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Tamate T, Nishioka S, Ry LD, Weldon RH, N AS, Nakasone CK. The influence of mental health on early outcomes following total hip arthroplasty. Arch Orthop Trauma Surg 2024; 144:1773-1779. [PMID: 38135788 DOI: 10.1007/s00402-023-05159-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 11/26/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Poor mental health is difficult to recognize and as a result, its association with recovery from total joint arthroplasty is difficult to assess. The purpose of this study was to investigate the relationship between overall mental health scores and outcomes in the early postoperative period following unilateral total hip arthroplasty (THA). METHODS This is a retrospective review of prospectively collected data involving 142 patients who underwent primary unilateral THA. Independent variables included patient demographics and preoperative Patient-Reported Outcomes Measurement Information System (PROMIS), Global Physical Health (GPH) and Global Mental Health (GMH) and Hip Disability and Osteoarthritis Outcome Score, Joint Replacement (HOOS JR) scores as well as diagnoses of depression or anxiety. Dependent variables included length of stay (LOS), disposition at discharge, narcotic consumption until discharge, 6-week postoperative GPH, GMH and HOOS JR scores and magnitude of change compared to preoperative scores. Preoperative GMH and postoperative outcomes were compared using Pearson correlation coefficient, independent t-tests, Pearson's Chi-Square test, and univariate logistic regression. RESULTS Patients with preoperative GMH scores below the 25% quartile were less likely to be discharged home and resulted in lower GPH, GMH and HOOS JR scores at 6-week follow-up compared to patients with preoperative GMH scores in the top 25% quartile. However, patients with low preoperative GMH scores demonstrated a greater magnitude of improvement in both the GPH and GMH scores compared to patients in the top 25% quartile. There was no difference in opioid consumption or LOS between either groups. When comparing patients with and without depression/anxiety, no difference was seen in any of the outcomes measured. CONCLUSION Unilateral THA offers significant improvements in both physical and mental function to patients with hip osteoarthritis and poor mental health, though overall scores remain lower than in those with better mental health.
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Affiliation(s)
- Trent Tamate
- John A Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA
- Department of Surgery, University of Hawai'I, 1356 Lusitana Street, Honolulu, HI, 96813, USA
| | - Scott Nishioka
- John A Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA
| | - Lawton Dylan Ry
- John A Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA
| | - Rosana Hernandez Weldon
- Office of Public Health Studies, University of Hawaii at Manoa, 1960 East-West Road, Honolulu, HI, 96822, USA
| | - Andrews Samantha N
- Straub Medical Center, Bone and Joint Center, 888 South King Street, Honolulu, HI, 96813, USA
- Department of Surgery, University of Hawai'I, 1356 Lusitana Street, Honolulu, HI, 96813, USA
| | - Cass K Nakasone
- John A Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA.
- Straub Medical Center, Bone and Joint Center, 888 South King Street, Honolulu, HI, 96813, USA.
- Department of Surgery, University of Hawai'I, 1356 Lusitana Street, Honolulu, HI, 96813, USA.
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Kop M, Kim N, Shimoda B, Unebasami E, Weldon RH, Nakasone CK. The prevalence of bilateral and ipsilateral radiographic osteoarthritis is high in White, Asian and Native Hawaiian/Pacific Islanders presenting for unilateral knee or hip arthroplasty. Arch Orthop Trauma Surg 2024; 144:1565-1573. [PMID: 38386068 DOI: 10.1007/s00402-024-05252-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/17/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND It is estimated that one-third of patients presenting with unilateral joint pain have contralateral osteoarthritis (OA) at first presentation. Most studies have primarily examined White patient cohorts. The purpose of this study was to determine the prevalence of contralateral joint OA for patients presenting for unilateral total knee (TKA), unicompartmental knee (UKA) or total hip arthroplasty (THA) among Asian, Native Hawaiian/Pacific Islander and White patients. METHODS Bilateral radiographic reports at initial presentation of 2,312 subjects who underwent unilateral arthroplasties (332 UKAs, 933 TKAs and 1,047 THAs) were reviewed. The presence of contralateral OA was recorded and compared by racial group and type of arthroplasty performed. Parametric statistical analyses were performed to determine differences between groups. Multivariable analyses were completed for each arthroplasty group to determine the influence on the presence of contralateral OA, presented as odds ratios and 95% confidence intervals. RESULTS Contralateral joint OA was present in 86.7%, 90.4% and 70.4% of UKA, TKA and THA patients, respectively. Concurrent hip OA was present in 41.6% and 59.5% of UKA and TKA patients. No racial differences in the prevalence of contralateral knee OA were found for knee arthroplasty patients. White patients (74.6%) had a greater prevalence of contralateral hip OA compared to Asians (66.5%, p = 0.037) amongst THA recipients. Increased age and body mass index were significantly associated with the presence of contralateral knee OA. Increased age, being male and being White were significant contributors for the presence of contralateral hip OA. CONCLUSION The prevalence of contralateral joint OA and concurrent hip OA is high in all three racial groups. Due to the extensive prevalence of contralateral and concurrent knee and hip OA, bilateral radiographic evaluation should be considered for all patients presenting with unilateral hip or knee pain due to OA.
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MESH Headings
- Humans
- Male
- Female
- Arthroplasty, Replacement, Hip
- Arthroplasty, Replacement, Knee
- Osteoarthritis, Hip/diagnostic imaging
- Osteoarthritis, Hip/epidemiology
- Osteoarthritis, Hip/surgery
- Native Hawaiian or Other Pacific Islander
- Prevalence
- Knee Joint/surgery
- Osteoarthritis, Knee/diagnostic imaging
- Osteoarthritis, Knee/epidemiology
- Osteoarthritis, Knee/surgery
- White People
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Affiliation(s)
- Mikaela Kop
- University of Hawai'I, John A Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA
| | - Nathan Kim
- University of Hawai'I, John A Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA
| | - Brent Shimoda
- University of Hawai'I, John A Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA
| | - Emily Unebasami
- University of Hawai'I, John A Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA
| | - Rosana Hernandez Weldon
- University of Hawai'i Office of Public Health Studies, 1960 East-West Road, Honolulu, HI, 96822, USA
| | - Cass K Nakasone
- Straub Medical Center Bone and Joint Center, 888 South King Street, Honolulu, HI, 96814, USA.
- Department of Surgery, University of Hawai'i, John A Burns School of Medicine, 1356 Lusitana Street, Honolulu, HI, 96813, USA.
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Weldon E, Agonias K, DeJesus J, Weldon RH, Au DLMT, Nakasone CK. Extended offset stems are infrequently required in anterior approach total hip arthroplasty and low usage does not compromise stability. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05239-z. [PMID: 38512461 DOI: 10.1007/s00402-024-05239-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 02/17/2024] [Indexed: 03/23/2024]
Abstract
INTRODUCTION Extended offset (EO) stems are commonly used in posterior approach (PA) total hip arthroplasty (THA), but usage rates and complications are not well studied with anterior approach (AA) THA. This study evaluated usage rates, radiographic outcomes and complications following AA THA between patients receiving EO stems and a matched cohort receiving standard offset (SO) stems. MATERIALS AND METHODS This retrospective review evaluated 1515 consecutive AA THA performed between 2014 and 2021. The recent 100 EO were included in radiographic and complication analysis and were matched to 100 SO stems based on stem size, procedure (unilateral/bilateral), sex, body mass index (BMI), and age. Data collection included patient demographics; pre- and postoperative radiographic measurements of leg length difference (LLD) and global hip offset difference (GHOD); and complications within 1 year. Independent t-tests and Chi-squared analyses compared EO and SO groups. RESULTS EO was utilized in 8% of all AA THA. Despite matching procedures, the distribution of racial groups was different between EO and SO groups, respectively: Caucasian (75% vs. 43%), Asian (12% vs. 35%), Native Hawaiian/Pacific Islander (NHPI) (9% vs. 13%), and other (4% vs. 9%) (p < 0.001). No fractures, dislocations, or revisions occurred within 1 year after surgery in either group. One deep infection was noted in the SO group. The proportions of patients following surgery who had a GHOD < 6 mm (76% vs. 82%; p = 0.193) and LLD < 6 mm (81% vs. 86%; p = 0.223) were not significantly different between EO and SO groups, respectively. CONCLUSIONS Prioritizing hip symmetry over stability results in a high proportion of patients achieving hip symmetry without high usage of EO stems in AA THA. Furthermore, low use of EO stems did not result in increased dislocations. Due to racial anatomical differences, Caucasian patients required EO stems to achieve hip symmetry more frequently than Asian and NHPI patients.
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Affiliation(s)
- Edward Weldon
- John A Burns School of Medicine, University of Hawaii at Manoa, 651 Ilalo Street, Honolulu, HI, 96813, USA
| | - Keinan Agonias
- John A Burns School of Medicine, University of Hawaii at Manoa, 651 Ilalo Street, Honolulu, HI, 96813, USA
| | - James DeJesus
- John A Burns School of Medicine, University of Hawaii at Manoa, 651 Ilalo Street, Honolulu, HI, 96813, USA
| | - Rosana Hernandez Weldon
- University of Hawaii at Manoa, Office of Public Health Studies, 1960 East-West Road, Honolulu, HI, 96822, USA
| | - Donna Lyn M T Au
- Straub Medical Center, Bone and Joint Center, 888 South King Street, Honolulu, HI, 96813, USA
| | - Cass K Nakasone
- John A Burns School of Medicine, University of Hawaii at Manoa, 651 Ilalo Street, Honolulu, HI, 96813, USA.
- Straub Medical Center, Bone and Joint Center, 888 South King Street, Honolulu, HI, 96813, USA.
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Singh D, Lawton D, Weldon RH, Au DLMT, Nakasone CK. Severe patellofemoral arthritis does not compromise 6-month post-operative range of motion or function following unicondylar knee arthroplasty. Arch Orthop Trauma Surg 2023; 143:6791-6797. [PMID: 37418007 DOI: 10.1007/s00402-023-04978-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/27/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND The presence of significant patellofemoral arthritis (PFA) is still considered a contraindication for unicondylar knee arthroplasty (UKA) by many surgeons. The purpose of this study was to determine if the presence of severe PFA at the time of UKA compromised early (< 6 months) post-operative knee range of motion or functional outcomes. METHODS This retrospective review evaluated unilateral and bilateral UKA (323 patients; 418 knees) between 2015 and 2019. Procedures were grouped by degree of PFA present at the time of surgery, including mild PFA (Group 1; N = 266), moderate to severe PFA (Group 2; N = 101), and severe PFA with lateral compartment bone-on-bone contact (Group 3; N = 51). Knee range of motion and Knee Society Knee (KSS-K) and Function (KSS-F) scores were collected both before and at 6 months following surgery. Group differences were evaluated with Kruskal-Wallis and Chi-square tests for continuous and categorical variables, respectively. Univariate and multivariable logistic regressions were performed to determine influential variables associated with post-operative knee flexion being ≤ 120° and presented as odds ratios (OR) and 95% confidence intervals (CI). RESULTS Pre-operative flexion was lowest in Group 3 (p = 0.010) with 17.6% of knees having flexion ≤ 120°. Post-operative flexion was lowest in Group 3 (119.1° ± 8.4°, p = 0.003) with 19.6% knees having flexion ≤ 120° compared to 9.8% and 8.9% in Groups 1 and 2, respectively. No significant difference in KSS-F following surgery was found; all three groups demonstrated similar clinical improvement. Increased age (OR 1.089, CI 1.036-1.144; p = 0.001) and body mass index (OR 1.082, CI 1.006-1.163; p = 0.034) were found to be associated with post-operative knee flexion ≤ 120°, while high pre-operative flexion (OR 0.949, CI 0.921-0.978; p = 0.001) was found to be inversely associated with poor knee flexion following surgery. CONCLUSION Patients with severe PFA demonstrate similar clinical improvement following UKA at 6 months as patients with less severe PFA.
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Affiliation(s)
- Dylan Singh
- University of Hawai'I, John A Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA
| | - Dylan Lawton
- University of Hawai'I, John A Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA
- Straub Medical Center, Bone and Joint Center, 888 South King Street, Honolulu, HI, 96813, USA
| | - Rosana Hernandez Weldon
- Office of Public Health Studies, University of Hawai'I, 1960 East-West Road, Honolulu, HI, 96822, USA
| | - Donna L M T Au
- Straub Medical Center, Bone and Joint Center, 888 South King Street, Honolulu, HI, 96813, USA
| | - Cass K Nakasone
- Straub Medical Center, Bone and Joint Center, 888 South King Street, Honolulu, HI, 96813, USA.
- Department of Surgery, University of Hawai'i, John A Burns School of Medicine, 1356 Lusitana Street, Honolulu, HI, 96813, USA.
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Phillips MM, Weldon RH, Maniar A, Patil U, Kostareva U, Agner J, Finn J, Sentell T. Social Networks, Health Information Sharing, and Pandemic Perceptions among Young Adults in Hawai'i during the COVID-19 Pandemic. Int J Environ Res Public Health 2022; 19:16833. [PMID: 36554713 PMCID: PMC9779529 DOI: 10.3390/ijerph192416833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/06/2022] [Accepted: 12/10/2022] [Indexed: 06/17/2023]
Abstract
Limited information exists about social network variation and health information sharing during COVID-19, especially for Native Hawaiians (NH), Other Pacific Islanders (OPI), and Filipinos, who experienced COVID-19 inequities. Hawai'i residents aged 18-35 completed an online survey regarding social media sources of COVID-19 information and social network health information measured by how many people participants: (1) talked to and (2) listened to about health. Regression models were fit with age, gender, race/ethnicity, chronic disease status, pandemic perceptions, and health literacy as predictors of information sources (logistic) and social network size (Poisson). Respondents were 68% female; 41% NH, OPI, or Filipino; and 73% conducted a recent COVID-19 digital search for themselves or others. Respondents listened to others or discussed their own health with ~2-3 people. Respondents who talked with more people about their health were more likely to have larger networks for listening to others. In regression models, those who perceived greater risk of acquiring COVID-19 discussed their health with more people; in discussing others' health, women and those with chronic diseases listened to a greater number. Understanding young adults' social networks and information sources is important for health literacy and designing effective health communications, especially to reach populations experiencing health inequities.
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Affiliation(s)
- Michael M. Phillips
- Office of Public Health Studies, Thompson School of Social Work & Public Health, University of Hawai’i at Mānoa, Honolulu, HI 96822, USA
| | - Rosana Hernandez Weldon
- Office of Public Health Studies, Thompson School of Social Work & Public Health, University of Hawai’i at Mānoa, Honolulu, HI 96822, USA
| | - Anam Maniar
- Office of Public Health Studies, Thompson School of Social Work & Public Health, University of Hawai’i at Mānoa, Honolulu, HI 96822, USA
| | - Uday Patil
- Office of Public Health Studies, Thompson School of Social Work & Public Health, University of Hawai’i at Mānoa, Honolulu, HI 96822, USA
| | - Uliana Kostareva
- Nancy Atmospera-Walch School of Nursing, University of Hawai’i at Mānoa, Honolulu, HI 96822, USA
| | - Joy Agner
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA 90089, USA
| | - Julia Finn
- Office of Public Health Studies, Thompson School of Social Work & Public Health, University of Hawai’i at Mānoa, Honolulu, HI 96822, USA
| | - Tetine Sentell
- Office of Public Health Studies, Thompson School of Social Work & Public Health, University of Hawai’i at Mānoa, Honolulu, HI 96822, USA
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Mondal D, Weldon RH, Armstrong BG, Gibson LJ, Lopez-Espinosa MJ, Shin HM, Fletcher T. Breastfeeding: a potential excretion route for mothers and implications for infant exposure to perfluoroalkyl acids. Environ Health Perspect 2014; 122:187-92. [PMID: 24280536 PMCID: PMC3915259 DOI: 10.1289/ehp.1306613] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 11/25/2013] [Indexed: 05/19/2023]
Abstract
BACKGROUND The presence of perfluoroalkyl acids (PFAAs) in breast milk has been documented, but their lactational transfer has been rarely studied. Determination of the elimination rates of these chemicals during breastfeeding is important and critical for assessing exposure in mothers and infants. OBJECTIVES We aimed to investigate the association between breastfeeding and maternal serum concentrations of perfluorooctanoic acid (PFOA), perfluorooctane sulfonate (PFOS), perfluorononanoic acid (PFNA), and perfluorohexane sulfonate (PFHxS). For a subset of the population, for whom we also have their infants' measurements, we investigated associations of breastfeeding with infant serum PFAA concentrations. METHODS The present analysis included 633 women from the C8 Science Panel Study who had a child < 3.5 years of age and who provided blood samples and reported detailed information on breastfeeding at the time of survey. PFAA serum concentrations were available for all mothers and 8% (n = 49) of the infants. Maternal and infant serum concentrations were regressed on duration of breastfeeding. RESULTS Each month of breastfeeding was associated with lower maternal serum concentrations of PFOA (-3%; 95% CI: -5, -2%), PFOS (-3%; 95% CI: -3, -2%), PFNA (-2%; 95% CI: -2, -1%), and PFHxS (-1%; 95% CI: -2, 0%). The infant PFOA and PFOS serum concentrations were 6% (95% CI: 1, 10%) and 4% (95% CI: 1, 7%) higher per month of breastfeeding. CONCLUSIONS Breast milk is the optimal food for infants, but is also a PFAA excretion route for lactating mothers and exposure route for nursing infants.
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Affiliation(s)
- Debapriya Mondal
- London School of Hygiene & Tropical Medicine, London, United Kingdom
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Weldon RH, Barr DB, Trujillo C, Bradman A, Holland N, Eskenazi B. A pilot study of pesticides and PCBs in the breast milk of women residing in urban and agricultural communities of California. ACTA ACUST UNITED AC 2011; 13:3136-44. [PMID: 22009134 DOI: 10.1039/c1em10469a] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Currently, there is no nationally representative human milk biomonitoring program in the United States (U.S.) and no studies have reported non-persistent pesticides in the milk of U.S. women. In this pilot study we developed a multiresidue laboratory method to measure non-persistent and persistent pesticides and polychlorinated biphenyl (PCB) congeners in human milk samples from women residing in the agricultural region of Salinas, CA (n = 13) and the urban San Francisco Bay Area, CA (n = 21). Samples were collected from 2002-2007. Median concentrations in pg g(-1) milk among urban and agricultural women, respectively were reported for: chlorpyrifos (24.5 and 28.0), cis-permethrin (81.9 and 103), trans-permethrin (93.1 and 176), hexachlorobenzene (191 and 223), β-hexachlorocyclohexane (220 and 443), o,p'-DDT (36.6 and 62.4), p,p'-DDT,(107 and 102), o,p'-DDE (5.65 and 5.17), p,p'-DDE (3170 and 3490), dacthal (2.79 and 3.43), PCB 118 (92.8 and 17.0), PCB 138 (183 and 38.2), PCB 153 (242 and 43.6) and PCB 180 (239 and 683). Among urban women, median concentrations were 4.02 and 4.32 pg g(-1) milk for chlorpyrifos-methyl and propoxur, respectively. These results suggest that neonates and young children may be exposed to persistent and non-persistent pesticides and PCBs via breast milk.
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Affiliation(s)
- Rosana Hernandez Weldon
- Center for Environmental Research and Children's Health, School of Public Health, University of California, 1995 University Ave, Suite 265, Berkeley, CA 94704, USA
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