Objective. To investigate the frequency of structural changes in the vastus medialis muscle in patients with osteoarthritis (OA) of the knee.Methods. Specimens of vastus medialis muscle from 78 patients with end-stage OA of the knee undergoing total joint arthroplasty were examined histopathologically. Morphologic changes were assessed in relation to clinical features that might have contributed to muscle injury.Results. All muscle specimens exhibited atrophy of type 2 fibers. In 32% of the patients, atrophy of type 1 fibers was also noted. Fiber type grouping of type 1 fiber in 15% of the patients and type 2 fiber in 37%, indicating reinnervation, led to the diagnosis of neurogenic muscular atrophy in 32% of the patients; selective atrophy of type 2 fiber in 68% of the specimens was interpreted as possibly resulting from pain-associated disuse. Signs of muscle degeneration and regeneration were found in 65% and 96% of the samples, respectively. Soft tissue changes indicating long-term disease, such as calcification, fibrosis, and lipomatosis, were frequently observed (in 69%, 71%, and 94% of the patients, respectively). Statistical analysis of clinical and morphologic parameters revealed a significant association between degenerative muscle changes and the presence of a varus deviation of the leg axis.Conclusion. Patients with OA of the knee frequently exhibit muscle changes, with probable multifactorial etiology. Selective atrophy of type 2 fibers might reflect pain-related immobilization of a limb. Changes such as neurogenic muscular atrophy, muscle fiber degeneration, and regeneration might contribute as cofactors in the development or progression of OA.The muscles surrounding the knee play an important role as active stabilizers and are crucial in protection of the joint structures against damaging influences (chondroprotection) (1-13). In a longitudinal study of female subjects (14), Slemenda et al showed that adequate quadriceps strength in healthy knees had a protective effect against the development of osteoarthritis (OA). In addition, there is considerable evidence that an imbalance in the activity of the joint-stabilizing muscles due to age-related reduction in sensory joint innervation (1,2,4,15) or proprioception (9-12,16-20) plays a decisive role in the development of OA of the knee. Slemenda and colleagues (20) and Brandt (21) have suggested that quadriceps weakness and atrophy might not only be the result of OA and resultant pain-related immobilization of the affected limb and muscles, but might also have to be regarded as direct preceding risk factors for the development and progression of OA. It is conceivable that, in addition to imbalance of muscle function, structural muscle changes might interfere with the chondroprotective effect of the musculature and thus contribute to the development of OA.Normal muscle contains 2 major fiber types, which differ with respect to histochemical staining pattern, twitch contraction time, and resistance to fatigue. The speed of contraction is mainly determin...

Medical malpractice charges from 1989 to 2002 were evaluated. A rising number of cases during this period is evident. The charges of practice falling below the standard of care (n = 285) were surveyed to determine who informed the prosecution, which clinical subjects are involved, what kind of charges can be found and whether such allegations can be appropriately assessed by means of a forensic autopsy. Forensic pathologists were found to be useful for ascertainment and interpretation of autopsy findings. If special questions arise, an additional expert opinion should be suggested by the forensic pathologist. There was no relevant shift in the range of subjects involved compared to former studies. The investigated charges might represent only a small fraction of cases of medical practice falling below the standard of care.

No abstract