Total knee replacement (TKR) and total hip replacement (THR) reliably relieve pain, restore function, and ensure mobility in patients with advanced joint arthritis; however these results are not uniform across all patient populations. Moreover, it is well established that knee replacement patients have outcomes inferior to those undergoing hip replacement procedures with lower rates of dissatisfaction with post-operative function and pain relief. We compared baseline demographic and symptom profiles in patients from a US national cohort undergoing primary TKR and THR to determine whether differences in demographic make-up, pre-operative symptoms, or pre-existing co-morbidities might contribute to these differences observed post-operatively. A cohort of 2375 patients undergoing primary TKR and THR was identified from the FORCE national research consortium from all surgeries performed between July 1st 2011 and March 30th 2012. This set of patients was derived from 120 contributing surgeons in 23 US states. Gathered data included patient demographics, comorbidity (Charlson Comorbidity Index), operative joint pain severity (Western Ontario and McMaster Universities Arthritis Index (WOMAC)), physical function (SF-36; Physical Component Score (PCS)), emotional health (SF-36; Mental Component Score (MCS)), and musculoskeletal burden of illness (Hip and Knee Disability and Osteoarthritis Outcome Scores; Oswestry Disability Index). Using descriptive statistics, we compared the baseline demographic characteristics and symptom profiles of patients undergoing TKR (n = 1362) and those undergoing THR (n = 1013).Introduction:
Methods:
There is an increasing trend within the US for utilization of total knee replacement for patients who are still of working-age. Numerous causes have been suggested, ranging from greater participation in demanding sporting activities to the epidemic of obesity. A universal concern is that increased arthritis burden will lead to increased disabilty and unsustainable health-care costs both now and in the future with increasing rates of revision surgery in the years ahead. This raises the critical question: Are younger patients receiving knee replacement prematurely? To address this issue, we compared the severity of operative knee pain and functional status in younger versus older TKR patients, drawing upon a national research registry. A cohort of 3314 primary TKR patients was identified from the FORCE national research consortium from all surgeries performed between July 1st 2011 and March 30th 2012. This set of patients was derived from 120 contributing surgeons in 23 US states. Data characterizing each patient undergoing surgery was derived from patients, surgeons and hospitals, and included the SF 36 Physical Component Score (PCS), the Knee injury and Osteoarthritis Outcome Score (KOOS) and the Oswestry Low Back Pain Disability Questionnaire. WOMAC scores were also calculated from the KOOS data and transformed to a 0-to-100 scale with lower scores representing worse impairment. Using descriptive statistics, we compared the demographic and baseline characteristics of patients younger than 65 years of age (n = 1326) vs. those 65 years of age and older (n = 1988).Introduction:
Methods:
We reviewed the outcome of a retrospective case series of eight patients with atlantoaxial instability who had been treated by percutaneous anterior transarticular screw fixation and grafting under image-intensifier guidance between December 2005 and June 2008. The mean follow-up was 19 months (8 to 27). All eight patients had a solid C1–2 fusion. There were no breakages or displacement of screws. All the patients with pre-operative neck pain had immediate relief from their symptoms or considerable improvement. There were no major complications. Our preliminary clinical results suggest that percutaneous anterior transarticulation screw fixation is technically feasible, safe, useful and minimally invasive when using the appropriate instruments allied to intra-operative image intensification, and by selecting the correct puncture point, angle and depth of insertion.
