The aim of this study was to observe the implications of withholding total joint arthroplasty (TJA) in morbidly obese patients A total of 289 morbidly obese patients with end-stage osteoarthritis were prospectively followed. There were 218 women and 71 men, with a mean age of 56.3 years (26.7 to 79.1). At initial visit, patients were given information about the risks of TJA in the morbidly obese and were given referral information to a bariatric clinic. Patients were contacted at six, 12, 18, and 24 months from initial visit.Aims
Patients and Methods
The purpose of this study was to evaluate trends in opioid use
after unicompartmental knee arthroplasty (UKA), to identify predictors
of prolonged use and to compare the rates of opioid use after UKA,
total knee arthroplasty (TKA) and total hip arthroplasty (THA). We identified 4205 patients who had undergone UKA between 2007
and 2015 from the Humana Inc. administrative claims database. Post-operative
opioid use for one year post-operatively was assessed using the
rates of monthly repeat prescription. These were then compared between
patients with and without a specific variable of interest and with
those of patients who had undergone TKA and THA.Aims
Materials and Methods
An important measure for the diagnosis and monitoring of knee osteoarthritis is the minimum joint space width (mJSW). This requires accurate alignment of the x-ray beam with the tibial plateau, which may not be accomplished in practice. We investigate the feasibility of a new mJSW measurement method from stereo radiographs using 3D statistical shape models (SSM) and evaluate its sensitivity to changes in the mJSW and its robustness to variations in patient positioning and bone geometry. A validation study was performed using five cadaver specimens. The actual mJSW was varied and images were acquired with variation in the cadaver positioning. For comparison purposes, the mJSW was also assessed from plain radiographs. To study the influence of SSM model accuracy, the 3D mJSW measurement was repeated with models from the actual bones, obtained from CT scans.Objectives
Materials and Methods
Normal sagittal spine-pelvis-lower extremity alignment is crucial in humans for maintaining an ergonomic upright standing posture, and pathogenesis in any segment leads to poor balance. The present study aimed to investigate how this sagittal alignment can be affected by severe knee osteoarthritis (KOA), and whether associated changes corresponded with symptoms of lower back pain (LBP) in this patient population. Lateral radiograph films in an upright standing position were obtained from 59 patients with severe KOA and 58 asymptomatic controls free from KOA. Sagittal alignment of the spine, pelvis, hip and proximal femur was quantified by measuring several radiographic parameters. Global balance was accessed according to the relative position of the C7 plumb line to the sacrum and femoral heads. The presence of chronic LBP was documented. Comparisons between the two groups were carried by independent samples Objectives
Methods
Accurate, reproducible outcome measures are essential
for the evaluation of any orthopaedic procedure, in both clinical
practice and research. Commonly used patient-reported outcome measures (PROMs) have
drawbacks such as ‘floor’ and ‘ceiling’ effects, limitations of
worldwide adaptability and an inability to distinguish pain from
function. They are also unable to measure the true outcome of an
intervention rather than a patient’s perception of that outcome. Performance-based functional outcome tools may address these
problems. It is important that both clinicians and researchers are
aware of these measures when dealing with high-demand patients,
using a new intervention or implant, or testing a new rehabilitation
protocol. This article provides an overview of some of the clinically-validated
performance-based functional outcome tools used in the assessment
of patients undergoing hip and knee surgery. Cite this article:
The routine use of patient reported outcome measures
(PROMs) in evaluating the outcome after arthroplasty by healthcare
organisations reflects a growing recognition of the importance of
patients’ perspectives in improving treatment. Although widely embraced
in the NHS, there are concerns that PROMs are being used beyond
their means due to a poor understanding of their limitations. This paper reviews some of the current challenges in using PROMs
to evaluate total knee arthroplasty. It highlights alternative methods
that have been used to improve the assessment of outcome. Cite this article:
We report the general mortality rate after total
knee replacement and identify independent predictors of survival. We
studied 2428 patients: there were 1127 men (46%) and 1301 (54%)
women with a mean age of 69.3 years (28 to 94). Patients were allocated
a predicted life expectancy based on their age and gender. There were 223 deaths during the study period. This represented
an overall survivorship of 99% (95% confidence interval (CI) 98
to 99) at one year, 90% (95% CI 89 to 92) at five years, and 84%
(95% CI 82 to 86) at ten years. There was no difference in survival
by gender. A greater mortality rate was associated with increasing
age (p <
0.001), American Society of Anesthesiologists (ASA)
grade (p <
0.001), smoking (p <
0.001), body mass index (BMI)
<
20 kg/m2 (p <
0.001) and rheumatoid arthritis
(p <
0.001). Multivariate modelling confirmed the independent
effect of age, ASA grade, BMI, and rheumatoid disease on mortality.
Based on the predicted average mortality, 114 patients were predicted
to have died, whereas 217 actually died. This resulted in an overall
excess standardised mortality ratio of 1.90. Patient mortality after
TKR is predicted by their demographics: these could be used to assign
an individual mortality risk after surgery.
This study compared the outcome of total knee
replacement (TKR) in adult patients with fixed- and mobile-bearing prostheses
during the first post-operative year and at five years’ follow-up,
using gait parameters as a new objective measure. This double-blind
randomised controlled clinical trial included 55 patients with mobile-bearing (n
= 26) and fixed-bearing (n = 29) prostheses of the same design,
evaluated pre-operatively and post-operatively at six weeks, three
months, six months, one year and five years. Each participant undertook
two walking trials of 30 m and completed the EuroQol questionnaire,
Western Ontario and McMaster Universities osteoarthritis index,
Knee Society score, and visual analogue scales for pain and stiffness.
Gait analysis was performed using five miniature angular rate sensors
mounted on the trunk (sacrum), each thigh and calf. The study population
was divided into two groups according to age (≤ 70 years Improvements in most gait parameters at five years’ follow-up
were greater for fixed-bearing TKRs in older patients (>
70 years),
and greater for mobile-bearing TKRs in younger patients (≤ 70 years).
These findings should be confirmed by an extended age controlled
study, as the ideal choice of prosthesis might depend on the age
of the patient at the time of surgery.
We report a study of 112 patients with primary anteromedial osteoarthritis of the knee and their families. Sibling risk was determined using randomly selected single siblings. Spouses were used as controls. The presence of symptomatic osteoarthritis was determined using an Oxford knee score of ≥ 29 supported by a Kellgren and Lawrence radiological score of II or greater. Using Fisher’s exact test we found that there was a significant increased risk of anteromedial osteoarthritis (OA) relative to the control group (p = 0.031). The recurrence risk of anteromedial OA to siblings was 3.21 (95% confidence interval 1.12 to 9.27). These findings imply that genetic factors may play a major role in the development of anteromedial OA of the knee.
