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Yakushiji K, Fujita K, Tabuchi Y, Matsunaga-Myoji Y, Tanaka S, Mawatari M. Long-term health-related quality of life of total hip arthroplasty patients and cost-effectiveness analysis in the Japanese universal health insurance system. Jpn J Nurs Sci 2023; 20:e12537. [PMID: 37088471 DOI: 10.1111/jjns.12537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 03/21/2023] [Accepted: 03/29/2023] [Indexed: 04/25/2023]
Abstract
AIM Total hip arthroplasty can effectively improve patients' motility with end-stage osteoarthritis. This study aimed to: (1) compare gradual changes in utility values with total hip arthroplasty and estimated values without; (2) evaluate total hip arthroplasty cost-effectiveness; and (3) evaluate cost-effectiveness by age, diagnosis, and comorbidity. METHODS Patients who underwent total hip arthroplasty between January 2008 and December 2009 were included. Patients completed the EuroQol preoperatively and at 1, 3, 5 and 7 years postoperatively. To derive the quality-adjusted life years gained, a utility score was obtained from the EuroQol item scores and combined with 7 years, and estimates were obtained by discounting the postoperative 1-year utility value at an annual rate of 2%-4%. Mixed-effects regression models were used to compare the estimated and the measured utility values. RESULTS Mean total cost was 1,921,849 yen, and quality-adjusted life years gain score was 1.746 with per cost as 1,100,715 yen. Compared with actual measurements, the estimated values from 1 to 7 years post-surgery differed significantly, and interaction was observed. Regarding age, the older the patient, the higher the cost per quality-adjusted life years. Patients with lower preoperative physical function had higher quality-adjusted life years gains, while the cost per quality-adjusted life years was lower. CONCLUSIONS Total hip arthroplasty was cost-effective. Compared with actual measurements, the estimated utility values from 1 to 7 years post-surgery significantly differed. Even among older patients and those with impaired preoperative physical functions, its cost was lower than patients' willingness to pay in Japan.
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Affiliation(s)
- Kanako Yakushiji
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kimie Fujita
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | - Yuriko Matsunaga-Myoji
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satomi Tanaka
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
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Gandhi N, Qadeer AS, Meher A, Rachel J, Patra A, John J, Anilkumar A, Dutta A, Nanda L, Rout SK. Costs and models used in the economic analysis of Total Knee Replacement (TKR): A systematic review. PLoS One 2023; 18:e0280371. [PMID: 37490490 PMCID: PMC10368258 DOI: 10.1371/journal.pone.0280371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 07/12/2023] [Indexed: 07/27/2023] Open
Abstract
OBJECTIVES The main objective of this review is to summarize the evidence on the core modelling specifications and methodology on the cost-effectiveness of TKR compared to non-surgical management. Another objective of this study is to synthesize evidence of TKR cost and compare it across countries using purchasing power parity (PPP). METHODOLOGY The electronic databases used for this review were MEDLINE (PubMed), Cochrane Central Register of Controlled Trials (CENTRAL), HTAIn repository, Cost effectiveness Analysis (CEA) registry, and Google Scholar. Consolidated Health Economic Evaluation Reporting Standards (CHEERS) was used to assess the validity of the methods and transparency in reporting the results. The Quality of Health Economic Studies (QHES) was used to check the quality of economic evaluation models of the studies included. The cost of TKR surgery from high income and low- or middle-income countries were extracted and converted to single USD ($) using purchasing power parities (PPP) method. RESULT Thirty-two studies were included in this review, out of which eight studies used Markov model, five used regression model, one each reported Marginal structure model, discrete simulation model, decision tree and Osteoarthritis Policy Model (OAPol) respectively to assess the cost-effectiveness of TKR. For PPP, twenty-six studies were included in the analysis of TKR cost. The average cost of TKR surgery was the lowest in developing country-India ($3457) and highest in USA ($19568). CONCLUSION The findings of this review showed that the Markov model was most widely used in the analysis of the cost effectiveness of TKR. Our review also concluded that the cost of TKR was higher in the developed countries as compared to the developing countries.
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Affiliation(s)
- Naline Gandhi
- Indian Institute of Public Health-Hyderabad, Public Health Foundation of India, New Delhi, India
| | - Amatullah Sana Qadeer
- Indian Institute of Public Health-Hyderabad, Public Health Foundation of India, New Delhi, India
| | - Ananda Meher
- Indian Institute of Public Health-Hyderabad, Public Health Foundation of India, New Delhi, India
| | - Jennifer Rachel
- Indian Institute of Public Health-Hyderabad, Public Health Foundation of India, New Delhi, India
| | - Abhilash Patra
- Indian Institute of Public Health-Hyderabad, Public Health Foundation of India, New Delhi, India
| | - Jebamalar John
- Indian Institute of Public Health-Hyderabad, Public Health Foundation of India, New Delhi, India
| | - Aiswarya Anilkumar
- Indian Institute of Public Health-Hyderabad, Public Health Foundation of India, New Delhi, India
| | - Ambarish Dutta
- Indian Institute of Public Health-Bhubaneswar, Public Health Foundation of India, New Delhi, India
| | - Lipika Nanda
- Indian Institute of Public Health-Hyderabad, Public Health Foundation of India, New Delhi, India
| | - Sarit Kumar Rout
- Indian Institute of Public Health-Bhubaneswar, Public Health Foundation of India, New Delhi, India
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Woo SH, Shin WC, Han JB, Lee SM, Moon NH, Suh KT. Component Asymmetry in Bilateral Cementless Total Hip Arthroplasty. Clin Orthop Surg 2023; 15:27-36. [PMID: 36778988 PMCID: PMC9880502 DOI: 10.4055/cios22028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/03/2022] [Accepted: 03/03/2022] [Indexed: 11/06/2022] Open
Abstract
Background This study investigated the results of component asymmetry (CA) in bilateral cementless total hip arthroplasty (THA). Methods This study included 300 patients, who underwent bilateral cementless THA between April 2000 and December 2017. They were divided into the component symmetry (CS) and CA groups; CA group was sub-classified into acetabular component asymmetry (ACA) and femoral component asymmetry (FCA). Radiologic and clinical outcomes of the CA group were compared with those of the CS group. Results The incidence of CA was 25.7% (77/300 patients), including 55 patients with ACA, 34 patients with FCA, and 12 with both components asymmetric. The mean time interval between operations in the CA group was significantly longer than that in the CS group (p < 0.001). The mean differences in horizontal and vertical distances from teardrop to the center of rotation of the acetabular component between both hips in the ACA group were significantly larger than those in the CS group (p = 0.033 and p < 0.001, respectively). The mean femoral component alignment angle difference between both hips was significantly larger in the FCA group than in the CS group (p < 0.001). The mean Harris Hip Score at last follow-up of the CA group was similar to that of the CS group. Conclusions CA in patients undergoing bilateral cementless THA was not rare, especially with a longer time interval between operations. Regardless of CA, when stable fixation of the components was achieved, satisfactory radiologic and clinical outcomes were obtained.
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Affiliation(s)
- Seung Hun Woo
- Department of Orthopaedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Won Chul Shin
- Department of Orthopaedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jung Bum Han
- Department of Orthopaedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Sang Min Lee
- Department of Orthopaedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Nam Hoon Moon
- Department of Orthopaedic Surgery, Pusan National University Hospital, Busan, Korea
| | - Kuen Tak Suh
- Department of Orthopaedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
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Evaluating the Functional and Psychological Outcomes Following Periprosthetic Femoral Fracture After Total Hip Arthroplasty. Arthroplast Today 2022; 18:57-62. [PMID: 36262668 PMCID: PMC9574344 DOI: 10.1016/j.artd.2022.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 06/29/2022] [Accepted: 08/10/2022] [Indexed: 11/05/2022] Open
Abstract
Background A fall after total hip arthroplasty (THA) that results in a periprosthetic femoral fracture (PPF) can have devastating functional and psychological consequences in older adults. There are few studies that have evaluated both functional and psychological outcomes of PPF post-THA in the same cohort. Methods This is a retrospective study of 130 people who underwent revision THA between 2005 and 2019 due to PPF. The Western Ontario and McMaster Universities Osteoarthritis (WOMAC), Harris Hip Score (HHS), and Short Form-12 (SF-12) assessed physical function, hip joint function, and psychological well-being, respectively. Descriptive statistics using means and standard deviation or frequencies and percentages were used to define the sample. The association between baseline demographic, clinical, and surgical factors on WOMAC, HHS, and SF-12 scores at 1-year post-PPF surgery was modelled using multivariable linear regression. The mean age (n = 130) was 80.6 ± 9.0 years, and 55.4% (n = 72) were female. The mortality rate was 15.4% (n = 20) at 1-year post-PPF surgery. One-year follow-up data were available for 35.4% (n = 46) of patients. Results The WOMAC (n = 37), HHS (n = 32), and SF-12 mental component summary (n = 46) scores at 1-year post-PPF surgery were 67.9 ± 20.3, 78.3 ± 15.0, and 52.7 ± 9.1, respectively. No significant association was found among age, gender, previous history of lower extremity surgery, Vancouver classification, and femoral bone grafting on WOMAC, HHS, and SF-12 scores. Conclusions Our study found that patients with PPF have fair hip joint function, poor physical function and psychological well-being, and a high mortality rate at 1-year post-PPF surgery.
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Influence of implantation of a total hip endoprosthesis on the ipsilateral leg alignment: the effect of sex and dysplasia of the hip. Arch Orthop Trauma Surg 2022; 143:3541-3549. [PMID: 36001169 DOI: 10.1007/s00402-022-04587-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 08/09/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Differences in leg and hip morphology exist between sexes and developmental hip dysplasia is known to alter proximal femoral morphology. The purpose of this study was to determine whether existing differences in leg alignment due to sex or developmental hip dysplasia have an effect on changes in leg alignment after total hip arthroplasty. MATERIALS AND METHODS 30 hip osteoarthritis patients underwent biplanar full-length radiography in the standing position preoperatively and 3 months after total hip arthroplasty. Differences in leg alignment between men and women and between patients with primary hip osteoarthritis and patients with developmental dysplasia before and after surgery were tested using a general linear model for repeated measures. RESULTS Implantation of a hip prosthesis had no differential effect on ipsilateral leg alignment in patients with hip osteoarthritis due to dysplasia and in patients with primary hip osteoarthritis. However, patients with hip osteoarthritis due to dysplasia had a 2.1° higher valgus both before and after surgery. After total hip arthroplasty, women had a significantly greater increase in varus angle (1.6° vs. 0°) and femoral offset (10.5 vs. 4.6 mm) compared with men. Because the change in acetabular offset was smaller (2.2 vs. 6.2 mm), the global femoral offset was only increased in women. Femoral torsion was constant for men (15.0° and 16.5°), whereas femoral torsion was significantly reduced in women (19.9° and 13.2°). CONCLUSIONS Hip arthroplasty has a greater effect on leg axis in women than in men. The axial leg alignment of women could change from a natural valgus to a varus alignment. Therefore, surgeons should consider the effects of total hip arthroplasty on leg alignment in patients with hip osteoarthritis. Whether these changes in leg alignment are also clinically relevant and lead to premature medial or lateral knee osteoarthritis should be investigated in future work. TRIAL REGISTRATION This study was registered with DRKS (German Clinical Trials Register) under the number DRKS00015053. Registered 1st of August 2018.
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Hanson HM, Friesen J, Beaupre L, Jasper L, Millington J, Jones CA. Supporting Rehabilitation of Rural Patients Receiving Total Knee Arthroplasty Through Physical Activity: Perceptions of Stakeholder Groups. ACR Open Rheumatol 2022; 4:863-871. [PMID: 35862257 PMCID: PMC9555196 DOI: 10.1002/acr2.11489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 06/05/2022] [Accepted: 06/16/2022] [Indexed: 11/06/2022] Open
Abstract
Objective To identify how patients with osteoarthritis waiting for and recovering from total knee arthroplasty (TKA) conceptualized and participated in physical activity behaviors in their rural setting and to gather perceptions of health care professionals and rehabilitation decision‐makers on the feasibility of a remotely led physical activity coaching intervention. Methods Using a qualitative descriptive study, we collected data from three stakeholder groups: patients waiting for or recovering from TKA (interviews), health professionals delivering a physical activity intervention to patients in the recovering cohort (focus group), and rehabilitation leaders involved in decision‐making at the local or provincial level (interviews). Results A total of 38 individuals provided their perspectives (25 patients, five health professionals, eight decision‐makers). Patients waiting for and recovering from surgery described the attributes of their rural environment that supported and restricted their ability to participate in physical activities. Patients recovering from TKA appreciated support for goal‐setting and problem‐solving during their rehabilitation. Health care professionals and decision‐makers commented on the benefits of the program's innovative use of relatively simple technology to support remotely delivered, personalized rehabilitation in rural settings. Conclusion This study adds to the limited voice of and about patients living with osteoarthritis who reside in rural settings and identifies facilitators and barriers to TKA rehabilitation in this population. Our findings highlight that it is important to consider the local context and the resources available to patients as they navigate living well with osteoarthritis.
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Affiliation(s)
- Heather M. Hanson
- Alberta Health Services, Edmonton, Alberta, Canada, and University of Calgary Calgary Alberta Canada
| | | | | | - Lisa Jasper
- University of Alberta Edmonton Alberta Canada
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Augmented Rehabilitation Program for Patients 60 Years and Younger Following Total Hip Arthroplasty-Feasibility Study. Healthcare (Basel) 2022; 10:healthcare10071274. [PMID: 35885801 PMCID: PMC9324868 DOI: 10.3390/healthcare10071274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 06/29/2022] [Accepted: 07/06/2022] [Indexed: 11/21/2022] Open
Abstract
The purpose of this study is to examine the feasibility, safety and outcomes of a study comparing a 6-week post-operative rehabilitation program to usual care in patients ≤60 years undergoing elective unilateral total hip arthroplasty (THA). Methods: A cohort of 24 THA patients were recruited during their 6-week postoperative visit to their surgeons. The community-based rehabilitation program, which was designed to improve function and increase activity, consisted of 12 structured exercise classes on land and water over 6 weeks. Physical activity was assessed using a Sense Wear Pro Armband (SWA). Participants completed the Hip Osteoarthritis Outcome Score (HOOS) and THA satisfaction questionnaire before and immediately after the intervention. Results: 14 participants received the augmented rehabilitation, and 10 participants were in the control group. All except one in the intervention group completed at least 80% of the sessions. The intervention group took significantly more steps/day (mean difference = 2440 steps/day, 95% CI = 1678, 4712) (p < 0.05), at the follow-up compared to baseline. The intervention group had a higher mean change of number of weekly PA bouts than the control group. Within the intervention group, all HOOS subscales were significantly higher at the follow-up compared to baseline. Conclusion: Findings provided pragmatic insight regarding the intervention and assessments of implementing an augmented rehabilitation program for elective THA.
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Hagman DS, Smith AF, Presley TL, Smith LS, Yakkanti MR, Price MR, Malkani AL. Primary THA Using Thin Polyethylene Liners and Large Femoral Heads: A Minimum 5-Year Follow-Up. J Arthroplasty 2022; 37:S588-S591. [PMID: 35276279 DOI: 10.1016/j.arth.2022.02.117] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/24/2022] [Accepted: 02/28/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Large femoral head sizes are commonly used in total hip arthroplasty (THA) to minimize the risk of instability. With small acetabular cup-size, large femoral head diameter often results in the use of thin polyethylene liners. The purpose of this study was to evaluate clinical and radiographic results of large femoral heads against thin polyethylene liners with minimum 5-year follow-up. METHODS This was a retrospective review identifying 58 primary THAs utilizing thin polyethylene inserts from one manufacturer (X3 polyethylene, Stryker, Mahwah, NJ) and large femoral heads (36 mm or greater) with minimum 5-year follow-up. A total of 3 patients were deceased and 11 lost to follow-up, leaving 44 patients for review. All patients were female with mean age 65.7 (range 26-85) and mean body mass index (BMI) 29.9 (range 19.6-45.4). Average length of follow-up was 8.5 years (range 5.1-11.3). Outcome measures included survivorship, complications, PROMs and radiographic analysis. RESULTS There were four revisions: two aseptic loosening, one prosthetic joint infection, and one recurrent dislocation. Average HOOS-Jr, FJS-12, and patient satisfaction using Likert score was 94.3/100, 92.9/100, and 4.69/5.00, respectively, with 94% of patients reporting being satisfied or very satisfied. Radiographic analysis at average of 8.5 years demonstrated well-fixed implants without evidence of progressive radiolucent lines, osteolysis, or failure of the polyethylene liner. Survivorship using failure of the thin polyethylene liner as the endpoint was 100% at an average of 8.5 years. CONCLUSION Thin polyethylene liners used with large femoral head sizes in small acetabular cups demonstrated excellent results at average 8.5-year follow-up with no cases of liner fracture or osteolysis.
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Affiliation(s)
- Dallas S Hagman
- Department of Orthopaedic Surgery, University of Louisville, Louisville, KY
| | - Austin F Smith
- Department of Orthopaedic Surgery, University of Louisville, Louisville, KY
| | - Terry L Presley
- Department of Orthopaedic Surgery, University of Louisville, Louisville, KY
| | | | | | | | - Arthur L Malkani
- Department of Orthopaedic Surgery, Adult Reconstruction Program, University of Louisville, Louisville, KY
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Frydendal T, Christensen R, Mechlenburg I, Mikkelsen LR, Overgaard S, Ingwersen KG. Total hip arthroplasty versus progressive resistance training in patients with severe hip osteoarthritis: protocol for a multicentre, parallel-group, randomised controlled superiority trial. BMJ Open 2021; 11:e051392. [PMID: 34686555 PMCID: PMC8543646 DOI: 10.1136/bmjopen-2021-051392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Hip osteoarthritis (OA) is the leading cause for total hip arthroplasty (THA). Although, being considered as the surgery of the century up to 23% of the patients report long-term pain, and deficits in physical function and muscle strength may persist after THA. Progressive resistance training (PRT) appears to improve multiple outcomes moderately in patients with hip OA. Current treatment selection is based on low-level evidence as no randomised controlled trials have compared THA to non-surgical treatment. The primary aim of this trial is to investigate whether THA followed by standard care is superior to 12 weeks of supervised PRT followed by 12 weeks of optional unsupervised PRT for improving hip pain and function in patients with severe hip OA. METHODS AND ANALYSIS This is a protocol for a multicentre, parallel-group, assessor-blinded, randomised controlled superiority trial conducted at four hospitals across three healthcare regions in Denmark. 120 patients aged ≥50 years with clinical and radiographic hip OA found eligible for THA by an orthopaedic surgeon will be randomised to THA followed by standard care, or 12 weeks of PRT (allocation 1:1). The primary outcome will be change in patient-reported hip pain and function, measured using the Oxford Hip Score, from baseline to 6 months after initiating the treatment. Key secondary outcomes will be change in the Hip disability and Osteoarthritis Outcome Score subscales, University of California Los Angeles Activity Score, 40 m fast-paced walk test, 30 s chair stand test and occurrence of serious adverse events. Patients declining participation in the trial will be invited into a prospective observational cohort study. ETHICS AND DISSEMINATION The trial has been approved by The Regional Committees on Health Research Ethics for Southern Denmark (Project-ID: S-20180158). All results will be presented in peer-reviewed scientific journals and international conferences. TRIAL REGISTRATION NUMBER ClinicalTrials.gov (NCT04070027).
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Affiliation(s)
- Thomas Frydendal
- Department of Physio- and Occupational Therapy, Lillebaelt Hospital - University Hospital of Southern Denmark, Vejle, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Robin Christensen
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Research Unit of Rheumatology, Department of Clinical Research, Odense University Hospital, Odense, Denmark
| | - Inger Mechlenburg
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lone Ramer Mikkelsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Søren Overgaard
- Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kim Gordon Ingwersen
- Department of Physio- and Occupational Therapy, Lillebaelt Hospital - University Hospital of Southern Denmark, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Kim KB, Lee SM, Moon NH, Do MU, Shin WC. Early unexpected failure of a vitamin E-infused highly cross-linked polyethylene liner: A case report. Medicine (Baltimore) 2021; 100:e27454. [PMID: 34731119 PMCID: PMC8519234 DOI: 10.1097/md.0000000000027454] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 09/20/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Total hip arthroplasty (THA) with a polyethylene (PE) liner is 1 of the most effective and successful treatment strategies for end-stage hip disorders. Vitamin E-infused highly cross-linked polyethylene is theoretically known to prevent failure due to oxidative degradation in the body, and is resistant to wear; therefore, successful long-term survival of THA is expected. PATIENT CONCERNS In June 2019, approximately 1.5 years after THA, the patient sat down and stood up without any specific issue; however, an unusual bullet sound occurred around the left hip joint. Since then, his discomfort persisted, and he was admitted to the emergency department. DIAGNOSIS Plain radiography and metal artifact reduction computed tomography performed in the emergency department revealed eccentric elevation of the prosthetic femoral head and suspected PE liner failure. INTERVENTION Revision surgery was performed for modular component exchange. To reduce the dislocation risk without performing cup exchange, conversion to dual-mobility articulation was performed. OUTCOMES During the regular follow-up post-surgery, the patient could perform daily life activities without any discomfort, and dislocation was not observed. At 2 years postoperatively, no significant changes were observed in the radiographic images. LESSONS This case report presents an unexpected failure of THA due to superior rim fracture and excessive wear at the locking mechanism of the vitamin E-infused highly cross-linked polyethylene liner. This is an interesting case, as early PE liner failure occurred without strong labor intensity or trauma. A modular component exchange was performed with a dual-mobility bearing, and no issues were observed approximately 2 years after the reoperation. Therefore, third-generation highly cross-linked polyethylene liners can also cause early failure without a clear cause, and this case report highlights the necessity of considering several strategies for reoperation. STUDY DESIGN Case report.
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Affiliation(s)
- Kyeong Baek Kim
- Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Sang-Min Lee
- Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Nam Hoon Moon
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University School of Medicine, Yangsan, Republic of Korea
- Department of Orthopaedic Surgery, Pusan National University Hospital, Busan, Republic of Korea
| | - Min Uk Do
- Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Won Chul Shin
- Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University School of Medicine, Yangsan, Republic of Korea
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Jasper L, Beaupre L, Jones CA, Spence JC. Stationary Behavior and the Step-Defined Sedentary Lifestyle Index in Older Adults After Total Knee Arthroplasty. Arch Phys Med Rehabil 2021; 102:1926-1931. [PMID: 34252393 DOI: 10.1016/j.apmr.2021.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 06/22/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To measure stationary behavior in a cohort of older adults after total knee arthroplasty (TKA) and determine the clinical utility of the step-defined sedentary lifestyle index (SLI) as a measure of stationary behavior after TKA. DESIGN Cross-sectional measurement study. SETTING Participants were recruited from a community intake clinic for hip and knee surgeries. PARTICIPANTS Sixty-five older adults 3 months after TKA (N=65). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Stationary behaviors, including stationary time, stationary bouts, breaks from stationary time, and the proportion of participants meeting the SLI, were measured in older adults 3 months post TKA using accelerometry. A 2-way analysis of variance test (α=0.05) was conducted to determine the effects of SLI (<5000 or ≥5000 daily steps) and possible interactions with sex on stationary behavior. RESULTS Participants spent 80% (13.17±2.3h) of their waking time in stationary time and had an average of 6.06 bouts of stationary time >30 minutes per day. Forty (61.5%) of the participants fell below the SLI of 5000 steps/d. SLI had significant effects on both waking stationary time (P<.001) and number of breaks in stationary time (P<.001), with participants taking <5000 daily steps having longer stationary times and fewer breaks in stationary time. Sex had a significant effect on the number of breaks in stationary time (P=.04), with men (n=23, 35%) reporting more breaks than women (n=42, 65%) (mean difference 13.36; 95% confidence interval, -2.67 to 18.69). No interactions were found between SLI and sex. CONCLUSIONS Both women and men had high levels of stationary behavior 3 months post TKA. The SLI discriminated waking stationary time and breaks in stationary time and may have clinical utility in measurement of stationary behavior.
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Affiliation(s)
- Lisa Jasper
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta
| | - Lauren Beaupre
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta; Division of Orthopaedic Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta.
| | - C Allyson Jones
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta
| | - John C Spence
- Sedentary Living Lab, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
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Moon NH, Shin WC, Do MU, Kang SW, Lee SM, Suh KT. Wear and osteolysis outcomes for highly cross-linked polyethylene in primary total hip arthroplasty compared with conventional polyethylene: a 15- to 18-year single-centre follow-up study. Hip Int 2021; 31:526-532. [PMID: 31912760 DOI: 10.1177/1120700019896970] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Although highly positive results for wear reduction of highly cross-linked polyethylene (HXLPE) have been reported around the 10-year follow-up, the long-term result related to reoperation and wear-related survival is still an issue. Therefore, this study aimed to compare the follow-up results of a single manufacture's polyethylene liner for >15 years in terms of survival and wear rate. METHODS This retrospective cohort study included 134 primary total hip arthroplasties (THAs) who were followed up for at least 15 years. The mean age at the time of surgery was 50.7 years (conventional polyethylene [CPE] group = 22; HXLPE group = 112). Linear and volumetric wear rates of polyethylene were measured, and the reoperation rate and radiographic osteolysis were evaluated and Kaplan-Meier survival analysis was performed in both groups. Implant-related complications were also examined. RESULTS HXLPE group showed a significantly lower wear rate in both linear and volumetric wear. None of the hip radiographs showed evidence of loosening or osteolysis in the HXLPE group. The survival rates at 15- to 18-year follow-up were 90.9% and 95.5% in the CPE and HXLPE groups when all-cause reoperation was the endpoint, and 90.9% and 100.0% when the wear-related reoperation was the endpoint, respectively. Implant-related complications were not different between the 2 groups. CONCLUSIONS Wear reduction and osteolysis showed a great advantage in HXLPE after a 15-year follow-up. Although the CPE and HXLPE showed excellent survival, wear and osteolysis were more frequent in the CPE; therefore, the high risk of reoperation in the future should be considered.
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Affiliation(s)
- Nam Hoon Moon
- Department of Orthopaedic Surgery, Pusan National University Hospital, Pusan, Republic of Korea
| | - Won Chul Shin
- Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Min Uk Do
- Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Suk-Woong Kang
- Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Sang-Min Lee
- Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Kuen Tak Suh
- Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
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13
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An X, Wang J, Shi W, Ma R, Li Z, Lei M, Liu Y, Lin F. The Effect of Passive Smoking on Early Clinical Outcomes After Total Knee Arthroplasty Among Female Patients. Risk Manag Healthc Policy 2021; 14:2407-2419. [PMID: 34113195 PMCID: PMC8187102 DOI: 10.2147/rmhp.s309893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/16/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The aim of this study was to assess whether passive smoking affects clinical outcomes among female patients with knee osteoarthritis after being treated with total knee arthroplasty (TKA). METHODS The study prospectively enrolled 216 female patients who did not smoke and those patients were classified into three groups in terms of the severity of exposure to environmental tobacco smoke. A three-month follow-up was conducted to assess the physical and mental outcomes between the three groups. The physical outcomes were evaluated by the visual analogue score (VAS), range of motion (ROM), hospital for special surgery (HSS) knee score, and postoperative complications. The mental outcomes were assessed by the anxiety and depression scale (HADS) and medical outcome study short form 36 (SF-36). Subgroup analysis of patients with and without surgical site infection (SSI) was also calculated. RESULTS Baseline characteristics were similarly distributed between the three groups (P>0.05). Patients in the heavy passive smoking group had a higher VAS and a lower ROM score as compared with patients in the no and mild passive smoking group at discharge (P<0.01), 1 month (P<0.01), and 3 months (P<0.01) after surgery. Patients in the heavy passive smoking group also had a higher rate of HADS more than 8 at postoperative 1 month (P=0.01) and 3 months (P=0.03) and lower SF-36 summary (P<0.01) and HSS score (P<0.01) at postoperative 3 months. Forty-five postoperative complication events were observed during follow-up. Patients in the heavy passive smoking group (8.51%) had the highest SSI rate, followed by patients in the mild (1.82%) and no passive smoking group (0.88%) at discharge (P=0.02) and postoperative 1 month (P=0.03). CONCLUSION Passive smoking negatively affects TKA among female patients. It may trigger poor pain and functional outcomes, aggravate depression and anxiety, and deteriorate quality of life after discharge from hospital. Avoiding exposure to smoking environment may be beneficial among TKA female patients before and after surgery.
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Affiliation(s)
- Xiao An
- Department of Orthopedic Surgery, Hainan Hospital of Chinese PLA General Hospital, Sanya, People’s Republic of China
| | - Junliang Wang
- Department of Orthopedic Surgery, Hainan Hospital of Chinese PLA General Hospital, Sanya, People’s Republic of China
| | - Weiqing Shi
- Department of Operation Room, the Fifth Medical Center of Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Rui Ma
- Department of Orthopedic Surgery, Hainan Hospital of Chinese PLA General Hospital, Sanya, People’s Republic of China
| | - Zhirui Li
- Department of Orthopedic Surgery, Hainan Hospital of Chinese PLA General Hospital, Sanya, People’s Republic of China
| | - Mingxing Lei
- Department of Orthopedic Surgery, Hainan Hospital of Chinese PLA General Hospital, Sanya, People’s Republic of China
| | - Yaosheng Liu
- Department of Orthopedic Surgery, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Feng Lin
- Department of Orthopedic Surgery, Hainan Hospital of Chinese PLA General Hospital, Sanya, People’s Republic of China
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14
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Prock-Gibbs H, Pumilia CA, Meckmongkol T, Lovejoy J, Mumith A, Coathup M. Incidence of Osteolysis and Aseptic Loosening Following Metal-on-Highly Cross-Linked Polyethylene Hip Arthroplasty: A Systematic Review of Studies with Up to 15-Year Follow-up. J Bone Joint Surg Am 2021; 103:728-740. [PMID: 33411465 DOI: 10.2106/jbjs.20.01086] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study compared the incidence of osteolysis, aseptic loosening, and revision following use of highly cross-linked polyethylene (HXLPE) or conventional polyethylene (CPE) at medium to long-term (>5 to 15 years) follow-up in primary total hip arthroplasty (THA). Incidences were quantified and compared with regard to age and method of implant fixation. METHODS Using the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines, 12 randomized controlled trials and 18 cohort studies were investigated for evidence-based outcomes following HXPLE and CPE use in 2,539 hips over a 5 to 15-year follow-up. RESULTS Lower rates of osteolysis, aseptic loosening, and implant revision were reported following use of HXLPE liners. Osteolysis was reduced from 25.4% with CPE to 4.05% with HXLPE in young patients, and from 29.7% to 6.6% in the older patient cohort. Similarities in osteolysis rates were observed when cemented (24.9% for CPE and 6.5% for HXLPE) and uncemented components (32.8% for CPE and 7.1% for HXLPE) were compared. No clear advantage in the type of HXLPE used was observed. CONCLUSIONS Over a follow-up period of up to 15 years, when compared with CPE, use of HXLPE liners reduced the incidence of osteolysis, aseptic loosening, and implant revision, regardless of the fixation method and including in younger and potentially more active patients. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
| | | | - Teerin Meckmongkol
- College of Medicine, University of Central Florida, Orlando, Florida.,Departments of General Surgery (T.M.) and Orthopaedics, Sports Medicine and Physical Medicine and Rehabilitation (J.L.), Nemours Children's Hospital, Orlando, Florida
| | - John Lovejoy
- College of Medicine, University of Central Florida, Orlando, Florida.,Departments of General Surgery (T.M.) and Orthopaedics, Sports Medicine and Physical Medicine and Rehabilitation (J.L.), Nemours Children's Hospital, Orlando, Florida
| | - Aadil Mumith
- College of Medicine, University of Central Florida, Orlando, Florida.,Department of Orthopaedics, Basingstoke and North Hampshire Hospital, Basingstoke, United Kingdom
| | - Melanie Coathup
- College of Medicine, University of Central Florida, Orlando, Florida
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15
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Wang Q, Lee RLT, Hunter S, Chan SWC. The effectiveness of internet-based telerehabilitation among patients after total joint arthroplasty: A systematic review and meta-analysis of randomised controlled trials. J Telemed Telecare 2021; 29:247-260. [PMID: 33459120 DOI: 10.1177/1357633x20980291] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The aim of this review was to systematically evaluate the available evidence on the effectiveness of internet-based telerehabilitation among patients after total joint arthroplasty regarding pain, range of motion, physical function, health-related quality of life, satisfaction, and psychological well-being. METHODS This was a systematic review with meta-analysis based on the Cochrane Handbook for Systematic Reviews of Interventions guidelines. Studies published in English or Chinese were searched using defined search periods, databases, and search terms. Two reviewers assessed independently the quality of studies. RevMan 5.3 was used for meta-analysis. Heterogeneity was assessed using the χ2 and I2 statistic. A random effect model and mean difference (MD) with 95% confidence interval (CI) was adopted. Standardised mean difference (SMD) was used if the outcome was measured by different scales. RESULTS Eleven studies with 1020 participants were analysed. Compared to face-to-face rehabilitation, internet-based telerehabilitation showed no significant difference in outcomes of pain (SMD-0.11, 95% CI-0.32 to 0.10), range of motion in flexion (MD 0.65, 95% CI-1.18 to 2.48) and extension (MD-0.38, 95% CI-1.16 to 0.40), patient-reported physical function (SMD 0.01, 95% CI-0.15 to 0.17), health-related quality of life (SMD-0.09, 95% CI-0.26 to 0.07), satisfaction (SMD-0.04, 95% CI-0.21 to 0.14), and psychological well-being (SMD 0.10, 95% CI-0.13 to 0.33). Internet-based telerehabilitation showed better outcomes in physical functional tests (SMD-0.54, 95% CI-1.08 to-0.01). DISCUSSION This review suggests that internet-based telerehabilitation has comparable effectiveness to face-to-face rehabilitation on rehabilitation outcomes among patients after total joint arthroplasty.
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Affiliation(s)
- Qingling Wang
- School of Nursing and Health Management, Shanghai University of Medicine and Health Sciences, Shanghai, China.,School of Nursing and Midwifery, University of Newcastle, Callaghan, NSW, Australia
| | - Regina L-T Lee
- School of Nursing and Midwifery, University of Newcastle, Callaghan, NSW, Australia
| | - Sharyn Hunter
- School of Nursing and Midwifery, University of Newcastle, Callaghan, NSW, Australia
| | - Sally W-C Chan
- University of Newcastle Singapore Campus, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Brain and Mental Health, University of Newcastle, Callaghan, NSW, Australia
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16
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Validity of Tools to Measure Physical Activity in Older Adults Following Total Knee Arthroplasty. J Aging Phys Act 2020; 29:651-658. [PMID: 33378742 DOI: 10.1123/japa.2020-0240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/03/2020] [Accepted: 09/29/2020] [Indexed: 11/18/2022]
Abstract
Few validated tools exist for measuring physical activity following total knee arthroplasty (TKA) despite the importance of returning to sufficient levels of physical activity post-TKA to achieve health benefits. This study examined the validity of two clinical measures-the Fitbit, a commercially available personal activity monitor, and the Community Healthy Activities Model Program for Seniors (CHAMPS), a self-report questionnaire-compared with a reference standard accelerometer, the SenseWearTM Armband (SWA). At 6-month post-TKA, 47 participants wore the Fitbit and SWA for 4 days and then completed the CHAMPS. Moderate-to-good correlation was observed between the Fitbit and SWA for steps (intraclass correlation coefficient [ICC] = .79), energy expenditure (ICC = .78), and energy expenditure <3 METS (ICC = .79). Poor-to-moderate correlation was observed between the CHAMPS and SWA (ICC = .43) with the questionnaire reporting lower daily energy expenditures than the SWA. Results showed that Fitbit may be a reasonable measurement tool to measure steps and energy expenditures in older adults following TKA.
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17
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Effect of Physiological Saline Solution Contamination on Selected Mechanical Properties of Seasoned Acrylic Bone Cements of Medium and High Viscosity. MATERIALS 2020; 14:ma14010110. [PMID: 33383870 PMCID: PMC7796448 DOI: 10.3390/ma14010110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 12/18/2020] [Accepted: 12/21/2020] [Indexed: 12/29/2022]
Abstract
Bone cements play a key role in present-day surgery, including the implantation of hip and knee joint endoprostheses. The correct and durable bonding of the prosthesis to the bone is affected by both the static strength characteristics determined in accordance with ISO 5833:2002 and the resistance to long-term exposure to an aggressive environment of the human body and the impurities that may be introduced into the cement during implementation. The study attempts to demonstrate statistically significant degradation of cement as a result of the seasoning of cement samples in Ringer’s solution with simultaneous contamination of the material with saline solution, which is usually present in the surgical field (e.g., during the fixing of endoprostheses). The results of statistical analysis showed the nature of changes in compressive strength and microhardness due to seasoning time and degree of contamination.
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18
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Use of Deep Learning Networks and Statistical Modeling to Predict Changes in Mechanical Parameters of Contaminated Bone Cements. MATERIALS 2020; 13:ma13235419. [PMID: 33260793 PMCID: PMC7731130 DOI: 10.3390/ma13235419] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 11/25/2020] [Accepted: 11/26/2020] [Indexed: 12/14/2022]
Abstract
The purpose of the study was to test the usefulness of deep learning artificial neural networks and statistical modeling in predicting the strength of bone cements with defects. The defects are related to the introduction of admixtures, such as blood or saline, as contaminants into the cement at the preparation stage. Due to the wide range of applications of deep learning, among others in speech recognition, bioinformation processing, and medication design, the extent was checked to which it is possible to obtain information related to the prediction of the compressive strength of bone cements. Development and improvement of deep learning network (DLN) algorithms and statistical modeling in the analysis of changes in the mechanical parameters of the tested materials will enable determining an acceptable margin of error during surgery or cement preparation in relation to the expected strength of the material used to fill bone cavities. The use of the abovementioned computer methods may, therefore, play a significant role in the initial qualitative assessment of the effects of procedures and, thus, mitigation of errors resulting in failure to maintain the required mechanical parameters and patient dissatisfaction.
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19
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Mukka S, Rolfson O, Mohaddes M, Sayed-Noor A. The Effect of Body Mass Index Class on Patient-Reported Health-Related Quality of Life Before and After Total Hip Arthroplasty for Osteoarthritis: Registry-Based Cohort Study of 64,055 Patients. JB JS Open Access 2020; 5:e20.00100. [PMID: 33354639 PMCID: PMC7748188 DOI: 10.2106/jbjs.oa.20.00100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Overweight status and obesity represent a global epidemic, with serious consequences at the individual and community levels. The number of total hip arthroplasties (THAs) among overweight and obese patients is expected to rise. Increasing body mass index (BMI) has been associated with a higher risk of mortality and reoperation and lower implant survival. The evaluation of perioperative health-related quality of life (HRQoL) has recently gained importance because of its direct relation to, and impact on, patients' physical, mental, and social well-being as well as health-service utilization. We sought to evaluate the influence of BMI class on HRQoL preoperatively and at 1 year following THA in a register-based cohort study. METHODS This observational cohort study was designed and conducted on the basis of registry data derived from the Swedish Hip Arthroplasty Register (SHAR) and included 64,055 primary THAs registered between January 1, 2008, and December 31, 2015. Patients' baseline preoperative and 1-year postoperative EuroQol-5 Dimension-3 Level (EQ-5D-3L) responses were documented by the treating department and reported to the SHAR through the patient-reported outcome measures program. The EQ-5D-3L includes a visual analogue scale (EQ VAS), which measures the patient's overall health status. RESULTS At 1 year of follow-up, all BMI classes showed significant and clinically relevant improvements in all HRQoL measures compared with preoperative assessment (p < 0.05). Patients reported improved perception of current overall health status for the EQ VAS. Underweight, overweight, and all obesity classes showed increasingly worse 1-year HRQoL compared with normal weight, both with unadjusted and adjusted calculations. CONCLUSIONS In this study, we found that all BMI classes had significant improvement in HRQoL at 1 year following THA. Patients who were underweight, overweight, or obese (classes I to III), compared with those of normal weight, reported worse hip pain and EQ-5D-3L and EQ VAS responses prior to THA and at 1 year postoperatively. These results can assist both health-care providers and patients in establishing reasonable expectations about THA outcomes. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Sebastian Mukka
- Department of Surgical and Perioperative Sciences, Orthopaedics, Umeå University, Umeå, Sweden
| | - Ola Rolfson
- Swedish Hip Arthroplasty Register, Centre of Registers, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maziar Mohaddes
- Swedish Hip Arthroplasty Register, Centre of Registers, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Arkan Sayed-Noor
- Department of Surgical and Perioperative Sciences, Orthopaedics, Umeå University, Umeå, Sweden
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20
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Moore AJ, Gooberman-Hill R. Why don't patients seek help for chronic post-surgical pain after knee replacement? A qualitative investigation. Health Expect 2020; 23:1202-1212. [PMID: 32648336 PMCID: PMC7696127 DOI: 10.1111/hex.13098] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 12/15/2022] Open
Abstract
Background Although many people are satisfied with their outcome after total knee replacement surgery for osteoarthritis, around 20% report chronic post‐surgical pain. People are often disappointed and unsure about whether their pain is normal and what can be done about it. Given the high prevalence of long‐term post‐operative pain after knee replacement, there is potentially a large hidden population with an unaddressed need for care. Objective In this study, we focus on understanding why some people choose not to consult health care for chronic post‐surgical pain after knee replacement. Methods Semi‐structured interviews were conducted with people who had received total knee replacement, at either of two National Health Service hospitals in the United Kingdom, and who had chronic post‐surgical pain (n = 34, age 55‐93 years). Data were audio‐recorded, transcribed and analysed thematically. Results We found an overall sense of futility amongst participants who believed that nothing further could be done for their on‐going pain. People's perception of their pain was often discordant with that of surgeons and physicians. Other factors that contributed to decisions not to seek help included low expectations about effectiveness and the risks involved in further treatment, treatment burden, participants' prioritization of other health conditions and views about candidacy. Many accepted their on‐going pain. Conclusion Our study indicates why some people with chronic pain after knee replacement do not seek further health care. Understanding patients' beliefs and expectations about chronic post‐surgical pain can inform approaches that might enable people to seek help in the future.
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Affiliation(s)
- Andrew J Moore
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, Southmead Hospital, University of Bristol, Bristol, UK
| | - Rachael Gooberman-Hill
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, Southmead Hospital, University of Bristol, Bristol, UK.,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
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21
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Berg U, W-Dahl A, Rolfson O, Nauclér E, Sundberg M, Nilsdotter A. Influence of fast-track programs on patient-reported outcomes in total hip and knee replacement (THR/TKR) at Swedish hospitals 2011-2015: an observational study including 51,169 THR and 8,393 TKR operations. Acta Orthop 2020; 91:306-312. [PMID: 32106731 PMCID: PMC8023888 DOI: 10.1080/17453674.2020.1733375] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Fast-track care programs have been broadly introduced at Swedish hospitals in elective total hip and knee replacement (THR/TKR). We studied the influence of fast-track programs on patient-reported outcomes (PROs) 1 year after surgery, by exploring outcome measures registered in the Swedish arthroplasty registers.Patients and methods - Data were obtained from the Swedish Knee and Hip Arthroplasty Registers and included TKR and THR operations 2011-2015 on patients with osteoarthritis. Based on questionnaires concerning the clinical pathway and care programs at Swedish hospitals, the patients were divided in 2 groups depending on whether they had been operated in a fast-track program or not. PROs of the fast-track group were compared with not fast-track using regression analysis. EQ-5D, EQ VAS, Pain VAS, and Satisfaction VAS were analyzed for both THR and TKR operations. The PROMs for TKR also included KOOS.Results - The differences of EQ-5D, EQ VAS, Pain VAS, and Satisfaction VAS 1 year after surgery were small but all in favor of fast-track for both THR and TKR, also in subscales of KOOS for TKR except KOOS QoL. However, the effect sizes as measured by Cohens' d formula were < 0.2 for all PROs, in both THR and TKR.Interpretation - Our results indicate that the fast-track programs may be at least as good as conventional care from the perspective of PROs 1-year postoperatively.
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Affiliation(s)
- Urban Berg
- Department of Orthopaedics, Clinical Sciences, Sahlgrenska Academy, Gothenburg University; ,Department of Surgery and Orthopaedics, Kungälv Hospital; ,Correspondence:
| | - Annette W-Dahl
- Department of Orthopedics, Clinical Sciences Lund, Lund University; ,The Swedish Knee Arthroplasty Register;
| | - Ola Rolfson
- Department of Orthopaedics, Clinical Sciences, Sahlgrenska Academy, Gothenburg University; ,Department of Orthopedics Sahlgrenska University Hospital; ,The Swedish Hip Arthroplasty Register, Sweden
| | | | - Martin Sundberg
- Department of Orthopedics, Clinical Sciences Lund, Lund University; ,The Swedish Knee Arthroplasty Register;
| | - Anna Nilsdotter
- Department of Orthopaedics, Clinical Sciences, Sahlgrenska Academy, Gothenburg University; ,Department of Orthopedics Sahlgrenska University Hospital;
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22
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Devasenapathy N, Malhotra R, Mittal K, Garg B, Kumar V, Zodpey S, Dogra H, Maddison R, Belavy DL. Higher Disability in Women Than Men Scheduled for Total Knee Arthroplasty for Degenerative Osteoarthritis: A Cross-Sectional Analysis From India. ACR Open Rheumatol 2020; 2:309-319. [PMID: 32386129 PMCID: PMC7301870 DOI: 10.1002/acr2.11137] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 03/24/2020] [Indexed: 01/27/2023] Open
Abstract
Objective Higher level impairments and activity limitation among those scheduled for total knee arthroplasty (TKA) is known. Sex differences in participation restriction which is the final domain of disablement pathway is not known. No data from developing countries exist on sex differences in disability levels at the time of TKA. Methods In a cross‐sectional analysis of 240 patients (188 women; 72 men) scheduled for TKA, impairment (pain, symptoms, quadricep muscle strength, and knee range of motion [ROM]), activity limitation (self‐reported and objective performance‐based measurements), and participation restriction were compared. Multivariable regression analyses were used to adjust for key sociodemographic and clinical characteristics. Associations between impairments and participation restriction were analyzed. Results Compared with men, women were more likely to have higher levels of impairment (knee injury and osteoarthritis outcome pain score adjusted mean difference [aMD]: −6.9 [95% confidence interval {CI} −13.7 to −0.18]; flexion ROM of less than 100° adjusted odds ratio: 5.7 [95% CI 1.6‐20.3]; and 36% lower muscle strength [95% CI 24%‐49%]) and lower objectively measured functional ability (walking speed aMD: −0.12 m/s [95% CI −0.23 to −0.02]; stair climbing time aMD: 9.5 s [95% CI 1.5‐17.5]). Participation restriction was higher in women compared with men. Of the impairment measures (pain, ROM, and muscle strength), pain contributed to participation restriction in both sexes. Conclusion This study demonstrated higher levels of disability in women than in men at the time of TKA. Effect of pain on participation restriction was higher compared with muscle strength and ROM. Evidence of delay in decision‐making to undergo TKA and reasons for delay need to be studied specifically in the context of lower middle–income countries.
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Affiliation(s)
- Niveditha Devasenapathy
- Indian Institute of Public Health-Delhi, Public Health Foundation of India, New Delhi, India, and Deakin University, Geelong, Victoria, Australia
| | | | - Kanchan Mittal
- All India Institute of Medical Sciences, New Delhi, India
| | - Bhavuk Garg
- All India Institute of Medical Sciences, New Delhi, India
| | - Vijay Kumar
- All India Institute of Medical Sciences, New Delhi, India
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23
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Fang Y, Ding C, Wang Y, Zhang H. Comparison of core decompression and porous tantalum rod implantation with conservative treatment for avascular necrosis of the femoral head: A minimum 18 month follow-up study. Exp Ther Med 2020; 20:472-478. [PMID: 32509016 PMCID: PMC7271720 DOI: 10.3892/etm.2020.8669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 02/26/2020] [Indexed: 02/07/2023] Open
Abstract
Porous tantalum rod implantation is a novel surgical method that is used to treat avascular necrosis (AVN) of the femoral head (hip). In the present study, the results of core decompression and tantalum rod implantation were compared with non-surgical treatment for AVN, and the survivorship of the femoral head was evaluated. In total, 60 patients with AVN femoral head were recruited and analysed. Non-surgical treatment was selected by 30 patients (41 hips), 7 with a Ficat score of I and 23 with a score of II. Non-surgical treatment included celecoxib, salvia miltiorrhiza and tetramethylypyrazine and a reduction in weight-bearing activities. Surgical treatment and porous tantalum rod implantation were selected by 30 patients (41 hips), 10 with a Ficat score of I and 20 with a score of II. After follow-up (average: 33.5 months), patients were evaluated by assessing post-operative complications, radiology, hip survivorship and Harris hip score. In the surgical group, pre-operative symptoms were significantly alleviated. No complications, including infection, delayed healing or fractures were reported. Final follow-up rates of femoral head survivorship were 4.9% in the non-surgical group and 36.7% in the surgical group. The Harris hip score was significantly improved following surgery when compared with non-surgical treatment (P<0.05). The results indicated that core decompression and porous tantalum rod implantation are beneficial short- and mid-term treatment methods for AVN of the femoral head.
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Affiliation(s)
- Yuan Fang
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China
| | - Changrong Ding
- Department of Electrocardiogram, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China
| | - Yingzhen Wang
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China
| | - Haining Zhang
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China
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24
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Singh JA, Cleveland JD. Socioeconomic status and healthcare access are associated with healthcare utilization after knee arthroplasty: A U.S. national cohort study. Joint Bone Spine 2020; 87:157-162. [DOI: 10.1016/j.jbspin.2019.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 11/27/2019] [Indexed: 01/23/2023]
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25
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McGough EL, Lin SY, Belza B, Becofsky KM, Jones DL, Liu M, Wilcox S, Logsdon RG. A Scoping Review of Physical Performance Outcome Measures Used in Exercise Interventions for Older Adults With Alzheimer Disease and Related Dementias. J Geriatr Phys Ther 2020; 42:28-47. [PMID: 29210934 DOI: 10.1519/jpt.0000000000000159] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE There is growing evidence that exercise interventions can mitigate functional decline and reduce fall risk in older adults with Alzheimer disease and related dementias (ADRD). Although physical performance outcome measures have been successfully used in older adults without cognitive impairment, additional research is needed regarding their use with individuals who have ADRD, and who may have difficulty following instructions regarding performance of these measures. The purpose of this scoping review was to identify commonly used physical performance outcome measures, for exercise interventions, that are responsive and reliable in older adults with ADRD. Ultimately, we aimed to provide recommendations regarding the use of outcome measures for individuals with ADRD across several domains of physical performance. METHODS A scoping review was conducted to broadly assess physical performance outcome measures used in exercise interventions for older adults with ADRD. Exercise intervention studies that included at least 1 measure of physical performance were included. All physical performance outcome measures were abstracted, coded, and categorized into 5 domains of physical performance: fitness, functional mobility, gait, balance, and strength. Criteria for recommendations were based on (1) the frequency of use, (2) responsiveness, and (3) reliability. Frequency was determined by the number of studies that used the outcome measure per physical performance domain. Responsiveness was assessed via calculated effect size of the outcome measures across studies within physical performance domains. Reliability was evaluated via published studies of psychometric properties. RESULTS AND DISCUSSION A total of 20 physical performance outcome measures were extracted from 48 articles that met study inclusion criteria. The most frequently used outcome measures were the 6-minute walk test, Timed Up and Go, repeated chair stand tests, short-distance gait speed, the Berg Balance Scale, and isometric strength measures. These outcome measures demonstrated a small, medium, or large effect in at least 50% of the exercise intervention studies. Good to excellent reliability was reported in samples of older adults with mild to moderate dementia. Fitness, functional mobility, gait, balance, and strength represent important domains of physical performance for older adults. The 6-minute walk test, Timed Up and Go, repeated chair stand tests, short-distance gait speed, Berg Balance Scale, and isometric strength are recommended as commonly used and reliable physical performance outcome measures for exercise interventions in older adults with mild to moderate ADRD. Further research is needed on optimal measures for individuals with severe ADRD. CONCLUSIONS The results of this review will aid clinicians and researchers in selecting reliable measures to evaluate physical performance outcomes in response to exercise interventions in older adults with ADRD.
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Affiliation(s)
- Ellen L McGough
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Shih-Yin Lin
- School of Nursing, University of Washington, Seattle, Washington
| | - Basia Belza
- School of Nursing, University of Washington, Seattle, Washington.,Health Promotion Research Center, University of Washington, Seattle, Washington
| | - Katie M Becofsky
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Dina L Jones
- Department of Orthopaedics, Division of Physical Therapy, and Injury Control Research Center, West Virginia University, Morgantown, West Virginia
| | - Minhui Liu
- School of Nursing, University of Washington, Seattle, Washington.,Center for Innovative Care in Aging School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Sara Wilcox
- Department of Exercise Science and Prevention Research Center, University of South Columbia, South Carolina
| | - Rebecca G Logsdon
- School of Nursing, University of Washington, Seattle, Washington.,Health Promotion Research Center, University of Washington, Seattle, Washington
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26
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Chen SK, Voaklander D, Perry D, Jones CA. Falls and fear of falling in older adults with total joint arthroplasty: a scoping review. BMC Musculoskelet Disord 2019; 20:599. [PMID: 31830974 PMCID: PMC6909481 DOI: 10.1186/s12891-019-2954-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 11/18/2019] [Indexed: 01/27/2023] Open
Abstract
Background Patients waiting or recovering from total joint arthroplasty (TJA) are at risk for falls which can lead to restriction of activity and negatively impact recovery. The objective of this scoping review is to critically appraise and synthesize the evidence in the reported number of falls, fear of falling, and risk factors associated with falls in older patients waiting for or recovering from TJA. Methods Seven electronic databases were searched with no date limits and using language restriction (English). The inclusion criteria were 1) cohorts that included older adults 60+ years of age, 2) reported prevalence of falls, fear of falling, and/or risk factors for falls in patients who were waiting or recovering from TJA and 3) cross-sectional studies, cohort studies, and case control study designs. The quality assessment of selected articles was assessed using the SIGN Guidelines Checklist. Results Of the 866 citations identified, 12 studies met the inclusion criteria and were reviewed. Prevalence of falls in pre-operative TJA patients and post-operative TJA patients ranged from 23 to 63%, and 13 to 42%, respectively. Of those five studies that examined fear of falling, pre-operative TJA patients reported greater fear of falling than post-operative patients. Modifiable risk factors for falls included fear of falling, joint range of motion, and depression. Conclusions An increased risk of falls in patients with TJA was reported both for patients waiting for and recovering from surgery. A number of modifiable risk factors were identified including fear of falling that could be targeted in fall prevention programs for TJA.
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Affiliation(s)
- Serena Kuangyi Chen
- School of Public Health, University of Alberta Edmonton, Alberta, T6G 1C9, Canada
| | - Don Voaklander
- School of Public Health, University of Alberta Edmonton, Alberta, T6G 1C9, Canada
| | - Danielle Perry
- School of Public Health, University of Alberta Edmonton, Alberta, T6G 1C9, Canada
| | - C Allyson Jones
- Department of Physical Therapy, University of Alberta Edmonton, Alberta, T6G 2G4, Canada.
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27
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Felix J, Becker C, Vogl M, Buschner P, Plötz W, Leidl R. Patient characteristics and valuation changes impact quality of life and satisfaction in total knee arthroplasty - results from a German prospective cohort study. Health Qual Life Outcomes 2019; 17:180. [PMID: 31815627 PMCID: PMC6902559 DOI: 10.1186/s12955-019-1237-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/24/2019] [Indexed: 01/16/2023] Open
Abstract
Background Evaluation of variations in pre- and postoperative patient reported outcomes (PRO) and the association between preoperative patient characteristics and health and satisfaction outcomes after total knee arthroplasty (TKA) may support shared decision-making in Germany. Since previous research on TKA health outcomes indicated valuation differences in longitudinal data, experienced-based population weights were used for the first time as an external valuation system to measure discrepancies between patient and average population valuation of HRQoL. Methods Baseline data (n = 203) included sociodemographic and clinical characteristics and PROs, measured by the EQ-5D-3 L and WOMAC. Six-month follow-up data (n = 161) included medical changes since hospital discharge, PROs and satisfaction. A multivariate linear regression analysis was performed to evaluate the relationship between preoperative patient characteristics and PRO scores. Patient acceptable symptom state (PASS) was calculated to provide a satisfaction threshold. Patient-reported health-related quality of life (HRQoL) valuations were compared with average experienced-based population values to detect changes in valuation. Results One hundred thirty-seven subjects met inclusion criteria. All PRO measures improved significantly. Preoperative WOMAC and EQ-5D VAS, housing situation, marital status, age and asthma were found to be predictors of postoperative outcomes. 73% of study participants valued their preoperative HRQoL higher than the general population valuation, indicating response shift. Preoperatively, patient-reported EQ-5D VAS was substantially higher than average experienced-based population values. Postoperatively, this difference declined sharply. Approximately 61% of the patients reported satisfactory postoperative health, being mainly satisfied with results if postoperative WOMAC was ≥82.49 (change ≥20.25) and postoperative EQ-5D VAS was ≥75 (change ≥6). Conclusion On average, patients benefited from TKA. Preoperative WOMAC and EQ-5D VAS were predictors of postoperative outcomes after TKA. Particularly patients with high absolute preoperative PRO scores were more likely to remain unsatisfied. Therefore, outcome prediction can contribute to shared-decision making. Using general population valuations as a reference, this study underlined a discrepancy between population and patient valuation of HRQoL before, but not after surgery, thus indicating a potential temporary response shift before surgery.
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Affiliation(s)
- Julia Felix
- German Research Center for Environmental Health, Institute for Health Economics and Health Care Management, Helmholtz Zentrum München, Postfach 1129, 85758, Neuherberg, Germany.
| | - Christian Becker
- German Research Center for Environmental Health, Institute for Health Economics and Health Care Management, Helmholtz Zentrum München, Postfach 1129, 85758, Neuherberg, Germany
| | - Matthias Vogl
- German Research Center for Environmental Health, Institute for Health Economics and Health Care Management, Helmholtz Zentrum München, Postfach 1129, 85758, Neuherberg, Germany
| | - Peter Buschner
- Krankenhaus Barmherzige Brüder München, Akademisches Lehrkrankenhaus der Technischen Universität München, Romanstraße 93, 80639, Munich, Germany
| | - Werner Plötz
- Krankenhaus Barmherzige Brüder München, Akademisches Lehrkrankenhaus der Technischen Universität München, Romanstraße 93, 80639, Munich, Germany.,Klinikum rechts der Isar, Technical University Munich, 81675, Munich, Germany
| | - Reiner Leidl
- German Research Center for Environmental Health, Institute for Health Economics and Health Care Management, Helmholtz Zentrum München, Postfach 1129, 85758, Neuherberg, Germany.,Institute for Health Economics and Health Care Management and Munich Center of Health Sciences, Ludwig-Maximilians-University, Ludwigstr. 28 RG, 80539, Munich, Germany
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van den Hout JA, Koenraadt KL, Wagenmakers R, Bolder SB. The Accolade TMZF stem fulfils the demands of modern stem design: Minimum 5-year survival in a cohort of 937 patients. J Orthop Surg (Hong Kong) 2019; 26:2309499018807747. [PMID: 30352541 DOI: 10.1177/2309499018807747] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
PURPOSE Modern hip stem design includes a prosthesis that has a predictable outcome in all total hip arthroplasty (THA) patients, regardless of approach, surgeon or patient characteristics. Introduction without a learning curve and, in cases of problems, the possibility for a simple revision are other prerequisites. The purpose of this study is to evaluate whether the Accolade TMZF stem (Stryker Orthopedics, Mahwah, New Jersey, USA) is suitable to fulfil these demands. We report our mid-term survival of the Accolade TMZF hip stem in all patients from the first implantation at our institute. METHODS From the start of using the Accolade TMZF stem (March 2009) until February 2011, 937 THA were performed by 12 surgeons using a posterolateral or anterolateral approach. Survival of the stem was calculated using Kaplan-Meier analysis. Effect of approach, patient age and comorbidity were analysed with a Cox proportional hazards' model. The learning effect was determined by comparing the number of revisions in the surgeons' first 20 THAs with their next 30 THAs and the subsequent THAs. RESULTS At 5 years, cumulative stem survival was 97.9% based on revisions for all reasons and 98.8% with aseptic loosening as endpoint. We found no effect of surgical approach, patient age or comorbidity on stem survival. No learning effect was found. CONCLUSION The Accolade TMZF stem fulfilled the demands of modern stem design.
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Affiliation(s)
| | - Koen Lm Koenraadt
- 2 Foundation for Orthopedic Research, Care and Education, Amphia Hospital, Breda, The Netherlands
| | - Robert Wagenmakers
- 1 Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands
| | - Stefan Bt Bolder
- 1 Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands
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Yakushiji K, Fujita K, Matsunaga-Myoji Y, Mawatari M. Expectations and depression in patients who have undergone total hip arthroplasty in Japan: A prospective cohort study. Int J Orthop Trauma Nurs 2019; 35:100708. [PMID: 31522957 DOI: 10.1016/j.ijotn.2019.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/24/2019] [Accepted: 07/08/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Patients with hip osteoarthritis may be severely depressed preoperatively due to pain and limited daily-living activities. Hence, evaluating their expectations preoperatively might underestimate their true hopes regarding the upcoming total hip arthroplasty (THA). AIM We aimed to assess changes in patients' level of depression, understand their expectations and fulfillment, and identify factors affecting fulfillment. METHOD We performed a longitudinal study of 366 Japanese patients who had undergone THA during 2005-2006. Those with THA of the contralateral hip were excluded. Patients' expectations, fulfillment, depression, and physical function were assessed perperative and at 6 weeks and one year postoperatively using our own questionnaire, the Arthritis Impact Measurement Scale 2, and by the Oxford Hip Score . Logistic regression analysis was applied to identify independent predictors of expectation fulfillment. RESULTS At 6 weeks, 78.1% expressed expectation fulfillment and drastic alleviation of depression. Preoperative depression and fulfillment of patient expectations at 6 weeks were significant predictors of expectation fulfillment at 1 year (95% confidence intervals: 1.01-2.48 and 2.30-9.92, respectively. CONCLUSIONS It is worthwhile for health providers to investigate patients' expectations early in the postoperative period by considering their preoperative depression to confirm fulfillment of expectations.
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Affiliation(s)
- Kanako Yakushiji
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Kimie Fujita
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | | | - Masaaki Mawatari
- Department of Orthopaedic Surgery, Saga University, Saga, Japan.
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30
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Nguyen USDT, Perneger T, Franklin PD, Barea C, Hoffmeyer P, Lübbeke A. Improvement in mental health following total hip arthroplasty: the role of pain and function. BMC Musculoskelet Disord 2019; 20:307. [PMID: 31253128 PMCID: PMC6599341 DOI: 10.1186/s12891-019-2669-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 06/05/2019] [Indexed: 12/05/2022] Open
Abstract
Background Mental health has been shown to improve after total hip arthroplasty (THA). Little is known about the role of pain and function in this context. We assessed whether change in mental health was associated with improvement in pain and function 1 year post-surgery. Methods This prospective study included patients enrolled in a THA registry from 2010 to 2014. We examined the mental component score (MCS) before and 1 year post-surgery, and 1-year change, in association with Western Ontario McMaster Universities (WOMAC) pain and function scores. All scores were normalized, ranging from 0 to 100 (larger score indicating better outcome). Analyses were adjusted for potential confounders. Results Our study included 610 participants, of which 53% were women. Descriptive statistics are as follows: the average (SD) for age (years) was 68.5 (11.8), and for BMI was 26.9 (4.9). In addition, the MCS average (SD) at baseline was 44.7 (11.2), and at 1-year after THA was 47.5 (10.5). The average change from baseline to 1-year post-THA in MCS was 2.8 (95% CI: 1.9, 3.6), for an effect size of 0.26. As for the WOMAC pain score, the average change from baseline to 1-year post-THA was 44.2 (95%CI: 42.4, 46.0), for an effect size of 2.5. The equivalent change in WOMAC function was 38.1 (95% CI: 36.2, 40.0), for an effect size of 2.0. Results from multivariable analysis controlling for covariates showed that an improvement of 10 points in the 1-year change in pain score resulted in a 0.78 point (95%: CI 0.40, 1.26) increase in the 1-year change in MCS, whereas a 10-point improvement in the 1-year change in function was associated with a 0.94 point (95% CI: 0.56, 1.32) increase. Conclusions Mental health significantly improved from baseline to 1-year post-THA. Greater improvement in pain and function was associated with greater improvement in mental health 1 year post-THA.
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Affiliation(s)
- Uyen-Sa D T Nguyen
- Department of Orthopedics & Physical Rehabilitation, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA, 01655, UK. .,Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, School of Public Health, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA.
| | - Thomas Perneger
- Clinical Epidemiology Service, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, CH-1211, Geneva, Switzerland
| | - Patricia D Franklin
- Department of Orthopedics & Physical Rehabilitation, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA, 01655, UK.,Department of Medical Social Science, Northwestern University Feinberg School of Medicine, 633 St. Clair St, 19th floor, Chicago, IL, 60611, USA
| | - Christophe Barea
- Department of Orthopaedic Surgery, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, CH-1211, Geneva, Switzerland
| | - Pierre Hoffmeyer
- Department of Orthopaedic Surgery, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, CH-1211, Geneva, Switzerland
| | - Anne Lübbeke
- Department of Orthopaedic Surgery, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, CH-1211, Geneva, Switzerland
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Myers CA, Laz PJ, Shelburne KB, Judd DL, Winters JD, Stevens-Lapsley JE, Davidson BS. Simulated hip abductor strengthening reduces peak joint contact forces in patients with total hip arthroplasty. J Biomech 2019; 93:18-27. [PMID: 31221457 DOI: 10.1016/j.jbiomech.2019.06.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 05/12/2019] [Accepted: 06/03/2019] [Indexed: 10/26/2022]
Abstract
Lower extremity muscle strength training is a focus of rehabilitation following total hip arthroplasty (THA). Strength of the hip abductor muscle group is a predictor of overall function following THA. The purpose of this study was to investigate the effects of hip abductor strengthening following rehabilitation on joint contact forces (JCFs) in the lower extremity and low back during a high demand step down task. Five THA patients performed lower extremity maximum isometric strength tests and a stair descent task. Patient-specific musculoskeletal models were created in OpenSim and maximum isometric strength parameters were scaled to reproduce measured pre-operative joint torques. A pre-operative forward dynamic simulation of each patient performing the stair descent was constructed using their corresponding patient-specific model to predict JCFs at the ankle, knee, hip, and low back. The hip abductor muscles were strengthened with clinically supported increases (0-30%) above pre-operative values in a probabilistic framework to predict the effects on peak JCFs (99% confidence bounds). Simulated hip abductor strengthening resulted in lower peak JCFs relative to pre-operative for all five patients at the hip (18.9-23.8 ± 16.5%) and knee (20.5-23.8 ± 11.2%). Four of the five patients had reductions at the ankle (7.1-8.5 ± 11.3%) and low back (3.5-7.0 ± 5.3%) with one patient demonstrating no change. The reduction in JCF at the hip joint and at joints other than the hip with hip abductor strengthening demonstrates the dynamic and mechanical interdependencies of the knee, hip and spine that can be targeted in early THA rehabilitation to improve overall patient function.
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Affiliation(s)
- Casey A Myers
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO, USA.
| | - Peter J Laz
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO, USA
| | - Kevin B Shelburne
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO, USA
| | - Dana L Judd
- Physical Therapy Program, University of Colorado, Aurora, CO, USA
| | - Joshua D Winters
- Physical Therapy Program, University of Colorado, Aurora, CO, USA
| | - Jennifer E Stevens-Lapsley
- Physical Therapy Program, University of Colorado, Aurora, CO, USA; Geriatric Research Education and Clinical Center, VA Eastern Colorado Healthcare System, Denver, CO, USA
| | - Bradley S Davidson
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO, USA
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Webber SC, Ripat JD, Pachu NS, Strachan SM. Exploring physical activity and sedentary behaviour: perspectives of individuals with osteoarthritis and knee arthroplasty. Disabil Rehabil 2019; 42:1971-1978. [DOI: 10.1080/09638288.2018.1543463] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Sandra C. Webber
- Rady Faculty of Health Sciences, Department of Physical Therapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Canada
| | - Jacquie D. Ripat
- Rady Faculty of Health Sciences, Department of Occupational Therapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Canada
| | - Navjot S. Pachu
- Applied Health Sciences Program, University of Manitoba, Winnipeg, Canada
| | - Shaelyn M. Strachan
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Canada
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Månsson E, Söderquist B, Nilsdotter-Augustinsson Å, Särndahl E, Demirel I. Staphylococcus epidermidis from prosthetic joint infections induces lower IL-1β release from human neutrophils than isolates from normal flora. APMIS 2018; 126:678-684. [PMID: 30168623 DOI: 10.1111/apm.12861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 05/22/2018] [Indexed: 11/27/2022]
Abstract
The aim of this study was to test the hypothesis that Staphylococcus epidermidis isolated from prosthetic joint infections (PJIs) differs from S. epidermidis isolated from normal flora in terms of its capacity to induce activation of caspase-1 and release of IL-1β in human neutrophils. The amount of active caspase-1 was determined over 6 h by detecting Ac-YVAD-AMC fluorescence in human neutrophils incubated with S. epidermidis isolates from PJIs (ST2) or normal flora. The amount of IL-1β was detected by ELISA in neutrophil supernatants after 6 h of incubation. Mean IL-1β release was lower after incubation with S. epidermidis from PJIs compared to isolates from normal flora, but no statistically significant difference was found in active caspase-1. Substantial inter-individual differences in both active caspase-1 and IL-1β were noted. These results suggest that evasion of innate immune response, measured as reduced capacity to induce release of IL-1β from human neutrophils, might be involved in the predominance of ST2 in S. epidermidis PJIs, but that other microbe-related factors are probably also important.
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Affiliation(s)
- Emeli Månsson
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,iRiSC - Inflammatory Response and Infection Susceptibility Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,Region Västmanland - Uppsala University, Centre for Clinical Research, Hospital of Västmanland, Västerås, Sweden
| | - Bo Söderquist
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,iRiSC - Inflammatory Response and Infection Susceptibility Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,Department of Laboratory Medicine, Clinical Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Åsa Nilsdotter-Augustinsson
- Department of Infectious Diseases, Department of Clinical and Experimental Medicine, Linköping University, Norrköping, Sweden
| | - Eva Särndahl
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,iRiSC - Inflammatory Response and Infection Susceptibility Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Isak Demirel
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,iRiSC - Inflammatory Response and Infection Susceptibility Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Fraenkel L, Benjamin Nowell W, Stake CE, Venkatachalam S, Eyler R, Michel G, Peters E. Impact of Information Presentation Format on Preference for Total Knee Replacement Surgery. Arthritis Care Res (Hoboken) 2018; 71:379-384. [PMID: 29799668 DOI: 10.1002/acr.23605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 05/22/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Patients have a poor understanding of outcomes related to total knee replacement (TKR) surgery, with most patients underestimating the potential benefits and overestimating the risk of complications. In this study, we sought to compare the impacts of descriptive information alone or in combination with an icon array, experience condition (images), or spinner on participants' preference for TKR. METHODS A total of 648 members of an online arthritis network were randomized to 1 of 4 outcome presentation formats: numeric only, numeric with an icon array, numeric with a set of 50 images, or numeric with a functional spinner. Preferences for TKR were measured before and immediately after viewing the outcome information using an 11-point numeric rating scale. Knowledge was assessed by asking participants to report the frequency of each outcome. RESULTS Participants randomized to the icon array, images, and spinner had stronger preferences for TKR (after controlling for baseline preferences) compared to those viewing the numeric only format (P < 0.05 for all mean differences). Knowledge scores were highest in participants randomized to the icon array; however, knowledge did not mediate the association between format and change in preference for TKR. CONCLUSION Decision support at the point-of-care is being increasingly recognized as a vital component of care. Our findings suggest that adding graphic information to descriptive statistics strengthens preferences for TKR. Although experience formats using images may be too complex to use in clinical practice, icon arrays and spinners may be a viable and easily adaptable decision aid to support communication of probabilistic information.
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Affiliation(s)
- Liana Fraenkel
- Yale University School of Medicine, New Haven, and Veterans Administration Connecticut Healthcare System, West Haven, Connecticut
| | - W Benjamin Nowell
- CreakyJoints, Global Healthy Living Foundation, Upper Nyack, New York
| | - Christine E Stake
- CreakyJoints, Global Healthy Living Foundation, Upper Nyack, New York
| | | | - Rachel Eyler
- University of Connecticut School of Pharmacy, Storrs
| | - George Michel
- Yale University School of Medicine, New Haven, Connecticut
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35
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Neuprez A, Neuprez AH, Kurth W, Gillet P, Bruyère O, Reginster JY. Profile of osteoarthritic patients undergoing hip or knee arthroplasty, a step toward a definition of the "need for surgery". Aging Clin Exp Res 2018; 30:315-321. [PMID: 28560544 DOI: 10.1007/s40520-017-0780-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Accepted: 05/23/2017] [Indexed: 12/31/2022]
Abstract
AIMS The objective of this study is to characterize, based on clinical, radiographic, health-related, quality-of-life-related, and demographic variables, the profile of a large, homogeneous, cohort of patients undergoing knee or hip arthroplasty, in a public hospital. Current regulatory guidelines for structure-modifying agent are not clear regarding hard clinical endpoint. The "need for surgery" has been suggested as a potential relevant outcome, but, until now, it is poorly defined. By characterizing a large number of patients who undergo total hip or total knee replacement, this paper aims at providing a contribution to the better definition of the "need for surgery" in advanced OA of the lower limbs. METHODS Consecutive patients who underwent primary knee arthroplasty (KA) or hip arthroplasty (HA) between December 2008 and February 2013, in an academic hospital, and who were diagnosed with hip or knee osteoarthritis (OA) (ACR criteria). Data collected at baseline included demographic and clinical data; Kellgren-Lawrence radiological grading; Western Ontario and Mc Master Universities Arthritis Index (WOMAC); EuroQol five dimensions questionnaire and EuroQol visual analog scale; and 36-item Short Form Health Survey. RESULTS 626 subjects were included, 346 with hip OA and 280 with knee OA. Significant differences between subjects in need of an HA or of a KA were seen in terms of age (66.5 years versus 65 for hip), duration of complaints (2188 days versus 1146.5 for hip), BMI (28.68 kg/m² versus 27.07), radiological status (severe OA were found in 79.85% in knee group and 68.73% in hip group), comorbidities (FCI higher in knee group), traumatic of surgical history (37 versus 6%), and health-related quality of life and function (patients with HA had a poorer clinical status regarding WOMAC and WOMAC subscale). CONCLUSION Significant differences were observed between patients undergoing KA or HA. These differences might be useful to better understand the "need for surgery" status in these indications. This concept may help to define responders and failures to pharmacological treatment of OA.
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Haghverdian BA, Wright DJ, Schwarzkopf R. Comparison of postarthroplasty functional outcomes in skilled nursing facilities among Medicare and Managed Care beneficiaries. Arthroplast Today 2017; 3:275-280. [PMID: 29204496 PMCID: PMC5712017 DOI: 10.1016/j.artd.2017.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 04/04/2017] [Accepted: 04/05/2017] [Indexed: 12/13/2022] Open
Abstract
Background After home health care, the skilled nursing facility (SNF) is the most commonly used postacute care modality, among Medicare beneficiaries, after total joint arthroplasty. Prior studies demonstrated that a loss in postsurgical ambulatory gains is incurred in the interval between hospital discharge and arrival at the SNF. The aim of this present study is to determine the consequences of that loss in function, as well as compare SNF-related outcomes in patients with Medicare vs Managed Care (MC) insurance. Methods We conducted a retrospective analysis of 80 patients (54 Medicare and 26 MC) who attended an SNF after hospitalization for total joint arthroplasty. Outcomes from physical therapy records were abstracted from each patient's SNF file. Results There was an approximately 40% drop-off in gait achievements between hospital discharge and SNF admission. This decline in ambulation was significantly greater in Medicare patients (Medicare: 94.6 ± 123.2 ft, MC: 40.0 ± 48.9 ft, P = .034). Larger reductions in gait achievements between hospital discharge and SNF admission were significantly correlated with longer SNF lengths of stay and poorer gait achievements by SNF discharge. Patients with MC insurance made significant improvements in gait training at the SNF beyond that which was acquired at the hospital, whereas Medicare patients did not (PMedicare = .28, PMC = .003). Conclusions Large losses in motor function between hospital discharge and SNF admission were associated with poor functional outcomes and longer stays at the SNF. These effects were more pronounced in Medicare patients than those with MC insurance.
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Affiliation(s)
- Brandon A Haghverdian
- Department of Orthopaedic Surgery, University of California, Irvine Medical Center, Orange, CA, USA
| | - David J Wright
- Department of Orthopaedic Surgery, University of California, Irvine Medical Center, Orange, CA, USA
| | - Ran Schwarzkopf
- Division of Adult Reconstruction, Department of Orthopedic Surgery, NYU Langone Medical Center, Hospital for Joint Diseases, New York, NY, USA
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George J, Navale SM, Schiltz NK, Siccha M, Klika AK, Higuera CA. Racial Disparities in Above-knee Amputations After TKA: A National Database Study. Clin Orthop Relat Res 2017; 475:1809-1815. [PMID: 27995560 PMCID: PMC5449317 DOI: 10.1007/s11999-016-5195-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Above-knee amputation (AKA) is a rare but devastating complication of TKA. Although racial disparities have been previously reported in the utilization of TKA, it is unclear whether disparities exist in the rates of AKA after TKA. QUESTIONS/PURPOSES (1) Which gender-racial group has the highest rate of AKA from septic and aseptic complications of TKA? (2) Which age groups have higher rates of AKA from septic and aseptic complications of TKA? METHODS Using National Inpatient Sample data from 2000 to 2011, AKAs resulting from complications of TKA were identified using a combination of International Classification of Diseases, 9th Revision procedure and diagnosis codes. Of the 341,954 AKAs identified, 9733 AKAs were the result of complications of TKA (septic complications = 8104, aseptic complications = 1629). Standardized AKA rates were calculated for different age and gender- racial groups by dividing the number of AKAs in each group with the corresponding number of TKAs. Standardized rate ratios were calculated after adjusting for demographics and comorbidities. RESULTS After adjusting for age and comorbidities, black men had the highest rate of AKA after TKA (adjusted rate in black men = 578 AKAs per 100,000 TKAs, standardized rate ratio [SRR] = 4.32 [confidence interval {CI}, 3.87-4.82], p < 0.001). Black men also had the highest rate of AKA after septic complications of TKA (p < 0.001). The adjusted rates of AKA were higher in patients younger than 50 years (adjusted rate = 473, SRR = 3.14 [CI, 2.94-3.36], p < 0.001) and older than 80 years (adjusted rate = 297, SRR = 1.85 [CI, 1.76-1.95], p < 0.001). CONCLUSIONS The rising demand for TKA has led to an increase in the number of AKAs performed for complications of TKA in the United States. Although we did not find an increase in the rate of AKA during the study period, certain populations, including black men and patients older than 80 years and younger than 50 years, had higher rates of AKA. Further studies are required to understand the reasons for these disparities and measures should be undertaken to eliminate these disparities. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Jaiben George
- Department of Orthopedic Surgery, Cleveland Clinic, 9500 Euclid Avenue, A40, Cleveland, OH, 44195, USA
| | - Suparna M Navale
- Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, USA
| | - Nicholas K Schiltz
- Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, USA
| | - Miguel Siccha
- Department of Orthopedic Surgery, Cleveland Clinic, 9500 Euclid Avenue, A40, Cleveland, OH, 44195, USA
| | - Alison K Klika
- Department of Orthopedic Surgery, Cleveland Clinic, 9500 Euclid Avenue, A40, Cleveland, OH, 44195, USA.
| | - Carlos A Higuera
- Department of Orthopedic Surgery, Cleveland Clinic, 9500 Euclid Avenue, A40, Cleveland, OH, 44195, USA
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Taheriazam A, Saeidinia A. Cementless One-Stage Bilateral Total Hip Arthroplasty in Osteoarthritis Patients: Functional Outcomes and Complications. Orthop Rev (Pavia) 2017; 9:6897. [PMID: 28713523 PMCID: PMC5505101 DOI: 10.4081/or.2017.6897] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 03/13/2017] [Accepted: 04/23/2017] [Indexed: 01/01/2023] Open
Abstract
Total hip arthroplasty (THA) is one of the successful and cost-benefit surgical treatments. One-stage bilateral THA (BTHA) has a large number of advantages, although there are concerns about the higher complications in this procedure. Aim of our study was to evaluate the complications and outcomes of cementless one-stage BTHA in osteoarthritis patients. A total of 147 patients from 2009 till 2012, underwent one-stage BTHA in Milad and Erfan hospitals, Tehran, Iran. A prospective analysis of the functional outcomes and complications of one-stage BTHA through Hardinge approach in patients with osteoarthritis was performed. We evaluated all patients clinically and radiologically with serial followups. A clinical hip score based upon the modified Harris Hip Score (MHHS) was performed preoperatively and again postoperatively. During the period of study 89 men (60.5%) and 58 women (39.4%) with a mean age of 54.67±7.08 years at the time of presentation were recruited. The mean surgical time was 2.8±0.25 hrs. The mean hospital stay was 3.83±0.65 days. Hemoglobin level decreased significantly after operation (P=0.038). There was two deep venous thromboses, one superficial infection and one temporal proneal palsy but no pulmonary embolism, dislocation, periprosthetic fracture or heterotrophic ossification. The mean preoperative MHHS score was 41.64±5.42 in patients. MHHS score improved to 89.26±4.68 in the last followup (P=0.0001). Our results recommended the use of cementless one-stage BTHA through Hardinge approach in patients with bilateral hip osteoarthritis.
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Affiliation(s)
- Afshin Taheriazam
- Department of Orthopedics Surgery, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
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Power FR, Cawley DT, Curtin PD. Simultaneous bilateral total hip arthroplasties in nonagenarians. Ir J Med Sci 2017; 186:947-951. [PMID: 28185060 DOI: 10.1007/s11845-017-1572-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 01/25/2017] [Indexed: 10/20/2022]
Abstract
Total hip arthroplasty (THA) is an effective and durable treatment option for hip osteoarthritis (OA). As life expectancy continues to increase, so too will the demand for joint arthroplasty in the 10th decade of life, frequently in cases involving osteoarthritis of both hips. Simultaneous bilateral total hip arthroplasty (SBTHA) is a valuable therapeutic option in appropriately selected patients with bilateral degenerative hip disease, although its use in the very elderly is poorly reported on in the literature. A case of bilateral hip OA successfully treated with SBTHA in a nonagenarian is presented and the literature is reviewed.
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Affiliation(s)
- F R Power
- Department of Trauma and Orthopaedic Surgery, St. Vincent's University Hospital, Dublin 4, Ireland.
| | - D T Cawley
- Department of Trauma and Orthopaedic Surgery, St. Vincent's University Hospital, Dublin 4, Ireland
| | - P D Curtin
- Department of Trauma and Orthopaedic Surgery, St. Vincent's University Hospital, Dublin 4, Ireland
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Haghverdian BA, Wright DJ, Schwarzkopf R. Length of Stay in Skilled Nursing Facilities Following Total Joint Arthroplasty. J Arthroplasty 2017; 32:367-374. [PMID: 27600304 DOI: 10.1016/j.arth.2016.07.041] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 07/20/2016] [Accepted: 07/24/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The most commonly used postacute care facility after total joint arthroplasty is a skilled nursing facility (SNF). However, little is known regarding the role of physical therapy achievements and insurance status on the decision to discharge from an SNF. In this study, we aim to compare functional outcomes and length of stay (LOS) at an SNF among patients with Medicare vs private health coverage. METHODS We retrospectively collected physical therapy data for 114 patients who attended an SNF following acute hospitalization for total joint arthroplasty. Medicare beneficiaries were compared with patients covered by Managed Care (MC) policies (health maintenance organization [HMO] and preferred provider organization [PPO]) using several SNF discharge outcomes, including LOS, distance ambulated, and functional independence in gait, transfers, and bed mobility. RESULTS LOS at the SNF was significantly longer for Medicare patients (Medicare: 24 ± 22 days, MC: 12 ± 7 days, P = .007). After adjusting for LOS and covariates, MC patients had significantly greater achievements in all functional outcomes measured. In a study subanalysis, Medicare patients were found to achieve similar functional outcomes by SNF day 14 as MC patients achieved by their day of discharge on approximately day 12. Yet, the Medicare group was not discharged until several days later. CONCLUSION Medicare status is associated with poor functional outcomes, long LOS, and slow progress in the SNF. Our results suggest that insurance reimbursement may be a primary factor in the decision to discharge, rather than the achievement of functional milestones.
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Affiliation(s)
- Brandon A Haghverdian
- Department of Orthopaedic Surgery, University of California, Irvine Medical Center, Orange, California
| | - David J Wright
- Department of Orthopaedic Surgery, University of California, Irvine Medical Center, Orange, California
| | - Ran Schwarzkopf
- Division of Adult Reconstruction, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, NYU Langon Medical Center, New York, New York
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Chatterji R, Naylor JM, Harris IA, Armstrong E, Davidson E, Ekmejian R, Descallar J. An equivalence study: Are patient-completed and telephone interview equivalent modes of administration for the EuroQol survey? Health Qual Life Outcomes 2017; 15:18. [PMID: 28114993 PMCID: PMC5259885 DOI: 10.1186/s12955-017-0596-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 01/17/2017] [Indexed: 11/13/2022] Open
Abstract
Background To determine if the EuroQol Health Related Quality of Life survey produces equivalent results when administered by phone interview or patient-completed forms. Methods People awaiting hip or knee arthroplasty at a major metropolitan hospital participated. They were randomly assigned to receive the EuroQol Health Related Quality of Life survey via telephone, followed by a patient completed form 1 week later, or vice versa. Equivalence was determined using two one-sided tests (TOST) based on minimal clinically-important differences for the visual analogue scale (VAS) and the summary Utility Index. Cohen’s Kappa scores were computed to determine agreement for the individual EuroQoL Likert scale items. Results Seventy-six from 90 (84%) participants completed the survey twice. Based on limits set at ±7 and ±0.11 for the VAS and Utility Index, respectively, equivalence was established between the two methods of administration for both the VAS (mean difference 0.05 [90% CI −3.76–3.67]) and the Utility Index (mean difference 0.06 [90% CI 0.02–0.11]). Varying levels of agreement, ranging from slight to substantial (κ = 0.17–0.67), were demonstrated for the individual health domains. The order of telephone and patient-completed survey administration had no significant effect on results. Conclusions Equivalent results are obtained between telephone and patient-completed administration for the VAS and Utility Index of the EuroQol Survey in people with advanced hip or knee osteoarthritis. The limits of agreement for the individual health domains vary which prevents the accurate interpretation of real change in these items across modes.
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Affiliation(s)
- R Chatterji
- South Western Sydney Clinical School, UNSW Australia, Liverpool, NSW, Australia. .,Orthopaedic Department, Liverpool Hospital, Locked Bag 7103, Liverpool, BC, 1871, Australia.
| | - J M Naylor
- South Western Sydney Clinical School, UNSW Australia, Liverpool, NSW, Australia.,Liverpool Hospital Orthopaedic Department, South Western Sydney Local Health District, Liverpool, NSW, Australia
| | - I A Harris
- South Western Sydney Clinical School, UNSW Australia, Liverpool, NSW, Australia.,Liverpool Hospital Orthopaedic Department, South Western Sydney Local Health District, Liverpool, NSW, Australia.,Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, 1 Campbell St, Liverpool, NSW, Australia
| | - E Armstrong
- South Western Sydney Clinical School, UNSW Australia, Liverpool, NSW, Australia.,Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, 1 Campbell St, Liverpool, NSW, Australia
| | - E Davidson
- Nepean Hospital Physiotherapy Department, Nepean Blue Mountains Local Health District, Penrith, NSW, Australia
| | - R Ekmejian
- South Western Sydney Clinical School, UNSW Australia, Liverpool, NSW, Australia
| | - J Descallar
- South Western Sydney Clinical School, UNSW Australia, Liverpool, NSW, Australia.,Ingham Institute for Applied Medical Research, 1 Campbell St, Liverpool, NSW, Australia
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Schilling C, Dowsey MM, Clarke PM, Choong PF. Using Patient-Reported Outcomes for Economic Evaluation: Getting the Timing Right. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2016; 19:945-950. [PMID: 27987644 DOI: 10.1016/j.jval.2016.05.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 04/29/2016] [Accepted: 05/18/2016] [Indexed: 05/02/2023]
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) are becoming increasingly popular in orthopedic surgery. Preoperative and postoperative follow-up often elicit PROMs in the form of generic quality-of-life instruments (e.g., Short Form health survey SF-12 [SF-12]) that can be used in economic evaluation to estimate quality-adjusted life-years (QALYs). However, the timing of postoperative measurement is still under debate. OBJECTIVES To explore the timing of postoperative PROMs collection and the implications for bias in QALY estimation for economic evaluation. METHODS We compared the accuracy of QALY estimation on the basis of utilities derived from the SF-12 at one of 6 weeks, 3 months, 6 months, and 12 months after total knee arthroplasty, under different methods of interpolation between points. Five years of follow-up data were extracted from the St. Vincent's Melbourne Arthroplasty Outcomes (SMART) registry (n = 484). The SMART registry collects follow-up PROMs annually and obtained more frequent outcomes on subset of patients (n = 133). RESULTS Postoperative PROM collection at 6 weeks, 6 months, or 12 months biased the estimation of QALY gain from total knee arthroplasty by -41% (95% confidence interval [CI] -59% to -22%), 18% (95% CI 4%-32%), and -8% (95% CI -18% to -2%), respectively. This bias was minimized by collecting PROMs at 3 months postoperatively (6% error; 95% CI -9% to 21%). CONCLUSIONS The timing of PROM collection and the interpolation assumptions between measurements can bias economic evaluation. In the case of total knee arthroplasty, we recommend a postoperative measurement at 3 months with linear interpolation between preoperative and postoperative measures. The design of economic evaluations should consider timing and interpolation issues.
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Affiliation(s)
- Chris Schilling
- Centre for Health Policy, School of Population and Global Health, the University of Melbourne, Carlton, Victoria, Australia; The University of Melbourne Department of Surgery, St. Vincent's Hospital, Fitzroy, Victoria, Australia.
| | - Michelle M Dowsey
- The University of Melbourne Department of Surgery, St. Vincent's Hospital, Fitzroy, Victoria, Australia; Department of Orthopaedics, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Philip M Clarke
- Centre for Health Policy, School of Population and Global Health, the University of Melbourne, Carlton, Victoria, Australia
| | - Peter F Choong
- The University of Melbourne Department of Surgery, St. Vincent's Hospital, Fitzroy, Victoria, Australia; Department of Orthopaedics, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
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Shin HJ, Kim EY, Na HS, Kim T, Kim MH, Do SH. Magnesium sulphate attenuates acute postoperative pain and increased pain intensity after surgical injury in staged bilateral total knee arthroplasty: a randomized, double-blinded, placebo-controlled trial. Br J Anaesth 2016; 117:497-503. [DOI: 10.1093/bja/aew227] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Human Pluripotent Stem Cells: Advances in Chondrogenic Differentiation and Articular Cartilage Regeneration. ACTA ACUST UNITED AC 2016. [DOI: 10.1007/s40610-016-0041-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Sonoda Y, Sawano S, Kojima Y, Kugo M, Taniguchi M, Maegawa S, Kawasaki T. Comprehensive geriatric assessment of effects of hospitalization and long-term rehabilitation of patients following lower extremity arthroplasty. J Phys Ther Sci 2016; 28:1178-87. [PMID: 27190450 PMCID: PMC4868210 DOI: 10.1589/jpts.28.1178] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 12/23/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study was performed to examine the effects of subacute physical therapy (PT) on activities of daily living (ADL), quality of life, and geriatric aspects of patients who underwent total knee arthroplasty (TKA) or total hip arthroplasty (THA). [Subjects] The subjects were TKA (n=56) and THA (n=39) patients who received PT on the first day of independent ADL (up to 2 weeks) and just prior to discharge (4 weeks). [Methods] The functional independence measure (FIM), grip strength, knee extension strength (KES), timed up and go (TUG) test, mini-mental state examination (MMSE), geriatric depression scale short form (GDS-15), fall efficacy scale (FES), and medical outcome study 8-item short-form health survey (SF-8) were used as outcome measure, and comorbidity involvement was also investigated. [Results] Improvements in FIM, KES, TUG, GDS-15, FES, and SF-8 scores were seen in both groups (effect size, 0.31-0.87). Poor PT effects were found for THA patients aged ≥65 years, for TKA and THA patients with an MMSE score ≤28, and for THA patients with two or more comorbidities. [Conclusion] Positive effects were seen in patients who received PT at 2-4 weeks after surgery. Thus, additional PT for approximately 2 weeks after the beginning of independent ADL may be beneficial.
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Affiliation(s)
- Yuma Sonoda
- Rehabilitation Units, Shiga University of Medical Science, Japan
| | | | - Yuka Kojima
- Rehabilitation Units, Shiga University of Medical Science, Japan
| | - Masato Kugo
- Rehabilitation Units, Shiga University of Medical Science, Japan
| | | | - Shoji Maegawa
- Rehabilitation Units, Shiga University of Medical Science, Japan
| | - Taku Kawasaki
- Rehabilitation Units, Shiga University of Medical Science, Japan; Department of Orthopedic Surgery, Shiga University of Medical Science, Japan
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Jasper LL, Jones CA, Mollins J, Pohar SL, Beaupre LA. Risk factors for revision of total knee arthroplasty: a scoping review. BMC Musculoskelet Disord 2016; 17:182. [PMID: 27113334 PMCID: PMC4845333 DOI: 10.1186/s12891-016-1025-8] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 04/09/2016] [Indexed: 01/10/2023] Open
Abstract
Background In spite of the increasing incidence of total knee arthroplasties (TKA), evidence is limited regarding risk factors for revision. The objective of this scoping review was to identify and assess demographic, surgical and health services factors that may increase the risk for revision surgery following TKA. Methods A scoping review was undertaken following an electronic search in MEDLINE (1990 to December 2013), CINAHL (to December 2013), EMBASE (1990 to December 2013) and Web of Science (1990 to December 2013). Results Of the 4460 articles screened, 42 were included of which 26 articles were based on registry data. Increased risk of revision was associated with demographic factors (younger age, African American), surgical factors related to the primary TKA (uncemented components, implant malalignment, increased surgery duration), and health services (low volume hospitals). Conclusions Identifying emerging trends in characteristics of those requiring revision following TKA can help identify those at risk and allocate appropriate resources. Further primary clinical articles on risk factors for revision of TKA are necessary to ensure maximal function and lifespan following TKAs. Electronic supplementary material The online version of this article (doi:10.1186/s12891-016-1025-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- L L Jasper
- Department of Physical Therapy, University of Alberta, Rm 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada
| | - C A Jones
- Department of Physical Therapy, University of Alberta, Rm 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada.
| | - J Mollins
- Alberta Health Services, Edmonton, Canada
| | - S L Pohar
- Canadian Agency for Drugs and Technologies in Health, Ottawa, Canada
| | - L A Beaupre
- Department of Physical Therapy, University of Alberta, Rm 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada
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Rosenlund S, Holsgaard-Larsen A, Overgaard S, Jensen C. The Gait Deviation Index Is Associated with Hip Muscle Strength and Patient-Reported Outcome in Patients with Severe Hip Osteoarthritis-A Cross-Sectional Study. PLoS One 2016; 11:e0153177. [PMID: 27065007 PMCID: PMC4827823 DOI: 10.1371/journal.pone.0153177] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 03/24/2016] [Indexed: 11/19/2022] Open
Abstract
Background The Gait Deviation Index summarizes overall gait ‘quality’, based on kinematic data from a 3-dimensional gait analysis. However, it is unknown which clinical outcomes may affect the Gait Deviation Index in patients with primary hip osteoarthritis. The aim of this study was to investigate associations between Gait Deviation Index as a measure of gait ‘quality’ and hip muscle strength and between Gait Deviation Index and patient-reported outcomes in patients with primary hip osteoarthritis. Method Forty-seven patients (34 males), aged 61.1 ± 6.7 years, with BMI 27.3 ± 3.4 (kg/m2) and with severe primary hip osteoarthritis underwent 3-dimensional gait analysis. Mean Gait Deviation Index, pain after walking and maximal isometric hip muscle strength (flexor, extensor, and abductor) were recorded. All patients completed the ‘Physical Function Short-form of the Hip disability and Osteoarthritis Outcome Score (HOOS-Physical Function) and the Hip disability and Osteoarthritis Outcome Score subscales for pain (HOOS-Pain) and quality-of-life (HOOS-QOL). Results Mean Gait Deviation Index was positively associated with hip abduction strength (p<0.01, r = 0.40), hip flexion strength (p = 0.01, r = 0.37), HOOS-Physical Function (p<0.01, r = 0.41) HOOS-QOL (p<0.01, r = 0.41), and negatively associated with HOOS-Pain after walking (p<0.01, r = -0.45). Adjusting the analysis for walking speed did not affect the association. Conclusion Patients with the strongest hip abductor and hip flexor muscles had the best gait ‘quality’. Furthermore, patients with higher physical function, quality of life scores and lower pain levels demonstrated better gait ‘quality’. These findings indicate that interventions aimed at improving hip muscle strength and pain management may to a moderate degree improve the overall gait ‘quality’ in patients with primary hip OA.
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Affiliation(s)
- Signe Rosenlund
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark
- Department of Orthopaedic Surgery and Traumatology, Køge Hospital, Køge, Denmark
- * E-mail:
| | - Anders Holsgaard-Larsen
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Søren Overgaard
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Carsten Jensen
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark
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Johal H, Devji T, Schemitsch EH, Bhandari M. Viscosupplementation in Knee Osteoarthritis: Evidence Revisited. JBJS Rev 2016; 4:e11-e111. [DOI: 10.2106/jbjs.rvw.15.00098] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Fujita K, Makimoto K, Mawatari M. Three-year follow-up study of health related QOL and lifestyle indicators for Japanese patients after total hip arthroplasty. J Orthop Sci 2016; 21:191-8. [PMID: 26740433 DOI: 10.1016/j.jos.2015.11.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 11/13/2015] [Accepted: 11/16/2015] [Indexed: 02/09/2023]
Abstract
BACKGROUND In non-Western countries including Japan, activities requiring deep flexion of the hip joint, such as seiza (kneeling with calves tucked under the thighs and buttocks resting on the heels) and using squat toilets are commonly practiced. The purpose of this study was to assess longitudinal changes in traditional health-related quality of life measures and measures of physical functions associated with lifestyle for Japanese patients pre-surgery and after total hip arthroplasty. METHODS Consecutive primary total hip arthroplasty patients between July 2003 and November 2006 were eligible. Patients were measured preoperatively and at 6 weeks, 1 year and 3 years postoperatively. Patients completed the EuroQol 5D, the Western Ontario and McMaster Universities Osteoarthritis Index and items related to Japanese lifestyle activities such as squatting. Changes in these scale scores across the four time points were tested, and we examined predictive factors of EuroQol 5D score at 3-year follow-up using multiple linear regression. RESULTS Of 1103 eligible patients, 576 completed questionnaires at all four time points. By 6 weeks post-surgery, reductions in pain and improvements in physical function and stiffness became highly significant, and improvements continued to 3 years postoperative. In contrast, improvements were far more limited for items related to Japanese lifestyle functions such as seiza and use of a Japanese squat toilet, even 3 years after surgery. Predictive factors of EQ5D at 3-year post THA were WOMAC pain and physical function, seiza, age and comorbidity measured at 3-year post THA. CONCLUSION The rate of improvement in QOL requiring deep flexion of the hip joint was much slower than that in QOL related to Western lifestyle. Our study suggests a need for lifestyle modification for THA patients in the other countries where kneeling and squatting are commonly performed.
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Affiliation(s)
- Kimie Fujita
- Department of Health Sciences, Graduate School of Medicine, Kyushu University, Japan.
| | - Kiyoko Makimoto
- Department of Health Sciences, Graduate School of Medicine, Osaka University, Japan.
| | - Masaaki Mawatari
- Department of Orthopedic Surgery, Faculty of Medicine, Saga University, Japan.
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Thambiah MD, Nathan S, Seow BZX, Liang S, Lingaraj K. Patient satisfaction after total knee arthroplasty: an Asian perspective. Singapore Med J 2016; 56:259-63. [PMID: 26034317 DOI: 10.11622/smedj.2015074] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Total knee arthroplasty (TKA) is an effective method for alleviating pain and restoring knee function in patients with severe osteoarthritis. However, despite the improvements in surgical technique and postoperative care, it has been reported that up to 19% of patients are dissatisfied after their operations. The aim of this study was to evaluate patient satisfaction levels after TKA in an Asian cohort, as well as assess the correlation between patient satisfaction levels and the results of traditional physician-based scoring systems. METHODS The medical data of 103 Asian patients who underwent 110 TKAs between December 2008 and June 2009 were obtained from our hospital's Joint Replacement Registry. The minimum follow-up period was one year and patient expectations were assessed before TKA. Patient satisfaction was assessed postoperatively using a 5-point Likert scale. Reasons for patient dissatisfaction were recorded. Standardised instruments (e.g. the Knee Society Score, the Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] and the generic Short Form-36 health survey) were used to assess the patient's functional status and the severity of symptoms pre- and postoperatively. RESULTS Among the 110 TKAs performed, 92.8% resulted in patient satisfaction. Patient satisfaction correlated with postoperative WOMAC function scores (p = 0.028), postoperative WOMAC final scores (p = 0.040) and expectations being met (p = 0.033). CONCLUSION Although there was a high level of patient satisfaction following TKA in our cohort of Asian patients, a significant minority was dissatisfied. Patient satisfaction is an important outcome measure and should be assessed in addition to traditional outcome scores.
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Affiliation(s)
| | - Sahaya Nathan
- University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Hospital, Singapore
| | - Branden Z X Seow
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Shen Liang
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Krishna Lingaraj
- University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Hospital, Singapore
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