» Children and adolescents with chronic pain are best managed by an interdisciplinary team.» In cases of complex regional pain syndrome (CRPS), the interdisciplinary team consists of a pain management specialist, such as an anesthesiologist or physiatrist, a physical therapist, an occupational therapist, a pain psychologist, and an orthopaedist. It may also include other professions, such as a gastroenterologist, psychiatrist, nurse practitioner, nutritionist, endocrinologist, acupuncturist, or social worker.» Key factors include rapid recognition of CRPS and the initiation of appropriate treatment, both for the pain syndrome as well as for the orthopaedic injury.» Intensive therapies have been shown to be effective in treating CRPS in children. Children often are more responsive to noninvasive treatments than adults.

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Objective This study examined the association of proximal femur shape with ipsilateral medial and lateral compartment knee OA. Design Radiographs were obtained from the NIH-funded Osteoarthritis Initiative. Cases of isolated radiographic lateral compartment knee OA were defined on baseline radiographs as Kellgren/Lawrence (K/L) Grade > = 2 and joint space narrowing (JSN) > 0 in the lateral compartment and JSN=0 in the medial compartment; isolated medial compartment knee OA had K/L ≥ 2 and JSN > 0 medially with JSN=0 in the lateral compartment. Controls had K/L < 2 and JSN = 0 in both compartments. Controls were frequency matched to cases by sex and 10-year age intervals. We characterized the shape of the proximal femurs on radiographs using Active Shape Modeling and determined the association of proximal femur shape with knee OA using logistic regression. Results There were 168 lateral compartment knee OA cases (mean BMI 29.72 ±5.26), 169 medial compartment knee OA cases (mean BMI 29.68±4.83) and 168 controls (mean BMI 26.87±4.2). Thirteen modes were derived for femur shape which described 95.5% of the total variance in proximal femur shape in the population. Modes 6, 8 and 12 were associated with prevalent lateral compartment knee OA. Medial compartment knee OA was associated with proximal femur modes 1, 5, 8, and 12. Conclusions Prevalent lateral and medial compartment knee OA are associated with different ipsilateral proximal femur shapes. Additional studies are needed to better define how the shape of the proximal femur influences compartment specific knee OA.

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.