Objective: Knee osteoarthritis (KOA) is a common musculoskeletal condition that particularly afflicts women in menopause. The purpose of this review is to describe the pathophysiology and treatment considerations for this subset of the population.Methods: Medline/PubMed indexed articles related to the pathophysiology, diagnosis, and management of osteoarthritis were included in this narrative review.Results and Conclusion: Menopause has a multitude of effects that affect KOA, including hormonal shifts; loss of bone mineral density, muscle mass, and tendon strength; and changes to pain perception. Here, we discuss how a practitioner can assess the factors that are known to worsen KOA symptoms, including postural (spine, pelvic, and knee) alignment and functional muscle strength. The development of an effective exercise program is at the forefront of management. Optimizing other lifestyle factors including nutrition and sleep are particularly important in this patient population. Sleep disturbance from vasomotor symptoms can also increase perception of knee pain, for which pharmacologic options such as gabapentin or duloxetine may be pursued. In total, these interventions have large ramifications in decreasing pain and increasing function through improved range of motion, body composition, and walking speed in women with KOA.

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Background Juvenile idiopathic scoliosis (JIS) outcomes with brace treatment are limited with poorly described bracing protocols. Between 49 and 100% of children with JIS will progress to surgery, however, young age, long follow-up, and varying treatment methods make studying this population difficult. The purpose of this study is to report the outcomes of bracing in JIS treated with a Boston brace™ and identify risk factors for progression and surgical intervention. Methods This is a single-center retrospective review of 175 patients with JIS who initiated brace treatment between the age of 4 and 9 years. A cohort of 140 children reached skeletal maturity; 91 children had surgery or at least 2 year follow-up after brace completion. Standard in-brace protocol for scoliosis 320° was a Boston brace for 18–20 h/day after MRI (n = 82). Family history, MRI abnormalities, comorbidities, curve type, curve magnitude, bracing duration, number of braces, compliance by report, and surgical interventions were recorded. Results Children were average 7.9 years old (range 4.1–9.8) at the initiation of bracing. The Boston brace™ was prescribed in 82 patients and nine used night bending brace. Mid-thoracic curves (53%) was the most frequent deformity. Maximum curve at presentation was on average 30 ± 9 degrees, in-brace curve angle was 16 ± 8 degrees, and in-brace correction was 58 ± 24 percent. Patients were braced an average of 4.6 ± 1.9 years. 61/91 (67%) went on to posterior spinal fusion at 13.3 ± 2.1 (range 9.3–20.9) years and curve magnitude of 61 ± 12 degrees. Of those that underwent surgery, 49/55 (86%) progressed > 10°, 6/55 (11%) stabilized within 10°, and 0/55 (0%) improved > 10° with brace wear. No children underwent growth-friendly posterior instrumentation. Of the 28 who did not have surgical correction, 3 (11%) progressed > 10°, 13/28 (46%) stabilized within 10°, and 12/28 (43%) improved > 10° with brace wear. Conclusions This large series of JIS patients with bracing followed to skeletal maturity with long-term follow-up. Surgery was avoided in 33% of children with minimal to no progression, and no child underwent posterior growth-friendly constructs. Risk factors of needing surgery were noncompliance and larger curves at presentation.