length discrepancy, while moderate nonprogressive deformity often does not require surgery. (10.5435/00124635-199803000-00003)
  • [L3] Measurement of TK with T2 on standing whole spinal radiographs resulted in a greater measurement error of up to 6.6°. (10.1186/s12891-021-04786-5)
  • [L3] Specific factors such as older age, female sex, higher comorbidity and prior meniscectomy lowered survival rates. (10.1007/s00167-015-3849-4)
  • [L3] These data confirm that age and BMD are major risk factors for vertebral fracture risk. (10.1186/1471-2474-13-163)
  • [L2] Our study shows a steady reduction in the global burden of vertebral fractures from 1990 to 2021. (10.1186/s13018-025-05915-9)
  • [L4] Average age of surgical intervention did not change significantly over the 7-year time span for any diagnosis. (10.1016/j.asmr.2019.07.004)
  • [L1] Early reimplation (abbreviated two-stage) provides similar outcomes to traditional two-stage exchange, though optimal timing and selection criteria remain undefined. (10.1016/j.arth.2025.10.075)
  • [L4] Early diagnosis, combined with an appropriate treatment course, ensures that both chemotherapy and surgical interventions yield satisfactory outcomes. (10.1186/s12891-025-09053-5)
  • [L3] Travel distance did not influence disease presentation or survival outcomes in soft-tissue sarcoma patients treated at a centralized sarcoma centre. (10.1302/0301-620x.107b3.bjj-2024-0488.r1)

See Also

References

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