Knee dysfunction in the general population and associated factors

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A saphenous vein graft was used which was proximally anastomosado lateral-end to the superficial femoral artery and distally to the proximal part of the deep inferior epigastric artery of the deep inferior epigastric artery flap. The distal end of the latter was joined to the peroneal artery of the fibula flap (sequential flap)." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Miguel de la Parra-Márquez, Oscar Zorola-Tellez, Silvia Cárdenas-Rodríguez, Jesús María Rangel-Flores, Gerardo Sánchez-Terrones" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Miguel" "apellidos" => "de la Parra-Márquez" ] 1 => array:2 [ "nombre" => "Oscar" "apellidos" => "Zorola-Tellez" ] 2 => array:2 [ "nombre" => "Silvia" "apellidos" => "Cárdenas-Rodríguez" ] 3 => array:2 [ "nombre" => "Jesús María" "apellidos" => "Rangel-Flores" ] 4 => array:2 [ "nombre" => "Gerardo" "apellidos" => "Sánchez-Terrones" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0009741115002340" "doi" => "10.1016/j.circir.2015.08.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0009741115002340?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2444050716300195?idApp=UINPBA00004N" "url" => "/24440507/0000008400000003/v1_201606080012/S2444050716300195/v1_201606080012/en/main.assets" ] "itemAnterior" => array:20 [ "pii" => "S2444050716300110" "issn" => "24440507" "doi" => "10.1016/j.circen.2016.04.005" "estado" => "S300" "fechaPublicacion" => "2016-05-01" "aid" => "155" "copyright" => "Academia Mexicana de Cirugía A.C." 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Tel.: +52 55 5629 0200 ext. 13846." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Disfuncionalidad de rodilla en la población general y factores asociados" ] ] "textoCompleto" => "BackgroundFunctional limitations of the knee are consequential to a series of events (progressive deterioration of the articular cartilage, alteration in the subchondral bone, changes in soft tissues and progressive deformity of articulation) which condition pain and reduce quality of life.<a class="elsevierStyleCrossRefs" href="#bib0135">1–5</a> It has been estimated that around 10–25% of people over 55 have incapacitating symptoms and of these a quarter are severely incapacitated.<a class="elsevierStyleCrossRefs" href="#bib0160">6–9</a>Among the main associated factors are: gender, age and body mass index (BMI). The National Health and Nutrition Examination Survey reported that chronic pain and articular limitation presented in up to 80% of people over 55,<a class="elsevierStyleCrossRef" href="#bib0180">10</a> compared with 0.1% in people aged between 25 and 34.<a class="elsevierStyleCrossRef" href="#bib0185">11</a> Other studies have demonstrated that obesity increases the risk of developing degenerative processes in the knee threefold,<a class="elsevierStyleCrossRefs" href="#bib0190">12,13</a> and it has been observed that a 5kg weight increase increases the risk of degenerative processes in the knee by 35%, leading to functional limitations in the joint<a class="elsevierStyleCrossRef" href="#bib0200">14</a>; furthermore, a cohort study demonstrated that a BMI over 30kg/m2 is a determining factor in knee pain, regardless of radiologic severity. Obesity is now considered as a public health issue in both Mexico and worldwide.<a class="elsevierStyleCrossRef" href="#bib0205">15</a> Another factor associated with functional limitation of the knee is being a female,<a class="elsevierStyleCrossRef" href="#bib0180">10</a> since it has been shown that a 1.57 risk presents in women aged 45–54, compared with men of the same age and in women aged between 65 and 74 this risk increases to 2.14.<a class="elsevierStyleCrossRef" href="#bib0210">16</a>At present, in Mexico, there are no studies which measure the articular dysfunction in the general population and its associated factors, specifically obesity, which is a modifiable risk factor. Considering that in Mexico, abdominal obesity presents in 74% of people over 30,<a class="elsevierStyleCrossRef" href="#bib0215">17</a> it is of the utmost importance that a study be conducted to determine the impact of BMI on knee function in order that in the future prevention strategies may be established to reduce the articular incapacity risk secondary to obesity.The aim of our study was to determine knee joint dysfunction and the associated factors in a primary care centre (Unidad de Medicina Familiar No 2 del Instituto Mexicano del Seguro Social).Material and methodsIn the above mentioned Primary Care centre a descriptive, analytical and transversal study was conducted, from May 12 to September 30, 2014, with prior authorisation from the Local Research Committee. Individuals were recruited in the waiting room.Inclusion criteria were as follows: men and women over 50, with any BMI. Those people who had already undergone surgical knee treatment or had an inflammatory process in the knee, amputation of one or both legs and those who did not complete the questionnaires were excluded from the study. Once they decided to participate in the study the participants filled out their medical history, were given a physical examination and were asked to fill out the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) self-administered questionnaire. Each participant was given a triptych with leg strengthening exercises and general recommendation for knee care, for the purpose of preventing or lessening knee symptoms in study participants.In order to calculate sample size we used the percentage gap formula. Age was considered a risk factor for dysfunction with a minimum difference at 19% with a α of 95% and a β of 80%, obtaining a sample of 106 individuals per group.There were 3 age group categories: ≤64 and ≥65; BMI was classified into 3 groups: normal (<25kg/m2), overweight (25–29.9kg/m2) and obese (>30kg/m2); functionality of the knee was measured with the WOMAC questionnaire, a specific questionnaire for osteoarthritis of the knee or hip, which consisted of 24 questions grouped into 3 dimensions: pain (5 items), stiffness (2 items) and functionality (17 items). The Likert version with 5 response levels for each level of intensity was used (none, slight, moderate, severe, or extreme), which was numbered from 0 to 4. Scores were standardised from 0 to 100, where the higher the score, the greater the problem. The overall scores considered the 3 dimensions and this classification was used to classify the subjects as asymptomatic (WOMAC<7) and subjects with symptomatology (WOMAC>7), in keeping with what was reported by other authors.<a class="elsevierStyleCrossRefs" href="#bib0220">18,19</a>Statistical analysisDescriptive analysis was carried out, and central and disperse tendency measures were used for the quantitative variables. For qualitative analysis absolute and relative frequencies were used.Inferential analysis: bivariate logistic regression was used to analyse the association between age, gender, BMI and knee function. ANOVA was used to compare the means of the WOMAC scores and BMI measurements. A p≤0.05 was considered statistically significant.Results240 individuals were invited to take part in the study, 218 of whom accepted; response rate was 90.1%. 218 subjects who met the inclusion criteria were included. The mean age of patients was 64.27 (SD 10.43), with a predominance of females (58.3%; n=127). Regarding BMI, overweight predominated. Demographic characteristics are described in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>With regard to the presence of functional limitation, this was associated with BMI, with being over the age of 65 and with females (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Analysis between the different BMI categories took place and each of the dimensions assessed by WOMAC, with a higher score being found – indicative of dysfunction – in obese and overweight patients, compared with those of normal weight, with statistically significant differences found (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>DiscussionIn our study we found there was a statistically significant association between age, the female sex, and BMI with knee function as measured by the WOMAC questionnaire.One European study reported that the incidence of articular dysfunction of the knee was strongly associated with an age above 50, the female sex and a higher BMI.<a class="elsevierStyleCrossRef" href="#bib0230">20</a>This research study found that age is an important factor for the presentation of pain and dysfunction in the knee. Schouten et al.<a class="elsevierStyleCrossRef" href="#bib0235">21</a> found that people over 60 presented an odds ratio (OR) of 3.84 (CI of 95%: 1.10–13.4), compared with a population under 49, for the presentation of pain and dysfunction secondary to loss of articular cartilage. A systematic review published in 2011<a class="elsevierStyleCrossRef" href="#bib0240">22</a> reported that age is a predictor of important progression for the development of pain and knee dysfunction, with an OR of 1.34 (CI of 95%: 1.15–1.57). The above mentioned coincides with our outcome.Another study reported a major dysfunction of the knee in women compared with men, with an OR of 1.57 in people aged 45–54 years of age and of 2.14 in patients aged from 65 to 74.<a class="elsevierStyleCrossRef" href="#bib0210">16</a> In one meta-analysis which included 46 studies it was reported that the female sex is one of the main factors for the appearance of pain and dysfunction in the knee in the adult population, reporting an OR of 2.66 (CI of 95%: 2.15–3.28).<a class="elsevierStyleCrossRef" href="#bib0245">23</a> In Mexico a prevalence of osteoarthritis higher in women than in men has been reported.<a class="elsevierStyleCrossRef" href="#bib0250">24</a> Previous results coincide with those obtained in our study.In Australia it was found that in patients with a knee osteoarthritis diagnosis, the score associated with articular dysfunction directly increased with BMI, and pain averages were higher in patients with obesity (40.1) compared with overweight patients (24) and normal BMI (23.4), and with the same tendency in other WOMAC areas.<a class="elsevierStyleCrossRef" href="#bib0225">19</a>Doctor Elbaz et al.<a class="elsevierStyleCrossRef" href="#bib0255">25</a> found a statistically significant association between symptomotology and articular function of the knee assessed by WOMAC and BMI, finding there was a progressive increase in all WOMAC functions in keeping with the increase of BMI. In our study we found very similar characteristics. The highest averages in WOMAC pain, stiffness and function were found in patients who were overweight and obese.Another systematic review reported that obesity is a very important risk factor in the articular dysfunction with a dose-response ratio. In other words, the higher the BMI, the bigger the risk of suffering from arthrosis and incapacity. This review included 12 observational studies, taking a BMI of 22.5 as a control group. It was found that with a BMI of 25 there is an OR of 1.59 (CI 95%: 1.34–1.81), for BMI of 30, an OR of 3.55 (CI 95%: 2.51–5.11), and for a BMI of 35, an OR of 7.45 times greater risk of suffering from oseteoarthritis of the knee (CI 95%: 4.19–13.13).<a class="elsevierStyleCrossRef" href="#bib0260">26</a>Doctors Ackerman and Osborne<a class="elsevierStyleCrossRef" href="#bib0225">19</a> found that the prevalence of pain and dysfunction was more frequent in overweight and obese patients. 16.48% of people with normal weight presented pain and dysfunction, 29.67% of people who were overweight and 53.85% of those who were obese.One study of cases and controls found that the patients who presented with obesity had an OR of 2.8 (CI 95%: 1.05–7.34) compared with those with a normal BMI.<a class="elsevierStyleCrossRef" href="#bib0190">12</a>In our study we found similar tendencies: 36% of patient with normal BMI, 47% of patients were overweight and 73% presented obesity which showed dysfunction. As a result of the above, it is recommendable in patients with modifiable risk factors mainly a BMI >30m/kg2, to create multidisciplinary early prevention strategies against obesity such as physical activity and healthy diet to reduce BMI and slow down the degenerative process and the articular symptoms.ConclusionsSymptoms and articular dysfunction of the knee directly increase with BMI, age and when the patient is a female, resulting in considerable health risk factors for the presentation of dysfunction in this joint.Conflict of interestsThe authors have no conflict of interests to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres671284" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec677696" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres671285" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec677695" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Background" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and methods" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0020" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0030" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflict of interests" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-02-13" "fechaAceptado" => "2015-08-20" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec677696" "palabras" => array:5 [ 0 => "Knee joint" 1 => "Body mass index" 2 => "Aged" 3 => "Gender" 4 => "Western Ontario and McMaster Universities Osteoarthritis Index" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec677695" "palabras" => array:4 [ 0 => "Articulación de la rodilla" 1 => "Índice de masa corporal" 2 => "Género" 3 => "Western Ontario and McMaster Universities Osteoarthritis Index" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "BackgroundKnee joint dysfunction is present in 80% of people over 50 years of age, and in women there is a 1.5 times higher risk compared to men. Another important risk factor is obesity, which leads to a 3 times increase in the risk of suffering functional limitations in the joint.The aim of this study was to determine knee joint dysfunction and the associated factors. Material and methodsAn analytical and descriptive study was conducted on 218 individuals older than 50 years of age in a primary care centre. A physical examination was performed on each patient, and the Western Ontario and McMaster Universities Osteoarthritis Index questionnaire was applied to them all. Logistic regression analysis was used to determine the association between age, gender, body mass index, and knee function. ANOVA was used to compare the means of the Western Ontario and McMaster Universities Osteoarthritis Index scores and body mass index measurements. A p<0.05 was considered statistically significant. ResultsThe mean age was 64.27 years (SD 10.43). An OR of 4.50 was obtained for having a disability in people over 65 years of age, 2.90 in obese people, and 2.02 in women. The mean scores in the 3 domains of Western Ontario and McMaster Universities Osteoarthritis Index were higher as the body mass index increased. ConclusionsWomen have greater disability than men, becoming more evident in older ages, and other risk of joint dysfunction increases up 3 times in obese patients." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "AntecedentesLa disfunción articular de rodilla se presenta hasta en el 80% de las personas mayores de 50 años, y en mujeres el riesgo aumenta 1.5 veces más en comparación con los hombres; otro factor de riesgo importante es la obesidad, que aumenta hasta 3 veces más el riesgo de presentar limitación funcional.El objetivo de este estudio fue: determinar la disfuncionalidad articular de rodilla y los factores asociados. Material y métodosEstudio descriptivo analítico que incluyó 218 personas mayores de 50 años, llevado a cabo en un centro de atención primaria. A los participantes se les realizó una exploración física y se les aplicó el cuestionario Western Ontario and McMaster Universities Osteoarthritis Index. Para determinar la asociación entre edad, género, índice de masa corporal y funcionalidad de la rodilla se aplicó un análisis de regresión logística, y para comparar las medias de las dimensiones del Western Ontario and McMaster Universities Osteoarthritis Index y el índice de masa corporal se utilizó el ANOVA. Se consideró un valour de p<0.05 como estadísticamente significativo. ResultadosLa edad media fue de 64.27 años (DE 10.43). Se obtuvo una OR para presentar discapacidad de 4.50 en personas mayores de 65 años, 2.90 en obesos y 2.02 en mujeres, y las puntuaciones medias en los 3 dominios del Western Ontario and McMaster Universities Osteoarthritis Index fueron más altas conforme se incrementaba el índice de masa corporal. ConclusionesLas mujeres presentan mayor discapacidad que los hombres, haciéndose más evidente en edades avanzadas, y el riesgo de disfunción articular aumenta hasta 3 veces más en sujetos con obesidad." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Solis-Hernández JL, Rojano-Mejía D, Marmolejo-Mendoza M. Disfuncionalidad de rodilla en la población general y factores asociados. Cirugía y Cirujanos. 2016;84:208–212." ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "BMI: body mass index." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n (%) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Gender</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">91 (42) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">127 (58) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Age</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">≤64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">104 (48) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">≥65 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">114 (52) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">BMI</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64 (29) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Overweight \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">87 (40) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Obesity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">67 (31) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1098171.png" ] ] ] ] "descripcion" => array:1 [ "en" => "General characteristics (n=218)." ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "CI: confidence interval; OR: odds ratio." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Bivariate analysis</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Multivariate analysis</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OR \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CI 95% \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OR \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CI 95% \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age>6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(1.7–6.49) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(2.21–9.55) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Overweight \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.02 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(0.46–2.27) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.03 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(0.43–2.32) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Obesity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(1.06–5.11) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.90 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(1.22–6.85) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Female sex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.92 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(1.01–3.68) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.02 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(1.06–4.08) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1098172.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Factors associated with knee dysfunction." ] ] 2 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "SD: standard deviation; BMI: body mass index." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">BMI \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Pain \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Stiffness \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Functional ability \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Normal (average±SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.5±22.91 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.91±20.58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18.64±24.13 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Overweight (mean±SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.59±15.44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.64±18.13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.12±16.07 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Obesity (mean±SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25.67±24.40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23.50±23.78 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28.06±25.20 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">p \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.003 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1098170.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Association of dysfunction with body mass index." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:26 [ 0 => array:3 [ "identificador" => "bib0135" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Factores predictivos de nivel funcional tras artroplastia total primaria de rodilla" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. 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Disfuncionalidad de rodilla en la población general y factores asociados

José Luis Solis-Hernándeza, David Rojano-Mejíab,

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rojanodavid@gmail.com

Corresponding author at: Manuel Villalongin 117, Colonia Cuauhtémoc, Delegación Cuauhtémoc, C.P. 06500, México, D.F., Mexico. Tel.: +52 55 5629 0200 ext. 13846.

, Marlene Marmolejo-Mendozac

a Servicio de Laboratorio de Análisis Clínicos, Unidad de Medicina Familiar No. 20, Instituto Mexicano del Seguro Social, México, D.F., Mexico

b Coordinación Clínica de Educación e Investigación en Salud, Unidad de Medicina Física y Rehabilitación Centro, Unidad Médica de Alta Especialidad, Hospital de Traumatología y Ortopedia Lomas Verdes, Instituto Mexicano del Seguro Social, México, D.F., Mexico

c Coordinación Clínica de Educación e Investigación en Salud, Unidad de Medicina Familiar No. 20, Instituto Mexicano del Seguro Social, México, D.F., Mexico

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    "titulo" => "Knee dysfunction in the general population and associated factors"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Background</span><p id="par0005" class="elsevierStylePara elsevierViewall">Functional limitations of the knee are consequential to a series of events &#40;progressive deterioration of the articular cartilage&#44; alteration in the subchondral bone&#44; changes in soft tissues and progressive deformity of articulation&#41; which condition pain and reduce quality of life&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">1&#8211;5</span></a> It has been estimated that around 10&#8211;25&#37; of people over 55 have incapacitating symptoms and of these a quarter are severely incapacitated&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">6&#8211;9</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Among the main associated factors are&#58; gender&#44; age and body mass index &#40;BMI&#41;&#46; The National Health and Nutrition Examination Survey reported that chronic pain and articular limitation presented in up to 80&#37; of people over 55&#44;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">10</span></a> compared with 0&#46;1&#37; in people aged between 25 and 34&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">11</span></a> Other studies have demonstrated that obesity increases the risk of developing degenerative processes in the knee threefold&#44;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">12&#44;13</span></a> and it has been observed that a 5<span class="elsevierStyleHsp" style=""></span>kg weight increase increases the risk of degenerative processes in the knee by 35&#37;&#44; leading to functional limitations in the joint<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">14</span></a>&#59; furthermore&#44; a cohort study demonstrated that a BMI over 30<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span> is a determining factor in knee pain&#44; regardless of radiologic severity&#46; Obesity is now considered as a public health issue in both Mexico and worldwide&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">15</span></a> Another factor associated with functional limitation of the knee is being a female&#44;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">10</span></a> since it has been shown that a 1&#46;57 risk presents in women aged 45&#8211;54&#44; compared with men of the same age and in women aged between 65 and 74 this risk increases to 2&#46;14&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">16</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">At present&#44; in Mexico&#44; there are no studies which measure the articular dysfunction in the general population and its associated factors&#44; specifically obesity&#44; which is a modifiable risk factor&#46; Considering that in Mexico&#44; abdominal obesity presents in 74&#37; of people over 30&#44;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">17</span></a> it is of the utmost importance that a study be conducted to determine the impact of BMI on knee function in order that in the future prevention strategies may be established to reduce the articular incapacity risk secondary to obesity&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The aim of our study was to determine knee joint dysfunction and the associated factors in a primary care centre &#40;Unidad de Medicina Familiar N<span class="elsevierStyleSup">o</span> 2 del Instituto Mexicano del Seguro Social&#41;&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">In the above mentioned Primary Care centre a descriptive&#44; analytical and transversal study was conducted&#44; from May 12 to September 30&#44; 2014&#44; with prior authorisation from the Local Research Committee&#46; Individuals were recruited in the waiting room&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Inclusion criteria were as follows&#58; men and women over 50&#44; with any BMI&#46; Those people who had already undergone surgical knee treatment or had an inflammatory process in the knee&#44; amputation of one or both legs and those who did not complete the questionnaires were excluded from the study&#46; Once they decided to participate in the study the participants filled out their medical history&#44; were given a physical examination and were asked to fill out the Western Ontario and McMaster Universities Osteoarthritis Index &#40;WOMAC&#41; self-administered questionnaire&#46; Each participant was given a triptych with leg strengthening exercises and general recommendation for knee care&#44; for the purpose of preventing or lessening knee symptoms in study participants&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">In order to calculate sample size we used the percentage gap formula&#46; Age was considered a risk factor for dysfunction with a minimum difference at 19&#37; with a <span class="elsevierStyleItalic">&#945;</span> of 95&#37; and a <span class="elsevierStyleItalic">&#946;</span> of 80&#37;&#44; obtaining a sample of 106 individuals per group&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">There were 3 age group categories&#58; &#8804;<span class="elsevierStyleHsp" style=""></span>64 and &#8805;<span class="elsevierStyleHsp" style=""></span>65&#59; BMI was classified into 3 groups&#58; normal &#40;&#60;<span class="elsevierStyleHsp" style=""></span>25<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&#44; overweight &#40;25&#8211;29&#46;9<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#41; and obese &#40;&#62;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&#59; functionality of the knee was measured with the WOMAC questionnaire&#44; a specific questionnaire for osteoarthritis of the knee or hip&#44; which consisted of 24 questions grouped into 3 dimensions&#58; pain &#40;5 items&#41;&#44; stiffness &#40;2 items&#41; and functionality &#40;17 items&#41;&#46; The Likert version with 5 response levels for each level of intensity was used &#40;none&#44; slight&#44; moderate&#44; severe&#44; or extreme&#41;&#44; which was numbered from 0 to 4&#46; Scores were standardised from 0 to 100&#44; where the higher the score&#44; the greater the problem&#46; The overall scores considered the 3 dimensions and this classification was used to classify the subjects as asymptomatic &#40;WOMAC<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>7&#41; and subjects with symptomatology &#40;WOMAC<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>7&#41;&#44; in keeping with what was reported by other authors&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">18&#44;19</span></a></p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Statistical analysis</span><p id="par0045" class="elsevierStylePara elsevierViewall">Descriptive analysis was carried out&#44; and central and disperse tendency measures were used for the quantitative variables&#46; For qualitative analysis absolute and relative frequencies were used&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Inferential analysis&#58; bivariate logistic regression was used to analyse the association between age&#44; gender&#44; BMI and knee function&#46; ANOVA was used to compare the means of the WOMAC scores and BMI measurements&#46; A <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#46;05 was considered statistically significant&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><p id="par0055" class="elsevierStylePara elsevierViewall">240 individuals were invited to take part in the study&#44; 218 of whom accepted&#59; response rate was 90&#46;1&#37;&#46; 218 subjects who met the inclusion criteria were included&#46; The mean age of patients was 64&#46;27 &#40;SD 10&#46;43&#41;&#44; with a predominance of females &#40;58&#46;3&#37;&#59; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>127&#41;&#46; Regarding BMI&#44; overweight predominated&#46; Demographic characteristics are described in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">With regard to the presence of functional limitation&#44; this was associated with BMI&#44; with being over the age of 65 and with females &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Analysis between the different BMI categories took place and each of the dimensions assessed by WOMAC&#44; with a higher score being found &#8211; indicative of dysfunction &#8211; in obese and overweight patients&#44; compared with those of normal weight&#44; with statistically significant differences found &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discussion</span><p id="par0070" class="elsevierStylePara elsevierViewall">In our study we found there was a statistically significant association between age&#44; the female sex&#44; and BMI with knee function as measured by the WOMAC questionnaire&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">One European study reported that the incidence of articular dysfunction of the knee was strongly associated with an age above 50&#44; the female sex and a higher BMI&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">20</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">This research study found that age is an important factor for the presentation of pain and dysfunction in the knee&#46; Schouten et al&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">21</span></a> found that people over 60 presented an odds ratio &#40;OR&#41; of 3&#46;84 &#40;CI of 95&#37;&#58; 1&#46;10&#8211;13&#46;4&#41;&#44; compared with a population under 49&#44; for the presentation of pain and dysfunction secondary to loss of articular cartilage&#46; A systematic review published in 2011<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">22</span></a> reported that age is a predictor of important progression for the development of pain and knee dysfunction&#44; with an OR of 1&#46;34 &#40;CI of 95&#37;&#58; 1&#46;15&#8211;1&#46;57&#41;&#46; The above mentioned coincides with our outcome&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Another study reported a major dysfunction of the knee in women compared with men&#44; with an OR of 1&#46;57 in people aged 45&#8211;54 years of age and of 2&#46;14 in patients aged from 65 to 74&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">16</span></a> In one meta-analysis which included 46 studies it was reported that the female sex is one of the main factors for the appearance of pain and dysfunction in the knee in the adult population&#44; reporting an OR of 2&#46;66 &#40;CI of 95&#37;&#58; 2&#46;15&#8211;3&#46;28&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">23</span></a> In Mexico a prevalence of osteoarthritis higher in women than in men has been reported&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">24</span></a> Previous results coincide with those obtained in our study&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">In Australia it was found that in patients with a knee osteoarthritis diagnosis&#44; the score associated with articular dysfunction directly increased with BMI&#44; and pain averages were higher in patients with obesity &#40;40&#46;1&#41; compared with overweight patients &#40;24&#41; and normal BMI &#40;23&#46;4&#41;&#44; and with the same tendency in other WOMAC areas&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">19</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Doctor Elbaz et al&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">25</span></a> found a statistically significant association between symptomotology and articular function of the knee assessed by WOMAC and BMI&#44; finding there was a progressive increase in all WOMAC functions in keeping with the increase of BMI&#46; In our study we found very similar characteristics&#46; The highest averages in WOMAC pain&#44; stiffness and function were found in patients who were overweight and obese&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Another systematic review reported that obesity is a very important risk factor in the articular dysfunction with a dose-response ratio&#46; In other words&#44; the higher the BMI&#44; the bigger the risk of suffering from arthrosis and incapacity&#46; This review included 12 observational studies&#44; taking a BMI of 22&#46;5 as a control group&#46; It was found that with a BMI of 25 there is an OR of 1&#46;59 &#40;CI 95&#37;&#58; 1&#46;34&#8211;1&#46;81&#41;&#44; for BMI of 30&#44; an OR of 3&#46;55 &#40;CI 95&#37;&#58; 2&#46;51&#8211;5&#46;11&#41;&#44; and for a BMI of 35&#44; an OR of 7&#46;45 times greater risk of suffering from oseteoarthritis of the knee &#40;CI 95&#37;&#58; 4&#46;19&#8211;13&#46;13&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">26</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Doctors Ackerman and Osborne<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">19</span></a> found that the prevalence of pain and dysfunction was more frequent in overweight and obese patients&#46; 16&#46;48&#37; of people with normal weight presented pain and dysfunction&#44; 29&#46;67&#37; of people who were overweight and 53&#46;85&#37; of those who were obese&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">One study of cases and controls found that the patients who presented with obesity had an OR of 2&#46;8 &#40;CI 95&#37;&#58; 1&#46;05&#8211;7&#46;34&#41; compared with those with a normal BMI&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">12</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">In our study we found similar tendencies&#58; 36&#37; of patient with normal BMI&#44; 47&#37; of patients were overweight and 73&#37; presented obesity which showed dysfunction&#46; As a result of the above&#44; it is recommendable in patients with modifiable risk factors mainly a BMI &#62;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>m&#47;kg<span class="elsevierStyleSup">2</span>&#44; to create multidisciplinary early prevention strategies against obesity such as physical activity and healthy diet to reduce BMI and slow down the degenerative process and the articular symptoms&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusions</span><p id="par0120" class="elsevierStylePara elsevierViewall">Symptoms and articular dysfunction of the knee directly increase with BMI&#44; age and when the patient is a female&#44; resulting in considerable health risk factors for the presentation of dysfunction in this joint&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflict of interests</span><p id="par0125" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Knee joint dysfunction is present in 80&#37; of people over 50 years of age&#44; and in women there is a 1&#46;5 times higher risk compared to men&#46; Another important risk factor is obesity&#44; which leads to a 3 times increase in the risk of suffering functional limitations in the joint&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The aim of this study was to determine knee joint dysfunction and the associated factors&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">An analytical and descriptive study was conducted on 218 individuals older than 50 years of age in a primary care centre&#46; A physical examination was performed on each patient&#44; and the Western Ontario and McMaster Universities Osteoarthritis Index questionnaire was applied to them all&#46; Logistic regression analysis was used to determine the association between age&#44; gender&#44; body mass index&#44; and knee function&#46; ANOVA was used to compare the means of the Western Ontario and McMaster Universities Osteoarthritis Index scores and body mass index measurements&#46; A <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 was considered statistically significant&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The mean age was 64&#46;27 years &#40;SD 10&#46;43&#41;&#46; An OR of 4&#46;50 was obtained for having a disability in people over 65 years of age&#44; 2&#46;90 in obese people&#44; and 2&#46;02 in women&#46; The mean scores in the 3 domains of Western Ontario and McMaster Universities Osteoarthritis Index were higher as the body mass index increased&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Women have greater disability than men&#44; becoming more evident in older ages&#44; and other risk of joint dysfunction increases up 3 times in obese patients&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Background"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Material and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">La disfunci&#243;n articular de rodilla se presenta hasta en el 80&#37; de las personas mayores de 50 a&#241;os&#44; y en mujeres el riesgo aumenta 1&#46;5 veces m&#225;s en comparaci&#243;n con los hombres&#59; otro factor de riesgo importante es la obesidad&#44; que aumenta hasta 3 veces m&#225;s el riesgo de presentar limitaci&#243;n funcional&#46;</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">El objetivo de este estudio fue&#58; determinar la disfuncionalidad articular de rodilla y los factores asociados&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Estudio descriptivo anal&#237;tico que incluy&#243; 218 personas mayores de 50 a&#241;os&#44; llevado a cabo en un centro de atenci&#243;n primaria&#46; A los participantes se les realiz&#243; una exploraci&#243;n f&#237;sica y se les aplic&#243; el cuestionario Western Ontario and McMaster Universities Osteoarthritis Index&#46; Para determinar la asociaci&#243;n entre edad&#44; g&#233;nero&#44; &#237;ndice de masa corporal y funcionalidad de la rodilla se aplic&#243; un an&#225;lisis de regresi&#243;n log&#237;stica&#44; y para comparar las medias de las dimensiones del Western Ontario and McMaster Universities Osteoarthritis Index y el &#237;ndice de masa corporal se utiliz&#243; el ANOVA&#46; Se consider&#243; un valour de <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 como estad&#237;sticamente significativo&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">La edad media fue de 64&#46;27 a&#241;os &#40;DE 10&#46;43&#41;&#46; Se obtuvo una OR para presentar discapacidad de 4&#46;50 en personas mayores de 65 a&#241;os&#44; 2&#46;90 en obesos y 2&#46;02 en mujeres&#44; y las puntuaciones medias en los 3 dominios del Western Ontario and McMaster Universities Osteoarthritis Index fueron m&#225;s altas conforme se incrementaba el &#237;ndice de masa corporal&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Las mujeres presentan mayor discapacidad que los hombres&#44; haci&#233;ndose m&#225;s evidente en edades avanzadas&#44; y el riesgo de disfunci&#243;n articular aumenta hasta 3&#160;veces m&#225;s en sujetos con obesidad&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Antecedentes"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Material y m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
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      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Solis-Hern&#225;ndez JL&#44; Rojano-Mej&#237;a D&#44; Marmolejo-Mendoza M&#46; Disfuncionalidad de rodilla en la poblaci&#243;n general y factores asociados&#46; Cirug&#237;a y Cirujanos&#46; 2016&#59;84&#58;208&#8211;212&#46;</p>"
      ]
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Gender</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">91 &#40;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">127 &#40;58&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">104 &#40;48&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">114 &#40;52&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">BMI</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">64 &#40;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Overweight&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">87 &#40;40&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">67 &#40;31&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">General characteristics &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>218&#41;&#46;</p>"
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">CI&#58; confidence interval&#59; OR&#58; odds ratio&#46;</p>"
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                  <table border="0" frame="\n
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Bivariate analysis</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Multivariate analysis</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CI 95&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CI 95&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;03&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">BMI&nbsp;\t\t\t\t\t\t\n
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Article information

ISSN: 24440507
Original language: English

DOI:10.1016/j.circen.2016.04.014

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 October	3	0	3
2024 September	11	2	13
2024 August	8	2	10
2024 July	7	7	14
2024 June	6	0	6
2024 May	9	8	17
2024 April	7	8	15
2024 March	11	4	15
2024 February	7	7	14
2024 January	11	7	18
2023 December	12	9	21
2023 November	6	4	10
2023 October	16	9	25
2023 September	9	4	13
2023 August	15	3	18
2023 July	8	6	14
2023 June	8	7	15
2023 May	26	5	31
2023 April	42	0	42
2023 March	9	2	11
2023 February	21	5	26
2023 January	10	3	13
2022 December	10	3	13
2022 November	17	7	24
2022 October	10	12	22
2022 September	10	10	20
2022 August	11	9	20
2022 July	7	11	18
2022 June	4	6	10
2022 May	11	10	21
2022 April	8	5	13
2022 March	7	8	15
2022 February	7	5	12
2022 January	16	5	21
2021 December	7	5	12
2021 November	8	7	15
2021 October	5	8	13
2021 September	8	7	15
2021 August	6	3	9
2021 July	4	7	11
2021 June	6	9	15
2021 May	14	8	22
2021 April	21	6	27
2021 March	11	5	16
2021 February	12	6	18
2021 January	9	5	14
2020 December	10	8	18
2020 November	11	7	18
2020 October	7	8	15
2020 September	16	7	23
2020 August	40	7	47
2020 July	9	11	20
2020 June	3	7	10
2020 May	3	4	7
2020 April	5	3	8
2020 March	8	2	10
2020 February	8	5	13
2020 January	6	1	7
2019 December	8	14	22
2019 November	7	3	10
2019 October	2	3	5
2019 September	3	2	5
2019 August	3	4	7
2019 July	12	7	19
2019 June	20	17	37
2019 May	43	55	98
2019 April	7	26	33
2019 March	3	3	6
2019 February	5	5	10
2019 January	4	3	7
2018 December	1	3	4
2018 November	1	2	3
2018 October	3	6	9
2018 September	7	13	20
2018 August	1	8	9
2018 July	2	2	4
2018 June	1	2	3
2018 May	4	6	10
2018 April	2	4	6
2018 March	6	3	9
2018 February	1	2	3
2018 January	4	4	8
2017 December	4	0	4
2017 November	4	1	5
2017 October	7	1	8
2017 September	5	0	5
2017 August	3	1	4
2017 July	5	1	6
2017 June	5	23	28
2017 May	9	1	10
2017 April	2	5	7
2017 March	4	83	87
2017 February	6	6	12
2017 January	4	0	4
2016 December	5	1	6
2016 November	7	1	8
2016 October	22	8	30
2016 September	11	2	13
2016 August	13	3	16
2016 July	28	5	33
2016 June	19	14	33

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