The purpose was to define the economic and health costs of waiting for total hip joint replacement surgery. A prospective cohort of 122 patients requiring primary hip arthroplasty (HA) was recruited from four hospitals in the lower North Island. Health related quality of life (HRQL), using self-completed WOMAC questionnaires, was assessed monthly from enrolment pre-operatively to six months post surgery. Monthly cost diaries were used to record medical, personal and other costs. Data was analysed using PC-SAS to test the strength of associations between costs and waiting times, and changes in HRQL pre- and post-surgery. The mean waiting time was 5.2 months and mean cost of waiting for surgery was $1,376 per person per month (pp pm) with medical, personal and social costs contributing $404, $399, and $573, respectively. Waiting more than 6 months was associated with an increased cost of $730 pp pm for a total cost of $2177 pp pm (p<
0.003). Age was correlated with greater loss of income (<
65 years) (p=0.001) and higher medical costs (<
65 years) (p=0.08). An incremental improvement over time in WOMAC scores post-operatively was identified (p=0.0001). Older age (p=0.01), community services card use (p=0.003) and a greater number of months waiting (p=0.1) were negatively correlated with post-surgical improvement after adjusting for other variables. Longer waits for HA incur greater economic costs and impact on patient recovery. This lends weight to the view that a shorter waiting time for HA significantly reduces costs to individuals and society and improves health outcomes.
The purpose of the study was to assess the incorporation of defatted, and deproteinated bovine cancellous bone in a sheep bone graft model. Cylindrical defects were created in the femoral condyles of 12 sheep using custom-made trephines. The defect was filled with a cylinder of prepared bovine bone. The removed cylinder of bone was implanted into a defect created in the opposite femoral condlyle. Fluorochrome bone labels were administered over an 8-week period and the sheep sacrificed at 10 weeks. Undecalcified thin bone sections were viewed with a fluorescent microscope. ln one sheep there was a technical problem leading to unsatisfactory histology. All other sheep showed similar histology. The autograft incorporated rapidly with the graft showing a rim of reactive bone and the graft itself showing rapid laying down of new bone on its surface. The xenograft showed a similar reactive rim of new bone with deposition of new bone throughout the graft and resorption of the graft material. This study demonstrates that specially prepared bovine cancellous bone can act as a scaffold for the depostion of new bone in a sheep model. The role of this material in humans is to be evaluated.
The aim of the study was to investigate functional outcomes and perceptions of quality of life in a series of elderly patients who have sustained tibial plateau fractures. A retrospective survey of all patients aged over 60 years who were admitted to Wellington and Hutt hospitals for treatment of a tibial plateau fracture between July 1996 and December 2000 was carried out. Patients were sent the Oxford 12 knee score and the Nottingham Health profile (NHP) by mail. Radiographs were reviewed to confirm fracture type and medical notes reviewed to ascertain treatment. Patients were divided into non-operative (plaster cast or brace; n=8) and operative treatment (open reduction and internal fixation (ORIF) or total knee replacement; n=15) groups. Of 42 eligible patients, 23 returned completed questionnaires (rr=55%). The mean age of patients was 73.6 years with 16 (69.6%) females and 7 (30.4%) males. Mean time to follow up was 38.7 +/−14.5 months. The mean Oxford 12 knee score was 39.3. The mean NHP-part I scores were 17.6, 8.4, 3.3, 14.4, 2.9, 9.3 for energy level, pain, emotional reaction, sleep, social isolation and physical mobility respectively. 73% of the patients felt that their present state of health was not causing problems with any of the activities mentioned in the NHP-part II. The perceptions of outcomes of tibial plateau fractures in the elderly after conservative treatment is comparable with operative treatment. The results show Oxford 12 Knee and NHP scores similar to other studies and indicate satisfactory knee function.
There is controversy regarding the best way to manage fit, independent patients with acute hip fractures. The aim of this study was to compare, nationally, the early complication rates of total hip arthroplasty (THA) in those patients with an acute fractured neck of femur (NOF) with a similar group of THA’s performed in patients with a diagnosis of osteoarthritis. Using the National Hip Joint Register and the New Zealand Health Information Service Database, 200 patients with acute hip fractures undergoing THA were identified and compared to 1102 THA’s performed on osteoarthritis patients. The mortality, revision, dislocation and infection rates were analysed at a minimum of one year. Acute THA had a 7.5% one-year mortality rate compared with 2.5% in the OA group (p <
0.01). The revision rate was 2.5% vs 1.8% in the acute and OA groups respectively. The dislocation rate was 4.3% for the whole group with a 8.5% for the acute group and 3.5% for the OA group (p<
0.01). In the acute group the dislocation rate using the posterior approach was 17.1 % compared to 3.1% for the lateral approach (p<
0.01). We conclude that acute THA is a useful procedure in fit patients with a fracture of the neck of the femur but that a posterior approach should be avoided.
Early discharge from hospital has the potential to reduce direct costs, but may result in patients being discharged without adequate preparation for a return to the community. This qualitative study aimed to investigate patient expectations of and satisfaction with in-hospital discharge planning after hip arthroplasty in early and late discharge patient groups. A prospective study of 33 consecutive patients requiring hip arthroplasty were recruited from two tertiary hospitals in the lower North Island. Participants were interviewed using in-depth, semi-structured interviews on the day of discharge from hospital and again four-eight weeks later. Comparative analysis of the interviews from patients in early and late discharge groups was made. Findings reveal good levels of satisfaction with discharge planning for patients in both early and late discharge groups, facilitated by the opportunity to attend a pre-assessment clinic. Discharge planning was viewed as a partnership between patients and key members of the multi-disciplinary team. While written information provided was timely, restricted opportunity for dialogue with health professionals limited patient knowledge and understanding of recovery. Different needs of participants indicate that discharge planning needs to be tailored and more responsive to individuals. The role of health professionals as a mentor-coach is pivotal. Further interaction from health professionals, as a follow-up to written information provided may be a way to improve the discharge process and lead to more consistent outcomes.
For patients who had sustained a subcapital fracture (n=117), 21% (P<
0.05) of those who had been treated with cannulated screws required further surgery compared with 2–14% who had the other types of surgery.